Category: Healthcare

Health care service in the USA Assignment

Health care service in the USA
Health care service in the USA

Health care service in the USA

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Abstract

The United States of America offers the best health care services in the world.  It is however unfortunate that some Americans still lack the best of the services due to varied reasons. Differences are evident along the lines of ethnicity and race. The less fortunate are mainly the non-white Americans, the blacks and the Indians. The situation has indeed attracted attention from researchers and academicians all over the globe. Quality health care should be available for all Americans regardless of their skin color. The health care system therefore needs to be more inclusive and available to people of different beliefs, sexuality, and religion among others. In general, a better health care system is needed to offer equal services to the entire population. Humanity is endorsed with intelligence that enable hem realize inequality and launch uprisings to fight for their rights. However, the affected groups are unable to air their concerns as a competent leadership is lacking in the system to call for quality health services to the groups.

Introduction

It is evident that change is required in health care but the lack of efficient leadership to drive the transformation offer the greatest challenge. Researchers have been reluctant in addressing the issue especially from the perspective of implementing changes that would result to equal services to people of different ethnicities. In some research works, however, researchers only point out the relation between health care for the public and emotional feelings. In this project, the role of appropriate leadership in driving transformations for provision of equal health care services to all Americans is discussed as a measure to ensure that the disadvantaged groups get their fair share. Studies carried out aim at improving health care services to all ethnic groups and races. Generally, emphasis is put on the minority groups

Disparities in the Provision of Quality Health Services to the Minority

In the US, ethnicity has been noted to influence access to health care with more difficulties for the non-whites. The research project takes a critical position and exhaustively examines the existence of disparities in access to health care for the minority groups. Transformation leadership is taken as the most appropriate vehicle in conveying the inevitable change required in the sector. In the paper, the influence of disparities in the health care sector on the implementation of the Affordable care act is examined and recommendations made on the best ways of handling the unacceptable situation. Extensive research is done to ensure that reliable evidence is used in the call exploration of the issue.

Research and review

Disparities in the health care sector as The Kaiser Family Foundation termed them entail inequality in care provision for Americans of different origin, religion, beliefs among other aspects of life (2013). With the disparities, different groups receive different levels of care and for the US skin color is among the leading factors leading to the differences. Agency for Healthcare Research and Quality wrote that differences are evident in the means in which diseases are handled in different populations as expected, disease outcomes also take the trend initiated by the variations in care provision (2012).

To further illustrate, the disparities also cause differences the type of diseases, injuries as well as disabilities and mortalities that different groups experience. From another perspective, differences result from insufficiency of health care services and cultural practices as a result of differences in social; and economic backgrounds.  A link is noted between the disparities, emotions as well as the societal issues for different populations. As Deng and Gibson (2008) noted, people with poor economic background receive poor quality care as compared to their rich counterparts. It is also noted that financial instability plays a role in destabilizing the emotional status of individuals. Economic factors are noted to be one of the leading contributors in determining the quality of care people receive regarding their health. People with poor socioeconomic status often get low quality care and end up being emotionally discouraged.

Disparities in access to health care are translated in the life expectance for people in different categories. The minorities are generally found to lead a shorter life as compared to the more abled majority of the Americans. The Affordable Care Act initiated by president Obama has nevertheless achieved in minimizing the gap in health care access between people in different groups. Since its establishment, disparities in the health sector are noted to have subsided with an approach toward equality.

To solve the problem of disparities in the sector, it is important for the leaders to bring changes by collaborating with the framers of policies in the sector. by developing appropriate strategies, leaders would lead their subjects out of the emotional setbacks that result with inequality in access of high standard care in health institutions. It would be important if leaders for example, enact policies that would bring the poor closer to the rich. The policy makers also have the responsibility to solve the issue and end the long-felt disparities. By improving the socioeconomic status of the minority, All Americans would afford the current insurance plans and access to care would be generally be equaled for all. As the Agency for Healthcare Research and Quality wrote, Americans would afford quality health care and there would be minimal pooling of funds into healthcare (2012). It should be noted that most of the shortcomings in ensuring equal access to quality health care are financial in origin.

Research shows that transformational leadership is the best tool in identifying change, formulating a vision as well as executing the changes from an authoritative position to obtain the required changes. (Assanova & McGuire, 2009). To create equality, leaders should institute essential reforms that create coordination and supervisory guidelines for the care of the minority groups (Alino & Alban, 2011). By taking the measure, leaders would be at a better position to evaluate their progress and implement the policies provided on the eradication of the disparities in the health sector. Leaders are in addition expected to understand the need of emotional intelligence as well as its influence on the lives of their subjects. In the mode of leadership, leader’s performance should go beyond the anticipations. This would be achieved by encouraging integrity and fairness through support provision and recognition. As Deng and Gibson (2008) wrote, leaders in transformational leadership try as much as possible to avoid self-interest and would therefore steer up toward elimination of the disparities and lead to the achievement of equal care for people of varied backgrounds.

Gap in the literature

In this research, a gap is noted to exist at the level of leadership and therefore needs to be filled. Assanova and McGuire noted that there exist volumes of leadership that can address the healthcare disparities for the different groups (2009). It is important to address the gaps as by so doing, the transformational leadership and an approach to emotional intelligence forms the basics in achieving curbing the disparities evident in health care provision.

Problem Statement

Disparities in the health sector involve provision of care between for people of varied races, ethnicities, religions and many other divisions. The imbalance existing in the sector results from social, economic as well as cultural factors. Disparities are seen in many forms. Among them is the access to health care, attendance given for various diseases, as well as genetic and ethnic factors. Disparities eventually lead to differences in disease outcomes for different populations.  In most cases, the outcome is more adverse for the disadvantaged minority groups as compared to the outcome seen in most other Americans. According to research, a link exists between disparities and low birth weights, and premature miscarriages among other reproductive health abnormalities. These issues often have significant effect on emotions and hence social activities undertaken by the different individuals.

Identifying Gaps to Impact Change

General health includes optimal body functionality inclusive of one’s mental status and functioning. Emotional senses also comprise the general wellness. It is therefore important that people’s emotions are protected from by offering the quality services to them without incidences of discrimination based on skin color, race, ethnicity, religion or any other factor likely to create divisions. It is necessary that leaders realize the impact of emotions on ones health. People often experience emotional destruction from discriminative treatment based on their status in the society. Obstacles noted to affect quality care provision to people include geographical locations, ethnicity, race, gender as well as one’s social status. Health disparities have effect on the psychological states of people and their performance is often influenced. Among personal factors affected by disparities are abilities, acquaintance as well as skills. In addition, health disparities are known to predispose people to chronic diseases and high death rates (Agency of Heathcare Research and Quality, 2012). Research has shown for example that African Americans have a 10% higher risk to cancer as compared to their white counterparts. The same case is seen with diabetes and other common chronic illnesses.

It is also notable that minority groups are less likely to consult private doctors as compared to the people in the majority groups. Poor access to health services is one of the factors that predispose the minority to diseases. Again, the problem roots from the economic status of the people. It is however saddening that the gap between the rich population and their poor counterparts often widens instead of narrowing. The whites in America continue to access health services with increasing efficiency while the situation worsens for the blacks. Such situation as Agency for Healthcare Research and Quality wrote impacts negatively on the livelihood of the minority groups. Minimizing the disparities in the sector would boost emotions at the personal level leading to improved health conditions for the minority groups. Transformational leadership that aims to care for emotional intelligence would lead to better lives for the minority groups and they would in turn enjoy a longer life span.                 

Personal Public Health Leadership Theory

One of the key pillars of an organization is its leadership. There has been intensive research to explore on appropriate forms of leadership. Researchers have developed multiple theories explaining leadership. Qualities that distinguish quality leaders have been outlined in many research works. Transformational leadership is one of the theories that offer explanations on most appropriate leadership practices. The theory emphasize on individual achievements. The theory for instance indicates that charisma is a necessary trait for leaders. Together with the ability to lead people toward high productivity, charisma makes a leader more appropriate to execute transformations (Lang, 2010). The bond that exists between transformational leaders and their subjects is a motivational factor and reduces incidences of distrust between the parties. In transformation leadership therefore, behavior of the parties is modified to allow healthy interactions between the parties.  The mode of leadership in addition orients employees toward a common goal making it easier for organizations to run smoothly. A serving interaction is established in the organization rather than that dominated by a feeling of power (Bass & Riggo, 2006). In addition, the leadership depicts direct relation with personal characteristics. Confidence and emotional feelings are depicted in transformational leadership. In this way, leadership integrates personal attributes with management. It is therefore necessary that transformational leaders be constituted in the management of organizations that require reforms. The style of leadership would work for situations requiring behavioral change in addition to improved management.

Nature of Organizational Change in Healthcare using transformational
Leadership approach

Professionals in health care provision are working to ensure that improvements are noted in the sector. Differences in care provision based on ethnicity, race, religion and color are intolerable for the profession. Leaders in health care are expected to be skillful and to depict competence by being emotionally supportive. The disconnection between leadership and emotional competence should be corrected for the best outcomes on the move to improve equal access to quality health care.

It is important for the framework employed in closing the gap to ensure that health goals are pursued. The framework should offer strategies to which leaders are expected to base their decisions. Such strategies should see to the reduction of individual interests and prioritize on achievements as an organization. By using such leadership methods, the disparities seen in quality health care provision would be solved.

A Representation of the Public Health Leadership Theory

       Set Directions: Mission, Vision and Strategy

 

Fig.1  Transformational leadership style cycle using emotional intelligence

Fig 2    The Nature of Organizational Change in Healthcare using transformational Leadership approach.

How the Visual Representation addresses the Literature Gaps

The system addresses gaps by development of concepts from scientific methods of data collection (Les & Magdelena, 2008). Among the developed concepts are theories that that explain different situations in from a scientific approach. The representations are scientific in origin and are the concepts are therefore reliable to refer to in order to understand scientific issues. After identification of the relevant issues, leadership strategies can be formulated to help solve the problems. Generally, visual representation offers proper understanding of situations which in turn allow for development of appropriate leadership techniques to handle the issues.

Method of Data Collection and Analysis

Data was collected by the use of structured questionnaires. Data analysis was enabled by the use of the SPPS statistical software as well as Monkey Survey.com. Data evaluation on the other hand was done through T-test. To maintain the validity of the research, randomization was used in selection of participants in the study. To evaluate transformational leadership, the Pearson coefficient was used together with ordinal and nominal measurement scales. By the use of the tools, the impact of transformational leadership on the lives of the minorities in the US  was determined.

Significance of the Study

The research study addressed a problem that is often neglected by researches. The research may open the way for more comprehensive studies regarding provision of quality services to the American minority groups. The study also offered transformative leadership as an approach to overcome the disparity. The research outcome provides important information and strategies that would help in handling the disparities.

Ethical Considerations

All activities in the study were bound within ethical requirements. To further guarantee privacy, standard guidelines regarding information handling will be strictly adhered to. As a requirement, the study will be approved by Public Health Department of Walden University. Permission will also be sought from relevant authorities in the community under test.

Conclusion

            The health sector in the United States has been characterized with disparities for long. As observed, the disparities root from differences between the rich and the poor. The larger the gap between the two classes, the more the disparities observed in the health sector. Among the key factors resulting to the disparities are socioeconomic status of the people, ethnicity, race, religion, values and beliefs among others. The best means of addressing the disparities as seen in this research involve the use of transformative leadership. Such leadership should see to increased social welfare among the minority and increased wages to close the gap. All Americans are entitled to equal access to quality health care and leaders should ensure that citizens enjoy the right. Emotional intelligence should also be coupled with transformative leadership for fast achievements in provision of equal access to services.

References

Agency for Healthcare Research and Quality (2012). National Health Care Disparities Report.
Retrieved from http://ahrq.gov/research/findings/nhqrdr/nhdr12/.

Alimo-Metcalfe, B., & Alban-Metcalfe, J. (2011). The development of a new transformational Leadership Questionnaire . The Journal of Occupational and Organizational Psychology, 74, 1 – 27 .

Assanova, M. & Mc Guire (2009). Applicability Analysis of the Emotional intelligence Theory.Indiana University. Retrieved from http://indiana.edu/~spea/pubs/undergrad-honors-honors_vol3_no1.pdf.

Creswell, J. (2011). Research Design: Qualitative, quantitative, and mixed methods approach Custom Ed. Thousand Oaks, CA: Sage Publication.

Deng, L. & Gibson, P. (2008). ” A Qualitative Evaluation on the Role of Cultural Intelligence in Cross-Cultural Leadership Effectiveness,” in International Journal of Leadership Studies, Vol. 3 Iss. 2, 2008, pp. 181-197, 2008 School of Global Leadership & Entrepreneurship, Regent University. URl.

Lang, M. (2010). Transformational leadership: fundamental, models, differences and impact on employees Norderstedt. Germany. Duck und Bindung.

Les, Z & Magdelena, L (2008) Shape Understanding System: The First Step towards the Visual Thinking Machines. Heidelberg. Springer.

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Cultural competency in health and social care & nursing care  

Cultural competency in health and social care & nursing care
Cultural competency in health and social care & nursing care

Cultural competency in health and social care & nursing care

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This is a 7 pages paper
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The M6A3: Cultural Competence: Registered Professional Nurse Responsibility Paper counts as 30% of your grade for this course.
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linked item M6A3: Cultural Competence: Registered Professional Nurse Responsibility Paper
Using APA format, write a six (6) to ten (10) page paper (excludes cover and reference page) that examines culturally sensitive nursing care. The paper consists of two (2) parts and must be submitted by the close of week six (6).
A minimum of three (3) current professional references must be provided. Current references include professional publications and valid websites dated within five (5) years. Additionally, a textbook that is no more than one (1) edition old may be used.

Part 1 – Introduction
Address the following:

  • Using your own words, define culturally competent nursing care. Support the definition with a professional literature citation.
  • Identify four (4) guidelines the registered professional nurse may use to enhance the ability to provide culturally competent nursing care. Provide one example the culturally competent nurse applies to each of the four (4) selected guidelines. At least one example must address care of patient(s) not occurring in an acute care hospital.
  • Describe how the registered professional nurse evaluates if the patient’s cultural needs have been met.
  • Describe whether cultural practices must be accommodated in all aspects of health care. Provide a specific example and rationale to support your response.

Part 2- Demonstrating Culturally Competent Nursing Care
Address the following:

  • Select one of the following cultures:
    Asian
    Native American
    Hispanic
  • Select four (4) cultural features, associated with the selected cultures that influence the provision of nursing care for patients with chronic illness and at the end of their lives. Describe how the four (4) cultural features influence the provision of care to the patients.
  • Provide two (2) nursing interventions that demonstrate nursing care, which reflect the respect for the dignity and uniqueness of those cultural features for patients experiencing chronic illness and at the end of their lives.

Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format.

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Part A:  Cultural competency in health and social care

The reforms in health care industry are focusing on ways to embrace diversity in providing care. Cultural differences affect patient’s perceptions about sickness, their assessment and disease outcome. With the advancement in technology, it has become easy for people to move from place to place making countries to be ethnically diverse than the nursing forces.  Thus, the nurses work with the patients from various cultural backgrounds. Therefore, the health care facility must provide a culturally competent healthcare environment.  Cultural refers to the way of life of a population including shared values, skills and languages (McClimens, Brewster & Lewis, 2014). It is the aspect of the society which defines person’s character due to the conscious and unconscious beliefs that have been installed in them. In this context, cultural competency refers to the ability to deliver quality care which is congruent with people’s social background and cultural expectations. A culturally competent organization is one that demonstrates that their organizations integrate awareness of the community health related cultural beliefs and how they impact the disease prevalence and the mortality rates. The healthcare settings must be established in a manner that acknowledges the value of culture and the repercussions if the health care providers fail to respect the diversity (Legha Et al., 2014).

Four essential elements are necessary in ensuring that the institutions are culturally diverse including a) valuing cultural diversity; b) valuing the cultural dynamics that makes the community interact effectively; c) adapting and reflecting to the understanding of the existing cultural diversity and d) possessing institutionalized cultural knowledge.  From all levels, the nurse must reflect on the diversity on the population the healthcare facility serves. This will facilitate the nurses to push better for care for the underprivileged and the underserved populations.  Valuing the diversity in the community it facilitates their understandings of the community perceptions about health. Everybody in the society or a nurse interacts with has a cultural identity which in one way impact their perception about culture. Importantly, the nurse must understand that culture is not static. It evolves over and over again with time (Dudas, 2012).

A client from developing country was admitted in one of the healthcare facility in this country. The person migrated into this country as an asylum seeker and all her life, she has believed and worshipped in one religion in the country of origin. Fortunately, on migration, the patient found other members in this country and fellowshipped together.  Whenever a person is admitted in hospital, there must be a ritual that has to be performed so as to scare away the evil spirits. The ceremony involves chanting, burning of the incense stick and produces some smoke. When the nurse in charge was requested, she was in a dilemma because she had never experienced these cultural rituals in public places before (Mareno & Hart, 2014). However, understanding the value  of cultural competence she discussed the matter with the senior  management  who evaluated the impact of disturbances  to the other clients  due to noise from chanting, risks for fire as the  burning of the things was being done  and the effects of smoke to patients from these  processes. The administration provided a separate room for the ritual. They even went ahead in incorporating the cultural concepts in their medication process. The patient was requested to chant prayers three times while facing west before taking the medication. Within a week, the patient condition had improved due to the increased cooperation with the medical providers (Norton & Marks-Maran, 2014).

From the case scenario, valuing the cultural components in the community will help the nurse reduce reactions and prejudices which could impact the patient-nurse relations. As a matter of fact, nurse culture is influenced by professional values as are slightly influenced by nurses’ beliefs.  Valuing cultural diversity is an important guideline because it the nurses responsibility to assess the patient’s needs and expectations as established by the patient cultural values.  For instance, some community beliefs that giving birth to disabled children is a curse; and is often associated with evil spirits. In such a case, it is more likely that the infant’s mother could feel distressed and confused. The nurse must listen to the patient to understand her concerns; and it is their responsibility to ensure that the mother overcomes the fear. These impacts the whole society as the woman could be bold to speak out for her child, empowering other women who are under similar circumstances (Legha Et al., 2014).

Additionally, the ability to recognize the cultural dynamics within the society is important. This is because it acts as a guide on how the community uses the dynamics to make sure that they live in harmony and that their health is protected or promoted. The cultural dynamics and potential interactions among the community increase the probability for stereotyping and misjudging. For instance, a nurse can associate certain ailments with cultural practices which seem unhygienic. In other cases, the nurse can discuss topics which are identified as bad omen to the society such as discussing issues of unborn child.  In this case, the nurse must listen to the patient’s description of their health conditions, the reason the patient thinks the disease is manifesting its symptoms and their perception on treatment (Norton & Marks-Maran, 2014).

Adapting and reflecting to the understanding of the existing cultural diversity is the third guideline that facilitates the nurses provide culturally competent care.  Every patient has a set values and beliefs that affect the way they view life and how they react to the world.  The best way to ensure that the nurse provides culturally competent care is through self-reflection on the values and barriers that could underscore his/her strategy to provide quality care to the patient. It is important for a nurse to reassess their interventions to various situations so as to identify issues that hinder or introduce cultural biasness; and where necessary seek assistance from other peers to establish the best intervention for a particular objective (Diaz, Clarke & Gatua, 2015).

Possessing institutionalized cultural knowledge is very vital in all sectors of health care systems. Nursing profession has cultural values too. These values include truthfulness, empathy, caring respect to patient preferences and promotion of health and autonomy. This nurse culture determines how a nurse interacts with the clients. For instance, a nurse who values patient empowerment and autonomy meets a patient whose cultural values does not allow them to make healthcare decisions for themselves, but the decision making process integrates the entire extended family could be in a dilemma, especially if the decision involves a  health care therapy that must be performed quickly to save the patient’s life. Therefore, the nurses must be empowered adequately so that they can make the right decision when faced by an ethical dilemma.  If the concept of cultural competency is ignored in medical schools, there will be increased mortalities, disease burden nurse burn out and increased turnover rates; especially in underprivileged societies in this nation (McClimens, Brewster & Lewis, 2014).

Part B: Culturally competent nursing care                                                   

The cultural belief is that illness is caused by ghosts, a punishment for not following taboos or loss of equilibrium between the body and the environment. The sick will often be stoic and quiet because the culture demands so. The sick person is more likely to request alternative therapy. The nurse must devise strategies that will integrate the patient culture when providing care. The culture does demands that terminal illness must not be discussed directly to the patient or in open discussion because it may hasten death events. The Native American like many other cultures emphasizes on cooperation and mutual aid.  In this context, the patient’s relatives will be mostly involved in decision making processes. The head of the family is the spokesperson of the person who is ill; and in most cases it is this person that will be used to communicate the family decisions.  Therefore, the nurse should consider integrating the community and the family in patient education. However, it is important for the nurse to observe the professional values including autonomy and independence (Hodge & Limb, 2010).

The most important issues in Native American culture are the spiritual; healing and that vary considerably from one tribe to another. The community is stratified into ranks, and member of each rank can be differentiated from the type of dress they wear. The dresses also indicate person rank in the society. Everything worn has a symbolic meaning on either prayer or healing. In this context, the healthcare must be vigilant when removing any clothes or ornament from the patient. If patient is not conscious to make decision if the cloth or the ornaments have to be removed, the items must be put very close to the patient and should be replaced back as soon as the medical operation is done. Some practices that are congruent with the health is burning sage, therefore, the nurse can spray sage as it is considered as a method of purification (McClimens, Brewster & Lewis, 2014).

The Native American culture has set standards for means and modes of communication. The person with higher authority is respected. Religious people are accorded the highest respect and must be addressed with respect.  Respect is shown by avoiding eye contact, keeping distance and having as little body contact as possible. In fact, the nurse should avoid hand shake. When the patient is speaking, he/she should not be disrupted as it is perceived as sign of disrespect.  In most cases, the client could make long pauses which are considered as a means of conversation, which implies that the patient is not in agreement with whatever the nurse is suggesting.  Speaking loudly to Native American indicates aggression, and it must be avoided. Where there is need to make an imperative command, the nurse must be emphatic and direct. If there is more healthcare recommendation or requests to be made, the nurse must give succinct explanation why the recommended process is important in a personable and polite way (Hodge & Limb, 2011).

Cultural assessment is one of the nursing interventions that is important in ensuring that quality healthcare is provides. This involves asking open-ended questions to the patient if he/she is conscious or a family member. This will improve the relationships between the nurse and the patient; making the patient becomes more cooperative. There are several cultural competence health assessment programs online which can be used to perform the process.  However, it would even be more appropriately if the health care facility designs their own tailor made cultural assessment program, one that fits the diverse people in the community. The nurse must also perform transcultural studies to understand the geographic region and values, beliefs and of the community living in the neighborhoods (Hodge & Limb, 2010).

Communication barriers are other challenges that enhance health disparities. Effective communication between the patient and the nurse facilitates better partnership. The patient is able to express about how he/she feels and his/her perceptions about the disease. The nurse can interact with the patient’s thought process which in turn facilitates the designing and implementation of the action plan. Health citizens will require establishing of a culture that embraces cultural competencies and reduces misunderstandings.  This way, the patients get empowered on ways to self-manage their health condition to meet their health care demands and   to improve the quality of life.  Effective communication between the patient and the nurse implies that the patient will be well informed and can be integrated in decision making processes. This in turn will facilitate provision of quality care, increase patient self-esteem and autonomy and improve their quality of life (Norton & Marks-Maran, 2014).

References

Diaz, C., Clarke, P., & Gatua, M. (2015). Cultural Competence in Rural Nursing Education: Are We There Yet?. Nursing Education Perspectives, 36(1), 22-26. doi:10.5480/12-1066.1

Dudas, K. (2012). CULTURAL COMPETENCE: An Evolutionary Concept Analysis. Nursing Education Perspectives, 33(5), 317-321. doi:10.5480/1536-5026-33.5.317

Hodge, D., & Limb, G. (2010). Native Americans and Brief Spiritual Assessment: Examining and Operationalizing the Joint Commission’s Assessment Framework. Social Work, 55(4), 297-307. doi:10.1093/sw/55.4.297

Hodge, D., & Limb, G. (2011). Spiritual Assessment and Native Americans: Establishing the Social Validity of a Complementary Set of Assessment Tools. Social Work, 56(3), 213-223. doi:10.1093/sw/56.3.213

Legha, R., Raleigh-Cohn, A., Fickenscher, A., & Novins, D. (2014). Challenges to providing quality substance abuse treatment services for American Indian and Alaska native communities: perspectives of staff from 18 treatment centers. BMC Psychiatry, 14(1), 181. doi:10.1186/1471-244x-14-181

Mareno, N., & Hart, P. (2014). Cultural Competency Among Nurses with Undergraduate and Graduate Degrees: Implications for Nursing Education. Nursing Education Perspectives, 35(2), 83-88. doi:10.5480/12-834.1

McClimens, A., Brewster, J., & Lewis, R. (2014). Recognising and respecting patients’ cultural diversity. Nursing Standard, 28(28), 45-52. doi:10.7748/ns2014.03.28.28.45.e8148

Norton, D., & Marks-Maran, D. (2014). Developing cultural sensitivity and awareness in nursing overseas. Nursing Standard, 28(44), 39-43. https://www.doi:10.7748/ns.28.44.39.e8417

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Hong Kong healthcare systems Essay

Hong Kong healthcare systems
Hong Kong healthcare systems

Hong Kong healthcare systems

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SAMPLE ANSWER

Introduction

Hong Kong healthcare systems can be described as mixed structure where private, public and alternative traditional medical therapy.   Research estimates that the public hospitals offer about 90% of the inpatient and outpatient services. The private sectors cover 70% of the outpatient and in-patient services. The public sector obtains funds from the government taxation and complemented by little copayments amounts from the patients pocket.  Due to the high life expectancy, Hong Kong population consists of the elderly people; consequently, this translates to a high frequency of diseases associated with old age such as psychosocial disorders, increased frequency of disease, high morbidity and mortality as well as the rate of government dependency.  Consequently, the health care costs are high and has been anticipated to rise. This has increased pressure to avail quality care to the society and at affordable costs. There are numerous health care reforms and introduction of new policies to ensure that Hong Kong citizens are healthy (Huque, 2013).

Hong Kong healthcare system is robust and has provided quality care to the citizens for the longest time. The government has continued to strengthen the healthcare system so as to improve the system.  The life expectancy of the Hong Kong people is highest in world which is reported as 80.9 years in males and 86.6 years in female. The infant mortality is the lowest and is recorded at 1.6 per 1000 births.  The growth rate is slow and is reported to be between 0.4 to 0.6% in the last three decades. The proportion of youths has continuously reduced by 5% from 17% in the last three decades. On the other hand, the number of the elderly people has continuously increased. The age trend in this nation indicates higher elderly than the youth. Whereas it is a good thing, this acceleration in the increase of the elderly people is not only affecting the nation’s Economic growth but also attributed to the healthcare burden especially among the chronic diseases (Lueng Et al., 2015).

 Health care system in Hong Kong

Healthcare reports estimates that about 50% of diabetes incidences in Hong Kong are from the elderly people. This metabolic syndrome has been listed as the leading cause of death as it accounted for 1.4% mortality in Hong Kong in 2013.  The psychological issues and mental health such as dementia has also been on the rise. These rates at which the psychological disorders are increasing seem to overburden the social workers making them seek for other alternatives.  Other non-communicable diseases such as thyroid cancer, respiratory disorders such as influenza, pneumonia and asthma have been reported to be the leading cause for hospitalization (Wong Et al., 2011). The most communicable disease which has been reported in Hong Kong is rotavirus and gastroenteritis. According to world health report in 2005, 35 million of 58 million deaths reported in the world are attributable to non-communicable (NCD) diseases such as cardiovascular diseases, cancer, accidents and injuries. The increases in these NCD are attributable to unhealthy lifestyle which involves consumption of unhealthy dietary, binge consumption of alcohol and sedentary lives. These brought forth increased burden among the families, the community and the government at large.

With this background of health concerns in Hong Kong, it is evident that primary health care is the frontline factor that acts as an interface between the healthcare system and the population.  Effective primary care indicates that there are greater equity in healthcare and that care is easily accessible and at an affordable cost. Literature indicates that there effective partnership and collaboration between the healthcare  and  service users provides the best patient outcome including reduced  emergency visits, better preventive care, better self-management for diseases with chronic diseases and reduced   hospitalization cost.  With the increased cost of care; and the challenges facing the health systems in Hong Kong calls for reforms in the primary care. HK government has been striving to reform its primary care.  Fortunately, Hong Kong health care systems are among the best in the world (Kung Et al, 2014).

However, NCD is the leading burden in Hong Kong and it is projected to continue to rise in the future years to come due to advancement in technology. This poses major challenge to the public health. Research indicates that improving primary care has economic benefits.  Promoting the primary health is a joint responsibility which requires everyone to participate in various sectors. The government major role is to provide legislative  policies and frameworks which regulate service user  and provider safety  by controlling the  hazards at the hazards; whereas  the business sector’s major responsibility is to improve  competitiveness  to facilitate  healthy choices. The Non-governmental   movements and community organizations role is to implement the programs that focuses on health promotion on subgroups and the vulnerable and underprivileged people in the society (Wong Et al., 2015). To achieve a high performance demands a healthcare system demands higher expenditure and efforts in fighting the NCD.   Investing in preventive care has been found to be the most the key factor in ensuring the economic development. For this reason, the government main objectives have been to provide the citizens with adequate support to enhance their sense of belonging and to maintain their dignity and enhance their worthiness. For the elderly and people living with disability, the government aims at providing cost effective care services. One of the systems that the government has embraced and is continuing to improve by expanding the home care based healthcare services as well as taking care through support such as “The Elderly Health Care Voucher Scheme (Yam Et al., 2011).”

The new infrastructure that the government has continuously planned to improve is the provision of healthcare services. The government has begun its initiative by increasing the number of hospital beds and surgery operation rooms to ensure that the healthcare capacity is widely accessible and meets the increasing demands.  Additionally, the government has continued to promote   primary care because it is the main link between the citizen and the health and social care.  This involves expanding community healthcare facilities so that healthcare can be easily accessible. The government is also establishing frameworks specific for each NCD to promote the healthcare of individuals.

Secondly, the government has broadened the quota systems for both the general practitioners in the outpatient and in the in-patient services. There are ongoing strategies to improve the emergency department to ensure that waiting time for emergency care is reduced.  The government in a joint venture with the private developers has increased service volume at an affordable cost. Some of these ventures include procuring of new haemo-dialysis services to ensure that the treatments are eligible to most patients with chronic renal failure.  Radiology resources are also being outsourced for patients from underprivileged patients with chronic diseases (Liu & Yueng, 2013).

The government has continued to strengthen the geriatric rehabilitation services and the outreach services at the community level. This is with the aim of improving quality of life of elderly, people with mental disorders and people living with disability. The government have also increased their regulations on the residential care for these people to ensure that the issue of safety and healthcare management. Currently, they are ongoing pilot study on the general outpatient Clinic and the impact of privatization of public program in Kwun Tong, Tuen Mun and Wong Tai Sin districts. This is with the effort to increase   the scope of care for the long term care of chronic diseases. The infrastructural development involves all the sectors in health including the mental health concerns. For example, the government is planning to increase the number of hospital beds in the largest mental health hospital in Siu Lam Hospital (Mercer Et al., 2010). This strategy aims at clearing up cases of severe complications of mental health associated with the prolonged waiting lists before the sick patients are attended to. This aims at strengthening the manpower of the mental health expertise through the introduction of peer support for patients with mental disorders. To promote the healthcare of its citizen, the government is also supporting other alternative traditional medicine. The Department of Health acknowledges this therapy and has funded several researches to evaluate the feasibility of these medicines.  Additionally, it has been indicated by the evidence based research that NCD is the major healthcare burden in Hong Kong. Therefore, the government has continued to regulate the nutrition and safety of the processes food. In fact, the food safety Laboratory in Pok Fu Lam is being expanded by the government to ensure that there is effective testing of packaged food product so as to safe guard the people safety (Owolabi Et al., 2013).

Additional to the establishment of these infrastructures that supports and promotes health, the department of health has implemented several pilot schemes that will provide financial care services   to the elderly. This includes implementation of discharge support program to the patients after they are discharged from the hospital and have challenges self-managing their health.  There are also on going pilot study to ensure that the elderly that need long the care such as Guangdong Residential care Service Scheme (Hui, 2010). These strategies are great and very beneficial to the   the society and the nation at large.  One cannot quantify the financial cost of any disease to the individual or even the community.  Economic analysis indicates that the cost of treatment for healthcare associated with NCD, injuries and poisoning is higher than the cost of NCD prevention and would save Hong Kong citizens from suffering and  reduce the death rates. The existing healthcare has limited focus on effective preventive strategies.  There needs more resources to establish systems that will inform the public as well as empowering the society. The voluntary organization and the department of health need to come together to integrate the necessary efforts towards both primary and secondary prevention strategies (Rashed Et al., 2014).

When socio economic evaluation was conducted on primary care in Hong Kong, it was found that most people use private health care as their main source of health care and often prefer to finance their health care costs from their pockets. The study indicated that Hong Kong citizen are more satisfied by the care quality compared to the public health care. The trend indicated that people who get quality care are those whose income is considerably high. This implies that only these people   who are above average as compared to those who used public clinics. Several other studies have found a stronger association between the qualities of care with the socio economic background of a person. The lower income group cannot afford primary care which attributes to the increase in NCD incidences and mortality rates. Even with the Voucher system which was established to help the elderly whose main aim was to provide financial assistance to the elderly so that they can also access care in the private sector. Such schemes are meant to reduce burden on the public health care facilities (Hui, 2010).

This is particularly important because Hong Kong epidemiological studies indicate that NCD are at high prevalence’s among the old and the low income households. It is estimated that the prevalence rate for chronic illness in Hong Kong is five folds higher in individuals above 65 years than the youth. The level of education is also associated with better health care and lower incidences of overweight. People with low education reports higher rates of diabetes type 2, hypertension and cancer (So Et al., 2012). Despite the increase in health care disparities, the department of health has offered little if any solutions to rectify the prevailing social and health care disparities. Most studies indicate that much economic costs can be saved through collaboration and working in partnership between the service user, service provider and other stakeholders whose energy is geared towards healthcare protection and promotion. Through pooled knowledge and information sharing, the existing disparities can be reduced effectively by applying public regulations and policies and collaborative actions by the public actions. The actions could range from investing in human capital to quality education. These mechanisms are the best approaches to combat poverty through increased employment (Rashed Et al., 2014).

The best strategy to reduce the prevalence of NCD is through an establishment of a clear vision which focuses on reminding people on the long term outcomes of their effort.   For a successful strategic framework, the Hong Kong must inform her citizens on the advantages of maintaining their health. This in turn will establish a caring community which integrates all the relevant stakeholders to ensure that the community sustains healthy lifestyle as guided by competent healthcare providers. Consequently, the country will establish a sustainable healthcare culture which aims at promoting health and incorporating strong elements of disease prevention with equal strength as the curative care among the public. This will significantly reduce the disease burden including premature mortality due to NCD or disability associated with NCD (Lam, Liu & Wong, 2012).

However, not even the voucher scheme that has facilitated reduction of health care burden. The NCD still remains a burden to the health ministry. This implies that it is time the government seeks other approaches to promote cultural change which places higher value preventive care   than the curative care. It has been suggested that the financing healthcare reform is more of a political move than a strategy to help the healthcare industry. The problem of the aging population is here to remain and so is the issue of increase in healthcare expenditure. There needs a critical analysis in the health care to look into new approaches that will ensure that the society health is protected, promoted and sustained. There  are other numerous  non ambitious elements that the   government can explore  to promote  health  which will involve the health care providers, service users  and other relevant  stake holders  so that they can be collaboratively  reach to a consensus and  pave way for more improvements  in the future (Cheng Et al., 2013).

Conclusion

In summation, it important for the department of health to establish strategic framework that will facilitate establishment of an environment which will promotes the health of the citizens. The government must engage the population in promotion of their health, their relatives and the community at large.  It is important for the health care department to establish strategies that will prevent or even delay the onset or progression of NCD for the Hong Kong populations. Drawing together the strengths each stakeholder to a pooled knowledge and also skills from   various relevant stake holders in the society will ensure that each aspect of the society is represented adequately and prevailing gaps are adequately addressed. The determinants of health are very pervasive such that health promotion and prevention of disease   will require involvement of the community in all sectors and all realms of environment including education and work place. Partnership is the most effective strategy of working with people from diverse backgrounds, tradition, values and beliefs.  This is because collaboration maximizes the strengths and weaknesses prevailing in the healthcare with the aim of attaining the overall objective which is establishing a healthy nation.

References

Cheng, V., Tai, J., Wong, Z., Chen, J., Pan, K., & Hai, Y. et al. (2013). Transmission of methicillin-resistant staphylococcus aureus in the long term care facilities in Hong Kong. BMC Infect Dis, 13(1), 205. doi:10.1186/1471-2334-13-205

HUI, E. (2010). Perceptions of ethical practices in Hong Kong public hospitals: inter- and intra-professional similarities and differences. Journal Of Nursing Management, 18(6), 746-756. doi:10.1111/j.1365-2834.2010.01102.x

Huque, A. (2013). Can Public Management Contribute to Governance in Developing Countries?. Public Organization Review, 13(4), 397-409. doi:10.1007/s11115-013-0259-2

Kung, K., Wong, C., Wong, S., Lam, A., Chan, C., Griffiths, S., & Butler, C. (2014). Patient presentation and physician management of upper respiratory tract infections: a retrospective review of over 5 million primary clinic consultations in Hong Kong. BMC Family Practice, 15(1), 95. doi:10.1186/1471-2296-15-95

Lam, W., Lui, P. L & Wong, W. (2012). Contemporary Hong Kong government and politics.        Hong Kong: Hong Kong University Press.

LEUNG, R., CHUNG, K., LI, V., CHEUNG, R., LAM, C., & ZIEA, E. (2015). Development of Electronic Health Record for Chinese Medicine eHR(CM) Sharing System in Hong Kong. Integrative Medicine Research, 4(1), 115. doi:10.1016/j.imr.2015.04.205

Liu, S., & Yeung, P. (2013). Measuring fragmentation of ambulatory care in a tripartite healthcare system. BMC Health Services Research, 13(1), 176. doi:10.1186/1472-6963-13-176

Mercer, S., Siu, J., Hillier, S., Lam, C., Lo, Y., Lam, T., & Griffiths, S. (2010). A qualitative study of the views of patients with long-term conditions on family doctors in Hong Kong. BMC Family Practice, 11(1), 46. doi:10.1186/1471-2296-11-46

Owolabi, O., Zhang, Z., Wei, X., Yang, N., Li, H., & Wong, S. et al. (2013). Patients’ socioeconomic status and their evaluations of primary care in Hong Kong. BMC Health Services Research, 13(1), 487. doi:10.1186/1472-6963-13-487

Rashed, A., Wilton, L., Lo, C., Kwong, B., Leung, S., & Wong, I. (2014). Epidemiology and potential risk factors of drug-related problems in Hong Kong paediatric wards. British Journal Of Clinical Pharmacology, 77(5), 873-879. doi:10.1111/bcp.12270

So, W., Chan, C., Choi, K., & Chan, D. (2012). Perspectives on the use of and service needs of cancer preventive services for ethnic minorities in Hong Kong: a study protocol. J Adv Nurs, 69(9), 2116-2122. doi:10.1111/jan.12067

Wong, E., Coulter, A., Hewitson, P., Cheung, A., Yam, C., & Lui, S. et al. (2015). Patient Experience and Satisfaction with Inpatient Service: Development of Short Form Survey Instrument Measuring the Core Aspect of Inpatient Experience. Plos ONE, 10(4), e0122299. doi:10.1371/journal.pone.0122299

Wong, F., Chan, F., You, J., Wong, E., & Yeoh, E. (2011). Patient self-management and pharmacist-led patient self-management in Hong Kong: A focus group study from different healthcare professionals’ perspectives. BMC Health Services Research, 11(1), 121. doi:10.1186/1472-6963-11-121

Wong, J., Cheung, E., Cheung, V., Cheung, C., Chan, M., & Chua, S. et al. (2004). Psychological responses to the SARS outbreak in healthcare students in Hong Kong. Med Teach, 26(7), 657-659. https://www.doi:10.1080/01421590400006572

Yam, C., Liu, S., Huang, O., Yeoh, E. K & Griffiths, S. M. (2011). Can vouchers make a difference to the use of private primary care services by older people? Experience from   the health care reform program in Hong Kong. BMC Health Services Research, 11, 255.

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Care plan for the chronically ill; Cancer

Care plan for the chronically ill
   Care plan for the chronically ill

Care plan for the chronically ill

Order Instructions:

Utilizing the information you have gathered over the weeks regarding the specific illness group you identified, this week, you will create a holistic plan of care for your chronic illness group.

Create the plan in a 3- to 4-page Microsoft Word document written in APA style format. Include the following in your plan:
•Start the paper with a brief introduction describing the chronically ill group you selected and provide rationale for selecting this illness and the participants. Clearly identify the purpose of the paper.
•Divide the report in two parts. In Part I, include a compilation of the assignments from Week 1 to Week 4. Identify how each week’s assignments help you to create a well-managed care plan.

•In Part II, include the care plan for your chronic illness group organized under the following headings:

  • Nursing Diagnoses
  • Assessment Data (objective and subjective)
  • Interview Results
  • Desired Outcomes
  • Evaluation Criteria
  • Actions and Interventions
  • Evaluation of Patient Outcomes

Include a reference page to provide reference for all citations.
•Include strategies for the family or caregiver in the care plan and provide your rationale on how they will work.

Support your responses with examples.

Cite any sources in APA format.

SAMPLE ANSWER

The chronically ill group chosen for this project is the cancer patients. The reason why cancer was chosen is because it is one of the leading killers in the world at an estimated eight million deaths per year. Globally, estimated populations of fourteen million people are usually diagnosed with cancer every year. (IHartmann, Loprinzi & Mayo Clinic, 2012, pg 5). Below is a report whose main aim is to create a plan of care for the cancer patients.

The assignments from the previous weeks played a major role in helping in the development of the care plan. The first assignment which was on the identification of the illness helped in the grasping of what the illness is all about that is in terms of the signs and symptoms. The second assignment was on the impact of the disease. This helped in showing how the disease can affect an individual and this provides perfect grounds of planning how to deal with such individuals. The third assignment which was on support need analysis of cancer patients helped in the drafting of an efficient nursing action and intervention. The fourth assignment  was on resources available for the people suffering from cancer. This was  crucial and helpful in the drafting of assessment data to be used in diagnoses since for the assessment data to be collected, these resources must be available to aid in the process of collecting the data.

 CARE PLAN

Nursing diagnoses

A common sign diagnosed among most of the patients is usually fatigue. (Weis & Horneber, 2014, pg 20)

Assessment Data

A number of tests are usually carried out  and these tests are as follows.

Firstly, there is the endoscopy test is done  to determine whether there are any abnormalities and this is done through the direct visualization of the internal body organs and cavities

Secondly, there is the carrying out of scans such as magnetic resonance imaging and this is done so as to identify metastasis and other diagnostic purposes

Thirdly, there is the biopsy test which may be taken from organs such as the bone marrow and the skin and the main function of this is to diagnose and delineate the treatment.

Fourthly, there is the using of screening chemistry tests such as electrolytes.

Fifthly, there is the counting of blood cells with the platelets and differential and this may be used to detect anemia, change in the blood cells or an increase in the number of platelets.

Sixthly, there is the conducting of chest x-rays to screen for possible diseases of the lung which can easily interfere with breathing.

Lastly, an interview is also conducted between the patient and the nurse.

Interview results

After the interview, some data is collected and this data is the result of the fatigue

  • The accumulation of cellular waste materials
  • Difficulty of sleeping and resting
  • Anemia, which causes tissue hypoxia.
  • Nausea and anxiety.
  • Disinterest in surroundings.

Desired outcome

The most desired outcome is to minimize the fatigue and enable the cancer patients to take part in desired activities at their maximum level of ability

Evaluation criteria

This is the criterion that was used in determining that the data collected is as a result of the fatigue and it is as follows;

The diagnosis of cancer and the chemotherapy treatments brings about overwhelming emotional demands which can easily bring about the fatigue.

The continuous and active growth of tumor combined with an increase in the amount of certain cytotoxins raises the metabolic rate which means that there is an increased use of energy in the body.

The medications used to control the pain have side effects which bring about the fatigue hence bringing about the nausea and anxiety.

The accumulation of cellular waste materials occurs as a result of the rapid breaking down of the normal and cancerous cells by cytotoxic drugs.

Difficulty of sleeping and resting occurs as a result of fear, anxiety and discomfort which come with the diagnosis of the disease.

The tissue hypoxia is as a result of anemia. The anemia is most likely caused by malnutrition and the suppression of bone marrow which is usually induced by the chemotherapy treatment. (Noogle, 2012, pg 420)

Actions and interventions

Once the fatigue has been diagnosed certain actions should be taken by the nurse and these are as follows;

Firstly, the symptoms and signs of fatigue should be assessed for and be determined whether or not they are present.

Secondly, the patients should be informed that the fatigue is as a result of the disease itself and the chemotherapy treatment

Thirdly, the patient should be aided to identify the pattern of fatigue and this is aimed at avoiding performing some activities during the greatest time of fatigue

Fourthly, there should be the Implementation of actions to minimize fatigue. Such actions include promoting a nutritional status that is adequate, administering anemia treatment as prescribed, facilitating the psychological adjustment of the patient to the diagnosis of the disease and the side effects of its treatment and also gradually increasing the patient’s activity as tolerated.

Lastly, if the signs and symptoms of fatigue continue to worsen, an appropriate health care provider should be consulted

Evaluation and intervention

Once the actions have been followed, the following will be used to assess whether the goals of the care plan have been reached

Firstly, the patients will be able to perform their usual activities of daily living as they used to perform before the illness.

Secondly, the patients will have an increase in the interest of their surroundings. Their level of concentration will also improve.

Thirdly, the patients will able to notice the feeling of their body experiencing an increase in the level of energy unlike before when they were experiencing the fatigue.

Strategies for the family/caregiver

The following actions from the caregiver or family of the patient are quite important since they aid in the quick recovery from the fatigue.

The family or care giver of such a cancer patient should give moral support to the cancer patient especially when the patient seems to be withdrawn from the surrounding environment.

It is also important for the family/caregiver of the patient ensures that the patient takes all the medication prescribed by the health professional.

At times a health professional might suggest for the patient to perform actions such exercises. The family/caregiver should ensure that the patient performs all this actions

The family/caregiver should have the contacts of the health professionals which is important in case of any emergency.

In conclusion, a care plan is effective in dealing with a diagnosis since it acts as an aid to a nurse in helping to determining and dealing with a certain diagnosis.

References

Hartmann, L. C., Loprinzi, C. L., & Mayo Clinic. (2012). The Mayo Clinic breast cancer book. Intercourse, PA: Good Books.

Weis, J,. & Horneber, M. (2014). Cancer related fatigue

Noogle, C. A. (2012). Neuropsychology of cancer and oncology. New York: Springer Pub.

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The State of the Nursing Profession

The State of the Nursing Profession
The State of the Nursing Profession

The State of the Nursing Profession

Order Instructions:

assignment “Key Questions”
Capstone Project
Key Questions

Directions: Submit a minimum of 2-3 pages APA format with a minimum of 3 references

Answer the following questions about your profession:

  • Where are we?
  • Where do we need and want to be?
  • What is the best way to get there?
  • How do we evaluate our progress?

SAMPLE ANSWER

The State of the Nursing Profession

As it has always been, the nursing profession is highly competitive. There is a growing need for more nurse practitioners day-in-day-out. The growing global population requires more nursing personnel to provide service to them. Hospitals are also being established all over the world creating job opportunities for nurses. The issue of insufficiency of health care services has been a concern in most countries. As most of these countries advance economically, they are able to improve the sector by the construction of hospitals of different categories to ensure that the basic need is accessed by all citizens. The need to equip the hospitals with health care professionals especially nurse practitioners and doctors has been prioritized by most present governments. Generally, the profession is at a good condition and there are unlimited job opportunities for nurses. Unlike several other professions, nursing allows graduates to practice in different environments all over the world, offering them a wide range of market. However, as De Milt, Fitzpatrick and McNulty noted, some practitioners experience discomforts in their job, just as they do experience satisfactions. Particularly, a good population of the practitioners is dissatisfied with the lack of collegiality in the profession, insignificance of intra-practice partnerships as well as the questionable growth of the profession, (DE MILT, FITZPATRICK, & McNULTY, 2011, pg. 87).As a result of such occurrences; some nurses consider the working environment unfavorable.

Nurses need to gain confidence with their profession. Though nurses are still needed in abundance, securing employment has been a challenge to some of them. National Students Nurses Association (NSNA) noted that new graduates in nursing face unemployment due to flooding of the registered nurses field by old experienced nurses (NSNA, 2012, Pg. 38). It is the wish of every nurse to get employed. It would be a disappointment, if after undergoing the intensive training in nursing, one would still have to take a long while to secure a job.Usually, most firms require experienced nurses, which is probably right for them. The question now comes in: how and where should the new nurses earn experience if they are not employed in the first place?

NSNA advised on the ways that would enable fresh young nurses overcome unemployment. New nurses are advised to first enroll as Certified Nursing Assistants (CAN) as a means of introducing themselves into the field where they would concurrently gain experience (NSNA, 2012, Pg. 58). While new nurses are not discouraged, they are advised that experience is crucial considering the nature of the profession. It is therefore an important thing to seek for them to become competitive. Nursing graduates are also advised to advance their education while still working as CNAs. Those with diplomas and associate degrees are advised to pursue RN (Registered Nurse), while those with RN are advised to pursue masters programs (NSNA, 2012, Pg. 38).

To improve the working environment for nurses, American Nurses Association (ANA) offered a guideline that constituted of six mechanisms. The six were ability to communicate in a skilled manner, team work orientation in service provision, making of sound and effective decisions, adequacy of staff, mutual recognition among nurses and pursuit of an authentic leadership style (ANA , 2010, Pg. 14).

Progress Evaluation

Achievements in nursing would be translated in the satisfaction seen among members of the profession. The more the unaddressed challenges are, the high the likelihood of nurses to feel insecure. The ease with which nursing graduates get employed is also likely to relate directly with achievements of the entire profession. If proposed methods to improve the status of the profession are implemented, a spirit of collegiality would be felt in the interactions among nurses. Generally, progress would be evaluated by the extent to which confidence in the profession is maintained.

Bibliography

ANA. (2010). Nursing: Scope and Standards of Practice. Maryland, MD: Silver Spring

DE MILT, D. G., FITZPATRICK, J. J., &McNULTY, R. (2011).Nurse Practitioners’ Job Satisfaction and Intent to Leave Current Positions, the Nursing Profession, and the Nurse Practitioner Role as a Direct Care Provider. NCBI, 23(1):42-50. doi: 10.1111/j.1745-7599.2010.00570.x.

NSNA.(2012). Realities of the Current Job Market. Retrieved May 8, 2015 from http://www.nsna.org/Portals/0/Skins/NSNA/pdf/RealitiesOfTheCurrentJobMarket.pdf

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Chronic Obstructive Pulmonary Disease Essay

Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease

Order Instructions:

Dear Admin,

Your task is submit your final Project Report. The completed report should be properly presented with a title page, table of contents, and references where necessary.

For this project, you will have studied the Philips Electronics model of business excellence through speed and teamwork (BEST). You will find this model described Project Study in the attachment.

You will also have read the following brief but important journal article: TQM and business excellence: is there really a conflict?

Also, read project proposal, project outline, and project case study all of them in the attachment before you start to write the project.

Your task is:

1.To assess the BEST model, with particular reference to the importance of teamwork in a company like Philips Electronics.

2.To evaluate the model against Adebanjo’s proposition that ‘business excellence and quality can and need to complement each other to provide organisations with the operational and business success they aspire to and which is necessary for survival in today’s market.’

3.To show how BEST tools and competencies could be applied to the pursuit of business excellence in your company or another company you think could benefit from using the model.

Also,

1) The answer must raise appropriate critical questions.

2) Do include all your references, as per the Harvard Referencing System,

3) Please don’t use Wikipedia web site.

4) I need examples from peer reviewed articles or researches.

5) Turnitin.com copy percentage must be 10% or less.

Note: To prepare for this essay please read the required articles that is attached

Appreciate each single moment you spend in writing my paper

Best regards

SAMPLE ANSWER

Chronic Obstructive Pulmonary Disease

This is a serious lung condition that manifests with emphysema coupled with chronic bronchitis. It is mainly prevalent in patients that are 40 years and above, especially cigarette smokers (Cherney, 2014, Pg. 50). These patients present with symptoms of coughing, production of sputum, or breathlessness. Owing to emphysema, the patients frequently experience shortness of breath, a situation where they have to make an extra effort to inhale sufficient oxygen by maintaining a high speed of breathing. In emphysema, the lungs of patients can only accommodate small volumes of air. There is also a notable deficiency in the amount of oxygen that reaches most body tissues. Old age is a predisposing factor to the disease and more so if associated with excessive smoking (Hanania, Sharma, & Sharafkhaneh, 2010, Pg. 600). It is therefore relevant for gerontological care nurses to give special attention to the condition. This paper not only discusses COPD in details, but also explores further into other secondary conditions associated with the condition. Selected mechanisms applied by nurses in handling COPD patients are also explored in detail. Such methods relate to COPD assessment as well as evaluation. Issues are addressed from the perspective of the nurse as well as from the patient’s perspective.

Assessment of COPD Patients

Just like in most other health care set ups, assessment of COPD requires collection patient’s history, from which an evaluation is made and appropriate medical measures taken. Health officials are expected to conduct history examinations on their patients and eliminate differential diagnoses to zero in to the patient’s status with regard to COPD.  A complete history collection usually offer details whether patients or their close relatives have ever been diagnosed with respiratory abnormalities, and more so emphysema, bronchitis or COPD at large. Childhood lung infections and atopic illnesses relate directly with the likelihood of COPD diagnoses on patients. In addition, history collection investigates on the living conditions of the patients, both in the past as well as in the present. In most cases, environment is a significant player in the aetiology of not only COPD, but also other common respiratory disorders. Such experiences as livingor working in dusty places plays are generally a threat to one’s respiratory health (Dweik & Mazzone, 2015, Pg. 10). When attending COPD patients, knowledge on the patient’s exposure to such conditions serves to enhance competence among nurses.The best techniques when attending patients involves nurses’ optimal knowledge on their patients from varied life aspects.

Miller’s Theory

Miller made remarkable contributions in the nursing profession by designing a theory that would guide nurses when attending aged patients. The theory is still widely applied in most health institutions in the world today. The theory has been subjected to constant modifications by its implementers in nursing care. It therefore offers up-to-date guidelines making it very relevant and appropriate for nurses who attend old people. In the present, Miller’s theory is commonly termed as “the functional consequences theory of promoting wellness in older adults” (Hunter, 2012, Pg. 37). He theory offers scientifically supported ways of improving the life quality among the aged populations, in addition to expanding their lifespan. It also relates all aspects of care in an integrated manner. A relationship is developed between nurses and patients with regard to the environment. Its incorporation of factors that affect health lure nurses to its application and to them, the theory just simplifies their day-to-day work. The theory emphasizes on important matters in the care for the aged, such as the risk factors that accompany aging, diminished body functionality as a result of old age and the linkage between one’s mind, body and spirit (Hunter, 2012, Pg. 38). In addition to problem identification, the theory suggests on appropriate ways of handling the challenges. It for instance suggests that care for the aged be directed toward alleviation of the negativity of functionality, the most predominant consequence of risk predisposition. The preferable outcomes achieved with the theory see to it that old people retain their body functionality to the best possible extent.In the care of an old OCPD patient like Kathleen, Miller’s theory is a first-hand instrument for a nurse. Despite the many challenges in her life, like being unable to cook for herself, Kathleen can still restore fun in her life with the application of Miller’s suggestions.

Age-Related Changes in COPD

As a COPD patient ages, like in the case of Kathleen, the ability to maintain wellness is decreased, patients become more prone to respiratory, cardiovascular, musculoskeletal and neurological among other disorders. Kathleen experience depression, which prompts her to seek solace by isolating herself from the community. Such a situation is common with COPD patients following neurological disorders. Again, the lady is observed to express musculoskeletal impairments when her mobility is reduced. The most conspicuous effect of COPD on Kathleen is the impairment of her respiratory system, where she developed shortness of breath as a result of emphysema.

Consequences of negativity in body functionality are also evident in Kathleen case when she fails for instance to cook for herself. Malnutrition is a serious problem and would make life more terrible for the COPD patient. It often results into increased risk to infections (NHS, 2015, Pg. 82). Usually, old people require energy to maintain basic body processes. Other matters of living affected by diagnosis with COPD among old people include physical life: environmental and social; as well as psychological life. To overcome problems associated with COPD, nursing care would involve educating the patients as well as practising the techniques that are suggested to achieve high results, such as the ones provided in Miller’s theory.

Care for COPD Patients

There has been improved research in the field of aetiology and pathophysiology of COPD in the last 50 years. There used to be a mistaken belief that little could be done on the progressive and irreversible nature of COPD. Since COPD is closely related to smoking many patients may feel as if they are not treated well due to a “self-inflicted illness.” It is this view that has commonly evoked an unsympathetic response from the patients’ relatives and unfortunately, some clinicians. Mostly, COPD affects individuals that cannot demand high standards of care such as the elderly and the poor (Bellamy & Booker, 2011, Pg. 89). Nurses should therefore, work toward attaining realistic aims of care provision such as slowing down or stopping the progression of the condition, reducing disability through achieving best possible symptom relief, and decreasing the number and severity of exacerbations.

The Role of Nurses in Care Provision

Early diagnosis is an essential step to attaining the above- stated objectives. Health officials also need to carry out regular reviews in order to make sure that necessary interventions are provided, information and education needs are attained, and signs and symptoms are well managed. The long-term management illness such as COPD is suited well to nurse-led care, so long as the nurse is trained well. COPD has a complex diagnosis and management procedure especially for elderly patients that have co-morbidity. For quality healthcare delivery, nurses should have high-quality training, continued improvement of professional development and work as a team with their colleagues.

Progression of COPD

The only effective intervention that has been identified in the slowing down of COPD progression is smoking cessation. Smoking quickly accelerates the decline of FEV1. However, this can be slowed down to an FEV1 of anon-susceptible smoker or a non-smoker at any level of COPD. Early cessation ensures that a patient acquires better outcomes, but it is not too late.

According to Roach, Bronner and Oreffo, healthcare professionals should create awareness on the subject of smoking cessation at every encounter (Roach, Bronner& Oreffo, 2011, 57). By so doing, they can prompt a smoker that is committed to thinking twice about smoking and its associated consequences. They may also encourage individuals that could be contemplating quitting make a serious cessation.

Some pharmacological medicines have also been developed to help patients quit smoking. Some of these medications include bupropion, varenicline, and nicotine replacement therapy (Kon, Hansel& Barnes, 2011, Pg. 67).  Therefore, clinicians should prescribe these medications to smokers that want to quit since they may improve their chances of success. There are some smokers that would like to quit and at the same time require special support. Such smokers should be referred to specialist services.

Reduction of COPD Symptoms

Breathlessness and a persistent cough are disabling and distressing. The primary clinical methods of managing these symptoms are;

  • Long and short-acting bronchodilators
  • Mucolytics
  • Pulmonary rehabilitation

Bronchodilators

These medications only have an effect on FEV1 in COPD.  However, they can also reduce the tone of bronchomotor, decrease hyperinflation of the respiratory system and improve the efficiency of respiratory muscles. COPD patients that take bronchodilators breathe efficiently and more comfortably. They also have an improved tolerance to exercise. The main categories of bronchodilators used are beta agonist and anticholinergic bronchodilators.

Mucolytics

These are drugs that aid in reducing sputum viscosity. As a result, they make it easier for patients to clear the sputum. Recent studies have shown that mucolytics can also reduce exacerbation number and improve the symptoms associated with coughing and production of sputum (Lee-Chiong, 2010, Pg. 362). Carnocisteine and mecysteine are some of the mucolytics used for long-term management of COPD.

Pulmonary Rehabilitation

Many COPD patients choose to live with breathlessness by shunning exercises. Patients lose their confidence, self-esteem, feel depressed, and isolate themselves from others. Pulmonary rehabilitation is aimed at reversing this. Patients should focus mainly on aerobic training so that they can condition their muscles once more and their endurance to exercise. Continued exercise also aids in reducing breathlessness. However, for successful pulmonary rehabilitation, patients should be committed and motivated as well. The patients should also be able to exercise as this will co-morbid cardiovascular related diseases and musculoskeletal problems that prevent the patients from exercising accordingly.

Reducing Exacerbations

According to MacNee, ZuWallack & Keenan, patients should be educated on self-management in order to reduce the worsening of exacerbations (MacNee, ZuWallack & Keenan, 2009, Pg. 134). Patients should also be provided with clearly written advice and also taught about when they should seek medical attention. Nurses should also ask patients about the number of exacerbations they experience afterwhich they will prescribe long-acting bronchodilators to those that have frequent exacerbations.

Conclusion

Tremendous progress has been achieved in comprehending the management of COPD. However, COPD is still a considerable burden on some patients and the caregivers but its prospects are quite promising (Bernhardt & Kasko, 2011, Pg. 36). COPD has been has been branded the “Cinderella” disease of the respiratory system, but the chances of “Cinderella” approaching the ball are improving.

Bibliography

Bellamy, D., & Booker, R. (2011). Chronic obstructive pulmonary disease in primary care: All you need to know to manage COPD in your practice.

Bernhardt, N. E., & Kasko, A. M. (2011). Nutrition for middle aged and elderly. New York: Nova Biomedical Books.

Bernhardt, N. E., & Kasko, A. M. (2011). Nutrition for middle aged and elderly. New York: Nova Biomedical Books.

Cherney, K. (2014, September 16). COPD: What’s Age Got to Do with It? Retrieved May 10, 2015 from http://www.healthline.com/health/copd/age-of-onset#Overview1

Dweik, R. A., Mazzone, P. J. (2015). Occupational Lung Disease. Retrieved May 10, 2015 from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/occupational-lung-disease/Default.htm

Hanania, N. A., Sharma, G., & Sharafkhaneh, A. (2010). COPD in the Elderly. Medscape, 31(5), 596-606

Hunter, S. (2012). Miller’s Nursing for Wellness in Older Adults. Lippincot Williams. 35-45

Kon, O. M., Hansel, T. T., & Barnes, P. J. (2011). Chronic obstructive pulmonary disease: (COPD). Oxford: Oxford University Press.

Lee-Chiong, T. L. (2010). Sleep Medicine Essentials. New York, NY: John Wiley & Sons.

Lötvall, J., & Busse, W. W. (2011). Advances in combination therapy for asthma and COPD. Chichester, West Sussex: John Wiley & Sons.

MacNee, W., ZuWallack, R. L., & Keenan, J. (2009). Clinical management of chronic obstructive pulmonary disease. Caddo, OK: Professional Communications.

NHS. (2015). Malnutrition. Retrieved May 10, 2015 from http://www.nhs.uk/conditions/Malnutrition/Pages/Introduction.aspx

Nici, L., & ZuWallack, R. L. (2012). Chronic obstructive pulmonary disease: Co-morbidities and systemic consequences. New York: Humana Press.

Roach, H. I., Bronner, F., & Oreffo, R. O. C. (2011). Epigenetic aspects of chronic diseases. London: Springer.

Voelkel, N. F., & MacNee, W. (2011). Chronic obstructive lung diseases. Hamilton, Ont: BC Decker.

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Assessment Practices in Health Care

Assessment Practices in Health Care Order Instructions: Reflect on current assessment practices for evaluating student learning in an educational or work-based health care setting.

Assessment Practices in Health Care
Assessment Practices in Health Care

Find three current research articles published in the last five years regarding health care assessment practices. These could be conducted in an educational or work-based health care setting.

Analyze the suggestions made in the articles regarding assessing students in a professional or classroom health care setting. What recommendations do you make regarding student assessment in a health care setting based on your analysis of the research articles?

Include in your review who must evaluate the students and health care professionals outside of the classroom. What role do adult learners take in the evaluation process?

Write a 1,050- to 1,750-word paper.

Format your paper consistent with APA guidelines. Current peer reviewed articles last 5 years

Assessment Practices in Health Care Sample Answer

Assessment Practices in Health Care

The health care industry is a sector that is filled with many dilemmas to solve when it comes to the aspects of assessing the competency of the nursing students and graduates. The failure to have available standard assessment procedures and scales to base the assessment and evaluation of the students in nursing is one of the major challenges facing this sector (Bourbonnais, Langford, & Giannantonio, 2008). Health care is very important in an economy since the health of the public determines its productivity and how the aims and goals of the economy are achieved. The nursing faculty of the higher education is faced with obligations that it needs to meet since the staff from their education systems are of high value to the society. The obligation to absorb and take through a high number of students through the nursing programs needs to be balanced with the obligation to ensure that the graduates have the required competencies and assure the public of their competency (Gaberson & Oermann, 2010).

One of the major obligations of the nursing faculties and the stakeholders in nursing is to assure the public of their safety when in the hands of the graduates of the nursing programs available. The public needs services which are of the highest quality and the students and graduates in this sector need to be highly competent thus the compelling need to have these competencies assessed or evaluated. The evaluation of nurses is not an easy task and the modern trends have suggested evaluation procedures which need to be well analyzed. Clinical evaluation has been facing serious challenges due to the need to identify individuals who have the qualities to fill the competencies needed in the industry (Lasater, 2011).

The development of reliable evaluation techniques and processes together with their validity to be used in the nursing environment is one of the key challenges that are faced by clinical nursing education and training. The formulation of evaluation tools which are widely acceptable across all nursing institutions and varied environments is very demanding to the faculty. Nurses are in most cases assessed based on their performances and the tools used in the evaluation are in most fail to clearly identify the performance expectations to be assessed. The tools developed have other issues of concern such as being poorly written and having unclear clinical outcomes and failure to acknowledge the different faculty approaches to clinical education. There are also different clinical environments and also varied student experiences and preparation which are also a major challenge in developing standard tools that can be used in nursing evaluation (Oermann, 2011). The roles of the faculty as both an educator and evaluator tend to clash when it comes to formulation of tools and practices of assessment.

In nursing environments the nurses are mostly evaluated on their competence on safely handling patients and being able to put into practice the knowledge and skills learnt in their nursing programs. Competence is measured depending on the ability of nurses to apply their knowledge and skills to ensure the health care providers offer safe and best quality care to the patients. Competent nurses should also be able to handle and analyze complex nursing situations relating to the patients, solve arising problems diligently and communicate in an effective way to all participants in health care giving and the recipients (Walsh, Paterson, & Grandjean, 2010). Nurses should also be able to understand all other factors affecting clinical matters arising from leadership and cultural beliefs. Despite this understanding of what needs to be assessed in the nursing programs, there is no defined consistent standard for evaluating the nurses and their competence in their field.

Despite lacking consistent standard for the evaluation of competence of the students and other participants in nursing, there practices which have been in use to assess their competence and their ability to offer safety in the health care sector. Evaluation or assessment is the process of data collection and analysis on various aspects of measuring nurse competency which are all aimed at determining whether the nursing program student has passed or not (Bourbonnais, Langford, & Giannantonio, 2008). On top of offering the desired knowledge and skills to the students, the nursing faculty is tasked with ensuring that they are able to offer competent service in the health care centers. Due to this obligation there is the need to continuously assess or evaluate the students. One of the assessment processes in the evaluation of nursing students is formative evaluation. Formative evaluation is an educative process that is aimed at offering the students guidance as they undertake the program (Lasater, 2011). In this evaluation process the students undertake various tasks that are aimed at assessing their application of knowledge and skills. Their competency is measured depending on the skills being measured in the assessment and feedback provided to the students to provide guidance on improvement actions. The feedback provides the students with an insight about their noticeable strengths and weaknesses and enables the students to be able to identify learning strategies to address the arising matters. Formative evaluation practices are aimed at giving students and the faculty important data which is useful in guiding the students and the faculty towards achieving the overall desired learning goals in clinical practice (Lasater, 2011).

Another assessment practice in the health care setting for determining the success of the learning process is summative evaluation. This is an assessment which is done at the end of the nursing program learning. Summative evaluation involves a process which is aimed at checking whether the students have achieved the required educational goals and whether they meet the desired standards of safety and competence in the clinical field (Walsh, Paterson, & Grandjean, 2010). This comes at the end of the program which determines the suitability of a nursing graduate and determines how one will be able to handle all the matters which arise during practice. To make sure the highly qualified nursing professionals are produced to the health care industry, nursing faculties should ensure that they integrate both formative and summative evaluation strategies in the learning processes.

There are various strategies which can be put into practice in the evaluation and assessment of the performance of nursing students to measure their performance and competence and aid in the progression of the learning process. These strategies or methods include observation of the actions of clinical students in practice, notes about performance, use of checklists and rating scales to determine the competencies of the nursing students, use of standardized patients and simulations to test the competence of the nursing (Gaberson & Oermann, 2010). The use of e-portfolios, conferences, group projects and self-assessments has also been tasked with the assessment of nursing students and also aid in progressive learning. Observation of the students in practice is one of the major strategies or practices that are used in health care assessment of the students. Notes can be taken which enable the detection of patterns in performance and guidance in improving the overall learning process. Observation can be used both as formative and summative evaluation process. The continuous notes taken during evaluation can be used to guide the learning process by identifying the mistakes that need to be addressed in progressive learning of the nursing program. The drawback of this practice is that the data collected in observation is not reliable due to the varied opinions of the people making the observations (Oermann, 2011).

Nursing students can also be assessed by using objective structured clinical examination (OSCE). This is an evaluation strategy that involves the students being evaluated outside their classrooms in different stations which provide the different environments which are important to provide data varied data for analysis (Bourbonnais, Langford, & Giannantonio, 2008). The students are assessed of their clinical capabilities through their interaction with simulated or standardized patients, their practical competence by demonstration of sufficient motor skills and techniques and also their static analysis by evaluation of cognitive skills during operations. This is a summative evaluation strategy that can be used in the grading of the nursing students and creates an understanding of how they will fare in the clinical field. The clinical evaluation tool provides the layout of the procedures in clinical evaluation of the nursing students. It seeks to find the consistency between the outcomes of the evaluation process and the competencies that are required in the practicing of nursing. The data collected in the evaluation process is analyzed by the instructors and other trainers of clinical instructors to determine how the nursing program can be improved to meet the obligations of health care (Walsh, Paterson, & Grandjean, 2010).

 Assessment Practices in Health Care References

Bourbonnais, F, Langford, S., & L.Giannantonio. (2008). Development of a clinical evaluation tool for baccalaureate nursing students. Nurse Education in Practice , 62-71.

Gaberson, K., & Oermann, M. (2010). Clinical Teaching strategies in nursing (3rd ed.). New York: Springer Publishing Co.

Lasater, K. (2011). Clinical judgment: The last frontier for evaluation. Nursing Education in Practice, 11, 86-92.

Oermann, M. H. (2011). Toward evidence-based nursing education: Deliberate practice and motor skill learning. Journal of Nursing Education, 50 , 63-64.

Walsh, T., Paterson, M., & Grandjean, C. (2010). Quality and safety education for nurses clinical evaluation tool. Journal of Nursing Education, 49 , 517-522.

 

Breast feeding Research Assignment

Breast feeding
Breast feeding

Breast feeding

Order Instructions:

Task 1 and Task 2 are both part of just one coursework for the module Food and Nutrition.
Any graph or table can be inserted in the essay if it is only relevant to the topic.
All the information needs to be referenced properly even the graph/table if it is included.
Further information is provided in the portfolio which i will attach.

I would really appreciate if you could show me a draft by the 25th.

SAMPLE ANSWER

Task 1: Breast feeding

None of the existing breast milk substitutes are as effective as breast feeding.  World health Organization (WHO) recommendations are exclusive breastfeeding for infants for at least six months and continued breastfeeding for at least two years. This implies that the infant should not be given any other food or drink. However, this does not exclude the vitamins and minerals they get during vaccination clinic. Breast milk is linked with increased immune system especially the gastrointestinal, allergies and atopic disorders.  This paper explores the current breast feeding trends in the UK; and using relevant evidence based arguments, an evaluation on the benefits for increased breast feeding initiation and duration will be conducted.

Fall and colleagues (2011) indicated that breast milk has an array of bioactive components responsible for innate immunity and adaptive immunity. This includes the soluble IgA. Additionally, it also has glycan’s such as mucins, glycolipids, proteins and complex carbohydrates. These components give innate and adaptive protection to the infant especially from cardiovascular diseases.  Hill and colleagues (2013) argues that the induction of breast milk oligosaccharides modulates the glycan’s on the epithelial cells; thereby enhancing protection from microorganisms such as Escherichia coli.  According to Arenz et al (2004) diarrhea in infants is 5times common in bottle-fed infants that the breast fed babies. The cost of treating these gastrointestinal disorders is 12 folds that of breast fed infants.

Richard et al (2005) encourages exclusive breast feeding for diabetic mothers in order to protect the infant from suffering hypoglycemia. Additionally, Park and colleagues (2014) recognized that breast feeding enhances the intimate relationship between the mother and the infant. This relationship has been associated with cognitive behavior and emotional stability of the infant during growth. Yan et al (2014) associates exclusive breast-feeding with reduced risks of overweight and obesity. Breastfed infants gain weight gradually than the formula fed babies. McCrory and Layte (2012) argue that breast milk protein content is low as compared to the formula milk. Formula feeding results to increase plasma –insulin levels; and is often associated to high concentrations of insulin growth factor I.  Exclusive breastfeeding closely correlates with high socioeconomic status; which is also associated with decreased childhood obesity incidences.  HHSSP (2013) approximates that 1.5 million lives are lost due to inadequate of breastfeeding. Breast fed infants have lower cancer incidences. They are less susceptible to lymphomas and leukemia.  Breast feeding is also associated as a means of family planning in some settings. Biologically, this can be linked to the delaying of ovulation and enhances proper child spacing.

Mcneal (2014) indicates that a 5% increment in breastfeeding could save £2.5 million UK health care cost.  Investigations estimate that the use of breast milk substitute costs USA $331-$475 per baby. In Australia, exclusive breast feeding could save more than £435 million.   It is estimated that the total cost of purchasing breast milk substitutes and the equipment necessary for feeding is about £250.  Breast milk is natural, renewable with no packaging or delivery costs. Exclusive breastfeeding saves health care costs. A study conducted in Glasgow indicated that 15% higher medical consultations for infants fed on formula than exclusively breastfed babies. UNICEF UK studies estimated £17million saving if 45% women breast fed exclusively and 75% babies were breastfed at discharge.

Evidently, breast feeding is beneficial both to the infant and the mother. Why do mothers still choose not to breast feed?  Karen and colleagues (2014) identifies the obstacles which hinder exclusive breastfeeding including short maternal leaves; lack of information on how to breastfeed and the benefits; inadequate support from the family; inadequate information on how to handle breastfeeding complications such as sore nipples (especially for first time mothers) and embarrassment.  Breast feeding initiation programs have doubled in the last two decades i.e. from 36% to 64% from 1990 to 2010 respectively. However, breast feeding rates are stagnant in the last 5 years.  In UK, 12% of mothers stop breast feeding within the first week of birth; 22% by two weeks and only 36% exclusively breast feed their infants for the first two months. In Scotland, the trend is contrary with rates increase by 4% in a span of 5years (36% in 1995 and 40% in 2000).  Dyson and Et al (2005) argues that the rates of breast feeding are lowest in Europe. Currently, only 25% of infants in UK are exclusively breastfed during the first two months; and only 16% are exclusively breastfed for first six months. The figure is projected to decrease in the next decade.  Of importance, cultural background determined the initiation duration for breast feeding. Studies indicated that Women from certain ethnic communities (Asian and Black) had lower breastfeeding rates. The low duration breast feeding rates are also prevalent among the white women.  Irfan and Oguz (2013) findings indicates that infants from this community are less privileged in terms of breastfeeding initiation and duration. Moreover, teenage mothers are also likely to delay breast feeding initiation .Duration rates in families of low socioeconomic status were found to be the lowest. However, little efforts have been made to reduce the health disparities between the underprivileged backgrounds in the past two decades.

According to Mona and colleagues (2014) inherent health disparity will continue to increase if no strategic interventions are put in place. Strategic interventions should be tailored to meet the needs of cultural and socioeconomic groups. Stake holders should collaborate on multifaceted strategies/programs to increase breast feeding initiation and duration. Five studies in the US on 582 expectant mothers indicated that breastfeeding educative program during pregnancy increase breast feeding initiation and duration in low social-economic mothers. However, there lacks an evidence based education program intervention for overall expectant mothers. In hospital, mothers who are trained on positioning of the infant when breastfeeding increase the chances of longer breastfeeding duration. Haider (2014) reports that postnatal NICE guidelines is supported by several evidence based studies; thereby indicating the role and importance postnatal training intervention.  Keiko and colleagues (2013)  advices that Health practitioners should take  lead and actively promote breastfeeding; in fact, every health institution should have a designated person who is held responsible for breast feeding program leadership and co-ordination. This intervention will ensure that various stake holders have adequate information and a strong framework to ensure quality health care services for both mothers and infants. The interventions efforts should be doubled when dealing with the underprivileged mothers.

Despite the underprivileged parental leaves, two thirds of the global labor forces are mothers (Boris, 2011).  According to Rossin-Slater Et al (2013), lengthier maternity leave is associated with less depressive symptoms among mothers. Increasing the leave by one week indicated up to 7% reduction in depression symptoms.  Lengthier paid leaves are also associated with significant reduction in infant mortality. A 10 week paid leave extension led to a 4.1% decrease on infant mortality. In 2010, study conducted in US, only 43% babies are exclusively breastfed at six months. The study indicated that nearly 900 infant’s death could be prevented if 90% of working mothers breastfed exclusively. This could save $13billion dollars annually.

Some mothers may not breastfeed due to mother-health related issues or the infant’s circumstances. In this case, the health professionals attending should provide the best evidence based advice. Most of the voluntary agencies have up to date information, and could be in apposition to give health practitioners useful information for particular circumstance. Hoddinott et al (2008) studies supports preterm infants and those born with several medical disorders should be breastfed. However, if the birth weight for the preterm babies is very low, then supplementary calories may be used. The main advantage of feeding preterm with breast milk is that breast milk is more tolerated better by the immature gastrointestinal system. This reduces the incidences of life threatening complications such as Necrotizing enterocolitis. The major challenge in this situation is the inaccessibility of breast pumps once these mothers leave the hospital premises. In some cases, they are forced to hire the facility from their own pockets (Horta Et al., 2007).

According to Christy (2014), there are increased concerns in UK on the level of mother-baby HIV transmission.  The transmission can occur during birth or later via breastfeeding. Therefore, breast feeding HIV positive mothers should be informed on the contexts and risks of breastfeeding. The UK National Assembly has guidelines for guidance on both antenatal and postnatal care for HIV positive mothers. There should be easy access to breast feeding information at community level through local programs. For instance, nurses could provide breastfeeding advices during the immunization sessions. Community psychiatrists handling mothers with mental disorders such as postnatal depression should be armed with appropriate breast feeding information. This ensures that the mothers are adequately supported. Moreover, community pharmacists should be informed on appropriate medication for breastfeeding mothers especially on contraceptives matters.  Despite the experience, education and wage gap differences; mothers experience significant wage penalty per child in terms of reduced working hours, unprecedented shifts to family friendly time and the numerous interruptions for child-bearing unprecedented-leave.  There is increased need to set of policies geared towards maternity policy, job protection and supplementary income during pregnancy among the industrialized countries (Jing &Jae-ho, 2014).

References

Arenz, S., Et al. (2004) Breastfeeding and childhood obesity- a systematic review. International journal of obesity 28, p1247-1256

Boris, Eileen. (2011) “No Right to Layettes or Nursing Time”: Maternity Leave the Question of U.S. Exception. Workers across the Americas: the Transnational Turn in Labor History. N.P., 71-193. Print.

Christy BN. (2014) Breast feeding: A holistic concept analysis. Public Health nursing 31:1 p88-96

Dyson, L. Et al. (2005) “Promotion of Breast feeding initiation and Duration.” Retrieved on January 26th 2015 from [www.dh.gov.uk/assetRoot/04/07/16/96/04071696.pdf]

Fall, HD. Et al. (2011) Infant feeding patters and cardiovascular risk factors in young adulthood: data from five cohorts in low and middle income countries. International journal of epidemiology, 40; p47-62

Haider, SJ. (2014) An evaluation of the effects of breast feeding support program on health outcomes. Health Services research 49; 6, p2017-2034

Hill, DR. Et al. (2013) Human milk Hyaluronic Enhances Innate Defense of the intestinal epithelium. The journal of Biological chemistry 288; 40, p29090-29104

Hoddinott, P. Et al. (2008) Clinical review: Breast feeding. BMJ336, P881-887

Horta, BL. Et al. (2007) Evidence of the long term effects of breast feeding. Geneva, WHO Retrieved on January 26th 2015 from [http://whqlibdoc.who.int/publications/2007/9789241595230_eng.pdf]

HSSP. (2013) “Breast feeding: A great start.” Retrieved on January 26th 2015 from [http://www.unicef.org.uk/Documents/Baby_Friendly/Research/Preventing_disease_saving_resources.pdfhttp://www.unicef.org.uk/Documents/Baby_Friendly/Research/Preventing_disease_saving_resources.pdf]

Irfan, S &Oguz, T. (2013) Factors influencing breastfeeding duration: a survey in a Turkish population. Journal of pediatrics, 172; 11, p1459-1466

Jing, KM& Jae –Ho, K. (2013) Factors affecting exclusive breast feeding during the firth 6 months in Korea. Pediatrics international 55; 5, p177-180

Karen, W. Et al (2014) Understanding infant feeding practices of new mothers: findings from the healthy beginning trial. Australian journal of advanced nursing 32, 1, p6-15

Keiko, O. Et al. (2014) Effectiveness of a breast feeding self-efficacy intervention: Do hospital practices make a difference. Maternal & child health journal 18; 1, p296-306

McCrory, C& Layte, R (2012) Breast feeding and risk of overweight and obesity at nine years age. Social Science & Medicine 75:323-330

Mcneal, M. (2014) The business of breast feeding. Marketing health services 34:4, p22-27

Mona, N. Et al. (2014). A complex breastfeeding promotion and support intervention in a developing country: study protocol for a randomized clinical trial. BMC public health, 14; 1, p1-20

Park, S. Et al. (2014) Protective effect of breast feeding with regard to children’s behavioral and cognitive problems. Nutritional journal 13; 1 p84-95

Richard, MM. Et al. (2005) Breast feeding in infancy and blood pressure in later life: systematic review and meta-analysis. American journal of epidemiology 161; 1, p15-26

Rossin-Slater, Et al. (2013) “The Effect of California’s Paid Family Leave Program on Mothers’ Leave-Taking and Subsequent Labor Market Outcomes.” Journal of Policy Analysis & Management 2: 224-245. Print.

Yan, J. Et al. (2014). The association between breastfeeding and childhood obesity: a meta-analysis BMC public health 14:1, p467-490

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Holistic care is necessary for individuals with chronic illnesses.

Holistic care is necessary for individuals with chronic illnesses.
Holistic care is necessary for individuals with chronic illnesses.

Holistic care is necessary for individuals with chronic illnesses.

Order Instructions:

Part 1

In your location, identify three medical insurance providers that operate as HMOs or PPOs. What are the types of services (disease management, case management, holistic care, care plans, educational programs, family support, etc.) offered by the HMOs or PPOs and ways in which the services have benefited your patients?

Part 2

Discuss two reasons why holistic care is necessary for individuals with chronic illnesses.

at least 1 citation for each part

SAMPLE ANSWER

Part1.  Medicare, Aetna health insurance, and Humana are some of the three medical insurance providers in my location. They provide health care plans to their members. These services help the members finance their health services or buy medicines when they are sick or someone they are taking care of is sick. The insurance providers also provide educational programs to its members on current health trends, what to avoid, and how to manage certain conditions (Kongstvedt, 2013, Pg. 27).

Part2. I believe every nurse knows about Florence Nightingale’s devotion to taking care of patients that could not take of themselves. Her emphasis on the connection between patients and their environment has made her be considered as the first and greatest holistic nurses. In fact she is branded “The Mother of Modern Nursing.” This just shows how significant holistic care is in nursing.

For me, holism is more that certain activities performed or words spoken to the patient. Holism is a philosophy; it is a means of ensuring that all parts of the patient obtain care. With holistic care, nurses manage to recognize and treat each patient differently (Morton & Fontaine, 2013, Pg. 74). Some patients have been found describing holistic nurses as “those nurses that truly care.” While there is nothing wrong with being goal-oriented or task-oriented in the nursing field, if a clinician is overly task-oriented, he/she tends to become severely rushed leaving patients feeling as if they are a burden or nothing else but a number. Holistic care aids nurses to balance all their roles and responsibilities that come with the title hence; their duties become their privileges and success

Secondly, holistic care entails healing the mind, body, and soul of the patients. It helps nurses think about and assisting patients with consequences of a disease on the body, mind, religion, emotions, and personal relationships. Holism involves taking into account the social and cultural differences and preferences of the patients.  I believe every person is his/her own individual.  Isn’t it essential then to individualize patient care?

References

Kongstvedt, P. R. (2013). Essentials of managed health care. Burlington, MA: Jones and Bartlett Learning.http://healthadmin.jbpub.com/kongstvedt6e/StudyGuides/04646_FMXX_studyguide.pdf

Morton, P. G., & Fontaine, D. K. (2013). Critical care nursing: A holistic approach. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

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Identification of the illness Essay Paper    

Identification of the illness
              Identification of the illness

Identification of the illness

Order Instructions:

Introduction

While treating the chronically ill, a major challenge is developing a plan of care that addresses the specific needs of a patient and a caregiver. You need to be in close touch with patients and their support group, family and peers, to come up with an ideal plan.

In this course project, you are going to develop a plan of care for a chronic illness group of your choice. While executing the tasks of this project, remember that while you need to give a general overview of the biomedical considerations of the case, the focus should always be on the psychosocial elements. Your perspective in this care plan should be the patient’s goals rather than that of the medical team.

Each week, you will complete a part of this project. You will submit a final completed project in Week 5. This course project will count for 40 percent of your grade, so be sure to take the time to carefully complete each of the weekly assignments and then put it all together in Week 5.

Ensure that you save a copy of this course project after you have submitted it at the end of this course. You are expected to resubmit this project along with the other course projects at the end of the Registered Nurse (RN) to Bachelor of Science in Nursing (BSN) program. File Transfer Protocol (FTP) details will be provided in the Capstone course.

Identifying a Group

Identify an area of chronic illness (something in the area of oncology) of specific interest to you. Explain your choice and your interest in it. Prepare a questionnaire utilizing your knowledge of health and illness, with the aim of acquiring all information you need from patients to prepare a plan of care for the specific illness group.

Support your responses with examples.

Cite any sources in APA format.

SAMPLE ANSWER

Identification of the illness        

The care for chronic illness requires articulate plans that involve the care giver and the patient. This is crucial especially in the oncology related illnesses. The chronic illness in the area of oncology that is addressed in this is cancer. Cancer illness has been on the increase in the recent times. Although there has not been a well known cause of cancer, this chronic illness has been associated with lifestyle that is subjective to the prevalent conditions for its development. There is interest in the care for this chronic illness because it subjects the patients to lots of pain and discomfort, hence, the need for nurses to articulate the care necessary for this chronic illness.

Much interest to this oncology chronic illness has emanated from the realization that early detection can lead to better treatment and even cure. On the other hand, for those that the detection comes a bit late, they are subjected to endure the bitter toil of the disease for the rest of their lives. Stricker & O’Brien (2014) observe that; this would interest a nurse in the making to choose this kind of ailment to develop the plan for care for it.  The interest follows the urge to see that the patients of this chronic illness are subjected to a care that is well planned such that the pain and discomfort is minimized. It is also crucial that those patients live a fulfilling life despite the challenges of the chronic illness. In this sense, it would be crucial to have a plan that encourages and enables the patients to engage in the( healthy ) activities that they used to engage in before  so as not to feel to have been thrown out of life by the illness.

It is also crucial to have a plan that enables the patients to engage in economical activities up to the maximum time possible. This is very crucial considering the economic impact of the illness. Cancer is associated with a lot of economical demands. This follows the high cost of the drugs and the processes employed in the treatment such as chemotherapy. Garland (2015) observes that; these utilize huge finances and if the patient comes from a weak background financial, it would be difficult to afford those services. Cancer illness also requires that the patient uses a healthy diet so as to boost the immunity. This is costly especially in consideration of the high cost of fruits that are much needed in the diet in order to keep a healthy diet.

In the preparation of plan of care, the interests of the patient as well as that of the care giver are put in to consideration. In order to come up with a viable plan for the cancer patients, it is crucial that the nurse making the plan considers the interest of the patient more than the interest of the care giver. Dulko, Pace, Dittus, Sprague et al (2013) note that; there is always expectation of difficulties to be encountered especially where there are languages or cultural barriers. However, the crucial point here is to engage the patient in the conversation and not just to have the plan in a document. In order to understand the interest of the patient it is crucial that the care giver engages in interaction with the patient to understand them well. This also calls for asking of questions to the patient so as to come up with a plan that is quite suitable for them. In order to acquire the required information, it is crucial that the involved nurse prepares the questions to be asked to the cancer patients in a bid to get direction to the care plan that suits them. Such questions would include:

Personal details: these include their name, age, gender and maybe some little background on them.

Specific diagnosis: It would be crucial for the nurse to establish whether the patient understands the specific diagnosis of their illness.

Initial treatment plan: The nurse should seek to understand what initial plans the patient had about the treatment of the disease. This helps the nurse to align the plan to the initial expectation.

Expected common and rare toxicities: The nurse establishes the toxicities expected and the allergies that the patient may have.

Who will take care of specific aspects of treatment and their side effects: this touch on the person that will be responsible in case the patient is subjected to conditions that do not allow them to be responsible for some of their personal issues?

Psychosocial and supportive care plans: the nurse asks the patient about the expectations of the patient about psychological and social support. For instance, I they would encourage visits to their residence to be guided on issues concerning the disease or if they would be willing to join support groups.

Vocational and financial concerns: For instance, would they still continue with their current jobs?

Advanced care directives and preferences: The nurse establishes the anticipation of the patient about advanced care directives and what they would prefer.

References

Dulko, D., Pace, C. M., Dittus, K. L., Sprague, B. L., Pollack, L. A., Hawkins, N. A., & Geller, B. M. (2013). Barriers and Facilitators to Implementing Cancer Survivorship Care Plans. Oncology Nursing Forum, 40(6), 575-580. doi:10.1188/13.ON

GARLAND, S. B. (2015). Planning Checklist For Chronic Illness. Kiplinger’s Retirement Report, 22(1), 1-4.

Stricker, C. T., & O’Brien, M. (2014). Implementing the Commission on Cancer Standards for Survivorship Care Plans. Clinical Journal Of Oncology Nursing, 1815-22. https://www.doi:10.1188/14.CJON.S1.15-22

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