Questions and Topics We Can Help You To Answer:
Paper Instructions:

For each discussion question, please write about a paragraph or more depending on the length needed to answer it completely. Also include references. 

Discussion questions 2 :
What is lymph, and how does it differ from the circulatory system? How does it interact with the immune system and why is this important? 

Discussion question 3: 
Read the following article in The Guardian, http://www.theguardian.com/science/2014/feb/11/gut-biology-health-bacteria-future-medicine about the wildly diverse microbial population that inhabits our gut! This article provides evidence that what we eat feeds different populations of different types of microbes. Depending on which microbes flourish, different byproducts may be produced and the chemistry of our digestive system can change. How could changes in pH alter our digestive lining? How could the uniqueness of each individual’s "Microbiome” result in individuals being susceptible to some diseases over others?
Use this document published by the American Academy of Microbiology, FAQ: Human Microbiome to accomplish your research for your responses.

Discussion question 5: 
After you complete your Background readings on the reproductive system, you will continue on to your Case Assignment investigating infertility, a common current issue in our country.  For this discussion, read these articles in ScienceDaily on cutting-edge research in this field by clicking on the following links: 
Endocrine disruptors impair human sperm function, research finds
Stress degrades sperm quality, study shows 
Post your reaction to these findings and comment on the potential effect of the environment and cortisol (glucocorticoids) on reproduction.

Questions and Topics We Can Help You To Answer:
Paper Instructions:

This is a research paper and it going to talk about China's Health Care System, what is it? and does it doing very well in China, and what it should improve, what is China's Health Care System's future.

Questions and Topics We Can Help You To Answer:
Paper Instructions:

Over the last 25 years or so the WHO and United Nations Development PROGRAM (UNDP), and many European countries have been talking about sustainability and resilience as core values in designing, developing, and remodeling communities. This vocabulary has recently become popular in policy circles in the United States.  What are sustainability and resilience, and how do they relate to mitigation? How can these three concepts be used so as to reinforce each other?  What are the limits?

for nursing class

Module 5 Annotated Bibliography Assignment – this assignment documents your
individualized research during the course.
Select a general topic from the provided list below and pursue a self-directed reading/research
program. Using the UWF online library you are to locate and read three scholarly research
articles from professional nursing journals on one topic of your choice from the list provided.
Do not use an online journal.
Literature should be relevant to the focus of the geriatric population and must be from scholarly
nursing journal research articles.
Your references and citations must be in APA format; there is a required minimum of 3
sources. Submit to Dropbox by the due date and time.
The use of annotated bibliographies may be a new concept to you. They are brief and concise
and more than a summary of the article. Further information is available through the UWF
library tutorial on both annotated bibliographies AND how to find a scholarly research article
• A bibliography is a list of citations to books, journal articles, and other works.
• An annotated bibliography is a list of citations to books, journal articles, and other
works accompanied by descriptive and/or critical paragraph length summaries
Module 5 – Management of Geriatric Syndromes: Annotated Bib Topics
• Falls in Older Adults
• Anxiety & Depression in the Older Adult
• Urinary Incontinence
• Sleep Disorders
• Dysphagia and Malnutrition
• Pressure Ulcers
Each article will be assessed on the following:
Annotation - Descriptive and/or critical paragraph length summary of the work and should
include its:
1. scope or purpose
2. intended audience or level
3. expertise and credentials of the author(s)
4. objectivity of author(s)
5. special features
6. timeliness
7. critical or descriptive evaluation
8. demonstrating correct APA format on ALL three journal article citations.
t is highly recommended you review the UWF library tutorial on annotated bibliographies
and view the included example. http://libguides.uwf.edu.ezproxy.lib.uwf.edu/bibliography
Another excellent resource on annotated bibliographies is the Cornell University Library
If you do not know how to access a scholarly journal article through the UWF database OR
don't know what a scholarly article is go to the UWF library tutorials.



There are 20 points possible for assigned submission. Evaluation rubric
Criteria Article 1 Article 2 Article 3
Scope or purpose 1 1 1
Intended audience or
level
1 1 1
Expertise, Credentials,
and Objectivity of
author(s)
1 1 1
Special
features/Timeliness
1 1 1
Critical or descriptive
evaluation
2 2 2

Reference APA 2 total points for all three articles correctly referenced (no partial credit)


The following annotated bibliography example accessed from Cornell University website. Note
the reference is lacking indentation and double spacing and is in bold. This is fine for this
assignment, but the remaining format (correct use of caps, italics, sequencing of information)
must comply with APA.
Waite, L. J., Goldschneider, F. K., & Witsberger, C. (1986). Nonfamily living and the
erosion of traditional family orientations among young adults. American Sociological
Review, 51 (4), 541-554.
The authors, researchers at the Rand Corporation and Brown University, use data from the
National Longitudinal Surveys of Young Women and Young Men to test their hypothesis that
nonfamily living by young adults alters their attitudes, values, plans, and expectations, moving
them away from their belief in traditional sex roles. They find their hypothesis strongly
supported in young females, while the effects were fewer in studies of young males. Increasing
the time away from parents before marrying increased individualism, self-sufficiency, and
changes in attitudes about families. In contrast, an earlier study by Williams cited below  shows
no significant gender differences in sex role attitudes as a result of nonfamily living.

An annotated bibliography has two parts:

Citation- Bibliographic information formatted according to a specific style (e.g., Turabian, APA, MLA). Bibliographic information usually includes the work's:
author
title
date
publisher information
volume/issue number
Annotation- Descriptive and/or critical paragraph length summary of the work. The summaries of the work may include its:
scope or purpose
intended audience or level
expertise and credentials of the author(s)
objectivity of author(s)
special features
timeliness
critical or descriptive evaluation

A Reflection on my Expectations in OB & Peds

Description

Studying this course will enable me to excel as a health care provider for prenatal and post-natal patients. I am very excited and cannot wait to learn from my lectures and activities on how to deliver safe health care. I expect to gain a lot of knowledge and experience from learning materials and activities that are informed by evidence-based research. I look forward to the successful completion of this course and expect that I will have all the necessary skills and knowledge that will qualify me to offer services that enhance the quality of patient outcomes. For this plan to be successful, I need to have a solid grasp of the various techniques and procedures that are essential for the Obstetric and Pediatric Nursing occupation.

Reflection

My present technological skills and aptitudes will be handy in this endeavor as they will find significant use in evaluating the data of my future patients and also enable me to properly document the various processes of providing them with care. The reason why I went for this course is that I have come to admire the high professionalism portrayed by various healthcare providers from various interactions I’ve had with them in hospitals and from various media such as documentaries, films, and YouTube videos. I look forward to internalizing all the rules, and codes of ethics, and standards of professional conduct so that I can also be an inspiration to future generations of health care workers.

Influencing factors

I look forward to asking lots of questions in the various classes and lectures, obtain a deeper understanding of the content through group discussions and library research. I also look forward to the challenge of doing well in the assignments and tests that will help me evaluate areas of the course material for strengths and weaknesses to be able to focus on excelling in the course. I will also comply with the various rules and regulations guiding my conduct as a student. I will therefore take time to familiarize myself with those requirements to comply with them satisfactorily. All in all, I will explore the various areas of care such as how to diagnose and treat various complications affecting the pregnancy, or the child.

What I plan on improving

Collaborating with fellow students has not always been my strong suit. This is an area where I would like to improve on during this course. In the past courses, I kept on thinking that I would work on this and form a study group with others but all my efforts were not very successful because of inadequate preparation and planning. To counter this challenge, I plan on carefully selecting the students who are as ambitious as I am to excel in this course and ultimately in their careers. After selecting and approaching these students we will together delineate goals and what we expect to obtain from the group and lay down rules to be followed in these discussions. I want to work on my listening skills which in the past have prevented me from fully benefiting from group interactions.

Learning

I look forward to learning from my instructors and role models on how they used their time and the strategies they employed to cope with the various challenges they encountered. I will then come up with a standardized plan supported by empirical evidence that will enable me to excel in the course and my career as a neonatal and postnatal health care provider. The nursing profession is infused with a lot of moral and ethical dilemmas which I expect to learn how to navigate. I also look forward to strengthening my values such as my belief in a strong work ethic and the inviolability of human life. I look forward to building my knowledge, skills and experience that will enable me to make a difference in my patients’ health outcomes.

 Bedside Shift Report

Introduction

In our current health care centers, there have been many efforts to improve patient care. One of these efforts has been achieved through focusing on patient-centered care, which can be achieved through Quality and Safety Education for Nurses (QSEN) competency. These competencies are essential when nurses are exchanging vital information concerning the patient, especially between the off-going and the on-coming nurses. This is particularly defined as a bedside shift report. The relevance of this report is to ensure that nurses offer safe continuity of care, delivering the best clinical practice. It is due to this need that the QSEN institution seeks to train nurses ensuring that they acquire knowledge, skills, and attitudes (KSAs), which are needed to improve the quality and safety of healthcare systems (QSEN Competencies, 2021). The primary area of concern is improving the quality and safety of patients’ care, through embracing patient-centered care, which has been possible through the implementation of the bedside shift nurses report.

In the nursing operation, information about the patients is very critical. This is an aspect that is deployed in the nursing department to exchange information between the off-going and the on-coming nurses, highlighting the patients’ details, such as medical situation, background, care plan, and treatment, to ensure effective continuity of care and best clinical practices (Dorvil, 2018). It is due to this reason that the QSEN institution, offers training on the quality of services needed by nurses to address the patients' needs. The major training is on the three competencies which include knowledge, skills, and attitudes to ensure effective patient-centered care. One of the most critical aspects in dealing with patients is knowledge, which entails understanding various dimensions associated with patients’ health conditions. Some essential information includes patient information, values, preferences, information, communication, and education. In addition, knowledge entails the description of cultural, ethnic, and social backgrounds, which affect the nature of services offered to clients (QSEN Competencies, 2021). More so, get a clear understanding of concepts such as suffering and pain and safety methods that can ensure effective health care and improve the involvement of the patients and the family in the treatment process. More importantly, the nurses need adequate information concerning limits and boundaries, taking keen considerations of the ethical and legal implications.

Additionally, there is a need to acquire adequate skills, which help implement care and evaluate care. Nurses also need to show many skills in communication, revealing sensitivity, and respect for diversity in human experiences. A competent nurse should actively engage patients, provide access to resources, assess their levels of communication skills, and build consensus. It is always important to resolve conflicts and ensure the provision of the needed care. Moreover, attitude is another critical aspect that needs to be portrayed by a nurse; this is a value that helps seeing health care situations through patients’ eyes (Boswell et al., 2021). Through this value, patients benefit from respect and encouragement. Also, this value is the opportunity where all aspects of humanity are respected. Additionally, due to attitude, nurses appreciate shared decisions, empowering patients and families, keeping continuous communication even during conflicts.

Nurses are mandated with critical positions in the health care systems to provide, monitor, and manage the services they deliver to their patients. The QSEN initiative was launched to redefine nursing education quality and safety competencies (Cengiz & Yoder, 2020). This was an initiative to ensure that graduating nurses have full competencies and meet the KSAs. These skills were supposed to be built from the grassroots, ensuring they are incorporated into nursing orientation, and continuous tests for the competencies gained (James et al., 2017). This was the only sure way to ensure increased patient safety knowledge and thus more quality services. These are the skills needed to fully embrace the evidence-based practice in nursing and improve the quality of services.

Evidence-based practice (EBP) on nursing care comprises the best evidence, patients' preferences, and nurses’ expertise. Since the introduction of EBP in the 1970s, there has been a positive impact on the quality of services offered to the patients. The EBP has led to improved safety and outcomes on patients, to the extent that the American Association of Colleges of Nursing (AACN) has shown concern. This organization seeks to appraise and integrate evidence as essential for nurse preparation (Boswell et al., 2021). Precisely, these competencies, as highlighted for pre-licensure nurses in QSEN institute competencies, entail knowledge, skills, and attitudes for EBP and meeting nurse needs. These are the essentials when providing safe and quality patient-centered care.

Conclusion

In conclusion, patient-centered care is one of the critical values that is needed in nursing. This entails checking on patients’ needs to ensure that they are met individually, meeting their preferences, culture, and other social background needs. This has been achieved by the bedside shift report, which is trained by the QSEN institution. The institution highlights competencies useful in ensuring nurses acquire the right knowledge, skills, and competence to address the current patients’ needs and those in the future. This is an assurance from the EBP, highlighting the importance of promoting patient-centered care and its impacts on improving the quality and outcomes of health care services.

References

Boswell, C., Sanchez, L., & Powers, R. (2021). QSEN competencies: How well are we doing?. Nursing Management, 52(4), 49-53.

Cengiz, A., & Yoder, L. H. (2020). Assessing nursing students’ perceptions of the QSEN competencies: a systematic review of the literature with implications for academic programs. Worldviews on Evidence‐Based Nursing, 17(4), 275-282.

Dorvil, B. (2018). The secrets to successful nurse bedside shift report implementation and sustainability. Nursing management, 49(6), 20.

James, D. H., Patrician, P. A., & Miltner, R. S. (2017). Testing for Quality and Safety Education for Nurses (QSEN): Reflections from using QSEN as a framework for RN orientation. Journal for nurses in professional development, 33(4), 180-184.

QSEN Competencies. (2021). Quality and Safety Education for Nurses: Patient-Centered Care. Retrieved from: https://qsen.org/competencies/pre-licensure-ksas/

 The Effect of Extremely Low Birth Weight Babies on the Family and Community

Short-Term and Long-Term, Socioeconomic Implications

Low birth weights are associated with more negative consequences to both babies and the community. Babies born with low weight suffer from several complications, some of which are short-term risks like the low immune system and long-term abnormalities connected with brain development. It is also an important indicator of future socioeconomic status. A baby who is very underweight when born may have difficulties feeding on the breast milk, which causes a low rate of gaining weight and low development of the immune system, making it difficult for the child's body to fight against diseases. Brain development determines the intelligence of a person. Children born underweight are known to have low mental quality and the ability to reason. With the melancholy intelligence of a person, it becomes so difficult to venturing into economic activities (Mathewson et al., 2017). This brings about the low living standards of an individual, making the person depend on others for socioeconomic needs.

Need for Care and Comorbidities Associated With Prematurity

The babies' care is dictated according to their health and their ability to permit treatment in their bodies. They need proper nutrition to compensate for the essential components not acquired in the uterus (Zhou et al., 2019). This will also increase the immune system of the body. Preterm birth causes several diseases in the newborn that mostly requires extra medical attention. These include respiratory distress syndrome, Anea and Bradycardia, and Jaundice. Low birthweight occurs when a baby is born weighing less than 5 pounds. The babies born under weighing are healthy and robust, but some are born with severe beneficial occurrences that always need special care (Parker et al.,2019) .preterm birth is born with a gestation period of 37 weeks. They do not complete the gestation period of 9 months. Fatal growth restrictions mainly bring this about.

Immigrants in the country are at greater heights of giving birth to low-weight babies than native women. The black women are the one who tends to deliver low weighted babies in contrast to the whites. The reason as to why the black is associated with such problems is because they reside in alow developed areas that are constituted to a very negative and unconducive environment such as drug abuse poverty and low education levels(Parker et al.,2019). There have been groups that have emerged in a fight for the eradication of such amenities. They fight against drug abuse and poverty. This helps pregnant women access proper health care and abstain from substance abuse, and in turn, it has reduced the rate of birth of low-weight babies.

References

Mathewson, K. J., Chow, C. H., Dobson, K. G., Pope, E. I., Schmidt, L. A., & Van Lieshout, R. J. (2017). Mental health of extremely low birth weight survivors: a systematic review and meta-analysis. Psychological bulletin, 143(4), 347.

Zhou, H., Wang, A., Huang, X., Guo, S., Yang, Y., Martin, K., ... & Wang, Y. (2019). Quality antenatal care protects against low birth weight in 42 poor counties of Western China. PloS one, 14(1), e0210393.

Parker, M. G., Gupta, M., Melvin, P., Burnham, L. A., Lopera, A. M., Moses, J. M., ... & Belfort, M. B. (2019). Racial and ethnic disparities in the use of mother's milk feeding for very low birth weight infants in Massachusetts. The Journal of pediatrics, 204, 134-141.

An Assessment of the Impact of COVID-19 on Tuberculosis Notifications in Mission Health Facilities in Zambia: An Interrupted Time Series Analysis

Table of Contents

CHAPTER 1. 5

1.0 Introduction. 5

1.1      Background of the Study. 5

1.2      Statement of the problem.. 6

1.3      Research Objectives. 6

1.4      Research Questions. 7

1.5      Significance of the study. 7

1.8 Definition of key terms and concepts. 7

CHAPTER 2. 8

2.0. Literature Review.. 8

Conceptual Framework. 9

CHAPTER 3. 10

3.0 Methodology. 10

3.1 Introduction. 10

3.2 Research Design. 10

3.3 Study Population. 10

Eligibility Criteria. 10

1.3.1       Inclusion Criteria. 10

1.3.2       Exclusion Criteria. 10

3.4 Sample Size. 10

3.5 Sampling Techniques. 10

3.6 Data Collection. 10

3.7 Data Analysis. 10

3.8 Ethical Considerations. 10

3.8 Data Analysis Plan. 10

3.9 Ethical Consideration. 10

3.10    Project Administration and Monitoring. Error! Bookmark not defined.

3.12 Dissemination Plan. 10

CHAPTER 4. 11

References. 11

Appendices. 12

Questionnaire. 12

LIST OF TABLES

LIST OF ABBREVIATIONS

 
CHAPTER 1

1.0 Introduction

This chapter gives the background of the study. It also states the statement of the problem, aims of the study, objectives, and research questions, importance of the study, delimitation as well as limitations of the study and finally, operational definitions of key terms used in the study.

1.1   Background of the Study

The coronavirus breakout has seen a great effect on the performance and care programs as almost all the attention has been diverted to adopting the policies in response to the Covid-19 pandemic (Wang et al., 2021). Many policies, including lockdowns and controlled gatherings, have been put in place to try and thwart the spread of the virus, not giving the required attention to the TB cases, which has led to a critical increase of deaths from tuberculosis in various countries (World Health Organization, 2021).

China had implemented a series of public health laws to prevent the ravaging effects of the virus. These policies had significantly impacted the TB notification rate in China compared to the past when the pandemic had not attacked. Research shows that the TB notification rate dropped by approximately sixty percent in the worst waves of the virus compared to the average level of 2017-2019 (Abayneh et al., 2020). The result also shows that the patients' delay in the worst times was significantly longer than before the pandemic; therefore, TB notification in China was significantly impacted by the virus.

In Malawi, the virus has affected tuberculosis diagnosis and care. Even though Malawi had no official lockdown, schools and borders were closed at the breakout of the covid-19 pandemic. In the aftermath, there was an instant reduction in TB notification by 35.9%. The fear of covid-19 even led to the temporary closure of some health facilities dealing with TB due to inadequate protective equipment against covid-19 (Soko et al., 2021). Covid-19 adversely impacted the TB disease diagnosis, treatment, and prevention as the medical attention is reversed to the covid-19 pandemic, leading to a rise in TB deaths (Aznar et al., 2021). The analysis also shows that the effects of the covid-19 pandemic, both the direct and indirect effects in Malawi, led to reduced TB notifications as the health sector was overwhelmed by these effects. It also created fear in them due to some of the health workers were being infected.

On the other hand, Zambia is one of the nations with the highest TB and TB burden; Zambia was missing at least 38-40% of the predicted TB burden by 2020. Zambia, however, scaled-up innovations to discover missing individuals with TB through a collaborative approach in 2020, making it achieve a more significant performance (Kapata et al., 2016). However, on the arrival of the covid-19 pandemic, the fight against tuberculosis was negatively affected. During the first eight weeks of the covid-19 breakout in Zambia, there was a reduction of 18% in weekly TB notifications all over the country. With the restrictions in personal contact, fewer people could visit the health facilities, hence reducing TB diagnosis.

1.2   Statement of the problem

Following the trends on COVID-19 and its effects on other health-related issues, research is needed to examine this relationship. The concern is to explore the impacts of Tuberculosis notifications and problems on Zambia's mission health facilities. According to the world health organization (2020), the current trends in the COVID 19 infection can affect TB patients if their treatment is interrupted. COVID 19 is more prevalent in TB patients as the two diseases affect the lungs with the same symptoms, such as fever and difficulty breathing (Mwamba, et al., 2020). This makes the diagnosis of the condition hard and mistaken for the viral attack, making the cases of TB notification limited, thus resulting in an 18 percent reduction in Weekly TB notification throughout the country. The effects were accelerated by the imposed measures in the attempt to control the COVID 19 spread worldwide, reducing the ability of the TB patients to access health facilities due to restrictions and coronavirus stigma, which affected service delivery, TB control, diagnosis, and programming (Kargarpour Kamakoli, et al., 2021). In addition, people examined for TB dropped immediately after reporting the first COVID-19 case; the drop was from 55% in 2019 to 51% in 2020. TB notification during the same period dropped from 714 to 589.

The various issues associated with this coronavirus, which significantly affect the effectiveness of service delivery in hospitals, have been a significant area of interest—facing challenges due to the measures that have been put in place to curb the spread of the virus. Since the coronavirus discovery, many shifts and changes in the daily activities and behaviors were implemented, whose effects have been felt globally across all sectors. The results are more prevalent to the health care servant where the high cases of infection have increased the burden overwhelming them. In contrast, they have increased risks, such as infection, limiting their response to other patients (Adams, & Walls, 2020). Thus, our project proposes to examine the impacts of COVID-19 on Tuberculosis notifications in mission health facilities. Using both an interrupted time series analysis for the quantitative review and qualitative methods, we will be in a position to assess the research objectives.

1.3  Research Objectives

The following are the objectives of the study. They have been categorized as general and specific objectives: -

1. General Objective

• The main objective of the study is to assess the impact of COVID-19 on TB notifications in mission health facilities of Zambia

1. Specific Objectives
2. To determine the impact of COVID-19 on TB notifications in mission health facilities in Zambia using an interrupted time series approach
3. To examine the impact of COVID-19 on TB notification by sex in the mission health facilities

• To investigate the factors affecting TB notifications

1.4  Research Questions

This study seeks to answer the following research questions;

1. What is the impact of COVID-19 on TB notifications in mission health facilities in Zambia?
2. How is the impact of COVID-19 on TB notifications by sex in the mission health facilities in Zambia?
3. What are the factors affecting the TB notifications in mission health facilities in Zambia?

1.5  Significance of the study

The study on the impacts of COVID-19 on Tuberculosis notifications in mission health facilities is one of the most significant researches in the present day, enhancing our understanding of this newly discovered and deadly virus. Despite the increased cases of infection, worldwide consideration needs to be made on the effects of the pandemic on the services delivery to the patient suffering from various conditions. This is necessary as the pandemic has increased the pressure on the health care workers who are the health care. Furthermore, the effects are considered to the TB patients as the pandemic infection has similar symptoms as TB and the areas of infection, respiratory surfaces, thus direct effects to TB notification program. This research aims to provide strategies implemented to curb the spread of the virus and how they would affect the response to other infections such as tuberculosis.

1.8 Definition of key terms and concepts

CHAPTER 2

2.0. Literature Review

2.1. COVID-19 and Tuberculosis Management

In examining the effects of COVID 19 on the health care services delivery to the patient, most concerns are gunned around tuberculosis. The impact of the pandemic of tuberculosis is fatal in most countries where the extent has not been discovered (Aznar et al., 2021). The effects involve the management of the disease due to the development of the various measures by the world health organization to counter COVID 19 infections. In return, this resulted in the drop in the notification of cases of people with TB by proximately 21% worldwide. The effects were increased transmission cases due to late diagnosis and death among the patients (World Health Organization, 2020).  Research in Spain reported that about 70% of TB units said changes in their normal TB operations. This can be used as evidence that COVID-19 has caused significant changes in TB care. Increased latent TB and active TB in children are also justified for an advanced transmission of TB among households due to the anti-COVID-19 measures.

2.2. Unsuccessful Tuberculosis Treatment Outcomes among Tuberculosis/HIV Co-Infected Patients

Various factors are associated with the unsuccessful treatment of tuberculosis. These factors have significant consequences on people with preexisting complications such as HIV infections. According to Azeez et al. (2018), the HIV endemic substantially contributes to the increased TB incidences. They also added that the joint between HIV and TB has extremely affected healthcare, especially in countries with limited resources. They researched to examine the pathological attributes, TB outcomes, and factors contributing to the unsuccessful results among the TB patients in various hospitals (Azeez et al., 2018). The research revealed that there were unsuccessful treatment outcomes with co-infected patients. This can be applied with COVID-19 and TB, where the two exist; the result would be unsuccessful treatment outcomes for both diseases.

2.3. Relationship between COVID-19 and tuberculosis notifications in Blantyre Malawi

According to Soko and Colleagues (2021), despite the lockdown measures in Malawi being limited to schools and border closure, the effects on the TB notification program were recorded to have increased. An immediate 35.9 percent drop in TB notification was experienced in April, with women being impacted more than men (Soko et al., 2021). This decline is associated with fear of COVID-19 infection, inadequate protective equipment, temporary facility closure, and COVID-19 stigma, which elevated the symptoms of TB (World Health Organization, 2020). There is a need for public health to deploy measures that can help to address the challenges associated with TB and coronavirus. This effort should convince the patients that diagnostic services are available and safe to attend even amid the pandemic.

2.4. Quality of Tuberculosis Services in Health Care Centers

 A critical area of concern is the quality of services in health care centers, especially in rural areas. According to, Bulage, et al. (2014), quality of care plays a significant role in TB control, influencing timely diagnosis, treatment adherence, and completion. To facilitate the provision of comprehensive quality services to the patients' supervision of the health care workers, enforcement of the patient follow-up procedures and installation of safety control measures are key aspects (World Health Organization. (2020). Staffing in the health care sector is the main factor affecting quality services to the patients (Katende, & Omona, 2021). The key factors affecting the services provided to the TB patients involve the poor altitude developed by the health care workers due to the fear created by the chances of getting infected by the diseases. This factor was constituted by the reported cases of limited safety resources for nurses and physicians, thus affecting the quality of services offered.

2.5. Prevalence of Tuberculosis in Zambia

Tuberculosis has been a significant disease affecting the Zambians. The reported prevalence cases are at 455cases per a hundred thousand people in the country, but the issue is made more fatal by the high chances of multi-drug resistance among the TB patients (Mutembo et al., 2019). Tb treatment is associated with a long treatment period where the drugs are toxic, resulting in high cases of mortality among TB patients. The greatest challenge in the treatment is the lack of reliable data on TB prevalence and measurements. According to Kapata et al. (2016), the risks of having TB were five times higher for HIV-positive individuals and HIV-negative individuals. At the end of the study, which announced that TB prevalence in Zambia was higher than previously estimated.

DNP Position Statements

The Doctoral Nursing Practice (DNP) has been with us since the 20^th century. With undergraduate nurses enrolling in various nursing programs to ensure further development of their skills. The advancement in learning based on nursing is usually expected to increase proficiency and competence in dealing with patients and management of health care facilities. In addition, it is expected to cause positive impacts on personal career and help improve patients’ outcomes and overall quality of service offered by health care institutions (Beeber et al., 2019). However, my feeling is that advancing nurse’s profession to the doctoral level is a waste of time and resources, and instead, nurses should be trained to undergraduate levels. They should therefore proceed to the clinics where they get experience from directly interacting with their clients.

Arguing against DNP, various scholars have revealed some factual information. Starting with is Dols and colleagues (2017), whose, according to their research, the DNP movement was associated with great dissatisfaction. This was deemed as a strain on the available resources that was a result of the increased enrollment. Also, in the United States, the program had failed to align with the national recommendations. Additionally, according to Beeber et al. (2019), the role of DNP outside of academic settings has not been clearly articulated as it does not significantly count. Although awarded big positions and roles, their impacts on staff, patients, and organizational outcomes are relatively insignificant. This raises debate whether DNP is really an appropriate course that needs to be offered to the nurses. In response to this question, Fitzpatrick (2007) argues that this program will be sufficient for nurses who need advanced practice and those who wish to become clinical teachers and leaders.

Based on these resources, especially that of Fitzpatrick, I find DNP relevant to some degree. This is especially for individuals who want clinical teaching positions and leadership positions, such as information technology management, nurse entrepreneurs, and nurse administrators. However, enrolling all nurses into DNP programs will mean a lack of nurse practitioners, and thus patients suffer, due to insufficient caregivers. 

References

Beeber, A. S., Palmer, C., Waldrop, J., Lynn, M. R., & Jones, C. B. (2019). The role of Doctor of Nursing Practice-prepared nurses in practice settings. Nursing outlook, 67(4), 354-364.

Dols, J. D., Hernández, C., & Miles, H. (2017). The DNP project: Quandaries for nursing scholars. Nursing Outlook, 65(1), 84-93.

Fitzpatrick, J. J. (2007). Is the Doctor of Nursing Practice (DNP) the Appropriate Doctoral Degree for Nurses?. MCN: The American Journal of Maternal/Child Nursing, 32(3), 138.

An Examination of Delegation Policies for UAPs in California

The California State Board of Nursing says that Unlicensed Assistive Personnel cannot be allowed to replace registered nurses in performing functions assigned to them or perform tasks that require a lot of technical skills and scientific knowledge. A registered nurse practitioner is permitted to offer some primary care services both in routine and emergencies. Unlicensed assistive personnel may not be assigned roles in place of registered nurses or be delegated with tasks that are beyond the skills and knowledge they have. Tasks that are not suitable for unlicensed assistive personnel include caring for patients with unpredictable outcomes or who are unstable. The California State Board of Nursing provides guidelines for a nurse practitioner in delegating patient care tasks to ensure that nurses delegate tasks to workers who are competent for the roles assigned, exercise judgment to ensure the circumstances are right for delegation and that all the functions delegated are within the licensed scope of practice of the registered nurse.

Unlicensed assistive personnel (UAP) may not function in the place of a registered nurse or have tasks delegated to them that are beyond their ability to carry out competently. Competency here means that these assistants should have the necessary scientific knowledge, and technical skills. Unlicensed assistive personnel is not allowed to administer medication, provide intravenous therapies or carry out tasks that require them to perform venipuncture procedures on a patient (Cahill, Painter, & Branch, 2021). Task and functions that involve tube feeding or alternative means of feeding that necessitate surgery such as parenteral procedures require knowledge and skills that are beyond those possessed by unlicensed assistive personnel. Unregistered medical assistants should not be assigned roles that require the application of invasive techniques such as tracheal suctioning, inserting catheters, and inserting nasogastric tubes. Tasks that cannot be delegated to medical assistants include assessing the condition of the patient, educating the patient and the family concerning healthcare problems, and carrying out laboratory tests that have at least moderate complexity.

A registered nurse is responsible for checking to ensure that the unlicensed assistive personnel has the necessary qualifications to carry out the task before it is delegated. This means that before assigning any task the registered nurse should check the documented evidence of the existing ability in terms of the appropriate skills, experience, and education for it. The registered nurse should adhere to the “Five Rights of Delegation” when assigning any task (Lowe, Gerald, Clemens, Gaither, & Gerald, 2021). The right task should be delegated which means that it should match the ability of the worker to satisfactorily perform it. It is necessary to monitor the circumstances and only delegate when the situation allows for the smooth accomplishment delivery of patient care. The right person should be selected and provided with the appropriate communication and direction. The person selected should also be supervised adequately.

The registered nurse should constantly monitor the unlicensed assistive personnel to provide guidance and assess their ability to perform the assigned patient care tasks accurately. This means that unlicensed assistive personnel cannot carry out any tasks without supervision or consulting with the nurse practitioner to obtain feedback about how the task is being carried out. However, simple routine tasks that do not require extensive skills and scientific knowledge can be delegated and done without constant supervision (National, 2016). Such tasks include observing, recording, and reporting treatment and clinical information such as patient’s behavioral changes. UAPs can also assist in simple rehabilitative measures such as motion exercises and providing patients with answers for general questions such as providing directions (Wagner, 2018). Registered nurses can also delegate general tasks without much supervision as long as they fall under the nurse’s scope of practice such as the collection of specimens for medical tests, assisting in hygiene tasks for patients, ambulation/mobilization of patients, and grooming tasks.

In the State of California, a registered nurse cannot delegate tasks to unlicensed assistive personnel in an ICU environment as they would in a general medical-surgical unit as this would violate most of the required guidelines. The five rights of the delegation include delegating the right task, under the right circumstances, to the right person, by providing the right supervision and correct direction and communication. Most patients who are referred to the ICU have conditions that require a high degree of problem-solving and the patient care tasks associated with these conditions often carry high risks that may have fatal consequences (Williams & Cooksey, 2004). The registered nurse also may lack the necessary sufficient information about the UAP concerning their experience such as whether the UAP has successfully done such tasks before. Even when supervising directly, it is not wise for registered nurses to delegate tasks because the patient’s condition can be unpredictable in the ICU environment.

In conclusion, before delegating duties to unlicensed assistive personnel registered nurses should check to ensure that the worker has documentation to show that they are competent to handle the functions to be delegated. Responsibilities of the registered nurse when delegating patient care tasks include ensuring that the worker meets the minimum required competence to handle the assigned function and making sure the task delegated are within the legal scope of practice. A registered nurse cannot delegate patient care tasks in the ICU environment like they would do in a general medical-surgical unit because the rules that guide delegation allow it to happen only under the right circumstances. Policies outlined by the California Board of Nursing strongly discourage nurse practitioners to delegate tasks within the ICU environment because most tasks are beyond the ability of the UAP to perform successfully.

References

Cahill, M. L., Painter, D. R., & Branch, J. L. (2021). The Authority for Certain Clinical Tasks Performed by Unlicensed Patient Care Technicians and LPNs/LVNs in the Hemodialysis Setting: An Update and Invitation to Take Action. Nephrology Nursing Journal, 48(2), 119. doi:10.37526/1526-744x.2021.48.2.119

Lowe, A. A., Gerald, J. K., Clemens, C., Gaither, C., & Gerald, L. B. (2021). Medication Administration Practices in United States’ Schools: A Systematic Review and Meta-synthesis. The Journal of School Nursing, 105984052110263. doi:10.1177/10598405211026300

National Guidelines for Nursing Delegation. (2016). Journal of Nursing Regulation, 7(1), 5-14. doi:10.1016/s2155-8256(16)31035-3

Wagner, E. A. (2018). Improving Patient Care Outcomes Through Better Delegation-Communication Between Nurses and Assistive Personnel. Journal of Nursing Care Quality, 33(2), 187-193. doi:10.1097/ncq.0000000000000282

Williams, J. K., & Cooksey, M. M. (2004). Navigating the difficulties of delegation. Nursing, 34(9). doi:10.1097/00152193-200409000-00026

Withholding and withdrawal of medical care.

Withdraw of health care is removing the health care services that are being given to patients. Stopping any treatment requires the physicians and patient to decide whether to control the treatment to continue. In therapy, the practice involves removing the therapy services most applying where the treatment is no longer effective in sustaining the patient's life. In some cases, the patients can decide to forgo the treatment by withdrawing treatment to allow them to die peacefully; the instances are ethically correct if they understand the consquences of treating its ineffectiveness in treatment (Bandrauk, Downar, & Paunovic, 2018).  This requires the patient to take another form of therapy to help them maintain their life. In this case, the process does not involve euthanasia, where the therapies' removal aims to end the patient's life without inducing the process through applying another drug. The method of withdrawal on the treatment involves removing therapies such as ventilators and other agents such as vasoactive.

The decision to remove the treatment is based on the discussion with the relevant relative to deduce that the practice is done for the good of the patient of the family members. After the debate, the relative with an attorney gets into the agreement as the doctors give them time to contemplate the implication of the withdrawal of the medical care. For instance, a patient under medical service diagnosed with prolonged consciousness was presented to the family member to decide whether the hospital can withdraw the treatment. The case was on after the consideration of the implication in cases he wakes up. To conclude, the court presented the issues to decide whether the patient's treatment should be withdrawn and die slowly. In the circumstances, the consideration of the greater good of the family and that of the patient is done to determine the way forward in some cases where the patient can decide, thus the relative needs to follow the will of the patient in a case where their give their consent.

On the other hand, withholding medical treatment involves cases where the medical treatment is not started on the patient. The issue is usually applied when the physician wants to protect the patient from complications of side effects associated with prolonging the patient's life using technology. Withholding of the treatment, like in cases of chemotherapy, is considered where the implication of the treatment method is considered and the physician decides that the treatment will cause more harm (Wallerstedt,.et al., 2020) This results in withholding of the treatment to protect the patient from the consequences of engaging in the treatment. The patient or the relative decides whether a patient should undertake a treatment after considering the antidote's effects on the patient.

For instance, a case where a woman was having a stroke is presented to a hospital after collapsing in her home. After diagnosis, the doctor discovers that she had a severe stroke that she will likely not recover. Connecting her to a breathing machine will require her to take drugs to reduce the swelling in her brain, but she may suffer from cognitive impairment after recovering. After discussion with her nephew, they concluded that not to connect her to the machine but to allow her to experience normal death without pain.

According to the code of medical ethics, there is no difference between removing the treatment and withholding the therapy for a patient aiming at prolonging life. In this, the ethic is considered concerning the greater good of the patient through discussion with the patient or the surrogate on the implication of withdrawing or withholding treatment for the patient. In making the decision, the process is made ethical if it is done for the greater good of the patient's health when all the relevant information about the patient and their condition is provided.

References.

Bandrauk, N., Downar, J., & Paunovic, B. (2018). Withholding and withdrawing life-sustaining treatment: The Canadian Critical Care Society position paper. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 65(1), 105-122.

Wallerstedt, S. M., Nilsson Ek, A., Olofsson Bagge, R., Kovács, A., Strandell, A., & Linderholm, B. (2020). Personalised medicine and the decision to withhold chemotherapy in early breast cancer with intermediate risk of recurrence–a systematic review and meta-analysis. European journal of clinical pharmacology, 76, 1199-1211.

Patient Safety

Building a safer health system in healthcare centers such as hospitals requires the adoption of a patient safety culture that is championed by each healthcare provider through proactively taking measures to provide a safe environment in which patients can recover their health. Leadership is the central factor that leads to the series of changes effected in the SICU and Hospital Hope at large and was inclusive of all staff regardless of their rank. The nurse manager played a pivotal role that consisted of actively promoting a culture that provided the safest environment for patients that was possible to be established as the daily practice. This form of leadership was not punitive and instead sought to learn from errors with the purpose of all hospital staff providing oversight to each other in a respectable manner. The framework most suitable for implementing practice change should entail the seven driving factors that promote safety through establishment and adherence to comprehensive safety policies. The seven factors included in the framework are patient-centered culture, leadership, a just culture, evidence-based practice, communication, and teamwork. Leadership is the most significant factor that facilitated the smooth and immediate transition to a more effective patient safety culture in Hospital Hope. Leadership is supplemented with other factors and these together form a framework that can effect change and make healthcare centers safer places for patients besides achieving the financial objectives of the health centers.

Leadership the most important factor in transforming Hospital Hope

The changes that took place to make Hospital Hope safer for patients especially those in the SICU can be attributed to the inspirational leadership of the management, the nurse managers, and the individual nurses. The IOM report had stimulated more awareness of patient safety issues, this had brought an impetus for all health care providers at all levels of leadership to want to embrace patient safety culture including at Hospital Hope thus taking ownership of it (Sammer & James, 2011). The nurse manager conceptualized a hospital environment where transformation for achieving the best quality and safe care possible would be available and set out to make it happen. The nurses took it upon themselves to lead inpatient care be it at the bedside or in the boardroom by taking ownership of patient care and leading from wherever they stand (Sammer & James, 2011). Thus, leadership from higher levels beyond the hospital organization down to the individual workers and even the medical assistants were part of the leadership team that propelled the hospital towards practices that promoted the safety of patients entrusted to its care.

The safety records achieved at Hospital Hope could not have been possible without the contributions of the nurse manager who actively promoted a daily practice in which the environment for patients was the safest that was possible. The major contribution made by nurse managers at the Surgical Intensive Care Unit (SICU) was to lead by example thus influencing their teams towards a culture that provides a quality and safe environment for the patient (Sammer & James, 2011). This was done by encouraging the team members to raise their concerns about the safety of their patients and encouraged those with special training and experience to bring their suggestions forward. The nurse manager in turn reported their findings to higher-level management and obtained support to aid in achieving the goal of safety in all operations of the hospital. Thus the leadership of the nurse manager played a key role in transforming excellence in terms of safety and quality success.

The aim of investigation and scrutiny on the practices of all healthcare workers in the hospital was meant to identify mistakes to learn from them instead of mete out punishment. This move was calculated to encourage all staff members to freely give their input without fear of victimization or reprisal even when they identified the mistakes of more powerful colleagues. Thus, nurses were encouraged to come forward with patient safety issues as well as patient harm through practicing a just culture that acknowledged the fallibility of humans and enhanced accountability. For example, a doctor who was observed failing to observe the best practice in preventing infection could be reminded by a graduate nurse of the necessity for doing the task the right way without negative consequences to the nurse (Sammer & James, 2011). Thus a platform was put in place that allowed the nurses to communicate their ideas to the leadership to improve the care for patients in terms of safety and quality.

Most effective framework for transitioning a health care center

The framework most suitable for implementing practice change should entail the seven driving factors that promote safety through establishment and adherence to comprehensive safety policies. The Seven Factors Framework is one best suited for facilitating the transition of an institution to a culture of patient safety within the shortest time possible and with minimal resources. This framework is facilitative in the fulfillment of the Institute of Medicine (IOM) four-tiered approach which attempts to improve the safety of patients through instating several changes in health care delivery (Sammer & James, 2011). The approach attempts to mobilize the nation to provide support through leadership forums, tools and research, and conventions concerning the safety of patients. It also provides a system in which errors are not ignored but instead serve to inform healthcare organizations by availing better knowledge that can be used to improve standards at all levels. Therefore, the seven-factor approach is sufficiently comprehensive and effective to ensure smooth transformation towards better safety outcomes.

The central tenet to the nursing profession is to devote oneself to the welfare of those committed to one’s care which signifies that a safe environment is one in which patient-centered care is provided. Sammer and James (2011) identify these central factors to the comprehensive plan towards a safer environment for patients as leadership, patient-centered culture, a just culture, evidence-based practice, communication, and teamwork (Sammer & James, 2011). A just culture is one in which the concept of accountability is more concerned with viewing human errors as a learning opportunity as opposed to being opportunities for punitive actions. The critical decisions on changes should be based on evidence that should be promptly communicated to enhance an environment of trust and teamwork. Establishing a patient care culture is a process that needs adequate and strategic planning and this necessitates a suitable framework that can be used to predict and anticipate all challenges and mitigate them to enhance the process of achieving the organizational culture in hospitals where patient safety is promoted.

In summary, within the Hospital Hope leadership is supplemented with other factors and these together form a framework that can affect change and make healthcare centers safer places for patients besides achieving financial objectives of the health centers. The leadership from higher levels beyond the hospital organization down to the individual workers and even the medical assistants were part of the leadership team that propelled the hospital towards practices that promoted the safety of patients entrusted to its care. Thus the leadership of the nurse manager played a key role in transforming excellence in terms of safety and quality success. The nurse leaders and managers also played a role in which a platform was put in place that allowed the nurses to communicate their ideas to the leadership to improve the care for patients in terms of safety and quality. For a hospital that requires changes in its practice, the seven-factor approach is sufficiently comprehensive and effective to ensure smooth transformation towards better safety outcomes. Establishing a patient care culture is a process that needs adequate and strategic planning and this necessitates a suitable framework that can be used to predict and anticipate all challenges and mitigate them to enhance the process of achieving the organizational culture in hospitals where patient safety is promoted.

References

Sammer, C., & James, B. (2011). Patient safety culture: The nursing unit leader’s role. Online J Issues Nurs, 16(3). doi: 10.3912/OJIN.Vol16No03Man03