Effectiveness of Curfews

Parents and guardians have sought out different ways to discourage bad behavior in children. The different methods used serve as both a form of punishment and deterrent. In addition, parents and guardians impose restrictions to discourage bad behavior. A good example is the imposition of curfews by parents and guardians as a way to keep teens out of trouble.

 The effectiveness of curfews heavily depends on the teenager’s willingness to respect the parent or guardian’s wishes regarding the curfew. Since there is no physical means of ensuring that the teenager adheres to the curfew, its success in keeping the teenager out of trouble will depend on the relationship that exists between the teenager and the authority figure. To some extent, curfews do help to keep teenagers out of trouble because the limit the time in which teenagers spend without supervision. Teenagers will therefore spend their time in school and short periods with friends before going home in time for curfew.

            Curfews also help to keep teenagers out of trouble because they help build on family relationships that mentor positive growth. Curfews help families to stay together as a unit and share bonding experiences such as sharing meals, playing games and other activities. This gives the parent enough time to spend with their children and mentor them on how to lead positive lives. The family experiences teach teenagers to care about other people and this is further extended to the community. The teenagers therefore develop the need to do good rather than engage in bad behavior. The curfews also give the parents and guardians enough time to get to know their children and discourage any bad behavior that they may have picked up.

            An argument can be made that curfews do little to discourage bad behavior because the teenagers can engage in the same activities when they are allowed to be outside. Since bad behavior is not limited to specific time periods, teenagers can engage in immoral activities during the day as much as during the night. Advancement in technology also means that the teenagers can communicate and share ideas through different platforms such as social media, video chats and other means of communication. Since the curfew does not restrict access to the web, teenagers can engage with one another and negatively influence each other even during curfews.

While this may be the case, curfews act as a symbol of both respect and control for the parent or guardian. Teenagers choose to respect the parent’s curfew because they either agree with its purpose or respect their parents enough to do as told. Respecting the parents wishes therefore means that the teenagers can also discern right from wrong and stay out of trouble out of respect for the parent. It also helps to build some level of trust between the parent and the child thus fostering better relationships that positively influence the teenagers’ development.

            Curfews are an ideal tool for discouraging bad behavior among teenagers especially because their success hinges on the trust established between the teenager and the parent. The lack of physical restrain means that the parent views the teenager as a responsible individual who can properly manage their time and get home in reasonable hours. The parent trusts the teenager and this in turn makes them more responsible and thus discourages bad behaviour. Although there are occurrences where teenagers break the curfew or end up sneaking out of the house, such occurrences are rare and the parent has more control over the teenager’s upbringing, thus discouraging bad behavior.

Research question

 What effects do daily criminal justice policies have on the 25% drop in inmates at local jails due to covid-19?

From March- June 2020, more than 208,511 convicts were expedited released in an attempt to cope with COVID19 regulations. As the pandemic spread, the penitentiary systems attempted to let go of more inmates to create room for social distance. Against this background, the decrease in the local jail population was attributed to the justice system policies which support effective medication and care of inmates (Department Of Justice, 2021). More so, the number of inmates held for minor crimes decreased by 45% hence coinciding with the COVID-19 decline rates. For the sake of retaining the means through which people could contain the pandemic, the criminal justice system had to ensure that each function operates at an optimal capacity and the only way to achieve optimal capacity is to ensure local jails does not succumb to the pressure the pandemic exerted on the rest of the national sector.

Methodology

 The best methodology that can be used to solve or explore the underlying problem statement further is through the application of mixed-methodology. Mixed-methodology covers all the aspects needed to explore the problem statement extensively without negating the primary elements of the entire investigation (Minton et al., 2020). In terms of procedures, mixed-methodology integrates more than one single technique while analyzing an issue. For instance, quantitative and qualitative data are applied in a single evaluation.  To illustrate further, the problem statement has both quantitative and qualitative aspects. Hence, applying mixed-methodology will cover these aspects with ease and problem statement requirements. Furthermore, the inmate populations declined. Therefore, there is a relationship between the decline in the number of prisoners and the pandemic. A mixed-methodology approach enables the researchers to explore in-depth the matters concerning the prison systems and at the same time cover all the vital aspects that they might come across. Therefore, this methodology will give room for the formulation of relationships derived from the problem statement.

Overcoming Challenges

 One of the main challenges is the separation of each methodology so that all the aspects can be explored without bias. An additional advantage is the research will rely on the secondary data availed through the bureau of justice statistics (Minton et al., 2020). More so, the reasons for expediting prisoners for the sake of meeting the COVI-19 pandemic protocols. The large decline in the number of prisoners was due to the curfew placed to reduce movements and other previous measures were put in place in the judicial system. The problem statement connects the criminal justice system with policies used to drive and influence incarceration. In terms of methodology trends, digital tools such as Microsoft Excel can be used to analyze the numerical data and help the researchers to evaluate the data in front of them. For instance, the definite separation of factual basis. Furthermore, the nature of the research has to rely on the objectivity and immediate implication of the data retrieved from the entire problem statement. In other words, the only way of eliminating the entire challenge is through the retrieval of accurate data.

How a Decline In Local Jail Inmates Relates To Criminal Justice

 The criminal justice system’s role entails decision making at the state and local level. These decisions impact COVID-19 protocols and regulations within and outside the criminal justice system. For instance, court orders are executed through the criminal justice system frameworks. Also law enforcement such as receiving expedition release due to COVID-19 are implemented through the criminal justice systems. Furthermore, the criminal justice system has to keep track of the regulations made and their impact on the community.

Methodologies That Might One Might Have Difficulty With

 All the numerical and none numerical aspects of the research can fit into a mixed-methodology approach. Hence, the researcher can easily use any methodology to explore the research question.

References

Department Of Justice (2021). Covid 19 Spurs 25% Drop in Inmates held in Local Jails

Minton, T., Ph.D, Z., & Maruschak, L. (2020). Impact of COVID-19 on the Local Jail Population, January-June 2020. Retrieved 11 March 2021, from.

Cerner Integrated Health Care Solutions

Health Care Entities Involved in Joey’s Continuum of Care

The Cerner Integrated Health Care Solutions has put in place a vision showing much concern for patients. The vision is to achieve an integrated health care solution for all services offered to Joey. Joey is a sixteen-year-old boy who has been diagnosed with schizophrenia. The latter is stated to be a mental disorder that costs the United States approximately sixty-three billion dollars annually. Cerner medical health center has a focus on applying an integrated health system that will meet him wherever he is and despite living with the condition of disorder, he is given a chance to maintain a high quality of stable living at a sustainable cost, this is precisely the aspect needed in a continuum of care. The health center has put in place some entities that enable it to achieve this aspect of care. The continuum of care begins after health risk identification at infancy, where the health institution launches an individualized plan of care. This form of care include the prescriptive services in childhood, after becoming a student, the school provider identifies his behavioral issues, such as distress, aggression, intolerance, inappropriate boundaries, social isolation and difficulty following direction. In a follow-up, Joey and his family are enrolled in a self-guided cognitive behavioral therapy program, where they are provided with financial counseling to predict the costs of care and knowledge on the value of following the care plan. The use of mobile therapeutic apps also helps Joey handle this condition on his own. However, when the condition gets worse he is moved from preventive services care to active treatment, where he is admitted to an inpatient psychiatric facility for more intensive care. After discharge from the hospital, his transition of care records is automatically transmitted to his next care provider, from where he gains support as he gains his optimal functionality, (305).

Information Needs and Challenges Involved in Capturing and Utilizing the Information

In order to address Joey's case efficiently, his comprehensive health information is needed. This is information is needed by the health care providers to get a better understanding of Joey’s mental disorder condition. However, the procedures used in capturing this information may not be possible with some of the care providers. Additionally, another challenge is how to use this information in care provision. In the bid to effectively address Joey’s case, it is essential to provide data-driven holistic preventive and supportive services. Some of the key information needed is his condition at infancy and the mother's condition. Other information needed is the symptoms he portrays while at school, in this case, the information is passed to the manager through his longitudinal record. More so, information on his history of genetic predisposition, which keeps his care team prepared at the beginning of schizophrenic episodes. Other information includes his progress, which makes him admitted, and after a while discharged from the health, care with this information been transferred automatically to the next care providers. His health progress is under the constant monitor to recognize and support him through his breaks and breakers in the journey to gaining independent life. The purpose of this data is to ensure support and assessment of the integrated health care system when addressing chronic diseases. This makes the health care provides capable to access the knowledge and resources they need, to provide the most appropriate care for Joey’s needs. However, there is a challenge in capturing the information needed in the care, where most of the health care institutions lack the skill of data collection or the right instruments to be used in the process. Alternatively, a health care institution might have the right resources but lack expertise capable to make good use of the available information in the provision of the best health care services, (309).

Source: https://www.youtube.com/watch?v=SRIthlFEiBw

Tourette Syndrome in Young People

Introduction history and other pertinent info diagnosis criteria, development of TS, and course of the disorder

 Tourette syndrome was first reported and discovered by Jean-Marc Gaspard Itard in eighteen-twenty-five in a woman in  France, but the disease was associated with coprolalia. The cases were first discovered in France in deaf patients and mental retardation, where they demonstrated tics. The womans Tourette sysdrome first signs were discovered on the Marquise de Dampierre, with invoicing cases of involuntary vocal and motor tics were in place (Al-Mosawi, 2018). Georges Gilles de la Tourette first described the disorder in eighteen eighty-five, where he described the disease's prevalence as both genetic and caused by environmental factors. Due to his description, the disorder got the name from the neurologist's name, thus named Tourette syndrome from his last name.

Disorders are illness in an individual body that disrupts either physical or mental functioning causing suffering, pain in an individual, or impairment of somebody.  Cases of the condition are divided into various issues such as psychological disorder, personality disorder, psychotic disorder. The diagnosis of these disorders is made on psychiatric diagnostic where a diagnosis is made to test instances of mental disorder on the patients, especially for children and adolescence (Perrotta, 2019). Topics of neurodevelopment disorder are related to the coordination of neural systems because it affects the body’s brain and nervous system. Issues such as Tourette syndrome are among the neurological conditions that affect the brain and the nervous system of the victims involving the coordination of the body functions. 

The Tourette syndrome symptom is sudden movements and sometimes vocal sounds that happen without realizing the activities' occurrence. The cases are repetitive and translated to motor tics and vocal tics depending on the movement or sound. Tourette syndrome (TS), motor tic, and sometimes vocal tic, is more common in teens and children and attacks the brain of the individual and the nervous system, causing a sudden and repetitive movement and sound. Tourette syndrome is transmitted from parent to offspring, thus considered a genetic disease or sometimes transmitted during the fetus’s development in the womb (Domènech, Cappi, & Halvorsen, 2021).  The cases of Tourette syndrome are neurology disorder, thus associated with communication of the nervous system, especially in the brain of the victim. The symptoms are discovered mostly when the patient is at the early years of three to nine years, being more common in boys than in girls

An example of such a disorder is transient childhood tics associated with children at the age of five to eight years, but it can persist in life long. The condition is more common in males than females, with symptoms disappearing from adolescence to adulthood, but the symptoms persisting occasionally (Kim, et al. 2018). TS conditions are worse in childhood, especially when adolescents get into adolescence, improving as one gets into teens and sometimes early twenties. In some cases, the TS symptoms disappear during adolescence, but the condition does not worsen in youth, but the patient may learn to mask it. Despite the signs, TS is associated with other conditions in the patient like anxiety, causing the patient to cause harm themselves and sometimes develop obsession in the patient.

 TS symptoms are involuntary, thus cause discomfort while suppressed or hidden from the public due to the patient's embarrassment. The diagnosis is done and verified to be TS after one year of observation by the doctor (Perrotta, 2019). The condition is identified through the motor and vocal tics, especially in teens. The cases of TS become suppressed when someone develops into adulthood. It can still be reduced by medication, usual neuroleptics for the tic suppression in children and adolescents.  TS is also buried by focusing on something to facilitate concentration on the tic; this can be done through various activities to redirect their mental and physical energy. Behavioral activities and treatment have been done through training to reduce the patients' occurrence of tic symptoms. The patients have to deal with physical associated with appearance, emotional challenges related to embarrassment, and social challenges related to the way others treat them. The predisposing factors to the tics' development are the genetic factor, environmental factors, gender, and age.

Review on diagnosis criteria

            The diagnosis of Tourette syndrome, according to the Diagnostic and Statistical Manual of Mental Disorders, can only be diagnosed when the tics have been exhibited for more than one year by the patient. For the condition to be considered TS, both the vocal and motor tics should be exhibited in this period, where the tics should operate simultaneously (Jones,  & Ramphul, 2019).  Similarly, tic development cases can be associated with substance consumption like cocaine making the occurrence of the diseases at the age eighteen and above not be associated with other causes of tics. The diagnosis of tics can only be made by observing the patient discover the motor and vocal tics and not through other means. The misdiagnosis of TS is associated with the disease having the mild, severe, and moderate expression of the disease's severity.

People diagnosed with TS and attention deficit hyperactive disorder (ADHD) are reported to have issues with disturbances in their sleep, a condition known as a sleep disorder. The disorder is associated with sleeping excessively during the daytime, insomnia, sleeping, walking, or sometimes sleep talking, where tic disorder cases were found to be persistent during sleep (Jiménez-Jiménez, et al. 2020). Sleeping disorder is thus one of the diagnosed cases of patients with TS and ADHD, where the issues are reported to be high where patients with this disorder have a high rate of sleeping disorder. Anxiety disorder, which is a symptom of TS and ADHD, is the most common cause of sleep disorder in these patients with a tic disorder, where a case of depression was reported to be expected in them. Patients with anxiety and depression symptoms are thus more susceptible to sleeping disorders in comorbidities and ADHD. In some patients, the sleeping disorder was associated with obesity and depression in patients, especially those diagnosed with TS.

 neurobiological and other influences

Neurobiology in TS involves the neurodevelopment nature of the condition associated with the nervous system's infection, thus causing the patients' involuntary repetitive vocal and motor tics. The TS cases are usually related to other conditions in the victim's body, such as ADHD, disorders in the obsession with obsessive-compulsive disorder, anxiety and depression disorders, autism spectrum disorder (Paschou, & Müller-Vahl, 2017).). Despite the medication in place, this disorder's treatment only aims to eradicate the tics, both motor and vocal tics, rather than treating the condition. The leading cause of the lack of a cure for the disease is the disorder's unknown cause. It is further influenced by the grounds of the infections commonly non-genetic, making TS complicated pathogenesis. Despite the unknown cause of the syndrome, the frontal cortex, which includes the neurons and the thalamus, is associated with the condition's cause and the imbalance of hormones such as dopamine in the body.

            The anatomical cause of the TS condition is associated with the overlapping of the genetic deviation, which affects the thalamus' volume, causing effects on the relay of the sensory signal in the body. The disturbance in the thalamus as the center of sensory transmission affects the relay of impulses from the brain to the body, making the tics familiar to TS and the symptoms expression. (Mufford, et al. 2019) The overlapping of genes is usually responsible for the TS. It’s known to cause brain circuitry problems, which in return affects the volume of the thalamus and the neuroimaging purpose of the frontal cortex. If the overlapping cases are reduced in an individual, T's occurrence cases are minimal as the neural network is not adversely affected in this case. Despite the effects of brain volume, the chances are not always associated with diseases in the victim’s body but are sometimes related to genetic issues.

            The imbalance of hormones such as dopamine is one of the causes of tic development. It’s a primary transmitter in controlling motor reflexes and the thalamus to integrate and relay the sensory and motor functions.  The effects and role of dopamine in TS development are demonstrated by the availability of dopaminergic agonists that causes an increase in the symptoms of TS (Godar, & Bortolato, 2017). Patients with TS and those without the condition are differentiated by the increased activation of the thalamus cortex due to the release of dopamine in their system. Dopamine receptor responsible for the therapeutic concerns to the patients with TS is through their ability to control the sensory cortex's repeated feedback responsible for detecting stimuli' availability. The overlap of the mechanisms in the release of dopamine and its effects on the sensory cortex makes the tool dependant on multiple entities, which overlap to bring the impact intended.

 cultural and genetic issues

            The TS aspects are affected by age, gender, and the tic disorder's demonstration are not dependent on culture but are rather neurobiological. The gender elements where males are more affected than females become familiar and the expression of TS in children and its disappearance as one gets into adolescence despite individual culture (Lee, et al. 2019). The cases are common to males but are more related to the brain system of the gender where aspects such as dopamine and aging are considered. The p[atient is the predisposing factor where the signs are demonstrated during childhood and appear to disappear during adolescence and adulthood. If the condition fails to disappear, it can be suppressed in adulthood or treated using therapy or medication on the patient.  Despite the neurobiological nature of the condition, some cultural aspects are sensitive to the culture, such as depression, anxiety, and some external problems associated with an increased individual culture. The modification of the tic movement in the patients depends on how they are handled by society and how they handle themselves, thus making it a cultural factor. Ts can be considered a genetic cause, but sometimes it's associated with the development when the foetus is developing in the mother’s womb.

            According to guidelines, in the treatment of tics, if the tics are not associated with pain, physical impairment, an embarrassment, the best treatment method for this case is to help the patient cope with the disorder through understanding the disease.  The treatment cases should also involve both the caregiver and the child and the doctor in deciding the best means of treatment (Stafford, & Cavanna, 2020). The cases of increase the child's hope for future improvement of the condition are therapeutic measures to take. If the tics are affecting the patients' daily life activities, the doctor should first introduce the patient to the comp[rehesive behavioral intervention for tics. This involves the activities aimed at relaxation of the muscles through training on the reversal of the behavior.

Suppose the disorder has progressed in the individual to the patient having neurodevelopment and psychiatric conditions. The doctor involved should diagnose the patient to check on other disorders associated with TS, such as anxiety, mood, ADHD, an OBd disorder, where the administration and prescription of medicine for both cases apply (Cree, et al. 2018). In cases involving medication, injections of botulinum toxin apply for muscle relaxation on the tic-producing muscles. DBS's case can only be applied to the patient whose condition is resistant to both medication and behavioral therapy where brain stimulation is needed. If the cases persist to adulthood, the treatment can be done under the doctor's observation where cannabis Sativa is used.

Treatment of Tourette syndrome

            The treatment of Tourette syndrome can be attained through medication or therapy to reduce the occurrence of the symptoms in the patient. Various medication types can be administered to control the expression of the tic’s movement on the patient. Still, most medicine has side effects, making them ineffective in treating the condition (Chadehumbe & Brown, 2019). The diagnosis of TS and ADHD is essential for estimating the therapy and medication administered to the children. The medicines on the disorder are dependent on whether the condition is moderate, severe, or mild. The treatment includes the medication that helps block the release of dopamine, thus reducing TS cases. Injection of botulinum into the muscle affected to relieve the tics, administering ADHD medication, and administering antidepressants to help control sadness and anxiety.

            The patients' therapy is done through behavioral therapy, psychotherapy, and deep brain stimulation to reduce tic development cases. The behavioral therapy cases are done through reversal training to operate against the tic movements in an incompatible way with thetic. Psychotherapy helps the patients cope with Tourette syndrome and obsession, depression from social pressure or anxiety (Jankovic, 2020).  The severe cases of tics call for special treatment where deep brain stimulation is used where it involves implanting developed battery-operated medical devices to stimulate the areas affected. The machine produces electrical stimulation and directs it to the target area where it has been affected, thus controlling the movement.

Recent research.

According to Marwitz, & Pringsheim, (2018). Clinical facilities of screening for anxiety and depression in children with an anxiety disorder in the children affected by TS were high; besides, the issues are also associated with mood disorders where these cases are familiar to them. The disorder diagnosis is made through screening of the patients for anxiety and depression, especially in children. The diagnosis requires that the children and adolescents be evaluated whether they meet the qualification on the diagnosis of both anxiety and depression while considering the symptom of the disorders in question. Diagnosis is where gender and age are considered during the diagnosis while assessing the relationship between tics and the anxiety and depressive symptoms. The children with high tic cases in extreme are reported to have increased chances of related disability had extreme cases of severe pressure and depressive symptoms.

According to Groth, et al. (2017).   Tourette syndrome in childhood disorder is a neurodevelopment disorder associated with tics development; some comorbidities mostly arise. The issues of tics, both motor and vocal tics, usually reduce as one grows to adolescence. Still, comorbid obsessive-compulsive disorder (OCD) and attention deficit-hyperactivity disorder (ADHD) were to diagnose coexisting psychopathologies and appear to be retained even at becoming more dominant in the adolescent period. This disorder's expression was more changing, but changes are more common in patients who are not victims of comorbidity. TS expression is predicted by factors such as the individual's environment, the parent's genetic inheritance, inherited genes, and neurobiological factors caused by genetics, metabolic, and other biological factors.

According to Darrow, et al. (2017).  Autism spectrum disorder is closely associated with tic disorder and comorbidity, where the genetic and neurobiological factor is in place at TS. Causes of autism were diagnosed where the characteristics of both cases were studied. The conclusion was found that tic disorder overlaps with autism disorder, where most patients with autism were found to have tic disorder cases. The repetitive behavior is almost the same in both cases of autism and tic disorder. It makes it even harder for the clinical officers to differentiate the two diseases when using (DSM-5) criteria used diagnosis of the two conditions. The cases reported a high case of anxiety and depression disease on the patients with autism and those with TS, indicating social impairment in both patients.

Different views on TS

            The current knowledge on the general body health and the mortality rate for Tourette syndrome and extreme conditions of a tic disorder is limited compared to other chronic diseases. In these studies, the relationship of tic disorder with Tourette syndrome is identified while associating the condition with health conditions such as allergies respiratory diseases causing the tics (de la Cruz, & Mataix-Cols,2020). The mortality cases have associated the patients' risks of suicidal issues, mainly due to increased anxiety and depression cases. Cases of autoimmune diseases are linked to the genetic, where the parent's direct relatives with this condition have an increased autoimmune rate.

            The sleeping disorder in children and adolescents with TS and chronic tic disorder is typical to these patients. The cause of this sleeping disorder is never determined and identified on its grounds as it is associated with factors such as patient characteristics and response to medication, the neurodevelopment disorder in the patient, or symptoms related to psychiatric disorders (Hibberd, et al.2020). Individual attributes in the patient also influence sleeping disorders associated with hormonal balance in the body or behavioural changes in the individual, such as hygiene. The sleeping disorder is more associated with the gender difference where the case is more common in females than in males. The most common cause of the sleeping disorder is medication, where some medicine causes loss of sleep to the victim.

Implication

 APRN practices must administer the medication and prescription on the drugs to ensure that they have followed the right remedy. Treatment on the TS is determined through therapeutic means; thus, APRNs are required for the different therapy sessions (Efron,  et al. 2020). These specialists are associated with specialists' activity by ensuring that the therapy is useful to the patient. The cases of diagnosis of the TS are done through observation for one year, thus requiring a specialist to ensure the consistent adherence of behavior in the patient. Most of this disorder causes depression and anxiety; therefore, it needs patient observation to reduce the causes of suicidal cases, thus reducing the causes of mortality.

 Specialists such as nurses help the doctors observe the patient and administer them to the patient to develop and control the disorder. As most of the disorder can only be diagnosed through observation, the nurse's presence is essential to help identify the condition. The therapy treatment, especially treatment where the patient's behavior is modified by practicing the opposite of the tic, requires a physical therapist. This is to help the patient develop the skill necessary to help them tackle the tic through practice. The availability of this therapist is essential to the tics that can be controlled through therapy.

Areas where future development is needed

             In the research on the cases of Tourette syndrome, the actual cause of the condition needs to be identified and studied to create clarity on the treatment by controlling the reason. They determine the therapy in terms of medication meant for treatment rather than preventing the symptom’s expression. The treatment measure should provide the patients with medication where the side effects are reduced to make them safe for the patient to mitigate other disorders' development. The tics effects in the brain thalamus need to be identified to remedy the movements due to failed response on the relay neurons in the patient’s brain.

In the treatment of the TS condition, additional research is needed to identify neuropathology cases where the disease models in animals can be done to help in the research. Neuroimaging will help understand the TS better concerning the diseases mental and neural networking associated with neural development. Genetic studies should help determine the genetic factors responsible for developing the condition as its genetically unknown. Understanding TS's genetic concept will help diagnose the disorder, its treatment, and identify the most effective therapy.

Conclusion

            Tourette syndrome is a neurodevelopmental disorder associated with effects on the brain, especially the thalamus and the nervous system. The condition is related to sudden and repetitive movements and sounds labeled as a motor or vocal tic. The disorder is evident through the action and the symptoms of depression and anxiety, and sometimes moods swing in the victim. The causes of the TS are genetic, but others are developed from the foetus before the child's birth but the sometimes associated with cultural aspects. The social and cultural part is concerned with developing disorders such as mood, depression, or anxiety disorder. The treatment is through medication and therapy to suppress the occurrence of movement but not eradicate the condition. The disease's mortality rate is minimal, but the deaths are caused by cases of suicidal activities from disorders such as depression.

Reference

Al-Mosawi, A. J. (2018). Gilles de La Tourette syndrome. Saarbrücken LAP Lambert Academic Publishing.

Chadehumbe, M. A., & Brown, L. W. (2019). Advances in the Treatment of Tourette’s Disorder. Current psychiatry reports, 21(5), 1-6.

Cree, R. A., Bitsko, R. H., Robinson, L. R., Holbrook, J. R., Danielson, M. L., Smith, C., ... & Peacock, G. (2018). Health care, family, and community factors associated with mental, behavioral, and developmental disorders and poverty among children aged 2–8 years—United States, 2016. Morbidity and Mortality Weekly Report, 67(50), 1377.

Darrow, S. M., Grados, M., Sandor, P., Hirschtritt, M. E., Illmann, C., Osiecki, L., ... & Mathews, C. A. (2017). Autism spectrum symptoms in a Tourette’s disorder sample. Journal of the American Academy of Child & Adolescent Psychiatry, 56(7), 610-617.

De la Cruz, L. F., & Mataix-Cols, D. (2020). General health and mortality in Tourette syndrome and chronic tic disorder: A mini-review. Neuroscience & Biobehavioral Reviews.

Domènech, L., Cappi, C., & Halvorsen, M. (2021). Genetic architecture of Tourette syndrome: our current understanding. Psychological Medicine, 1-9.

Efron, D., Payne, J., Gulenc, A., & Chan, E. (2020). Assessment and management of tic disorders and Tourette syndrome by Australian paediatricians. Journal of paediatrics and child health, 56(1), 136-141.

Godar, S. C., & Bortolato, M. (2017). What makes you tic? Translational approaches to study the role of stress and contextual triggers in Tourette syndrome. Neuroscience & Biobehavioral Reviews, 76, 123-133.

Groth, C., Debes, N. M., Rask, C. U., Lange, T., & Skov, L. (2017). Course of Tourette syndrome and comorbidities in a large prospective clinical study. Journal of the American Academy of Child & Adolescent Psychiatry, 56(4), 304-312.

Hibberd, C., Charman, T., Bhatoa, R. S., Tekes, S., Hedderly, T., Gringras, P., & Robinson, S. (2020). Sleep difficulties in children with Tourette syndrome and chronic tic disorders: a systematic review of characteristics and associated factors. Sleep, 43(6), zsz308.

Jankovic, J. (2020). Treatment of tics associated with Tourette syndrome. Journal of Neural Transmission, 1-8.

Jiménez-Jiménez, F. J., Alonso-Navarro, H., García-Martín, E., & Agúndez, J. A. (2020). Sleep disorders in tourette syndrome. Sleep medicine reviews, 101335.

Jones, K. S., & Ramphul, K. (2019). Tourette syndrome and other tic disorders. StatPearls [Internet].

Kim, S., Greene, D. J., Bihun, E. C., Koller, J., Hampton, J., Acevedo, H., ... & Black, K. J. (2018). Transient tics aren't: Outcome of recent-onset tic disorder at one year.

Lee, M. Y., Wang, H. S., Chen, C. J., & Lee, M. H. (2019). Social adjustment experiences of adolescents with Tourette syndrome. Journal of clinical nursing, 28(1-2), 279-288.

Marwitz, L., & Pringsheim, T. (2018). Clinical utility of screening for anxiety and depression in children with Tourette syndrome. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 27(1), 15.

Mufford, M., Cheung, J., Jahanshad, N., van der Merwe, C., Ding, L., Groenewold, N., ... & Stein, D. J. (2019). Concordance of genetic variation that increases risk for tourette syndrome and that influences its underlying neurocircuitry. Translational psychiatry, 9(1), 1-10.

Paschou, P., & Müller-Vahl, K. (2017). The Neurobiology and Genetics of Gilles de la tourette Syndrome: New avenues through large-Scale Collaborative Projects. Frontiers in psychiatry, 8, 197.

Perrotta, G. (2019). Tic disorder: definition, clinical contexts, differential diagnosis, neural correlates and therapeutic approaches. J Neurosci Rehab, 2019, 1-6.

Perrotta, G. (2019). Tic disorder: definition, clinical contexts, differential diagnosis, neural correlates and therapeutic approaches. J Neurosci Rehab, 2019, 1-6.

Stafford, M., & Cavanna, A. E. (2020). Prevalence and clinical correlates of self-injurious behavior in Tourette syndrome. Neuroscience & Biobehavioral Reviews, 113, 299-307.

DALLAS CHILDREN’S ADVOCACY CENTER

The Dallas children advocacy center (DCAC) is a children advocacy center established in Texas to deal with the children experiencing criminal child abuse in their family or those experiencing violence. According to the program, they believe that education is the key and the best tool to protect children from those who seek to harm children. Thus, the centers’ mission becomes to help improve the children's lives of the offenders by providing a lead on the issues associated with child abuse, especially in Dallas. They do so by coordinating the investigation of the cases, the prosecution of the offenders, and ensure the healing of the abused children in the Dallas society. The cases of child abuse happening in the community amounting to 28,131 reports on child abuse.  The process requires to allot of funds, and the association is a non-profit association; thus, all the funds are acquired through grants, fundraising, and donations to create revenue to run the place.

The organization meets its revenue needs through fundraising, where they have a revenue of $204,915. Fundraising at DCAC has been effective by developing fundraising techniques that ensure the fundraising operation is made possible. The organization has been getting fundraising for decades, with the amount raised totalling one million dollars with over five hundred and fifty volunteers and a thousand donors. The fundraising included the appetite, aim advocacy, having 200 attendance at the Dallas club event, and art advocacy. More than 100 local and regional all-around artists were represented in the special event (DALLAS CHILDREN’S ADVOCACY CENTER annual report, 2017: 15).  The last special event had the keynote speakers as Jon Dorenbos, a two-time NFL Pro Bowler, a great performer in the NBA who shared his life story with people motivating and advising them on the importance of their choice. The special event had $1,149,216 as per the 2007 annual report; the company also receives gifts acquired through face-to-face interaction with people with high status in the community like the leaders in both political and other sectors.

Grants are obtained from the government agencies or corporations where they are granted in relation to where they are from the leader’s donation or obtained through a proposal request by the organization. For example, the Texas bar association was responsible for offering seventy-five thousand dollars to the DCAC to help and continue to fight against child abuse. The grant was to educate the first responders on handling and responding to child abuse cases and neglected children. The grants are used to educate the patrol officers to enable them to interrogate the children effectively without instilling fears in them. The united state department has also been on the front line to provide the grants; they offered more than $ 12.9 million to children advocacy centers to enable them to instil training to the respondent and reach more children. DCAC has educated respondents who include parents, some community members, and other professionals like police having the education done through seminars to have five thousand attendees from each in the US. The workshops give them knowledge and skills to identify and report children's cases with the abuse cases and provide the professionals with certified training in the field through the four hundred and seventy-five workshops and three hundred speakers. The program had a total of 100 405 educated personnel in all fields in  2019.

The amount of money offered through philanthropic support from individuals to Dallas children advocacy as per the 2015 annual report includes a total of more than five thousand dollars for gifts donors. The exceptional event cases where the company was holding had one thousand attendance with the amount donated to the company totalling $711500 ((DALLAS CHILDREN’S ADVOCACY CENTER annual report, 2015: 16). The organization's support was an event done at the individual level where people were volunteering in the organization's activities like playing with the children and folding their clothes. A total of 1806 volunteers were made from this, with 16,397 hours were given to the organization's service (Dallas children advocacy center: financial, 2019).  This amount represented the amount presented by individuals and the individual people in our special event, including auction and art advocacy. An event held by Dallas Gun Club aimed to advocate one hundred and fifty dollars to support the Dallas children advocacy center. The event was a competition and challenging tournament where sponsors and their teams gathered for hunting and fishing experiences. The event also had a raffle of luxury, having lunch between the sponsors and their teams, the recreational items and activities, and a live auction where valuable products were on sale.

 The program's fundraising strategies need to incorporate more events and activities to raise funds and use different fundraising techniques. The fundraising strategy activity includes special events like the auction where commodities are sold to the highest bidder, and the sales go back to the center. The special event also includes scenarios where the people make sales of things they do not use at home and donate money. The proposal to get grants from non-government organizations and the government provides the organizations with funds. Creating a capital endorsement campaign where it’s done with the short time frame where they can an object such as the renovation or construction of a new building, sometimes the charity can be involved in the marketing effort to do it on behalf of charity provide money to the organization. The money obtained from these market activities by the DCAC acts as a fund source for the organization, promoting fundraising programs.

Recommendations.

In the fundraising strategies, the organization should enhance the marketing for big corporations to enhance their funding. The agreement between the organization's management should request the big partner corporation to ensure that they offer them. The events where the special event is help should be broadcasted to the community where the organization gains its benefits and uses it for advertising a corporation under them. The strategy needs consideration of not offending the chief donor to avoid loss of more funds. The marketing department should also ensure that the organization is well marketed to ensure that they get more donations by giving the children the statistics they help save and the numbers that benefit from the program more frequently rather than ding it annually.

The special events should be done frequently to include the art advocacy, appetite, and aim advocacy to incorporate other activities. The activities such as sport will attract more people causing the event to be more profitable in fund collection. The organization should interact in the activities that will help create more funds by ensuring that they have got the attention of society's critical members. The alignment with prominent community members benefits the organization more as they tend to give more huge gifts and donations, creating more money for the company. To capture these people's attention in the community, the company should ensure they focus on engaging in golf players and incorporating them in the special event. The aspect of inviting prominent keynote speakers also creates the interest of most prominent people to attend the event as the activity is viewed as a center for meeting them. The same applies to the ordinary people more attracted to the prominent figures, thus attending to see their idles.

References

Dallas children advocacy center annual report of 2017  retrieved from https://www.savejane.com/wp-content/uploads/DCAC-18

Dallas children advocacy center annual report of 2015 retrieved from Center for Children's Advocacy Annual Report 2015 by Center for Children's Advocacy - issuu

Dallas advocate center: financial retrieved from

https://dcac.org/about-us/financials/

Meeting Acute and long-Term Health Challenges

Chronic Conditions

Introduction

Chronic health conditions require intervention or management from nurses, doctors, and other healthcare practitioners to cure or control medical interventions, clinical operations, or therapies.

These long-term health conditions include type I and type II diabetes, e.g., hypertension, angina, Chronic respiratory, conditions, such as asthma, and COPD (chronic obstructive pulmonary disease), Tom Williams has been diagnosed with types 2 diabetes and hypertension.

Diabetes develops when the body becomes resistant to insulin, and this can ultimately result in blindness, kidney failure, and reduced circulation.

 Hypertension is a high blood pressure illness. Tom’s diabetes is presently been managed with Metformin and glipizide. The combination of metformin and glipizide integrates two actions which assists the body manage high sugar levels and also stops liver from storing sugar.

Underlying long term illnesses can also develop into severe or acute diseases such as heart failure, myocardial infarction, and stroke. His diabetes could result in total blindness, while bilateral cataracts could be as result of Tom’s age (78 years).

The effects of hypertension and diabetes can be a risk factor to Tom’s well-being, impacting his social mental health.

Tom was an ex-tobacco smoker, which can pose a risk for angina or COPD, even though he stopped smoking. Tom family history has been assessed through his care plan.

We are considering the impact of Tom’s underlying health problems, on both his physical and mental well-being.

Generally people with chronic health problems may also have multiple health conditions, leading to other complication. When this is the case, the types of interventions or nursing approaches used for patients should be person-centred.

The biopsychosocial health factors on Tom’s life, such as diabetes and hypertension can lead to mental health and adverse wellbeing, which would require Tom to visit psychiatric nurse or mental health nurse, sometimes the patients are advised to follow mental wellbeing therapy.

The social implications of Tom Williams’ health condition

Effects on psychosocial impact on an individual or patient cannot be under-estimated. Tom’s social life was good before dwindling over the past few years.

The stress related to well-being and health promotion are inter-woven with the approaches used by practitioner to treat and manage patient. With reference to Tom, his autonomy must be respected and consented to when managing his health plan.

Anxiety can lead to the patient’s social isolation, and uncertainty. Similarly, Tom’s case is linked to social isolation due to diabetes’s exacerbated symptoms, hypertension and other destructive symptoms which might raise his anxiety levels and lead to social isolation.

Tom’s was diagnosed with type 2 diabetes with hypertension, is monitored with several medications.

The psychosocial implications of people who are hypertensive or living with diabetes are most common among some ethical background or race, due to their social-economic situation. stress or emotional wellbeing (Butler, 2017). Diabetes and hypertension are common among low-income countries. Some illnesses are common or present among race, geographical region, or ethnicity regarding dietary lifestyles. These cultures commonly consume high cholesterol foods, or food rich in fibre, resulting in chronic health problem.

Tom had an excellent social life with his wife in a small bungalow, this situation diminished over few years, they moved to a smaller apartment compared to what they previously enjoyed.

Tom may not be socializing like before, having withdrawn syndrome, and may have become less active, which is not helpful for someone who is living with diabetes 2 and hypertension.

The continual increases in Tom’s health assessment of care, and the impact of unemployment on the entire family can also be a major stressor effecting Tom’s well-being (Brooker, and Nicol, 2011). Their new home may be small, and not well ventilated like the former bungalow. The stress of socialising with activities, e.g., playing sports or other recreational activities, might have stopped due to financial concerns and this is another factor we considered.

Tom’s past history of smoking pose risk for COPD or angina. His family may also have a history of smoking.

 The connection of chronic obstructive pulmonary disease (OCPD) and smoking is one predominant among some people. In this particular case Tom’s family background makes him more susceptible and heart disease.

National and internationally health condition impact?

According to Dellinger et al. (2013) type 2 diabetes can lead to the development of additional medical problems. Due to Tom’s type 2 diabetes diagnosis, he is also at-risk factor for blindness, kidney injury and heart failure.

 Tom was readmitted to the hospital after 48hours when he discharged himself against the hospital approval, in this case, the nursing team would educate Tom about self-care management of his medications and make him more accountable for his self-medication and prompt him to communicate his health status on time.

The consequences of Tom’s not finishing his antibiotics had a serious impact on him during his readmission. It also had psychosocial effects on his family in general, because lack of timely treatment of diabetes can lead to depreciated social and economic assets among other challenges such as depression and eating disorders.

Weight management and a healthy diet are one of the global nursing promotions used to treat diabetes, Tom weight was at 109kg, we need to consult his care plan to check his height and establish his body mass index (BMI). An increase in BMI is directly linked to diabetes and increased vulnerability of acquiring other diseases. Most men have a higher probability of developing more complications than women.

Severe health problems, such as the ones Tom is experiencing now, can lead to death.

Changes in diet, exercise or even medications are very significant to health problems like diabetes, AKI, hypertension, cancer, and obesity are some of illness associated to some races like (BAME) Black and Asia minority ethnic groups (Cox, Schallom, and Jung, 2020).

Another good example is the COVID-19 vaccine, some patients reject the offer of getting the Pfizer/ Biotech vaccine but prefer to wait for the Oxford/AstraZeneca version as an example of nationalism. This goes against internationalism. Since individual with full mental capacity has the autonomy to decline or accept clinical intervention.

World health organisation (WHO) is also an example of international influences, when we consider worldwide health interventions.

Total words: 946

Summary of Tom’s Condition

An overview of Tom Williams’s critical concerns regarding his Long-term illness.

 Nurses must have the competencies and nursing skills to assess, diagnose and recognise early signs of acute health problems.

Furthermore, regardless of age, sex, and ethnicity, nurses can manage health challenges, using the basic nursing processes of News 2; RCP, sepsis screening tools (sepsis 6 in cases of red flags).

When we assess Tom Williams’s background, we can generally assume that he may be having acute health complication from some underlying illnesses, e.g., Tom’s diabetes has been a long-term health problem, managed with metformin and glipizide.

Atrial fibrillation, the heart rate is fast, irregular and reduce blood flow to the heart, with symptoms such as shortness of breath, and fatigue, and Tom is susceptible to this, having experienced it in the past. Tom is awaiting surgery for bilateral cataracts for his impaired vision, a common condition for patients over 60 years of age.

The ABCDE approach and the NEWS 2 scores used mostly by health care practitioner worldwide. Regarding Tom, this score shows some ascending urinary tract infections, which can also lead to a neurogenic bladder, a condition which the brain is unable to transmit signal, due to injury, affect mainly the bladder and its neighbouring organs.

Tom’s present temperature was 38.6^oC, but an auscultation air entry is heard in all the four quadrants of his lungs with crepitation heard in both bases.

An E-GFR of 48, is an indication that Tom needs urgent medical intervention, because GFR of 60 or higher is normal, while lower than 60 is an indication of kidney injury.

The concern of pressure sores around the sacrum, is common among patients over 70years, due to dehydration and illness like diabetes, it is also common during hospital admission because of mobility problems and confinement to bed, without hourly repositions of the patients (Butler, 2017). This leads to the possibility of incontinence of urine, faces and poor hygiene, which can potentially be why Tom has pressure sores that can lead to ulcer. Therefore, Tom’s condition seemed to be geared towards improvement due to current medication and the lifestyle changes that he makes in his life.

Identify and critically discuss Tom Williams’ care priority and care management.

Breathing assessment, one of the most important things to note during an ABCDE assessment ensures that patient airways are patent prior to breathing assessment by looking, listening, feeling, and measuring. In this particular case, Tom’s airway is patent because he is alert but reluctant to be in hospital.

We can assess Tom’s care plan and his present assessment. Clinical concerns would indicate why he was admitted to the hospital and the tests carried out to determine any long-term health challenges. We know the possibilities that Tom may develop an ascending urinary tract infection, which is the inability to expel urine. The risk of sepsis is crucial to Tom’s health and must be screened since one of the parameters of the NEWS 2 ABCDE also score 3 (respiration) since Tom has an impaired immunity (diabetes). In addition, his age of 78 years old indicates a Sepsis screening should commerce when patients show signs of unwell or has some physiology abnormality.

Tom’s blood glucose was 18.7mmol/L, a great difference from an earlier reading of 18.2mmol/L, and normal reading of 4-8mmol/L. We are of the impression that Tom confusion can be a result of ascending urinary tract infection or the side effects of his medications or the possibility of an underlying health problem like Acute kidney injury (AKI).

In order to attain multiple aims Tom’s medical delivery structures has to be aligned with his medical condition and the medication from the doctor. The care management emerges from primary ways of handling medical condition and designing ways of preventing emergencies. Defining the care management according to Tom’s condition will increase the quality of the medication.

Using an ABCDE assessment after Tom was readmitted at 19.00u: -20.00u.

Tom’s Background: -

• Type 2 diabetes for 20 years (prescribed metformin and Glipizide)
• Atrial fibrillation (prescribed digoxin and aspirin)
• Hypertension for which he has prescribed an ACE inhibitor (Ramipril)
• Awaiting surgery for bilateral cataracts
• He used to smoke but quit up several years ago.

Assessment from 19.00 u– 20.00u

Airways:

• Confused (2) Breathlessness.
• Airway maintenance okay
• Sits up in bed and comfortable,
• Feeling nauseated

   Breathing:

• R = 32/min NEWS 2 score = 3
• Spo2 = 90% NEWS 2 score= 3

Circulation:

• HR = 98/min                                                                  P= Irregular
• BP = 90 /63 NEWS 2 score = 3

 Urine output: Urethral catheter inserted on admission drained 80mls.

 CSU: sent for culture and sensitivity.

Complaints of nausea:

Tom has not passed urine for 14 hours; this is an indication of UTI.

Disability:

Blood Glucose = 17.4 mmol/L

Temperature: = 38.6^oc   News2 score = 1

Confused

Lethargic and slow to respond to verbal commands: This can be an indication of shock, stroke or UTI.

Exposure:

• Skin and mucus membranes dry and cracked.
• Pressure sore stage 4 on the sacrum

NEWS 2 = 10

Chart 2: NEWS 2 threshold and triggers due to an aggregate score 7 or more.

Clinical risk = High

Response = Urgent or emergency response

Situation, background, assessment, and recommendation (SBAR)

Clinically effective detection and management of patient are essential to their care and general wellbeing. In this case, Tom needs a medication tailored to meet his personal medical needs.

Respecting patent centred care and wishes, knowing your patient and having knowledge about their care and needs, would help the practitioners make informed decisions regarding Tom’s care.

If the trigger scores for Tom are in the high-risk range, then the outreach team should be contacted immediately and when relevant, evidence should be compared and contracted to supported intervention.

Evidence based Intervention.

Evidence based assessment is a way to interpret the patient’s present condition to ascertain any long-term potential risk, prevent health deterioration and access timely intervention. Evidence based intervention are reliant on Tom’s progression due to the assessment of the expected outcome. Due to the isolation of specific mannerisms.

This method has been effective in patients with same signs and symptoms as Tom (Gain, 2014). When a nurse identifies concern, they should seek immediate advice and support.

Keeping Tom safe during hospital admission by staying with him throughout

The major aim is to monitor and reassure Tom hourly, which including airways observations and, breathing, because Tom may go into shock, causing a stoke or occult sepsis. Dehydration is another reason to continue monitoring Tom. His urinary tract infection (UTI) can also lead to other health complications.

Tom should be encouraged to sit at a 45 degrees angle in his bed, unless there are spinal cord injuries and bed reposition hourly, because of Tom age, there is the possibility of infection and the catheter inserted also pose a risk of infection. Repositioning helps relieve pressure on his bottom and promote good blood circulation.

Hourly screening for Sepsis is very crucial to Tom’s health because if there is need for escalation of health treatment or if any concern is observed, more advanced health practitioner could be in the position make any necessary interventions or recommend transferring him to ICU.

It is critically important in the management of sepsis to act fast, if any red flag is present that is why we would recommend retesting and reassessing Tom as a high-risk patient. He should be monitored to determine the type of antibiotic to be administered to be and if it is achieving the goals.

Communication and reassurance are vital to every patient (Elwyn, and Fisher, 2014) due to the connection it has to shortening the recovery period. We must also seek consent before any clinical intervention since the patient is conscious and has the capacity to give consent. As we know from the report, that Tom was not happy with the face mask, therefore nasal mask was used instead.

Tom’s weight is another factor, as it is weight of 109kg, we cannot measure his BMI without knowing his height, but that information can be assessed from his care plan or hospital passport.

Plan to contact relatives in accordance with Tom’s preferences.

Every patient has information about how, when and who to contact in the case of emergency or end of life in their care plan, this makes it possible to involve family and friend, whether it for family engagement or empowerment (Elwyn, and Fisher, 2014). The presence of family is vital source of psychological stability for patient like Tom, it helps in quick recovery while maintaining a contact with family.  More so, some hospital has a team of medical staff members who can give patients encouragement and a social life.

Conclusion

We conclude that Tom maybe having an episode of severe acute health complications caused by one or more his finding from his assessment using the ABCDE approach and NEWS2.

Using NICE guideline as reference, if we consider Tom in this case study, his data’s assessment indicates that maybe be at the risk of acute kidney injury because his health condition is deteriorating rapidly.

It is recommended that his serum creatinine be assessed hourly, by the handover nurses, while reassessing, while keeping Tom safe and reassurance in this vital stage. Family member should also be informed to be on standby.

There are various impediments to Tom’s health diabetes, as an ex-smoker COPD is liable to any chest pain, or angina, which can also lead to stroke or hypertension.

Tom should be referred to a nephrology team because we are uncertain of the cause of acute Kidney injury, but since chronic kidney diseases in adults like Tom show less than 60ml/min/1.73² of (eGFR) Tom may likely be at risk for following disease:

Diabetes, acute kidney injury, heart failure, liver disease, oliguria (when urine output is less than 0.5ml/1kg/hour) and hypovolaemia.

Total words part B:1859

References:

Brooker, C. and Nicol, M., 2011a. Alexander's nursing practice [Non-fiction]. 4th ed. / Chris Brooker and Maggie Nicol. edition.: Churchill Livingstone.

Cox, J., Schallom, M. and Jung, C., 2020. Identifying Risk Factors for Pressure Injury in Adult Critical Care Patients. American Journal of Critical Care, 29 (3), 204-213.

Dellinger, R., Levy, M., Rhodes, A., Annane, D., Gerlach, H., Opal, S., Sevransky, J., Sprung, C., Douglas, I., Jaeschke, R., Osborn, T., Nunnally, M., Townsend, S., Reinhart, K., Kleinpell, R., Angus, D., Deutschman, C., Machado, F., Rubenfeld, G. and Webb, S., 2013. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Medicine, 39 (2), 165.

Gain (2014) guideline for the treatment of hyperkalaemia in Adult Gain. Accessed at www.gain-ni.org

Elwyn, G. and Fisher, E., 2014. Higher integrity health care: evidence-based shared decision making. Circulation: Cardiovascular Quality & Outcomes, 7 (6), 975-980.

Evridiki, P., George, E. and Riitta, S., 2010. The concept of individualized care in nursing. Cyprus Nursing Chronicles, 11 (3), 4-19.

Hampton, S., 1998. Clinical. Can electric beds aid pressure sore prevention in hospitals? British Journal of Nursing, 7 (17), 1010-1017.

Levy, M. M., Artigas, A., Phillips, G. S., Rhodes, A., Beale, R., Osborn, T., Vincent, J.-L., Townsend, S., Lemeshow, S. and Dellinger, R. P., 2012a. Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study. The Lancet Infectious Diseases, 12 (12), 919-924.

Nyholm, L. and Koskinen, C. A. L., 2017. Understanding and safeguarding patient dignity in intensive care. Nursing Ethics, 24 (4), 408-418.

Peter, G., 2012a. Clinical management of SIADH. Therapeutic Advances in Endocrinology and Metabolism, 3.

Poorchangizi, B., Farokhzadian, J., Abbaszadeh, A., Mirzaee, M. and Borhani, F., 2017. The importance of professional values from clinical nurses' perspective in hospitals of a medical university in Iran. BMC medical ethics, 18 (1), 20.

Price, B., 2019. Delivering person-centred care in nursing [Bibliographies Non-fiction]. Learning Matters.

Rothman, M., Levy, M., Dellinger, R. P., Jones, S. L., Fogerty, R. L., Voelker, K. G., Gross, B., Marchetti, A. and Beals, I. V. J., 2017. Sepsis as 2 problems: Identifying sepsis at admission and predicting onset in the hospital using an electronic medical record–based acuity score. Journal of Critical Care, 38, 237-244.

Tait, D., James, J., Williams, C. and Barton, D., 2015a. Acute and critical care in adult nursing [Bibliographies Non-fiction]. 2nd edition. edition.: Learning Matters.

Van Assche, J., van der Kaap-Deeder, J., Audenaert, E., De Schryver, M. and Vansteenkiste, M., 2018. Are the benefits of autonomy satisfaction and the costs of autonomy frustration dependent on individuals' autonomy strength? Journal of personality, 86 (6), 1017-1036.

Zaidi, H., Bader-El-Den, M. and McNicholas, J., 2019. Using the National Early Warning Score (NEWS/NEWS 2) in different Intensive Care Units (ICUs) to predict the discharge location of patients. BMC public health, 19 (1), 1231.

Butler, A. M. (2017). Social determinants of health and racial/ethnic disparities in type 2 diabetes in youth. Current diabetes reports, 17(8), 1-4.

Top of Form

Summary

‘Why Americans are numb to the staggering coronavirus’ is an article written by William and Brittany. Despite the high Covid-19 death toll, Americans have thrown caution to the wind. As evidenced in the article, during a certain burial ceremony, most of the people in attendance did not adhere to the covid-19 protocols. Neglecting covid-19 regulations seems to be the new norm in America. No one is alarmed by the extensive spread of the coronavirus and the increasing death rate. Each day, experts monitor the progressive spread of the disease in the USA. Yet, Americans remain adamant about the covid-19 regulations. Americans are used to the high death rate and have not taken hid of rules and regulations put in place to prevent the virus from spreading further (Wan and Brittany np). According to psychologists, whenever there is a high death toll, the brain develops numbness towards the disaster. For instance, many people die and out of the numerous deaths, there is no face or name attached to the deaths. In this particular pandemic, the death toll is covered by close friends and family members. In the end, the impact of deaths is not felt across the population. In simpler terms, failing to attach names to individual deaths makes the high death rate normal to most Americans. Also, due to a high death toll, it is difficult to develop compassion when there is no name attached to them. Thus, the larger the number of dead people, the harder it becomes to attach compassion to the deaths connected to the covid-19 virus. Therefore, the more the deaths, the less compassion which later translates into failing to adhere to the covid-19 protocols.

2

According to William and Brittany, death is the new normal in the USA. The progression of the disease is being tracked daily. Everybody has been affected by the disease. Yet, Americans are still not shaken. The general population is growing numb to the covid-19 pandemic. One of the reasons for this observation is the high death rates being recorded and announced with each passing day (Wan and Brittany np). Day by day, the increasing death rates make it hard for people to develop empathy and compassion towards the people who have lost loved ones in the pandemic Also, the government cannot attach a name to each death hence making it hard for people to become sensitive towards the victims of the pandemic. For instance, Americans are no longer wearing masks while attending public functions.

 An alternative reason for the numbness is the economic hardships that emerged due to covid-19 protocols. Since covid-19 became a global pandemic, most people have been forced into isolation (Wan and Brittany np). Numerous livelihoods have been affected due to the covid-19 virus. In my personal opinion, living an isolated life for more than 8 months is bound to spark some negative psychological impacts on the majority of people. For example, the majority of Americans lost their jobs due to the pandemic while others were separated from loved ones. Also, the sudden change from social life to isolated life makes it hard to come to terms with the difficulties surrounding the pandemic. Most of the people are bored of staying at home and the government is not giving them enough money to cater to their needs.

3

Thesis statement

  An increase in the number of deaths results in a lack of empathy. Consequently, the financial hurdles stemming from the covid-19 pandemic have left people with no option but to resume normal life without any fear of the impending situation the pandemic created.

Introduction

 Covid-19 has disrupted the entire world due to the isolation and financial hurdles it has caused over time. Its origin is said to be Wuhan China. Due to the nature of the disease, it forced people into isolation and quarantine centers to prevent it from spreading further into other regions. The government was forced to stop economic activities and force people to stay home so that they could minimize the spread of the illness. Also, schools closed and children were forced to attend online classes. The change in lifestyle and the urge to resume created dissatisfaction with the current life. Hence, with time, most people numbed from the issues revolving around the illness.

 Even though the death toll was high, people were more concerned about their lives and survival than adhering to the covid-19 protocols. It is vital to note that the announcement of a vaccine and the arrival of a new covid-19 strain has created more tension on the ongoing tension (Wan and Brittany np). Some people do not want to remain in isolation for the rest of the year and opt to break the covid-19 guidelines stipulated by the ministry of health.

 In summary, the Americans have numbed themselves due to the financial hurdles created by covid-19 and the high death toll which denies them a chance to singly isolate each death and sympathize with the loss. Since the beginning of the covid-19 pandemic, the government shut down public spaces to isolate people and prevent the illness from spreading wider across the nation. Rising cases of covid-19 tend to lose meaning to the members of the public.

 Work cited

Wan, william, and Brittany shammas. "Why Americans are numb to the staggering coronavirus death toll". Washington post, 2020. Online. Internet. 14 Feb. 2021. . Available: https://www.washingtonpost.com/health/2020/12/21/covid-why-we-ignore-deaths/.

Attention Deficit Hyperactivity Disorder

Introduction

Psychiatric medical experts, especially nurses, have come across many patients with disorders. A common disorder that has been on the rise in the contemporary world is Attention Deficit Hyperactivity Disorder (ADHD), in most cases, diagnosed among children. According to Mayo Clinic, this condition is chronic and is affecting millions of children. Additionally, this disorder is a combination of many challenges ranging from impulsive behavior, little sustenance on attention, and hyperactivity. The clinic also reports that individuals diagnosed with ADHD disorder are likely to struggle with low self-esteem, sometimes with troubled relationships, students experience low performance at schools. Although, the prevalence of ADHD is much on young children and adolescence, the condition has been noticed in adult patients. The disorder targets the brain, making the patients challenged in controlling their behaviors, and how they pay attention. Similarly, according to WebMD, ADHD disorder is commonly diagnosed in patients with pre-existing mental disorders, and in most cases, boys over girls.

ADHD stands out second as a chronic illness in children affecting their behavioral condition. The diagnostic of this disorder has been the use of observable specific behavior in multiple settings. In the United States, national survey report of 2016, 9.4 percent of children ADHD diagnosis and 8.4 percent had this disorder (Wolraich et al., 2019). This disorder has a long history, despite the change in name over time. In the middle years of the 19^th century, its characteristics were described by a German physician Heinrich Hoffman, and his discussion was presented in the children’s book. The significant characteristics of this disorder, as discussed in a meeting held in Roya College of Physicians, in 1902, ADHD was found a defect in moral character. A few years later, it was observed that the disorder would appear in patterns of restless, inattentive, easily aroused, and hyperactivity. It was also noted that children might suffer from minimal brain damage or dysfunction, which could be passed across a generation or caused by environmental factors.

Additionally, after brain damage was found to contribute to ADHD minimally, this disorder was revised and became behaviorally descriptive. Then followed its reflection in the psychiatric classification system DSM-II, and its name became hyperkinetic reaction of childhood disorder. The research and changes were continual that in 1980, studies also revealed that the primary impairment had shifted from hyperactivity to inattention, thus changing the name to attention-deficit disorder in DSM-III. Further, it was categorized into three sub-types, inattention, hyperactive, and combined, in DSM-IV, which stands to date in DSM-5. In the latter edition, the subtypes have become presentations, including people across all the lifespans. Across ages of advancement and evolution since its discovery, the diagnostic criteria for ADHD remains almost the same, which involves the clinicians (Steinau, 2013). In the 1960s use of teacher- or parent-reported behavior–rating scales have been deployed to determine significant impairment as described in the DSM-5

WebMD also confirms that it is prominent among children and teens, and in some situations, can continue to adult ages (Bélanger et al., 2018). It is always advisable that before the condition of the disorder worsens, the patient seeks a pediatrician for evaluation, treatments, and therapy. Although the exact cause of ADHD is not clearly defined, the specialist attributes its development to genetic, environmental, or problems associated with the nervous system. Research is still underway to get the exact cause of this disorder and make them administer the right medication and therapy. This essay presents a comprehensive review of diagnostic criteria and influencers that can be used when considering ADHD symptoms; it will also include a discussion of neurobiological and other influences. Besides, this essay incorporates the cultural and genetic issues that need to be considered in treatment and professional-based guidelines, including views related to ADHD, APRN practice issues, and areas associated with this disorder that need to be addressed in the future.

Diagnostic Criteria and Influences to Include When Considering Diagnoses with ADHD Symptoms

There is a need to carry out diagnoses and find out the symptoms that are associated with ADHD. This will ensure that the type of treatment and therapy administered to the patients are the right ones. Additionally, carrying out the diagnosis would help the health providers identify ADHD symptom criteria, come up with alternative causes to these symptoms, and other related conditions such as anxiety and other forms of depression that might be responsible for these symptoms. It is important to note that a profound means to carry out this diagnosis is still underway, although much effort has been put into research ADHD. However, before carrying out any evaluation, some set conditions need to be followed carefully. Among these conditions include identifying the symptoms behaviors that must be present in two or more settings; secondly, the nature of the symptoms must be impairing; thirdly, the symptoms' behavior has been present in the child before 12 years (Cabral et al., 2020). Lastly, the symptoms should not be a result of another disorder that is not ADHD.

Some common characteristics of ADHD include anxiety, learning disabilities, depressions, undetected seizures, sleep problems, medical disorders affecting brain functionality. Most of these symptoms are associated with sudden life changes, such as deaths, family break-ups, relocation to new homes, and other weird behaviors, depending on the patients' age. According to Cleveland Clinic, adults have been found capable of recognizing the behaviors caused by ADHD within themselves, when their children are diagnosed. However, some patients have been found incapable of seeking professional aid to help them find anxieties and depression caused by ADHD. Additionally, the American Psychological Association (APA) provides guidelines that help psychiatrists in diagnosis.  According to APA, to be diagnosed with ADHD, a child must have more than six symptoms belonging to the inattention or hyperactivity category over the last six months. For adults, one should portray more than five established ADHD behaviors belonging to the same categories, for the same period as children.

Moreover, for ADHD symptoms or behavior, the patients, either child, adolescents, or adults, must meet some criteria, which is as follows: the patient must portray symptoms that interfere with school, home, or work life. Also, they should be present in two or more settings and, lastly, present before the age of 12 years (Cabral et al., 2020). Through these symptoms, healthcare officials will be in a position to decide whether the patient has ADHD or not. However, for the overall diagnosis process, there must be a strategic procedure that needs to be followed. According to the Centers for Disease and Control and Prevention, so far, there is no single test to diagnose ADHD, and many other problems, anxiety, depression, like sleep disorder, as well as other learning disabilities. A common practice with ADHD diagnoses among children is that the healthcare providers are to identify whether the patient's symptoms are worth diagnosis (Bélanger et al., 2018). More importantly, the American Academy of Pediatrics (APP) prompts that the health experts seek information from the teachers, parents, and other adults who have interacted with the children at different places. Through these strategies, the healthcare provider is capable of explaining whether the symptoms belong to another condition or occur at the same time as ADHD.

In order to ensure that ADHD diagnosis proceeds successfully, “the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5),” is used. This standard is used across communities to determine the number of children with ADHD and its impact on public health. DSM-5 criteria for ADHD use persistent patterns of inattention or hyperactivity to show its interference with functioning (Pacchiarotti et al., 2020). When addressing inattention, some of the common characteristics present include easily distracted, often troubled, seems not to listen when talked to directly, loses necessary things, fails to give close attention, and often trouble when organizing personal tasks, and so on. For the hyperactive case, one fidget with or taps hands or feet, might leave seats before time, runs about situations, unable to play during leisure, often talks excessively, troubled waiting their turn, and intrudes others, among many others.

Precisely, the DSM-5 criteria for ADHD include some fundamental approaches. The first criteria are the inattentive type diagnosis, which helps identify the listening skills, lost or misplaced items, forgetting of daily activities. This criteria also identifies the diminished daily activities, fall of focus, and in-school children's inability to complete homework and school assignments. The second criteria are the hyperactive or impulsive diagnosis criteria. The patient portrays over-talkative behavior, restlessness, incapable of staying sited in class, difficulties in waiting for a turn, and generally interruptive. Other diagnosis requirements include symptoms that are evident before 12 years, symptoms found not exclusive and oppositional behavior, and other mood disorders (American Psychiatric Association, 2013). Lastly, children need to carry out a classification to identify patients who meet both inattentive and hyperactive criteria for the last six months. Besides, those that meet the inattentive criterion, but not hyperactive criteria for the same period, and finally, those that meet the hyperactivity criterion, but not inattentive for the stated period of the past six months.

Conversely, for DSM-5 criteria on adults, the diagnosis criteria are different. For adults, all the requirements must be met for a diagnosis of ADHD. The criteria include five or more inattentive or hyperactive symptoms, which must be persistent for more than six months. The latter symptoms should adversely have impacted development levels either socially, academically, or occupationally. The second criteria are that inattentive or impulsive symptoms should have been present before 12 years (American Psychiatric Association, 2013). Thirdly, symptoms should be portrayed in at least two settings: school, workplace, or at home. The fourth is clear evidence that the symptoms show the reduced quality of overall functioning of the individual. Lastly, the symptoms should not occur exclusively during schizophrenia or other psychotic disorders.

Neurobiological and Other Influences of ADHD

Attention, Deficit Hyperactivity Disorder, cannot be attributed to one cause but intertwined pathophysiological entities. These causes range from various genetic influences and environmental risk factors present in some individuals, thus creating a chance or a spectrum for neurobiological complications. Based on latter complications, ADHD and the symptoms of both inattention, hyperactivity, and impulsivity characteristics common with these children are neurological. Although much of the research had not been carried out over the last few decades, there has been some sense of evidence provided. In the previously stated evidence, neurological structures and systems play a significant part. Precisely focusing on genetics, neurobehavioral, biochemical, and neuroanatomical associates of ADHD, the motor-regulatory system involving both subcortical and frontal systems are closely intertwined with ADHD (Corral & Hernández, 2018). The same studies highlight the possibility of genetics to portray deficiencies in neurotransmitters. After carrying out a family study, it is discovered that parents and children might be affected by the same condition of disorder through the same transmitters. Although so far, there is no neurobiological marker for this disorder, thus demanding an appropriate diagnosis that should critically carry out a reliable behavioral assessment, and treatment, which is carefully monitored by medical specialists to bring about informed behavioral interventions.

Moreover, apart from the neurobiological influences, there are other factors responsible for ADHD. As we had stated earlier, this disorder has been discovered in recent days, mainly associated with boy children, which results from biological conditions instead of poor parenting. However, we cannot attribute its course purely to genetics as other pathophysiological entities are also present and capable of causing the same complications. These factors primarily can be categorized as environmental factors for ADHD, including prenatal factors, which are basically associated with the mother’s lifestyle during pregnancy. An excellent example is alcohol exposure, which has been attributed to hyperactive, impulsive, or increased risks of psychiatric disorders, due to pre-existing abnormalities induced in the brain structure before birth (Corral & Hernández, 2018). Apart from alcohol, smoking has a great fold and contribution to ADHD risks; maternal smoking has been reported to have a powerful relationship, the reason being that smoke affects the nicotinic receptors, thus resulting in dopaminergic activity, causing ADHD.

Additionally, malnutrition and dietary deficiency make part of the postnatal factors responsible for ADHD. Precisely the imbalance between omega-3 and omega-6 fatty acids in the body are potential causes of this disorder. Also, the deficiency of iron in the body, especially during the pregnancy period, has been highlighted by various psychiatric researchers, to cause this problem. More so, complex models, which is an interplay between genes and the environment, seek considerations. For this reason, recent scholars try to examine the joint association between these two factors and exposure to prenatal conditions; among these conditions, the research reveals a close interconnection between the genotypes and prenatal exposure responsible for ADHD.

Cultural and Genetic Issues to Consider in the Treatment of ADHD

Culture may sound lesser, but when it comes to mental health, it counts a lot. It has fundamental effects on mental health, mental illness as well as on mental health services. Similarly, ADHD can be attributed to cultural issues, which have been based on racial and ethnic minorities on most occasions. Also, genetic factors can be part of the social factors responsible for the cause of disorders, the reason being genes are shared across families, thus making part of the culture. Precisely, culture and social factors are fundamental contributors to the cause of mental disorders, of varying nature, ranging from depressions, anxiety to ADHD (Slobodin & Masalha, 2020). Although the mental disorder is caused by complex interactions between various psychological, biological, social, and cultural factors, each has a stronger or weaker influence depending on the type of disorder. For instance, it is because of the cultural and social factors that highly contribute to depressions and post-traumatic conditions, as opposed to other causal agents.

The cultural background drives that responses based on ADHD, bringing unsettled, concerns, and common reactions. Although most pediatrics neglect the aspect of race and ethnicity when diagnosing this disorder and its subsequent treatments, to some degree, it impacts these processes. The minority group of children has been found to have high risks of been diagnosed with ADHD, as opposed to high social class individuals, the whites. Similarly, when whites are diagnosed, they have higher access to medications. More so, the cultural beliefs and attitudes impact diagnosis and affect treatment-seeking behaviors, due to differences prescribed for the whites and the minorities (Fairman, Peckham & Sclar, 2020). Additionally, culture has some connection to ADHD treatment between African Americans and whites, even if they belong to the same socioeconomic status. Again, differences in ethno-cultures are genetically generated and also associated with a combination of other factors.

Additionally, based on the genetic perspectives, some factors existing in specific families might cause ADHD. The type of genes varies across ethnic groups as well as cultural and social groups. The presence of these groups is a challenge, too, as individuals need to understand how to cope with daily problems attributed to these adversities, failure to which might result in seeking mental health treatment, as they are less represented in the mental health services. However, this should not be the excuse as there is a need to seek early treatment for the disorder before its conditions get to the extreme ends. More importantly, when handling ADHD patients, it is essential to consider all the cultural and social factors responsible for the disorder; also, the genetic factors are worth addressing.  This is in the bid to address the cause of the disorder first, as it would enable the psychiatrists to give cause-related treatment as opposed to symptom-based treatment. The cause-related treatment helps address the challenge based on its origin and thus the best in medical practice.

ADHD Treatment Options and Guidelines

When addressing brain-related treatment and therapies, the psychiatrists need to be fully equipped with competent skills. Currently, ADHD has no cure, although some treatments help reduce its associated symptoms and improve overall functioning. In common practice, the specialist offers medication, education, psychotherapies, and sometimes combined treatments. According to the National Institute of Mental Health (NIH), ADHD in many people reduces hyperactivity and impulsivity; these medications aim to improve the patients' focus, work, and learning ability (Mattingly et al., 2017). Although, some medications need to be tested before they get administered to some patients, and patients should be keenly monitored and carefully follow the prescriptions. Precisely the medications are aimed at improving the individual’s physical coordination. The medications belong to various groups, the common ones being the stimulant; others are non-stimulants, including psychotherapy and psychosocial interventions.

Mental health specialists revealed that stimulants are the common medication used in treating ADHD. Although the latter disorder is a stimulant, it is treated with stimulants, which increase brain chemical dopamine and norepinephrine, which helps in thinking and attention. These stimulants work best if administered under strict medical supervision; however, they are associated with some side effects upon misuse (Mattingly et al., 2017). A common effect of overdose of these stimulants is high blood pressure, heart rate, and anxiety. Thus, it is advisable that if a patient has these pre-existing conditions of hypertension, liver, kidney disease, and anxiety disorders, make it known to the doctors before receiving these medications. The NIH department also informs the patients that in case they experience decreased appetite, personality change, stomach aches, increased anxiety, sleep problems, among other side effects, they should seek medical advice. Conversely, some non-stimulants take longer to start working as opposed to stimulants. However, they might improve focus, attention, and impulsivity in ADHD patients at the end of it all. The non-stimulants are prescribed for patients who have revealed the side effects on stimulants, or when stimulants were not effective; at times, both are administered to increase the overall effectiveness.

Further, some psychosocial interventions have been found helpful with some patients and their families to manage the ADHD conditions and improve daily functioning. Children and patients, may need guidance on ADHD to help them, understand their parents, families, and teachers, thus reach full potential and succeed. Starting with behavioral therapy, which is psychotherapy, has been found successful in changing individuals' behaviors. It incorporates all the involved people’s role to monitor and give a self-appraisal in behavior change. Secondly, cognitive therapy teaches the patients to get mindful techniques, which places them in a position to accept their thoughts and feelings, thus improving concentration. Other therapies include family and marital therapies to address couple interactions, parental skills training, specific behavioral classroom management interventions, stress management techniques, and support groups. All these strategies, therapies, medications, and interventions aim to help ADHD patients stay organized, and improve their overall daily functioning.

Recent Research Applicable to ADHD Aspects and Treatment

The ADHD problem has been discovered in the few recent decades; thus, not much has been done. It is because of this reason that many contemporary scholars have been at the forefront of research on this disorder. All these researches aim to advance the knowledge or the knowledge on this disorder and thus the know-how to treat it. This is after a continuous failure and ineffectiveness in addressing ADHD patients in terms of medication-based treatments that have been questioned. They have not discussed the broader clinical needs common with the majority of ADHD individuals appropriately. Another area that has raised concern is the less effectiveness in non-pharmacological approaches that have been employed to address ADHD as it was expected (Cortese & Coghill, 2018). Additionally, the present-day scientists and clinic studies have posed a challenge to the existing conceptions on ADHD as they seem to affect future clinical approaches.

In order to solve the challenge of inclusion in the contemporary world from the past approaches, sets of new clinical practices are deployed. Scholars have embarked on serious research to try to understand ADHD. The current study uses data from the national surveys from where they gather data to be used on policy research and community-based research. They can understand the number of individuals with ADHD, conditions they might experience, and the type of treatment administered to them. Before the treatment, the specialists need to provide an account of how they go about the diagnosis, epidemiology, and then present the treatment procedures, as presented in “the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases.” Additionally, the current researches focus on understanding the causes of pathophysiological aspects associated with ADHD as scientifically presented in the recent decades. Finally, we need to address the discoveries, and some key challenges applicable to current models and treatment of ADHD, and how these discoveries promote new perspectives.

Controversies Associated With Attention Deficit Hyperactivity Disorder

Based on the fact that attention deficit hyperactivity disorder is a discovery and that much research has not been done about it, there exist many public disagreements. The latter disputes are a result of the existence of unclear information. Most of this information relates to the causes of the disorder, diagnosis, and the methods of treatment used, precisely using stimulants on children. These controversies have resulted in debates around ADHD, where some individuals even go to the extent of the question of whether this is a mental illness or a neurological description of a normal condition. Another source for debate is its cause and the accuracy of the current prevalence rates (Mahone & Denckla, 2017). This has extended into queries on the methods used in diagnosis and treatment.

Addressing the question of whether ADHD is a mental illness or not has been on the forefront. There is a need to find out whether ADHD can be categorized as a mental illness. Some experts describe this as brain-based variations, with most people stating that ADHD is not a disorder, as normal individuals at times portray the same symptoms as those with the disorders. However, another group of individuals who are fully convinced that this is a disorder supports their stand as individuals with this disorder activity and abilities greatly vary from normal people. Additionally, they agree that ADHD is a neurological disorder, influenced by environmental factors; however, the detractors claim that this type of disorder is primarily caused by psychological factors (Timimi, 2018). The existence of these debates calls for psychiatrists to address these controversies and understand what exactly ADHD is and how it should be dealt with; more so, they should clearly highlight how this disorder should be treated, especially the young children.

Advanced Practice Registered Nurses (APRN) Practice

APRN is an abbreviation of Advanced Practice Registered Nurses. This is a category of registered nurses who have earned a graduate-level degree such as Masters of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) and has been trained in one of four a recognized APRN practice. The four major roles of APRN include certified nurse-midwife (CNM), certified registered nurse anesthetic (CRNA), clinical nurse specialist (CNS), and nurse practitioners (NP) (McCauley et al., 2020). For nurses to get registered, they must get to higher education institutions where they get many skills and thus in a position to address the issues and the controversies that are associated with ADHD. More importantly, these nurses are more critical in addressing vital health complications, especially in the United States. Their skills allow them to serve patients and provide additional aid needed by patients whose conditions require much more specialized attention. They are capable of recording ADHD patients’ medical histories and diagnostic tests, writing the correct medication prescriptions, and sometimes referring patients to further care.

When dealing with ADHD patients, advanced practice registered nurses (APRNs) uses advanced diagnostic methods to identify and diagnose this disorder. These methods used are highly understudies, thus promising high degrees of accuracy. Children suspected to have symptoms of this disorder in the face of the APRNs are sure of recognition and diagnosis methods which are perceived much accurate (Vlam, 2006). In most cases, these nurses use American Academy of Pediatrics diagnostic guidelines for diagnosing this disorder in children, which is closely related to other methods used by other care providers. Although, the APRNs feel much comfortable when handling APRNS disorders diagnosis and treatment.

Future Implications

Future researchers need to answer the questions that arise with ADHD issues. There is much work that current and future researchers need to do, majorly on gathering knowledge on this disease. First and foremost, the researchers need to agree on the definition of ADHD as it has been seen to vary from different conditions, thus affecting the past and the current studies (Pallanti & Salerno, 2020). There is a need to carry out a scientific study that should come up with a measure or a standardized treatment of this disorder, which should not raise questions on whether to be administered to children. Additionally, today’s researchers need to address how ADHD affects each subgroup are affected by ADHD and get exact models that can handle the challenge and thus get the appropriate medication for each sub-group, either cultural, racial, or family. Scholars also need to critically examine how genes and environment interaction effects, and other factors are associated with ADHD and how they can be delineated from other forms of normal activities.

Conclusion

In general, ADHD is one of the common psychiatric disorders among children, especially in boys. Even though the condition might be present in girls and adults, portraying almost the same characteristics or symptoms across all genders. Most commonly, ADHD patients portray abnormal behavior, through the use of the following criteria: the patient must portray symptoms that interfere with school, home, or work life, present in two or more settings, and lastly, present before the age of 12 years, in diagnostic of this disorder. The neurobiological and environmental factors have also been profound in causing ADHD, thus requiring a systematic method to address how these factors affect the treatment guidelines. Culture and social factors have also been found significant in determining the type of mental illness and mental health institutions in a region. Most importantly, the treatment of ADHD revolves around stimulants, non-stimulants, and psychosocial interventions; although some of these methods have not been effective, they help in reducing inattention and hyperactivity and thus improving functioning. However, due to some interventions' failure, ADHD nurses need to get higher education to place them better in addressing this disorder and eliminate much of the current controversies.

References

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Cabral, M. D. I., Liu, S., & Soares, N. (2020). Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Translational pediatrics, 9(Suppl 1), S104.

Corral, M. D. R. G., & Hernández, P. S. (2018). ADHD: neurobiological Basis and Social Aspects. MERIDIeS: revista de investigación científica para alumnos de enseñanza secundaria, 17, 81-90.

Cortese, S., & Coghill, D. (2018). Twenty years of research on attention-deficit/hyperactivity disorder (ADHD): looking back, looking forward. Evidence-based mental health, 21(4), 173-176.

Fairman, K. A., Peckham, A. M., & Sclar, D. A. (2020). Diagnosis and treatment of ADHD in the United States: Update by gender and race. Journal of attention disorders, 24(1), 10-19.

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Public Health Program Planning & Implementation

Introduction

Overview

Suicide is common in Sevier County Utah, and it was the number one cause of death for community members ages 10-24, and the suicide rate in central Utah was 32 per 100,000 in 2019 (Utah Department of Health, 2020(UDOH), 2020). Some of the root causes are other family members and friends have committed suicide, Utah has a large number of guns in households. Religious beliefs, of the Latter-Day Saints, and other religions shame people for having a sexual orientation other than heterosexual. Drug and Alcohol abuse is commonly associated with suicide, and this is due to poor mental health treatments.

With these high rates, it leaves people to wonder about the happenings but according to research, it shows there are several reasons, such as mental health, attitudes, and religion. The methods of suicide include the use of firearms, hanging, and poisoning. The goal is to reduce suicide and attempted suicides, which will help the overall health of the entire population in Utah. Suicide is a vicious circle that leaves many healthy people dead, and the people who care for and love the victim of suicide pick up the pieces of their shattered lives due to the mental health problems that plague our communities.

Once the program is implemented it will increase the knowledge of the facility and staff about risk factors associated with suicide, how to respond to students about suicide, and identify students who may be at risk for suicide. Most importantly is to ingrain in children to seek help before suicide becomes an issue, and be able to ask for help learning to self-regulate their feelings and share their feelings. Middle schools currently have suicide prevention programs, so this is not new, only the introduction to elementary school new. Utah has money for $ 500 in grant money that will be allocated to each elementary school for suicide prevention (Utah State Legislature, 2021)

Interviewing Stakeholders and Key Informants for Planning and Implementation

Programs such as Yellow Ribbon ask 4-help use a method that makes it easy for the targeted youths to seek help. Therefore, there is a need to engage various stakeholders through interviews intended to assess if the program is making the impact and possible changes that would lead to more acceptance in the society. Further, the planning should be based on feedback and suggestions collected during the interview. Therefore, there should be progressive engagements through interviews to ensure proper planning and implementation.

When engaging stakeholders, it will be significant to consider people who are against having guns. Many people think the way to gun control is to get rid of guns, limit access to guns, or put tight restrictions on guns. Their voice should be heard because many of the people, who oppose having guns are victims of gun violence. They would be considered stakeholders because they are members of the community or public and taxpayers. Yet, I appear in agreeance with you on guns. Guns are not going anywhere but up; more and more people are purchasing firearms, and it is better to be aware and educated on the usage of firearms. Plus, furthermore and it has been shown that half of the people who commit violent gun crimes do not meet any prohibiting conditions (Webster, & Wintemute, 2015) and most deaths from firearms are from suicide and not homicides in the past 30 years and that homicides have decreased and suicides for increased (Wintemute, 2015).

Barriers to Service

Some of the barriers are people have become accepting of suicide as a means of death, committing suicide has become a cultural norm and an acceptable way to deal with life. Having ready access to guns is over 50 percent of the cause of death by suicide. Utah has an open carry for handguns, and many people use guns for hunting, becoming culturally acceptable to leave guns not locked or guns are left loaded and ready for action. Mental Health treatment is not diverse, in small communities, everyone knows everyone, and church and the school have no separation, making people less likely to seek help when needed.

Problem Statement of the Study

 Suicide runs in families, yet many people keep silent on the facts that lead to suicide. When young people commit suicide, it takes away from the communities to see needed changes to make a life where everyone can feel loved and accepted. Poor gun handling and corrupt licensing have led to the presence of illegal firearms in the hands of children. As a result, there is an increasing trend of unintentional shooting. Lack of training and knowledge in firearms handling has eased incidences of suicide using guns.

Methodology

Theoretical Orientations to Types of Program Designs.

Proposed solutions to prevent suicide, is to ensure that children feel loved, and are taught to deal with stress positively. Raise awareness about suicide, starting at a young age, teach children to share their feelings, and let them know it all right to be different. Enforce gun safety, implement policies that prohibit loaded guns, teach gun safety, because if teachers can have guns in schoolchildren need to be aware of the capabilities and proper ways to handle guns. Implement mental health programs and screening for suicide ideology, would help get to the root causes of suicide before it becomes a reality.

Project Goals and Impact Objectives

The first goal and in reducing suicides and attempted suicides is by helping our elementary children deal with mental health issues and learn to self-regulate and share their feelings. Studies show that such programs like the "Yellow Ribbon ask 4-help" have reduced and helped children and parents deal with suicide (Ross, 2019; Hoover & Mayworm, 2017). The idea is to reach children in their adolescence to seek help before suicide becomes the issue (Schmidt, et.al 2015). Prevention is better than cure and taking caution at early stages will save many lives.

 Through these services, the mental health educator will train teachers, how to present classes, and teach Yellow Ribbon to ask 4-help curriculum in schools. The initial training program will focus on a designated teacher and caregiver who will undergo 3 hours of training and is given yearly. The two will be trained and become trainers of the other teachers and children on how to deal with their feelings, fears, and emotions. Building a strong sense of self-worth, and how to identify people they can trust with their feelings, and knowing when to ask for help for themselves or others.

The objective of formulating and implementation of the Yellow Ribbon ask 4-help program before the end of the 2020/2021 academic year will be to target elementary schools in Sevier County Utah. It is projected that the program will have a positive impact on children. The targeted results will be to reduce fear and suicide mentality by 75 percent among children. Therefore, the objective will be to change the children’s fear and build self-confidence and be outspoken when they need help. It will increase the rate of reporting and helping their friends in reporting incidents instead of keeping to themselves and fuel suicidal thoughts. As a result, the intensity of the suicide intervention program will be significant.

The second goal is gun control because people use guns to commit suicide more than any other method, this can be done through gun safety training that includes parents, this can be implemented through and become part of the yearly hunter safety program, to include children that don't hunt, yet will receive a certificate of completion. Research shows that gun ownership, increases 26.9 percent in the youth suicide rate, (Boston University School of Medicine, 2019). Safety training among children will play a significant role in reducing unintentional gun accidents. Guns will not be in the wrong hands or held carelessly when children are involved.   

The objective would be to ensure that all children and parents who own guns, attend a gun safety course, and become certified to hunt safely as required by hunting regulations. The program would be implemented by hunting season, which starts in August and runs through November. This will include an updated gun safety program, including all people who will want to attend, and it will be like a sporting event like golf or bowling. Reducing the rate of gun death by suicide by 50 percent in the first year.

The third goal is to offer free telehealth programs in rural Sevier County Utah that can be accessed through libraries or home computers. This will help and protect individuals, who feel they need help but do not have local mental health care providers they can trust, and who are not biased. The statistic shows that 80–90% of people who attempted or committed suicide had depression (Shahtahmasebi, 2013). With telehealth, people will be able to remain anonymous to their family and peers and be able to pick a counselor that is more appealing to their needs, such as lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) issues without bias.

 The objective is to have a computer with access to telehealth providers in libraries and ensure that people know how to access home computers or cell phones to make the connection for counseling, this can be done within 6 months, inform the community about the available access, which will be free. Such plans will help to cut down the suicide rates by at least 25 percent within the first year of access.

Methods and Timelines Chart Activity

                                        Evaluation

A proposal on suicide prevention has been submitted, and will be reviewed for funding and because part of the funder's concerns will be if my proposal meets ethical responsibilities because information gained through my plan will be used for research purposes to show that it is working at reducing suicide. Therefore, when following up on the proposal will include sending an email addressing how the health plan will meet ethical and federal guidelines that meet informed consent from participants in my planned proposal by the institutional review boards (IRBs).

There will be also an executive summary of the plan proposal and a graph or a chart that is easy to understand the program; because it can influence and gain more attention when making the final decisions on if they will adopt the plan (Issel, 2013).  The second important thing is to keep the funder informed about the program. There will be quarterly newsletters on the outcomes, of the program to include items that are directly affected by the program even if they do not precisely in preventing suicide, such as how getting children in touch with their feelings, and the ability to ask hard questions also prevents bullying in the schools.

In addition, the program will also include how training programs for teachers and others who attend the training feel about the training by documenting the results on questioners to be shared with the funders. Keep in constant touch with the funders and letting them know how the program provides benefits, not just suicide alone will help keep the funders interested and want to donate more in the following years.  Another thing would be to compare your program to other programs and point out the differences and what is the same, always looking for improvement and fill in the gaps that are missing through guided research.

To evaluate the program all participants will complete pre and post-tests for knowledge and awareness of identifying risk factors, and training students about how to share their feelings, not only about suicide but also about other mental health issues. Furthermore, all volunteers in the program must pass the free suicide training offered monthly by the National Alliance of Mental in Utah.

In the Yellow Ribbon, ask 4-help program data shows that help-seeking from a crisis hotline, which increased from 2.1% to 6.9%, (Brooks et.al, 2009) in high school students, other reports were insignificant, yet awareness about suicide is hard to collect data, and any education that gives hope to less suicide is beneficial. Data used from using the helpline that is included in the curriculum, as part of the program will give information on how many people in the area use the hotline to prevent suicide, through area codes used in the area.

Budget

Through grants and the Utah State Education funds paying the wage of the Social Worker, leaves the amount of 19,153.00. The remaining amount of money can be raised through individual or corporate donations. Suicide touches the lives of everyone, and in rural communities, where everyone knows everyone else finding contributions should not be a problem. The study will use a Private Researcher to collect and send all data for suicide prevention.

References

American Foundation for Suicide Prevention (AFSP), (2021) Research Grant Information, Pilot           Innovation Grants. Retrieved at https://afsp.org/research-grant-information#grant-cycle-    2020---2021

Boston University School of Medicine. (2019, January 17). U.S. youth suicides more prevalent    in states with higher gun ownership, study finds: On average, three youths between 10-       and 19-years old die by firearm-related suicide every day. ScienceDaily. Retrieved February 2, 2021, from www.sciencedaily.com/releases/2019/01/190117090446.htm

Brooks, D., Wright, C. Emme, D., (2009) Yellow Ribbon Suicide Prevention Program, Office of Suicide Prevention at the Colorado Department of Public Health and Environment. Grant # 09000050, retrieved at https://www.YellowRbn_Tlbk_Elem_Preview.pdf

Hoover, S. A., & Mayworm, A. M. (2017). The benefits of school mental health. In Handbook of             rural school mental health (pp. 3-16). Springer, Cham.

Issel, L. M. (2013). Health program planning and evaluation: A practical, systematic     approach for community health (3rd ed.). Retrieved from             https://www.vitalsource.com

Krisberg, K. (2017). Few gun owners get safety training. The Nation’s Health, 8, 21.       

Lu, M. W., Woodside, K. I., Chisholm, T. L., & Ward, M. F. (2014). Making connections:           Suicide prevention and the use of technology with rural veterans. Journal of Rural             Mental Health, 38(2), 98–108. https://doi-org.proxy-      library.ashford.edu/10.1037/rmh0000021 

Ross, M. (2019). Suicide prevention methods within a modern-day society: focusing on mental    health in our school prevention programs.

Schmidt, R. C., Iachini, A. L., George, M., Koller, J., & Weist, M. (2015). Integrating a Suicide   Prevention Program into a School Mental Health System: A Case Example from a Rural         School District. Children & Schools, 37(1), 18–26.

Shahtahmasebi, S. (2013). Examining the Claim that 80-90% of Suicide Cases Had Depression.   Frontiers in public health, 1, 62. https://doi.org/10.3389/fpubh.2013.00062  

Utah Department of Health (UDOH), (2020) Public Health Indicator-Based Information System,             Report of Suicide, retrieved at             https://ibis.health.utah.gov/ibisphview/indicator/view/SuicDth.LHD.html

Utah State Legislature, (2021) 53F-5-206. Grant awards for elementary suicide prevention          programs. Retrieved at https://le.utah.gov/xcode/Title53F/Chapter5/53F-5-    S206.html?v=C53F- 5-S206_2018032220180322

Yellow Ribbon Suicide Prevention Program, (2021) Training Programs, and custom printing,     retrieved at https://yellowribbon.org/what-we-do/training-programs/adult-gatekeeper-            training.html

Health Care Staff Problem and Remedies

In health care, the essential role is to maintain or sometimes improve patients' health in the health care unit. This is attained by preventing diseases, diagnosing the patients' conditions, treatment, and recovery of the patient’s ailment through medication.  The health care unit is founded by doctors, nurses, and other medical professional services. This requires the availability of this experienced personnel and facilities essential in providing medical services to the patients. Diagnosis is critical to the physical and examination of the patients before administering the medication required. The staffing of hospitals is one of the essential tools in the health care services where the patients need the attention of health care personnel for the diagnosis, treatment, and medication. The staff, that is, nurses and other medical staff, face many issues when in the line of duty. This problem includes a shortage of staff, long working hours for medical personnel, hazardous workplaces, and bullying and harassment in the working environment.

The shortage of staff in hospitals has proven to be the most pressing issue in the health care services where the nurses and doctors have been in low supply to the patients available. The shortage of medical personnel worldwide of the global problems in health care; the deficit has attributed to over seven million health workers worldwide (Aithal, & Aithal, 2017). The obligation concerning various healthcare departments' specialists includes cardio surgeon, cardiology nurse’s neural surgeon. The shortage in the health care staff has increased the risk in the continuity of microbial infection, the resistance of patients to these diseases, and the economic impact of conditions on a nation.

The shortage of health care workers has led to them working long hours to cope with the long list of patients in need of their attention. These workers' operation in long hours reduces their efficiency because of being exposed to stress for a long time, making their body and mind tired (Dixit, V., & Ghosh, S. (2019). The health care unit requires the doctors and nurses to respond faster to the patients' needs as failure may lead to the death or worsening of their situation, sometimes delayed response may cause the patient's conditions to be irreversible. The urgency in the health care needs all the staff and other medical staff in their right state of mind to provide these services to the patients. The opposite is correct for health care as they work for long hours in a stressful environment reducing their efficiency as they are exposed to a patient with a different mindset and stress.

The shortage and stress in the health care workers are not only the issue with the but also their exposure to the microbial bacteria and pathogens in the hospitals as they take care of the patients. Health care workers are the first line of defense when a nation is attacked by any biological disease exposed to these bacteria and conditions as they interact with the patients (Park, et al., 2019). This makes the health workers at high risk of contaminating the diseases even before the disease and the causative agent have been identified to determine the disease's treatment. This exposes the staff to various pathogens, making their working environment hazardous and harmful to all these workers' well-being in health care. Sometimes the nurses and doctors lack the required protective gear to protect them from these pathogens exposure to prevent them from getting infected.

Health care workers involved in the health issues suffer from bullying and discrimination concerning their diagnosis and the patient's and family members' beliefs. Health workers face stigmatization such as harassment and violence from inside their working environment and outside where they are discriminated against (Dye, et al. 2020). They are distinguished in terms of their long working hours, having distress psychological and physically in terms of fatigue associated with long working hours making them appear anti-social. The cases of violence and harassment among workers worldwide are reported to be directed to the health care workers. COVID 19 has accelerated the stigmatization of the health care workers where they were exposed to violence; these cases of stigmatization and violence increase the level of stress and psychological resulting in moral injuries.

Remedies

The shortage of healthcare staff has arisen as an issue in the health care unit where remedies in the sectors have been undertaken to ensure coverage of this shortage. The lack of nurses and other medical staff can be solved through adequate funding of the sector and nurses to motivate them to get into the industry, adequate training of the medical personnel and other medical staff (Abubakar, et al. 2018). To solve the medical staff shortage, countries such as Nigeria have medical tourism where medical staff is attracted to the government to promote their health sector. They develop machines and equipment essential for diagnosing various diseases such as cancer, chemotherapy to cancerous cells, kidney transplant, and chronic diseases.  This reduces healthcare costs as they move to countries where they lack development, meeting their health care at low cost.

The medical staff's cases are exposed to pathogens, bacteria, and viruses equipped with the appropriate gears, especially for the COVID 19, where it’s a necessary protection for their health from the virus. Health care safety can be attained by providing relevant information about the diseases and pathogens, and viruses in place to enable them to take the right measures in protecting themselves (Ali, et al. 2020). The information is relevant where the details about a particular disease and its causative agent are known, making the taking of measures easier. The case of unknown viruses and bacterial illness requires that the medical staff have protective gears needed to protect them from the virus before acquiring the relevant knowledge about the virus. Being the leaders in the corona fight, the health care worker has to have protective gear to protect them from the virus and other pathogens.

The decree to increase the number of health care workers is one of the measures to reduce the cases of these workers working for long workers and reducing stigmatization and violence against health workers. The subject of violence is solved by developing policies and workers organizations fighting against the violence against female workers and health care workers (George, et al., 2020). This reduces the stress and trauma associated with this stigmatization and violence, which increases the productivity of these health workers as their environment is made more conducive. Education provided to the citizens on the effect of stigmatization and the need to treat everyone with respect and equality makes these cases reduce as people learn the impact of their actions.

The ethical implication on the remedies on the case involving medical staff and the issue affecting them will help determine how the team will work and respond to their needs. The need to respond to the patient's need fast can be solved by increasing the health care workers, which reduces their working hours, increasing their efficiency and effectiveness in their work. Stigmatization and violence eradication help minimize this worker's psychological stress, making their working environment more conducive. In most cases where workers' health has involved information on the diseases, and causative agent helps reduce infection to the workers and the protective gears.

References

Aithal, A., & Aithal, P. S. (2017). ABCD Analysis of Task Shifting–An optimum Alternative Solution to Professional Healthcare Personnel Shortage. International Journal of Health Sciences and Pharmacy (IJHSP), 1(2), 36-51.

Dixit, V., & Ghosh, S. (2019). Analyze Impact of Occupational Stress in Healthcare Professionals: A Critical Review. Invertis Journal of Management, 11(1), 30-37.

Park, S. Y., Lee, J. S., Son, J. S., Ko, J. H., Peck, K. R., Jung, Y., ... & Shi, H. (2019). Post-exposure prophylaxis for Middle East respiratory syndrome in healthcare workers. Journal of Hospital Infection, 101(1), 42-46.

Dye, T. D., Alcantara, L., Siddiqi, S., Barbosu, M., Sharma, S., Panko, T., & Pressman, E. (2020). Risk of COVID-19-related bullying, harassment and stigma among healthcare workers: an analytical cross-sectional global study. BMJ open, 10(12), e046620.

Abubakar, M., Basiru, S., Oluyemi, J., Abdulateef, R., Atolagbe, E., Adejoke, J., & Kadiri, K. (2018). Medical tourism in Nigeria: Challenges and remedies to health care system development. International Journal of Development and Management Review, 13(1).

Ali, S., Noreen, S., Farooq, I., Bugshan, A., & Vohra, F. (2020). Risk assessment of healthcare workers at the frontline against COVID-19. Pakistan Journal of Medical Sciences, 36(COVID19-S4), S99.

George, A. S., McConville, F. E., de Vries, S., Nigenda, G., Sarfraz, S., & McIsaac, M. (2020). Violence against female health workers is tip of iceberg of gender power imbalances. bmj, 371.

Patient Protection and Affordable Care Act

Four Improvements for Patients with Private Insurance

 The patient protection and CA assisted numerous people to get health insurance coverage because it reinforced the medical system. With the establishment of ACA, patients with private insurance policies received lowered premiums and even cost-sharing was made possible. For instance, senior citizens and people with disabilities were registered for the medical program. Also, in terms of purchasing a prescription, most of the patients received discounted drugs (Chu et al., 2020). One of the central roles of ACA is to ensure all Americans because it is unconstitutional to remain uncovered due to insurance cover. Also, the ACA put in place medical insurance market spaces such as health.gov websites to monitor people who registered and applied for medical insurance cover. Despite overpriced private prices, ACA was able to increase the number of people with insurance medical cover. Hence, medical premiums were more competitive due to the reduced prices.

Impact of ACA and the Success

 One of the main reasons for high rates of premium is that ACA enabled more than 20million people to acquire medical insurance and eliminated the pre-existing prerequisite required for the legislative clause. In the meantime, the increasing number of insured people increased the risk pool as people were forced to cover costly medical conditions (Ibrahim et al., 2020). One failure of ACA is the expensive taxes to support most of the ACA expenses that came as a result of the medical plan. In terms of success, it was one of the most consistent and impactful health plans ever seen. The consequential due to its inclusive plan reformed agenda due to increased insurance coverage through cost-sharing. Additionally, it reformed the laws with the primarily accommodated more patients with chronic illnesses.

References

Chu, Q. D., Li, T., Hsieh, M. C., Yi, Y., Gibbs, J. F., Lyons III, J. M., & Wu, X. C. (2020). Positive impact of the Patient Protection and Affordable Care Act Medicaid expansion on Louisiana women with breast cancer. Cancer.

Ibrahim, A. M., Nuliyalu, U., Lawton, E. J., O’Neil, S., Dimick, J. B., Gulseren, B., ... & Ryan, A. M. (2020). Evaluation of US Hospital Episode Spending for Acute Inpatient Conditions After the Patient Protection and Affordable Care Act. JAMA network open, 3(11), e2023926-e2023926.

 Effective Treatment of Veterans with PTSD: Comparison Between Intensive Daily and Weekly EMDR Approaches

Introduction

The United States army has participated in many multinational missions worldwide since the Second World War. Most of the soldiers deployed went through and continue to undergo potentially traumatizing events that had not been part of their experience. From the time the Second World War and the Gulf War ended, events like recovering semi-decayed bodies from mass graves, the dangers of being injured, and even death from suicide bombers and planted explosive devices severely affected the mental health of the soldiers and ability to continue serving in the military. For this reason, research into trauma-related disorders like Post-Traumatic Stress have been intensified. PTSD is a devastating and debilitating psychiatric disorder that may develop after a patient has experienced a life-threatening situation (APA, 2013). A population at significantly increased risk for PTSD in veterans who have experienced combat or other life-threatening events. According to the National Center for PTSD (2018), the prevalence of PTSD is between 11% and 30% for veterans, depending on the service era. The prevalence is the greatest in veterans who served in the Vietnam War. In the study, “Effective Treatment of Veterans with PTSD: Comparison between Intensive Daily and Weekly EMDR Approaches,” Hurley (2018) evaluates the effectiveness of Eye Movement Desensitization And Reprocessing (EMDR) in treating veteran patients with PTSD.

Designed by F. Shapiro in 1988, EMDR is a therapeutic technique with over three decades of research and established evidence-based benefit in treating PTSD (Shapiro, 1989). This therapy involves focusing on the sound or hand movements while the affected individual talks about the traumas they underwent.  Negative thoughts, feelings, and behaviors result from unprocessed memories. By having a patient focus on bilateral stimulation, they will surface traumatic memories and become less distressed by those images. Shapiro developed an eight-stage process for EMDR, which is completed over a series of 60-90 minutes. In this study, Hurley (2018) aims to determine whether  EMDR therapy administered twice daily is as effective as EMDR therapy administered weekly for 18–20 sessions and whether the treatment outcome persists (Hurley, 2018).

Background

            In this study, 30 veterans were randomly assigned to two groups of 15. Participants were screened by mental health providers and met tested positive for PTSD. One group was treated with EMDR daily, and the other group was treated with EMDR weekly, with Both groups having the same number of total sessions. Both the weekly and daily EMDR groups were treated with the standard EMDR protocol established in 2005. In the daily intensive treatment group, the most distressing memories were targeted during the morning sessions. The afternoon sessions targeted residual materials remaining from the morning session and helped the participants attain stability and calmness before ending the day. An essential difference between the two treatment groups is that the group that took daily sessions had an extended closing period to ensure the client's self-regulation and stability. The weekly treatment group did not receive this as this group's treatment schedule was not intense (Hurley, 2018). There were three points in the study where all participants were evaluated. They were first evaluated pre-treatment, post-treatment, and 1-year follow-up.

State of the Science

The study addressed the first question of whether EMDR therapy administered twice daily has a positive effect on veterans' PTSD symptoms. This study demonstrated that daily intensive EMDR and weekly EMDR produced statistically significant PTSD symptom reduction (Hurley, 2018). Additionally, the results also showed the following changes in The Impact of Event Scale-Revised (IES-R) scores. IES-R was mainly designed as a measure of post-traumatic stress disorder.  In the daily intensive treatment group, the mean IES-R score changed from 53.20 to 17.40. In the group that took weekly treatment, the mean IES-R score changed from 51.80 to 16.07 (Hurley, 2018). This provided evidence for the second research question. The therapy administered twice daily provides equivalent outcome results as administered weekly for 18–20 sessions, as measured by the IES-R. Based on the study results, it was concluded that both daily intensive and weekly EMDR produced approximately equal outcome results.

Significance to Clinical Psych Practice

PTSD is a highly prevalent disorder precisely in veterans. It is essential that screening and close monitoring be done in this population since they are at a greater risk. EMDR has proven to be the most effective means of treating PTSD; therefore, it is essential to note that both nursing students and active nurses can help combat the growing menace. Nurses also note that many of the techniques utilized in EMDR can be performed even if a nurse isn't trained in EMDR. Many of the techniques integral to EMDR, such as mindful breathing, body scanning, and appropriate history taking, can be incorporated by a nurse into their clinical practice. Nurses screening for PTSD can use structured interviews, self-report measures, and multiscale personality entries. The most recommended criteria are structured interviews, which can assess all other associated disorders.

Recommendations/Nursing Considerations

It is challenging to diagnose PTSD because the symptoms are closely related to other psychological disorders. However, with proper training, nurses and other medical practitioners, licensed counselors, and psychiatric mental health nurse practitioners (PMHNPs) can efficiently conduct PTSD interventions. Some of the ways nurses can intervene at the bedside at local hospitals include cognitive therapy, exposure therapy that helps patients reduce flashbacks and nightmares, and psychopharmacology. This entails the use of anti-anxiety drugs and antidepressant drugs. Additional training can help expand skills and career opportunities for active nurses to prepare to carry out nursing interventions for PTSD. EMDR is still recommended in the future due to its effectiveness in treating conditions that have been unsuccessful before.

 Cognitive therapy is a medication that assists patients to identify and alter hypothetically destructive thinking patterns such as fear and trauma. Cognitive therapy is centered on teaching patients on assessing and changing disturbing thoughts that occur after trauma. As the patients change thoughts, the emotions also change. Most of the time, trauma alters thinking patterns. These negative thinking patterns are the underlying reasons for the sustenance and prevalence of PTSD (Center, 2018). Through the application of cognitive therapy, the nurse can help a patient acquire skills that could assist them to control their thoughts. The role of the nurse is to create a connection between mannerisms and thinking patterns. More so, cognitive therapy aims to better a patient's functionality through altering the thinking patterns. It is one of the most effective treatment because it assumes that betterment in one domain leads to the improvement of another one. For instance, accepting positive thoughts leads to proper behavior.

 Apart from cognitive therapy, exposure therapy is used to assists PTSD patients minimize recurrences and hallucinations. Through exposure therapy, the patient is exposed to situations that previously triggered PTSD circumstances and reminiscences until a point where the patient can comfortably cope with the situations. Exposures might be actual or even fictional. Virtual reality technological devices could be used to bring about exposure therapy. Subsequently, eye motions and recovery are combined with exposure therapy. The nurse normally observes eye motions to assist patients process shocking recollections and at the same time control the outcomes. Eye motion desensitizations and reprocessing (EMDR) are used to capture hurtful feelings, recollections, and other types of stress that the patient might have experienced in the past. In the end, the nurse has to process these experiences in a constructive way that relieves the patient from PTSD symptoms (Center, 2018). Most of the time, after PTSD, the patients might find it hard to regain their normal routine after suffering from PTSD. At this point, the patient might develop a negative perception of the entire world. These thoughts can prevent a patient from fully recovering and continuing with normal life. this intervention teaches the patient new methods for handling disturbing thoughts and ways of developing more positive thoughts towards the world and immediate surroundings. For the most part, the nurse normally encourages close family members to come and engage the patient more productively. For instance, the family might form new routines for the family members. Also, the patient’s family members are meant to shape the immediate surrounding of the patient and affirmatively help to bring meaning back to the life of the patient. Some of the chances of bringing into place the effectively needs proper training and observation.

 The first phase entails assessing patient intial history and designing the medication. During this phase the therapist can take 1-2 sessions. From the patient’s history, the therapist can create  or design a medication plan. The second phase is centered on preparation. Normally, it would take 1-4 sittings depending on the severity of the condition. the third phase is dominated with assessment of the patient’s details as the therapist is forced to separately evaluate fact in a manageable and standardized manner (Menon, & Jayan, 2010). The forth phase is about desensitization where the therapist assesss the patient’s destructive emotions and thoughts through SUD ratings hence the patient’s reaction are captured in detail. additionally, the fifth phase is known as installation. The aim of the installation pahse is to increase the impact positive thoughts have on the patient. the sixth phase is the body scan which occurs after ascertaining that the patient only thinks positive thoughts. Phase 7 is the closure section. Closure ensures that the client has improved in each and every aspect after undergoing the therapy. The eighth phase is the reevaluation phase and it directs the therapist through medication plans required to handle the patient’s main challenges. The significance of EMDR is based on conditioning ideologies hence the negative thoughts are replaced with positive thoughts. Therefore, the procedure is reliable and effective

 The nurse has to offer social support to the patient and their close relatives. It is mutual for individuals suffering from PTSD to isolate themselves from relatives and close friends (Center, 2018). This is because the patients might not want to burden their relatives with their issues. even though it is vital to respect others, the nurse has to step in and ensure that the connection between the patient and the rest of his or her relatives and close friends. It is vital to note that the nurse should not pressure a PTSD patient into doing things that he or she does not want to do. This way, the PTD patient will learn to express his experiences in a laid back manner that would be beneficial for his wellbeing and other things and intuitiveness.

Summary

            Post-traumatic stress disorder is a prevalent and debilitating psychiatric condition that may develop following life-threatening events. One of the most promising therapies is eye movement desensitization and reprocessing. This study considered EMDR particularly in the veteran population, which is at increased risk for PTSD. It demonstrated that EMDR produces significantly improved symptoms in veterans suffering PTSD, even those whose symptoms have been refractory to other forms of therapy and psychopharmacology. The statistically significant benefits also proved to be maintained after long-term follow-up. EMDR is a treatment modality that requires minimal resources, is cost-effective, and can be performed at the bedside. Nurses in the clinical psychiatric practice must be aware of PTSD and the benefits of EMDR. Many of the components of the 8 phases of EMDR could easily be incorporated into nursing care. If more nurses were trained in EMDR, it might revolutionize the field of clinical psychiatry. It is evident that EMDR is an effective method, with an increase in mental health cases primarily caused by the pandemic, the number of cases may continue to rise. Nursing courses and curriculum should be designed to incorporate a course or a unit to train EMDR to all students to deal with the rising menace.

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. pp. 271–80. ISBN 978-0-89042-555-8.

Hurley, E.C. (2018). Effective treatment of veterans with PTSD: Comparison between intensive daily and weekly EMDR approaches. Frontiers in psychology, 9, 1458.

National Center for PTSD (2018). PTSD Basics. U.S. Department of Veterans Affairs. Retrieved from https://www.ptsd.va.gov/understand/what/ptsd_basics.asp

Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress. 2 (2): 199–223.

Center, S. (2018). Effective Treatment of Veterans With PTSD: Comparison Between Intensive Daily and Weekly EMDR Approaches. Retrieved 11 February 2021, from https://www.frontiersin.org/articles/10.3389/fpsyg.2018.01458/full.

Menon, S. B., & Jayan, C. (2010). Eye movement desensitization and reprocessing: A conceptual framework. Indian journal of psychological medicine, 32(2), 136-140.