Health insurance

Plan to purchase health insurance for 50 employees.

The best approach to offer insurance to employees is through the Health Maintenance organizations. The organizations bear the responsibility of providing medical care to company employees. The company can create a system where the cost of the health insurance with its employees (Felman, 2018). An agreed amount can be deducted directly from the employee’s salaries to cater for the insurance. The company will also add to the money deducted from employees so as to ensure that they have a better insurance cover. The company will be responsible for representing the employees to the health maintenance organizations to ensure that the best terms are agreed upon.

Impact of employee lifestyle choices

Employees lifestyles determine various factors when choosing health insurance, among which is the type of insurance cover to choose. The financial aspect of employees’ lifestyle for instance will determine whether they are able to afford the insurance cover plan suggested by the company(Felman, 2018). In addition, the lifestyle will determine the frequency in which the employees need medical assistance as well as the nature of treatments offered. Employees who work in high risk environment are more likely to require medical care. Life choices and health economics will therefore determine whether the company should opt for low costing health insurance or cheaper ones.

Implications of the affordable care act.

The Affordable care act seeks to ensure that all citizens can get access to good quality care at a relatively low price. Since its introduction, the Act has helped to improve the quality of health and access to medical care (Courtemache et al, 2018). Medical insurance has become more affordable and the government has introduced policies such as Medicaid that help people access medical care regardless of their financial capabilities. The affordable care act has also increased people’s life expectancy and reduced mental illnesses. Access to better medical care translates to high life expectancy as people are more committed and have the means to protect their health and mental wellbeing.

Advantages of private health insurance over government health insurance

One advantage that private health insurance has over insurance provided by the government is that private health has shorter waiting periods for patients. Take the case for elective surgery as an example. Patients with private health insurance covers spend shorter periods on waiting lists for elective surgery compared to those with government insurance (Seeto, 2020). Private health insurance is therefore ideal for employees as it will ensure that they get the treatment they need in advance and in so doing, beat some of the ailments that require fast treatment following infection.

            Another advantage is that private health insurance covers offer more benefits than government insurance policies.  Patients with private health insurance get medical cover among other benefits, and are also treated in their private rooms in hospitals if necessary. Since the government focuses on providing access to medical health to the public, little attention is paid to the patient’s comfort and preference (Seeto, 2020). While most patients under the government insurance policy are likely to be treated in rooms of four, patients with private health insurance enjoy the privacy of being treated in their own rooms.

Disadvantages of private health insurance over government health insurance

One major disadvantage with Private health insurance covers is that they are relatively expensive. Patients have to pay significant amount of money every year and due to the popularity of private insurance, the cost increase yearly.  Another disadvantage is that the insurance does not cover full payment of the cost of treatments and patients often have to pay out of pocket (Seeto, 2020). The insurance covers a certain percentage of the treatment cost. The patient then pays the reminder from their own pocket and this may make the insurance cover rather expensive compared to government insurance covers.

References

Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2018). Effects of the           Affordable Care Act on Health Care Access and Self-Assessed Health after 3   Years. Inquiry : a journal of medical care organization, provision and financing, 55,    46958018796361. https://doi.org/10.1177/0046958018796361

Felman A, (2018) “What is health insurance?” Medical News Today, retrieved from,             https://www.medicalnewstoday.com/articles/323367

Seeto T, (2020) “Pros and cons of private health insurance” Canstar

Insomnia Diagnostic Criteria and Treatment

Introduction

Insomnia is a prevalent medical condition. Insomnia is a collective indication and medical experts require a diagnostic approach which permits them to identify a specific type of treatment. These diagnostic approaches help in the practical management of insomnia among adults and the formation of basic treatment. Insomnia cases tend to advance with age, however, more prevalent among women than men (Daley et al., 2009). Although medical research unveils that older men experience more interrupted periods of sleep, individuals who have broken up, widowed, or alienated suffer from insomnia than any other group of people. Socioeconomic status influences insomnia levels in most people.

June, a 42-year old lady, was referred to a medical institution after doctors diagnosed her with a chronic sleeping disorder. The chronic insomnia affected her daytime productivity and functionality. June is a single parents of four teenagers. She started presenting insomnia symptoms ten years ago when her business enterprise nearly collapsed due to insufficient capital. Even though her business venture recovered six months later, June’s chronic insomnia persisted for a decade. Based on her medical history, June took Temazepam and Zolpidem together with other antidepressants. The medication never improved her condition. June soon threw in the towel due to the devastating side effects of those drugs. The doctors examined her sleeping patterns and daily routines. After assessing both her medical history and sleeping patterns the doctors recommended the following treatment- improving hygiene, minimizing caffeine consumption, sleeping early, avoiding alarm clocks and reading a book whenever she is unable to fall asleep. After eight months, her condition improved.

Insomnia Diagnostic Criteria

 As stated earlier, insomnia is extensively prevalent, usually incapacitating and frugally challenging sleep disturbance triggered by different circumstances, medication, feelings, environmental factors, and behavioral aspects (Roth, 2007). Even though numerous consensually driven nosology has outlined various insomnia phenotypes, investigations about these phenotypes have been disadvantaged due to insufficient operative studies and diagnostic criteria to define the criteria. The lack of standard diagnostic criteria sometimes leads to unreliable findings hence impeding phenotypes due to the variable definitions. For more than 30 years psychiatrists have struggled with an inconsistent diagnostic system which resulted in insignificance and unchecked results. Largely the inconsistencies were due to operative criteria within the diagnostic manuals. Patients suffering from insomnia usually have numerous challenges such as unrefreshing sleep patterns, inability to sleep peacefully or remain asleep for a long period of time. Insomnia duration has vital diagnostic consequences. Transient insomnia lasts for a short duration and results from stressful situations or even some forms of medications. Other minor instances that can cause transient insomnia are jetlag and some rare forms of medical conditions. On the other hand, insomnia which lasts for more than three weeks is said to be chronic and normally triggered by different causes. The symptom duration is vital as it helps in determining the diagnostic variance and assessing secondary challenges, including the practice and misappropriation of alcohol and substance abuse- this can be both causatives and impact chronic insomnia (Taylor et al., 2007). According to medical reports, insomnia affects 10-18% of the entire adult populace worldwide. Opposite to popular belief, irregular sleepless nights are a common phenomenon among many individuals hence insomnia can be persistent or period depending on the underlying problem causing it. In situations where a patient is symptomatic, the medics try to unveil the underlying disorder causing insomnia (Riemann et al., 2017). For more clarity, primary insomnia is connected to medicinal, psychiatric, or environmental issues. Medical experts ought to determine the causative agents of insomnia while keeping in mind the fundamental issues. Addressing short term insomnia through the identification of certain stressors (Cheuk et al., 2012). One of the first steps is identifying and then defining the key sleep symptom- for instance, insomnia, excess sleepiness, or disruptive behavior while sleeping are some of the overlooked sleeping patterns

Treatment options and guidelines

 Adopting better sleeping practices and addressing matters related to insomnia such as stress or underlying medical conditions can reinstate soothing sleep for most of the patients suffering from insomnia. If the above interventions fail, medics may commend cognitive behavioral therapy to assist in improving sleep quality. Cognitive behavioral medication is designed to assist insomnia patients cope or regulate undesirable thoughts and activities which keeps them vigilant at night (Manber et al., 2008). Cognitive behavioral therapy is the first medication patients receive. Normally, more effective than other forms of medication. The cognitive portion of the treatment focuses on identifying and then changing beliefs that negatively impacts a patient’s sleep. It assists a patient eradicate harmful thoughts and anxieties which keeps him or her awake. More so, the medication may involve eradicating harmful sleep patterns. The behavioral portion assists an insomnia patient produce positive sleeping habits and avoid disruptive behaviors at night. In fact, the behavioral portion of the cognitive behavioral treatment, comprise of stimulus control medication which assists patients eradicate elements which causes the mind resistant to sleep.

Neurobiological and Other Influences

As explained above, there is not a definitive insomnia diagnosis. Medics apply various mechanisms to diagnose and interpret the insomnia levels. Insomnia exhausts the brain and incapacitates its ability to carry out key functionalities such as sustaining joyful moods, health status, and high productivity.  During insomnia, the brain loses its ability to focus, innovate, and retain long and short term memories. This negatively impacts the brain usually causes mood swings (Hertenstein, 2017). Consequently, a sleep-deprived person experiences illusions, mania, impulsive mannerisms, unhappiness, mistrust, and forlorn thoughts. Generally, if the brain's functionality is hindered, then other physical aspects of one's life are disrupted.

Previous medical systems centered their research on psychological and behavioral mechanisms for clinical purposes. However, those psychological and behavioral procedures lacked neurobiological specifications. Any insomnia model needs to consider neurobiological aspects before it can be certified effective for the treatment of insomnia. The concurrent occurrence of sleep and rousing neural activities assists in explaining medical phenomenology and medication impacts of insomnia (Morin, & Espie, 2007). Neurobiological mechanisms of assessing insomnia heavily rely on conditioning ideals. Sleep is perceived partly as a conditioned reaction to a stimulant within a sleep surrounding. According to neurobiological aspects, the bedroom is conducive surrounding for inducing sleep. However, under insomnia situations, the bedroom stimulates frustrations and restlessness. Thus, the neurobiological basis forms the regulatory medication in the treatment of chronic insomnia. Therapy tends to try and reconnect the sleep surrounding the stimulus effect it had before insomnia hence the restriction of other activities in the bedroom area. Neurobiological diagnostic approaches lead to examinable medications which can later be verified. In spite of the medical utilities, neurobiological interventions are not effective on their own hence the need to combine these forms of medication with other types of medication.

Insomnia disorder can manifest itself in terms of quantity or quality. The progressive research on comprehending nature, etiology, and other diagnostic features of insomnia has not yet unveiled a standard diagnostic model for the sleeping disorder. The comprehending of insomnia pathophysiology offers medics vital details on conditions, under which the illness develops and how it sustains itself (Ramakrishnan, 2007). Presently, evidence reliant evaluations and medications for insomnia have been formulated. The diagnostic criteria of insomnia are reliant on medical consensus. Extensive advancement is dependent on verified etiology and pathophysiological challenges. Particular frameworks provided through government platforms help in researching insomnia issues within the society.

Insomnia Guidelines

 Insomnia is a significant public health predicament that needs immediate attention and precise diagnosis. The existence of one type of insomnia does not invalidate other conditions. Other disorders may coexist with insomnia. For example, comorbid insomnia can coexist with depression. The primary aim of insomnia medication is to improve sleep quality and duration. This way, the medication improves insomnia related consequences. Besides, insomnia specific results indicate the amount of time one remains awake after waking up and this proves the correlation between staying awake and falling asleep. The balance between sleeping and staying awake should mark the effectiveness of insomnia medical treatment. Each patient should have a sleeping diary where they record sleeping patterns and record any discrepancies experienced each night (Kessler et al., 2011). The formation of a distinctive connection between bedroom and sleeping patterns helps in upgrading sleep-related challenges. It is vital to note that sleep diary details must be gathered before and during active medication and incase the patient relapses into insomnia. Previous medical approaches included one behavioral measure such as incitement control therapy or the combination of mental and stimuli control treatment. The combination of mental and developmental intermediations is effective and commended in the medication of chronic and mild insomnia. These medications are effective for adult patients.

Important Cultural Issues

            Cultural pressures affect sleeping behaviors. Biological clocks influence bedtimes but culture affects waking up time and quality of sleep. Cultural pressures and day to day tasks impact biological clocks and influence sleep duration and patterns. For instance, some cultures praise hard work and sacrifice (Daley et al., 2009). Consequently, people may forego sleep in order to attain success in life. Thus, culture forms a pattern of concepts, customs and traits which in turn affect sleeping patterns. Furthermore, culture affects perspectives on sleep, sickness and even belief systems. How people interpret pain relies heavily on cultural norms. Cultural issues create bias and leads to varied medical preferences and opinions. It is vital to note that cultural competence allows medics to inquire on a patient’s belief system and values. These values and beliefs can then be applied in insomnia treatment and diagnosis. Furthermore, some cultures encourage collectivism- implying that people will welcome beliefs without question.

Cultural norms affect sleep duration and lifestyle. An important element of sleep is assessing sufficient sleeping intervals and the effect of short and long sleeping durations on health. Cultural believes shape the determinants of sleep patterns which are vital for the extension of both health and everyday routine (Roth, 2007). Sleep both a biological function and a behavioral intervention hence cultural sensitivity. Culture can either sensitize the community on the importance of sleep or can dissuade them from normal sleeping patterns. In the end, culture dictates the type of behavior and attitude people will have toward sleep hence influencing the occurrence or rarity of insomnia.  

Different views and perspectives

Even though sleep is a vital biological process, people rarely practice good sleeping habits. Due to acceptable reasons, human culture has paid little to no attention at negative impacts of insomnia. Society is against sleeping pills and other types of medication. Sleeping problems are often overlooked and ignored due to social strains placed upon life. For example, sleeping is associated with laziness or under achievement (Baglioni et al., 2010). Thus patients seek medical advice whenever their conditions worsen. Failure to come up with a standardized diagnostic criteria hinders effectively treatment and advancement in insomnia medication. Insomnia relies on the patient’s account and perspective rather than a specific medication. According to psychologists, improving mood and taking part in constructive work may cure insomnia. On the other hand, for most medics, insomnia is a fundamental indication for numerous illness. Hence, treating the underlying illness will certainly cure insomnia. Thus, medicating an underlying illness may indirectly cure insomnia.

Conclusion    

 In summary, insomnia is a sleeping disorder that affects the amount and quality of sleep one gets each night. The condition can either be chronic or acute and it can also be inconsistent. Acute insomnia lasts for one night or seven days while chronic insomnia lasts for three nights or three months. There are two types of insomnia- primary and secondary. Primary insomnia is not linked to any underlying medical condition while secondary insomnia is directly associated with an underlying medical condition. Primary insomnia is caused by stress-related factors while secondary insomnia is triggered by underlying mental issues such as depression and anxiety. Based on findings from the latest research, sleeping at a specified standard time is recommended for all insomnia patients. A standard sleeping time aligns with the everyday routines of a person's internal clock (Roth, 2007). Evidence also unveils that lack of standard time affects cardiovascular functions of the body hence increasing other risk factors. Having a standard sleeping time. APRNs are advised to observe patient’s sleep patterns and behavior in order to detect effective medication. APRNs also help reset patient’s biological clock. The scope of APRN permits him or her to diagnose, assess and recommend insomnia medication. For example, APRNs influence sleeping time and daily patient routine hence helping in preventing insomnia. These duties allow APRNs to response to overnight stressors, influence patient diet and mental performances.

References

Baglioni, C., Spiegelhalder, K., Lombardo, C., & Riemann, D. (2010). Sleep and emotions: a focus on insomnia. Sleep medicine reviews, 14(4), 227-238.

Cheuk, D. K., Yeung, W. F., Chung, K. F., & Wong, V. (2012). Acupuncture for insomnia. Cochrane database of systematic reviews, (9).

Daley, M., Morin, C. M., LeBlanc, M., Grégoire, J. P., & Savard, J. (2009). The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep, 32(1), 55-64.

Kessler, R. C., Berglund, P. A., Coulouvrat, C., Hajak, G., Roth, T., Shahly, V., ... & Walsh, J. K. (2011). Insomnia and the performance of US workers: results from the America insomnia survey. Sleep, 34(9), 1161-1171.

Manber, R., Edinger, J. D., Gress, J. L., Pedro-Salcedo, M. G. S., Kuo, T. F., & Kalista, T. (2008). Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep, 31(4), 489-495.

Morin, C. M., & Espie, C. A. (2007). Insomnia: A clinical guide to assessment and treatment. Springer Science & Business Media.

Ramakrishnan, K. (2007). Treatment options for insomnia. South African Family Practice, 49(8), 34-41.

Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., ... & Hertenstein, E. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of sleep research, 26(6), 675-700.

Roth, T. (2007). Insomnia: definition, prevalence, etiology, and consequences. Journal of clinical sleep medicine, 3(5 suppl), S7-S10.

Taylor, D. J., Mallory, L. J., Lichstein, K. L., Durrence, H. H., Riedel, B. W., & Bush, A. J. (2007). Comorbidity of chronic insomnia with medical problems. Sleep, 30(2), 213-218.

Importance of Nurse-Sensitive Indicators in Relationship to Patient Outcomes

Selection of a Condition or Disease

            The condition chosen is pressure ulcers. The condition arises among patients when they experience injuries to the skin and its underlying tissue because of prolonged pressure. The condition is also referred to as bedsores. Pressure ulcers often affects skin that covers bony areas of the patient (Peterson et al., 2015). The body parts often affected include hips, tailbones, ankles, and heels. Bedsores is most prevalent in patients that have other underlying medical conditions that make them spend most of their time in the chair or in bed. They often develop in patients within hours or days. Most sores heal with treatment, however some never heal fully. Nursing practitioners can initiate a number of steps to prevent and help patients with pressure ulcers heal.

Identification of Nurse-Sensitive Indicators

            The indicators often reflect three aspects in relation to quality of nursing care. Structural indicators relate to the availability of nursing practitioners, their skill level, and the professional accreditations. Process indicators concerns with measuring patient assessments and interventions, while outcome indicators reflect the outcomes among patients that depends on quality and quantity of nursing care.

            Nursing-sensitive indicators is an increasing area of concern in the acute care setting leading to considerable development in research. The development arises from collaboration between nursing executives and nursing academics. The indicators continue to produce valid and reliable means of improving quality and performance in caring for patients with pressure ulcers within the acute care setting. The indicators are among the variables which practitioners have used to enhance strategies for improving patient outcomes. The nursing practice environment exhibits complexities and variations highlighting importance of the measures, theories, and models. The various reforms and policies within the health sector continues to advocate for development of nursing-sensitive indicators to support implementation of evidence-based practice.

            One process indicator in preventing pressure ulcers among vulnerable elderly patients is risk assessment. The assessment should be done on admission to predict the likelihood of formation of pressure ulcers and form a basis for intervention. If the assessment risk score is high, then a preventive intervention measure is addressing their repositioning needs and management of tissue loads within the first twelve hours to prevent formation of pressure ulcers.

            Another process indicator is nutrition. For example, if a vulnerable elderly patient is judged to be at risk of developing pressure ulcers and has malnutrition, then it is vital to institute a dietary intervention. Poor dietary habit is an independent indicator of developing pressure ulcers among patients requiring acute care. Studies link risk for malnutrition including low caloric intake, involuntary weight loss, low albumin level, anorexia among others and formation of pressure ulcers (Cullen, 2015). They further link the severity of malnutrition and the severity of the ulcers.

            Pressure ulcer evaluation is another process nursing-sensitive quality indicator. For example, if a patient has a pressure ulcer, they should be assessed for location, depth, size, stage, and presence of necrotic tissue. The assessment provides data for later comparison of the healing process and also in predicting healing time. A structural indicator is the management of full-thickness ulcers. If the ulcer does not show no improvement with 4 weeks of administering treatment, then the plan should be assessed for appropriateness and presence of cellulitis.

            Another structural indicator of care is the pressure ulcer debridement. If the patient presents full-thickness trochanteric or sacral ulcer, then the practitioner should perform debridement using an enzymatic, mechanical, or autolytic procedures within three days to remove any dead tissue. Cleaning is another structural indicator that determines patient outcomes. If the patient that requires acute care exhibits a stage 2 or greater sore, then is necessary not to use a topical antiseptic to clean the wound.   

              If a patient that requires acute care has full-thickness pressure ulcer and exhibits signs and symptoms of infection and they do not have another identified cause, then it essential to debride the necrotic tissue within twelve hours (Peterson et al., 2015). The measure will reduce dead tissue which are a medium for bacterial invasion. Finally, the last indicator is topical dressing. In instances where patients needing acute care have a clean partial or full-thickness pressure ulcer, then a moist environment should be available around the wound together with a topical dressing. The reason is to facilitate better healing, because moist environments are the most ideal.

Plan of Care using Nurse-Sensitive Indicators

            Using the indicators in practice will help care for patients holistically to deliver evidence-based and patient-centered care. The indicators of quality care in managing and treating pressure ulcers will facilitate creating a comprehensive care plan. The indicators such as risk assessment and nutrition will help in making early and accurate nursing diagnoses of pressure ulcers. The indicators will also help in achieving the desired outcomes among patients in the acute care setting. For example, it is important to debride the necrotic tissue within the require time frames, not cleaning a stage 2 or greater ulcer with a topical antiseptic, and undertaking comprehensive evaluations to improve patient outcomes. The indicators will also help in improving nursing interventions in managing and treating pressure ulcers. For example, it important to provide a moist wound-healing environment and cleaning with topical antiseptic in instances where patient have a clean full-thickness or partial-thickness pressure ulcer. Finally, the indicators will help in evaluation of the quality of care. Keeping data helps in comparing the healing process and also in predicting outcomes.

References

Cullen, G. E. (2015). Reducing Hospital Acquired Pressure Ulcers in Intensive Care. BMJ Open Quality. Retrieved from doi: 10.1136/bmjquality.u205599.w3015

Peterson, J., Adlard, K., Walti, B., Hayakawa, J., McClean, E., & Feidner, S. C. (2015). Clinical Nurse Specialist Collaboration to Recognize, Prevent, and Treat Pediatric Pressure Ulcers. Clinical Nurse Specialist, 29(5), p. 276-282. Retrieved from doi: 10.1097/NUR.0000000000000135

Safety and Health Program Benefits of Management

 Two safety and health management program benefits of management/leaders walking around

Leaders walking around helps to improve the efficiency of the organization. This is because the management can meet the employees face to face and discuss with them the issues that they may be going through. It is easier for a leader to just enquire about a situation directly from the employees by walking around. This also enables leaders to get feedback from employees which helps them in the decision making processes and acts as a motivation for the employees because they feel included and cared for (Howard 2014). It also speeds up the time in which adjustments in the organizations are made because they do not have to wait for meetings or the right time to address an issue. This increases the employee trust with their leaders which is important in the growth of the organization.

It also ensures that the employees express their commitment to safety for themselves and the other employees. The relationship built between the employee and leader enables them to learn more about what each of them did not know enhancing the safety and health for everyone in the organization. When leaders involve themselves in walking around, it shows that they are passionate about developing a culture of safety in the organization and are willing to engage in effective measures. It removes the idea of leaders seeing and acting on what they want or think is right but they rather get the realistic idea of what is happening (Howard 2014). This method enables the leader to meet the employee in the actual work situation and environment giving them a first -hand experience of the activities taking place. This makes the leader have a clear understanding of the strengths and weaknesses of the organization which helps to make decisions.

Another benefit for leaders walking around is that it creates stronger communication channels improving employee-superior relationships. This method ensures that the leaders improve the way they communicate with the employees. It emphasizes the significance of effective communication in the organization (Mishra 2015). It enables the leaders to learn the art of listening effectively and speaking efficiently to the employees. The improved communication between the leaders and the employees helps to develop an environment that is open to air out their opinions. This method ensures that the leaders do not enforce communication but make it a part of the organization. The regular communication between the leaders and the employee through the walk-around method has shown to improve relationships making the employees feel motivated about their work. The feeling that you and your opinions as an employee are valued by the leaders and the organization helps to boost employee motivation. It also helps to boost employee loyalty towards the organization and its leaders.

The method enhances the regular communication with employees about the status of workplace safety and the related issues (Mishra 2015). It provides the employees with relevant information about the specific related programs concerning their job assignments. The walk around method enables the employees to feel comfortable talking about any safety issues they may be facing and with the leaders they can discuss the solutions. This helps to speed up the implementation process for the solutions discussed. It enables the employees to give responses to the effectiveness of the implemented solution and if it is capable of controlling safety and health risks.

References

Howard, D. M. (2014). Perspectives of Senior Executives on the Benefits of the Fellowship

Experience: Reflections by Douglas Silverstein and Justin Brueck of NorthShore University Health System. The Journal of Health Administration Education, 31(4), 327.

Mishra, S. (2015). Effective communication for corporate sector: A need for a paradigm shift.

Indian Journal of Health and Wellbeing, 6(7), 749.

Part 1

 ″Unnatural Causes Place Matters ″ Dr. David Williams argues that health campaigns focused solely on changing individual behavior are naïve because “the choices of individuals are often limited by the environments in which they live.”

            The community that I reside in has greatly influenced my health choices through various pathways, such as communal stressors, neighborhood resources, and structural factors. A large percentage of my neighbors always stresses on the significance of keeping our buildings and surround yards clean at the time. What this means is that we should ensure that no random trashes should be scattered everywhere. To ensure that those guidelines are adhered to, I always remind my roommates and neighbors about the importance of living in a clean environment free of diseases and other environmental hazards. The main state policies that are implemented within my community include Smart Growth policies and eradication of poverty. Even though my neighborhood makes or formulates better healthy choices, one of the things I would like them to consider is to ensure that they have used water appropriately to avoid wastage. Since each leaver their sprinkler running at least the whole day, it is a clear indication that they are wasting such a precious natural resource. By engaging in a conversation with them, I believe they will change their perspectives regarding the importance of living in a clean environment.   

Part 2

How do you make an unhealthy neighborhood healthy?

            The general availability of opportunities and resources is one of the primary means for transforming an unhealthy neighborhood into a healthy one. Therefore, to ensure that that has been achieved it will be important to ensure that the entire communities have partnered with county government so that structural facilities, such as better houses, schools, hospitals, clean drinking water, dustbins, and so on are available (Hofrichter et al., 2010). Health education should also be provided to educate people about the significance of healthy living standards.

What makes a neighborhood unhealthy to begin with?

            Poor neighborhoods the lack of equitable access to quality healthcare services, well-maintained recreational facilities, and other related infrastructure contribute greatly to making a neighborhood to be unhealthy. When a neighborhood is disadvantaged, its residents are exposed to pollutants, dilapidated housing, and other sources of stress for instance overcrowding, violence, and crime (O'Campo & Dunn, 2012). All of that can be attributed to the formulation and implementation better developmental policies together with community integration.

 What are the challenges involved in trying to improve neighborhood conditions?

            One of the main challenges that are involved when trying to improve neighborhood conditions is the formulation and implementation of poor development policies. As a result of that, policymakers and the community ends up failing to effectively address the problems of the neighborhood distresses (Holsinger & Holsinger, 2012). This is coupled with the lack of wide portfolio for community conscious strategies and programs that can improve neighborhoods simultaneously.

References

Hofrichter, R., & National Association of County & City Health Officials (United States). (2010). Tackling health inequities through public health practice: Theory to action. Oxford University Press

Holsinger, J. W. J., & Holsinger, J. W. (2012). Contemporary Public Health: Principles, Practice, and Policy. Lexington: The University Press of Kentucky.

O'Campo, P., & Dunn, J. R. (2012). Rethinking social epidemiology: Towards a science of change. Dordrecht: Springer Science+Business Media B.V.

INDIGENOUS HEALTH

Abstract

Indigenous health wellbeing of the Indigenous Australians and their communities. This essay explores the impact of colonization on health in Victorian Indigenous populations. Colonization resulted in health disparities for the Indigenous populations causing chronic diseases such as diabetes to become of existence. This was caused by the introduction of western diets for the Indigenous populations who were used to traditional diets and foods. Diabetes in the indigenous population became the second cause of death because, upon colonization, these populations were discriminated against and could not access healthcare which had become very expensive. Due to the low economic status, these populations became disadvantaged in such a way that they were jobless, lacked income and human rights. Their emotional well-being deteriorated upon colonization because of the sexual exploitation by the colonizers, their children were taken away from them and diseases killed their families. This caused a huge impact on their social behavior hence creating barriers. Closing the health care gap between the Indigenous and the non-indigenous has become a challenge for the government and the diabetes cases continue to rise. There have been health promotions interventions that have been developed to educate the Indigenous people about diabetes and ways in which it can be managed. Empowerment, education, self-management, and web-based interventions can help Indigenous people acquire more knowledge about the disease. The Victorian Indigenous population has been targeted because of its historical, political, and cultural impact and outcome of Indigenous health. The health promotion interventions will work towards educating the Indigenous populations on how to live healthier.

Introduction

How does colonization in Australia continue to affect Indigenous health in regards to diabetes? Indigenous health is the holistic wellbeing of indigenous Australians which comprises of their physical, emotional, and social wellbeing. It is also the well-being of the whole community whereby each person can attain their full perspective as a human being. Upon colonization, the indigenous people have experienced inequalities in health, diabetes being one of the diseases that has been introduced. This has been a result of the Victorian Indigenous populations having a low social economic status, living a westernized lifestyle which includes unhealthy diets and lack of easy access to healthcare. Education, self-management, and web-based interventions for diabetes in the indigenous populations can help to improve knowledge about the disease and improve the general well-being of the people.

Health status incorporates factors such as social and emotional well-being and functioning. Social and emotional well-being is indicated by the extent people face stressors in their lives. Upon colonization, the Indigenous population was prone to stressors that included loss of their land, loss of their children who were taken away from them, sexual exploitation and family members who died as a result of diseases that were brought by the people who came to their land (Waterworth et al. 2015.). The indigenous populations experience stressors that include the death of family members or friends, joblessness, illnesses such as diabetes, and mental illness. These stressors had a negative impact on the Indigenous populations because they also experienced discrimination from the colonizers. The negative impact included the populations becoming exposed to poor health care and diseases such as diabetes.

Diabetes and the complications it causes results in early deaths worldwide and in Australia, it is no different and majorly high in the indigenous populations. Aboriginal and Torres Strait Islander population are known to have the longest continuing culture in the world and have lived for many years. The process of colonization has made the Aboriginal people experience health disparities compared to the rest of the Australians (Adams et al.  2017). This led to the government agreeing to close the gaps and improve health outcomes for the Aboriginals but unfortunately not much has been achieved so far. Diabetes which is the second cause of death in the Aboriginal population came into existence to the population after colonization. This is because colonization disrupted the traditional lifestyles and introduced western diets which have resulted in increased rates of chronic diseases. Research shows that in every ten Aboriginal people, one of them has diabetes and this applies even to the younger generation. This is causing very many deaths and complications because diabetes increases the possibilities of development of other problems for example heart diseases and others later in life.

Since colonization, healthcare services for the Victorian Indigenous populations have become expensive. There has been increased expenditure on health services for the Indigenous populations and this has not helped in closing the health outcome gap rather has made it more difficult for them to access healthcare. There has been a lack of recognition for these populations and therefore their health has not been considered as important as the other Australians. The prevalence of poor health for the Aboriginal Victorians is determined by psychological distress, food insecurity, financial stress, and lifestyle risk factors. Most of this was as a result of colonization whereby the Indigenous population’s lands were dispossessed, the government policies that allowed their children to be taken from them leading to the destruction of families and communities (Markwick et al. 2014). Indigenous people cannot afford a healthy meal due to a lack of employment or financial income. They relied on the produce they got in their lands before they were taken away from them. The population lacks access to community help and services and are not valued by society. The lifestyle risks that are faced by the Indigenous populations include excessive intake of alcohol, smoking, not enough fruit and vegetable consumption, and lack of physical exercise which results in diseases such as hypertension and diabetes among other complications.

For the social-economic status, the Aboriginal Victorians experience low income, are unemployed, or are unable to work leading to the incapability for them to live a healthy life. Low income makes it difficult for the Indigenous Victorians to afford a healthy meal, and access healthcare. Unemployment which is a result of low educational levels is connected to low levels of health knowledge. Help from families and friends concerning stressful moments and healthcare is also a problem for the Aboriginal Victorians because they were more affected by the removal of their children from their families after colonization (Markwick et al. 2014). This is also a threat to their social life since they find it hard to trust other people and this causes an impact in the behaviors that would enhance their collective wellbeing. Trust is vital in the healthcare system and helps to increase the health and wellbeing of an individual and when it does not exists, the affected person does not gain. The trust issues resulted from the colonizers taking their land, children, discrimination, and denying them their rights. Lack of trust leads to the non-attendance of health services which leads to medical complications and risk-taking behaviors and this is because the healthcare system fails to address their cultural security. Evidence shows that even the Aboriginal Victorians who use health services do not get the same quality of care compared to non-Aboriginals.

There is a strong connection between diabetes and its prevalence with the socioeconomic disadvantages of the indigenous populations. Despite the government’s initiative of closing the gap, data has shown that very little has changed in terms of health and wellbeing in Aboriginal Victoria (Hill et al. 2017). The Indigenous population has the worst health and healthcare, the lowest life expectancy, and the highest mortality rates compared to the rest of the Australians. They also have the most death cases resulting from diabetes and mainly because they are an ethnic minority and also because of their low social-economic status hence associated with poor outcomes in diabetes. Social-economic determinants that make health worse in the Indigenous population include overcrowding, poor housing, low labor force, and low income. Health care access is significant in socially determining the health outcomes of diabetes but because of the low levels of health literacy that exist in the Indigenous population, it is difficult for them to figure this out.

Health promotion is a process that ensures people are in charge of what determines their health and therefore improves their health. Through its empowerment, health promotion can contribute largely to health equity and social justice. Empowerment is the central factor that will help to close the gap in the health and well-being of the Indigenous populations and the other Australians (Percival et al. 2018). Health promotion will help the Indigenous populations to increase the capability as individuals, families, and communities to take control of their lives. For people living with diabetes, this will help them gain insight into the need for healthcare. It will also empower them to engage in physical activity and have healthy diets. The will to close the gap has led the government and the non-governmental institutions to develop health promotion tools or interventions. These are structured guidelines, instruments, programs, and resources that are designed to improve development, implementation, and assessment of Indigenous health promotion programs or enhance the ones that are already in existence. The tools include one that determines the quality improvement in health promotion, the family well-being empowerment program, and one that monitors the ecological methodology of the programs. The health promotion tools help to engage and relate, develop and use evidence, modify programs for diverse groups, and strengthen the capability.

The process of engaging and relating comprises of developing and sustaining relationships with people, organizations, and the community at large. This involves developing trust with the Indigenous population. Trust is an issue with the Indigenous populations because of what they went through after colonization and therefore important for them to undergo this process. The strengthening capability is a process that focuses on the level of the worker and the organization. This process helps to improve the accessibility of resources, knowledge, and skills by a practitioner in health promotion (Percival et al. 2018). It also entails strengthening and changing the environment to support Indigenous health promotion. This includes offering training, mentorship, and any other requirement that the Indigenous researcher or worker may need. This will help to ensure that the Indigenous population gets the health services they deserve and help reduce the deaths caused by diabetes.  Modification of diversity programs and settings is a process that supports the adaptation and modification required to fit the implementation setting. This allows the programs to fit the preferred group that is intended for. Developing and using evidence is a process that entails having a recognition of the different sources of evidence and using the correct ways according to culture to gather and combine the different sources. This will help to improve Indigenous health promotion.

A health program that is geared towards preventing diabetes in Victoria was developed to support individuals that were considered to be at a higher risk of diabetes. It was intended to help them take a healthier life approach and make changes in their lifestyles for example take healthier foods and drinks, and be physically active. This would help to reduce the risk of developing diabetes and other complications such as cardiovascular diseases (Kagie et al. 2019). The program included the impact of different kinds of food on one’s health and the kind of food that is healthy and affordable. It also included how an individual should spend their money on food and how a person can maintain and healthy weight. The program also enlightens individuals on what to look for on a food label and how to choose healthy foods. The free program also gave insights into the different ways of becoming active and preventing diabetes.

Education and self-management are very important when it comes to diabetes care. Evidence shows that suitable cultural self-management programs can influence and improve an individual’s management practices, physical activity, and quality of life. Web-based programs for diabetes have also shown an improvement in different individuals (Adams et al. 2017). A diabetes strategy developed to reduce diabetes among the Aboriginal people includes peer support programs that are either done by phone, physically, or through the web. Health promotion focused on the Aboriginal population has increased its focus on web-based and digital environments. Web-based health interventions for diabetes improve knowledge, helps to track and monitor the disease, and have more impact on the change of behavior. With most of the Aboriginal people having access to the internet, the web-based interventions have created a platform where people can advance their knowledge about diabetes and how to control and manage it.

Victorian Indigenous populations have been targeted because of the cultural, political, and historical outcomes of their health and well-being (Burrow and Ride 2016). The Indigenous populations were among the first populations to occupy Australia before the colonizers came to possess the land they owned. Chronic diseases such as diabetes resulted from the introduction of unhealthy diets brought by the colonizers. Colonization resulted in the lack of access to healthcare for the Indigenous populations and this caused an increase in the risk of diabetes. Diabetes has been rated the second cause of death in these Indigenous populations making it a serious problem and a point of focus. Health inequality due to racism, poor housing, low income, and unemployment has existed since colonization for these populations. The Indigenous populations experience a gap in the health status compared to the other Australian populations and closing the gap has been a challenge for the government.

Conclusion

Indigenous health is the physical, emotional, and social wellbeing of the Indigenous populations in Australia. Colonization had a great impact on the health of these populations because they experienced discrimination, sexual exploitation, land dispossession, and lack of human rights. This destroyed their health and social well-being and also gave rise to chronic diseases such as diabetes which has caused a lot of deaths including young people. This is because they interfered with the traditional lifestyles that the Indigenous people were used to and introduced western diets. Because of their low social- economic status, the Aboriginal Victorians, they are unable to live a healthy life or even have access to healthcare. Being social-economically disadvantaged has also led to the prevalence of diabetes in the Indigenous populations. Health promotion interventions have been established to try and close the health care gap between the indigenous and non-indigenous populations. Health programs and tools have been developed to educate individuals, offer the relevant resources to practitioners, and contribute to the health and well-being of the Indigenous populations. Web-based interventions have also been introduced to create a platform where people can interact and find more information concerning diabetes. Victorian Indigenous populations have been targeted because of the association of the historical, cultural, and political health and well-being outcomes. Future research on Indigenous health should focus on having members of the Indigenous population being representatives in the policy-making decisions to help establish policies that will be geared towards improving their health and well-being.

References

Adams, K., Liebzeit, A., Browne, J. and Atkinson, P., 2017. How’s your sugar? evaluation of a

website for aboriginal people with diabetes. JMIR diabetes, 2(1), p.e6.

Burrow, S. and Ride, K., 2016. Review of diabetes among Aboriginal and Torres Strait Islander

people.

Hill, K., Ward, P., Grace, B.S. and Gleadle, J., 2017. Social disparities in the prevalence of

diabetes in Australia and in the development of end stage renal disease due to diabetes for Aboriginal and Torres Strait Islanders in Australia and Maori and Pacific Islanders in New Zealand. BMC Public Health, 17(1), pp.1-8.

Kagie, R., Lin, S.Y.N., Hussain, M.A. and Thompson, S.C., 2019. A Pragmatic Review to Assist

Planning and Practice in Delivering Nutrition Education to Indigenous Youth. Nutrients, 11(3), p.510.

Markwick, A., Ansari, Z., Sullivan, M., Parsons, L. and McNeil, J., 2014. Inequalities in the

social determinants of health of Aboriginal and Torres Strait Islander People: a cross-sectional population-based study in the Australian state of Victoria. International journal for equity in health, 13(1), p.91.

Percival, N.A., McCalman, J., Armit, C., O’Donoghue, L., Bainbridge, R., Rowley, K., Doyle, J.

and Tsey, K., 2018. Implementing health promotion tools in Australian Indigenous primary health care. Health promotion international, 33(1), pp.92-106.

Waterworth, P., Pescud, M., Braham, R., Dimmock, J. and Rosenberg, M., 2015. Factors

influencing the health behavior of indigenous Australians: Perspectives from support people. PloS one, 10(11), p.e0142323.

Nursing Practices

• Define anterior, posterior, lateral, medial, superior, inferior, PRONE, supine (related to body positions)

Anterior: this is the view seen from the front side of the body nearing the front side

Posterior: this is the view from the back side of the body nearing the back side of the body. Lateral: this is a side view viewed farther from the body midline.

Medial: this is the view nearing the body to midline; it is viewed from the side.

Superior: this is the view of the body when viewed from the upper part of the structure toward the head.

Inferior: this view is seen from the lower part of the structure away from the head.

PRONE: this is the positioning of the body where the interior surface faces downwards in a horizontal view.

Supine: this is the positioning of the body where the interior surface faces upwards in a horizontal view.

• Explain how to manage a hyperthermic blanket on a patient.

            Start explaining to the patient what you intend to do in case he or she is not unconscious. Place a bath blanket beneath the hyperthermia or hypothermia blanket to prevent direct contact with the skin. This is in particular utilized mostly when the process is for warming the body as the temperature may burn the skin. During the process it is important to keep checking patient’s temperature (Dumville et al., 2013). In any case, the monitor in the blanket does not measure body temperature; the use of the normal thermometer can be utilized. In the case of hyperthermia, the blanket is removed even before the body temperature is slightly above normal since the body will continue cooling afterward. Continue monitoring body temperature.  

• Explain how to clean a surgical wound.

            When cleaning surgical wound the following process is followed to prevent infections. Start by washing the wound gently with soup and water; this assists in removing the crust from the wound. Make sure not to scrub or soak the wound in water. Ensure not to utilize rubbing alcohol, hydrogen peroxide, or iodine as they are harmful to the tissue and slows down the healing process of the wound. After cleaning with water and soap air dry the incision or use a dry, fresh towel before dressing the wound with bandages.

• Explain how to irrigate a wound to prevent spread of infection

            Irrigating a wound simply is a steady flow of a solution across an open wound surface (Dumville et al., 2013). To irrigate a wound follows this simple process: First gently impart stable stream or irrigation solution into the open wound until the syringe empties. Ensure the solution flows from the clean part of the wound to the dirty part; this prevents contamination of would from dirty particles. Ensure that the irrigation solution reaches all parts of the wound.  

• What part of a nursing job description can never be delegated to a CNA or Unlicensed Aide

            The CNA being the personal assistance to the nurse have their duties in place. The nurse has limits on the duties that can delegate to the personal assistance without violating the nursing guidelines (Diana et al., 2017). Further from the minor assistance delegated by the nurse, the unlicensed aide cannot be delegated to perform any activities to patients whose status is unstable and which require assessment from the main nurse. For instance, the nurse cannot delegate actions that need advanced education to UAP such as deciding the type of medicine to be given to the patient or deciding on the type of test to be conducted in the laboratory.  

• How does a nurse manage dehiscence?

            Dehiscence is termed as a life threatening emergency, hence, requires an agent care and management. In this case, the nurse is supposed to manage by ensuring the effective measures are followed as follows: first, the nurse is supposed to ensure there is no infection; in case the dehiscence is infected the nurse is supposed to apply antibiotics. In prevention of further possible infections, the nurse is supposed to change wound dressing occasionally. The nurse is also supposed to ensure the wound is not covered at all times since exposing the wound to open air speeds up healing, prevents infection as well as allowing new tissues to growing from inside. Finally, the nurse is supposed to negatively pressure would therapy; this is wound therapy which is to pump that assists in speed healing.    

Reference

Diana, J. D., MBA, R., JD, P. D. B. M., & Grant, R. N. (2017). Law for Nurse Leaders. Springer Publishing Company.

Dumville, J. C., McFarlane, E., Edwards, P., Lipp, A., & Holmes, A. (2013). Preoperative skin    antiseptics for preventing surgical wound infections after clean surgery. Cochrane      Database of Systematic Reviews, (3).

Nursing Interventions

 I chose this article because it covers my area of nursing which I am interested in and that is the critical care nursing. The article includes a nursing intervention that is used in the intensive care unit which is the ICU patient diary. The patient diary is used to write notes concerning the patient of events that they may not remember or may not even know.  This article gives more insight into the importance of including family members to be a part of writing the ICU diary. This enables them to express their thoughts and show support and care to the patient and be a part of their recovery journey.

The ICU diary is an intervention that is holistic and caring since it has been reported to enhance the recovery of patients and prevent post-traumatic stress after being hospitalized. For the critical care nurses, writing the diary improves their perception about the patient and their condition (Ednell Siljegrenb & Engströmc 2017).  It also leads to more personal and holistic nursing. The ICU diaries help to give a record of the needs and insufficiencies experienced by the patient which contributes to the improvement of nursing care. The ICU diaries have a huge clinical benefit to the patient and are a cost-effective intervention.

The diary is written in an informative way for it to be a source of comforting and instilling confidence in the patients and families. The ICU diary intervention allows the patient’s relatives to access the diary, whether by writing or reading and this makes them feel encouraged about the progress and also act as the patient’s motivation towards recovery (Ednell Siljegrenb & Engströmc 2017). Writing the ICU diary shows commitment, compassion for the CCN because they have to write with respect and consideration.

References

Ednell, A. K., Siljegren, S., & Engström, Å. (2017). The ICU patient diary–A nursing

intervention that is complicated in its simplicity: A qualitative study. Intensive and Critical Care Nursing, 40, 70-76.

                                                            Nursing: reflective journal

Introduction

          In the modern health care sector, nurses always work in an environment that is characterized or associated with multiple complexities and challenges. The practical experiences and knowledge that I gained have given me the opportunity for overcoming the complexities and challenges of the health care system so as to be able to deliver quality services to not only patients but also to disadvantaged populations. As a result of that, the experience I have acquired whilst handling patients from different ethnicities have given me an opportunity for sharpening my leadership and professional skills. As a baccalaureate nurse who anticipates or desires to work within different settings, I cannot afford to depend only on my proficiency in training, or immature optimism associated with cooperation and collaboration. Consequently, my teaching and practical experiences have assisted me in improving my potential to execute leadership skills and knowledge as well as participate appropriately in delivering efficient health care services to patients and vulnerable populations. Lastly, I managed to learn and master the context of the modern and continuously evolving health care system.

New practice approaches

            For decades that have passed, the nursing field has encountered multiple changes. As a result of that, I have managed to learn how to adapt to such changes so as to remain significant in providing excellent health care services to all patients. For example, in the process of continuing utilizing nursing evidence-based practice has greatly assisted me in handling various problems such as obesity, heart attack, asthma, and diabetes. Despite that, what I came to realize is the fact that such principles or standards have not been embraced adequately in the delivery of health care services. Within the conventional healthcare environments, patient safety researches have extensively emphasized the need of evaluating records for the purpose of assessing patient safety problems and other related issues. The idea behind that is to aid in demonstrating the fact that modern health care practices have the potential of enhancing patient safety and the quality of the services being provided (Borbasi et al., 2019). Ideally, I have managed to learn the fact that nursing is one of the fields that are rich with evolving practices that advocate the utilization of experimental or empirical studies. Currently, the nursing field has extensively provided outstanding leadership for health care improvement via the use of research findings.

            Nevertheless, the utilization of nursing evidence-based practices has transformed healthcare institutions in several ways. A large percentage of the higher learning institutions have continued to recognize the importance of the recent health care trends through the introduction of various changes in the nursing programs being offered so as to take into consideration evidence-based practices. For learners pursuing a nursing degree, accessing course material that focuses on improving nursing knowledge is ultimately important. These initiatives mainly emphasize on the importance of nurses making informed decisions that can aid in promoting the understanding of the spiritual, ethical, and clinical background of the patients. Furthermore, the continued uses of nursing evidence-based practices have resulted in the refurbishment of nursing studies. Due to the fact that nursing programs might consist of numerous courses related to research, it is the learner's responsibility to ensure that he or she has identified the importance of improving his or her skills (Craig & Dowding, 2019). Although I have realized that conducting research cannot be a habitual endeavor, it is vital to comprehend issues or problems that are pertinent to modern scientific evidence. The reason for that is because such pertinent issues are likely to provide outstanding impacts both on the present and forthcoming career development..   

Inter-professional collaboration   

            In the modern healthcare industry, health care duties have been perceived to be burdensome, multifaceted, and complex for a single physician to accomplish. Ideally, a single issue may demand the input of several professionals obtained from diverse specialties. I can testify that this is the most interesting experiences that I have learned or observed. The duty of the nursing profession is to induce change as well as advance health care delivery. As a result of that, it is the responsibility of a nurse to understand the fact that a single person cannot have the ability to perform or execute all of these tasks. More importantly, I have managed to learn the fact that inter-professional collaboration moves away from an empirical healthcare environment to the extent of including edification contexts.  The modern healthcare environments require sophisticated or chronological organizational systems that rely on not only interrelationship but also on the integration of different services provided by various healthcare providers (Institute of Medicine (U.S.), 2015).  Usually, each of these health care providers has their areas of emphasis and professionalism.

            Additionally, inter-professional collaboration is important in successfully solving problems such as medicine and technological improvement, broadening the demand for modernized healthcare services, reduced healthcare resources, and so on. Nurses also work in the same context in which professional cooperation occurs in fostering the need for understanding the needs of the patients as well as providing health care system-wide activities and procedures. Similarly, inter-professional collaboration is important both within major and small health care organizations. In a healthcare environment that emphasizes the importance of increasing the demand for accountability and transparency, it is the duty of nurses to ensure that they have accessed the extent or level of the health care standards that they provide. In the modern competitive and problematic world, the survival of any patient requires that the performance of healthcare organizations should display the highest health care standards with incurring high medical expenses (Institute of Medicine (U.S.) et al., 2013). Last but not least, inter-professional collaboration has the potential of improving the likelihood that better health care standards can be effectively achieved irrespective of the nature of teams and expenses that aid in addressing health issues.

Ethical consideration in healthcare

            According to research, nurses do encounter difficulties when addressing ethical issues associated with health care delivery to patients. Because of that, ethical issues and problems might evolve inside any healthcare situation in which deeper moral considerations ought to be taken into account. Therefore, in the nursing profession, I had the opportunity of learning the significance of comprehending the ethical culture and climate of the healthcare circumstance that I was working at. Ideally, ethical culture takes into account how ethical matters and other related circumstances that lead to ethical concerns or issues are handled within a healthcare institution. In the field of nursing, ethical practices can be established by seeking guidance from ethical professionals. These professionals play a crucial role in the establishment of ethical codes that consists of recommendations and guidelines that can be utilized for the purpose of responding to ethical issues or problems.

            Whenever an ethical problem evolves, it is imperative to respond to an efficient ethical climate that aid in integrating workers’ opinions on how ethical concerns are discussed, handled, and/or addressed. In the nursing field, a nurse takes a collective and individual responsibility to develop, maintain, as well as improve their ethical environments or settings of the empirical conditions and contexts of recruitment that are extremely supportive in securing high standards of health care (Parris et al., 2015). It is this responsibility that allows nurses to have the opportunity for upholding the importance of ethical environments in which nursing ethical practices are required in realizing the needs and preferences of the patients and their families.

Health disparities

            Although nurses have the responsibility of ensuring that health care services can be easily accessed by all patients, the general advancement of health equity programs has been encountering numerous challenges. For example, people have been facing racial-based disparities in the process of trying to access health care services. As a result of that two main approaches can be utilized for the purpose of reducing disparities in the access and/or provision of health care services. In most cases, health care disparities evolve whenever a particular group of people has the opportunity of enjoying access to better health care services than others. Such a situation often highlights differences in the rate of deaths amongst various populations. Usually, health care disparities are contributed by income inequalities amongst people. For example, middles class individuals might encounter difficulties in obtaining efficient health care services as compared to high-class individuals. Therefore, by using the selection process, nurses can assist in investigating as well as examining health disparities between groups of people. This process can be regarded as being the tendency of grouping individuals according to their social gatherings, residential places, and soon (Barr, 2019). For example, people who like participating in physical exercises will most probably live in regions where they can access facilities like the gym while those individuals who like staying indoors or isolating themselves often opt to reside in auto-reliant regions.

            On the other hand, such a scenario plays a crucial role in understanding the health differences amongst individuals who belong to different income levels. For example, individuals who wealthy and live sedentary or inactive lifestyles are probable to be troubled with health issues such as diabetes, obesity, and cardiovascular diseases, unlike those living poor homesteads who engage in tedious activities like long-distance walking. Such a scenario in particular circumstances is regarded as being a justification for ethnic, professional, or academic discrepancies in health. This advocates why the majority of intellectuals or scholars and individuals with high socioeconomic standards are healthier. Despite that, my opinion is that various environmental factors play a considerable role in escalating health disparities in a particular country (Weinstein et al., 2017). That can be based on the compositional and contextual impacts that exist. Compositional factors or issues typically represent the characteristics of the society in terms of the environment they thrive in while contextual factors often impact neighborhoods. For example, when specialized healthcare organizations end up attracting a large percentage of chronologically sick patients from a certain neighborhood, their health situations as compared to intermediate neighborhoods can be considered to be compositional.

References

Barr, D. A. (2019). Health disparities in the United States: Social class, race, ethnicity, and the social determinants of health. Baltimore : Johns Hopkins University Press

Borbasi, S., Jackson, D., & East, L. (2019). Navigating the Maze of Research: Enhancing Nursing and Midwifery Practice. Amsterdam : Elsevier Press

In Craig, J. V., & In Dowding, D. (2019). Evidence-based practice in nursing. Amsterdam : Elsevier Press

Institute of Medicine (U.S.). (2015). Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Washington, D.C. : National Academies Press

Institute of Medicine (U.S.)., Cuff, P. A., Institute of Medicine (U.S.)., Institute of Medicine (U.S.), & National Research Council (U.S.). (2013). Interprofessional education for collaboration: Learning how to improve health from interprofessional models across the continuum of education to practice : workshop summary. Washington, D.C. : The National Academies Press

Parris, K., Zuccarini, M., Mirr, J. M. P., & Blair, K. A. (2015). Advanced practice nursing: Core concepts for professional role development. New York, New York: Springer Publishing Company.

Weinstein, J. N., Geller, A., Negussie, Y., Baciu, A., & National Academies of Sciences, Engineering, and Medicine (U.S.). (2017). Communities in action: Pathways to health equity. Washington, DC: The National Academies Press.

Professional Responsibilities and Overlapping General Roles in Patient Care

Introduction

Healthcare and healthcare services not only involves treating a patient but also showing care and providing emotional support. Emotional support and caring for the patient help in their healing process hence very important. Because of the many responsibilities connected to the provision of healthcare services, there is also an increase in allied professionals and overlapping roles of professionals. 

Problems associated with the multidisciplinary approach to patient care include poor communication from the different levels of healthcare workers. Communication barriers between specialists who feel are better than the rest is a prevailing problem. That mentality from these specialists leads to derailed procedures and decisions regarding the patient (Epstein 2014). It also does not promote teamwork which is important in healthcare in terms of providing the quality of care for the patients. In the operating room, the major problems include music and talking which acts as a distraction and therefore increases the operative risks and this leads to blaming games.

The inclusion of the patient in decision making is the professional’s responsibility. Patients and family members would want to feel included in the decision-making process. The professionals should communicate frequently about the patient (Epstein 2014). Communicating with the patient about their information, progress will enable them in their recovery process. It is satisfying to a patient when they are respectfully and with compassion given information about their condition and possible recovery.

Conclusion

Overlapping roles of professionals causes problems that negatively affect the patient’s outcome. Poor communication between professionals and other healthcare workers is a major problem. Professionals should take it as their responsibility to communicate with the patients about their health and recovery. This information should be given respectfully and compassionately.

References

Epstein N. E. (2014). Multidisciplinary in-hospital teams improve patient outcomes: A review.

Surgical neurology international, 5(Suppl 7), S295–S303. https://doi.org/10.4103/2152-7806.139612

 Nursing Today and Beyond

Introduction

 There are revolutionary changes in the global health systems, and these changes are affecting the future of the nursing profession. In clinical settings, healthcare workers are at the forefront in performing many roles and responsibilities. Nurses are expected to provide patient satisfaction yet, they face professional changes that brings physical and emotional exhaustion.  Challenges such as stress and burnout, providing mental health in a community setting, challenges in using telehealth technology, and challenges in cultural competency. An important point to note is that it is important to explore and understand the challenges and implement strategies to help nurses overcome the challenges they encounter. Another important point to understand is that the Institute of Medicine (IOM) has a positive impact on nursing in that it implements recommendations towards improving healthcare. It is also important for nurses to explore and understand the key message of 'Future of Nursing" for them to implement the best practices in nursing professionals. Furthermore, the Institute of Medicine has also developed five core competencies to help nurses improve health care. The committee found that patients experience many challenges merely because health care professionals do not provide optimum care. Thus, when these core competencies are applied together, nursing profession will change greatly and work toward a common vision. However, it is important to explore the obstacles that may hinder nurses achieve the core competencies and help them overcome to continue providing better care.  Overall, nurses are expected to provide quality care and positive patient outcome but numerous studies have confirmed that various pressing challenges need to be addressed and create a bright future of nursing.

Challenges in nursing

Nurse burnout

 In the nursing profession, nurses are working in complex organizational settings and working environment's which are rapidly changing. An important point to understand is that the global health system has changed to address the epidemics. Nurses are working in challenging situations such as lack of support from executive-level managers, lack of material respires, lack of quality improvement, lack of relationship between nursing professionals, among other issues. Dall 'Ora et al (2020) assert that in 1974, Freudenberg observed that mental health clinicians lacked motivation and commitment.  Malachi introduced six theories of burnout and assert that burses experience burnout due to excessive workload, lack of sufficient resources to complete the task, lack of reward, lack of social support and connection with the manager, inequality, and limitations in employing own values. Vahey et al (2004) add that burnout is associated with mental problems and psychological distress. For example, nurses develop psychological problems and behavioral problems such as drug abuse. Health care organizations suffer from employees' absenteeism, and unable to retain staff. Nurses also are unable to provide proficient care hence lower patient satisfaction. Note that nurses feel emotionally exhausted, they became unwilling to care for patients, or in other words, they offer poor quality care.  An important point to note is that according to the Institute of Medicine, performance characteristics are measured based on effectiveness, efficiency, patient-centeredness, and more (Vahey et al. 2004). Also, patient satisfaction is not achieved by looking at the effectiveness or efficiency but it is measured by looking at all aspects of care. Nurse burnout indicates that nurses will be unable to achieve the performance characteristics merely because the work environment is not favorable.

How to overcome this challenge

 One way to successfully overcome this challenge is through leader empowering behavior. Mudallal et al (2017) assert that leaders should be at the forefront to create structural and psychological empowerment which will in turn lead to nurses' job satisfaction and decrease burnout.  Note that nurses cannot solve the problem by themselves since they do not have control over the work environment. Thus, it is the role of the leaders to create a positive work environment.  Mudallal et al (2017) assert that head nurses have the role and responsibility to manage nursing functions, create positive work environment and empower nurses. To reduce burnout, leaders should provide autonomy, they should help nurses achieve organizational goals by proving the required resources, they should recognize employees' ability and higher performance, and they should allow them to express their opinion as well as to make contributions. 

Technology and telehealth nursing

Another challenge that nurses are facing today is the use of new technology known as telehealth technology.  In the Journal for Nurse Practitioner, Balestra (2018) assert that nurses are using telehealth technology to provide long-distance care. On a positive note, technology has brought clinicians and patients together. Note that health care providers are meeting the needs of patients in both rural and urban settings and hence the practice is improving health care. However, nurse practitioners are facing challenges that expose them to liability issues. First, nurses have full authority within a state. However, telehealth technology allows nurses to move out of state to offer medical service (Balestra, 2018).  Note that when a nurse with a single-state license moves out of a state, the regulatory authority of the new state will take legal action if the nurse lacks an appropriate license. Another challenge is reimbursement.  According to the telehealth reimbursement policies, not all services are reimbursed or in other words, specific services receive reimbursement while others do not especially those performed in rural areas.  The third challenge is fraud and abuse. According to the anti-kickback law, health care providers should not receive bribes or in other words, they should not have financial interests while providing services (Balestra, 2018. If a nurse receives compensation, he or she faces legal action such as imprisonment and fines.

                                                   How to overcome this challenge                  

 To avoid the potential liability issues, one way a  health care providers should do is to understand the Nurse Practice Act (NPA) not only in the state they offer services but also in other states. Note that NPA differs and thus, it is important to become familiar with the different standards of care (Balestra, 2018). On the same note, before moving across states, the healthcare provider should have the appropriate credentials. In using telehealth technology in all states, the provider should adhere to the legal requirement to avoid the risks and liabilities.

Mental health in the community

 Another challenge that nurses experience today is that the community mental healthcare setting has affected the role of nursing. First, the creation of new structures in the community has introduced more role requirements. This means that nurses are working in a new nursing environment where they are exposed to emotional burnout. For example, nurses report that mental health nursing within the hospital nursing is associated with a positive working environment, support, autonomy, and emotional burnout. However, in mental health nursing within the community settings, nurses report poor colleague relationships, organizational problems, and work pressure (Farmakas et al. 2014). In Western countries, mental illnesses have increased and patients seek help from primary healthcare providers (PHC). However, the PHC is unable to meet their needs merely because they have a negative attitude towards people with mental illness. Health care provider fears that people with mental illness are violent.  However, the challenge of unable to meet the needs of mentally ill people arises from a lack of theoretical knowledge (Farmakas et al. 2014). For example, in Sweden PCN lack knowledge on how to interact and communicate with the mentally ill patient and this means that the patients receive inadequate care.

How to overcome this challenge

 Farmakas et al. (2014) assert that nurses need to work in a supportive work environment while working in the community setting. Note that the community environments differ from the hospital environment in that the former has more work pressure. Even though nurses enjoy independence and autonomy, they lack attractive work environments. Another way to overcome the challenges is to provide the mental health nurses with the proper knowledge for them to have confidence in their work. Nurses need more competence and clinical experience for them to develop a positive attitude and provide quality care.

Cultural competence

Cultural competency is important within the healthcare setting as it allows the healthcare providers to meet the needs of all people including racial/ethnic minorities. In other words, cultural competency allow healthcare providers to work in a different cultural environment meeting the needs of minority groups (Shepherd et al. 2019).  However, nurses are facing challenges merely because they lack cultural knowledge. In other words, cross-cultural training is inadequate since nurses’ work in a complex environment where some cultural groups have different concepts about heath. Some even rely on folk health beliefs yet nurses use conventional methods (Shepherd et al. 2019). This makes it difficult to engage with patients.  However, nursing attests that these challenges arise from limitations of knowledge hence they are unable to address cultural needs.  

How to overcome this challenge

 To improve cultural competence, there should be cultural competence training. From the study, participants recommend that the training should be performed by speakers from different cultures (Shepherd et al. 2019). Thus, the main point about cultural diversity is employing multi-cultural staff to offer training. Apart from staff diversity in cultural training, there is a need for staff diversity in providing care so that staff can speak the language to different cultural groups.

Future of Nursing Report

Key Message #3

 Message #3 is very important as it states that nurses should work as a team with physicians and other health professionals. A point to note is that nurses are not only required to provide high-quality care to patients but they should go beyond and bring a positive impact to the U.S healthcare system (Shalala. 2011). To bring a positive change in the system, nurses should be adaptive- this means that they should have the capability to work in a challenging environment and also adapt to changes. Second, nurses should continue with lifelong learning because the nursing practices are changing and the curricula are updating. Thus, they should develop new knowledge and understanding to meet the changing practices. Another important point about this message is that nurses should take full responsibility not only in care provision but also in identifying problems, proposing solutions, and implementing plans (Shalala. 2011).They should also participate in decision making and express their opinions for improving care. In general, this key message #3 require leaders to develop leadership qualities and play the role of solving problems, making decisions, and adapting to the changes.  This message is important to the nursing profession in that as the nurse takes a leadership role and collaborates with other professionals, they can identify problems, implement strategies, and make everything move smoothly (Shalala. 2011). Another point is that as nurses expand their roles, they will bring wide-reaching changes that will transform the healthcare system and create a positive work environment. 

Institute of Medicine's five core competencies

Provide patient-centered care

 This competency means that health care providers should put the patient first.  This is because, many patients have developed chronic convictions and it is predicted that half of the population will develop a chronic condition (Knebel & Greiner, 2003). Recent researchers have found that health care providers treat disease but they do not put into concern patient's cultural background, job, environment, and other factors. Thus, clinicians should consider psychological and social factors during an encounter to develop a positive experience for the patient. To meet this competency, nurses should communicate effectively with the patient and allow him or her to participate in the decision making of the care plan. During the communication, the nurse should listen to the patient's views including self-management activities, individuality, and values (Knebel & Greiner, 2003). The nurse should provide care strategies as well as comfort and emotional support.

One barrier to patient-centered care is language difference.  Note that while providing patient-centered care, health care providers need to interact with all patients including minority populations.  If the nurse does not have language competency, he or she will not understand the patient's needs. Language barriers will cause misunderstanding and both the patient and the nurse will not be able to make decisions related to care. To overcome this barrier, there should be training for nursing staff. The training will help the nurse understand language differences and gain language competence, and more importantly, will learn how to address aggressive behaviors when handling patients from different backgrounds.

Work in interdisciplinary teams

 Health care providers should collaborate with other health care professionals.  Working as a team will allow the team to combine knowledge and skills hence improve care delivery.  Today, the health care system has changed and nurses are working in a complex environment.  Patients are suffering from chronic illnesses that demand quality care. Working as a team will address the complexities, share ideas on using the technology, and develop relative solutions. Nurses should promote teamwork through working collaboratively with other workers, participate in decision making, and propose a solution to issues.

Barriers may arise from failure to recognize other professionals' roles, hierarchical administrators may implement top-down policies, members may disagree on the opinion and rely on different goals, and members may be influenced by traditional and cultures. However, members should resolve conflict and focus on a mechanism of negotiation until they arrive at a common goal. They should develop a positive attitude toward other's opinions or in other words respect other’s values and cultures.

Employ evidence-based practice

 For nurses to achieve clinical effectiveness, they should use evidence-based practice at the point to care.  Evidence should be incorporated in all aspects of care including intervention, prevention, and diagnostics. For example, nurses should come up with new findings, consider the source of evidence, and connect the findings to the clinical decisions, and share the knowledge with clinicians about the available evidence.

However, nurses may face barriers to employing evidence-based practice due to lack of time to conduct research and find new practices. Time is not the only barrier but factors such as lack of nursing journals and lack of internet access may hinder nurses from gaining knowledge.  However, clinicians can overcome the barriers through researching the online database and Web sites such as the Evidence-based Nursing and apply the latest evidence.

Apply quality improvement

 The Institute of Medicine states that nurses should provide services that align with current professional knowledge. Nurses conduct various quality problems such as duplications of services, errors in patient safety, harm to patients, useless tests, and delay in diagnosis, among other problems.  Quality improvement means that health care providers should focus on quality rather than task completion that does not bring effectiveness. Nurses can achieve this competency by putting all things into consideration that is; patients, process, outcomes, and more. They should also use the current practices, be aware of the errors and hazards, and conduct self-assessment.

 However, nursing may face obstacles such as lack of information infrastructure and lack of supportive leadership. Leaders may fail to help nurses strategize on quality improvement and nurses may find it challenging. A quality improvement system is needed but nurses may lack resources for planning and implementing. Thus, the health care system should be at the forefront creating quality improvement methods so that nurses can stay on track.

Utilize informatics

  Lastly, nurses should use information technology in the clinical realm.  Technology such as telemedicine, e-mail, order entry systems, and other tools help nurses in making health-related decisions, communicating effectively, reducing errors, among other improvements.  To achieve this competency, nurses should use tools such as data analysis software, and email. 

However, nurses may face barriers such as poor usability, organizing data, lack of technical support, software challenges, and lack of training and, more. All the same, nurses should have training in technologies and ensure compliance to avoid legal issues while dealing with patient-based information.

Conclusions

 Nursing is an important profession that brings positive changes in individual’s life as well in society. Nurses not only provide care but they also act as leaders and employ the managerial and technical skills in nursing quality care. Despite their positive roles, nurses face many challenges such as burnout, cultural challenges, lack of technical knowledge, and other problems that hinder them from meeting their goals. However, the paper recommends ways in which the nurses should overcome the challenges, and reminds nurses to apply the Institute of medicine core competencies and key messages in nursing practices.  Another point is that nurses should apply core competencies described by the Institute of medicine to provide better care. They should be aware that to manage the ever-changing environment within the health care system, nurses need to be skilled. The competencies are the foundation of quality care and this means that these competencies will improve their practices. Overall, the health care system should sustain nurses by combating their challenges and empowering them.

References

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National Academies Press.

Living the Mission, Restorative Justice, Black and Brown Solidarity, and Mental Health

Introduction

Living the Mission presentation examined how you as a student engage in cultural, social religious, and ethical values in service to others. Restorative Justice Practices which are mostly used in schools are policies that are implemented to ensure a safe learning environment. Black and Brown Solidarity involves the African American racism that is experienced even in schools.  The mental health presentation brought to my understanding that the lack of resources makes the Latinos not seek mental health attention. I first want to say it was a pleasure to be involved with these presentations for the information I got is very relevant to today’s issues.

Living the Mission was an examination of what you as a student are doing to engage in cultural, social religious, and ethical values in service to others (Worrall 2007). I feel that volunteering at my CBSL site allows me to serve others in a meaningful way. When at the school I often hear probably, overworked teachers and staff yelling at the children. The CBSL site lacks resources and staff which can foster an environment of stress and burnout. The children and families that I serve at the CBSL site have many barriers, poverty being the main one they face daily. Living the mission for me is helping when needed and to listen when necessary. The children at my site are all very unique with different personalities for most of my time is spent talking to the student as we complete homework or other tasks. Participants in this discussion had an opportunity to talk about how they live the mission and the majority of them had very unique and colorful histories. They spoke about their struggles and how they led to them to start living the mission, serve but most importantly make a difference. I was inspired on hearing how some came to be students at De Paul.

Restorative Practices are used in Chicago Public Schools and focus on preventing and addressing harm (Rich, Mader & Pacheco-Applegate 2017). The main principle of these practices is that, in case of harm caused to another person, the response should be repairing the harm done rather than retaliating against the wrongdoer. It emphasizes more on the offender making amends for their wrongs and puts a focus on assisting the victims. The hosts explained that when this idea of restorative practice was first introduced in the Chicago Public School System they didn’t believe it would work. The hosts advised that restorative practices are now widely accepted in the Chicago Public School System for they saw a decrease in behavioral issues, suspensions, and other student problems. The hosts also noted that their programs have expanded and often requested by schools.

 During the Virtual Reimagining and Black and Brown Solidarity in Chicago, they talked about the systemic racism seen in many institutions including academia. During one of the sessions, I attended a De Paul instructor spoke about how hard it is for someone to get tenure and how academia lacks diversity including De Paul. When the hosts spoke about solidarity between the Blacks and Browns they were saying that oftentimes the Latino community feels that their issues are different from African-Americans (Márquez 2014). The hosts stated that the issues, missions, and goals of both people are the same and systemic racism will only be changed if people come together. In North Chicago, poverty is evident and when interacting with the student, the stories you hear are those of basic survival. The children often talk about relatives or parents in prison, jail, or dead as a result of gun-related violence. My CBSL site is predominately Latino and African American and the students all have similar stories. I believe if the Latinos and African Americans in this community came together it would improve the CBSL site for the school was taken over by the state several years ago. The people in the community have no control over who runs their schools hence underperformance. I believe that if my CBSL and the community of North Chicago incorporated restorative practices it would foster an environment of healing for this community.

  The meeting on Mental Health within a Global Pandemic and Civil Uprising shed light on the fact that minorities particularly Latinos couldn’t obtain mental health services due to a lack of available resources. The host talked about the defunding of mental health clinics in the Chicagoland area and how it has led to an increase of suicide particularly among African Americans. The solution to this problem according to the host is that people must all come together with one voice and demand that resources be allotted to impoverished neighborhoods (Taylor & Stanton 2007). All these events demonstrated how marginalized and impoverished communities suffer the most from a lack of resources. I learned that we all must do our part in ensuring that funds and resources are allotted to communities in need.

Conclusion

The four presentations demonstrate the issues that we are facing today. I believe the practices of restorative practices would benefit the children at my CBSL site because they encourage students to talk and have peace circles. People living a mission to promote a better life make an impact because it would take solidarity and cooperation from all parties involved for it to be successful. Resources and funds must be allocated to the communities in need.

References

Márquez, J. D. (2014). Black-Brown Solidarity: Racial Politics in the New Gulf South.

University of Texas Press.

Rich, L., Mader, N., & Pacheco-Applegate, A. (2017). Restorative justice programming and

student behavioral and disciplinary outcomes. Chicago, IL: Chapin Hall at the University of Chicago.

Taylor, S. E., & Stanton, A. L. (2007). Coping resources, coping processes, and mental health.

Annu. Rev. Clin. Psychol., 3, 377-401.

Worrall, L. (2007). Asking the community: A case study of community partner perspectives.

Michigan Journal of Community Service Learning, 14(1), 5-17.