What strategies can staff nurses use to collect and share evidence that could impact health policy decisions?

 Staff nurses play a significant role not only in the provision of patient care but also in policy development. Nurses support medical care and create a healthy population by participating in policymaking. Thus, nurses need to be more aggressive in their health functions. For them to intervene in policy development, they must work as leaders in their area of practice and not only working but also being proactive and innovative (Knebel & Greiner, 2003). Thus, they must evaluate the healthcare system and identify gaps that need to be filled to deliver effective care. Thus, they are professionals in providing care and in making decisions to influence practice standards. Staff nurses impact the health care policy formulation related to resource allocation, improving quality, best clinical practice, among other issues (Knebel & Greiner, 2003). Note that as they work to improve the quality of care, staff nurses improve knowledge and understanding, and while making health care policy, they will offer information with greater transparency toward formulating a policy. Note that a healthy system cannot be designed without healthcare professionals. Thus, staff nurses should collect and share information using the following practices;

• Patient-centered care

 Staff nurses should collect information using the patient-centered care approach. This means that the staff nurses should create a participatory decision-making process with the patient and understand and respect their unique values (Knebel & Greiner, 2003). Note that this approach will allow the staff nurse to understand the social-economic disparities and during the policymaking, the staff will share information that will improve health outcomes and reduce disparities.

• Teamwork and collaboration

 Staff nurses should collect information by working with inter-professional teams. Note that interdisciplinary collaboration will help the staff nurses review the care plan, identify barriers for quality care, and offer solutions, and work together toward common goals.

• Evidence-based research

 Another strategy that staff nurses can use to collect and share information is through evidence-based research. This means that staff nurses can conduct relevant research and come up with practice recommendations, after conducting research, the staff nurse can transfer knowledge to the healthcare care system to improve the performance (Hughes, 2008). Note that this strategy will enable the staff nurse to partner with other professionals and discuss if the evidence-based research should be implemented in every practice. In other words, during policymaking, the staff nurses will get the opportunity to talk about new knowledge and its role in improving performance (Hughes, 2008).General-evidence-based practices mean that nurses need to be committed to learning new skills that will bring positive changes in the healthcare system.

• Quality improvements

 Staff nurses can collect information that could be used in policymaking by ensuring the quality of care. This means that nurses need to adhere to the health care system's strategic goals, adhere to the standard of care, and identify barriers affecting quality improvement (Knebel & Greiner, 2003). During policy making, there will be quality reporting and communication about the quality improvement plan.  Staff nurses will talk about ways to improve care and state the appropriate tools to measure the quality of care.

• Informatics

 Staff nurses can collect information by using information and technology. The latter will help the staff nurse improve safety and quality (Knebel & Greiner, 2003). Moreover, the nurse will evaluate the information technologies and during policymaking, the policymakers will see the need of improving technology to minimize safety errors, communicate, and support decision making.

Reference

Knebel, E., & Greiner, A. C. (Eds.). (2003). Health professions education: A bridge to quality.

National Academies Press.https://www.ncbi.nlm.nih.gov/books/NBK221519/

Hughes, R. (Ed.). (2008). Patient safety and quality: An evidence-based handbook for

nurses (Vol. 3). Rockville, MD: Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK2659/

Depression in the elderly

Introduction

 Depression among the elderly is on the rise given that 6.5 million Americans aged 65> suffer from the illness. Some develop depression in early life and others show depression symptoms in later life. Depression in the elderly is an issue of concern in that the mental condition is ignored and perceived as normal. In other words, it is believed that depression is a natural reaction to the developmental and social changes that elderly people go through. Depression is also mistaken as dementia, stroke, arthritis, and other illnesses. The elderly rely on the misconceptions that depression is a personal weakness, depression medication is costly, depression is normal in life, among other misconceptions that make them ignore depression treatment.  However, it is important to note that if depression is left untreated, the victim is at risk of developing other long-term consequences such as suicide, and self-injury. The National Institute of mental Health asserts that a larger percentage of elderly with depression are not unidentified. Note that people have stereotypical thinking which hinders the elderly from talking about their feelings and seeking treatment.  Organizations that focus on improving the mental health of the elderly such as WHO, NIMA, NIMH, and others assert that elderly are important people in the society and rather than seeing depression as part of aging, people need to recognize depression and provide medication and psychotherapy to make them feel better. Depression in the elderly can be treated and there are a number of strategies that can be used to help the elderly live a normal life. It is the role of the healthcare providers, mental health professionals, and other stakeholders in mental healthcare to come to light and provide long-term care, education, and support to the elderly. Geriatric depression is not a normal reaction but it is a medical problem that deserves special attention from health care professionals who should work together to meet the needs of the elderly.

Aging Perceptions

 The first thing to understand about the elderly is that older people are devalued in modern societies. The latter has created a young-oriented culture which does not care about the elderly (Arenson & Reichel, 8). In the youth-oriented culture, children view the elderly as useless since they struggle so much and they do not have anything to offer to the community.  Families develop discriminatory thoughts and see the elderly as insignificant and worthless. Respect and devaluation are also found in the place of work, in the media, in the clinical setting, and the society at large (Arenson & Reichel, 8). To make it worse, this is an overlooked problem simply because the societies believe that the elderly do not bring enormous benefits. This research calls for social awakening and develop a positive attitude toward the elderly. Rather than seeing people with gray hair and wrinkles as insignificant and useless, the society should see them as important people with a capability of starting a business, bringing social development, and enjoying life to the fullest. An important point to understand is that even though there are medical conditions such as dementia and heart disease that cause depression, there is evidence that the elderly develop depression as a result of a lack of sense of purpose. Note that older people lose a sense of purpose when society or people around them show disvalue or ignorance. As stated above, older people are excluded and discriminated and the stigmatized attitudes lead to depression in older people (Holm et al. para 3). They live in  social stigma  and as they develop a sense of being disvalued, they develop depression. To make it worse, healthcare providers do not pay attention to the mental disorder or rather they believe that it is a normal process associated with aging. Therefore, before understanding depression in the elderly, it important to note that society has a negative perception of the elderly.  Society sees the elderly as people with undesirable characteristics and develops prejudicial and discriminatory practices toward the elderly ((Holm et al. para 4). Consequently, the elderly experience stigma and they are unable to find purpose in life. Note that for the elderly to find a purpose in life, they need to be engaged, they need support, financial security, mental and physical health, and a sense of self-worth (Holm et al. para 3). Unfortunately, older people are not in a position to achieve these elements since they find a challenge in creating a social network. What happens is that they feel inferior and develop an emotional pain that leads to depression.

Understanding depression in older adults

 Depression is a public health problem that increased mortality as a result of decreased physical function and cognitive function. A point to understand is that some older adults experience depression earlier in life or early-onset depression and others in old age or what is known as late-onset depression (Fiske et al. 365).  Research and studies find that late-onset depression is genetically influenced or it occurs due to the family history.   However, scholars are interested in understanding the late-onset depression and neurological findings report that late-onset depression occurs as a result of structural brain changes (Fiske et al. 365). Some scholars say that late-onset depression occurs due to vascular risk factors and concomitant cognitive deficits. However, following the standard criteria for mental disorders, it is not advisable to put other medical conditions in place when diagnosing depression. Focusing on other medical conditions may lead to underdiagnoses or overdiagnosis. It is important to note that depression is different in other neurological syndromes such as stroke, parkinson's diseases,   and dementia (Fiske et al. 36).  For example, depression as a result of a stroke is characterized by vegetative symptoms such as intention, and loss of appetite.  Depression as a result of dementia is characterized by difficulty concentrating and social withdraw. In general, it is important to use the DSM-IV criteria in diagnosing depression to prevent underdiagnoses. 

Causes of depression

Biological factors

 Patients with cardiovascular disease are likely to develop depression as a result of rehospitalization, and health care costs. Other contributing factors include neuroendocrine and inflammatory systems.  Patients with diabetes are likely to develop depression due to impaired glucose metabolism (Fiske et al. 365). Patients with dementia suffer from cognitive impairment and they are at risk of developing depression due to cognitive and behavioral changes. Patients with stroke suffer from functional impairment and it becomes burdensome hence leading to depression (Fiske et al. 365). Another biological risk factor is chemical changes in the brain where the parts of the brain such as the amygdala are unable to regulate the emotional process.

Psychological risk factors

  Individuals with early-onset depression develop neuroticism in later life.  This means that they develop negative feelings about themselves. They are disturbed, irritated and develop fear and loneliness. They have ruminative thoughts and as a result of being so concerned about their mental problem, they increase the level of depression (Fiske et al. 355). Note that older people lose a sense of control, and they lack purpose in life.  They become helpless and develop negative thinking which aggravates the depressed state. 

Social factors

   Older people develop late-life depression as a result of financial difficulties and lack of financial support, functional decline, change in the living institution, emotional abuse, and other life stressors (Fiske et al. 375). Some older adults have interpersonal dependency and autonomy but they are unable to accomplish their goals due to lack of close relationships. Older people are unable to cope with the loss of a loved one. They experience social isolation and after the second year of loss, they develop depression. Older people rely on their loved ones such as spouses for financial support and companion and this means that their financial status deteriorates and starts to struggle (Fiske et al. 375). As stated above, older people are underrepresented in society and they are economically disadvantaged.  As a result of financial struggle and exposure to unsupportive society, they become vulnerable to depression. Note that elder people lack social support network where they could attain emotional support and other types of help.

Barriers to effective treatment

 An issue of concern about depression in the elderly is that the mental condition goes undiagnosed and untreated. Mental health professionals believe that depression symptoms are physical and they do not provide effective treatment to manage the condition (Roose & Sackeim, 29). Thus, older people continue suffering from emotional problems. Simply because the condition is perceived as a response to stress. For example, a wife may develop depression after losing a spouse and mental health professionals may conclude that it is a normal reaction to the grief.  Depression in older people contributes to physical and social impairment (Roose & Sackeim, 29). Thus, the more the condition is undiagnosed and untreated the more the older suffer from other medical illnesses. Health care providers and families do not see the need for effective treatment or they pay little attention simply because they are older and old age is associated with weakness. Mental health professionals fail to recognize depression due to inadequate awareness. What happens is that healthcare providers rely on other coexisting medical disorders such as dementia. Thus, they are unable to diagnose depression and to offer the right treatment intervention. There is also a shortage of mental health services. This means that health care institutions lack reimbursement for counseling and training and this makes it hard for primary care providers to offer quality care (Roose & Sackeim, 29). Rather, they give the patients a mental health referral and patients are unable to travel to other facilities to seek specialty services. Another thing that hinder effective treatment is a stereotype. As stated above, people believe that depression is a natural condition, and what happens is that the late-life depression contributes to a broader negative impact not only to the elderly but also the family and society.

  Ellison and Verma (28) add that despite the high prevalence of first-onset depression and later-onset depression among older people, the depressive symptoms are not identified.  Only less than 40% receive depression treatment and this means that 60% and above do not receive treatment. To make the matter worse, even those who receive treatment do not comply with the treatment. The authors assert that the barrier to care is multiform in that patients, providers, society, and financial organizations play a role in hindering effective care. The patient-related barrier means that the elderly are unable to recognize the changes occurring in life and causing negative impacts. Those who recognize negative changes do not recognized the importance of sharing feelings with a mental health professionals (Ellison & Sumer, 28). They seek a family doctor as they believe that the concurrent medical condition will go away. Some older people recognize changes and the need to communicate with a mental health professional but they do have the confidence and self-esteem to report their feelings. They do understand the health benefits and if they recognize the enormous benefits, they face challenges due to lack of financial resources and where to seek assistance (Ellison & Sumer, 31). Provider-related barriers mean that health care providers rely on patient's coexistence of medical illness and they do not put depression as a priority consideration. Clinicians do have experience or lack knowledge and skills on how to use screening instruments and what happens that they rely on false-positive or false-negative results which may lead to underdiagnoses and overdiagnosis (Ellison & Sumer, 31). There is also a shortage of mental health specialist and this indicates that older people suffering from depression receive care from primary care settings where they are cared for by general practitioners. The organizational barrier means that mental health professionals do not work toward common goals. In other words, they employ different therapeutic approach and they do have standardized clinical decisions (Ellison & Sumer, 33).  The majority of mental health facilities have trained professionals who can work in different areas such as counseling and psychiatry. This means that there are no specialty services and this means that it is difficult for the elderly to receive treatment and care from mental health specialty.

  Another barrier to effective treatment is the intervention barrier. Note that depression in the elderly occurs as a result of many factors such as aging-related changes and medical problems.  There are also different interventions and treatment and mental health professionals do not understand which treatment is effective (Ellison & Sumer, 41). There is limited research or in other words, there is no evidence-based research on depression topic and this makes the professionals lack a scientific understanding. The limited scientific knowledge forces the professional to provide equal treatment without efficacy research. The last barrier to effective care is a societal barrier (Ellison & Sumer, 42). Note that society has a negative perception toward the elderly and local communities do not provide safe and effective treatment simply because society does not recognize the psychiatric disorders. 

Interventions

Cognitive-Behavioral Therapy

Roose & Sackeim (288) assert that CBT is effective for late-life depression. CBT means a group of therapies that aim at helping people control their moods and their psychosocial movement. Cognitive-behavioral theorists assert that depression is influenced by genetic and biological factors. Thus, skills acquisition will help the elderly learn about problem-solving,   and self-management. CBT is a short-term therapy that teaches the elderly with depression symptoms on how to control their psychosocial environment (Roose & Harold, 288). There is evidence from randomized trials that after treatment, the elderly decrease depression. Elder people can interpret situations that change behaviors and after identifying the distorted cognition, one can use techniques that will distract oneself from unpleasant activities (Roose & Harold, 288). The elderly can alter the unpleasant event and irrational thoughts and increase pleasant events by applying adaptive thoughts.

Interpersonal psychology

 IPS works well in the later-life depression. The elderly can focus on stressful life events such as grief and after conducting analysis or having a deep understanding of the event, the elderly will develop better social functioning (Roose & Harold, 290). An elderly may also focus on the social relationship and after identifying the barriers to interpersonal connections, he or she will develop coping strategies and plan on how to solve the issues.

Dialectical behavioral therapy

            Older adults with a personality disorder can use dialectical behavioral therapy to improve behavior and thinking. Note that during times of depression, the elderly have a bitter attachment or they find it difficult to accept the reality of stressful life events such as the death of a loved one (Roose & Harold, 292). Secondly, they become problem avoidant or they are unwilling to solve the problem. Third, the elderly may reject support or demand support. Fourth, the elderly develop self-pity and believe that life is meaningless. When the elderly develop these personality disorders, dialectical behavior therapy will help them develop adaptive responses to stressful events.

Problem-solving therapy

 This type of therapy is effective in depressed elderly. The mental health professional helps the elderly in identifying problems and creating real solutions. The elderly may also develop an action plan and actionable strategies (Stern, 151). The method is effective in that the elderly will develop confidence that the problem is solvable and he or she will manage the situation.

Brief psychodynamic therapy

 In brief dynamic therapy, an older person will gain awareness and insight about a problem. They will understand the emotions and behaviors and recognize that they are behaving in a certain way due to negative feelings and motivations (Stern, 151). Thus, the elderly will employ healthy ways to manage the psychological problems that prevent leading a fulfilling life.

Recommendations to improve access to care

 The first recommendation is prevention which should be done by identifying risk factors and working as a multidisciplinary team to reduce the risk factors. The public needs to gain awareness of the signs of depression. Raising awareness will destigmatize depression and people with depression symptoms will gain the confidence to talk about their feelings and seek treatment (Ellison & Sumer, 44). The second recommendation is translational research. This means that health care providers and mental health professionals should apply scientific knowledge and discoveries in the treatment of elderly depression. The scientific knowledge will shed light on the best practices in diagnostic and intervention (Ellison & Sumer, 44). The third recommendation is interventional studies. Note that mental health professionals are facing challenges in providing the best drug intervention. There is a need to conduct clinical trials to understand the safety and efficacy and assess functional and cognitive capabilities. The fourth recommendation is health services research. New practice guidelines, knowledge on the role of mental health professionals, morbidity risks, and the effectiveness of the treatment are needed (Ellison & Sumer, 45). Finally, providers of mental health need to improve their skills and knowledge to provide quality services and encourage depressed individuals to seek treatment. Insurance groups should also provide insurance coverage to the patients of mental problems to make it easy for them to achieve quality treatment (Ellison & Sumer, 46). Depression can be prevented if only health care providers recognize the risk factors and implement prevention strategies. 

Conclusion

 Depression is common among older people aged 65 years and above. The research paper finds that different factors such as family history, environmental factors such as loss of loved one, psychological factors such as personality traits, and stressful life events contribute to depression. There is also evidence that older people with the physical illness are likely to suffer from depression later in life. An important point to note from the research paper is that whether an elder has earlier-life depression and later-life depression, it is important to seek treatment.  Healthcare providers and mental health professionals should not see depression as a natural reaction but they should treat it like other diseases. They should come up with interventions which are effective or which will bring a difference in people's life. There are many interventions to treat depression and it is the role of mental health providers to select the most effective intervention to prevent depression. The main concern about depression in a leader is that older people with depression are unrecognized in society as well as in the healthcare setting. They are stigmatized and the stigma makes them believe that depression is an insensitive topic and so they do not express their feelings. The research paper recommends the use of translational research to come with effective practice in treating depression and preventing future incidents. Current psychological interventions are providing positive results but there are barriers to treatment.  An important area that needs improvement is to understand the barriers and remove them to ensure that mental health professionals achieve their objectives, and patients receive quality care.

Work cited

Arenson, Christine, and William Reichel. Reichel's Care of the Elderly: Clinical Aspects of

Aging. Cambridge [u.a.: Cambridge Univ. Press, 2009. Print.

Ellison, James E., and Sumer Verma, eds. Depression in later life: a multidisciplinary

psychiatric approach. CRC Press, 2003.

Fiske, Amy, Julie Loebach Wetherell, and Margaret Gatz. "Depression in older adults." Annual

review of clinical psychology 5 (2009): 363-389.

Holm, Anne Lise, Anne Lyberg, and Elisabeth Severinsson. "Living with Stigma: Depressed

Elderly Persons’ Experiences of Physical Health Problems." Nursing research and practice2014 (2014).

Roose, Steven P, and Harold A. Sackeim. Late-life Depression. Oxford: Oxford University Press,

2004. Internet resource.

Stern, Debra. Epidemiology of Aging. Place of publication not identified: Jones & Bartlett

Learning, 2017. Print.

Stress

What is stress

            Stress is defined as the body’s way of reacting to stimulus both internally and externally regardless of whether the stimulus is a demand or a threat. The stimulus occurs regardless of whether the need or threat is real or imagined allowing the body to respond accordingly and rapidly in what is referred to as the stress response or flight-or-fight. While stress is often referred to negatively, the misconception has to do with the notion that stress only occurs when the body is responding to danger, pain, or some form of loss. However, stress can also be beneficial as it helps one remain alert, focused and also acts as an early warning system. Through stress, people react better when in an emergency situation. Stress is responsible for the quick action and reflexes as well as adrenaline that kicks in when someone is in danger. Enough stress can cause an individual to engage in reflex actions such as stopping a car abruptly, jumping out of the path of danger and also avoiding situations that could put the individual in harm.

Types of stress

• ACUTE STRESS 

Acute stress is the most common and brief form of stress that an individual experiences and in frequent presentation. It is often as a result of reactive thinking engaged by the individual and it is often characterised by negative thoughts. Acute stress is often as a result of the individual lack of understanding or confidence in events that have recently occurred and also when anticipating situations and events that may occur in future (Ehrenfeld, 2018). A good example is the attitude that one may develop following an argument. Acute stress is experienced if the individual involved in the argument continues to harbour negative thoughts regarding the argument that reoccur in the mind. Other causes of acute stress include upcoming deadlines where the individual has doubts on his ability to accomplish what is expected in time (Ehrenfeld, 2018). although acute stress does affect the individual, its effects are often limited to the duration in which the individual continues to induce it. Since acute stress is caused by the individual’s thoughts and fears, the stress often goes away after the element causing the fear is reduced or done away with.

• EPISODIC ACUTE STRESS  

Episodic acute stress is as a result of frequent acute stress and it is common among people who experience frequent stress triggers. Most people with episodic acute stress often experience chaos and their life requires them to solve a lot of crisis (Ehrenfeld, 2018). Other common characteristics include experiencing life in a rush and living in constant pressure. The stress is often as a result of the individual’s tendency to take on more responsibilities than one can handle. The constant pressure makes it hard for people experiencing episodic acute stress to be organized or finish tasks in time. the individuals feel constantly pressured and this only intensifies the episodes of acute stress.

• CHRONIC STRESS

Chronic stress tends to be the most harmful compared to acute and episodic acute stress. This is especially because, if left untreated, it could negatively affect the individual’s mental and physical health. Its negative impact is because of the duration that factors promoting it affect the body and also their consequences (Ehrenfeld, 2018). Factors such as physical abuse, unemployment and substance abuse lead to chronic stress. Since chronic stress develops over time, lack of managing it could result in the individual feeling hopeless and develop negative attitudes towards stress management (Ehrenfeld, 2018). The impact tends to have far reaching consequences because the elements causing the stress have either been part of the individual’s life for too long, or the effects have become too complex to resolve.

Causes of stress

            Stress occurs as a result of factors referred to as stressors. Stressors can be both positive and negative depending on the factor causing them as well as the type of reaction they trigger. Poor working environments and any experience that creates negative stimulus is responsible for negative stressors while events such as getting married or buying a house are responsible for positive stressors (Mayo Clinic, 2019). Stressors result from both internal and external factors. Other than stimulus from society, stress also occurs as a result of self-generated activities such as worrying about something or developing a pessimist approach towards life.

Regardless of what stimulus evoked the stress, its existence is greatly because of how people perceive events that occur in their life. The argument is based on the fact that events that are considered as stressful to some may only appear as a minor inconvenience to others (AIS, 2016). Take public speaking as an example. To some people, standing in front of a crowd is stressful and even makes it difficult for some to formulate words. There are however people who are rather comfortable in front of a crowd and are in no way affected by the audience (Cantor & Ramsden, 2014). There are also those who perform best when working under pressure as it pushes them to give the best results. Pressure may however be a stress stimulus as some people find pressure a hinderance rather than a motivator. Although people may react differently to stress stimulus, there are common areas that have a likelihood of causing individuals to develop stress and they include;

• Stress at work

Stress at work is caused by the desire to meet set objectives set by the organization. Excessive stress could interfere with a person’s productivity and make it difficult to fulfil the assigned tasks. In such a setting, the individual will find it hard to engage with others. The stress can also affect the individual’s physical and emotional health, making it even more difficult to meet the set objectives (Segal et al, 2020). Stress may also occur as a result of the approach one takes in trying to accomplish personal goals. Other than meeting organizational goals, employees have their own personal goals which are fulfilled depending on how they go about their work. Since a job determines a lot regarding an individual personal life, stress at work can also affect people while at home or among friends.

• Job loss and unemployment stress

Employment is how people earn a living and make enough to support the lifestyles they lead. Loosing a job is therefore a stressful experience as it only threatens an individual’s livelihood, but also forces them to adopt new lifestyles. Often times, loosing as job triggers feelings such as anxiety, anger and depression which greatly contribute to stress.

Effects of stress

Some of the common effects of stress include irritability, anxiety and depression. The effects occur regardless of whether the stress is perceived or real. There are however more severe effects that could greatly affect an individual’s life if not well managed.

• Central nervous and endocrine systems

The central nervous system is responsible for the flight-or-fight response that helps people know how to react to danger. The process starts in the hypothalamus which sends stimulus to the adrenal glands and prompts them to release stress hormones. The hormones in turn increase the heartbeat rate which sends blood rushing to the area that has experienced the stimulus (Oxington, 2005). The blood for example could be directed to the muscles and this makes it easier to support any decision, whether to fight or flee. The effect is however supposed to only last until the stimulus causing the stress goes away and the same process occurs but this time to inform the system to return to normal. In the case of individuals with chronic stress, the process may take longer and the body stays in a state of anticipating stress even when the stress stimulus is gone. In such an occurrence, the individual is likely to overreact or engage in harmful activities such as drug abuse or social withdrawal in an attempt to reduce the perceived stimulus.

• Immune system

Stress can positively impact an individual especially when the stimulus is intended to protect the body. Since stress triggers reactions that help individuals avoid infections and physical injury, its occurrence can help the individual have a stronger immune system. If the individual experiences too much stress however, the stimuli could weaken the stress hormones in the immune system and thereby lower its ability to fight bacteria and other diseases (Wingo, 2016). Individuals experiencing such forms of stress tend to be more prone to illnesses such as the flu. It also takes longer for them to recover from such illnesses.

Managing stress

            While stress has the potential to cause harm to an individual, it is something that can be managed. Spending time with friends and family is one of the common approaches taken to manage stress. The exposure puts the individual in a setting that discourages seclusion as people engage in various activities and conversation. The interaction provides the distraction needed to shift focus from the stress causing stimulus to something different and this could help overcome the stress (Mayo Clinic, 2019). Other than creating a distraction, family and friends offer support and help the stressed individual to shift their perceptions towards what causing the stress.

            Managing stress also requires one to remain active. Engaging in activities can help individuals draw more meaning to their life and the achievements they make. Staying active prevents the mind from acting on the individual’s fears to create stimulus that could trigger stress (Mayo Clinic, 2019). When engaged in an activity, the mind will divert more attention to the task at hand and in so doing, draw attention from the stress trigger. It is however advisable for individuals to engage in activities that have a positive impact on the individual’s life to avoid the chances of experiencing more stressors.

            Another approach that can be used to manage stress is seeking professional help. Individuals who are greatly affected by stress can seek the services of professional such as counsellors and other caregivers to help them to better understand their condition. Since some stress is caused by an individual’s or anticipation of a future that may not even come to pass, professionals can help individuals to manage their anxiety. Teaching patients how to prevent thoughts from running wild can help them to better manage stressful conditions without having to suffer from the negative side effects.

References

American Institute of Stress, (2016) “Stress effects” retrieved from,            https://www.stress.org/stress-effects

Cantor, D., & Ramsden, E. (2014). Stress, shock, and adaptation in the twentieth century.            University of Rochester Press

Ehrenfeld T, (2018) “The three types of stress” Psychology today, retrieved from,             https://www.psychologytoday.com/us/blog/open-gently/201812/the-three-types-            stress#:~:text=According%20to%20the%20American%20Psychological,chronic%20s       tress%20is%20often%20ignored.

Mayo Clinic, (2019) “Stress symptoms: Effects on your body and behaviour” retrieved from,             https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-    symptoms/art-20050987#

Oxington, K. V. (2005). Psychology of stress. New York: Nova Biomedical Books.

Segal J, Segal R, Smith M, and Robinson L, (2020) “Stress symptoms, signs and causes” Help Guide, retrieved from, https://www.helpguide.org/articles/stress/stress-       symptoms-signs-and-causes.htm

Wingo, M. K. (2016). The impact of the human stress response: The biologic origins of    human stress. Roxwell Waterhouse

Case Study #3 – E. coli and the Chronic Disease Continuum

            In the current world, healthcare is described by a grizzled populace. To be specific, many individuals experiencing chronic illness and extraordinary influence on everyday experience are implied by this trend. However, the vast growing knowledge of medical technics and advancing technology has enabled more diagnostic and treatment possibilities. In this case, substantial healthcare complexity increases a situation that has become a primary priority requirement in healthcare systems and management due to these trends. Bearing in mind that the nurses must assist patients in finding their inspiration to acquire better health, all necessary output in healthcare is required. In achieving this, there are different tools that nurses can utilize in guiding patients in the right direction. One of the main tools used in this cause is the health continuum. Therefore, the health continuum can be demonstrated as an illustration that draws a connection amid the treatment paradigm and the wellness paradigm. With this understanding, this paper will help the learner understand the Chronic Disease Continuum in the context of the Escherichia coli case study.

1. Environmental determinant (e.g., E. coli). Describe the incubation period, clinical syndrome, pathophysiology, characteristic foods, and specimens.  

           Bearing in mind that different factors can contribute to the spread of chronic disease, it will focus on environmental factors (Geller, Stacie, et al. 152). It is noted that chronic disease can be initiated from one person bearing a single germ such as E. coli (Escherichia coli). Still, many of the major chronic diseases have no single cause. In the context of E. coli bacteria, the study has shown that the bacterium inhabits mainly the lower intestines of warm-blooded animals; this includes humans. The bacteria are discharged in the environment through feces or even through the wastewater effluent. Even though it is said that most types of E. coli bacteria are harmless as they can only cause relatively brief diarrhea to the infected patient, other nasty strains can have the potential to cause chronic illnesses.

           Although people may think that E. coli cannot cause chronic illnesses to the population, if the bacteria are not controlled, it can lead to a considerable mortality rate like any other chronic disease. Environmentally, the bacteria have a potential means of transmission as the ways of affecting people are very prone (O'Connor et al. 1051). Environmental determinants of E. coli being daily intakes such as water and food; if contaminated with these bacteria, a massive death can be experienced.  

           The incubation period can be described from the infection introduction to the contaminating bacteria and the beginning of medical sickness. Precise information on this boundary is valuable in contracting the conceivable period of introduction, eliminating optional circumstances, and proclaiming the final stage of the outbreak. Additionally, it is valuable to understand the pathogenesis of E. coli and to assess the conceivable degree of the infection of diseases. In the vast eminent STEC O104 flare-up in Germany, the development time was extensive than anticipated bringing about testing epidemiological examinations, especially while grouping applicable introduction details. 

           Regardless of its significance, accessible reports on the incubation time of E. coli are contradicting, for example, the varying expected disseminations projected by the Health ministry and the Center for Disease Control and Prevention (WHO). Therefore the incubation period of the E. coli (Escherichia coli) is estimated to be 3-4 days after a person is exposed. Still, in some cases, the time can be short even to one day.  

            The irresistible portion of E.coli O157: H7 is, anyway, low. One examination shows that as not many as ten effective microbes can cause ailment in people. The pathogenesis of E. coli: H7 effects from its creation of Shiga poison that harms the digestive tract by sloughing off of colonic mucosa cells and outcomes in hemorrhagic looseness of the bowels (Clark, William F., et al. 34) The Shiga poison has systematic affects vascular endothelial cells, bringing about vasculitis, and shows in hemolytic uremic disorder, stomach torment, and seldom, thrombotic thrombocytopenic purpura (Clark, William F., et al. 34). E. coli 0157:H7 Shiga poison starts the incendiary course that causes leukocyte total, apoptosis of the influenced cells, platelet collection, microthrombi development, hemolysis, and renal brokenness, as the renal glomeruli have specific helplessness to a microthrombi arrangement. According to Awofisayo-Okuyelu, A. et al. study, E. coli 0157: H7 Shiga poison impact shows in the kidney and its most extreme indications; it can bring about a prolix vasculitic grievance that influences numerous structure frameworks and different organ letdowns.  

1. Health risk behaviors and other factors.

            Risk factors are things that people experience throughout their lives that help in building infection conditions. These factors can be demonstrated by various items such as family, exposure to the environment, age, gender, ethnicity, or even being healthy. However, if one has no risk factors, one should undergo medical screening to avoid later implications. Also, it is essential to seek healthcare attention to confirm whether one is supposed to undergo health screening. For many individual behaviors determines the impacts and the extent by which various risk factors can be controlled. In this case, individuals are expected to ensure the food and water consumed is clean and free from contamination.

1. Chronic conditions. 

           Escherichia coli O157 (E. coli O157) has been connected to the gastrointestinal sickness in people, including various food and waterborne episodes around the world. The O157 serogroup of E. coli is of specific worry as it is connected with severe side effects, such as hemolytic uremic condition (HUS), and the primary source of intense renal disappointment in children (Awofisayo-Okuyelu et al. 132). Also, chronic conditions, for example, receptive joint pain (ReA), peevish gut disorder (IBS), incendiary inside illness (IBD), and Guillain Barré condition (GBS), have likely connected to contamination by foodborne pathogens, for example, E. coli O157. 

           The Health ministries presented the International Weight of Illness exertion to extend infection trouble gauges past death rates. Diarrheal illness is evaluated to be the fifth driving reason for bleakness around the world, causing an expected 2.2 million deaths every year. As diarrheal sickness can be brought about by numerous pathogens, the specific number of cases ascribed to E. coli O157 is unsure. An expanded comprehension of malady movement and the sequelae related to E. coli O157 contamination could help endeavors to grow progressively precise weight of ailment (BOD) gauges for E. coli O157.

1. Chronic Disease -adult or childhood. 

           The chronic disease in this context as different impacts as far as age is concerned. Younger children are likely to experience more consequences than adults. However, the associations among episodic and chronic contaminations and lack of healthy sustenance are intricate and bi-directional (Walson, Judd & James 231). For instance, children with ailing health seem to be at significantly complicated danger of diarrhea, with equally more significant frequency and expanded seriousness announced in undernourished children. Notwithstanding an expanded recurrence of irresistible sickness, children with a lack of healthy sustenance are at substantially more severe danger of increasingly severe sickness and endure altogether progressively intense and prolonged haul grimness and mortality when tainted. A clearer detachment between the acute condition and foundation dangers has been made (Awofisayo-Okuyelu et al. 142). Youngsters with E. coli are bound to contemporaneous mind in any coordinated event administration of youth disease (IMCI) threat sign. They might be bound to have a microbial pathogen distinguished as a likely causal specialist of the runs than no malnourished youngsters.

Conclusion 

           From the above case study, it can be attested that considering the effects of patients and the outbreak characteristics on the incubation period are significant for the public health professionals in the context of E. coli and the Chronic Disease Continuum. By considering this, it will assist in extending or limiting the exploratory period as they collect the necessary information. However, further study is needed to control the impact of appearances that have not been observed.

Work cited

Awofisayo-Okuyelu, A., et al. "Analysis of individual patient data to describe the incubation        period distribution of Shiga-toxin producing Escherichia coli." Epidemiology &    Infection 147 (2019).

Clark, William F., et al. "Long term risk for hypertension, renal impairment, and cardiovascular   disease after gastroenteritis from drinking water contaminated with Escherichia coli       O157: H7: a prospective cohort study." Bmj 341 (2010).

Geller, Stacie, et al. "The continuum of maternal morbidity and mortality." American Journal of Obstetrics & Gynecology 189.6 (2003): S152.

O'Connor, Siobhán M., Christopher E. Taylor, and James M. Hughes. "Emerging infectious         determinants of chronic diseases." Emerging infectious diseases 12.7 (2006): 1051.

Walson, Judd L., and James A. Berkley. "The impact of malnutrition on childhood            infections." Current opinion in infectious diseases 31.3 (2018): 231.

World Health Organization. Antimicrobial resistance global report on surveillance: 2014             summary. No. WHO/HSE/PED/AIP/2014.2. World Health Organization, 2014.

Vaccines

Introduction

            A vaccine is a form of medication that is introduced to the body to help train the immune system to fight diseases that the body is yet to come into contact with. Vaccines differ from other forms of medicine because they attempt to prevent diseases from occurring rather than treating them once they do. The vaccine is administered in the form of molecules called antigens which are also present in all forms of bacteria and viruses. Once the antigens are introduced in the body, the immune system can identify them as hostile inhabitants of the body and produce antibodies to fight against the symptoms they cause. Once the antigens exist in the body, the immune system can recognize the same antigens in the future even if they are caused by an actual virus or bacteria. Although the antigens in the vaccines have been neutralized to ensure they cannot harm the body, the immune system’s preparation to get rid of the hostile invaders ensures that the body is ready to fight off diseases in case the same antigens enter the body.

           The success of vaccines in preventing diseases has a lot to do with the various changes and developments that have occurred in the process of making them. The history of vaccines can be traced back to the 19th century where Salmon and Smith pioneered the field of vaccines when they injected immunogenic components into an organism (Dunn & McCullers, 2008). Their achievements were incorporated in the technology used by scientists like Louis Pasteur and even modern forms of vaccines used today. In the 1970s researchers discovered that DNA sequencing was possible allowed the expression of proteins which facilitated the development of better vaccines (Dunn & McCullers, 2008). The first recombinant vaccine was developed in 1986 which led to the development of the vaccine for Hepatitis B. the 1980s also saw to the advancement in vaccine development as it paved the way for the adjuvantation where the presentation of antigens in vaccines could be improved to make the immune system more resistant to diseases.

           The major concerns that people have when it comes to vaccinating children mostly have to do with the effect that they will have on the immune systems as well as the side effects. Children today receive more vaccines than they used to in the past and this has raised concern that introducing so many antigens could affect the child’s immunity (McCarthy, 2019). While it is true the vaccines do introduce antigens to the body, they are nothing compared to the antigens that the baby picks up daily. Children tend to touch items as they crawl, play, and get dirty. The experience with the outside world exposes children to antigens that are more dangerous than the ones contained in vaccines.

            Another factor that creates uncertainty when it comes to vaccinating children is a result of the various side effects associated with some vaccines. Although the side effects vary depending on the child and type of vaccine, among other factors, children have been known to display various side effects such as mild pain and swelling on the points of injection (OVG, 2020). Children have also been known to develop mild fevers, seizures, and other forms of discomfort especially on the first days of vaccination.

            Lastly, vaccinating children is challenged by the fear that the vaccines are safer for adults compared to children. This is especially because vaccines are made using antigens from the same or similar diseases they are intended to prevent (McCarthy, 2019). Lack of a basic understanding has created an environment where parents are distrustful with the processes involved in making vaccines and therefore tend to hesitate before subjecting their children to vaccination.

            Despite the various restrictions that parents have concerning vaccinating children, the fears are based on misinformation and lack of understanding. Concerning the effect that vaccines are likely to have on the child’s immune system, the vaccines do more to boost the immune system than cause harm. Although the vaccines contain antigens from the disease they try to prevent, the process of making vaccines is done in such a way that all the harmful elements of a virus or bacteria are removed (WHO, 2020). The antigen injected is safe and cannot harm the child. Instead, the antigens train the body to fight such diseases thus making the child more immune to diseases.

            Although there is a likelihood that the children will develop side effects, the symptoms are often mild and go away over time. The side effects are however a small price compared to the harm that the child could face if exposed to the diseases that vaccines try to prevent. Similar to how there exists medicine for adults and children, a lot of research is conducted to ensure that the vaccine administered is safe for children (WHO, 2020). A lot of procedures are followed before allowing a vaccine to be administered and this ensures that the ones in use are safe for children.

            Despite the various benefits that vaccines hold in promoting quality health, their use, especially on children is yet to get the acceptance it deserves. This is mainly because people lack adequate information regarding vaccines and how they work. Medical professionals should liaison with influential people in society and policymakers to share information on vaccines as a way to assist people to make better decisions concerning health.  

            Most of the information regarding research suggest that vaccines do more harm than good. It is therefore my recommendation that you take the child for vaccination so as to protect him from diseases in future. Instead of avoiding medical treatments based on personal opinions and fears, I would also suggest consultations with medical professionals. They have access to all forms of information and can greatly help you understand more about vaccines and even advice on how to deal with side effects in case they occur.

References

McCarthy, C. (2019). “Why do parents worry about vaccines?” Harvard Health Publishing,         retrieved from: https://www.health.harvard.edu/blog/why-do-parents-worry-about-   vaccines-2019080217406

McCullers, J. A., & Dunn, J. D. (2008). Advances in vaccine technology and their impact on        managed care. P & T: A peer-reviewed journal for formulary management, 33(1), 35–          41.

Oxford Vaccine Group. (2020). “What is a vaccine and how does it work?” University of Oxford, Retrieved from: https://vk.ovg.ox.ac.uk/vk/how-do-vaccines-work

World Health Organization. (2020). “Six common misconceptions about immunization”    Retrieved from:             https://www.who.int/vaccine_safety/initiative/detection/immunization_misconception            s/en/index2.html

 Quality of Care and the Basic Sources of Law

Introduction

Quality of care is the level of value that is given by any healthcare resource. It is an evaluation of whether something is good and whether it is suitable for what it is purposed for. The basic sources of law are the rules that make it possible for any state to govern its territories. The quality of care has changed over time and a lot of improvements have been noted in recent times.

In the 18th century up to the recent years, healthcare and quality of care have shown great advances in the healthcare industry (Marjoua & Bozic 2012). In the 18th century, hospitals were poor and had very bad reputations for the quality of care being worse.  The medical practitioners then had little medical knowledge and were not able to research and this caused patients not to get cured. There is an improvement in infrastructure, systems have been developed to help monitor and increase the effectiveness in healthcare. Improvement in the quality of care has also been associated with good leadership.

The common law is the form of law that is consequential from decisions made by the judiciary in courts and similar tribunals. Most of the legal principles and policies that are used today courts in the United States originated from the English common law (Jones & Bartlett 2015). Statutory law is written law that is passed by the legislature. Administrative law is the body of law that governs the administrative activities of the government. Common law is prevalent in healthcare because the court has to be involved and the judicial decision has to be made.

Conclusion

The quality of care has changed from the past years and has improved. Infrastructure has improved and the systems have helped in terms of efficiency and effectiveness. The basic sources of law have made it possible for states to govern their territories. The laws also help in judicial decisions in healthcare.

References

Jones & Bartlett (2015). Government, Law, and Ethics Retrieved from http://samples.

jbpub.com/9781284065923/Chapter2.pdf

Marjoua Y& Bozic J. K (2012) Brief history of quality movement in US healthcare. Retrieved

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702754/pdf/12178

_2012_Article_9137.pdf

Advocacy in nursing

What types of advocacy exist for nurses today?

             Nurses act as advocates for children, patients, and their own rights. They play a big role in the nursing profession in empowering the communities and addressing environmental issues (Sattler & Lipscomb, 2003). Types of advocacy are;

• Case advocacy

 This type of advocacy is also known as patient advocacy since nurses  advocate for individual patients to ensure that their needs are met. Nurses act as a patient representative and ensure that patient's voice is heard, and their rights are not violated (Sattler & Lipscomb, 2003).  For example, nurses can raise issues concerning inaccurate diagnosis, unclear instructions, poor decisions from the family, and the need for better treatment. Case advocacy promotes effective nursing practices since nurses are interested in patients' justice (Sattler & Lipscomb, 2003). Case advocacy also increases trust and respect since the community recognizes that nursing has appropriate performance and they are improving the quality of care.

• Class advocacy

  Class advocacy involves taking actions on behalf of the populations. For example, the populations are affected socially and economically (Sattler & Lipscomb, 2003). In class advocacy, nurses act as advocates in making policies aimed to improve the social conditions.  Populations may be suffering from poverty and poor health due to injustice and inequalities. Nurses are concerned with the well-being of the disadvantaged populations and they recommend health policies and programs that aim at creating healthier communities. 

How advocacy can be demonstrated in everyday practice.

 Advocacy can be demonstrated through the following practices;

• Create a healthy work environment; Nurses and managers should have a positive communication system that promotes a collaborative environment. Effective communication and collaboration will increase trust and respect and nurses will ensure efficiency and efficacy (Sattler & Lipscomb, 2003). In nursing practices, nurses should be advocates for patients by ensuring safety in providing care and after discharge.
• Connecting the community to resources; Nurses can demonstrate advocacy in helping the patient as well as the community access the resources for quality care such as financial assistance, support network, and other needs (Sattler & Lipscomb, 2003).  The community may also face injustice issues and nurses should demonstrate advocacy by working with the community to identify the problem and hence provide community development and empowerment.
• Mediation; another way nurses can demonstrate advocacy is through mediation or working with the community and the opposing party to facilitate resolution (Sattler & Lipscomb, 2003). In such a scenario, the nurse many propose reasonable solutions to end the differences.
• Expert testimony; this is a practice to demonstrate advocacy in that nurses can give ideas and opinions concerning their areas of practice (Sattler & Lipscomb, 2003). They may present records about environmental exposure and provide knowledge and experience to achieve solutions and justice. 
• Political astuteness; nurses can demonstrate advocacy by engaging in political practices such as being part of the political campaigns (Sattler & Lipscomb, 2003). The nurse will get the opportunity to express the issues facing the community such as unemployment, insecurity, violation of rights, and influence the political leaders in recognizing individual rights.

Three factors that make up the definition of advocacy are; equality, change in system and practices, and quality care (Sattler & Lipscomb, 2003).

• A healthcare advocacy group known as Healthcare-Now has demonstrated that it is an advocate for patients' equality by fighting for a single-payer healthcare system. This means that the organization wants the patients to receive comprehensive coverage and the government should be responsible for coverage (START Study Guide, 2020). The organization promotes equality by ensuring that all Americans are insured and can access health care services.
• Physicians Committee for Responsible Medicine (PCRM) has demonstrated the advocacy role in changing the system and practice. The non-profit organization is concerned with the nurses' practice and proposes changes in practices and research (START Study Guide, 2020). For example, nurses should educate patients on the importance of taking care of their health, and the importance of using effective scientific methods rather than using animals.
• Families USA demonstrates the role of advocacy for high-quality care through comprehensive coverage, preventive services, disease management program, health information technology, and drug cost reduction.

Reference

Sattler, B., & Lipscomb, J. (2003). Environmental health and nursing practice. New York: Springer.

 START Study Guide. (2020). Health Advocacy Organizations. http://www.startguide.org/orgs/orgs07.html#cat1

External Factors that Influence a Nurse Manager’s Decision Making

 Provide an overview of the role of the nurse manager

The nurse manager is responsible for the supervision role whereby she supervises the staff in the hospital. She oversees the care of the patients, makes decisions concerning budgets and management. She is also responsible for setting the working plans, organizing and managing meetings, and is an ultimate decision-maker. The nurse manager’s role is to create a nontoxic and healthy setting for the healthcare team and this helps to contribute to the standard care of the patient. She is liable for influencing the professional environment and nurture a culture where the team members can contribute to the care of the patients and also grow professionally Deyo, Swartwout & Drenkard (2016). Other than making critical decisions that help in the care of the patient, the nurse manager also is liable for other duties that include, management of staff and cases, planning of treatment, and discharging of patients. She is also responsible for recruitment and mentoring, coming up with educational plans, and managing records.

A nurse manager’s role associated with the impact on the policies of health is viewed to be challenging (Bogaert, Peremans, Wit, Heusden, Timmermans, & Havens 2015). This is regarding the difficult needs of the patient and the staff being involved in the process of deciding on the healthcare settings. The influence on the health policy of a nurse manager is responsible for protecting the standard care by enabling access to the needed resources and prospects. It is also capable of influencing decisions and other affairs that are associated with health and healthcare through political awareness, communication, and relationships with other associates of the staff. This helps in improving the work environs and increases the outcome of patients meaning that it increases the quality of care. This process is associated with the knowledge, skills, influence, support, and their capability to change. Each of the nurses has different individual views on the issues related to health and their influence on this process and the outcome of the patient. With the rapid change and development of the health systems, nurses who are a part and parcel of the system must embrace the changes and developments.

The impact of regulatory agencies on decision making according to Bogaert et al. (2015) is that health system guidelines are ranked differently in three categories. There is a category of those policies that are not essentially generated by the government. The other category includes policies that are developed for the entire country and have been developed by the government. The last category includes policies that are in the middle of the other two policies and are normally developed by the authorized administrations. The use of the three levels of policies is important in nursing management to clarify and define the policy influence concept. When the concept is clarified, a common language is arrived at and this helps in increasing the credibility of future studies.

Hospitals have to make a profit to enable them to continue existing. The rise of the number of cases in hospitals has led to the perception that the admission of patients, their treatment, and discharge are influenced by not only the medical aspects but by economic factors too. This is done with the perception of making a profit and this has led to the decision making process become partly commercialized (Wehkamp, & Naegler 2017). The current economic conditions are causing a big influence on medical care negatively impacting the patients, physicians, and nurses. The economic pressure on a hospital can undermine the independence of medical decision making. When a patient is starting treatment, they put their trust in the physician taking care of them and the hospital itself. This is because the physician’s principle is to maintain and restore the health of the patient. This principle is violated when a medical decision making in the hospital is impacted by non-physicians on financial grounds that the wellbeing of the patients is no longer represented by the paramount duty. Limited financial resources influence in a big way the medical and managerial actions. Losses incurred in hospitals are compensated by profits that are generated from the treatment of patients.

Analysis of the interview

The decision making for a nurse manager is a significant process of making judgments in regards to the care of the patient and management. A nurse should be capable of using their skills of decision making to ensure the providence of safe and effective nursing care. There is a rise in demand for healthcare services over the last years whereas the health systems have been faced with a lot of challenges because of the limited financial resources, increased cost of healthcare and demand, and finally expectations from the public (Alaseeri, Rajab & Banakhar 2019). For nurses to be able to respond to the patient’s nursing care needs, they are required to be competent decision-makers hence being able to thrive in the uncertain nature of the healthcare environment. Nurses are often needed to make clinical, non-clinical, ethical, management, and practice decisions every time they have to deal with a patient. They make decisions during the process of nursing in the clinical care of the patient to determine interventions and consequences by the use of clinical reasoning skills.

Research shows that a nurse manager makes very many critical decisions concerning a patient which can affect their safety, standard care, and their outcomes. The factors that influence the nurse’s decision making are the nurse’s personal and patient attributes, organizational, and environmental factors. The nurse’s attributes are known to be the nursing experience, clinical knowledge, demographic factors, self-rule, and assertiveness about the care of the patient (Alaseeri, Rajab & Banakhar 2019). The organizational factors are the interrelations between the multidisciplinary team, the hospital's vision and mission, the policies and rules of a hospital, and its resources. Despite the significance of the decision making of a nurse, some barriers impact the process of making decisions in hospitals. The unacquainted nurse aspects of decision making have a negative contribution to the performance of a nurse, the organizational, and consequences of the care of the patient. Barriers that negatively impact the quality of care and professional decision making include overworking, critical patient conditions, inadequate time, stressful situations, insufficient training about making decisions in the practice, insufficient awareness on how to handle a situation, and lack of resources. It is therefore important to improve the capability of a nurse to make the right decisions and know how they should handle situations despite them being critical to achieving the desired consequences for the patient and the healthcare institution.

References

Alaseeri R., Rajab A. & Banakhar M. (2019). Factors Influencing Nurses’ Decision-Making

Process: An Integrative Literature Review. Journal of Nursing and Health Science (IOSR-JNHS). 8(4) 36-48 www.iosrjournals.orgDOI: 10.9790/1959-0804023648www.iosrjournals.org

Deyo, P., Swartwout, E., & Drenkard, K. (2016). Nurse manager competencies supporting

patient engagement. JONA: The Journal of Nursing Administration, 46(3), S19-S26.

Van Bogaert, P., Peremans, L., de Wit, M., Van Heusden, D., Franck, E., Timmermans, O., &

Havens, D. S. (2015). Nurse Managers' perceptions and experiences regarding staff nurse empowerment: a qualitative study. Frontiers in psychology, 6, 1585. https://doi.org/10.3389/fpsyg.2015.01585

Wehkamp, K. H., & Naegler, H. (2017). The Commercialization of Patient-Related Decision

Making in Hospitals. Deutsches Arzteblatt international, 114(47), 797–804. https://doi.org/10.3238/arztebl.2017.0797

Significance of Discourse and Speech Communities in Nursing

A discourse community is a collection of individuals that share established discussions which are known as elementary principles and suppositions and methods of interactions about those objectives. Discourse communities have particular objectives and they achieve them by communicating. They exist because of the interactions between people, the writing that they generate, and the beliefs that they have about the other members of the community. A discourse community consists of a set of common objectives, interaction, and communication among members, the capability of the provision of information as well as feedback, categories of communication, and a group of members that have similar levels of prowess in a particular subject. A speech community is a group of people that have the same linguistic norms and expectations in terms of the use of language.

A discourse community is a collection of individuals that share the same kind of activities or are members of the same field such as nursing. These are people who have a similar or a particular way of communicating with each other. They have common goals, values, and beliefs which are requirements for a discourse community (Cram 462). Discourse communities must have a way of conveying messages and exchanging information and each of these varies according to the group. Nurses are important in patient care and play a very important role in assisting patients to manage their sicknesses, prevention of diseases, and promoting health in the communities. The more they become skilled the more they are accustomed to more responsibilities and become included in their discourse communities. They learn more about the objectives, principles, and language of the discourse community. This is done towards making the nurses understand and learn more to help those that are beginners in nursing. A discourse community is further defined as an idea of languages or genres as a basis of shared expectations, participation, and expressions.

 The characteristics of a discourse community include an agreed set of common objectives and should have a technique of intercommunication among the participants. Another characteristic is that a discourse community utilizes and has possession of one or more genres in communication and techniques which help to provide feedback and information. Discourse communities have members that have acquired the same level of expertise. The goal of nursing is to provide quality care, improve, and promote well-being. Another goal is to cure and manage infectious diseases. The nursing discourse community promotes education continuation and self-wellness which it finds to be valuable for the patients and the nurses themselves. In concluding about the characteristics of the discourse communities, nursing has to incorporate people with a high level of expertise and the new graduates. In discourse communities, each member has a status in the group (Emlen 680). The way different people exchange information varies according to their group. Exchange of information may include, meetings, conversations, newsletters, or any other mode of written or spoken communication. This shows that discourse communities have a wide range of getting things done through different ways of communicating.

 In the speech community, the three factors that are major in identifying it are area, which shows a relatively fixed scope, the population that is stable and has an appropriate number, and finally the language variety which has been accepted and is used in that particular area. Identification and interaction work through different types of verbal communication. A speech community can be developed if it meets the criteria on its religion, population, and identification. Each factor in speech communities has its value. Discourse communities interact with wider speech communities which is a broader term than the discourse communities (Cram 478). Speech communities are important for discussions of spoken and written discourse. Factors that help define speech communities are social, geographical, political, cultural, and ethnic factors. In nursing, language is used to ensure quality care and educate patients and their families of that care. The language provides the human lifestyle in the way to communicate meaning and understanding within society. It is unique to the society and culture that we are born in, one that we decide to work, live or become part of and forms the social structure of the community and the nation as a whole.

The nurse’s professional identity is enveloped as clinicians, researchers, and educators. They embrace several mediums that help to improve communication for the members of the team. With the rise of technology, some organizations have installed communication devices that ease the process of communication among the staff and the patients. This makes it easier and there is an effective flow of work throughout the organization. When there is an effective flow of work, patients get a good quality of care. The language provides communication for nurses and through communication, there is the conveying of information and understanding. Communication could be through written or spoken words, visual systems, interactions with colleagues and patients, and thorough documentation from different sources. As a nurse, it is important to have good communication skills and be able to listen at the same time. It is also important to be patient mostly in a case where the patient is not able to speak due to a health issue that has affected their speech. Communication plays a major role in ensuring that there is the existence of sound relationships, cooperation which is part of their professional practice. The way communication is done between the patient and the nurses have a very big impact on the outcome of the patient. Effective nursing communication helps to reduce medical errors and makes a positive outcome for the patient (Gudrun & Berggren 774). Clear communication ensures that there is an understanding between people and the message being conveyed is done effectively. Poor communication can lead to confusion or conveying the wrong message which can be a major problem in the nursing culture and can lead to dangerous outcomes. Interaction between people is like a cycle whereby one person evokes a reaction from another person and the reaction stimulates another reaction from the first person.

Nursing culture works towards the collaborative care of individuals from all groups, ages, and communities who are sick or well. It involves promoting health, prevention of diseases, and quality care for the sick (Gudrun & Berggren 772). It involves caring for the mentally ill, the disabled, and the physically ill. It also involves educating patients and their families about health conditions and providing medication and treatments. I am very passionate about ensuring that people are in good health. In this culture, I can meet different types of people, and with different conditions and illnesses. This allows me to explore more to be able to assist them. I do follow-ups on my patients to ensure that the well-being of my patients is restored and they can live their normal lives. Nursing culture to me includes giving hope and supporting the sick emotionally ensuring that they feel safe and in good hands. Healthy people too need to be provided with information about preventive and wellness measures.

Some of the terms and roles used in the nursing culture are, a primary caregiver who is a nurse whose interventions work towards meeting the physical, psychological, spiritual, and environmental needs of patients and their families using critical thinking skills. A nurse leader is involved in the disciplinary team for patients and contributes to the improved quality of care for the patients. A nurse leader coordinates the patient’s physical and psychological evaluations, their care, education, and support. They also help the patients to navigate through the hospital system and giving them referrals to allied health professional for them to get better care. They are responsible for maintaining clinical competencies and participating in the activities that help in the development of other healthcare professionals. A patient advocate’s role is to respect the decisions made by the patients and boost patient autonomy.  This role includes having a nurse-patient relationship to help secure the protection of the rights of patients and act as an intermediary between patients and health providers. A nurse educator is in charge of educating the patients, their families, and the community at large (Gudrun & Berggren 778). A nurse specialist is a recorded nurse who is accomplished and has the authorization to function in an advanced and extended clinical role.

The professional standards and expectations in nursing culture include quality assurance standards that ensure that nurses practice their profession with quality efforts which help to promote their competences and their practices. Another standard is confidentiality which is the privacy of the patients that should be practiced. All information belonging to the patient should be kept confidential. Employers should ensure that they hire new health staff who are competent and this guarantees quality services to the patients. Discourse communities are important to comprehend because they are part of how people communicate with the social world around them (Cram 463). For one to be a member of the nursing discourse community, they first have to embrace their role as a nurse and have a passion for the nursing field and the people in it. Nursing school is the place where a person starts getting in the nursing discourse community by learning the terminologies and the knowledge that is common among the nurses. Another way that one can get involved in the discourse communities is through research, by getting familiar with the dos and don’ts of nursing. In general, discourse communities bring people together who have common objectives, and purposes and contribute to the group with mechanisms that are only limited to the group members. Being a part of the discourse community as a nurse enables one to interact with other nurses sharing knowledge and embracing the different opportunities in nursing and being part of growth.

Quality of care is very important in the nursing culture. A major issue in the nursing community is the shortage of staffing. Nurses often undergo long working hours to provide standard care and mostly this happens when there is a shortage of workers. There is a significant rise in the shortage of nurses in healthcare organizations and is believed that they might worsen over the next few years. It is a concerning situation for the nurses where there are shortages. This is because they are not able to provide quality care because they are involved in other duties. According to “Staff Shortages Hurting Nursing Homes the Most.” (88), standard care is important for the patients and their families and the shortages make it difficult for them and the nurses. This makes the nurses feel like they are not providing enough care and to reduce this feeling they end up overworking and feeling dissatisfied. It affects them physically and emotionally which is a feeling that one gets when feel like they are not performing their duties as they should. The shortages of staffing also hinder the safety of the patient. This is because one worker has a lot of patients to attend to and cannot follow up on one patient to know how they are progressing. In nursing, patient care involves penetrating through to a patient and when they are limited, that is not possible.

Nursing shortages result in increased morbidity and mortality rates. It is also one of the main reasons that nurses lack to be satisfied with their workplace and sometimes opt to find another employer. The challenges that hospitals face in providing enough staffing includes a high number of experienced workers who are retiring. There is also an increased demand for nurses due to population aging and not enough supply nurses to meet the current demand. Shortages in staffing lead to nurses sometimes being expected to perform duties that are not professional such as housekeeping duties, transportation among others. There is reduced employment and improved over time and also the decrease in the time of stay of a patient. Staffing shortages cause the nurses to work for long hours which is a risk because of fatigue that could give rise to medical errors (Brian et al. 400). Many nurses leave their job because of high demand and expectations. When nurses are overloaded due to a shortage of staffing, the lack of satisfaction that they get from this leads to a lack of motivation, nonattendance, turnover, and perform their duties poorly. This threatens the quality of care for the patient and the effectiveness of the organization. This leads to the patient’s dissatisfaction due to a lack of standard care.

High workload stresses the nurses in different settings leading to emotional exhaustion which can lead to anger, burnout, and other emotional outbursts. Nurses with these kinds of stresses cannot be able to perform their duties effectively affecting patient care and safety. The nursing workload leads to the violation of an organization's policies and rules. This is because nurses perform their duties sometimes in a hurry and not enough care of whatever they are doing so that they can finish and attend to some other duty (Brian et al. 404). They also tend to improvise their own rules or procedures to complete their tasks which are a violation of the clinical protocol. In general, workload leads to irresponsible behavior which could lead to accidents in the healthcare organization. Protocol violation mostly happens when the nurses are pressured or have high workloads due to crisis conditions. Under these pressures and amounts of work, the nurses may not have enough time to use the right procedures or rules to provide quality health care to the patients. The relationship between nursing overload and quality of care for the patients greatly affects this particular nurse with the overload. Staff shortages decrease the period nurses may have to assist other nurses. It also leads to a lack of training for new nurses. The shortage of staff causes overcrowding which causes an escalation in the period of hospitalization. This also has an impact on the organizations, hospitals, clinics, and healthcare facilities. If they cannot accommodate patients, this means that they lose out of business making it unsuccessful.

Conclusion

A discourse community is a collection of individuals that interact through dialogues which are regarded as basic principles and suppositions and methods of interactions about those objectives. Speech communities are important for discussions of spoken and written discourse. Overcrowding leads to nurses committing more mistakes. Nursing culture to me includes giving hope and supporting the sick emotionally ensuring that they feel safe and in good hands. Staffing shortages cause issues like patients having to wait for long hours for consultation with the doctor which can lead to a patient’s situation becoming worse. Staffing shortages also impacts the patient’s well-being because they do not get the required attention. For the ones who get the chance to be admitted, they are attended by a nurse who is exhausted and overworked meaning that the patient does not get quality of care.

Works Cited

Cram, Ian. “Coercing Communities or Promoting Civilised Discourse? Funeral Protests and

Comparative Hate Speech Jurisprudence.” Human Rights Law Review, vol. 12, no. 3,

2012, pp. 455–478.

Emlen, Nicholas. “Public Discourse and Community Formation in a Trilingual Matsigenka-

Quechua-Spanish Frontier Community of Southern Peru.” Language in Society, vol. 44, no. 5, 2015, pp. 679–703.

Rudolfsson, Gudrun, and Ingela Berggren. “Nursing Students' Perspectives on the Patient and the

Impact of the Nursing Culture: a Meta‐Synthesis.” Journal of Nursing Management, vol.

20, no. 6, 2012, pp. 771–781.

“Staff Shortages Hurting Nursing Homes the Most.” AJN, American Journal of Nursing, vol. 91,

90. 1, 1991, pp. 85–90.

Gulbis, Brian E., et al. “The Impact of Drug Shortages on the Pharmacy, Nursing, and Medical

Staffʼs Ability to Effectively Care for Critically Ill Patients.” Critical Care Nursing

Quarterly, vol. 36, no. 4, 2013, pp. 400–406.

Informative Essay about a Doctor

  Introduction

A doctor is a person who restores and maintains health through the practice of medicine. A doctor is in charge of giving a diagnosis of a particular disease, or any condition that affects our health and provides the treatment required. He is equipped with knowledge, skills, and devices that enable him to diagnose and treat his patients accordingly and with quality care. The doctor listens to the patient, understands their problem, and uses his scientific expertise to know how to treat the disease or health issue. For every main system in our body, there is a specific doctor who is specialized to treat each. A doctor can be found in public health organizations, teaching facilities, private facilities, and hospitals among other settings. A doctor is part of a global well-respected profession that has the highest ideals and standards to uphold by taking care of the health and well-being of patients by diagnosing and treating them medically.

A doctor is a noble person who works all his life to mitigate the sufferings of other people.  He dedicates his life to serve patients and releases the distresses and hurt of human beings. He treats them from their ailments and works towards making their life healthier and better. A doctor should have the ability to put their tools in good use.  He should use his ears to listen to their patients, his eyes to ensure that he sees everything that the patient shows, and his hands to feel everything that is hidden from his eyes. He should use his mind to detect everything that is unspoken and when all this information has been put together, he has to use their mouth to tell his patients what they think and use their body language to give assurance to the patient. A doctor has to be patient to be able to educate and explain to the patient before prescription of drugs and to be able to think clearly about the best decision (Rizo, Jadad & Enkin 2002). Patience and having a clear mind for a doctor is significant because sometimes the considerations and decisions he makes are not part of what he learned. The doctor also has to know what language to use to explain to the patient and make them understand. This means that a doctor has to approachable, have social and communication skills to be able to successfully interact with the patient.

A doctor has to know their limits because their profession can be overwhelming and exhausting. He needs to allow himself to gain relief and regain energy to perform effectively. A doctor should be confident enough to perform a task or make a decision when he has the ability to and also requests for assistance and backing when he is incapable of making the decision. A doctor has to involve other people in his profession. Working with those in occupations that are related to medicine for example nurses can be of great help because most of the time nurses have many years of working experience which is an advantage to the doctor (Rizo, Jadad & Enkin 2002). Working with the other people in the same profession as a doctor is always in the best interests of the patient. A doctor has to have effective interactions with patients, be able to listen to them, and try as much to be compassionate because the final accountability for their health decision is his.

Generally, a doctor has to be a moral person, a good partner, a good client, a noble colleague, and should genuinely have the passion to help other people. This means that even when it comes to a patient, helping them will be a fulfillment and a source of strength and inspiration. Compared to other professions, a doctor has to be special in some kind of way. He has to be extra dedicated, humane, and selfless. He is more dedicated and keen on his work because his patients’ lives depend on him. A doctor has to be optimistic so that he can inspire and give confidence to his patients about their pain and suffering (Rizo, Jadad & Enkin 2002). This also helps to encourage the patient giving them hope and assurance that they will be well. A doctor works to avoid the increase of epidemics and other unsafe diseases that come up now and then. Sometimes these diseases take a lot of years for the doctors to research to find the cure. The life of a doctor is not easy, this is because of the off hours that he attends to patients sacrificing his break, sleep, and sometimes doesn’t eat. A doctor at times has to work without rest to attend to fatalities of accidents or pandemics and this he has to do with a smile. He acts as a motivation to the patients even when he is distressed.

As a doctor, a patient should be capable of trusting you with their lives and well-being. Therefore a doctor has to demonstrate veneration to the life of humans and ensure that he meets the quality of care that is expected. A doctor has to ensure that their patient is their first concern and ought to keep his skills and knowledge up to date to be able to provide quality care. He should promote and protect the health of patients and other people and should take action if he suspects any patient safety, and dignity being compromised. A doctor should treat all patients individually and respect their opinions and dignity. He should listen and respond to the patient’s concerns and what they prefer. He should ensure that the patient understands the information they need and also involve them in making decisions about their treatment and care (Rizo, Jadad & Enkin 2002). A doctor should support his patients in how they should take care of themselves to help them improve and maintain their health. A doctor has to maintain his trust with patients and his colleagues. A doctor needs to be honest and act with integrity, to be fair to colleagues and patients.

A doctor’s significance goes beyond saving lives. It includes helping the patients to reduce pain and suffering, having a quick recovery from an ailment, and learning to live with a disabling injury. It also includes a patient’s ability to enjoy life, even when their diseases cannot be cured. A doctor should ensure that the patient and their family feel their significance in all instances. These are the things that make a doctor very important in the society because a patient’s wellness is important for not only their family but also to their employers when they get well and can resume work (Hurwitz & Vass 2002). Doctors help to prevent diseases which are less expensive to people and are good for their health and also helps to keep their income intact. When doctors promote prevention and preventive medicine, the gap between the rich and poor populations is reduced.

With the rise of information and communication technologies, a doctor has to embrace technology to support him with recent information and research. Technology, for example, the computerized systems help a doctor in reducing time and keeps data updated. Technology to a doctor increases efficiency and productivity (Hurwitz & Vass 2002). Access to the patient’s records is easier to store and find and it’s also easy to detect a mistake. Not only for doctors alone, but technology in health care as a whole has also had a positive impact, and the most significant one being the quality of care for the patients.

Conclusion

 Through the practice of medicine, a doctor is a person who restores and maintains health in human beings. A doctor pledges his lifespan to serve patients and releases the miseries and agony of people. A doctor’s profession can be overwhelming, hard, and exhausting so they need to know their limits to maintain the quality of care to the patients. A doctor has to be extra dedicated, humane, and selfless compared to other professions. He needs to attend training to update his knowledge and skills. A doctor should promote prevention and prevention of drugs to reduce the gap between the rich and the poor. A doctor has to embrace technology to support him with recent information and research.

References

Hurwitz, B., & Vass, A. (2002). What's a good doctor, and how can you make one? BMJ

(Clinical research ed.), 325(7366), 667–668. https://doi.org/10.1136/bmj.325.7366.667

Rizo, C. A., Jadad, A. R., & Enkin, M. (2002). What's a good doctor and how do you make one?

Doctors should be good companions for people. BMJ (Clinical research ed.), 325(7366), 711.

Value Based Care

Q.1

Health is defined as a state where one achieves full physical, social and mental well-being. Although different forms of infirmity and diseases can affect a person’s well-being, their absence is in no way a definition of health. Understanding what good health and well being entails is beneficial as it helps nurses and other caregivers to better treat patients and help them manage their condition (Putera, 2017). With the emergence of chronic ailments that affect the ageing population, there has been a shift in how caregivers approach treatment as attention is focused more on managing medical conditions as well as treating them.

            To help meet the needs of the new healthcare objectives, the value-based healthcare approach was introduced to try and offer better care and improve patient experience. The approach focuses on improving the value of care where value comprises of the expected health outcomes from the patient in relation to the cost charged for the care offered (Putera, 2017). Through value-based care, caregivers are able to assess all activities involved in the cycle of care. Since the process requires input from both patients and caregivers, value-based care is able to strengthen primary care, assist in development of integrated healthcare systems and the establishment of payment schemes that reduce the occurrence of hazards and in so doing, increase the value of care.

            Since the goal for value-based healthcare is to improve the quality of care offered, it is likely to bring about changes in the role that nurses play in health institutions. This is especially because the value-based approach focuses on more than just treating patients and prescribing medication (Hensel, 2018). The approach will have great ramifications especially in helping patients with chronic diseases manage their conditions. A shift is likely to occur where nurses will focus more on keeping patients away from hospital as much as possible. With value-based healthcare, nurses will bear the responsibility of assisting patients manage their conditions even at home (Hensel, 2018). This means maintaining communication with patients even after being discharged from hospital. Value will therefore be assessed on how well nurses assist patients without having them visit medical institutions.

Emerging trends suggest that technology will play a major role in ensuring that value-based healthcare has the desired impact in improving the quality of care. As such, nurses will be required to learn new skills and also practices that help them to effectively use the technology used to reach patients (Hensel, 2018). New approaches are required especially because nurses train on how to offer care to patients who visit medical institutions. With value-based care, nurses will require training to ensure that they can use the technology needed to effectively assist patients both at the hospital and in their homes.

Q.2

Attempts to improve the quality of care offered have led to the emergence of interprofessional collaboration where health providers team up with clients in participatory collaborative approaches that seek to share the burden of decision making that is experienced in health and other aspects of society. It is a system that incorporates the use of decision making and effective communication as a way to allow synergistic influence of skills and the collective knowledge of individuals in a group (Brashers et al, 2020). it operates on various elements such as accountability, communication, assertiveness, autonomy and mutual respect which are passed on to the members making up the collaborative teams. Through the collaborative interactions, professionals in the medical field work in a diverse environment as they share different cultural traits and are able to share skills and knowledge that help improve the quality of care.

            Interprofessional relationships can be used to promote collaboration within an organization and the quality of care especially because they make it easier to understand the objectives set for care givers. Through it, caregivers are able to brainstorm on ideas as a team and this lessens the burden as professionals work together and learn from one another (Brashers et al, 2020). Caregivers are able to share the knowledge they possess, develop a better understanding of each other’s values and in so doing, create an environment that is focussed purely on offering the best quality of care.

            Interprofessional education collaboratives can be formed when two professionals decide to work on health issues together. In order to enhance their efficiency, experimental training programs can be used to help adjust to some of the changes that may come about as a result (Brashers et al, 2020). Training programs that use simulations for instance can promote interprofessional teamwork by creating an environment that facilitates cooperation without the risk of actually harming the patient. The interprofessional education collaboratives are important in that they help individuals grow in various aspects including;

• Values/Ethics

When professionals from different professions work together towards a common goal, an ideal working environment is created where caregivers respect each other’s shared values and in so doing, improve the quality of care.

• Roles/Responsibilities

The relationship also allows one to identify their own role and role played by others in an organization. In such a setting, caregivers are likely to have a better understanding of their work and the contribution from others and this promotes responsibility and accountability (IPEC, 2016).

• Interpersonal communication

Other than interacting with patients, the relationship established through IPEC’s promotes interaction between colleagues. The relationships-built help one to gain more insight in medicine as well as the approaches to take when preventing diseases, treating patients and also helping them manage their conditions.

• Teams and teamwork

Since the approach relies on each caregiver’s input, participation promotes teamwork as caregivers share ideas and weigh in on decisions that greatly promote the delivery of quality medical care.

References

Brashers V, Haizlip J, Owen JA. (2020) The ASPIRE Model: Grounding the IPEC core    competencies for interprofessional collaborative practice within a foundational          framework. J Interprof Care. doi:10.1080/13561820.2019.1624513

Hensel C, (2018) “How nursing will evolve under value based care” MedCity News,        retrieved from, https://medcitynews.com/2018/03/nursing-will-evolve-value-based-            care/?rf=1

Interprofessional Education Collaborative. (2016). Core competencies for interprofessional          collaborative practice: 2016 update. Washington, DC: Interprofessional Education          Collaborative. Retrieved from, https://health.tamu.edu/iper/research/ipec-2016-core-            competencies.pdf

Putera I. (2017). Redefining Health: Implication for Value-Based Healthcare         Reform. Cureus, 9(3), e1067. https://doi.org/10.7759/cureus.1067