Asepsis and infection

Reflective journal

While being in the healthcare environment, it has become apparent to me that hygiene is the most important activity that healthcare professionals should apply in all aspects of daily activities.  In the modern era, healthcare-associated infections are common in the healthcare system, and they pose significant consequences that affect health, social-wellbeing, and economy (Bonewit-West & Hunt, 2019).  This knowledge tells me that healthcare providers are required to apply clinical competence to reduce healthcare-associated infection.

 During clinical rotation, I have cared for a patient with acute CVA.  Mr. E.J, an 87-year-old retired teacher was admitted to the hospital due to cerebrovascular accident (CVA).  The patient developed a pressure ulcer (PU) in his sacral area because he could not move around and preferred to stay at his bed.  The condition of the patient has helped me learn more about health-care-associated infection, and aseptic techniques.  His condition was more challenging because the pressure ulcers or wound should be protected through dressing but despite these challenges, it was my role to main asepsis. 

            While dealing with the patient, I have learned that medical assistants or in other words healthcare workers should apply asepsis and infection control techniques to safeguard the well-being of the patient, and also to protect other healthcare providers from being exposed to infectious diseases (Bonewit-West & Hunt, 2019). While caring for patients, it is important to note that there are two types of microorganisms-non pathogens- harmless microorganisms such as bacteria, fungi, virus, and others. The other type of microorganism is pathogens such as Salmonella Typhi, E Coli, and this means that they are harmful to the body (Bonewit-West & Hunt, 2019). To prevent pathogenic microorganisms from causing infections, healthcare workers should practice medical asepsis.

 While in the healthcare environment, and in specific while caring for Mr. E. J, I must say that the fundamental nursing care practice in the prevention and control of infection is hand hygiene.  From my personal experience, I can say that healthcare-related infections contribute to unintended consequences including morbidity and mortality, length of hospital stay, microorganism resistance, high financial costs, and more (Bonewit-West & Hunt, 2019). However, such events can be prevented by aseptic and infection control techniques such as hand hygiene. This is a low-cost action that has been recommended by The Centers for Disease Control and Prevention (CDC). From my experience, hand washing means using soap and water because soap has agents that remove dirt.  Note that hands contain microorganisms known as normal flora and they are found in the dermis. Hands also contain microorganisms known as transient flora which are found in the epidermis (Bonewit-West & Hunt, 2019).  Thus, it is advisable to use soap and water and rub the hands for 15 minutes to remove the flora.  I have also learned that antiseptic hand washing or the use of antimicrobial soap can help kill microorganisms and discourage the growth of bacteria. Alcohol-based hand rubs are also effective in reducing bacterial growth (Bonewit-West & Hunt, 2019).  My last take is that gloves play a great role in preventing healthcare providers and patients from infections.  For example, while taking care of the patient, I must wear clean disposable gloves to avoid infections from blood, feces, and other body substances.

            During invasive procedures, health care providers can use the Aseptic Non-Touch Technique as described by Clare & Rowley (2018). The authors assert that ANTT®b is an effective aseptic technique which means that the health care provider should avoid touching wounds.  Also, it means washing hands, and wearing gloves during clinical procedures.  The authors say that ANTT® should be viewed as a quality improvement tool that aims at making the practice better (Clare & Rowley, 2018). Thus, the health care system should implement ANTT® and ensure that health care providers practice safely and effectively.  ANTT® will protect the workers as well as the patients from infections.  During the procedure, medical assistants should identify the key parts of the equipment used to perform procedures and this will prevent harm.

Summary

            The most interesting experience while working in the healthcare environment is that as a medical assistant, I have a great impact on the life of others. This is because, all patients count on me for assistance and for this reason, and I should apply hygiene practice in my daily activities to reduce the risk of infection and illnesses.  For example, in my recent hospital case, I noticed that   Mr. E.J has a condition that could not allow him to apply hygiene practice. As a nurse, I provided proper hygiene care to ensure that the patients develop a positive experience, and more important to ensure that the patient is protected from infections.  Also, I have learned that people view caring using a different perspective. I view caring as understanding the patient, providing support and empathy, accepting the patient's condition, and choose to care.  I have gained a known knowledge that ANTT® practice framework is one of the best aseptic techniques to reduce infections.  ANTT® principles indicate that healthcare providers should understand the possible risk that they are likely to pose, should understand the standard of sepsis, and they should identify the key parts of clinical equipment, among other principles.   Finally, I have learned that hand wash is a simple act that ensures patient safety and quality of care.  However, I believe that more knowledge about ANTT® is needed so that health care workers can have a total adherence.

Reference

Clare, S., & Rowley, S. (2018). Implementing the Aseptic Non-Touch Technique (ANTT®) clinical practice

framework for aseptic technique: a pragmatic evaluation using a mixed-methods approach in two

London hospitals. Journal of infection prevention, 19(1), 6-15.

 Bonewit-West Kathy & Hunt Sue. (2019). Today's Medical Assistant - E-Book: Clinical & Administrative

Procedures. Elsevier Health Sciences

Creation of Medications

Over the years, the development of drugs has significantly increased with a proper understanding of the mode and mechanism of action, indications, side effects as well as issues of overdose. Although the process of coming up with a drug is long, it ensures that an effective medication with the least side effects and safe is discovered and has undergone necessary tests. This paper will describe a medication, including its side effects and dosage to different individuals and the process that the drug undergoes before it is approved for marketing.

Tandarin is an anticoagulant medication (named because of the therapeutic effect) that works in reducing blood clotting and thus reduces complications that could have resulted from them. The drug will be given a chemical name based on its atomic molecular structure, tandarin is its generic name given by the United States Adopted Names (USAN) Council, and Glendin as its brand name assigned by the company for the purpose of marketing. It is available in both tablets and intravenous solution.

The methods that can be used to administer the drug include the oral and intravenous (IV) route. The former involves taking drug tablets through the mouth with water while IV involves injecting the drug directly to a vein. The drug through the oral route is absorbed in the small intestine and then moved to the liver before it goes back to the bloodstream to the target organ. One of the side effects of the medication is bleeding, which can be severe in the case of overdose.

The dilution of the medication is done using sterilized water for injection, as per the recommendations. The dose will be given by the weight in Kgs* Dosage, and it changes because the action of the drug varies in its extension with the body weight. The drug before its approval underwent preclinical phase where it was tested on animals, phase one of a clinical trial involving the determination of safety in humans, phase two of a clinical trial where the drug was given to patients with the disease for efficacy, phase three for testing a larger group and determining the dosage and other factors and finally drug application after collection and analysis of all data. Conclusively, drug creation is a process that involves several steps to promote the development of an effective drug.

Contemporary approaches to treating children’s and adolescent’s attention-deficit hyperactivity disorder

The author is a parent of a kid who was diagnosed with attention deficit hyperactivity disorder (ADHD). Instead of following the doctor’s advice she researched the topic and identified alternative ways to successfully combat the disorder. According to the data collected by National Health Interview Survey ADHD is among the most common disorders among the younger generation especially among adolescents. 8% of children and 15% of adolescents (“General Prevalence of ADHD”, 2020) suffer attention-deficit hyperactivity condition (ADHD). It is described by damaging levels of inattentiveness, impulsivity and hyperactivity. ADHD negatively impacts school performance, causing kids to repeat grades or even drop out of school. This disorder also makes establishing the social relationships difficult. Though treatment can be an operational cure for persons of all ages who have ADHD, further efforts are required for those with the syndrome. Responders to ADHD treatments, can also have important remaining signs and impairment postmedication management. As clinicians evaluate the advantages and disadvantages of lasting prescription use for every child or adolescent they mention about the importance of the corresponding medications. Drugs are not the only option for treating ADHD.

Kids who have attention-deficit hyperactivity condition (Sprich and al, 2016) demonstrate impairing levels of inattention, hyperactivity, and impulsivity. This disorder is usually first detected in childhood and regularly continues into adulthood. It is common for kids to have trouble concentrating and performing at one time or another. Nevertheless, children having ADHD never mature from these manners causing problems at school, home, or when they are with friends. ADHD in teens can place them on a line to negative results such as drug abuse, dangerous driving (Sprich and al, 2016). ADHD is categorized into three groups, they are determined based on the type of the strongest symptoms. First is the Predominantly Inattentive Presentation. For a person with this sort of ADHD it is difficult to establish or end an assignment, to be attentive to information, or to follow directives or dialogues. The other type is the Predominantly Hyperactive-Impulsive Presentation. An individual with this sort of disorder plays and talks more. It is difficult for him / her to be still for long time. The individual feels impatient and has problem with impulsivity. The third type of ADHD Collective Presentation when symptoms of the above two types are both present (“What is ADHD?” 2020).

From the neurobiological stand point the dysfunction in the corticostriatal-thalamic-cortical loops have remained related with ADHD. Catecholamine (dopamine and noradrenaline) dysfunction has similarly been involved in ADHD. The best normally used prescriptions act on this structure. Neuroimaging studies have shown that the stimulant medications have corrected hindered brain development, minor basal ganglia, cerebellum plus frontal lobes (Bhat, 2016). Stimulating medications act on dopamine and noradrenaline reuptake inhibitions, and presynaptic release. Methylphenidate is a dopamine reuptake blocker, dexamphetamine gets almost dopamine blockade and presynaptic relief. Various medications are accessible in generic and patented drugs and contain immediate release (IR), slow release (SR), extended release (ER), and long lasting (LA) inventions. Ritalin (methylphenidate formulation) is the most common medication for treating ADHD. It is available in 3 forms with the longest duration action of 5-6 hours (Ritalin SR). Biphentin is another methylphenidate formulation lasting up to 8-10 hours. Different chemical formulations have a range of side effects including decreased appetite, weight reduction, initial insomnia, and headache and rebound irritability. Recently there has been a rise of interest towards alternative ADHD treatments.

Cognitive behavioral therapy (CBT) remains a problem-specific, goal-oriented tactic that requires the person’s lively participation to succeed. It is a form of psychotherapy that emphases on their present-day encounters, opinions, and actions. Frequently, a sequence will consist of 20 one on one gatherings, however this is not an every time the case. CBT is a cooperative therapy, demanding the person and therapist to work together. Agreeing to the American Psychological Association (APA), the individual finally acquires to be their own counsellor. CBT is based upon a number of beliefs: starting with unsupportive conducts, learning unhelpful behavior and learning more advantageous ways of reasoning and acting are some of the aspects people consider can cause psychological issues. New habits can also release signs of mental and physical situations and let people act in enhanced ways. Physicians base CBT on the philosophy that difficulties arise from the denotations people provide to events, together with the events themselves. CBT can have a beneficial influence on how people feel, act and provide them with managing policies that help them cope with encounters. Even though CBT is a potential therapeutic solution for treating ADHD medical treatments represent a traditional approach.  

ADHD is adversely associated with a variety of educational achievements. The researchers applied Danish managerial record data to examine the influence of medical treatment of ADHD on children’s educational performance (Keilow, Holm & Fallesen, 2018). The grade point average (GPA) was used as a performance criteria. By use of organizational register statistics on children, who start medical usage, the researchers conducted an ordinary experiment to assess the outcome of medical usage on school-leaving GPA. This study evaluated a very significant number of cases which exceeded 550,000. The researchers sampled all kids detected with and cured of ADHD out of the overall number of kids, those finished Danish compulsory schooling from 2002 to 2011. To discover kids who were psychologically cured, they choose children, who redeemed one medicine for any sort of ADHD prescription (atomoxetine, methylphenidate, and modafinil) amid teenage and about to school-leaving examinations. To define the influence of medical cure of ADHD, the investigators used the longitudinal data and defined three types of pharmacological treatment patterns: Discontinued Pharmacological Treatment (DPT), Continuous Pharmacological Treatment (CPT) and Ambiguous Pharmacological Treatment (APT). The variance amid the three types of management allowed the researchers to assess the influence of treatment. DPT was defined as having acquired prescription for extreme three months inside the statistics window that only permitted the original medicine test and dosage titration. Similarly, the description of continuous treatment (CPT) was limited to kids, who possess a consistent and unwavering application of medication with procurements being not further than three months spaced out. The designs of the residual category, the APTs, were unclear as they could not be persuasively kept in either one of DPT or CPT group. These are kids, who recurrently come in in and out of medical usage. Totally the three groups were equally limited. In every evaluation, CPT was a reference cluster, where the researchers investigated other treatment influence of DPT and APT (termination and uncertain treatment) related to CPT (constant treatment). The substantial influence of treatment on both exam and teacher estimated GPAs was observed. The data showed the drop of the both types of the GPA’s for kids from part or full treatment discontinuation groups. It was found that amplified efficiency of the medication of ADHD might ease part of the GPA gap amid children detected with ADHD and their peers. The results also demonstrated that medication might control the undesirable social outcomes of ADHD. Worth mentioning that the contemporary medical industry also offers alternative ADHD treatments.

CBT can be efficiently applied for treating ADHD in kids and adolescents taking psychiatric drugs. 46 adolescents between ages 14 and 18 participated in the study performed by S. E. Sprich and colleagues (Sprich and al, 2016). The adolescents had a principal ADHD diagnosis through a Clinical Global Impression Severity Rating of 3 or more which is equivalent to moderate or more severe form of ADHD. Other criteria of the participant’s selection was a constant dosage of an FDA-approved prescription. Every participants finished seven units of medication over 12 sessions, 10 of which were one psychotherapist to one teen, and the remaining two involved the parent as well. The majority of the ratio of 1:1 sessions were devoted to psych education, planning, organization, distractibility and adaptive reasoning. The parent-adolescent conferences were focused on educating parents about ADHD with the goal of extending the treatment upon completion of the formal part. The researchers used the extensively evaluation scale to determine overall anguish and damage related to ADHD signs. CBT resulted in the reduction of the adolescent symptoms severity. CBT-targeted therapy for adolescent ADHD may serve as a much-needed alternative or complement to medication.

Important to mention that CBT can be efficiently applied for treating ADHD in kids and adolescents not taking psychiatric drugs. The Spanish researcher A. Mirada conducted the study to investigate the influence of the medication program of a cognitive-behavioral coordination for overactive kids and if the influences of these medication endure over any span of time (Miranda, 2000). 42 kids aged 9 to 12 years old participated in the study. The participants met a number of criteria including ADHD diagnosis based on 2 worldwide acceptable mental disorders scales. “Stop and Think” interference program published by Kendall and his team in 1980 was utilized with minor adjustments. This cognitive-behavioral self-discipline therapy comprised reasoning and acting techniques (modeling, self-instruction, and behavioral contingencies) used to solve numerous difficulties. Its major objective was to advance attentiveness and thinking. The kids were taught to use self-instructional approaches through the procedure of problem-solving to deliberate possible options of action, to mirror on potential consequences, and to make choices about preferences. The message of self-instructions included five stages: one is the problem definition (“What do I have to do?”); then the problematic approach (“I have to think of all possibilities”); third, concentrating attention (“I have to concentrate and think of nothing else”); fourth, choosing an answer (“Having considered all possibilities, I think this is the correct answer”); fifth, self-test/self-reinforcement for precise performance or rectification of mistakes (“I have worked well. Or I have made a mistake. I’ll do better next time if I remember to slow down”). To enable the attainment of self-instructions, kids accomplished numerous psych educational responsibilities (word puzzles, or tangram puzzles, arithmetic problems) during 12 sessions. In the beginning of every session the counselor displayed the steps of self-instructional process while acting the first assignment of this session. She also established the use of managing approaches after an improper reply, designed to substitute overly bad reports with more suitable reports. Then she requested the kids to apply self-instructions to alike tasks. There were three conferences debating personal problem-solving responsibilities where the kids got trained to identify personal plus other’s opinions and moods, to recognize signals that show what the others are reasoning and feeling, and to determine the possible reasons of such emotions. Lastly, the therapist educated them to use self-instructions to theoretical problems and afterward with real-life problems. The intervention program was used in 22 sessions for a period of 3 months. Then the trials applied to assess the effectiveness of the courses comprised of teacher plus parent forms selected to get facts concerning the youngsters’ overactive characters also about the difficulties kids undergo at home as well as school. Evaluation was completed at three time periods: past cure, just after cure, and about two months after the cessation of medication (follow-up valuation). Results of the tests post hoc indicated that children recorded expressively better in each variable throughout the posttest stage than the phase before test. The variables included the mental disorders evaluation, antisocial, school problems, psychopathological disorders and internalization criteria. The noteworthy differences were likewise preserved in the follow-up stage.

References

Bhat V., Hechtman L. (2016). Considerations in selecting pharmacological treatments for attention deficit hyperactivity disorder. Clinical Pharmacist, Feb 2016. Retrieved from: https://www.pharmaceutical-journal.com/research/review-article/considerations-in-selecting-pharmacological-treatments-for-attention-deficit-hyperactivity-disorder/20200602.article?firstPass=false

Centers for Disease Control and Prevention. (2020). What is ADHD? Retrieved from: https://www.cdc.gov/ncbddd/adhd/facts.html

Children and Adults with Attention-Deficit/Hyperactivity Disorder. (2020). General Prevalence of ADHD. Retrieved from: https://chadd.org/about-adhd/general-prevalence/

Keilow M., Holm A and Fallesen P. (2018). Medical treatment of Attention Deficit/Hyperactivity Disorder (ADHD) and children’s academic performance. Plos One. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207905

RE: Week 7 Discussion

 I believe that healthcare marketers must have a customer mindset; that is, understand the customer's needs, wants, and perceptions to meet their wants and needs (Fortenberry, 2010).  Note that by understanding the customers' perceptions, the healthcare marketers will identify and satisfy consumer demand, and more importantly, provide quality healthcare.  Another important point is that customers' perceptions will assist marketers in creating health plans that address the health care that consumers want (Fortenberry, 2010).  Therefore, healthcare marketers must allow the patients to judge the tangible elements of the healthcare services, and technical competence and this will help the marketers generate optimum satisfaction.

PEST analysis can be a useful tool to monitor and evaluate the environmental forces that might affect the healthcare institution.  First, PEST analysis is important in that healthcare decision-makers will consider the outside environment and be in a position to make strategic planning (Fortenberry, 2010).  For example, decision-makers will collect information from the external environment and the information will help understand the growth or decline of a market.  In general, PEST analysis is a useful tool that can help decision-makers know how to do the business or in other words make cost-effective decisions.

Example of PEST analysis used in healthcare organizations to analyze events and trends include

• Technological factors- It is important to note that technological forces influence the healthcare industry and therefore the health care organization considers technological factors in strategic planning (Fortenberry, 2010). This means that the healthcare industry considers technology development, information and communications, innovation potential, and other technological advancements that could bring opportunities for growth.
• Economics forces- This is an example of PEST analysis which the healthcare industry uses to evaluate factors such as inflation, unemployment, and other economic issues that influence the financial performance. If healthcare organizations find an environment that is characterized by poor economies such as a high rate of unemployment, they understand that such an environment is not favorable for health services since fewer people will purchase the products or even pay hospital costs (Fortenberry, 2010). Alternatively, the healthcare organization considers an environment with strong economies as favorable in that the consumption of healthcare goods and services is high.

The major reason as to why there are intense competition and rivalry within the healthcare industry is because there are many new players in the industry.  For example, medical groups that provide services to their communities are now establishing family practitioners,   and building company clinics, where they are offering primary care to their employees.  Secondly, competition is intense due to the threat of substitution.  For example, technological changes have influenced the healthcare industry and organizations are using new technology to improve their performance. Thirdly, competition and rivalry are intense due to the power of buyers. This means that hospitals with strong supplier relationships have strong competition. Such hospitals receive the best products, services, and resources and lower costs.  For example, the Affordable Care Act provides quality patient care.  Finally, competition is intense as some organization is using the Blue Ocean strategy. This means that healthcare organizations create new markets and offer new delivery benefits.

 Porter's Five Forces assists the organizations to understand the marketplace competitors or rather the competitive environment.  Note that for organizations to achieve marketing success, they must understand the competitive elements and the Model helps the organization understand the competitors, the new entrants the power of customers, the power of suppliers, and more (Fortenberry, 2010).   The forces are also important as they enable the healthcare industry to create a corporate strategy and enhance long-term profitability.

 Example of Porter's Five Forces Model include;

• Power of suppliers- within the healthcare industry, few suppliers of hospital equipment such as imaging equipment, surgery scalpels, and others can be more powerful since they have the freedom to raise prices.
• Power of buyers- within the healthcare industry, large-volume buyers have more power. Therefore, organizations must be customer-focused, and understand the needs and want of customers to increase their bargaining power.

Reference      

Fortenberry, J. L., & Fortenberry, J. L. (2010). Health care marketing: Tools and techniques. Sudbury,

Mass: Jones and Bartlett Publishers

Berkowitz, E. N. (2017). Essentials of health care marketing.  Jones & Bartlett Learning

Truvada as a drug has been designed to target, young women at the adolescent stage, homosexual men who have sex with their fellow men, sex workers and individuals in the health profession. Prep medication is administered to HIV negative patients (Celum, n.p).  Prep is designed to function as an additional form of medication that can be used while implementing other forms of preventive measures. In most cases, individual wonder what Prep is?  Prep is an abbreviation for Pre-Exposure Prophylaxis.  Taking Prep helps in protecting oneself from HIV-1. Taking Prep daily while using other preventive methods to include safer sex practices such as the utilization of condoms and lubes while ensuring proactive communication between partners helps in reducing the chances of contracting HIV-1. It is also important to consider getting tested regularly for HIV and various sexually transmitted infections while communicating with your healthcare provider with a focus on learning about factors and practices that can increase your chances of contracting HIV.  Truvada pill is taken once each day and under no circumstances should the pill be taken after sex as a form of “morning-after pill”. One is required to confirm their HIV status with their healthcare provider before taking the Truvada since it is medically designed for HIV negative individuals.  It is important to note that one is not allowed to take Truvada with a focus on reducing their chances of contracting HIV-1 unless it is confirmed by a doctor that you are HIV-negative. For Truvada to work effectively it is advisable to get tested once in a span of three months to be certain of one’s HIV status while continuing with Truvada.

As mentioned earlier Truvada combined with safe sex practices reduces the risk of contracting HIV-1. Precautions for taking Truvada include, one must weigh 77 pounds and above, the individual must be HIV-negative but has a high chance of contracting HIV-1 (Centers for Disease Control and Prevention, n.p) A clinical trial that was conducted on the medication revealed that HIV- negative men and transgender women who are regularly involved in sexual activities with men are at a high risk of contracting HIV-1.  The study also provided insight and proved that when Truvada is used while maintaining safe sex practices it is very much possible to reduce the chances of contracting HIV in male-female relationships while one partner is HIV-positive. The chances of Truvada protecting an individual from contracting HIV-I are higher compared to taking a placebo (sugar pill).

Just like any other medication, Truvada is accompanied by some common side effects to includes severe headaches, abdominal pain, and weight loss. When the side effects persist, it is important to notify one’s healthcare provider. The rare and most alarming side effects of Truvada include kidney infections which in most severe cases lead to kidney failure. In the case of kidney problems, it is important for one’s healthcare provider to conduct blood and urine tests to identify any kidney problem that can hinder the administration of Truvada.   The doctor should request patients to terminate the use of Truvada after detecting kidney problems that could be as a result of Truvada (Mascolin, n.p), Scientific medical-related research has also established that overconcentration of lactic acid in the bloodstream is a serious and rare medical condition that can be caused by the intake of Truvada and in severe cases can lead to death. One should notify his/her doctor right away if the following side effects occur; weakness, unusual and persistent muscle pain, shortness of breath that is accompanied by fast breathing thus causing abnormal heartbeats, abdominal pain that is subsequently followed by nausea and vomiting, dizziness and liver problems (Ng, et al., n,p).  Truvada is also known to cause bone associated problems inclusive of bone pains and softening that can lead to bone fractures.

It is advisable to notify a healthcare provider when one suspects that they have contracted HIV-1, after the contraction of HIV one will need more medicine to accompany the Truvada in order to treat HIV-I (Ng et al., n.p). Taking only Truvada makes the process of treating HIV-1 only harder. To clear things I a glad to inform you that as people seem to now understand that people who are HIV-1 positive and are undetectable have less than a 98 percent chance of passing HIV-1. You do not have to be afraid as HIV-1 is not a death sentence. You can live a long and heaty life, have kids, be married and be yourself. I can relate to HIV-1 as it’s been my best friend for 6 years, I have had one child while having HIV-1. My partner does not take Truvada by choice and doesn’t have HIV-1. Get tested and stay safe it’s not just a homosexual thing.    

Works Cited

Celum, Connie L., et al. "HIV pre‐exposure prophylaxis for adolescent girls and young women    in Africa: from efficacy trials to delivery." Journal of the International AIDS Society 22        (2019): e25298.

Centers for Disease Control and Prevention. "Preexposure prophylaxis for the prevention of HIV             infection in the United States-2017 Update: a clinical practice guideline. 2017." (2019).

Mascolin, Mark. “Weighing Risks of TDF/FTC PrEP Side Effects in People Without HIV”.         2012. Retrieved from; https://www.thebodypro.com/article/weighing-risks-of-tdfftc-prep-          side-effects-in-peop

Men, Heterosexual. "Effectiveness of Prevention Strategies to Reduce the Risk of Acquiring or    Transmitting HIV." (2015).

Ng, Yeow Chye, Angela Caires, and Jack Mayeux. "Message from an urgent care PrEP provider for health care professionals." Journal of the Association of Nurses in AIDS Care 29.1          (2018): 130-132.

Ng, Yeow Chye, Jack J. Mayeux, and Thuy Lynch. "Initiating PrEP Services in Urgent Care."

Community Health Assessment

Introduction

A community health assessment is the evaluation of health issues using data collection and analysis. This gives a detailed summary of a community’s needs and challenges. Through the community health assessments, improved policies and strategies are developed.

According to Savage (2019), the demographics in the community include gender, age, race, and education levels. This data will help in the assessment to know the people living in the community. These statistics will help to give the necessary information about the leading health issues in the community. Guidance on the resources and services available is also provided by the statistical data, and this makes it easy to guide on the ones that need to be added. The data will help to guide on the solutions needed to improve health in the community.

Medlock, Shtasel, Trinh, and Williams (2019) state that strategies that align with the national CLAS standards will help to address racial and ethnic differences in the community. They will help to improve the healthcare quality of products and services and avoid healthcare differences. This will be done by implementing culturally appropriate services. Due to the diverse population, communication will be improved by implementing linguistically appropriate services.

Demographics will help in keeping records of the morbidity and the mortality rate in the community. Savage (2019), explains that this will help to implement different methods of preventing and curing diseases. This will help in the development of epidemiological concepts such as immunization to prevent diseases. Components such as decision making, commitment, communication, working together and being aware of each other will lead to quality healthcare. This will help them to achieve goals that they set together. They will be able to communicate and work with each other and come up with solutions to problems facing them.

Teaching strategies among cross-cultural diversity is a strategy that will improve communication and understanding in the community. This will help people to engage in activities and change their mindsets concerning healthcare. According to Jongen, McCalman, Bainbridge, and Clifford (2017), people will be taught of the different lifestyles, cultures and the value of beliefs and traditions and how to be able to live together. Developing perfect working systems for the people in the community will be able to improve healthcare. Improving the healthcare provider’s education and knowledge to give better and quality healthcare is another strategy. Stakeholders will help in providing improved and quality products for the people. They will help in improving systems to cater for more people and with quality services.

According to Savage (2019), a community health assessment is a strategy used to describe the health of a community by collecting and analyzing data. The data is used to bring communities together and educate them concerning health. It is also used to obtain resources and get solutions to improve health in the community. It is the first step in the development and improvement of a health program. It helps in understanding the different features affecting health, for example, the environment, resources, culture, and infrastructure. The assessment helps to find solutions for these problems hence improving healthcare.

Conclusion

            Community health assessment is a useful strategy in improving healthcare. The data collected is used as guidance to finding the perfect solutions. It helps to directly interact with the people living in the community, therefore, giving firsthand information to the ones conducting the assessment.

References

Jongen C., McCalman J., Bainbridge R., Clifford A. (2017). Cultural competence in health: A

review of the evidence. (2017). Singapore: Springer.

In Medlock, M. M., In Shtasel, D., In Trinh, N.-H., & In Williams, D. R. (2019). Racism and

psychiatry: Contemporary issues and interventions. Cham, Switzerland: Humana

Savage, C. L. (2020). Public/community health and nursing practice: Caring for populations.

Philadelphia, PA: F.A. Davis Company

 Health Promotion and Disease Prevention of Obesity

Abstract

The objective is to discuss the strategies and policies that will help in matters concerning health. To know the causes of obesity and how the disease can be prevented. Discuss the dangers of obesity and what other diseases it can come with. Find health programs that can be put in place to help people with obesity. The implementation of new and improved policies will help to promote health. Knowledge of living healthy lifestyles to avoid diseases like obesity will be of great assistance.

Keywords: Health promotion, prevention, strategies, obesity, disease, health, improve.

Introduction

Health promotion is the use of different policies and strategies to improve healthcare. For example training people on the benefits of living in clean environments, training them on the importance of healthcare. It is the process of introducing effective health programs to create awareness and improve healthcare. Obesity is a disease caused by excessive fat in the body that increases the risks of health problems and other diseases. Disease prevention of obesity involves different ways of preventing obesity. Programs that help to prevent obesity including healthy living have been implemented.

Discussion

Health is defined as the conditions in which people are born, live, and work. The difference between health statuses in different places is brought by social and economic conditions. The distribution of resources and money determines health in a certain region. If the resources are not equally distributed, some of the people will not get good healthcare. Training the healthcare professionals1 on effective strategies to improve health and address the social conditions affecting health will impact health promotion. Each health professional needs to be able to work best in their department, so there should be enough professionals so that every one of them can handle their roles effectively. Health promotion includes educating the people in the communities on different activities of taking care of the environment they live in.¹

Environmental risks are the largest contributors to diseases and health. These are things like waste materials, emissions, and lack of resources. They cause injuries and sometimes premature mortality and even long term disability. Managing the environment is an important role in the protection of people’s health. Putting up measures that will help in the reduction of these risks to reduce health problems. Living in a healthy environment is a big attribute to preventing diseases hence a strategy of promoting health.²

Health promotion is the result of health education and health policies and strategies which should be implemented for the sake of long term needs. Supportive environments should be made a priority in improving health. Health education has been marginalized and yet it is the most contributing factor in health promotion. Health education helps to get skills, knowledge that is required when an individual wants to volunteer or make decisions of their own. It helps to raise awareness of the need for policy and environment changes to promote health. It helps to develop an awareness of the factors influencing health in the communities and skills to enable them to work together. Effective health promotion must be planned systematically and establishing a foundation, planning and then put it into practice. The key approaches to improving healthcare are, adopting organized planning, knowing the need and importance of ideas and other forms of evidence. Another approach is supporting empowerment models and the need to tackle the qualities and differences in health status.⁸

Health promotion includes physical, social and mental promotion. Mental health promotion comprises of prevention of illnesses and increasing the well-being of a person. It is important to sustain the social and emotional well-being developed in early childhood. The achievement of disease prevention and health goals is attributed to empowerment approaches which help to identify the relationship between individuals and the environment. Health promotion can be defined as the prevention of diseases, treating and healing sick people. The priorities set out for health promotion were, increasing investment for developing health and creating strong partnerships. Health promotion is the responsibility of the government and is an important component of public programs and policies. The government should ensure enough funding, healthy public policies and facilitate infrastructure to aid in health promotion.⁸

The goals to be achieved by a representation known as the stewardship in health promotion include reducing the risks of diseases caused by people’s actions for example smoking in public places. Another goal is to reduce diseases caused by environmental conditions such as drinking dirty water and improving housing qualities. This representation will protect the health of the children and the elderly. It will help people living in addictions on ways to avoid unhealthy behaviors. Access to medical centers and health equalities will be ensured. The application of the medical model emphasizes on the prevention in health promotion. A system has been developed for program planning, evaluation, and implementation, and build partnerships. It is also capable of communicating and writing reports.⁸

The acronym Re-aim used as a tool to design and evaluate health promotion planning represents five stages. The first one is, reach which stands for the spread of a promotion program within a certain population. The second one is effectiveness which represents the benefits of a program. The third one is the adoption which represents how the health promotion professionals take the program. The fourth one is an implementation that represents how the program is used by health promotion professionals. The fifth and final one is maintenance which represents how the continuity of the program. The conclusions of health promotion research programs have an impact on public health. For example, research has proved that the increase of taxes on cigarettes reduces consumption which is a strategy used for health intervention. Research has also shown that the individual acceptance of vaccines help in improving health. Another example is the use of bed nets in areas affected by malaria.⁹

There are two mainly used types of research which are, observational and experimental. Observational research is when elements are seen as they naturally exist. This is where behaviors are observed and recorded. This is a non- experimental research because the variables are not controlled or changed. Experimental research involves manipulating and controlling variables. The variables can be measured, counted and be compared. It is a method of assessing the effectiveness of a health intervention.⁹

Gender, age, social, and economic factors have been associated with obesity. Obesity occurs when the intake of calories is more than the body can burn. This is mostly due to overeating and not exercising. It can be defined as excessive fat accumulation in the body caused by increased intake of food and no physical activity, various studies show that physical and mental disorders are contributed by overweight and obesity. In most developed countries, obesity caused by unhealthy lifestyles is similar to the one caused by old age. Interestingly in these developed countries, the most affected gender is women. Most of the people living in urban lifestyles tend to develop obesity more than the ones living in rural lifestyles. This is brought by poor health diets and lack of physical exercise. ³

Obesity in children too seems to be on the rise. The number of overweight children who are below 5 years of age globally has increased from 32 million to 41 million in the year 2000 and 2014 respectively. Research shows that globally the number of obesity in adults has doubled from the year 1980 to 2014 from 5% to 11% in men and 8% to 15% in women. This has led to many deaths and disabilities hence the need for prevention. The main reason for the increase in this condition is access to unhealthy food and drinks which are cheaper and quicker to get compared to healthy foods.⁴

The mortality and morbidity rate tend to be higher among obese people compared to other individuals.  Obesity is closely related to risks of other diseases like high blood pressure, heart diseases, kidney disease, breathing problems and stroke among others. Prevention of the disease is viewed to be more cost-effective than the treatment itself which is costly. Health providers should come up with epidemiological measures for obesity since it has become a serious condition. Cost-effective policies and programs should be developed to prevent the disease. To prevent and reduce obesity worldwide, there is a need for an increase in awareness to help in the development of solutions. The organization responsible for coming up with strategies for preventing and managing obesity should be able to come up with weight loss and prevention strategies.³

Identifying the most affected population by the condition will help the policymakers to come up with improved programs that will help to improve their well-being and health. Exclusive breastfeeding for children has been proven to reduce the risk of obesity and overweight in the later years of life. This makes an environment that supports mothers to breastfeed very important since it is a prevention strategy. Taxes on healthy foods need to be reduced to make it affordable to everyone thus preventing the condition. Easy and correct labeling of food and drinks will help to improve the consumer’s knowledge of healthier products. The marketing of foods that are high in fat should be limited and the overall elimination of solid fats from processed foods. There should be school policies set to promote physical activity and healthy food intake. Physical activities in the communities and workplaces should be promoted.⁴

Another strategy is to reduce the portions of food intake for obese and overweight people and eating slowly to know when one is full. This will help to reduce weight and stop the habit of overeating. An increase in fruits and vegetable intake compared to high energy food intake will help in the prevention of the condition. The ban on sales and distributions of unhealthy food within and around schools should be considered. Systems that monitor the lifestyle and diseases should be developed globally to provide detailed data that will help in decision-making. The system will help to monitor how and where common the condition is and assess the need for intervention and the strategies to be used.⁵

In the clinical management of obesity, the reduction of weight loss should not be the ultimate goal. The goal is to communicate with the patient and make them understand and practice the ways of living healthily. Motivation and counseling have been proven to help patients lose weight and prevent them from going back to unhealthy lifestyles. Research has shown that the loss of 10% of body weight which is achieved by losing fat tissue is capable of reducing morbidity linked to obesity. Dietary education is very important in educating people on how to prevent themselves from obesity. Foods enriched with fiber that can help to reduce weight and are the most preferred. Scientific research shows that an active lifestyle plays a protective role in preventing weight gain and obesity. It also shows that an inactive lifestyle promotes the condition. The primary prevention of obesity starts with maintaining your body against it and not losing weight. It has been proven that in all treatments for weight loss is physical activity has the most effective results.⁶

The government should invest in every way possible to help see that all the prevention strategies are achieved. They should help to fund these prevention programs and strategies. Proper outdoor playground and walking tracks should be developed to enable regular physical activities to take place with ease. Cycling is another example of physical activity that could be used to prevent obesity and help in weight loss. The appropriate physical activity should be done for at least 30 minutes for more days in a week. Disease control and prevention centers advocate for 150 minutes a week. The reduction of salt and fatty acid intake decreases the risk of the condition. High calories and sugars lead to obesity so their intake needs to be controlled.⁷

Effective management of obesity in children is identifying and assessing the weight changes. Parents should be able to recognize their child’s weight gain. Children’s weight varies throughout their growth and is different between sexes. Therefore both gender and age need to be considered when interpreting weight. Appetite control could be used to control obesity both in children and adults. For the ones that re already affected, completion of a pediatric weight management program will motivate them to embrace behaviors associated with physical, physiological and emotional health. From a medical view, people will learn how to achieve and maintain weight loss. Healthy eating patterns will be acquired from this program.¹⁰

Conclusion

 Health promotion and disease prevention tend to be related. When health is improved, solutions to prevent diseases are implemented. Health education is the most important factor in effective health promotion. People get to learn about themselves, increase their self -esteem and learn the art of communication. Skills are also acquired through health education enabling people to adopt new living and health ideas. This knowledge helps them to understand what it entails to attain an effective goal in improving health. Obesity is a disease that is mainly caused by lifestyles. Intake of unhealthy foods and lack of physical activities are a large contribution to obesity. Obesity could be prevented by having healthy diets, controlling one’s appetite and the major one is physical activities. These physical activities include walking, running, cycling, exercising and any other activity that involves body movement.

References

1. Institute of Medicine (U.S.). (2016). A framework for educating health professionals to address the social determinants of health. Washington, DC: The National Academies

Press.

2. Prèuss-èUstèun A, World Health Organization. (2016). preventing disease through healthy environments: A global assessment of the burden of disease from environmental risks; Geneva, Switzerland : World Health Organization, [2016]
3. Zubiría M G, Alzamendi A, Ongaro L, Spinedi E,  Giovambattista A, (March 15, 2017). Dietary and Hormonal Factors Involved in Healthy or Unhealthy Visceral Adipose Tissue Expansion; Intech
4. World Health Organization. Kallioinen M, Granheim S I, (2017). Overweight and obesity in the Western Pacific Region: An equity perspective. Philippines; World Health Organization. Western Pacific Region[2017]
5. Rechel B, World health organization: regional office for Europe role of public health organizations in addressing public health problems in Europe; The Case of Obesity Alcohol and Antimicrobial Resistance; [S.l.] WHO regional office for E, 2018.
6. Sbraccia P, Nisoli E, Vettor R. (2016). Clinical management of overweight and obesity: Recommendations of the Italian Society of Obesity (SIO). Cham : Springer [2016]
7. Kelishadi R, (2019). Primordial prevention of non-communicable disease. Cham: Springer.
8. Green J, (2015). Health promotion; Sage publications
9. Salazar L F, Crosby R A, DiClemente R J, Jossey-Bass (2015). Research methods in health promotion. San Francisco: Jossey-Bass.
10. Melinda SS, Stewart TG Kristian T von Almen. Handbook of pediatric obesity: clinical management; crc press

Intervention and Health Promotion Plan for Diverse Population

Introduction

A health intervention is a strategy or a program developed to improve health in a population of different ages, gender, background, religion, and even race. This programs help to educate and train people the importance of healthcare. Healthcare is majorly a need in these areas, given that some areas are prone to poverty, poor health and lack of good and affordable healthcare. Due to people living in poverty in some of the areas, preventable diseases cause death to people, hence the need to promote healthcare and create awareness. The more populated a place is the more the need for an intervention in matters concerning healthcare.

Part 1: Intervention and Health Promotional Plan

Innovation is a great component that we will use to improve healthcare. New ideas and solutions will be implemented to improve the qualities and services in healthcare. This will include coming up with new products in the healthcare sector to aid in satisfying the patient’s needs .Innovations will be implemented to make services more efficient, eliminate waste of any materials and lower the costs of the products and the services to be offered. This will ensure that even the poor people will be considered and treated.

Performance management is a strategy that will be used to improve the quality of healthcare. This entails establishing proper ways or systems that will give accurate information and at the right time. This will help to know if a health program is working effectively or maybe needs to be changed or updated. This way correct details will be recorded and will help in follow ups. The established systems will be monitored closely and regularly so as to give accurate data.

The human resource management will be improved by developing and advancing the staff’s careers through training time by time. This will help them add more knowledge creating a room for better services to the patients. Regular meetings will be important to help them air their challenges and progresses and discuss how to solve and deal with the challenges. Communication platforms will be provided to ensure that every staff feels free to speak and be heard. Team building activities will be made priority so that the employees can get to know each other, share about themselves. It will give a chance for them to share about their experiences in and out of work making them comfortable and confident in each other.

Technical package is a strategy that will be developed to show evidence and will be used to reduce health problems. It will be used to reduce or control the risk of a possible outcome of a disease. For example a technical package for vaccination will be developed to avoid some diseases that can be protected early enough. Immunization will be given free to every child that needs it. These strategies will be used to control and reduce the healthcare costs.

Partnerships with different organizations will help to improve healthcare. This will enable us to get resources, for example finances, products and even services. They will help in giving ideas that will benefit both parties and help to promote health in the community. Partnering with other organizations will promote and give a big boost to healthcare for example in terms of advertising. They will help us to create more awareness to the people in the community. They will help us reduce on cost in this plan or maybe give us ample time to pay for goods and services. They will aid in providing a means of transport for example an ambulance which is needed for people who live in the interior.

Part 2: Evidence based foundations

In our intervention and promotion plan we will use epidemiological evidence to find the most likely causes of certain diseases in the community. This will be done to reduce the quick spread of infectious diseases to a large number of people over a short period of time. For example we will use programs that will be effective to make sure that clean and safe water is available to the people. This will reduce the risk of diseases like diarrhea and cholera that are mainly caused by taking dirty water. We will develop a deworming program in the community that is cost friendly to eradicate infections brought by worms. This will help and improve health among people living in this diverse populations. This will help in ending and preventing some of the diseases in the community.

Part 3: Cross Cultural Collaborative Opportunities and Strategies

Cross cultural training will be provided to the community to ensure that everyone understands the benefits of healthcare. This will help to bring and improve awareness about the different cultures and bring more openness among them. It will include the importance of cleanliness and hygiene in the community. For example living in an environment that has no stagnant water will keep off mosquitoes that cause malaria, healthy diets keep us from diseases, drinking clean water is essential too. This training will help even those in the community that do not believe in healthcare. It will educate them on the importance of healthcare and also ways of living a healthy life. Training on how to perform first aid and how important it is to the community will be done. This will help to reach out even to the aged and are in need of healthcare.

A leader will be appointed to help control and help in decision making. The leader will promote and encourage hard work and dedication from the employees. He or she will ensure that quality healthcare is provided, safety for the patient and the staff too. He or she will come up with agendas and make sure that everyone participates and that each and everyone’s suggestions is listened to. He or she will be responsible of creating a conflict free environment for the employees, either in high levels or low levels. He or she will make every employee feel that their work is appreciated.

A written document for the staff will be provided to ensure that everyone understands perfectly the rules and regulations that have been implemented. The document will contain guidelines that will govern the workflow in the healthcare. This will make everyone be clear and know their duties, which is also a way that will promote transparency. It will help to promote open communications and be clear on the expected performance for the staff. The document will be written in a way that is not biased and considers the rights of everyone including the patient.

An open environment will be promoted so as to make sure that everyone will be equally treated and their voices will be equally heard. This will ensure that all questions and opinions count taken into consideration. This will also promote open communication to everyone thus increasing self-confidence and reducing misunderstandings. This will create an environment that makes people feel secure and safe. It will also promote discipline and respect both from the staff and from the patients.

Conclusion

Intervention and Health plan for diverse population is important in a community. Most people live without knowledge or any training to attend to themselves or a sick person causing deaths that can be prevented. Health plan is a need in the diverse population because of the many cultures and different people living there. The health promotion programs will empower the people living in the community to live healthy lives and prevent themselves from some of the diseases. Creating awareness on living, eating, and taking care of our surroundings reduces the chances of catching a disease.

 Musculoskeletal System

Osteoarthritis

Osteoarthritis is a musculoskeletal condition that is clinically characterized by joint pains, tenderness and limited joint movements. This medical condition can occur at any joint but is largely experienced at the hips, knee, hand and foot and spine joints.  Osteoarthritis is the most common form of arthritis that affects millions of individuals worldwide (Sinusas, 2012).  The risk factors of this type of arthritis include, age, gender, obesity, genetics and past trauma. The diagnosis of this diseases has been based on the frequency of occurrence of joint pains that are worsened by movements. In severe cases the disease can cause irreversible damages that can result in disabilities. Osteoarthritis of the knee is a major cause of impaired mobility among women. In 1990, this type of arthritis accounted for 2.8% of people living with disabilities. The risk of contracting the disease rises with age and as a result extended life expectancy has a high potential of increasing the number of people with this condition (Woolf, et al., 2003). The burden will be greatly felt by developing countries where life expectancy continues to increase and where joint replacement is not yet readily available.

            The commonest symptom of this condition is joint pain, the joint pain continues to worsen with extended periods of activity, this limits the daily living activities of an individual. Treatment for this condition can be categorized in four classes; pharmacologic, complementary and alternative, nonpharmacologic, and surgical. When beginning treatment, it is important to start with the safest and least invasive therapies and slowly proceed to more invasive therapies (Felson, et al., 2018). Surgical treatment is reserved for severe cases where the patient fails to respond to behavioural and pharmacologic therapy and for cases where severe pain leads to loss of function. Limitations of treatment are a few and include, difficulties using the level of pain as a diagnosis since improvement of the condition may not be accompanied by reduction of pain but by increased joint movement.  The pain that characterize this condition is multifactorial and treatment that targets a single mechanism of pain may be insufficient when it comes to delivering large treatment effect in cases where the mechanism is not operational in the majority of patients (Felson, et al., 2018). Lastly, surgical treatment does not relieve pain in all the individuals with the disease.

Inconclusion, osteoarthritis is the most common form of arthritis, it a musculoskeletal condition that is clinically characterized by joint pains. risk factors of this type of arthritis include, age, gender. Treatment include, pharmacologic, complementary and alternative, nonpharmacologic, and surgical. Only a few limitations of treatment exist.

References

Felson, D. T., & Neogi, T. (2018). Emerging Treatment Models in Rheumatology: Challenges     for Osteoarthritis Trials. Arthritis & Rheumatology, 70(8), 1175-1181.

Sinusas, K. (2012). Osteoarthritis: diagnosis and treatment. American family physician, 85(1),     49-56.

Woolf, A. D., & Pfleger, B. (2003). Burden of major musculoskeletal conditions. Bulletin of the world health organization, 81, 646-656.

Eating Disorders and the Perception of Beauty

           Different individuals and cultures have different perceptions of eating habits. Some consider fatness as fashionable and attractive throughout their community. Similarly, obesity was considered a sign of wealth since those who obtained adequate food and were well fed were people with money. Recently, most regions across the globe have been characterized by food shortages which have contributed to weight issues. According to Blodgett, Jones, Haugen, and Schaefer (32) for the longest time thinness has always been considered fashionable and this trend has increased since the 20th century as opposed to the previous eras. Eating disorders refer to a range of psychological conditions leading to the development of unhealthy eating habits. Eating disorders are mental health conditions with a marked obsession with food or body shape. The disorders are capable of affecting anyone regardless of gender and age although they are highly prevalent among young women. Often, eating disorders are reported among adolescents, with about 13% of the youths experiencing at least a single eating disorder (Stice, Eric, C. Nathan Marti, and Paul Rohde 445). The disorders might start manifesting with an obsession with food, body weight, or even the shape of the body. In some cases, eating disorders can lead to certain serious health consequences which may, in turn, result in death if not managed. However, the eating disorders can present with several symptoms, mostly inclusive of severe restrictions of food, food binges, or such purging behaviors as vomiting or over-exercising. Besides, shapely backsides are now celebrated with several "likes" on social media. Probably, an eating disorder is a worldwide problem that is terminating our lives at an early age. Throughout history, there has been a featured idea of an “ideal” body image specifically in women, leading to eating disorders as a result of high societal pressure.

In the contemporariness of society today, everything is changing and the concept of beauty is no exception. Beauty has gradually changed especially for women to a desperate point where most are adopting extreme behaviors in search of ideal beauty (Juli 450). Different types of media such as films, music, and social media have widely contributed to these perceptual changes. It is through the media that people get to learn about what is ideally recognized as beauty. Physical appearance has widely been popularized as the ideal beauty while the need for an attractive personality is ignored. Food attachment and their effects on physical beauty is a notion that is well established within society today. Eating is no longer just a source of energy but also contributes highly to weight gain a notion that has contributed to increased weight disorders that involve starving oneself to achieve the ideal body image (Blodgett, Jones, Haugen and Schaefer 32).

      The women’s prevalence of the eating disorder defects owes to their body image which has always been under the pressure due to male gaze influence. Following the history of women, fat women were considerably beautiful as well as rich, in comparison to the current time, where skinny women who look like skeletons are considered the most beautiful (Williams 216). The ever-changing beauty standards affect girls and their perception of their body in the present ages. The pressure from the modern beauty standard contests as presented on social media, pose a challenge on young girls of 21st century, developing eating disorders in an attempt to acquire the desired size and body shape as well.

Based on Thompson and Hammond (232) eating disorders are serious psychological and physical health conditions. The conditions develop in different forms such as anorexia, binge and bulimia eating disorders. The disorders have increased to the point of being normalized as the means of attaining an ideal body. The overall concept of weight is generally determined by how a person consumers food (Rodgers 122). Food consumption changes are not surprising since the media provides extensive information on ways through which individuals can enhance their physical attraction. Besides, the use of cosmetics, controlling the amount of food that individuals eat is one of the most glorified means for enhancing beauty.

           Eating disorders are prevalent among young individuals since they are the most affected by the perception of body image. People tend to judge others based on their physical appearance. Young people are influenced by the need to fit in within a society that highly accepts thin rather than chubby members (Juli 450). Despite the description of the disorders with the term “eating”, eating disorders mean more than just as it concerns food. The condition presents as a complex mental health condition, requiring the intervention of medical expertise as well as psychological experts in the management of their course.

           Eating disorders have various triggers which mainly arise from the assertion of the media for physical attractiveness. The desire for more attention across social media platform has fueled the increase of abnormal eating habits (Thompson and Hammond 233). Anorexia nervosa is common and the most popular eating disorder. The condition generally is likely to develop in adolescence stages or during young adulthood, tending to affect many women compared to men. The anorexia victims generally perceive themselves as overweight, even if their condition manifests dangerous underweight. The victims considerably tend to be attentive in monitoring their weight constantly, avoiding consumption of certain types of foods, as well as severe restriction from their calories. The condition encourages individuals to starve themselves as a means of controlling weight gain (Rodgers 123). The victims have an intense fear of gaining weight, being persistent in behaviors that help to avoid weight gains, although in most cases are underweight. The victims, however, tend to have a relentless pursuit concerning thinness as well as unwillingness in maintaining a healthy weight. In most cases, there is a heavy bodyweight influence or perception of body shape on self-esteem. The victim also presents with a distorted body image, inclusive of denial to be seriously underweight.

As presented in commercials or any other media, women are generally defined as beautiful especially those with the ideal body (Perloff 364). Most women are characterized by low self-esteem based on the pressure subjected to them by society following harsh criticism. In this case, it is not surprising to find women believing that they are fatter than they are and uglier than what is perceived as the ideal beauty. There is a fixation that lies on the physical attractiveness. From a tender age, boys and girls are taught that the value of each female lies in their sexuality and beauty (Tiggemann and Slater 632). The notion is responsible for gender-based stereotypes which are mainly dominant in the business setting.

Anorexia is prevalent since women, unfortunately, learn that their value is grounded on their beauty (Tiggemann and Slater 632). Rather than judging women based on their qualities or brains the society is quick to judge them based on their physical attractiveness. For women, the worth increases with beauty. The media has never shied from presenting flawlessness as the idea of beauty (Rodgers 123). To boost their confidence men and women focus on attaining the set standards of beauty in whichever means. The glorification of physical beauty with respect to weight is responsible for growing eating disorder cases.

The lack of self-worth and confidence among young people leads to obsessive-compulsive symptoms, which are significantly most often in patients with eating disorders. Exemplary, most anorexic people are usually preoccupied with constant thoughts concerning food, and some are in danger of obsessively collecting recipes or hoarding food (Perloff 364). However, those individuals have a challenge of eating in public, and exhibit and have an exhibition of strong desires in controlling the environment they are involved in, with a limited ability to be spontaneous.

A perfect body is almost a necessity in society today. The society is totally to blame for the problem as it has taught women and men that physical attractiveness is the actual measure of beauty. Everyone wants to be perfect not just to attract attention but also to feel confident and enhance their worth. The adoption of eating disorder mainly presents itself by individuals focusing on reducing their overall food intake to reduce weight and maintain a slim structure that is desired by society. Bulimic and anorexic people are particularly victims of societal propagation of weight and beauty (Perloff 365). In the search for the ideal body, this has exposed them to deadly disorders.       While some people are obsessed with food avoidance others cannot stop eating which is responsible for obesity. Surprisingly plus-size individuals are participating in modeling which to some extent is encouraging weight gain (Mills, Amy and Hogue 145). Bulimia Nervosa is also among the commonly known eating disorders. Similarly to anorexia, bulimia also tends to develop among the adolescents and early stages of adulthood, appearing to be less prevalent in men in comparison to women. The victims of bulimia frequently take unusual large quantities of food in certain periods. In each binge eating episode, the victim is usually stopped from eating by a painfully full stomach. However, during a binge, the individual has too much desire for eating for him to stop eating. The binge happens with different types of food, although most commonly occur with foods that the victim is likely to avoid. Most importantly, the bulimia victims try to purge in an attempt to compensate for the consumed calories, relieving gut discomforts. The purging in this context may mean such behaviors as forced vomiting, fasting, use of laxatives, diuretics, enemas, as well as involvement in excessive exercise.

      Social stigma and self-esteem issues are some of the factors that trigger eating disorders. Young people especially women tend to feel as though they are too fat even when they are in perfect body weight and shape (Mills, Amy and Hogue 145). Such perceptions obstruct their perception of their body image leading to abnormal eating behaviors. The symptoms of bulimia are similar to those of the anorexia, specifically those experienced in binge eating or purging subtypes. However, the victims of bulimia have the usual maintenance of relatively normal weight, rather than being underweight. Some of the common symptoms experienced in a condition of bulimia nervosa are:

• Recurring episodes of binge eating without control from the victim.
• The victim recurrently present with inappropriately purging behaviors purpose to control their weight gain.
• There is self-esteem from the influence of body shape as well as weight.
• The victim fears to gain weight, although in most cases he or she has a normal weight

            Binge eating disorder is the most common among all the eating disorders, specifically in the US. Like the other eating disorders, the conditions develop during adolescence as well as at early adulthood stages, but it can develop later in life. The symptoms presented in victims of Binge eating disorder are similar to those in victims of bulimia as well as binge eating subtype of anorexia (Tak, Hendrieckx, Nefs, Nyklíček, Speight and Pouwer 289). For instance, the patient typically consumes unusually large quantities of food within a relatively short time, feeling a lack of control during those binges. The binge eating disorder victims have no restriction of calories, neither do they present with purging behaviors like vomiting, excessive exercise, among others to compensate on the binges. The symptoms of binge eating disorder include;

• The patient eats a large amount of food within a shortly and does not stop until he is painfully full. 
• The victim feels to lack control during the binge-eating episodes.
• The victim also has such feelings of distress as shame, disgust, and guilt, while they think about their binge-eating behavior
• The victim does not present with purging behaviors, like restriction on calories, vomiting, exercising excessively, and laxative or diuretic use, for the compensation of the binges (Mills, Amy and Hogue 145).

            People with binge eating disorder are often overweight and obese, increasing their risk in terms of medical complications in link with excess weight, for example, heart disease, stroke, and type II diabetes. Being overweight attracts criticism and the stigma might trigger suicide cases or worsen the eating disorder. The most significantly, people with binge eating disorder are characterized by consumption of large amounts of food which are uncontrollable over a short time. Funny enough the patients do not purge as opposed to the other mentioned eating disorders.

           Eating disorders are influenced by a facet of factors although the exact cause of the disorders is unknown. However, the cause may be biological, psychological as well as environmental factors. For instance, the biological factors endure irregular functioning of hormones, genetic disorders, and nutritional deficiencies. Psychologically, the factors may denote the negative body image of a person and poor self-esteem. Besides, aesthetically oriented sports such as diving, rowing, and ballet among others may encourage eating disorders for one to maintain a lean body for better performance (Culbert, Racine and Klump 1150). However, childhood and family trauma, as well as cultural influence, contribute to eating disorders.

           Different eras have had different ideas concerning body size and shape, with different perceptions of eating habits and eating disorders (Culbert, Racine and Klump Culbert et al 1150). However, the etiological models of the image of the body and the eating concerns highlight the role of focus socially on slenderness as well as muscularity of the body concerning the eating concerns. Considerably, interpersonal interactions have played a vital role in promoting the development of certain body image and eating concerns, for instance, youths are involved in online interaction although the body image in such a forum is not clear. Social media and the internet present with characteristic theoretical leads which are believed to have an association with the body image as well as eating concerns.

      Following the 19th century, the body image disturbance still has something to do with the development as well as the maintenance of clinical eating disorders. For instance, in Greek architecture, the statues they made were commonly curvy, pale with slightly flushed cheeks and soft faces that were round. The statues simply indicated what an imaginably beautiful woman was. The women were considered the objects of fertility, lust, and beauty (Benton, Catherine & Bryan 25). However, to acquire the shapes termed as beautiful, the eating habits played a key role in shaping them. This means that fatness was considered ugly and therefore the eating disorders could result from striving to gain a beautiful body image.

      The current employs the modeling industry as a fixer of their body shape and image to improve on their beauty. Following Victoria’s Secret Model, the modeling industry is costly ion terms of healthy to make one thin enough to secure the big jobs in the beauty industry (Holland, Grace & and Marika, 115). Ideally, it is hard to work on the lean bodies with the model, with losses of clients following each gain in about a half-inch in body size (Holland, Grace and Marika 115). However, remaining thin was considered a recovery from an eating disorder according to the model. The idea implies that the manageable body size is the best description of beauty in this era. It is not anymore described as an eating disorder hence most individuals have gained influence from social media and the internet to acquire the most preferred images.

           Today’s mothers must be worried about the eating disorders associated with their daughters and might have never imagined of similar situations among the mothers in the Victorian era. Ideally, food consumption is necessary for survival, going hand in hand with health and nutrition as the buzz words since one's birth. But most of the times eating disorder remains a concern of human beings. The poor Victorians lived a treacherous life. The earlier manifestations of certain eating disorders experienced today were also evident in the Victorian era. The era is a narration of a story about disordered eating as well as the diseases resulting from the eating disorders (Hughes 210). For instance, fasting was common among individuals in the Victorian era. The young pre-adolescent girls in this era were considering their survival ability without nourishment a symbol of sanctity. Some could last for a quite long period without consuming any food (Holland, Grace & and Marika, 115). Such girls were termed as the Fasting girls in the Victorian era, refusing to consume food and fasting for long periods. The character of the girls was perceived as a miracle in the Victorian era. The kids developed eating disorders to acquire recognition in the society.

           The eating disorder in the Victorian era was an alarming issue since it resulted in several deaths. However, the girls were accused of hysteria, superstition as well as deceit, and controversies since it is seemingly impossible to completely abstain from food without dying. The eating disorders led to the division of the society into those believing in the duality of mind and body, and those relying on science, including material facts. The critics in the Victorian era argued that eating disorders resulted from depression, anxiety, and hysteria recognizing a disease for nervously absent appetite (Holland, Grace & and Marika, 115).

           Similarly, the women in the Tang Dynasty were characterized by austere as well as prolonged fasting among Shangqing Daoist priestesses. It was a part of a lifestyle practiced in an attempt to achieve a mystical state of after existence of life, the immortality of the body and residence in the Shangqing heavenly kingdom. The fasting practice was considered religious and could not be conceptualized as a form of an eating disorder (Ferguson, 13).

           Social media has effectively discovered a way into entire classrooms, dinner tables, and workplaces. Children, teenagers, or even adults, everyone exclusively seems to have a recommendable presence in the world of social media (Tiggemann and Amy 632). The wide ranges of social media platforms are used by all age groups inclusive of Instagram, Facebook, Snapchat, and Twitter, which are increasingly difficult to cease their pressures as well as social media influences. Social media, however, influences one’s relationship with food and to fear of gaining weight (Ferguson13). Most importantly, several individuals in the social media world chronicle their body fitness, choosing foods, and involving themselves in exercise regimes. Those struggling with an eating disorder, the constant streaming of body and food-conscious posts heighten the stress and anxiety levels in the context of ‘perfect body image’.

In conclusion, eating disorders is a worldwide problem that is severely destroying the lives of young men and women. Throughout history, there has been a featured idea of an “ideal” body image specifically in women, leading to eating disorders as a result of high societal pressure. The eating disorders are seemingly unable to be controlled due to different perceptions of the body size and shape, with the majority regarding thinness as beautiful, while others regard fatness as wealthy. The society is to blame for promoting the idea that beauty is measured by physical appearances. People are beauty irrespective of their different sizes and it is the contemporary society’s perception of beauty as lean structures that have contributed to the growing eating disorders in general.

Works Cited

“Eating Disorders (for Teens) - Nemours KidsHealth.” Edited by D'Arcy Lyness, KidsHealth,                  The Nemours Foundation, Jan. 2019.

Benton, Catherine, and Bryan T. Karazsia. "The effect of thin and muscular images on women's               body satisfaction." Body image 13 (2015): 22-27.

Culbert, Kristen M., Sarah E. Racine, and Kelly L. Klump. "Research Review: What we have                  learned about the causes of eating disorders–a synthesis of sociocultural, psychological,                and biological research." Journal of Child Psychology and Psychiatry 56.11 (2015):                1141-1164.

Feeding Hope, Neda. “Risk Factors.” National Eating Disorders Association, 3 Aug. 2018.

Ferguson, Christopher J., et al. "Concurrent and prospective analyses of peer, television and                     social media influences on body dissatisfaction, eating disorder symptoms and life                        satisfaction in adolescent girls." Journal of youth and adolescence 43.1 (2014): 1-14.

Holland, Grace, and Marika Tiggemann. "A systematic review of the impact of the use of social             networking sites on body image and disordered eating outcomes." Body image 17 (2016):             100-110.

Howard, Jacqueline. “The Ever-Changing 'Ideal' of Female Beauty.” CNN , Cable News                           Network, 9 Mar. 2018

Hughes, Elizabeth K., et al. "Eating disorder symptoms across the weight spectrum in Australian             adolescents." International Journal of Eating Disorders (2019).

Jaret, Peter. “Eating Disorders and Depression: How They're Related.” WebMD , WebMD, 16                 July 2010

Juli, Maria Rosaria. "The" Imperfect Beauty" in Eating Disorders." Psychiatria Danubina 31.Suppl 3 (2019): 447-451.

Killgrove, Kristina. “Here's How Corsets Deformed The Skeletons Of Victorian Women.”                       Forbes, Forbes Magazine, 16 Nov. 2015

Malcolm, Bridget. “This Victoria's Secret Model Wants You to Stop Trying to Look Like Her.”               Harper's BAZAAR , 20 June 2018

Mills, Jennifer S., Amy Shannon, and Jacqueline Hogue. "Beauty, Body Image, and the Media." Perception of Beauty (2017): 145.

            Mind, 29 May 2019

Muhlheim, Lauren. “Perfectionism in Eating Disorders.” Verywell Mind , Verywell

Perloff, Richard M. "Social media effects on young women’s body image concerns: Theoretical perspectives and an agenda for research." Sex Roles 71.11-12 (2014): 363-377.

Raevuori, Anu, et al. "Highly increased risk of type 2 diabetes in patients with binge eating                      disorder and bulimia nervosa." International Journal of Eating Disorders 48.6 (2015):                  555-562.

Rodgers, Rachel F. "The relationship between body image concerns, eating disorders and internet use, part II: An integrated theoretical model." Adolescent Research Review 1.2 (2016): 121-137.

Salafia, Elizabeth H. Blodgett, et al. "Perceptions of the causes of eating disorders: a comparison of individuals with and without eating disorders." Journal of eating disorders 3.1 (2015): 32.

Stice, Eric, C. Nathan Marti, and Paul Rohde. "Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women." Journal of abnormal psychology 122.2 (2013): 445.

Stice, Eric, et al. “Prevalence, Incidence, Impairment, and Course of the Proposed DSM-5 Eating             Disorder Diagnoses in an 8-Year Prospective Community Study of Young Women.”                     Journal of Abnormal Psychology, U.S. National Library of Medicine, May 2013.

Tak, Sanne R., Christel Hendrieckx, Giesje Nefs, Ivan Nyklíček, Jane Speight, and Francois Pouwer. "The association between types of eating behaviour and dispositional mindfulness in adults with diabetes. Results from Diabetes MILES. The Netherlands." Appetite 87 (2015): 288-295.

Tak, Sanne R., et al. "The association between types of eating behaviour and dispositional                        mindfulness in adults with diabetes. Results from Diabetes MILES. The                                         Netherlands." Appetite 87 (2015): 288-295.

Thompson, S. H., and K. Hammond. "Beauty is as beauty does: Body image and self-esteem of pageant contestants." Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity 8.3 (2003): 231-237.

Tiggemann, Marika, and Amy Slater. "NetGirls: The Internet, Facebook, and body image concern in adolescent girls." International Journal of Eating Disorders 46.6 (2013): 630-633.

Williams, Gianna. Internal landscapes and foreign bodies: Eating disorders and other                              pathologies. Routledge, 2018.

Evidence-based translation for advanced nursing practice

From personal experiences, I have learned that evidence-based practice is very important as it enables the health care provider to use well-designed studies from randomized control trials, meta-analysis, qualitative study, clinical cohort study, practice guidelines, among other sources of evidence (Lui, 1).  I have learned that evidence-based practice guide clinicians in clinical practice. I have utilized evidence-based health care and it has helped me by providing a useful insight especially in patient care. For example, I have applied evidence-based practice in dealing with patients with stroke. In most cases, stroke affects the elderly individuals, and lower incidents in young individuals. Stroke affects the quality of life by causing negative effects on physical and cognitive abilities (Lui, 1).In finding the preventative measures, we implemented the evidence-based practice of rehabilitation.  According to several studies, patients with stroke become disabled after discharge. For example, a community-based cohort study found that 58% of patients with stroke (from 85 years) died after post-stroke (Lui, 1). Another multicenter cohort study found that elderly patients who are taken to nursing facilities do not suffer from multi-morbidity. To prevent patients with stroke from developing cognitive impairment and other post-stroke condition, we referred them to rehabilitation where they could receive natural mechanisms of recovery.  Note that stroke causes brain damage and neurogenesis or self-repair occurs through the higher intensity of therapy. In rehabilitations, patients discharged from acute care received skill learning which promoted plasticity and improved stroke recovery (Lui, 1). They also received motor retraining which promoted motor recovery. Therefore, using the evidence-based practice of stroke, rehabilitation improved the quality of care in that there was an improvement in functional outcomes, reduction in hospital stay, and other benefits.

 An evidence-based practice model that I might use in my doctorate project is the Iowa Model for Evidence-Based Practice to Promote Quality Care. The project that I have identified is Depression screening after stroke in patients under 64 years old.  The rationale for choosing this model is that the model is patients-centered, and the purpose of the project is to promote quality care, or in other words to promote excellence (Brown, 152). From multiple research, I have learned that patients with stroke suffer from post-stroke depression.  Therefore, my project will focus on the need for assessment and treatment of post-stroke depression. Note that screening is useful as it will detect depression and clinicians will be able to improve depressive symptoms through treatment in acute care settings.  In the project, the aim is to evaluate whether early screening of depression will reduce mortality, and improve quality of life (Brown, 152). The lowa model is associated with strengths in that it will focus on the problem (depression),  it will identify the team that will be involved in the practice (depression screening),  it will evaluate whether the practice has achieved the desired practice change, and the model will address the PICOT questions, that is;  population, intervention, control, outcome, and time. In general, the lowa model will help come up with research findings, and implement the findings into clinical practice. Note that the purpose of the project is to come up with evidence-based practice and in this, the practice is screening for depression in patients with stroke to improve the quality of care (Brown, 152). However, the lowa model is associated with weaknesses as it only focuses on a team of clinicians and this means that there are barriers to implementation. There must a team to develop, implement, and evaluate the practice. Nevertheless, I will use the model in my current and future projects since it will help come up with a clinical question, address the problem with the interest stakeholders, and ensure a successful implementation.

Work cited

Brown, Carlton G. "The Iowa Model of Evidence-Based Practice to Promote Quality Care: An

Illustrated Example in Oncology Nursing." Clinical Journal of Oncology Nursing 18.2

(2014).

Lui, Siew Kwaon, and Minh Ha Nguyen. "Elderly stroke rehabilitation: overcoming the

complications and its associated challenges." Current gerontology and geriatrics

research 2018 (2018).

 Roles in Advanced Practice Nursing

Introduction

            The roles of advanced Nursing include physical examine, diagnosing, prescribing and administering medication to patients. Advanced nurses have more freedom of making decisions and suggesting treatments and also serve as consultants to the junior nurses in the health sector According to the APRN Consensus Model there are four roles an APRN can hold: certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), clinical nurse specialist (CNS), and nurse practitioner (NP).

Role transition from Registered Nurse (RN) to Advanced Practice Nurses (APN) is a difficult task and may involve a lot of anxiety, loss of confidence in clinical skills, feeling of incompetence in the clinical filed and conflicts (Barnes, 2015). This transition happens in a series of phases. The purpose of this paper is to ensure that one student gets a chance to explore the roles of APN and come up with APN professional development plan. Second, it makes the students understand how difficult and time consuming it is to adjust to a new role, one should give him/ herself ample time to ease the self-doubt and anxiety that comes with the transition.

Below is discussion of the four APN roles which include CNP, CNS, CRNA & CNM.

Certified Nurse Practitioner (CNP) deliver intense care to patients in a clinical field. As stated by American Association of Nurse practitioners (AANP), CNPs work in close liaison with various healthcare providers to offer and avail a full range of healthcare services (Barnes, 2015). Some of the roles of CNP include; treating patients after close examination in addition to supporting the treatment of chronic diseases and educating patients and giving medication prescription. Work environment include; hospitals, outpatient settings, hospice and palliative care services and nursing homes. CNP are registered nurses with a master’s degree qualification.

Clinical nurse specialist (CNS) are the advanced practice nurses (APNs) primarily working in the field of oncology and they have more intradisciplinary and interdisciplinary consultative and collaborative skills in practice. A CNS is a specialist who improves patient’s outcomes and nursing care using evidences to train nurses (Colligon, et al., 2015). CNS often identifies opportunities for development and growth and also have interest in research thus updating institutional standards of care and aiding their nurses to adapt to them.

Certified registered nurse anesthetist (CRNA) provide anesthesia in rural facilities in countries like US. In well developed countries you will find a CRNA in every healthcare as it is a requirement in the health sector. CRNA are made up from student registered nurse anesthetist (SRNA) of which is a difficult transition. The role transition of CRNA starts when one is in school and continues for the first or two years once one gets into practice. Some of the factors that influence the transition of CRNA include; mastery of self-efficacy and confidence, supportive work environment, expert mentoring and guidance, previous experiences as a SRNA, peer support. Besides that there are also factors that impede transition of CRNA which includes: Practice Limitations, Harsh Work Environment and Case Complexity and Workload (Malina, & Izlar, n,d).

Certified nurse-midwives (CNM) are solely responsible for offering gynecological care and advice to women of all ages from adolescence to the time of menopause. The roles of CNM include; aiding women throughout the pregnancy that includes prenatal and postpartum treatment, providing woman-centered support hence enhancing normalcy in giving birth, taking care of newborns for the first few months (Fitzpatrick, & Kazer, 2006). CNM are based in hospitals, clinics, and may also attend home births when need. CNM is personnel who equally holds both gynecologist and midwives’ skills in clinical area.” As a rationale of choosing CNP against CNS, CNP is a certified nurse who has been give the authority of ambulatory practice, long term and acute care while on the other hand CNS is a nurse specialist who is only accountable for diagnosis and treatment of diseases, prevention of illness and health promotion among individuals and families (Fitzpatrick, & Kazer, 2006). Having studied the NP practices, I have come to learn and realize each role of the four has a different role, some of the roles are general in the clinical setting.

Transitioning from RN to NP clearly shows that these nurses will experience full transition of their roles within their first year of practice. The scope of work of RP is totally different from that of RP and this makes it even hard for a well-trained RP in transition to NP. Scope of tasks of RN and NP are defined by the state laws and board of nurses (MacLellan, et al., 2015). In US, an example of board of nurses is the American Association of Nurse Practitioners.  RN are responsible for evaluating the effects of medication on patients and subsequently report the findings to the NP for close examination while facilitates the development of an alternative treatment plan. The main difference between these two roles is brought about by the fact during studies NP nursing students learn advanced assessment skills with a focus on creating a difference in medical diagnosis; therefore, NP nurses are able to execute lab orders and treatment options (MacLellan, et al., 2015). The NP is then responsible and well trained in interpreting test, and also executing and directing works within the NP’s scope of work to identify patient outcomes in a well-organized manner.

Factors to consider for a smooth transition from RP to NP include understanding the transition and supporting the transition. In understanding the transition, one has to get the difference between the two scopes of practices and appreciate them. It is important to introduce  and establish a strong relationship with a mentor who will be responsible for supporting the student during the transition during the early stages of the transition which is in graduate school (Barnes, 2015). Strategies to consider for a smooth transition include using your experience carefully and setting realistic expectations.

Conclusion

            Inconclusion, this study has greatly enabled me to understand how transition happens from being a RN to APN and from being RN to NP. CNP are responsible for delivering intense-care to patients in clinical fields. CNS are APNs primarily working in the field of oncology. CRNA are solely responsible for the provision of anesthesia in facilities located in rural areas.  CNM are APN who are responsible for the offering gynecologic care to women in all aspects of pre-maternity and post maternity care. This has also made me to appreciate the different roles of APN and their working areas and more so the reason as to why CNP is preferred to the other roles. This discussion will also aid in showing a learner the need to advance his/ her academic status in nursing after practicing for a couple of years.

References

Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The        Journal for Nurse Practitioners, 11(2), 178-183.

Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare            redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).

Colligon, S., et al., (2015). The NP and CNS: Advanced Practice Nurse. Retrieved from; https://www.accc-cancer.org/docs/Documents/oncology-issues/articles/ND15/nd15-the-         np-and-cns-advanced-practice-nurse-roles

Malina, D., & Izlar, J. Education and Practice Barriers for CRNAs” by Debra Malina. OJIN: The             Online Journal of Issues in Nursing, 19(2).

Fitzpatrick, J. J., & Kazer, M. W. (2006). Encyclopedia of nursing research. New York: Springer             Pub.

MacLellan, L., Levett‐Jones, T., & Higgins, I. (2015). Nurse practitioner role transition: A           concept analysis. Journal of the American Association of Nurse Practitioners, 27(7), 389-  397.

Barnes, H. (2015, July). Nurse practitioner role transition: A concept analysis. In Nursing Forum             (Vol. 50, No. 3, pp. 137-146).