Over the years, the roles of registered nurses have been crucial in the healthcare system with the determination to deliver patient-centered and evidence-based care to individuals seeking care. This is in line with the responsibilities indicated by the nursing unions and aims for collective bargaining agreements entered between then and other stakeholders (Coombs et al., 2015). Besides, the majority of the union memberships in the United States has been steadily rising. This paper will discuss the roles of nursing unions and collective bargaining for APRNs.
Collaboration is one of the roles of the nursing unions and collective bargaining for APRNs that is currently expanding because of the number of individuals joining the unions. They are mandated to work with other institutions, both in the private and public sectors, to promote the quality provision of health services by their members (Coombs et al., 2015). Besides, their main role in this is to promote strength among its members through unity. In addition, they fight for fair shift lengths and allowances, which then improves patient outcomes. Thus, their roles are inevitable.
Furthermore, they work to discuss issues of wages and protection of the nurses and all individuals receiving care services from them. Various studies indicate that health facilities that work with unionized nurses have better patient outcomes than their counterparts, and they receive a better wage, which is mainly driven by collective bargaining (RegisteredNursing.org, 2019). Apart from that, the nursing unions and collective bargaining agencies have a role in the establishment of standards that define how services by the nurses can be provided. This not only helps to protect nurses from working beyond their scope but also patients from caregivers who deliver services under unfair circumstances.
Conclusively, nursing unions, and collective bargaining play a big role in promoting better patient outcomes. This is because of their roles in protection and working to seek fair services for both the nurses and patients. Therefore, their roles are inevitable in healthcare.
References
Coombs, C. K., Newman, R. J., Cebula, R. J., & White, M. L. (2015). The bargaining power of health care unions and union wage premiums for registered nurses. Journal of Labor Research, 36(4), 442-461.
RegisteredNursing.org. (2019). Do Unions Benefit or Harm Healthcare & Nursing Industries? Retrieved 3 December 2019, from https://www.registerednursing.org/do-unions-benefit-harm-healthcare-nursing/
Mental health disorders are among the most common conditions in the world, affecting individuals of different socials classes, age and gender. They are caused by various environmental factors, including genetic exposure of individuals. The post-traumatic stress disorder is one of the conditions that is triggered by a terrifying event and in which the individual either witnesses or experiences it themselves and results in symptoms such as severe anxiety, nightmares and flashbacks (Westfall & Nemeroff, 2018). This can occur together with the presence of uncontrollable thoughts about the situation. This paper will discuss PTSD resulting from childhood neglect and terrorist attack exposure.
PTSD from Childhood Neglect
Children usually undergo a series of development and body changes as they grow up. However, repeated adverse childhood experiences have the capacity to affect the brain, body and the nervous system and probably the whole life of an individual (Brewin, Rumball & Happé, 2019). Child neglect involves abandonment, lack of the necessary supervision and attendance of emotional and psychological needs and failure of to offer the basic needs such as medical care, nourishment, education, clothing and shelter (Westfall & Nemeroff, 2018). This results in repeated traumatic situations and abuse which occur before the child’s sense of self, cognitive abilities and the brains systems becomes well established, leading to complex PTSD.
Besides, the neglect often makes the child feel hopeless and overwhelmed by the situation they face because of the inability to have the necessary coping capabilities thus making them believe that the world is dangerous (Westfall & Nemeroff, 2018). Also, it results in low self-esteem and behavioral consequences such as drug abuse, use of alcohol and criminal or abusive behavior. Although the dangers for neglect are not easily identified, it has a huge impact on the development of the individual (Brewin, Rumball & Happé, 2019). This then increases there a risk for development of the PTSD which will have a huge impact both psychologically and emotionally in the long-term
PTSD from Terrorist Attack
Terrorism can be described as a systematic use of violence in order to generate a climate of fear in a particular population, usually with aims of political interest. It results in loss of lives of individuals, destruction of properties, disabilities, and at the time it results into serious health consequences depending on the user during the attack (García-Vera & Sanz, 2015). Various studies have indicated that experience or witness of terror attacks results in the feeling of helplessness and fear in individuals (Gregory et al., 2019). This has the possibility to be spread from one person to another and thus to the whole community. Although the issues of fear can be addressed and reduced after a period of time depending on the size of the community, history and diversity, the issue of PTSD is challenging because of the psychological impact it has on the lives of the individuals.
Terrorist attacks and post-traumatic stress disorder have been closely linked by various studies that indicate that they have a relation. According to Gregory et al. (2019), the frequency of having symptoms of mental distress is high among individuals who had previously witnessed or involved in a terror attack. The exposure to terrorism increases the likelihood to develop PTSD (García-Vera & Sanz, 2015). Therefore, the flashbacks of memories which result from exposure indicate PTSD
Conclusion
Conclusively, various mental health conditions are caused by different factors, including genetic predispose. Post-traumatic stress disorder is one of the common cases that has been closely linked with experience or witnessing a terrifying event. For instance, neglect in children predisposes and individual to PTSD due to insufficient mental development to help in coping with stress. On the other hand, being a victim of terror attack results in flashbacks of disturbing memories that predisposes and in individual to the disorder.
References
Brewin, C. R., Rumball, F., & Happé, F. (2019). Neglected causes of post-traumatic stress disorder.
García-Vera, M. P., & Sanz, J. (2015). Psychopathological consequences of terrorism: the prevalence of post-traumatic stress disorder in victims of terrorist attacks. Fundamental rights and vulnerable groups. Sharjah, UAE: Bentham Science Publishers.
Gregory, J., de Lepinau, J., de Buyer, A., Delanoy, N., Mir, O., & Gaillard, R. (2019). The impact of the Paris terrorist attacks on the mental health of resident physicians. BMC psychiatry, 19(1), 79.
Westfall, N. C., & Nemeroff, C. B. (2018). Child Abuse and Neglect as Risk Factors for Post-Traumatic Stress Disorder. Post-Traumatic Stress Disorder, 443.
Question 1. What can Percy do to facilitate a more meaningful relationship with both the chairs and the administrators?
In any working environment, establishing an effective working relationship comes up with various benefits. Basically, work becomes enjoyable whenever people have a good working relationship. For instance, in case a health care organization desires to implement some changes, a good working relationship gives healthcare provider gives them the propensity of becoming creative and innovative. Furthermore, this in return gives each physician a freedom of enjoying the work they do (Brooker & Waugh, 2007). This takes into account the importance of limiting the energy and time wasted in handling problems related with negative relations.
As a result of that, the first thing that Percy needs to take into consideration is the dynamics of the culture of their institution. The reason for that is because the culture of their organization is one of the underappreciated forces that motivate a good working relationship with the chairs and administrators. Percy should also understand the fact that effective workplace will be one of the tipping point upon which various challenges are solved. Furthermore, understanding the culture of their healthcare organization will aid in increasing job satisfaction, loyalty, and more (Masters, 2005). In return, there is the need of boosting ones loyalty amongst each other to enable the chairs and the administrators to perceive a more sense of psychological value from him.
On the other hand, it is evident that each person on the relationship spectrum has the potential of contributing on the manner in which worker participation aid in shaping their healthcare working environment. Therefore, to build a good relationship between the chairs and administrators, Percy should take into account the fact that such a relationship is ultimately the end product of two fundamental factors. This takes into account the frequency at which they interact and communicate with their chairs and administrators and their relatedness. In so doing, there is the need of establishing effective trust between the two parties. The reason for that is because it is one of the foundations for every effective organization-employee relationship. Additionally, in order for Percy to trust his chairs and administrators, there is the need for forming a powerful and influential bond that will assist to communicate and work more effectively. This is to imply that each member ought to be honest and with each other regarding their actions and thoughts (Brooker & Waugh, 2007). This in return assists in minimizing energy and time wasted in watching your back.
Nonetheless, other than having mutual understanding of all that transpires within their healthcare organization regarding compensation, it is important for him to ensure that their management authority is aware of the efforts each employees dedicates towards the job assigned to do. This in return has the potential of enabling the department of surgery to be mindful in taking the responsibility of their actions and words. This is imperative because it will not allow their negative emotion and opinions to impact their workers (Masters, 2005). In so doing, it means that it will be easier to enhance effective communication with all workers regarding any issues that might arise. The reason for that is because a good relationship is one of the factors that greatly rely on individual honesty and openness to communication.
Question 2. Should faculty compensation be left to the individual department to determine? Who else might be able to assist with this process?
Yes. The guiding principle regarding employee compensation is based upon reward productivity to tighten the relationship that exists between compensation and work effort. When compensation is left within individual department to determine, it is easier to provide incentives for extra work done by each worker. As a result of that, it implies that transparency in employee compensation is greatly enhanced. Moreover, the same approach ought to be approved by individual department committee, for instance, representatives of each faculty (Fottler et al., 2010). The significance of that is that it brings about fairness in standardization of compensation amongst departments for all issues dealing with medical directorships and coverage compensation. Ideally, the reason for that is because it is obvious that each department has its own customized approach or plan that ensures that each person has adhered to their working principles that era approved by the medical compensation committee (Bashker, 2014).
Accordingly, it is evident that funds allocated for individual compensation is one of the issues that must be based on the approved compensation guidelines of the compensation committee. Ideally, the reason for that is because health care payment, as in the case of Percy is one of the largest sources of medical revenue to their department. Although taxation is also used for the purpose of fostering organization’s daily operations, it is important to include each department in determining the compensation components used (Dunham & Pinczuk, 2004). In the process of engaging each individual department and compensation committee in this exercise, it means that it will be easier to avoid conflicts of interest that might arise from each department. The significance of this is that it will give the workers an ample time to attain the goals of their faculty, minimize labor turnover, as well as increase workers’ motivation (Jones et al., 2012). This is in return assist in making a person not to start feeling devalued.
References
Bashker, D.B. (2014). Employee Benefits Design and Compensation (Collection). FT Press
Brooker, C., & Waugh, A. (2007). Foundations of Nursing Practice. Elsevier health Sciences.
Dunham-Taylor, J., & Pinczuk, J. (2004). Health care financial management for nurse managers: Merging the heart with the dollar. Sudbury, Mass: Jones and Bartlett Publishers.
Fottler, M. D., Khatri, N., & Savage, G. T. (2010). Strategic human resource management in health care. Bingley, UK: Emerald.
Jones, C., Finkler, S. A., & Kovner, C. T. (2012). Financial Management for Nurse Managers and Executives - E-Book.
Masters, K. (2005). Role development in professional nursing practice. Sudbury, Mass: Jones and Bartlett.
Pressure ulcer is a serious health problem that causes immobility, pain, and suffering, as well as high hospital costs to the elderly. A point to note is that the prevalence of pressure ulcers is high in adult yet preventing pressure ulcers remains a challenge. The National Pressure Ulcer Advisory Plan defines a pressure ulcer as an injury that is localized on skin because of friction. The formation of pressure ulcers occurs due to mechanical loading. The increased pressure results in tissue hypoperfusion, and tissue impairment. The magnitude of pressure and the pressure duration increased damage. Patients who are vulnerable to pressure ulcers are immobile patients who are found in geriatric clinics, retirement homes, home environments, and intensive care units. The main purpose of this paper is to focus on pressure ulcer prevention since this remains a big challenge. There is a disagreement concerning the preventability of pressure ulcers. Note that there is wide range of measures recommended for the prevention of pressure ulcers but there is no strong evidence that the recommended measures reduce pressure ulcers. There are two major methods of prevention; frequent manual repositioning and the active support surface. Repositioning means placing patients in a different body position after every 2 or 4 hours so that the pressure can be alleviated or redistributed. On the other hand, the active support surface is the use of pressure relieving devices such as mattresses that can shift pressure to other areas.
PICO QUESTION
Does alternating pressure support surface compared to patient repositioning prevent pressure ulcers in older adults?
PICO
Population- the elderly
Intervention-Patient repositioning
Comparison-active support surface/ pressure air mattress
Outcome-prevent pressure ulcers
Search history
In the literature review about preventing pressure ulcers, the PICO question which has four elements (population, intervention, comparison, and outcome) helped in searching the right sources. I used the EBSCO Research database and clicked article, and Scholarly Peer-Reviewed Journals with keywords: pressure ulcer, pressure ulcer prevention, patient repositioning, alternating pressure air mattress, and pressure ulcers in geriatrics. I also clicked the published date and selected sources, which were published between 2006-2019. I also selected detailed sources and after viewing the details, I selected 10 quality sources.
Scope and Significance of the problem
Pressure ulcer is a serious issue that has negative impacts on patients, and the healthcare system. Patients experience pain that restricts them from engaging in physical and social activities. Nursing homes suffer from financial costs, which increase because of prolonged hospitalization and severe cases that require more resources (Malbrain et al.2010). It is important to understand that health and social policies have created residential homes for older people, and these homes are either government-subsidized or private. They offer care and attention to older people. Research has found that older people in these facilities are likely to develop pressure ulcers due to factors such as immobility, being inactive, being in an unconscious state, among other factors (Malbrain et al.2010). These factors contribute to comorbidity conditions such as renal disorder, cardiac, and others, which increase pressure ulcers. In an acute care setting, the prevalence is 0 to 12% and in the critical care setting, the prevalence is 24.3% to 53.4%, whereas in an elderly care setting the prevalence is 1.9 to 59% (Ebi rt al.2019). These prevalence are influenced by factors such as friction, lack of positioning, prolonged hospitalization, among other factors. For example in Germany, 400,000 people suffer from pressure ulcers. The patients who suffer from pressure ulcers in geriatric clinics, retirement homes, and home environments are 10%, 30% and 20% respectfully (Pickenbrock et al.2017). A study conducted in Ethiopia reported that in all settings, the cost of treatment ranges from 2.65 € to 87.57€. Another study conducted in Germany reported that the cost of treating pressure ulcers is 50,000 (Pickenbrock et al.2017). For an individual patient to treat pressure ulcer in the U.S, he or she will spend over $17 billion (Peterson et al.2013). An important point to note that pressure ulcer does not only contribute to pain and suffering but it negatively impacts the economy given that in 2010, Netherlands spent 1% for the health budget. Besides, pressure ulcers contribute to morbidity mortality. The worse thing is that Medicare does not cover health expenses for stage 3 and 4 of pressure ulcers (Rich et al.2011). This is because, the clinical guidelines have several measures to prevent ulcers. The major recommendation is manual repositioning every 2 hours. However, this recommendation had not been effectively implemented in healthcare settings. Failure to adhere has been influenced by the argument that patients need active support surface. Focusing on the significance of the problem, nurses will benefit from this literature review by gaining knowledge of pressure ulcers and in specific on the areas of prevention.
Significant to nursing
The topic 'prevention of pressure ulcers' is significant to nurses in that nurses have a primary responsibility to monitor the skin of the patient to prevent the ulcers. Thus, they should know the condition, the risk factors, and prevention. Some studies show that in some healthcare settings, nurses have poor knowledge of pressure ulcers (Ebi et al, 2019). This is very dangerous give that pressure ulcers increase morbidity and mortality, and it has economic and social negative impacts. Thus, the literature review is designed to help the nurses improve pressure ulcer knowledge and minimize the risk. In the nursing home, it is the role and responsibility of nurses to conduct routine skin inspection and look for signs of pressure damage such as blisters, swelling, scratches, and others. They should ensure that patients have healthy skin by preventing skin damage using measures such as regular movement and support surface (Ebi et al, 2019). This review will help nurses learn the importance of changing the position after the recommended time or frequently. The literature view also talks about support surfaces and this is very important to nursing in that they will learn an alternative method of providing support and comfort such as bed mattresses or other products.
Personal connection to the problem
I am interested in the topic of pressure ulcers in that when I visit the older adults at the long-term care facilities, I find elderly hospitalized patients with pain and suffering due to pressure ulcers. I see families struggle with hospital bills since the treatment cost is very high. I also learn that the majority of the elderly suffer from pressure ulcers due to immobilization, advanced age, pressure, friction, among other factors (Demarré et al. 2013). In this literature review, I believe that hospitals should utilize this knowledge and implement alternating pressure surface to minimize tissue damage. I learn that the hospitals have been using patient repositioning but it also important to try support surfaces such as foam mattresses as they will redistribute the pressure. Pressure ulcers can indeed be avoided but healthcare professionals should increase knowledge, and more importantly come up with prevention programs to make a big difference in elder lives. I believe that older adults need interpersonal qualities such as caring about them, showing them care on time, giving them quality care, and being honesty and kind to them (Demarré et al. 2013). These qualities will help them develop social and psychological wellness.
Outline
Synthesis of Evidence
Pressure ulcer prevention using specialist support surface is evidenced by;
Pressure redistributing support systems prevent pressure ulcers by redistributing pressure.
Patient repositioning is a hazardous activity in that some critically ill patients have ventilator tubing, and intravenous lines and the movement may interfere with skin (Malbrain et al.2010)
It is difficult to reposition critically ill patients due to hemodynamic. Thus, the support surface will reduce the pressure ulcer risk through pressure redistribution (Black et al.2012).
Placing patients at the pressure-reducing mattress and turning them at unequal time intervals prevent pressure ulcers (Vanderwee et al.2007).
For-profit private residential care homes should improve care and reduce the occurrence of pressure ulcers by using prevention materials such as pressure-relieving mattresses, employ adequate manpower, and offer training for pressure ulcer prevention (Kwong et al.2016)
Low-Pressure air mattress prevents severe pressure ulcers (Kwong et al.2016).
Patient repositioning
Patient repositioning should be the standard of care. Repositioning should be done at every 2 hours or nurses should monitor intervals to minimize risk. (Peterson et al.2013)
Bedbound patients should be repositioned after every 2 hours (Rich et al. 2011
Nurse training
Nurses failure to prevent pressure ulcers due to lack of adequate knowledge and lack of pressure-relieving devices
Nurses need knowledge and pressure-relieving devices (Ebi et al.2019).
Placing support material is the best way to prevent pressure ulcers since the material such as the dynamic mattress will align the body parts (Pickenbrock et al.2017).
Improve the life of informal caregivers and hence prevent pressure ulcers
Eliminate factors that increase the levels of burden such as the lack of financial remuneration, and lack of experience (Rodrigues et al.2016).
Critique of Evidence
Malbrain et al.2010)
Small pilot study
Error reduction
Various research designs
Vanderwee et al. 2007
Randomized controlled trial
No bias (vanderwee)
Kwong et al.2016
Randomized controlled trial
Large sample size
Kwong et al. 2016
Evidence-based approach
Action research study
Rodrigues et a. 2016
Quantitative variables
Qualitative variables
Correctional analysis of variables
Multivariate techniques
Black et al. 2012
Small sample size
Failure to enroll in the sample size
Ebi et al.2019
Failure to complete the knowledge questionnaire
Participates did not follow instructions
Peterson et al.2013
Observational study
Long period (2007 to 2009)
Larger sample size
Demarré et al. 2013)
Randomized Controlled Trial
Use of pooled database
Rich et al, 2011
Lack of evidence to support frequent repositioning
Gaps in the Evidence
Black et al. 2012
Use larger samples to get reliable result
Ebi et al.2019
Be objective during the questionnaire
Ensure the questions focus on the topic
Avoid misleading question
Ask short questions
Rich et al, 201
Use a randomized controlled trial to compare groups and yield best results
Comparison to your Practice
The information from the article is similar to my practice
The prevalence of pressure ulcers is indeed high in long-term care facilities than in other facilities such as home care. Older people are a vulnerable population especially those in a long-term care facility.
I have evidence that elderly people who use support systems such as foam mattresses relieve pressure ulcers.
Repositioning is also used in nursing homes but I have seen challenges associated with how often to reposition and which position is the best
I look forward to understand the best alternating pressure mattresses between low-air loss mattresses and air-fluidized mattresses. This will help use the best mattresses in long-term care facilities.
However, regardless of the mattresses, the articles have agreed that pressure-redistributing mattresses reduce the risk of pressure ulcers
I highly agree that pressure ulcers can be prevented since I have seen people recovering by using support surfaces.
Conclusion
Studies indicate that pressure ulcer is a healthy issue and healthcare professionals need to use the right prevention strategy.
The repositioning has been the common method but current evidence report that repositioning is limited and therefore nursing homes should shift to support surface.
An alternating pressure air mattress is effective for a patient with pain on movement.
Note that some patients cannot be turned and therefore pressure reduction devices will cause a pressure reduction
References
Malbrain, M., Hendriks, B., Wijnands, P., Denie, D., Jans, A., Vanpellicom, J., & De Keulenaer,
(2010). A pilot randomised controlled trial comparing reactive air and active
alternating pressure mattresses in the prevention and treatment of pressure ulcers
among medical ICU patients. Journal of tissue viability, 19(1), 7-15.
Vanderwee, K., Grypdonck, M. H. F., De Bacquer, D., & Defloor, T. (2007). Effectiveness of
turning with unequal time intervals on the incidence of pressure ulcer lesions. Journal of
advanced nursing, 57(1), 59-68.
Kwong, E. W. Y., Lee, P. H., & Yeung, K. M. (2016). Study protocol of a cluster randomized
controlled trial evaluating the efficacy of a comprehensive pressure ulcer prevention
programme for private for-profit nursing homes. BMC geriatrics, 16(1), 20.
Kwong, E. W., Hung, M. S., & Woo, K. (2016). Improvement of pressure ulcer prevention care
in private for-profit residential care homes: an action research study. BMC
geriatrics, 16(1), 192.
Rodrigues, A. M., Ferreira, P. L., & Ferré‐Grau, C. (2016). Providing informal home care for
pressure ulcer patients: how it affects carers' quality of life and burden. Journal of
clinical nursing, 25(19-20), 3026-3035.
Black, J., Berke, C., & Urzendowski, G. (2012). Pressure ulcer incidence and progression in
critically ill subjects: influence of low air loss mattress versus a powered air pressure
redistribution mattress. Journal of Wound Ostomy & Continence Nursing, 39(3),
267-273.
Ebi, W. E., Hirko, G. F., & Mijena, D. A. (2019). Nurses’ knowledge to pressure ulcer
prevention in public hospitals in Wollega: a cross-sectional study design. BMC
nursing, 18(1), 20.
Pickenbrock, H., Ludwig, V. U., & Zapf, A. (2017). Support pressure distribution for positioning
in neutral versus conventional positioning in the prevention of decubitus ulcers: a pilot
study in healthy participants. BMC nursing, 16(1), 60.
Peterson, M. J., Gravenstein, N., Schwab, W. K., van Oostrom, J. H., & Caruso, L. J. (2013).
Patient repositioning and pressure ulcer risk-Monitoring interface pressures of at-risk
patients. Journal of Rehabilitation Research & Development, 50(4).
Rich, S. E., Margolis, D., Shardell, M., Hawkes, W. G., Miller, R. R., Amr, S., & Baumgarten,
(2011). Frequent manual repositioning and incidence of pressure ulcers among
bed‐bound elderly hip fracture patients. Wound Repair and Regeneration, 19(1),
10-18.
Demarré, L., Verhaeghe, S., Van Hecke, A., Grypdonck, M., Clays, E., Vanderwee, K., &
Beeckman, D. (2013). The effectiveness of three types of alternating pressure air
mattresses in the prevention of pressure ulcers in Belgian hospitals. Research in
What do you think is the greatest advantage and the greatest disadvantage of independent NP practice? Why do you think that?
The greatest advantage of NP independent practice or full practice authority is the provision of cost-effective, high-quality care (Hahn & Cook, 2018). I think so because when nurse practitioners are given full practice authority, they can advance their profession. They seek the market gaps and get access to nursing expertise, hence bring true innovation. Note that full practice authority means that all barriers are removed and therefore they can expand the scope of practice and meet the education and practice requirements (Hahn & Cook, 2018). Through engaging in education and training, NP can bring better care and better health and low cost. I believe the great advantage is having the ability to provide high-quality care to patients with chronic health issues (Hahn & Cook, 2018). NP are excited to innovate new ways for cost-effective care. They apply their clinical skills and knowledge to bring change in the healthcare industry.
Disadvantage
The great disadvantage of NP independent practice is the lack of a nurse-doctor relationship. I think so because the independent practice has created a professional boundary where there is no sharing of knowledge (Pritchard, 2017). Now, health care management has become a sole profession. I believe that health care management should be a partnership between a doctor and nurse but the practice of giving NP full potential has resulted in conflict in the doctor-nurse relationship (Pritchard, 2017). Even though the full practice authority allows nurses to explore creative pursuits, there is a big disadvantage in that nurse and doctor no longer work together. It seems like doctors have lost their medical authority and the power have been given to nurses and this raises the concerns of safety, and doctors' authority and power.
References
Hahn, J. A., & Cook, W. (2018). Lessons Learned from Nurse Practitioner Independent Practice:
I am personally interested in this topic because I am concerned with the lives of women who die due to unsafe abortions. Low-income women with unwanted pregnancies do not have access to safe abortions due to restrictive laws, high cost, third-party authorization, stigma, among other barriers. They engage in unsafe abortions, which lead to complications and death. Other people should be interested in this topic and support the legalization of abortion or support the elimination of legal obstacles so that women especially those from poor countries can access safe abortion and hence reduce the rate of maternal morbidity and mortality. The topic of legalization of abortion is important to a large group including women and the federal government. Women will benefit from abortion legalization in that they will have access to safe abortion and a reduction of maternal death. The government will also benefit in that it will have the power to control the unwanted birth though education and ultimately protect the lives of women. The paper argues that the government should allow women to end unwanted pregnancies and the legalization will save women's lives by preventing serious health complications because of unsafe abortion.
FIRST SECTION
Main argument
The government should protect women's right to choose abortion. The federal government at the legislative level should remove the financial and legal restrictions and provide women with access to abortion (Congressional Research Service, 14). The government should also provide women with adequate information on parenting skills. The government should target the sensitive population, that is; young and women from low-income countries and provide them with legalization access. It should also combine access and behavioral change. This means that the government should provide sexual education to reduce abortions (Congressional Research Service, 14). The main purpose of the federal government is to provide a National Abortion Care. This includes abortion services to women in poor and rural communities.
Logic response to abortion
Warriner & Shah (1) asserts that the government should legalize abortion to prevent unsafe abortions. First, it is important to understand that abortion is illegal. Therefore, women take a risk to commit abortion and finally, women, families, as well as society, bear the costs. Thus, it is logical to legalize abortion; that is, to help women move from unsafe abortion to safe abortion and this will improve their lives (Warriner & Shah, 3). For example, adolescents with unwanted pregnancies are likely to engage in unsafe abortion. Note that adolescents suffer from lack of financial resources and lack of knowledge about unsafe abortion and therefore they risk unsafe abortion and the consequences are infertility, among other complications that can affect their entire life (Warriner & Shah, 4). Thus, it is reasonable or practical to provide safe abortions rather than dealing with consequences that arise from unsafe abortion. It is the high time to eliminate unsafe abortions and its complications and hence eliminate mortality and morbidity. To see whether the legalization of abortion makes sense, the government should first understand that abortion is a health issue affecting women and youth worldwide. It is contributing to a high rate of mortality and morbidity. In global, about 210 million women become pregnant. Out of five women, one woman commits abortion. Out of 46 million abortions, 19 million abortions are unsafe (Warriner & Shah, 3). Developing countries such as Africa, South-East Asia, Europe, North America, and other countries commit a high rate of abortion. It is important to note that women commit unsafe abortion due to restrictions. The restrictions do not prevent women from committing abortion but they highly contribute to morbidity and mortality. Thus, it is reasonable to legalize abortion and make it safe.
The ethical response to abortion
Patil et al (545) applies the ethics of human rights and argues that women have the autonomy or right to choose. Another ethical principle is the right to life. Thus, abortion is morally justified in that women should have the right to have or not have children. Another ethical consideration is raising a malformed child. Some conditions such as congenital abnormalities such as neural tube defects, orofacial clefts, and others cause infant morbidity and mortality (Patil et al, 545). These abnormalities can be detected during pregnancy by the use of ultrasound. After the diagnosis, women may decide to continue or to terminate the pregnancy. On the ethical ground, it is important to consider factors like these to prevent the mother from raising a disabled child (Patil et al, 545). Thus, it is important to consider the ethical principles of autonomy and dignity and provide women with the right to chose.
Emotion response to abortion
Gerdts et al (401) argue that it is emotionally sound to legalize abortion in that women experience the burden of travel to seek an abortion and therefore the legalization will benefit them emotionally. It is important to understand that many countries have barriers to abortion such as waiting periods, poor clinical training, lack of trained providers, among other barriers such as geographical distance, lack of reimbursement, complicated approval practices, lack of confidential services and more (Gerdts et al, 402). Women who live in countries with such restrictions are forced to travel to other countries to seek abortion services. For example, in 2014, abortion cases for non-residents in the UK were 5521 (Gerdts et al, 401). This is an indication that women face abortion barriers and opt to travel abroad. When these women plan to travel abroad, they encounter other barriers such as lack of family support, lack of travel cost, race, and class challenges, among other barriers. Thus, it is emotionally sound to legalize abortion so that women access a safe abortion in their own country rather than traveling abroad. Note that these women suffer emotionally in that they need travel costs and time off work (Gerdts et al, 401). Moreover, they are mentally affected by the length of stay, traveling alone, and the cost of accommodation. Thus, the government should consider these factors and eliminate the barriers to safe abortion.
SECOND SECTION
Opposing side
Logic response
Adamek (27) states that legal abortion is associated with long-term adverse effects. One hundred and eight studies of induced abortion reported that abortion increases breast cancer. The other 2 studies reported the same. Out of the total 110 studies, only 29 studies lacked a link. In January 1973, the U.S Supreme Court legalized abortion. Between 1980 and 1998, the total cases of breast cancer were 40%. This happed after the legalization of abortion (Adamek, 27). In 1973, women aged below 40 were vulnerable to breast cancer but today, the aged ranges from 20 to 59. Abortion also is associated with psychological effects. In 1987 and 2000, a study was conducted and findings showed that women who committed abortion committed suicide (Adamek, 32). Another national sample found that women who committed abortion developed alcohol abuse behaviors.
Ethical responses
According to deontological ethics, God is the source of life and human being does not have the authority to end life. Thus, abortion is a sinful act because it goes against the law of the universe. Almost all religions including Christianity, Hinduism, and Buddhism condemn abortion (Stefan, 932). According to deontological ethics, it is evident that when a woman becomes pregnant, she should take care of the child. Here, women do not have a choice but she has a responsibility as commanded by the law of nature. Thus, women should do the right action, which is adhering to the rules. She should act as the moral agent and do the moral duties as commanded by the rational nature.
Emotional response
Rosett et al (506) argue that abortion contributes to psychological distress such as depression, suicidal attempts, self-mutilation, and others. Psychological distress occurs because abortion is a traumatic experience. After the traumatic event, women are likely to develop posttraumatic stress disorder (PTSD). A study conducted in 2004 showed that 15% of women developed PTSD after abortion (Rousset, 507). After the abortion process, women lack social support, experience financial difficulties, pressure from a partner, feeling of shame, are some of the risk factors that contribute to PTSD. Therefore, abortion should be illegal to save women from developing PSTD.
THIRD SECTION
Fatal flaws of arguments against abortion
REBUTTAL 1
The big problem in the first argument against about abortion is that there are no studies to support that abortion increases the risk of breast cancer. Some pro-choice activists justify the illegality of abortion with distorting facts. Some health professionals such as David A. Grimes do not accept the facts. David A. Grimes says that those who are for abortion and breast cancer are non-physicians who lack knowledge (Adamek, 27). There is no link between breast cancer and abortion and several professional organizations such as the National Cancer Institute, Royal College of Obstetricians, World Health Organization, and others have disproved the claim.
REBUTTAL 2
The big problem in the second argument about abortion is that the arguments have an unproven rationally claim (Stefan, 932). It is easier to refute on this claim in that atheists and scientists might provide testable evidence and intersubjective verifiability to prove the claim wrong. The assumption relies on faith, which is revelatory and is derived from direct experiences. The faith is far from logical demonstration-relies on terms of premises and a true conclusion. In general, the argument has no neutral ground yet critics can provide evidence to unproven the claim.
REBUTTAL 3
The big problem in the third argument about abortion is that the argument lacks empirical data to link abortion with psychological distress (Rousset, 507). This argument is questionable in that how can a woman make a clear decision to terminate the pregnancy and later experience emotional harm. Instead, women who make sound decisions about the abortion gains an enhancing experience. However, women can develop emotional distress due to factors such as pressure to have abortion, mental health condition, among other factors. Thus, future research should show evidence of post-abortion syndrome. In the future, it is important to conduct a qualitative study to understand how medical and surgical abortion contributed to PTSD.
Conclusion
The research paper has changed my opinion on the topic. First, I once thought that only irresponsible women seek an abortion. I have learned that all women regardless of age, education, religion, and marital status can seek an abortion. Second, I once thought that all women with unwanted pregnancies who seek an abortion get relief. However, I have learned that not all women feel relieved. Some women do not make their own decision but they are forced by circumstances such as fetal abnormalities. These women prefer to terminate their pregnancy to avoid giving birth to an abnormal child. Such factors may influence women to developmental distress since it was not their wish to end the pregnancy but they were forced by conditions. Third, I once thought that when abortion is made illegal or forbidden by law, women would fear from engaging from unprotected sexual activities to reduce the risk of facing the law. However, I have learned that illegal abortion increases the rate of abortion, especially in low-income countries. I have also learned that abortion should be made legal so that women can have access to a safe abortion procedure.
During the research, I found that the aborting topic needs in-depth research to understand it more deeply. If I would get an opportunity to continue with research, I would like to expand the topic and include questions like; should the numbers of abortions be reduced? This question is important as it helps the government come up with other effective measures to prevent unwanted pregnancy. The second question is; should there be for-profit abortion clinics to expand the structure of health-care delivery? This question is important, as it will help understand whether there should be professional collaboration and allow women to access health care anywhere anytime.
Work cited
Adamek, Raymond J. “Legal Abortion Threatens Health and Fertility: Why Aren’t Women
Informed?” Human Life Review, vol. 43, no. 4, Fall 2017, pp. 27–37. EBSCOhost,
The nursing services over the years have undergone a series of advancements with the introduction of evidence-based practice, which was made possible by research. Besides, nursing theories have formed the foundation for the development of nursing interventions that are effective, safe to the clients. This paper will discuss the meaning of nursing according to my understanding, factors that influenced my philosophy, concepts of nursing metaparadigm, and the theories that align with my thinking.
Meaning of nursing
Nursing is a complex and yet so easy profession, and I believe that it is mainly driven by the act of compassion, care, and addressing the needs of individuals seeking health services. Besides, it is all about helping individuals in attending their daily needs, whether they are sick or not, and in such a way, they gain strength to perform their duties themselves. In my career as a nurse, one thing I learned is that nursing cannot have its clear meaning without the act of compassion and having a caring heart for the patient. Therefore, to me, it involves the act of being there for someone who needs you the most.
However, to provide these services, the application of the knowledge, skills, and evidence-based practice is key in the delivery of quality and patient-centered care. The profession also has its challenges, such as dealing with ethical dilemmas, angry patients, people from different cultures, and ages, which then makes it an interesting career where you can learn, develop and understand individuals even more. Therefore, nursing, to me, is a profession where you learn and deliver services every day with love, care, and compassion.
Factors that Influenced my Nursing Philosophy
My interest in being a nurse started when I was still young, but it was significantly contributed by my grandfather, who worked as a counselor. One thing I loved about him was the love, care, and compassion he had while attending some of his clients. He was dedicated, and sometimes he could take me to visit his friend who had an accident, and his leg was amputated. During this period, we could meet with his friend’s caregiver dressing the wound, and I could help in passing some of the tools she used to clean it. At times, she gave me a stethoscope and taught me how to listen to a heartbeat, and since then, my love for the profession grew.
Apart from that, I become a member of a first aid team when I joined a school where I was able to interact with a group of people. One of the things that motivated me all through was the “thank you” that people told me whenever I helped them. I was also encouraged by my friends, parents, sibling, and especially my grandfather, who even called me his doctor. Therefore, my passion and the love for nursing developed from the people around me. It is something that I loved since I was young and established itself, even more, when I joined the school.
Throughout my journey as a nurse, I have worked in various places, including attending the needs of individuals with severe and persistent mental illnesses in the community and those with complex care necessities with significant social barriers. I also worked together with an interdisciplinary committee in managing cases and providing teachings on the management of medication. Currently, I work in the emergency room, where I attend patients with diverse needs. The nursing profession is the best career that has suited well with my interest in working with patients and families in addressing challenges they face first-hand.
Philosophical Thoughts on the Four Concepts in Nursing’s Metaparadigm
The nursing metaparadigm has four concepts, which include the environment, health, person, and nursing. These are four elements that cannot be separated in the delivery of the care services because the cause and effect are in one place. Nursing, as I described above, is an issue of care and compassion, and therefore, the four concepts in the metaparadigm are inseparable when it comes to it.
The person, in this case, is the individuals seeking health services not necessarily because they are sick, and it includes individuals or group that matters to the patient. Therefore, the care structure of the individual is considered based on their social, health, and spiritual needs. The premise is to empower the individual to manage his/her health with self-preservation and dignity with positive personal connections (McEwen & Wills, 2017). On the other hand, I believe health is the ability of an individual to carry out activities of daily living without aid and their access to it. The health and wellness of an individual covers their genetic makeup and lifespan and how they are integrated with social, emotional, physical, and spiritual well-being in their health for better benefits. Thus, it describes a balance in the life realms in human beings.
The environment is another important factor that has an impact on the outcome of a patient because of its effects on the physical, psychological, social, and spiritual needs. This focuses on the surroundings of the patient with both external and internal influences. I believe the environment in which the patient is offered the care service has an impact on their health and well-being. This is because human beings are social beings, and the way we interact with family, friends, and other individuals affects the way we think, feel, and react, which then has an impact on health (McEwen & Wills, 2017). Therefore, adjustments of the environmental factors to suit the patient improves their health status.
Besides, nursing is also a crucial component because of its aim to ensure the patient is complete, independent, or whole. This is achieved through the establishment of mutual relationships in a safe and caring environment. In this case, the application of the principles of knowledge, skills, communication, professional judgment, and collaboration is crucial in performing nursing roles to promote better health outcomes. The nursing metaparadigm has elements that cannot be separated from the healthcare provider because it has an impact on the outcome and well-being of each individual receiving care services.
Nursing Theory
The theory that aligns with what I believe nursing is all about is the need theory developed by Virginia Henderson to indicate the unique focus of nursing of practice. This theory emphasizes the enhancement of the independence of a patient to promote quick recovery in a health facility (Gonzalo, 2014). Besides, it offers measures that can be employed by the nursing personnel to address the basic needs of a client. However, the theory assumes that each patient desires to come back to his/her good health, nurses provide care to patients until they can care for themselves, and are willing to serve day and night.
Furthermore, the theory has 14 components that demonstrate an approach that can be employed by nurses to ensure that they offer effective and efficient care services to the individuals. These are in the four categories, which include social, psychological, physiological, and spiritual needs.
Some of the physiological components include:
Eat and drink adequately
Select appropriate clothing
Breathe normally
Maintaining body temperature within a reasonable range through adjustment of both the environment and clothing
Sleep and rest
The psychological aspects include:
Communications with other individuals in conveying opinions, emotions, fear, or needs.
Discover, learn, and satisfy the interest that results in health and normal growth and use of the available hospitals.
Social needs
Working in a manner that establishes a sense of achievement
Participation in various kinds of activities.
Spiritual and moral needs
A person worships according to his/her faith.
Furthermore, I identify with nursing theorists such as Florence Nightingale, Jean Watson, Hildegard Peplau, and Orem because of their recognition of community health in their work. Another theorist whom I closely relate to my philosophy with is Ann Boykin and Savina O. Schoenhofer, who formed the theory of nursing as caring (Alligood, 2017). The main focus of this theory is the discipline of knowledge and professional practices, nurturing the individual living, and enhancement in caring. Based on the two theories, when nursing is viewed as a profession that is determined in addressing the needs of the patient through the application of the informed decision and evidenced-based practices in caring, then the goals set have a high probability of being achieved. It is also worth to note that every human being requires care services at some point in time, and therefore, the foundation of the profession that is built upon the aspect of care and addressing the needs of individuals is likely to have better outcomes. Besides, theories that focus on the elements of addressing the needs of the patient, care, and compassion are formulated from these two models used as the basis.
Conclusion
In conclusion, the nursing profession is a unique one that is determined to make a change in the society in three ways, which I strongly believe are care, compassion, and addressing the needs of individuals, sick or not. In this career, some of the factors that influenced me into it are the interest I developed when I was young and the individuals who were around me who believed in what I was doing. Apart from that, I think that the four concepts in the nursing metaparadigm are the core components for care delivery, and they are inseparable because each has an impact on the health outcome of the patient.
References
Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book. Elsevier Health Sciences.
Gonzalo, A. (2014). Virginia Henderson: Need Theory Study Guide Retrieved 27 November 2019, from https://nurseslabs.com/virginia-hendersons-need-theory/
Marchuk, A. (2014). A personal nursing philosophy in practice. Journal of neonatal nursing, 20(6), 266-273.
McEwen, M., & Wills, E. M. (2017). Theoretical basis for nursing. Lippincott Williams & Wilkins.
With respect to the Health Insurance Probability and Accountability Act (HIPAA), employees and their employees are eligible to access healthcare services under the health insurance coverage. According to Califf & Muhlbaier (2003), the act outline that a physician has the responsibility to maintain discretion about the patient’s health unless the patient request otherwise. Since the pilot visited for a regular checkup, the role of the physician is to create awareness about his health condition, advise him about health management and treatment and let him decide on whether he will continue to work until he retires. The physician should not report about the condition because the airline had not requested the pilot’s health checkup, which implies that he has no obligation to inform the airline.
A proper treatment plan is vital since a murmur can best be managed with medicine as well as making all the necessary lifestyle changes. The main concern is that it is not clear how long the patient has lived with the condition. However, with proper treatment, this can help in disabling the symptoms and allowing the pilot to go on with his work for a month before he retires. Despite the fact that he serves a delicate role that involves flying hundreds of patients on board, he does not work alone. There is always a co-pilot on board to assist and other staff, such as engineers and a medical team, which means that the passengers would be safe. A murmur being a manageable health condition implies that with proper treatment, the patient can make conscious decisions about his job. Reporting to the airline would jeopardize his retirement benefits, which are unethical since treatment can be useful in slowing its overall growth.
Adults can remain healthy for a long time after being diagnosed with a murmur since the condition is not severe when it is well managed. The medical treatment provides almost immediate recovery, and it is apparent that the doctor should recommend an appropriate and comprehensive treatment to relieve the patient from the symptoms of the heart condition and enable him to work efficiently. The doctor should, therefore, act in a professional manner, which means protecting the privacy of the patient and promoting autonomy. The patient has the right to decide without the interference of the physician or any other person (Abdalrahman et al., 2015). In addition, he has the capacity to make decisions about his health and work as he has an independent mind that is capable of personal reflection. The physician should, therefore, respect the decision that the patient makes irrespective of whether it aligns with his personal beliefs.
In summary, the physician owes the patient a duty of care, which includes protecting his health information if the patient does not want it to be disclosed. Besides, the airline has no contract with the physician, which eliminates the need to report to it about the health of the pilot. As an individual with the mental capacity to make the decision, the physician should only inform the patient about his health as well as the treatment and management plan that he needs to adapt to control the symptoms better and allow him to make the decision. Reporting to the airline about the patient’s health status is a violation of confidentiality.
References
Abdalrahman, I. B., Osman, A. M. A., Ali, B. M. A., Mustafa, E. I. E. S. M., Ali, E. E. H., & Muneer, M. S. E. (2015). Autonomy and confidentiality: patients’ perspectives. Tropical doctor, 45(2), 79-83.
Califf, R. M., & Muhlbaier, L. H. (2003). Health Insurance Portability and Accountability Act (HIPAA) Must There Be a Trade-Off Between Privacy and Quality of Health Care, or Can We Advance Both?. Circulation, 108(8), 915-918.
Medicinal cannabis has brought a lot of controversies concerning its legalization in the United States because it is still considered illegal by the federal government. However, it has been legalized in Washington, DC, along with 29 other states. Besides, the National Institute of Health indicates that it has been in use for over 3000 years for medicinal purposes, with 85% of American people supporting its call for legalization.
Thesis statement
This paper will provide an argument on why medicinal marijuana needs to be legalized.
Body
It helps in relieving chronic pain and reduction of alcohol and substance addiction
In studies that have been conducted on its effectiveness in relieve of pain, the findings indicated that it was.
A study also should that use of marijuana helped individuals struggling with alcohol and drug addiction to fight it
Therefore, medicinal cannabis is more beneficial; thus, it should be legalized.
Management of cancer
Research indicated that oral cannabinoids or smoked cannabis are effective in managing the side effects of chemotherapy in cancer patients
Cannabinoids have been found to slow down growth and eliminate some types of cancer
It thus helps in addressing some of the conditions that other medications have not been proved effective. Therefore it should be legalized.
Regular and daily usage can result in mental illnesses
Research studies have indicated that daily and regular use of cannabis predisposes individuals to complications of bipolar disorder.
Other evidence has found a link with regular marijuana use with increased experiences of suicidal thoughts
Although there is evidence to link marijuana use with mental illness, it is connected mainly with regular use but not the one which is under control and dosage as medicinal cannabis. Therefore, it should be legalized.
Conclusion
In conclusion, medicinal marijuana has many benefits than risks. Besides, its complications are linked with regular and daily use, which is not commonly the case with the ones for medicinal purposes. Therefore, it should be legalized to help patients with health challenges to address their issues and live a better life.
It is true that homeless children face devastating experiences that negatively affect their health and well-being. In 2009, The National Centre on Family Homelessness found that in the U.S., one child in every 50 children is homeless. The U.S Department of Housing and Urban Development also finds that children become homelessness because their families lack affordable housing, lack access to resources, lack access to quality health, unemployment, among other factors (Guarino & Bassuk, 2010). Another important point to understand about homelessness children is that they suffer from traumatic stress, which is triggered by domestic violence, physical and sexual abuse, lack of sense of security, poverty, among other factors. The traumatic experiences affect children's growth and development and most of them experience language disabilities, speech delays, delays in motor skills, personal growth, among other areas (Guarino & Bassuk, 2010). They also become vulnerable to both acute and chronic illnesses such as asthma and neurological deficits respectively.
Homelessness is a serious issue that needs to be dealt with in order to save children from depression, anxiety, and other emotional and behavioral problems. I think that in addition to community outreach which should be done by community volunteers, clinicians, and childcare workers should work with homeless families to identify the needs, solve the traumatic stress, and implement strategies to eliminate homelessness (Guarino & Bassuk, 2010). I think that apart from providing the homeless children with services and resources, it would be better if the childcare providers are educated about the traumatic stress so that they can help children who have come across multiple traumas to manage past traumas. Thus, I propose a trauma-based response to help the children manage feelings and situations. Secondly, after ensuring that children are able to manage the traumatic situation, service providers should create a safe environment where children gains emotional safety. The service provider should now conduct child assessment to identify the needs of children and create referral networks so that the children can receive care and intensive services (Guarino & Bassuk, 2010). Finally, service providers should promote relationships and strengthen attachments between children and their parents.
Reference
Guarino, K., & Bassuk, E. (2010). Working with families experiencing homelessness:
Understanding trauma and its impact. Zero to Three, 30(3), 11.
Cosmetic surgery is a surgical procedure to improve body imperfections. A point to note is that body imperfections may occur due to factors such as aging, illness, congenital, among other factors. Both teens and adults are uncomfortable with their body imperfections or deformities since they affect their self-confidence and social acceptance. Thus, they desire to alter their appearance to look young and beautiful, and more importantly, improve their self-esteem. Cosmetic surgery is a debatable issue in that some people argue that it is less significant and it increases risks of serious diseases. Others argue that cosmetic surgery increases beauty, increase confidence levels, and increase physical attractiveness. The purpose of this paper is to address this issue and conclude whether people should undergo cosmetic surgery or not. After conducting comprehensive research, my point of view is that cosmetic surgery harms mental well-being and it is unhealthy. It increases the risk of Body dysmorphic disorder, Venous Thromboembolism (VTE), and the practice is not evidence-based. Thus, people should not undergo cosmetic surgery in that after the procedure, people develop a feeling of dissatisfaction and inadequacy. Thus, people should improve self-image and appeal to others through self-love and self- acceptance
Body Dysmorphic Disorder (BDD)
The first argument against cosmetic surgery is that people who undergo cosmetic surgery suffer from BDD – they feel that some parts of their bodies are flawed. According to the American Society of Plastic Surgeons, 50% of patients who undergo cosmetic surgery suffer from BDD and undergo 'surgery revision' (Newell, 318). This is because modern societies have constructed cultural norms that value physical appearance and therefore both adults and young teens want to fit in such a society by undergoing facial reconstruction. It is important to note that the majority undergo cosmetic surgery to increase their self-esteem, improve body imperfection, and reduce social anxiety, among other reasons (Newell, 316). However, these people are not aware of the disorders associated with cosmetic surgery. For example, BDD is a psychiatric disorder or a condition where a patient detects physical defects. Patients develop obsessive thoughts and ritualistic compulsory behaviors, which motivate them to think about their appearance. After undergoing cosmetic surgery, they believe that they must repeat a surgical intervention to correct their defects. The worst thing is that after repeating the surgery, only fewer than 10% gain satisfaction (Newell, 318). This means that the majority does not gain relief and therefore they continue to repeat the procedure and hence become plastic surgery addicts. Many physician-authored articles recommend that surgeons should not operate patients with plastic surgery addiction. However, plastic surgeons do not follow this recommendation but they continue to perform the procedures (Newell, 318). Therefore, cosmetic surgery is bad in that it gives unrealistic expectations. This is because, when a patient undergoes surgery, he or she expects to achieve a transformation but on the contrary, the surgery does not eliminate bodily flaws. What happens is that rather than achieving one's desire, people develop addiction and request for revisions. In general, cosmetic surgery does not solve the problem but it becomes a habitual practice, which leads to other health problems.
Evidence-based and cosmetic surgery
The second argument against cosmetic surgery is based on evidence-based practice. Ahuja (14) asserts that plastic surgeons do not conduct trials and therefore they apply their wisdom, confidence, and skills, to perform the surgery. There are many surgical techniques in the area of cosmetic surgery but these techniques have not undergone peer evaluation. Therefore, in many cases, the surgical techniques cause unsatisfactory results. Surgeons who engage in unethical practices are subjected to lawsuits and eventually destroy their image (Ahuja, 15). For example, an independent plastic surgeon who qualifies to perform brachial plexus repairs will go beyond to perform perforator flap without adequate knowledge. Another situation is when a surgeon qualified for hand and neck goes beyond to perform myocutaneous flap. These are some of the ethical dilemmas where surgeons go-ahead to perform procedures without evidence-based knowledge. This means that in cosmetic surgery, surgeons do not apply moral principles but they use their choices and values. In other words, their practices are not evidence-based (Ahuja, 15). Note that the evidence-base approach requires the clinicians to conduct systematic research and use clinical evidence and meet the patients' interests.
Venous thromboembolism
The third argument against cosmetic surgery is based on venous thromboembolism (VTE). Venous thromboembolism causes morbidity and mortality among plastic surgery patients. In a hospital setting, 33,000 plastic surgery patients die due to deep venous thrombosis and pulmonary embolism annually (Mlodinow et al. 191). During a cosmetic surgery procedure, anesthesia increases the risk of VTE. For example, one study reported that 10, 0000 facelifts resulted in 0.35% and 0.14% DVT and PE respectively. Also, patients undergoing body contouring are at risk of developing VTE. In 2005-2011, 48, 634 patients who underwent mastectomy and breast reconstruction developed VTE. This means that patients undergoing cosmetic surgery are given anesthesia, which contributes to venous thromboembolism (Mlodinow et al. 191). It is also important to note that the duration of anesthesia is a factor to put into consideration. Thus, more time under anesthesia increases the risks of VTE. Another important point is that venous thromboembolism creates a financial burden not only to patients but also to the healthcare system and the plastic surgery centers (Mlodinow et al. 191). Therefore, cosmetic surgery is associated with side effects in that apart from detecting some defects and sense of dissatisfaction, patients are likely to develop VTE.
Cosmetic Surgery in teenager
Dr. Gabrielele Caswell asserts that surgeons should not perform cosmetic surgery on children unless for psychological reasons. At the age of 13 to 19, teenagers are influenced by the social and cultural environment to do things that are out of control (Kuldeep, 57). For example, they want to conform to the cultural norms of having a good physical look yet they ignore the associated adverse effects such as medical problems. They undergo surgical procedures such as breast reduction, otoplasty, among other procedures to improve satisfaction. However, teenagers do not realize the risks and they are not psychologically prepared for the procedures (Kuldeep, 57). Teenagers should understand that breast argumentation should be done due to congenital defects. For example, some patients have tuberous breast deformities that cause breast constriction, and other congenital abnormalities that may require surgical operation. However, teenagers who seek cosmetic surgery due to aesthetic reasons should not receive the procedure (Kuldeep, 58). Surgeons should ask for informed consent from parents, and they should provide training on the risks such as bleeding, wrinkling of the skin, implant leakage, breast sensation, among other risks.
Lack of enough knowledge
The fifth argument against cosmetic surgery is based on a lack of enough knowledge. Alharbi et al (227) find that medical practitioner lacks enough knowledge of plastic surgery. They perceive it as a medical specialty and thus they include burn surgery, craniofacial surgery, hand surgery, breast reconstruction, and others in reconstructive procedures. The truth is that healthcare providers do not have the knowledge of plastic surgery but they perform plastic and reconstructive procedures. During a cross-sectional study to assess the perceptions of healthcare providers about the plastic surgery, the health care providers said that disorders such as burn deformities, breast reduction, electrical burns, Botox, abdominoplasty, among others require cosmetic surgery (Alharbi et al. 227). The conclusion was that healthcare providers do not have knowledge about the discipline yet they perform the procedure. This means that misconception and lack of knowledge may result in adverse effects on the patients.
BBE News opinion on cosmetic surgery
BBC News provides a point of view on cosmetic surgery and Tom Shakespeare states that in 2002 and 2003, 10, 7000 cosmetic surgery were performed by the British Association of Aesthetic Plastic Surgeons. After 10 years, the surgeons performed 50,000 cosmetic surgeries. According to the South Korean survey, women at the age of late 20s and early 20s go for cosmetic surgery to look young and beautiful (BBC, 1) Note that today cultural norms judge women on their appearance and therefore they struggle to conform to the cultural norms. However, Tom Shakespeare argues that people may look different from cultural expectations but the difference will not hinder society from seeing you attractive. What makes society accept you is not appearance but it is personality. For example, the disabled people who are happier with their flawed bodies or minor defects are attractive to non-disabled people. People who are dissatisfied with their body appearance prefer to go for a surgical fix. However, 10% of people who prefer surgical fix suffer from Body dysmorphic disorder (BDD) or a condition where people feed dissatisfied because the surgery did not solve their problem (BBC, 1). Since cosmetic surgery brings both psychological and health issues, Tom Shakespeare gives an opinion that people should solve their body imperfection with psychological and cultural procedures but not surgical procedures. The society should create a culture that accepts all body types such as young and old, big and skinny, among others so that all people can have body satisfaction.
Conclusion
Cosmetic surgery is a surgical procedure aimed at improving physical appearance, well-being, beauty, among other benefits. However, patients and surgeons ignore the adverse effects associated with cosmetic surgery such as psychiatrist disorders, unrealistic expectations, risks of multiple cosmetic procedures, and other potential complications. Patients should understand that some health care providers who perform the procedures lack enough knowledge and they end up messing one's life. The field of cosmetic surgery also lacks outcome assessment, in other words, there is little attention to the outcome, and therefore the procedure rarely benefits the clients. In most cases, patients develop Body dysmorphic disorder, which increases addiction to plastic surgery. Therefore, before engaging in the procedure, surgeons should consider the patients' attitudes, expectations, and the history of a psychiatric condition, among other factors. To change the physical appearance, people should not struggle to conform to cultural norms. Rather, people should break the norms and develop unconditional love. Self-love and self-acceptance are the most important factors that can change one's life and help one develop a positive look.
Work cited
Mlodinow, Alexei S., et al. “Increased Anaesthesia Duration Increases VenouscThromboembolism Risk in
Plastic Surgery: A 6-Year Analysis of over 19,000 Cases Using the NSQIP Dataset.” Journal of
Plastic Surgery & Hand Surgery, vol. 49, no. 4, Aug. 2015, pp. 191–197. EBSCOhost,
doi:10.3109/2000656X.2014.981267.
Ahuja, Rajeev B. “Ethical Practice of Evidence-Based Medicine: A Review for Plastic
Surgeons.” Indian Journal of Plastic Surgery, vol. 46, no. 1, Jan. 2013, pp. 11–
EBSCOhost, doi:10.4103/0970-0358.113701.
Newell, BrittanyL. “Informed Consent for Plastic Surgery.” Journal of Legal Medicine, vol. 32,
3, July 2011, pp. 315–335. EBSCOhost, doi:10.1080/01947648.2011.600171.
Kuldeep Singh. “Cosmetic Surgery in Teenagers: To Do or Not to Do.” Journal of Cutaneous &
A psychological assessment is a thorough and comprehensive evaluation of individuals seeking health services on their mental, emotional, and physical health as well as how they perceive themselves and their capability to interact and work well in the community. The evaluation process requires expertise, which then makes it necessary to performed by a professional to enable them to gain more understanding about the condition of the patient and will allow them to determine their present and future behavior (Waugh et al., 2017). It is one of the crucial processes in health care because of its abilities to enable the health care team to develop an individualized care plan that will provide instruction on how the client will be managed, including all actions that are required. The whole process is carried out by the use of question and answer strategy in which the client is expected to provide honest answers. However, questions that clients are asked depends on the conditions/state of the patient during the visit to the health facility (Waugh et al., 2017). The information provided by the client is usually gathered by the therapist and later used to develop a health care plan that will be used to manage the patient. This paper will discuss all processes from the assessment of the patient to the development of the treatment plan.
Part 1: Intake
Eliza is an 18-year-old female student and a Caucasian client who studies at the City University. During the first session, the therapist offered her intake form to fill. Unfortunately, the client was not willing to offer complete info, which could be used to come up with an effective treatment care strategy. However, from the little information she provided, she claimed to have low self-esteem with experiences of anxiety and stress. Furthermore, she disclosed that the relationship between her and her mother, working as a secretary in the elementary school, was good. She further indicates that her treatment process was not voluntary.
Since the information provided was little, the therapist asked her to fill a cross-cutting measure (CCM) 1. This was to ensure that the psychological assessment process was complete. The responses provided by the client in cross-cutting measure 1 would function as a screening tool, and that would aid the provider later in facilitating the identification of symptom-specific diagnosis (Black & Grant, 2014). The completed CCM-1 shows she had experienced mild anxiety, which then required her to fill PROMIS Diagnostic and Statistical Manual of Mental Disorders fifth edition Level 2-Anxiety for an adult.
However, to facilitate a complete assessment, the health provider needed the parents of the client, both Burt, and Joan, to help in filling the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders fifth edition –Informant Form (PID-5-IRF)-Adult. Due to the fact that the patient was not willing to provide enough info that was crucial together with the not observing to attend to the treatment on free will, the therapist believes that her parents will play a significant role in facilitating understanding precisely. Besides, she was experiencing challenges in school.
At the end of the assessment process, the health provider will be able to determine the clients manifesting concerns. Further, after identifying the problem, a collaborative approach will be used by both the client and the therapist to come up with goals that can be attained and then consider it in developing a treatment care plan that is effective (Waugh et al., 2017). The client, together with the counselor, will also be able to discuss and identify various possible interventions and later choose the most appropriate and effective one to implement. Also, the assessment will provide methods that can be used to evaluate the effectiveness of the strategy utilized, which then will provide feedback that facilitate decision making concerning the care.
Part 2: Biopsychological Assessment
Eliza is an 18year-old female student and Caucasian client from City University who was referred to the facility to look for health services. This occurred after she was caught on her campus, dormitory consuming alcohol. However, the client denied the claims that she was intoxicated. According to her, she was drinking alcohol because her friends were also doing the same; thus, she never saw it as something substantial or something that required attention.
Moreover, she indicated her school as a life-stressor. Also, she states that she assumed college would not have a lot of work as it is, which is different from her form of high school. The client now reports that the college work has overwhelmed her and also admits that she has challenges putting up with it. From this, it is clear that transitioning from high school to college was problematic for the client. Besides, the social aspect that is present in college affects her and has the possibility of influencing greatly on her life than the way she admits herself.
Additionally, the client also believes that she has a valuable social relationship and feels like the friends she associates with taking advantage of her. The client also states that she misses her high school friends. It is necessary to note that the client might be lacking the essential support systems, which might make her current condition more complicated for her or challenging to withstand. Besides, the consumption of alcohol, in this case, it is not a crucial factor. This is because the client admitted that she took them because her friends were also doing the same. Thus, it was a case to fit in the group. Furthermore, the fact that the client was ok with her friends' behavior, and the way they influenced her to consume alcohol indicates that she needed to have friends.
Eliza also indicated her life experience in high school, which she depicts as an easy one. In this case, the current situation can be associated with the desire to have friends, together with low self-esteem. She also admits being a participant in an internet game, which might indicate that she is an addict of internet service. Besides, she also reveals her poor social relationship between her and her parents, which she also indicates that she is overwhelmed at home because she is the only child that contributed to it. The client also confirms that there is little association with the parents, which is about once a week. On the other hand, she denied the use of alcohol and substance abuse. She also refuses any suicidal thoughts in the past or currently. However, she admits that she had experimented with marijuana, which she did not like.
Diagnosis
Based on the information offered by Eliza, together with those obtained from the assessment symptoms, some of the possible conditions that the client could be ailing from are a depressive, avoidant personality, mild gambling, and adjustment disorders.
Initial Treatment Goal
The first primary aim of the treatment process was to support the client in relieving symptoms of anxiety and also to reduce or to help her control her gambling ideations
Treatment Plan
Cognitive Behavior Therapy
CBT can play a significant role in the management of adjustment disorder and depressive disorders. The main aim of the therapy is to reduce symptoms of the condition and to help the client view her current school as non-stressor. This kind of treatment will enable her to keep a record, for example, at the point when she feels anxious or when she thinks that her friends are taking advantage of her (Pilgrim, 2019). From this, the therapist will be able to review the records kept by the client, which will then enable them to come up with better approaches to address the situation.
Psychotherapy
In this type, the client will be taught coping skills to help them manage stress and also practical social skills that will enable her to make friends more easily. It is one of the therapies that have both short and long-term benefits because it focuses on addressing the immediate challenges that are faced by the individual (Pilgrim, 2019). This can include avoidance of personal relationship challenges and stressful situations.
Group Therapies
Group therapy involves bringing together individuals with similar conditions. This will promote a better understanding and will also bring a sense of belonging. Besides, it facilitates the sharing of information among individuals (Pilgrim, 2019). This type will help her id addressing the gambling ideation and will also enhance her social skills. This can be done every week.
Family Counselling
This can be done twice monthly, and it can help in addressing the challenges she faces with her family. It will also act as an opportunity for the client to inform the parents about the problems she is facing during the adjustment process in the college. Besides, parents will also have a better understanding of the roles in the children's lives and growth.
Part 3: Treatment Planning
The info offered by the patient and the diagnosis will form the basis for the necessity of finishing the Diagnostic and Statistical Manual of Mental Disorders fifth edition Level 2 cross-cutting measure. This is due to the previous completion of the CCM-1. Besides, she will be required to complete CCM-2 regularly after certain intervals, such as a month to aid in monitoring her symptoms.
Furthermore, it will help in tracking the patient's depressive indicators to facilitate decision making concerning the treatment process. CCM-2 also aids in the assessment of the usefulness of Cognitive Behavioral Therapy. Patient Health Questionnaire (PHQ) can be utilized in the monitoring of the patient’s depressive indicators. The symptoms of the client will help in the identification of the severity of the condition. Moreover, PHQ can be used during intake as well as every session as it is useful because it seeks to find out from the patient the degree and frequency of the indicators. Furthermore, the provider can monitor the treatment process effectiveness through the use of the Hamilton Anxiety Rating Scale (HAM-A).
Part 4: Referral
The present condition of the client might create a need for referral. This is because of the unusual personality disorder and the patient's psychiatric comorbidity that may need more attention from a specialized nurse. The therapist will enlighten the patient on the need to refer her to more experienced and specialized and requesting her to complete the referral form. However, some of the things to consider include the reputation and availability of the necessary resources at the health facility that the patient will be sent to. After this, the therapist will advise the client to continue utilizing the available treatment methods to monitor the disease progression and effectiveness of the methods used to intervene.
References
Black, D. W., & Grant, J. E. (2014). DSM-5 guidebook: The essential companion to the Diagnostic and statistical manual of mental disorders, fifth edition
Pilgrim, D. (2019). Key concepts in mental health. SAGE Publications Limited.
Waugh, M. H., Hopwood, C. J., Krueger, R. F., Morey, L. C., Pincus, A. L., & Wright, A. G. (2017). Psychological assessment with the DSM–5 Alternative Model for Personality Disorders: Tradition and innovation. Professional Psychology: Research and Practice, 48(2), 79.
First, it is important to understand that motivation plays a significant role in healthcare and the health workers need to be motivated for them to increase performance and achieve organizational goals (Daneshkohan et al, 2015). It is also important to note that health workers are vital human resources and therefore the healthcare facility should ensure job satisfaction and motivation to retain workers, reduce the cost of recruiting and hiring, and ensure smooth operations. However, if an organization does not motivate its workers, the entire health system will be negatively affected since workers will leave jobs, there will be low productivity, the rate of absenteeism will be high, and customers will get poor services and hence damage the reputation of the health organization (Daneshkohan et al, 2015). Focusing on the case study, some factors that cause healthy workers demotivation at Kaluyu Memorial Hospital include;
Lack of effective communication
There is no communication between nurses and superiors. First, nurses have a negative attitude toward the management and therefore there is no coordination of services between nurses and superiors. It seems like managers are not accountable and responsible and this makes workers develop fear which hinders them from communicating. In general, the supervisors are unhelpful or they do not pay attention to workers' issues.
Lack of peer relationships
Lack of effective communication is not only between workers and between managers but some workers feel unsafe and decrease morale reason being some of their co-workers have taken a dominant role. Workers do not work as a team and there is no harmony. In meetings, some employees hold back whereas others have a personality and behaviors that discourage others to talk.
Poor management
Poor management is a demotivating factor at Kaluyu Memorial Hospital. There are no save and private spaces where working mothers can pump breast milk. The workers feel demotivated in that they pump in bathrooms and others lack a refrigerator to store the milk. The organization does not support workers, and the workplace is full of challenges. The hospital is also experiencing financial losses and this means that the frontline team has not defined the clear purpose of the organization, and it has not implemented strategic initiatives. Note that the poor management practices have demotivated workers and as a result, it has led to underperformance.
Lack of recognition and appreciation
Lack of recognition is a discouraging factor and this makes the workers develop a sense of unfairness. Note that nurses perform more tasks such as providing basic needs to the patients, administer medication, among other roles. However, they are not appreciated for the good work or they do not get the credit. Doctors are credited for the good work that nurses have done. This makes health workers lose morale, develop low self-esteem, and feel demotivated.
Potential negative impact of the demotivational factors
The above demotivational factors have negative impacts on some areas. For example, the lack of effective communication will affect the delivery of services in that health workers will not access critical information from superiors. Without communication, there is no exchange of communication, there is no flow of information, and as a result, there will be clinical discrepancies and medical errors (Thu et al, 2015).When there is lack of peer relationships, workers do not understand their duties and responsibilities, and they lack collaboration, and effective decisions. This will result in a lack of patients’ safety and medical errors due to lack of unity in solving problems and working toward a common goal. Poor management such as lack of effective communication, valuing employees, managing finance, and other roles will have a detrimental effect on the health care organization (Thu et al, 2015). Employees will leave the organization, the organization will increase human errors, poor management will lead to loss of medical devices, and all these will cause financial losses.
Question 2
Herzberg's model of motivation
According to Herzberg, employees increase performance if they are satisfied with the job and if there is no work dissatisfaction. Therefore, employees need satisfaction, and they need to stay away from dissatisfaction. The theory of motivation-hygiene states that employees need motivators such as self-development, flexibility, authority, and recognition for them to increase performance (Hur, 2018). They also need hygiene factors such as interpersonal relationships less conflict, good working conditions, and job security.
Herzberg's two-factor theory applies to the Kaluyu Memorial Hospital scenario in that from the case study, employees lack job security, interpersonal relationship; they lack effective communication and good management. According to the two-factor theory, the health care organization should consider hygiene factors and motivating factors. On motivating factors, hospital managers should change the structure of the hospital and create a new culture of recognition and appreciation, and employee growth and development (Hur, 2018). These motivators will encourage employees to work hard. On hygiene factors, the hospital should provide working mothers with safe and private places to pump breast milk. Managers should also provide workers with job security and increase supervision so that they can eliminate fear (Hur, 2018). There should be a working relationship between workers and superiors to prevent employees from being demotivated.
Question 3
Effective communication plays a significant role in the organization as it promotes an efficient team, promotes employees' health and safety, builds trust, and promotes a healthy workplace. Therefore, in the health care organization, health care workers should have open communication that promotes mutual interaction and help create a better work environment (Zvirbule, 2015). A communication system that will improve the situation at Kaluyu Memorial Hospital is an upward communication system. This system of communication will allow the flow of information from employees to superiors (Zvirbule, 2015). From the case study, employees are experiencing many challenges that need to be addressed by the top management. Therefore, in this situation, employees must express their grievances, give their views, and allow the management to make decisions. This system of communication can occur through meetings, complaints, grievances procedures, and other methods that will allow employees to express themselves (Zvirbule, 2015). This system of communication will change employees' behaviors and increase satisfaction in that through employees-managers interaction, employees will express their attitudes and emotions, and more importantly, they will develop a sense of belonging. Upward communication will also give managers the opportunity to communicate with employees the role of the organization, goals, values, organization interest and more (Zvirbule, 2015).I believe that the upward communication will place the organization in a better position since both employees and managers will engage in planning and development, promote harmony, and promote collective decisions. Both parties will have a mutual understanding and ultimately, the hospital will function effectively. Upward communication will also promote a personal relationship between superiors and workers and the relationship will hold the organization together, improve effectiveness, promote openness, and unity.
References
Zvirbule, L. (2015). Internal Communication as a Tool for Enhancing Employee Motivation:
Case Study of Roche Latvia.
Hur, Y. (2018). Testing Herzberg's Two-Factor Theory of Motivation in the Public Sector: Is it
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