Introduction

            Polycystic ovary syndrome (PCOS) is basically a disease that is medically proved to be a hormonal disorder that specifically affects the reproductive age of women. According to medical research, a large percentage of women suffering from this disorder have been noted to have prolonged and frequent menstrual periods that is at times accompanied by excess androgen (male hormone) levels (Akhter et al., 2018). As a result of that, it is possible for the ovaries to end up developing several small follicles (the collection of fluid) that in return makes them to fail to release eggs regularly. Although the exact cause of this disorder is not yet known, medical research suggests that it is important for women to ensure that they have received early diagnosis and treatment. On the other hand, the reason as to why this disorder have been realized to be affecting a large percent of women is because they fail to seek early diagnosis (Shanaki et al., 2018).

            According to the modern research, Polycystic ovary syndrome (PCOS) is ultimately linked with the continued development of other associated clinical conditions, for instance, diabetes, especially  type 2,  insulin resistance, heart complications, abnormal cholesterol level and blood pressure, and high cholesterol level. Currently, it has been realized at least 50 percent of the women suffering from this disorder end up developing type 2 diabetes before attaining the age of forty years or above. About percent of the women ovulatory fertility issues reported are associated with PCOS. Furthermore, the majority of the women who can conceive with this disorder have been noted to have a higher risk of suffering from gestational diabetes, miscarriage, preeclampsia, pregnancy-induced blood pressure, and premature delivery (Lee et al., 2018).

                                                            Causes

            According to the modern medical research, the exact cause of this disorder is not yet known. Regardless of that, there are various factors that have the potential of increasing the women chances of developing this disorder. These factors include;

1. a) Excess insulin level – insulin is a pancreatic hormone that that facilitates the utilization of sugar by cells so as to generate energy. In case a person’s cells end up becoming resistant to the hormonal action of insulin, his or her blood sugar level will rise. This in return will increase the chances of producing more insulin. As a result of that, the presence of the excess insulin will increase the production of androgen hence causing ovulation difficulties in a woman.
2. b) Low grade inflammation- clinically, this condition is associated with the production of a chemical that is aimed at fighting human infections by the white blood cells. Therefore, research suggests that the majority of the women suffering from polycystic ovary syndrome (PCOS) have low grade inflammation. It is this condition which has been noted to increase the production of ovaries which results to blood vessels and heart problems (Akhter et al., 2018).
3. c) Heredity – research indicates that family genes might be associated with the development of polycystic ovary syndrome (PCOS) in women.
4. d) Excess androgen – the excessive production of androgen have been noted to increase the chances of increasing androgen production lading to acne and hirsutism (Shanaki et al., 2018).

                                                            Complications

            The development of polycystic ovary syndrome (PCOS) is associated with various complications which include: premature birth or miscarriage, infertility, high blood pressure or gestational diabetes, and infertility. Other women have been found to develop nonalcoholic steatohapatitis which is a typically a severe inflammation of the liver that is caused by the excessive accumulation of fats in the liver.

            Furthermore, other than sleep apnea and abnormal uterine bleeding, other women also develop metabolic syndrome. According to medical research, metabolic syndrome refers to a various conditions that include uncontrolled blood sugar, triglyceride or abnormal fat level, and irregular blood pressure, that increase the risks of cardiovascular diseases in women. This condition is also associated with things like eating and anxiety disorders, and endometrial cancer (Lee et al., 2018).

                                                Tests and diagnosis

            According to the modern clinical research, there is no approved test can be utilized for the purpose of determining the presence or the development of polycystic ovary syndrome (PCOS). Regardless of that, it is possible for physicians to diagnose the cause of this condition through a person’s medical history. This is one of the physical examinations which include pelvic examination and blood tests that aid in measuring cholesterol, hormone, and glucose levels. Moreover, ultrasound is also another possible means of examining the nature of woman’s ovaries and uterus (Takasaki et al., 2018).

                                                            Treatment

            Due to the fact that the cure for PCOS has not yet been found, the approved treatment is aimed at managing the symptoms that affects the patient. The treatment to be administered by the physician will ultimately depend on the choices of the patient that is whether she desires to become pregnant so as to reduce the chances of developing secondary clinical complications, for instance diabetes and heart disease. Some of the recommended treatments include birth control pills to assist in regulating hormones and menstruation. Secondly, diabetes medication can also be used as a means of managing diabetes. Thirdly, fertility medication is also another method that can be used to reduce the chances of developing PCOS in case a women desires to conceive (Takasaki et al., 2018).

            Fertility treatment can also be approved a means of decreasing the symptoms associated with PCOS. This takes into consideration inseminations or in-vitro fertilization (IVF). Moreover, excess growth of hair might be reduced through the use of drugs. Propecia can equally be administered but not for women who wishes to become pregnant (Gupta et al., 2018). Other approved possible means for controlling the growth of air include electrolysis, mineral and vitamin use, hormonal treatment, or laser hair removal. Surgical treatment include oophorectomy (the removal of one or both ovaries), cyst aspiration (the removal of fluid from the cyst), hysterectomy (the removal of parts of the ovary or the whole of it), and ovarian drilling to reduce androgen levels (Shah & Bobade, 2018).

            Last, but not least, a number of home and personal lifestyle interventions have also been approved as another means of making huge differences as well as relieving some symptoms. These include eating healthy, including plenty vegetables and fruits and engaging in regular physical exercises. Moreover, managing or maintaining a healthy weight has been noted to have the potential of reducing the level of androgen as well as reducing the risk of developing diseases such as heart disease and diabetes. Smoking is also prohibited because it has the likelihood of increasing the levels of androgen production and heart disease (Gupta et al., 2018).

                                                Conclusion

            Since the causes of this disorder are unclear, it implies that it is possible for affected women to continue experiencing the negative effects of it throughout their life. Despite that, it is recommended that early diagnosis it the ultimate means to assist in relieving the symptoms associated with it as well as to reduce complications.

                                                            References

AKHTER, A., MUSHTAQ, R., KARIM, A., KHAWAJA, S., & AKRAM, A. (2018). Relationship of Infertility with Weight and Polycystic Ovarian Syndrome (Pcos) in Specific Female Population of Karachi, Pakistan. FUUAST Journal of Biology, 8(2), 293–297. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=133746705&site=eds-live

Gupta, V., Sharma, S., Raina, S., & Bedi, G. (2018). Clinical, ultrasonographic, and biochemical correlates of polycystic ovarian syndrome: A case–control study from a Tertiary Care Center in North India. Journal of the Scientific Society, 45(1), 8–12. https://doi.org/10.4103/jss.JSS_41_17

Lee, H. J., Bahr, J. M., Bitterman, P., Basu, S., Sharma, S., Abramowicz, J. S., & Barua, A. (2018). Polycystic Ovarian Condition May Be a Risk Factor for Ovarian Tumor Development in the Laying Hen Model of Spontaneous Ovarian Cancer. Journal of Immunology Research, 1–13. https://doi.org/10.1155/2018/2590910

Shah, D., & Bobade, S. (2018). Polycystic Ovarian Syndrome and Autism. Journal of Psychosocial Research, 13(2), 435–442. https://doi.org/10.32381/JPR.2018.13.02.18

Shanaki, M., Moradi, N., Fadaei, R., Zandieh, Z., Shabani, P., & Vatannejad, A. (2018). Lower circulating levels of CTRP12 and CTRP13 in polycystic ovarian syndrome: Irrespective of obesity. PLoS ONE, 13(12), 1–12. https://doi.org/10.1371/journal.pone.0208059

Takasaki, A., Tamura, I., Okada, H. M., Orita, T., Tanabe, M., Maruyama, S., & Morioka, H. (2018). Usefulness of intermittent clomiphene citrate treatment for women with polycystic ovarian syndrome that is resistant to standard clomiphene citrate treatment. Reproductive Medicine & Biology, 17(4), 454–458. https://doi.org/10.1002/rmb2.12219

Concept Analysis of Surgery

Naming of the concept

Identification and isolation of the concept

            A wide range of interventions are usually used to treat patients in the health care, one of it is surgical intervention.  Surgical interventions are usually employed in cases where it is necessary to improve the health of the patient and also facilitate recovery from other conditions.  Provision of high quality care is important to facilitate recovery from surgery and also to meet the needs of the patient (Perdue et al., 2018).  The practice of surgery has become common in healthcare and it can be done to serve different functions such as explorative, diagnostic and curative.

Dictionary and thesaurus definition

                According to by Merriam-Webster (2018), the term surgery is “a branch of medicine concerned with diseases and conditions requiring or amenable to operative or manual procedures”.  Surgery is further defined as the actual performance of procedures by surgeons.  The word surgery may describe a place where an individual trained in surgery practices or in British English as a physician or dentist office.  Additionally, surgery is a special period of time; during this time period constituents may visit their representative in British Parliament to seek consultation (by Merriam-Webster, 2018)

Critical attributes

            Concept analysis needs determination of the critical attributes of the characteristic that are mostly frequently associated with the concept and shows up on reference to it (Walker & Avant, 2011).  Based on this, the critical attributes that were identified for surgery are:

• Invasive in nature – all procedures even so-called non-invasive surgery enters tissue at some point and this entry remains invasive.
• Tissue damage- physical alteration in some form will always occur with surgery.
• Permission- some form of consent or approval will always occur. This permission may be provided from the individual, the family or caretaker in the instance of veterinary surgery.  Even in the instance of emergency surgery a two-provider consent is obtained therefore permission is always a requirement.

Background for the Concept

Literature Review

            The first recorded evidence of surgery was in the practice of cranial opening called trephining.  The practice was widely performed in the early ages and it proceeded to the middle age and later to renaissance (Castiglioni, 2018).  The practice of cranial opening was performed in Europe, South America and in Africa and it is not clear why it was done but it has been claimed to get rid of body spirits.  However, the origin of the practice is not certain.  The people of South America also practiced dental surgery where teeth which had cavities were filled with precious stones for the purpose of demonstrating ritual adherence in spiritual practice.  Additionally, bloodletting was also practiced in Egypt and ancient Greek with believe that it would treat variety of disease states (Lawrence, 2018).  Bloodletting was a form of surgery which tried to enter into the vascular system to facilitate removal of blood considered impure.         In the middle ages and renaissance, barbers and their cutting instruments were surgeons and would travel to perform minor surgeries which included extraction of teeth, treating injury and bloodletting.  Surgery was learned through observation and result with little ability to prevent sepsis or reduce pain.  Interestingly women often practiced surgery until 1700s when studies on surgery began to be offered at universities where women were excluded (Lawrence, 2018).  Andreas Vesalius is considered a founding father of modern surgery.  His focus on understanding human anatomy, through human dissection led to major advancements in the practice of surgery.  His observations recorded in De Humani Corporis Fabrica Libri Septem corrected many erroneous misconceptions held as far back as the Greek and Roman Empire (Lawrence, 2018).

            In the 16th century, Ambrose Pare influenced the development of surgery when he came up with rose oil, emollient of egg yolk and turpentine for gunshots which were better than cauterizing.  Ambrose developed the practice of legation of blood vessels to reducing blood loss during the practice of surgery.

            Not until the advent anesthesia in the late 1800s was it possible to perform complex internal surgery and amputation was the most advanced curative surgical procedure.  In 1865, Joseph Lister developed the concept of microorganisms causing pathology of sepsis and disease.  Lister as a result of his understanding of this this related concept then developed the concept of sterilization of instruments utilizing carbolic acid.  By the 20th century, the practice of asepsis and sterilization became standard practice and greatly advanced the practice of surgery (Castiglioni, 2018).

Concept with Antecedents, Cases, and Consequences

Antecedents

The concept of surgery antecedents are the presence of surgical instrument/equipment and some form of tissue disturbance.  Surgical instrument/equipment is needed to aid in performance of surgery as there is no realistic way to incise or open tissues without the aid of an instrument.  Some form of tissue disturbance must exist, it can be further categorized as one of the following disturbances 1.)  Injury (wound) 2.)  Pathology (disease) or 3.)  Psychological disturbance (desire to correct a perceived anomaly).  These two antecedents will always be present in order to initiate the concept of surgery.  Cosmetic surgical procedures repair a psychological desire for improvement and though there may be no pathology or injury, these surgeries are valuable to patient’s psychological health (Perdue et al., 2018).

Though there is a need to perform surgery in sterile conditions they are not always required in emergent situations.  The surgeon need not be present for the performance of surgery as there are instances of robotic surgery where an individual at a distance can perform the surgery without ever touching the patient.  Though surgery is often a complex act that often requires a specialist to perform them, there are some surgical procedures that are routine and can be completed by an assistant, so a surgeon is not necessarily an antecedent for the performance of all surgery.

The optimal success of surgery often requires collaboration and assistance; however, it can be completed individually by a sole provider.  The presence of the surgical room and surgical table are ideal, but they are not required to initiate surgery.  Typically, surgery is performed with an anesthetic, but some patient conditions do not require anesthesia where the individual has loss of neural function or when they may use mental hypnotic techniques that would negate the use of traditional anesthetics for the performance of surgery.  The antecedents to surgery is the presence of surgical instruments and the existence of some form of tissue disturbance requiring surgery.

Model case

James is a 24-year-old man who married recently and worked in a construction company as a supervisor.  During his normal routine at work, equipment fell, and he was hit on the head, which resulted in the development of a subdural hematoma.  He was brought to the hospital by ambulance and his condition worsened causing him to lose consciousness.  His pupils were fixed and dilated, and he developed neural posturing and his hemodynamics were deteriorating rapidly.  A neurosurgeon suspecting herniation signed an emergency consent and rushed him to the operating room to perform a decompressive evacuation of the hematoma.  Upon evacuation of the hematoma and clipping of the bleeding vessel, James’s vital signs almost immediately stabilized.  He was taken in critical but stable condition to the neuro intensive care unit where he recovered and was discharged three days later without neurological deficit.

Borderline case

Caroline is a 21-year-old college student went to a party she was invited to from someone she had met online.  While at the party she drank too much and was given some unknown substance, which caused her to lose consciousness.  She woke up in the morning in a bath of ice and noticed a bloody bandage with an incision into left flank.  She had been kidnapped and her left kidney had been taken from her body without her consent and sold on the black market.

Related case

            Ken is a 21 year-old male client who works in a construction company.  While he was at work, he fell from the stairs and injured her hand.  He had mild pain and that evening while he was going back home, he decided to buy some painkillers and took them before he went to sleep.  When he woke up the following morning, he had severe pain with the hand inflamed and decided to visit a doctor.  He was assessed and an x-rays was ordered.  They x-rays results came and there was a small fracture which did not require surgical intervention according to the doctor.  He was informed and advised to avoid using the hand and also to continue with the pain relief.  He was advised to visit the facility after two weeks for checkup.  Two weeks later he came to the facility and there was a significant improvement.

Contrary case

  Jane is a 28-year-old single mom living in El Paso with her five-year-old son.  She has a history of a fracture in the scapula and has come to the health facility due to severe pain on the area where the scapula had fracture.  An x-ray was requested, and it showed a new fracture different from the one before.  The client reports that she was hit by the door but did not think that was the cause.  There was a need for surgery, but the client stated that she does not want to go for the surgery, and she wants only pain killers to help her control the pain.  She could not see the potential harm of the crack, advice from the health care workers was given, but the client responded negatively.  She was given pain relief and she reported she was better on a scheduled visit that was set for follow-up.

Invented case

             Evan is a 26-year-old male who woke up one morning with a severe headache.  He described the pain as the worst headache he had ever had.  He asked his house to call a health drone, which arrived within 3 minutes.  The health drone scanned his body and discovered a cerebral aneurysm.  The drone issued Evan a pill, which he consented to swallow.  The pill contained nano-surgical robots that were absorbed under his tongue into the vascular system.  The nano-robots traveled to the bleeding vessel built a stent with nano-particles which bypassed the rupture and directly repaired the tissue it in a matter of 7 minutes.  The drone ordered medications that would prevent seizures and infections to be added to all house food orders for Evan for the following two days.  Evan went to work the next day and has recovered fully.

Consequences

            Consequences are the incidences that come up due of the occurrence of the concept.  The consequence of surgery includes post-surgical pain and tissue loss.  When postoperative pain occurs, it is always a result of the surgery.  Although regional blocks and pain medications may alleviate the pain, they wear off or sometimes cannot control the pain due to the disruption of pain receptors and cause pain persistence depending on the severity of pain that the client is experiencing.

All surgical procedures result in loss of body tissue, and in many instances, it can result in loss of a whole organ or portion of it.  There is always a loss of surrounding tissues, fat or blood from the surgical site even if an implant is placed such as a pacemaker or a breast implant there is loss of blood or in the instance of dental caries, tooth loss is caused by the surgery.  Maybe the most dramatic example of loss would be in the situation of an amputation of a part of the body or a limb.  Removal of a leg will also result in emotional trauma at the loss of a body part and the psychology of loss regarding the functional impairment.

Many surgeries in addition to tissue loss cause loss of freedom as patients are frequently hospitalized.  There may be interference with the daily routines and habits of the person during recovery.  Loss of companionship separating the individual from their family or pets members which may create anxiety and fear.  Even veterinary surgery will cause damage of tissue and very often the loss of privilege as they are often confined or have protective devices placed on them that cause a loss of freedom of movement.

Empirical referents

            Empirical referents are the class or even categories of real phenomena in which their existence demonstrates the concept occurrence (Walker & Avant, 2011).  The critical attributes of the surgery are not abstract, the concept is more concrete and has a physical healing aspect.  The phrase “cold blue steel heals” is an empirical referent to the critical attributes of the invasive nature opening a tissue with consent to physically alter that tissue for the purpose of betterment of the organism.

Interrelationships

Though surgical tools and the presence of tissue disturbances must exist to proceed with surgical interventions, they tie in directly to the healing power of direct physical intervention.  The empirical referent of “cold blue steel heals” occurs only after the patient has been informed and consented in some form.  Where that consent cannot be obtained directly, it is assumed that the individual would have wanted to be repaired rather than allowed to die.  The consequences of surgery are pain and tissue loss regardless of the critical attribute being addressed.  No matter the etiology; injury, pathology or psychological disturbance, healing is the ultimate goal is to improve the lives of all surgical patients.

Relevance to Nursing

Nurses play a crucial role in the delivery of care to all the patients who undergo surgery, and it helps in better understanding and in promotion of ways that facilitate the provision of high-quality care to the clients.  Understanding the consent process will prevent wrong-site surgical procedures and will empower nurses to advocate for patients who are unable to provide consent.  An understanding of the concept of surgery helps nurses develop nursing interventions that assist their surgical clients and result in better outcomes (Hardin & Kaplow, 2019).  The development of surgical patient care plans focused on evidence-based practices that improve surgical outcomes promotes holistic nursing care.  Surgical patients who receive necessary care improve pain management aid self-care.

References

by Merriam-Webster, D. (2018). America's most-trusted online dictionary.(2017). Merriam-webster. com.

Castiglioni, A. (2018). A history of medicine (Vol. 2). Routledge.

Hardin, S. R., & Kaplow, R. (Eds.). (2019). Cardiac surgery essentials for critical care nursing. Jones & Bartlett Publishers.

Lawrence, C. (Ed.). (2018). Medical theory, surgical practice: studies in the history of surgery (Vol. 9). Routledge.

Perdue, T. O., Schreier, A., Neil, J., Carels, R., & Swanson, M. (2018). A Concept Analysis of Disturbed Body Image in Bariatric Surgery Patients. International journal of nursing knowledge.

Rothrock, J. C. (2018). Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences.

Walker, L. O. (81). Avant. KC (2011). Strategies for theory construction in nursing. New Jersey: Pearson/Prentice Hall.

Anemia

Anemia is a hematologic disorder where the blood does not have enough healthy red blood cells. Anemia occurs when one experiences rapid bleeding that leads to sudden blood loss. Chronically, anemia occurs when one’s body does not produce enough hemoglobin to maintain the required level of red blood cells. Iron deficiency in the body is the most common cause of anemia.

Severe anemia causes symptoms such as pale appearance of the skin, shortness of breath and lack of energy. The tests to diagnose anemia are not complex. The amount of red blood cells in the blood are studied using a microscope lenses to asses if they are the likely to cause that condition, they have a characteristic appearance and it is easy to identify them. When the other components of the blood are assessed they will help come to a conclusion if the condition is dues to other serious causes such as bone marrow disease (Mayo clinic, n.d).

Treatment is different and may vary with age. In the elderly, there is no specific therapy for chronic anemia apart from to treat or manage the underlying disorder. Iron therapy does not benefit these people. Erythropoietin is helpful to some patients; the dosage is up to 50 to 100per kg three times a week but can be increased to 150U per kg per dose if the patient is not responding to the usual dose (Goodnough, & Schrier, n.d). However, erythropoietin has negative effects such as; it caused high blood pressure, fever, and swelling (Cleveland clinic, n.d). In children treatment depends on the specific cause of the child’s anemia. Treatment may include vitamin and mineral treatment, changing the diet of the child, blood transfusion to replace lost blood and stem cell transplant for cildren with sickle cell anemia (Dana-Faber & Boston Children, n.d). Stem cell transplant has severe effects on the child, effects such as; nausea, diarrhea, and mouth sores. It puts the child at a higher risk of getting infections since the child’s immune is suppressed by the therapy (Dana-Faber, 2018).

Conclusion

Anemia is a hematologic disorder that affects all genders and age. It is caused by low levels of red blood cells contained in the hemoglobin that are responsible for transporting oxygen. Symptoms of anemia include paleness of the skin and shortness of breath. In elderly patient’s anemia may be treated using erythropoietin which has negative effects such as causing high blood pressure. Treatment of anemia in children vary from the type of anemia. When treating sickle cell anemia using stem transplant the child is likely to experience negative effects such as diarrhea.

References

Cleveland clinic (n.d) Erythropoietin-Stimulating Agents. Retrieved from             https://my.clevelandclinic.org/health/drug/14573-erythropoietin-stimulating-agents

Dana-Faber & Boston Children (n.d). Anemia. Retrieved from;             https://www.danafarberbostonchildrens.org/condition/blood-disorders/anemia.aspx

Dana-Faber (2018). Stem Cell Transplant for Pediatric Patients: What to know. Retrieved from;             https://blog.dana-farber.org/insight/2018/01/stem-cell-transplants-pediatric-patients-          know/

Goodnough, T. S., & Schrier, L. S., (n.d) Evaluation and Management of Anemia in the Elderly. Retrieved from; https://www.ncbi.nlm.nih.gov/pmc/article/PMC4289144/#!p=6.19835

Mayo clinic (n.d). Anemia. Retrieved from; https://www.mayoclinic.org/diseases-            conditions/anemia/symptoms-causes/syc-20351360

 Nursing Informatics 

 Introduction

Executing a new EHR program or even substituting to a more innovative one can be one of the utmost disrupting expectable actions that can be practiced in a hospital, affecting almost every employee and work flow with the facility. Instantaneously after the execution, workflow disturbances that are formed by technologies like automated admission can give rise to a widespread range of inadvertent significances for example incompetent workarounds, disturbances in steadiness of care and other automatically rooted mistakes.  Eminence could also agonize because the health care workers might be confused by the unexpected changes in the manner in which test results are retrieved, consultation notes, prior admission or discharge documentation and the manner in which they document patient care.

Numerous concerns have in the past been raised in regard to EHR implementation and the way that the switching can unfavourably impact patient well-being and eminence in the few months after conversion. There are hospitals that have reported an amplification of death rates in the first several months after the new program was executed. The fear that the shift may principal to harm is also reasonable given that apparently less upsetting work flow fluctuations such as admittances on the weekend or new beginners in the hospital have a tendency of causing negative outcome on the patient for instance increased death rates.

Graduate QSEN Competencies in EHR Implementation

QSEN (Quality and Safety Education in Nursing) is a national movement that helps guide nurses to reshape the ‘reason’ and ‘manner’ that they convey nursing care so that they can safeguard high quality, benign care (Dolansky & Moore, 2013). The general objective of QSEN is to look into the challenge of formulating future nurses with the information, abilities and approaches that are essential to incessantly advance superiority and well-being of the health care structures that they work in. QSEN is a significant component when it comes to implementing a new EHR program because nurses need to be educated about the manner in which that they are supposed to take care of patients which includes even the administration of medicine at the right time and in the right quantity (Skiba, 2011).

There are five competencies that guide nurses in providing effecting patient care and they comprise; patient centred upkeep, cooperation and partnership, evidence based practice, prominence upgrading, well-being and informatics (Dolansky & Moore, 2013). The EHR program that will be developed will be designed in such a way that it is able to identify the patient as the foundation of control and also full partner in offering empathetic and corresponding care that is grounded on the respect of the favourite, standards and requirements of the patient. It will be capable of analysing multiple dimensions of patient centred upkeep which include the coordination and incorporation of care and also participation of close relations. The EHR program will take into considerations the social, political and economic dimensions of patient care processes and the implications that the patient centred care will have.

An effective EHR program is one that is able to assimilate philosophies of cooperation and actual communication with awareness of eminence and wellbeing capabilities. It should be easy to use for the patients, their family and also for the entire medical staff in order for it to be effective and to avoid any confusion (Dolansky & Moore, 2013). Before it is implemented in a hospital setting, the program will be analysed whereby, input from all team members will be assessed to help improve its performance. Doing this will empower contributions of other members of the society, and it plays a great role in helping patients achieve health goals.

Before any implementations of programs, it is important to have proper research conducted to understand the impacts that a programs would have on the health facility. Conducting research using correct research methods helps to understand the best techniques to use to implement the EHR program in a manner that makes it effective (Skiba, 2011).

The best EHR program is none that has the least negative impacts on the patient care and the overall work performance of the workers. When implementing the EHR program proper safety measures will be put in place so that in case of any errors with the program, it will be easy to correct them in good time to avoid more damage getting done. Families, patients and the health care team will always be alerted when an error occurs with the new system to ensure that the avoid making any erroneous inputs in the course of providing health care.

Security and Ethical consideration in implementation of the new EHR program

Ethical issues that are related to EHR confront health workers, when information on a patient is shared or connected without the knowledge of that patient; their independence is put in jeopardy.  This may lead the patients to keep some of the information to themselves because they lack self-confidence in the safety of the hospital structure keeping their personal data which may compromise their overall treatment (Papoutsi et al., 2015). In the past, thousands of patient’s health data have been risked through mistakes and others through theft. It is hence important for health workers as well as policy makers to come to an agreement on the best strategies to ensure that patient’s data is safe and medical care is ethically provided.

Privacy is an important concept when it comes to medical information. Patients have the right to keep their medical information private without having it disclosed to others. Information of a patient should only be disclosed to a third party only after permission has been granted by the patient or allowed by the law (Papoutsi et al., 2015). The new EHR program will be structured in such a manner that patient information is kept private and also safe. Only authorised individuals will have access to patient information for instance insurance and health care institutions. So the first stage in establishing the EHR program will be to establish the authorised users, which will be founded on pre-recognized role based freedoms. The manager will begin by identifying the user, determining the level of information that they will be answerable for, the usage and the misappropriation of the data that they look at. They will only have entrée to the data that they require to carry out their errands.

Security measures will also be put in place to ensure that there is no security breach that could threaten patient privacy. The EHR program will include safety actions including antivirus and intrusion detection software as well as firewalls, which will greatly help to protect data integrity. There are also policies and procedures that will be put in place to help maintain patient privacy and confidentiality. For one, employers will be expected not to share their ID with any person, to always use their ID as right of entry to the patient automated records and to always ensure that they log off when leaving a terminal. Security personnel will be selected by the institute to work with the group of health IT specialists.

There will always be regular random routine audits which will guarantee amenableness with the hospital procedure. All system doings will be trailed in the inspection trials and this take account of comprehensive listings of content, length and the operator, the audit will be able to generate day and time for all admissions and records for all alterations to EHR. In a case scenario where there is unsuitable admittance to a medical file, the system will be able to harvest data about the title of the individual gaining entree, the interval and time, the records retrieved and the period of the analysis. This is very important information when defining whether the entree was flawed or intentional unauthorised view.

Consideration to make in EHR Implementation

System operations of many EHR projects are always unsuccessful normally because they undervalue the prominence of one or more clinicians to attend as judgement frontrunners for workers in the clinic. It is significant that clinicians direct co-workers in understanding their functions in the execution and registering of their connection in undertaking as EHR assortment workflow design and worth enhancement (McAlearney et al., 2015). Clinical workers often have diminutive awareness of the clinic’s workflow and the functions that others play in provision of care. This unsighted predicament consequences in insufficient scheduling for positive execution without recognizing a consistent best exercise technique to do the task, every user ends up struggling.

When two schemes are joined, a boundary is formed, that is the border between the operator and the computer structure. These boundaries are important to the whole success of the application course (Houston-Raasikh, 2014). Boundary issues are the utmost system dangers because these let-downs can be imperceptible at the start. Lack of orderly deliberation of operators and errands, constantly consequence in poor boundaries, poorly calculated user boundary account for unintentional adverse result leading to lessened time proficiency, poor value of upkeep and augmented menace to patient safety. A boundary that is poorly calculated fails to convey the much needed eminence of care which clues to user displeasure (Houston-Raasikh, 2014). The defective user boundary which was minor at the beginning ends up increasing over time which ends up leading to EHR program abandonment.

Benefit of EHR for the organization

 A new EHR program in this case AdvancedMD, is effective and beneficial because it will allow the organization to advance workflow competence while it is being customizable and supple all at the same time. With the EHR program, it is easy for the organization to agenda schedules, manage dissolutions, and confirm insurance analysis, registrations and even assess transfer data completed in just one screen (McAlearney et al., 2015). It is easy to have activities computerized and appointment appeals for patients can effortlessly be accomplished through a portal designed for patients.

Doctors have the choice to design records in the manner in which they desire and they can use both speech and transcriptional tools which allows them to view patient records in the format that best suits them.  It is easy to configure patient charts according to the preference of the physician; it is easy for one to look at family history, allergies and other important details, all in one screen (McAlearney et al., 2015). Another important aspect of this HER program is that clinicians and the patients can easily be sent medical advice and reminders which ensures effective medical care. The users can issue digital prescriptions and have controlled substances monitored and prescriptions can also be signed and sent directly to the pharmacy which greatly enhances patient experience through this program (McAlearney et al., 2015).

References

Dolansky, M. A., & Moore, S. M. (2013). Quality and Safety Education for Nurses (QSEN):

The Key is Systems Thinking. Online Journal of Issues in Nursing, 18(3), 1–12. https://doi.org/10.3912/OJIN.Vol18No03Man01

Houston-Raasikh, C. (2014). What the Others Haven’t Told You: Lessons Learned To Avoid

Disputes and Risks in EHR Implementation. Nursing Economic$, 32(2), 101–103. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=95580667&site=ehost-live

McAlearney, A. S., Hefner, J. L., Sieck, C. J., & Huerta, T. R. (2015). The Journey through

Grief: Insights from a Qualitative Study of Electronic Health Record Implementation. Health Services Research, 50(2), 462–488. https://doi.org/10.1111/1475-6773.12227

Papoutsi, C., Reed, J. E., Marston, C., Lewis, R., Majeed, A., & Bell, D. (2015). Patient and

public views about the security and privacy of Electronic Health Records (EHRs) in the UK: results from a mixed methods study. BMC Medical Informatics & Decision Making, 15, 1–15. https://doi.org/10.1186/s12911-015-0202-2

Skiba, D. J. (2011). Informatics and the Learning Healthcare System. Nursing Education

Perspectives (National League for Nursing), 32(5), 334–336. https://doi.org/10.5480/1536-5026-32.5.334

Gleevec use in treating Chronic Myeloid Leukemia

Chronic myeloid leukemia (CML)

The Chronic myeloid leukemia (CML) is a category of cancer that begins in some specific cells of the bone marrow that form blood. It accounts for 15% of all leukemias in adults, and it is estimated to be about one case in every ten thousand cancer cases (Kujak & Kolesar, 2016).  Before the advent of Imatinib, the median survival of CML patients was approximately six years meaning that the estimated prevalence was approximately 25,00-30,000. This has however changed with the mortality rates decreasing to 2% annually (Kujak & Kolesar, 2016). In this type of cancer, a genetic change transpires in the immature types of myeloid cells that are responsible for making red blood cells, platelets and most of the white blood cells excluding for the lymphocytes. This alteration leads to the formation of abnormal gene that is known as BCR-ABL that results into the CML cell (Sausville, 2003).

The cells in with leukemia develop and divisions causing an accumulation in the bone marrow and hence a dripping into the blood system. The leukemia is defined to be acute contingent on whether the abnormal cells are developed or undeveloped. In the enduring leukemia, the cells mature partially but not wholly, meaning that the cells may seem like they are standard but they are not (Sausville, 2003). They are not able to battle infections and they tend to live longer and gather out standard cells in the bone marrow. The chronic myeloid leukemia (CML) is branded by unnecessary production and recurring cytogenetic irregularity that is commonly known as Philadelphia chromosome (Ph). This aberration results from a stable translocation amid chromosomes 9 and 22 which ferocities the peak point gathering area gene on chromosome 22 the ABL genetic factor on chromosome 9 (Kujak & Kolesar, 2016).

The risk factors for getting CML include older age where most of the people that are diagnosed are normally around 64 years, males are more prone to the disorder and radiation exposure for instance radiation therapy for other cancer types (Kujak & Kolesar, 2016). The leukemia is not genetic in nature meaning that the chromosome transmutation that clues to the leukemia cannot be passed down from the parents to the children.

Gleevec as a Treatment options for CML

Gleevec also scientifically known as Imatinib mesylate or STI-571 was the leading signal transduction inhibitor (STI) that was used in the scientific background. The drug is recently diagnosed adult and paediatric patients that suffer from PH+ CHL (Philadelphia chromosome positive chronic myeloid leukemia) when it is in the chronic stage (Druker, 2015). The drug is administered as a pill by mouth and it can be taken one time or two in a day liable on the concentration of the disorder and general general well-being of the person. In CML, the drug is given in 400 mg dosage per day  and it may increase after the failure of interferon alpha therapy where it is increased to the dosage of 600 mg per day in the absence of sever adverse drug reaction (Gleevec case study, 2004). The drug should be taken with meal and with lots of water whereby it can also be dispersed in water for the patients that have a problem with swallowing.

History and science of Gleevec

This was the leading STI (signal transduction inhibitor), which was utilized in a scientific background for the management of CML. The medication helps to prevent BCR-ABL protein from applying its function in the oncogenic trail in CML. Imatinib directly constrains the constitutive tyrosine kinase action (Deininger et al., 2009). It fixes to BCR-ABL kinase sphere by averting the transmission of a phosphate assembly to tyrosine on the protein substrate and the succeeding instigation of phosphorylated protein (Gleevec case study, 2004).  As a consequence, the diffusion of proliferative indications to the nucleus is congested and leukemic cell apoptosis is prompted.

Pharmacokinetics of Imatinib is branded by speedy and whole oval biohandiness and a comparative dose revelation association. There is no noteworthy interface of Imatinib with food consumption (Druker, 2015). Its station half-life is roughly 18 hours which permits for once a day quantity. The median top plasma focuses at fixed state of Imatinib directed orally one time every single day at 400 mg dosage and a median through intensities are 5.4 M and 1.43 M correspondingly.  Imatinib is usually processed by the cytochrome P450 system (Druker, 2015). The action of CYP enzyme hinders intrinsic inconsistency which could be the source of elevated inter-patient disproportion in Imatinib coverage. Drugs that are inhibitors or inductors of CYP3A4 isoenzymes have been revealed to modify Imatinib pharmacokinetic action.

Efficacy of Imatinib

Phase i trials

Stage 1 trial was started in the year 1998 and it joined up patients that agonized from CML in chronic point (CP) that were resilient to interferon alpha (IFN alpha) (Gleevec case study, 2004). Practically all patients whose conditions were managed using at least 300 mg Imatinib each day attained comprehensive haematological response (CHR). Major and complete cytogenetic response was acquired by thirty one percent and thirteen percent of the patients correspondingly. The reactions were robust, only two reversions out of the 53 patients was eminent after a trailing of about 263 days (Gleevec case study, 2004).

Phase ii trials

Three trials were instigated in the year 1999. The study populace comprised patients with CML in myeloid BC, reverted PH+ALL, CML in A, and patients who were resilient to IFN alpha. The outcomes attained in patients ailing from BC with myeloid phenotype principally established the outcomes gotten in phase 1 study (Peng et al., 2004). In dissimilarity to patients with myeloid type syndrome, none of the individuals treated for lymphoid blast crisis and for reverted PH+ALL had sturdy reaction to Imatinib. A reflective evaluation amid two dose units that is 400mg and 600 mg exhibited a meaningfully longer time to evolution and generally endurance for the 60 mg unit (Peng et al., 2004). Grounded on this research, the endorsed prescription for the patients in progressive phases of CML was fixed at 600mg every day.

Phase iii trials

A world-wide study equating Imatinib at a single daily prescription of 400 mg and IFN alpha plus cytarabine in recently detected patients with CML in CP was commenced in the year 2002. The outcomes of the study exhibited an exceptional efficiency of Imatinib and its advantage with deference to the charges of CHR, major cytogenetic response (MCyR) and complete cytogenetic response CCyR  (Hughes & Branford, 2006). At 18 months, the degree of CCyR in the patients treated with Imatinib was 76% as equalled to the patients treated with IFN alpha plus cytarabine. An inclusive survival ratio is 85% for patients getting Imatinib and it is actually 93% when only CML linked bereavements and those prior to stem cells transplantation are deliberated (Hughes & Branford, 2006).

Comparison between Imatinib and interferon alpha in treatment of CML

Studies that have been conducted comparing Imatinib and interferon alpha as treatments for CML show that Imatinib brings out much better results (Deininger et al., 2009, O’Brien et al, 2008).  Imatinib at 12 months has been associated with higher complete haematological response which is at the rate of 97% to 69%, in complete cytogenetic responses rates it is at the rates of 76% to 14%. And a rate of 87% to 35% in reference to major cytogenetic response Imatinib is associated with a 56% reduction in mortality as compared with interferon alpha in the overall (O’Brien et al, 2008).

One of the side effects of using Imatinib for MCL is that it causes myelosuppression which refers to a disorder in the bone marrow where activity is decreased leading to fewer blood cells, platelets and white blood cells (O’Brien et al, 2008). This can transpire at any interval in the course of Imatinib therapy but it is most common in the leading weeks of treatment. Other side effects that are noted with the use of Imatinib for MCL are nausea and occasional vomiting which are basically dose related and they are also mild (Hochhaus et al., 2009). These are effects that can be eluded in maximum number of the patients when Imatinib is administered with nutrients which do not modify the drugs pharmacokinetics. Diarrhoea is another common toxicity of Imatinib which is most likely caused by local irritant effects, it can however be controlled by anti-diarrheal medications (Hochhaus et al., 2009). Mild fluid retention and edema are also prevalent dose interrelated harmfulness of Imatinib that transpire in about fifty percent to seventy percent of the patients. This can be as a result of reserve of targets that are accountable for the reliability of vessels by Imatinib (Hochhaus et al., 2009).

Conclusion

The results that are obtained with Imatinib mesylate up to the current day are impressive.  Imatinib is a revolution not only for managing CML but also for aiding to comprehend how to improve directed therapies for management of many other menacing syndromes. Even though the therapy for CML is not yet realized by just obstructing the Bcr-Abl kinase, there is high likelihood that other drugs established from Imatinib will permit for testing of ground-breaking theories to finally support realization of this objective. Imatinib is likely to much more effective when used with other therapies and there is also a need for detailed research to determine the optimal treatment pathways.

References

Deininger M, O’Brien SG, Guilhot F, Goldman JM, Hochhaus A et al., (2009 ). International

Randomized Study of Interferon Vs STI571 (IRIS) 8-Year Follow up: Sustained Survival and Low Risk for Progression or Events in Patients with Newly Diagnosed Chronic Myeloid Leukemia in Chronic Phase (CML-CP) Treated with Imatinib. Blood. ASH Abstract: 1126.

Druker, B. (2015). A Better Way to Treat Cancer. Fortune, 172(5), 31–32. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=109948101&site=ehost-live

Gleevec case study. (2004). Gleevec Case Study: Benefits of Aggressive Pre-Launch

Marketing in an Immature Market, 1–15. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=17038516&site=ehost-live

Hochhaus A, O’Brien SG, Guilhot F, et al. (2009). Six year follow-up of patients receiving

imatinib for the first-line treatment of chronic myeloid leukemia. Leukemia;23(6):1054–1061. doi: 10.1038/leu.2009.38

 Hughes T, Branford S. (2006). Molecular monitoring of BCR-ABL as a guide to clinical

management in chronic myeloid leukaemia. Blood Rev.;20(1):29–41. doi: 10.1016/j.blre.01.008.

Kujak, C., & Kolesar, J. M. (2016). Treatment of chronic myelogenous leukemia. American

Journal of Health-System Pharmacy, 73(3), 113–120. https://doi.org/10.2146/ajhp140686

O’Brien SG, Guilhot F, Goldman JM, et al. (2008). International randomized study of

interferon versus STI571 (IRIS) 7-year follow-up: sustained survival, low rate of transformation and increased rate of major molecular response (MMR) in patients (pts) with newly diagnosed chronic myeloid leukemia in chronic phase (CML-CP) treated with Imatinib (IM) [abstract] Blood.;112(11):76. Abstract 186.

Peng B, Lloyd P, Schran H. (2005). Clinical pharmacokinetics of imatinib. Clin

            Pharmacokinet.;444:879–894. doi: 10.2165/00003088-200544090-00001.

Peng BM, Hayes M, Resta D, et al. (2004). Pharmacokinetics and pharmacodynamics of

imatinib in a phase I trial with chronic myeloid leukemia patients. J Clin Oncol.;22:935–942. doi: 10.1200/JCO.2004.03.050.

Sausville, E. A. (2003). Imatinib for chronic myelogenous leukaemia: a 9 or 24 carat gold

            standard? Lancet, 361(9367), 1400. https://doi.org/10.1016/S0140-6736(03)13145-5

Sexually Transmitted Infections

Strategies to educate and treat a patient with high risk behaviors for STI’s

                First, it is very important for the patient to understand the meaning of sexually transmitted infections. Explaining to the patient that they are infections transmitted through sexual contact, especially in unprotected sex is very vital (American College of Obstetricians and Gynecologists, 2017). Explain also the dangers of having STI to the patient. This will help him/her understand the conditions well. Teaching about various ways that the infections can be transmitted by a person who having the infection can be helpful for them to protect themselves from contracting or even transmitting to others.

            Providing information on the on the causes also improves the knowledge of the patient concerning the conditions. Teach the client on the viral and also bacterial causes. It is also necessary to teach the client about the risk factors for the infections and ways they can reduce their risk of getting (American College of Obstetricians and Gynecologists, 2017). This will help the patient be in a better place to protect himself/herself and avoid risk factors. Inform them about the most common sexually transmitted infection to improve the patient knowledge. Teach also the patient concerning the available treatment for the various STI’s.

 The pathophysiological process and the consequences of patients with untreated HIV

            In the case where a patient does not receive treatment. The condition progresses slowly and the defense mechanism of the individual is overpowered (Bhatti, Usman & Kandi, 2016). The condition mainly attacks the immune system, mainly the CD4 cells. As the immune system and defense mechanism overpowered, there is entry of opportunistic diseases and cancers, which is normally rare for a healthy individual (Bhatti, Usman & Kandi, 2016). HIV causes a decrease in the CD4 cell count in the peripheral blood causing decrease in activation of the humoral immune system together with the cell-mediated immunity. If no treatment is administered, depletion of the CD4 cells continues until the patients succumbs to AIDS. A test for this involves the use of a blood sample (American Academy of Pediatrics, 2019). This is usually done to determine the presence of the virus.

Barriers to African American LGBT men regarding HIV treatment.

            Most of the individuals are stigmatized. They are also discriminated which is also facilitated by homophobia. This actually affect whether they will seek or obtain quality health care service which includes being tested and also prevention services including getting treatment (Villarosa, 2017). Other individuals are not even aware of their HIV status which thus lowers their opportunity to take advantage of the available treatment.

            Lower socio-economic factors which affect access to quality health care and also access to better education on prevention, including the available treatment. The side effects of the medication also seems to be a challenge (Villarosa, 2017). Some individuals are not sure of the effectiveness of preventive drugs such as PrEP.

            There is also poor funding to facilitate the strategies which can be used to improve prevention and also testing. This thus lowers the number of individuals which could have benefited from the treatment because they are not aware if they have the condition (Villarosa, 2017). Limited resources by care providers with little knowledge on caring for those living with HIV also is a barrier to treatment. Others include poor literacy and mental disorders.

5 common STI’s and their treatments

Chlamydia

 Treatment involves use of antibiotics which can be given orally or as an injection. Treatment involves those who have been in sexual contact with the person.

Gonorrhea

Use of antibiotics, injectable and oral medications can be used in combination

Genital herpes

Antiviral drugs are used even though it does not cure but in an outbreak it can limit the severity and length of outbreak (Office of Communications, 2017). Suppressive therapy is also used to reduce transmission to the partners.

Human immunodeficiency virus infection

Suppressive therapy is available. There is no cure. Combinations of anti-retroviral drugs are given to control the virus and help in improving the immune system.

Syphilis

In early stages it can be treated with single injection of antibiotic. Avoidance of sexual contact is important until the sores are healed. In late stages longer treatment with antibiotics is necessary.

Clinician approach on sensitive matters

            Understanding the needs of the patients is always necessary. Assessment of the patient knowledge of the sensitive matters facilitates understanding the knowledge needs of the patient. Considering the patient choices and being understanding to the patient. It is also important for them to provide the best quality care while respecting all the needs of the patient.

References

American College of Obstetricians and Gynecologists. (2017, June) How to prevent STI’s.

American Academy of Pediatrics. (2019) Diagnostic Testing For Sexually Transmitted Infections. Retrieved from https://www.healthychildren.org/English/health-issues/conditions/sexually-transmitted/pages/Diagnostic-Testing-for-Sexually-Transmitted-Infections.aspx

Bhatti, A. B., Usman, M., & Kandi, V. (2016). Current scenario of HIV/AIDS, treatment options, and major challenges with compliance to antiretroviral therapy. Cureus, 8(3).

Office of Communications. (2017, January 31) Treatments for Specific Types of Sexually Transmitted Diseases and Sexually Transmitted Infections (STDs/STIs). Retrieved from https://www.nichd.nih.gov/health/topics/stds/conditioninfo/specific

Villarosa, L. (2017). America’s hidden HIV epidemic: Why do America’s Black gay and bisexual men have a higher HIV rate than any country in the world. New York Times Magazine, 6.

Workplace bullying for nurse in South Australia

Work place bullying is an overwhelming concern all over the world. The rate at which bullying occurs at the work place is very high and what makes it more sad is the fact that it is grossly underreported. Work place bullying can be described as a conflict that occurs between people working together and lasts for a long period. Bullying is any form of activities and practices that are focussed to one or more employees which are all undesirable for that person. These actions are normally conducted deliberately or instinctively but they cause disgrace, fault and anguish which affect job enactment and end up triggering an unfriendly working habitation for the targets.

There are many reasons why people get bullied, but what is intriguing is the reason as to why some people are more prone to bullying as compared to others. The social identity theory argues that in order for people to achieve positive self-image, they use the process of self-categorization. This is where they group themselves into two groups, there is the in or out group sets and people compare these groups thus upholding constructive personalities if they favour the in-set above the out-set (Haslam & Reicher, 2006). Nurses tend to have a large share of bullying which includes; physical violence, verbal abuse, sexual and racial harassment. During the last two decades in South Australia, nurse bullying has appeared to be a popular topic, most of which goes unreported due to awkwardness that the targets have to tolerate and also as a result of distress (Sauer & McCoy, 2018).

The nurses that experience bullying at the work place often tolerates many bodily and emotional challenges for example high tension, low self-worth, sleep disorders, nervousness and substantial decline in their work input (Hartina et al., 2018). The fact that nurses devote the prime time of their day at the hospitals working, it is definite that exposure to harassment conducts unfavourably distresses patients care and work execution (Vessey et al., 2009). The targets of work place emotional violence find social associations to be difficult both in and out of the work place. They also have a tendency to experience privation of backing in the work place since there is the attitude of non-disclosure that has been embraced by many nurses which shields the culprits (Sauer & McCoy, 2018).

All nurses are eligible to operating in a non-violent setting, without any occurrences of violence and they have the freedom to make their own choices.  Work place oppression disturbs patient outcome, upsurges work-related tension and aggravates turnover of employees (Hartina et al., 2018). In South Australia, the subject of work place harassment for nurses is getting more consideration, though there is a worry that the republic is till dragging at the back as compared to the other first world nations in regard to the issue. The threats for clinical faults are in elevation when the nurses have signs of post-traumatic tension syndrome as a consequence of mistreatment (Yildirim, 2009). This sources the medical care sector to significantly agonize because of a reduction in nursing efficiency and also the loss of capable nurses. Harassment for most of the nurses comes from their supervisors, which sources more hurt for the targets as likened to a bullying from a fellow staff affiliate because in this case the nurse does not have any one to report the violence to. One of the programs that help to ensure that nurses are safe at their work places in South Australia is the SafeWork SA program.

SafeWork SA Program

SafeWork SA is an Australian Government agency that was established in the year 2009. The program aims at helping ensure that the work place is healthier and safer for employees most especially in the health care sector (SafeWork SA, 2019). It helps to create a national consciousness of the scopes and significances of work related calamities and grievances and it endorses the aim of basic shield for all employees in conventionality with South Australian’s labour ethics. SafeWork SA jurisdiction falls under OHSA (occupation health, safety and welfare) legislation, as the government agency that plays a key role in addressing bullying in South Australia (SafeWork SA, 2019). This includes the investigation of the complaints of work place bullying through the use of its Occupation Health and Safety (OHS) inspectorate functions. The organization is normally subsidised by Commonwealth together with the national government and it has fifteen associates who collaborate with the agency employees to guarantee that purposes of the tactical and effective strategies are reached (SafeWork SA, 2019). The memberships include a sovereign chairperson, nine associates who from the commonwealth, two associates that characterize the comforts of workers, two others who characterize the wellbeing of the managers and lastly the chief executive officer (SafeWork SA, 2019). The associates come together at least three intervals every year to discuss matters relating to the program.

As a part of its everyday operations, SafeWork SA obtains grievances of workplace harassment, where it comportments inquiries of these problems in harmony with the necessities of OHSW Act of 1986 (Government of South Australia, 2019). This act allows SafeWork SA OHS examiners to denote workplace bullying grievances to the Industrial Relations Commissions (IRC) of South Australia for appeasement or arbitration where they have motive to trust that the problem can be resolved. SafeWork is able to arraign a proprietor or a worker for going against any of OHS provisions. SafeWork SA also provides education, support and information to employees, employers and the community in general on all aspects of work place bullying (Harris-Roxas et al., 2011).

SafeWork employs inspectors who are given the role of responding to and investigating bullying complaints. SafeWork SA contemplates that workplace harassment better handled through the looking at the breach that subsists amid the administration of Industrial Relations (IR) and OHS matters and that a more all-inclusive tactic to intimidation matters may be mandated (SafeWork SA, 2019). This is because, although oppression offers an OHS danger to the plaintiff’s emotional wellbeing, the assessment and inquiry of the grievance needs ability set dissimilar to those tangled in dealing with physical dangers. Bullying is an issue that falls on the side of IR because it focuses on human resource and the basic management of people. It is hence logical for bullying to be handled in a manner that involves objection measures that are more thoroughly associated with conduct management performances (Harris-Roxas et al., 2011). To be able to manage the complications in evaluating psychosocial threats, it is vital for inspectors dealing with harassment criticisms to have good working familiarity of the aspects that steered to and intensified the probability of intimidation in the work place.

SafeWork SA statistics of workplace bullying

Since the year 2006, the number of work place bullying files by the SafeWork SA has been steadily increasing. In the year 2011, the number of new files that were opened grew to 165 and it has continued to increase more so with most of the victims being nurses (Harris-Roxas et al., 2011). The sad fact about all this is that the statistics show that most of the work place bullying files rarely reach the stage of being considered for prosecution meaning that most of the bullying perpetrators continue to enjoy their freedom as they continue to conduct more actions of bullying. This is a consideration of the intricacies of dealing with harassment since it is habitually problematic to institute whether or not the supposed conducts founded workplace harassment or they were somewhat rational activities conducted by an employer (Harris-Roxas et al., 2011). Though trial mandates in respect to workplace harassment have been organized by the SafeWork SA in the past, there are no tribunals that have been followed in South Australia even in the current day.

SafeWork SA current acts

SafeWork SA administers the OHSW Act which regulates the prevention of bullying in workplaces in accordance with sections 19, which requires employers to always ensure that they provide their employees with a harmless working setting and this relates to all zones which comprise the worker’s mental wellbeing.  The other one is section 21, which necessitates a worker to take sensible caution to evade unfavourably upsetting the fitness or well-being of another individual over an act or oversight at work (Government of South Australia, 2019).  SafeWork SA offers elimination rations, which indicates that sensible directorial action engaged in a sensible way by a manager in relation to the engagement of a worker is not deliberated as impending within the scope of establishment. SafeWork SA permits for an inquiry procedure by an examiner to be steered once a grievance has been established (Harris-Roxas et al., 2011). And it also offers for the transfer of a grievance, if no resolution is made after sensible phases have been engaged by the two groups to the commission for deed within five days after the problem has been raised.

In section 55A, SafeWork SA definition of bullying as ‘inappropriate behaviour’ play a great impact on the manner in which bullying cases are handled. It acts as a support for defensive processes to be reputable in work residences as well as providing an intensified consciousness amid employers and workers of the concerns of unsuitable workplace conduct (Harris-Roxas et al., 2011). All the same, the usage of constitutional description of intimidation does not require a steady appraisal of the provision set that mistreatment is an emerging zone of regulation.

Education and support services provided by SafeWork SA

SafeWork SA has come up with a number of strategies to help provide education and sustenance in order to help avert and also counter workplace oppression. There is a help centre where SafeWork SA is able to receive and respond to enquiries or complaints from the members of the public in regard to work place bullying which can be done through telephone call, inscription or even face to face (SafeWork SA, 2019). SafeWork also offers information conferences on workplace harassment which are steered by their proficient employees to any organization that requests them to. SafeWork also has a website which features information on bullying and it includes practical guides for both the managers and workers on ways to prevent and deal with harassment cases at the work place (SafeWork SA, 2019). All this are effective strategies that can greatly help eradicate cases of bullying at the work place, most especially for nurses.

Conclusion 

SafeWork SA is effective in helping to show the negative impacts that bullying has on the society and the manner in which laws that have been put in place are ineffective because they fail to consider some important elements that contribute to increased bullying. SafeWork SA always expects workplace bullying policies and procedures to be developed and adhered to by the employers. It ensures that any policies that are developed are in consultation with the staff and that they include both the prevention and resolution strategies of work place bullying in order to help reduce bullying at the workplace. Some of the limitations that have been detected by SafeWork SA in regard to laws dealing with bullying are in relation to the measure of what truly constitutes systematic bullying behaviour. SafeWork SA implies that there is need for the definition of the term bullying at the work place to be broadened in order to be able to cover some isolated incidences that are not covered by the law. The law at the moment requires the bullying behaviour to be repeated and systematic in order to be considered as bullying and it hence does not encompass to those secluded and possibly severe occurrences. Most of the bullying cases that are not prosecuted in South Australia are all because they did not fall within the range of endowment and this includes cases where the alleged bullying situation was severe but it was not recurrent.

The arguments by SafeWork SA are reasonable and very true, in the case of bullying for nurses. There are nurses that experience violence at the work place once, for instance once could be raped while at the work place. This is an event that is not likely to happen again because they will always be cautious. It is however unfair that the victim does not get legal justice because it was a time incidence. This is likely to lead to more cases of violations for other nurses who will not bother to make a complaint because they are afraid that their case will not be heard all because it is a onetime incidence.

References

Duffy, A.L. (2004). Bullying in schools: A social identity perspective. Doctoral dissertation.

Nathan: Griffith University. Retrieved June 30, 2010, from http://www4.gu.edu.au:8080/adt-            root/uploads/approved/adt-QGU20070131.112422/public/02Whole.pdf

Government of South Australia (2011): The South Australian approach to Health in All

Policies: background and practical guide, Version 2. Adelaide: Government of South Australia;.

Harris-Roxas BF, Harris PJ, Harris E, Kemp LA. (2011): A rapid equity focused health

impact assessment of a policy implementation plan: An Australian case study and impact evaluation. Int J Equity Health, 10(6):1–12..

Haslam, S.A., & Reicher, S. (2006). Stressing the group: Social identity and the unfolding

dynamics of response to stress. Journal of Applied Psychology, 91(5), 1037−1052. http://dx.doi.org/10.1037/0021-9010.91.5.1037, PMid:16953766

Hodson, R., Roscigno, V.J., & Lopez, S.H. (2006). Chaos and the abuse of power: Workplace

bullying in organizational and interactional context. Work and Occupations, 33(4), 382−416. http://dx.doi.org/10.1177/0730888406292885

Hartina, P, Birks M & Lindsay D 2018, 'Bullying and the nursing profession in Australia: An

            integrative review of the literature', Collegian , Vol.25, no. 6, pp. 613-619. 

SafeWork SA. (2019, April 24). SafeWork SA. Retrieved from

            https://www.safework.sa.gov.au/

Sauer P A & McCoy T P 2018, 'Nurse Bullying and Intent to Leave,' Nursing Economics,

            September-October, Vol. 36, no. 5, pp. 219-245.

Vessey, J.A., DeMarco, R.F., Gaffney, D.A., & Budin, W.C. (2009). Bullying of staff

registered nurses in the workplace: a preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments. Journal of Professional Nursing, 25(5), pp. 299-306.  

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 Review56(4), pp. 504-511.

Trader Brian loss from gas future

Introduction

The Amaranth Hedge fund, headquartered in Greenwich, Connecticut, was founded by Nicholas Maonis in 2000, and it built a solid reputation within the hedge fund community due to its energy transactions, before the infamous scandal happened. After helping the fund make significant profits in gas after the major disruption suffered as a result of hurricanes Katrina and Rita in 2005. Amaranth’s head gas trader Brian Hunter made another bet in the following year another extremely leveraged bet on natural gas price moving higher. However, with natural gas supplies increasing the threat of severe hurricanes diminishing, the price of natural gas continued dropping and Amaranth’s losses grew up to $6 billion. At the beginning of the year that it experienced its downfall it had $7.4 billion in assets and just before the month of its downfall it had assets worth $9.2 billion.

Story of the trader

Hunter first became outstanding as an energy trader at Deutsche Bank in 2001, and he was specialized on natural gas trades. He performed remarkable and personally earned $52 million and generated around $17 million profits for his company. At the end of2003, Hunter’s group earned about $76 million in profit. Unfortunately, within a week’s time, he had incurred losses of approximately $51.2 million. A series of similar negative events forced Hunter to leave his position at Deutsche Bank, and start his next career at Amaranth Advisors as head of the energy trading team. Hunter made $200 million for the hedge fund only within his first six months, which impressed his boss and made himself a lot of rewards and great compensation (Goodman, Leah, 2014).

His achievements impressed his bosses who in return as a gesture of good will build an office in Calgary, Alberta which allowed this Canadian trader to move back to his home town. In 2006 March, he was named among a list of top traders where he was number twenty-nine in Traders Monthly.  He continued to profit Amaranth. It is estimated that he earned the company around $800 million and as a result of these huge profits he was rewarded with about $75 million. But then something went wrong in his predictions one time and he was responsible for leading to the closure of the company (Mccall, 2009). Hunter was 32 years old when he sunk Amaranth’s $9.6 billion hedge fund. Following the law suit that was made due to his attempt to try and manipulate the prices of natural gas he agreed to pay $750,000 to resolve the law suit against him. The details of the law suit were disclosed by New York Federal court.

Gambling on weather

Most of the investments that Amaranth had made were conservative and the energy department consistently earned annual returns of 30%. Hunter was able to come to more speculative conclusions using natural gas on the future contracts of the company. This worked in his favor when hurricanes namely; Rita and Katrina were responsible for disrupting the process of producing natural gas which in return increased the price of natural gas at this particular time Hunter’s speculation were correct and he earned the company $1 billion and a good reputation (Mccall, 2009). He made a risky bet and it paid off in 2005 but this was not always going to be the case since the same bets would be responsible for bringing down the company in the following year.

After weather was responsible for propelling the returns of the company it was only natural for Hunter to gamble on weather again the following year 2006.  Meteorologists has already warned that severe hurricanes like the ones experienced in the previous years would not occur again, Hunter went further and placed a high bet on the prices of natural gas moving high like in the previous years. The inventories that are needed to ensure gas supply increased and the threat of hurricanes diminished. In September the same year the price of natural gas fell bellow its support level which was $5.50 and went ahead to drop by 20% by two weeks. This spontaneous drop in the prices of natural gas meant that Amaranth was losing. Its loss amounted to $6 billion within the span of a very short time (Mccall, 2009).

 By the third week of the month of September in 2006, the United States was not experiencing any major hurricanes that would distort the supply of natural gas, therefore, its price continued to fall drastically. Amaranth has invested in the future of natural gas it is known that it used borrowed money to double down its initial investment. Their future contracts had higher equities as a result of the leverage that they had given to their traders. Hunters prediction on the weather had been made to win the company high returns in the year 2007, the period between March and April. When his strategy was at the verge of losing, he compounded the losses that were taking place in Amaranth by using the strategy of doubling down which included borrowing more fund and used them as leverage and eventually Amaranth ended up having borrowed $8 billion for every $ 1 billion that they owned (Mccall, 2009). The funds of the company declined and went below $3.5 billions and was later liquidated. Its loss led to the loss that was experienced by San Diego Employees Retirement Association which has invested $175 million with the company after its huge success in 2005.

By placing a large hedge fund Amaranth was trying to achieve larger gains by hedged positions. In an ideal situation Hedging is responsible for lowering the risk of the funds. And if the contracts they had invested in in the future were to move in one direction, then the funds would be responsible in profiting one contract as the over was used to hedge in the opposite direction. However, many hedge funds make huge bets on moves they are sure about unlike the huge bet that was made out of its former results. If trade of the future contracts would have gone as planned and speculated, Amaranth and its investors would have benefited greatly. This strategy of benefit on hedge funds does little to minimize the risk that would occur if the contract moves in the direction that was not speculated. And since all the contracts went in the opposite direction that was not speculated Amaranth bore a very high risk (Mccall, 2009).

Following the collapse of this huge company many reports concluded that the loss they had incurred had exceeded 65% of their initial investment. It transferred its assets to a third party that consisted of Citadel LLC and JPMorgan Chase on September 2006. Fortress investment was responsible for liquidating its assets and in the following year Amaranth and Hunter were charger with trying to manipulate the prices of natural gasses. Following the collapse of Amaranth so many law suits followed (Mccall, 2009). Its collapse marked the collapse of the largest Hedge fund in the history. 

How trading went wrong.

The only thing that seems to have gone wrong was Hunter’s prediction on weather. And his speculation that the same hurricanes that occurred in 2005 were likely to occur in 2006. Also hedging a large amount of money on future contracts was a wrong decision since they failed to put in place possibilities that the future contracts might move against the direction they had predicted. Like all hedge funds those of Amaranth were kept secret although it is well known that Hunter had made a large investment on the speculation that the prices of natural gas would go high. Also, the fact that it placed its hedge fund and did not at all put any strategy in place to minimize the risk might be one of the reasons things went wrong (Mccall, 2009). Also, Amaranth and Hunter made the mistake of confusing paper trading gains with cash profits. Hunter also when he took his chip off the table and lost around $5 billion for a hedge that boasted of having a world class system for risk management. Amaranth also let a ruthless dealer take large risks without properly measuring the risk or without senior management involving the risk team. They also failed to dedicate resources and expertise to study the market but instead they made a decision following possibilities of certain events happening.

Aftermath

            On the other hand, taking into account the aftermath of the whole situation, it implies that the majority of the initial energy investment that the company made was ultimately considered to be more conservative. As a result of that this mandated the energy desk to end up posting annual returns which was estimated to be 30% more than what was earned during the previous years. Consequently, it gave Hunters the potential or the opportunity of making speculative positions through utilizing some of the future contracts that were aimed at improving the economic wellbeing of the company (Timeline-Amaranth's Brian Hunter settles with U.S. CFTC, 2014).  Although this ultimately worked in favor of the calamities that the company had experienced earlier, the continued production of natural gas extensively assisted in pushing its price throughout the whole year.

Proper economic investment is one of the factors that have been noted to have the potential of improving the performance of the business enterprise. Because of that, the speculations that Hunters had is the one that proved to be the precise means of correcting the existing flaws as well as increasing what the company could have earned during the epic season or reputation. Therefore, this implies that Amaranth, especially, Hunter were left with no choice but to extensively invest in natural gas futures as well as on the basis on the reports that were initially obtained from various potential natural gas investors. The reason for that is because the money that the company had borrowed was the one the management authority perceived to have the opportunity of doubling their initial investment (Mccall, 2009).

            Nonetheless, research regarding the activities of this business indicates that the intention of Amaranth and Hunter was to achieve large gains taking into account the hedge funds with the hedged financial positions. Taking that into account, the hedging strategy of the company ought to take into consideration the risks to be encountered. The reason for that is because such invested funds consist of both bearish and bullish positions. As a result of that, it means that in case the future contracts that the company was to have been aimed at ensuring that it has ultimately moved it in similar direction.  This is to imply that the hedging funds ought to have the ability of profiting the business with a single contract. Ideally, this is to suggest that some of the contracts that the management authority could have entered into might have been already sold or just used for the purpose of hedging against a particular movement that was directed in the same profit earning criterion (Timeline-Amaranth's Brian Hunter settles with U.S. CFTC, 2014). Despite that, the management authority of the company later ended up realizing that a large percentage of the hedge funds is the one that has the potential of making he bets in the existing market as well as moving in one particular direction concerning the company’s leveraged bets. Furthermore, this means that in case the traders performed as planned, the company ended up realizing that the funds invested by potential investors could have seen profound returns (Inshakov et al., 2019).

            According to the modern economic world, contracts to be entered in the near future are the one that has the ability of increasing risks as compared to equities. What causes that is the leverage that the business organization ends up offering to future traders. For instance, when it comes to equity market, a trader is recommended to come up with more than 50% of the entire value of trade. Therefore, what the company realized, especially Hunter is that traders, in the future market has several opportunities of entering a market position that has only 10% of the finance up front. The reason for that is because a large percentage of the hedge funds that the majority of these companies that they obtain mainly comes from external borrowing through advancing credit from banks which in return make them to add more leverage.  As a result of that, the effect of this is that it increases risks as well as the potential size of the profits that company will generate in the long run (Mccall, 2009).

            Conversely, to counter the effect of this, Amaranth, especially Hunter also ended up implementing a strategy that was aimed at playing or enhancing the financial spread between the contracts that were entered.  Because of that, Hunter was forced to bet the general spread between the hedging decisions that was to widen those contracts. Although such a strategy later narrowed down, Hunter had no option but to compound loses that was obtained through utilizing doubling down strategy stated above. In the process of embarking on external borrowing so as to initiate new financial positions, the end result of this is that the hedge funds ended up becoming more and more leveraged (Hunt & Evans, 2009).

At the end of the day, the truth is that potential investors concerning the Amaranth Fund were ultimately left stranded scratching their heads as well as wondering the kind of investment that could have been made on their funds.  Thus, the lack of transparency was also one of the issues that they considered to have made their funds not to be wisely invested. As time went by, it was realized that such investors had no idea about the hedging funds were ultimately doing with the invested funds.   In other words, the hedge funds ultimately come with free rein with respect to the invested capital. The reason for that is because it was later realized that the majority of the hedging funds is what end up making their money to come up with performance fees which can in return be generated through leveraging its gains (Goodman, 2014). From economic perspective, the large the gains, the better the financial position the company will be in in respect to the hedging funds. For instance, in case the funds were to remain at 70% or fall below that, it implies that the general performance fee could have been decline to zero. What the management authority realized from that is that the structuring of their fee is the one that has the ability of improving the focusing of hedge fund traders as well as implementing some of the exceedingly risky strategies (Fuerderer et al., 1999).

                                    How to prevent from the situation (my strategy)

From the information that was initially collected, it was found out that Amaranth used to make sells that was ultimately more that its energy portfolio. As a result of the liquidity and margin calls, it is evident that the company did not have the potential of seeking alternative selling strategies in their energy sector. As a result of that Amaranth later ended up conforming that Brian Hunter had secretly left the company although that was an extremely minute comfort for potential investors who could have invested a lot of funds to the company (Goodman, 2014).  As a result of that, for the company to prevent such a situation, it is important for the company to ensure that such investors have not been left with the option of liquidating all that was left out of their initial investment after the transaction was carried out aimed at selling its assets.

Despite of the past investment, it is also important for the stakeholders to ensure that they have illustrated all the risks that were involved when it comes to making such a large investment in the hedge funds. In the process of resolving seeking external borrowing, it is important for the management authority to come up with other new financial strategies that will ensure equable utilization of the existing resources (Mccall, 2009).  The end result of this is that the hedge funds will be easily leveraged.

Conclusion

With respect to the above scenario, the truth is that the regardless of the epic downfall that was experienced, the hedging funds of the business needed to be wisely invested. Equally, the failure of Hunters to foresee the forthcoming risks of his rated is what ended up rendering him blameless. On the other hand, although this had absolutely worked in accordance with the strategies implemented, the objective behind that entailed favoring some of the tragedies that the business had initially experienced. Conversely, the continued generation of natural gas is what they company and its stakeholders perceived to have the ability of increasing its future prices.          The wellbeing of any business organization relies on the profits to be generated which in return increase its economies of scale. Therefore, proper economic investment is one of the factors that the company could have also realized to have the potential of improving the performance of the business enterprise. Equally, the speculations that Hunters had is the one that proved to be the precise means of correcting the existing flaws as well as increasing what the company could have earned during the epic season or reputation.

References

Fuerderer, R., Herrmann, A., & Wuebker, G. (1999). Optimal Bundling: Marketing Strategies for Improving Economic Performance. Berlin, Heidelberg: Springer Berlin Heidelberg.

Goodman, L. M. (2014). THE 'ROGUE TRADER' WHO GOT AWAY WITH IT. Retrieved from https://www.newsweek.com/rogue-trader-who-got-away-it-271105

Hunt, L. C., & Evans, J. (2009). International handbook on the economics of energy. Cheltenham, UK: Edward Elgar.

In Inshakov, O. V., In Inshakova, A. O., & In Popkova, E. G. (2019). Energy sector: A systemic analysis of economy, foreign trade and legal regulations.    Cham, Switzerland : Springer Press

Timeline-Amaranth's Brian Hunter settles with U.S. CFTC. (2014). Retrieved from https://www.reuters.com/article/amaranth-settlement/timeline-amaranths-brian-Hunter-settles-with-u-s-cftc-idUSL2N0P413B20140915

Nursing remains the most productive yet stratified careers in the world when it comes to acknowledged credentials and a vast discrepancy existence between approved ranks and listed caregivers. Even though the standards, differ greatly from one country to the next, personal LPNS may need to perform the same duties as their RN counterparts. The duties may be management of circulatory fluids, the removal of blood for the sake of examination and other crucial elements that come with the occupation.

The ever-increasing numbers of LPNs are pursuing a higher education in order to qualify for RN positions. This is partly due to alterations within the medical sector and the need for more RNs on the labor force is causing this shift. Therefore, the need for an efficient transition from one side on to the next; facilitated by a good nursing framework and program.

 Role transition from LPN to RN: personal experience: GOALS

As an individual practicing LPN and planning a transitional phase into the unknown future of RN, occupation, I faced numerous challenges and hindrances, which assisted, strengthen my pursuit and my resolve to work towards my end goal.

The scarcity of nurses continues to be a persistent challenge hence the need to build up systems that will enable the department grow and flourish. My pursuit for a higher education will enhance my caregiving skills and equip me with relevant information for treating and administration of drugs.

 One of my main personal goals is fulfilling my ambitions as an RN. The achievement will inspire the people around me to be better and to do better in other sectors of life even if it is not necessarily being an RN. I want to be a light of hope for my neighborhood and cause a chain of events or a pendulum effect that will impart  one generation to the next. Second goal is touching the lives of other people through my services. Nursing impacts the lives of people more than people know. First of all nursing is a solo independent career of its own, with its specific functions. Therefore transitioning into RN will enable me to touch more lives. Thirdly, the transition will change my life for the better, especially in terms of finances. I do not mean this in a selfish manner but in a generous way. Nursing itself is a selfless career and I making that decision to move into the next level of my career will definitely assist me financially. Financial stability comes with its fair share of mental wellbeing and comfortably meeting my needs and those of my children.

Comparison of LPN to RN practice

Nursing is an occupation that necessitates the healing process of patients. Their central role is vital. Yet, still the difference between LPN and RN is vital for the nursing fraternity. LP is the short form a licensed nurse that is a basic caregiver type of nursing. In some nations, an LP is also known as a certified vocational nurse. The variation between two lies in the educational programs. The LP requires basic form of education or teaching or training. On the other hand, RN more in terms of formal training. More so, an LPN needs information, skills, and familiarity with specific medical activities. Nevertheless, the rank has fewer duties than an RN.

In addition, an LPN has to work and corporate with a supervisor. An LPN program takes 12 for it to be complete. LPNs assess patients, note vital symptoms in patients, and offer a lending hand in while tending to a wound. Subsequently, LPNs work in home medical centers, clinical institutions and in nursing home.

Registered nurses must accomplish several functions; nevertheless, the most vital is providing patients with medical needs, monitoring their progress as they under the recovery journey, and safeguarding the patient from any harm. He or she notes the instructions left behind by the medical specialist and carefully implements them accurately. RN has the full responsibility of over the patient and their progression consequently formulates care plans based on the present condition of the patient. In addition, they have the potential of intervening in case of an emergency. In other words, the RN plays the leadership role and handles all the matters pertaining decision making, rational decision making and delivering appropriate medical services to the patients.

 Personal role alterations

As I enter into this newfound phase, I must seek all the help I need from family and colleagues alike. I cannot change my social and family life hence I must bring all the people on board and let me share my dreams as I indulge other my ambitions and life changes. The truth hurts but this journey will not be easy. I need emotional support from all the family members as I make this personal sacrifice for them; I need all the people to support me. In fact, in will do all the things in my power to enhance my personal close relationships and to move with them all along the way.

A health care worker cannot afford to make a mistake; no matter what the society thinks of them. In other words, a patient’s satisfaction relies on the manner in which a nurse offers his or her services. Majority of the public are of the opinion that explanation and data from a caregiver is satisfactory. This is because nurses cover every element of care and comfortably explain to patients the best way to recovery. In terms of responsiveness, the public are of the opinion that nurses are accurate and can solve medical issue when called upon to do so by the public making them reliable. Therefore, I have a lot to give and take at the same time as I move from one mountain to the next mountain. I have a duty to serve and deliver good results rather move from one place to another.

Plan of action

Nothing can take place in life without hard work, dedication, and commitment. For the sake of success as I pursue I have put my best foot forward and go an extra mile while in order to succeed in the educational program. Success is necessary for me and the only option. I have a deep-seated feeling that my love for the profession will drive everything else and deliver success at my doorstep. For people to entrust me with their lives, I have to show my dedication ad servant attitude through this educational program.

RNs are similar to leaders. Leadership is not hereditary and thus one cannot be a leader from birth. Some may argue that the exposure to leadership positions at a young age sets one into a leadership path, early in their lives. However, exposure is not equal to attaining successful academics. History has enough examples of people who failed to leave up to expectations although they were leaders from an early onset. Although all of the above may be true, leaders are made; it is fact that stands undebated for centuries. People do not have qualities that make them leaders from birth. In fact, leaders learn a lot from their day-to-day activities, which later shape their perspectives and decisions on various matters. On the other hand, enrolling to a program does not automatically make one a leader. Making a nurse means that a person is willing to learn. Some people succeed and give out good results after learning while others fail. Therefore coupled with proper management skills ensure one get ahead of his time and reap the benefits of all qualities encompassing a leader.

Learning process takes place within a designated institution and it is up to the learner to realize the task ahead of them and settle on an institute suited for their academic journey. Students give varying factors for transferring but regardless of the underlying reasons, which forces one to move, it may be for the better. In my personal case, an objective without a strategy is synonymous to wishful thinking and I like putting my words into action rather than delay and regret later in life. My objectives are purely academic and life moves on no matter hence the pressing need to move at the same pace with life.

In summary, life has its own ups and downs, cries, and laughter but in the end, I have to emerge as a qualified RN. My duties are ahead of me and my desires to set the pace in the society are some of the elements that drive my passion to drive change and establish a firm foundation in life and nursing as a profession.

 Depression

Abstract

            Depression as a disorder that is associated with the brain functions affects the feelings, actions and thoughts. It causes one to develop feelings of sadness and lack of interest in activities that one had been enjoying previously. It is usually associated with several risk factors which include; genetic predisposition, drug abuse or withdrawal, physical and sexual abuse and changes in life events among others. There are various ways in which one can reduce depression. One would also engage themselves in spiritual matters like prayers and meditation. Setting goals, relaxation, music therapy and setting time for personal beauty are some of the lifestyle habits that would play an important part in reducing stress. There is also aspect of engaging oneself with social groups, friends, pets, therapists. Others include; physical care like regular exercises, good sleeping patterns, hydrotherapy, yoga and regular water intake. There are campaigns that are meant to solve the problem of depression especially among the students. There also several coping mechanisms that are used by the family affected by depression.

Introduction

Depression is a disorder that is associated with the brain functions and affects the feelings, activities and thoughts. It causes one to develop feelings of sadness. Sometimes an individual become uninterested with the things they had been enjoying before. An individual might present with signs like thoughts of suicide or death, feelings of un worthlessness or guilty, fatigue or loss of physical energy, difficulty to sleep or excessive sleeping, having depression or sad moods, changes of appetite, lass of enjoyment on the activities once used to enjoy before and difficulty in making decisions, concentrating or thinking. Risk factors of depression are genetic predisposition, drug abuse or withdrawal, physical and sexual abuse and changes in life events among others. There are several ways in which one can reduce depression and they include; Physical self-care, emotional self care and being engaged in support groups.  There are campaigns that are meant to solve the problem of depression especially among the students. There also several coping mechanisms that are used by the family affected by depression. It is essential to develop ways to enable people to control and avoid the risk factors that predispose one to depression.

                                                                Risk Factors

Genetic Predisposition

            About 40% of depression cases are usually associated with inheritance. Inheritance cases mostly increase through the adolescents because of the heritable depression causes that are associated with age (Williams & Hill, 2012). This means that it is possible for one to get depression if there is a family history of the same. The dominant genres are passed from the parents to the children. This might happen from one generation to another.

Social difficulties

            Depression is mostly associated with tangible challenges. These challenges include: having academic difficulties in school, bullying, disrupted care and rejection by the parents basing sexuality aspects (Williams & Hill, 2012). Sometimes a parent might discriminate the children basing on the gender. They might show much care to either the male and leave the female alone or vice versa. This would lead to a discriminated child getting a sense of lack of belongingness since the parents are not embracing them in the right manner. As a result, the child develops depression due to a feeling of loneliness. An individual with academic difficulties like lack of school fees or poor performance regardless of the much efforts to learn might develop depression. Bullying is also another factor that usually occurs among the students while in the school and causes depression.

Abuse

            This might involve sexual or physical forms of abuse to an individual. Physical abuse may involve being told off by the teachers or parents while sexual abuse involves being harassed sexually and the effects might be noticeable until puberty (Williams & Hill, 2012). Emotional abuse is also associated with depression. An incidence of sexual abuse might lead to depression as the victim will keep recalling the act. This would make them feel disgraced. Stigmatization from the people who might be having information concerning the episode might also cause depression to the victim. Sometimes the individual might develop various conditions from the incidences like rape, for instance; a young lady who undergoes a misfortune of rape might be diagnosed with inability to carry pregnancy to term and deliver safely. This might cause depression as the individual is very young and with no or one or two kids. They may also face a challenge of lack of spouses to marry them which would facilitate the development of depression. Physical abuse where the teacher might happen to hate a child or even have a tendency of beating might cause learner to develop depression.

Life Events

            These are mostly caused by parents when they change the events of life. The changes mostly affect children. This involves both good and the good things (Williams & Hill, 2012). Examples of the good things is like graduating or moving into somewhere new or having a new born baby. Other factors include retirement, divorce and separation of the parents or death of a loved one.

Parent Loss and Poor Parental Care

            Loss of parents especially mother is mostly associated with depression in most of the cases.  For example; cases where a mother dies or gets very ill might cause the children to go into depression. Low parent care which is aimed at providing warmth to the children might also be associated with depression.

Cognitive Factors

            Difficulty in schooling might cause depression which in turn would result in to decline in performance. The depression might go to a greater extent if the student or pupil is not taken care off as they can drop out of school having the fact they are performing poorly (Williams & Hill, 2012).

Anxiety

            Anxiety disorders increases the likelihood of someone getting into depression. An individual who had been through a traumatizing event might develop depression later in life (Williams & Hill, 2012). This is usually very dangerous as the victim finds it difficult to adapt to the usual life activities.

Lack of Enough Exercise

            Inadequate exercise is mostly associated with depression and panic disorders. Adequate exercise increases the sense of wellbeing and control as well as pain threshold (Williams & Hill, 2012). It would be therefore important for people to exercise regular to reduce depression.

Early Bipolar

            There is usually depression before the first episode of mania. The individual becomes depressed for a while before they become manic (Williams & Hill, 2012). They usually tend to be quiet and not interested with activities that are happening in the environment.

Drug Abuse

            Drug abuse or withdrawal is also associated with many known cases of depression. Some drugs might bring the individual down that they had been and tend to be depressed most of the time (Williams & Hill, 2012). Withdrawal of the drugs also causes depression as the victims had been kept high by the drugs. Immediately they stop consuming them, they break into depression.

Ways to Reduce Depression

Physical Self-Care

            This can be done through regular exercises, nutrition, having enough sleep, hydrotherapy, acupuncture, yoga, touch, medication, breathing exercises and regular water intake. Something like exercise enables to boost the endorphins which are responsible for the feeling of goodness (Bloch & Bloch, 2009). Exercise is a very nice strategy when it comes to reduction of depression. One should choose to practice on something that one enjoys most.  Having enough sleep enables to reduce depression and having less might cause the situation to worsen. Good nutrition also plays an important role in improving the situation. It is also advisable to reduce the stressful moments in life and work on happy moods and well-being. Stress triggers depression and also prolongs its period. One should think about all the activities that cause stress like unsupportive relationships, work overload or health problems. Once an individual has managed to identify the stressors, the next step would be planning on how to avoid them or reduce their implications.

Spiritual Connection

            One can connect themselves with spiritual matters as they would play an important role in reduction of depression. This includes engagement in meditation, prayers, inspiration texts and self-forgiveness (Bloch & Bloch, 2009). One would also take a step of finding meaning and purpose and being involved in the spiritual community.

Lifestyle Habits

            This includes a number of factors like relaxation, setting goals, finishing the tasks, humor, stress reduction, pleasurable activities, music therapy, setting time for beauty, time management and creative self expression. These activities will play an important role in reduction of depression (Bloch & Bloch, 2009). On should engage in the activities thy moist enjoy. . It is also encouraged that someone should get involved in practices of relaxation techniques as they could help in reducing the depression symptom. On should also engage in setting realistic goals. After setting the goals, the next step would be working on the same. If someone is a fun of music, it advisable that they should listen to some and even dance. This enables to reduce depression as the mind is kept busy hence no time to engage in irrational thoughts that would trigger the condition.

Social Support   

            This involves seeking support from people who are close associates. They include; family, therapist, friends, support groups, minister or rabbi, pets and animals, volunteer work and day treatment (Bloch, & Bloch, 2009). Engaging oneself with a pet during the very lonely and desperate moments usually helps to reduce depression. It also give someone a sense of being important.

Mental or Emotional Self-Care

            This involves activities like having optimistic thoughts, self-forgiveness, being engaged in psychotherapy, daily affirmations, feeling personal feelings, being engaged in mood chatting, reading a gratitude journal, overcoming the depression stigma, release of the negative beliefs and working through the grief process. Having happy thoughts does not help in reducing depression (Bloch & Bloch, 2009). The best way is having positive thoughts. One should avoid being too hard on self. There should be less cool statements that give more descriptions in a realistic manner. Make sure that there is no strict perfection and this has been a major cause of depression. One should have socialization with positive people. There should also be an initiative of investigating on the coping mechanism of the people who look bright. One should try the optimism of the bright people in order to cope with personal difficulties. Whenever there is a negative thought, taking a step of writing it down in a notebook plus the things that have caused it to happen and then checking on it during the happy moods moment is a nice way of reducing depression also.

Campaigns and Awareness

Student Mental Health in California

            This is la campaign that had been meant to improve the mental status for the students in California. It had been funded by California counties by the use of funds from Mental Health Services Act of the year 2004. Emails had been sent by the campaign requesting the principals to give ratings concerning the severity of the problems found in the schools being related to the mental health of the students (Kaufman, et al. 2015). The high as well as middle school teachers had been asked concerning some problems like depression and suicidal attempts. These activities had been carried out inform the California Mental Health Services Authority concerning the efforts they were expected to put in order to improve the mental health of the students. The thoughts of suicide and depression are very frightening issues that can be faced by an individual in life. Unfortunately, many people have not been able to act on those two things and this includes the students.

Coping Styles for Families Affected by Depression

            The strategies applied in coping with depression at the family level plays a n important role in the wellbeing of an individual both physically and psychologically. They help the individual during the episodes of events which are stressful in life or negative situations. There are several coping mechanisms. The first one is emotional-oriented coping strategy. This is usually associated with minimal-adaptive personality features and distress that affect one psychologically (Undheim, Wallander & Sund, 2016). It has been found that the reverse of this regards the coping of the task. Skills in problem solving have been reported to be related closely to task oriented strategy by minimizing the impacts of the problem. Studies have been showing that the individuals who are depressed usually rely on emotional related strategic coping mechanism. The predictors of anxiety, depression, and stress are the most people who use mal-adaptive coping. This mainly is associated with young students in college and among the youths in China who are in the age bracket of 8-14 years. Orientation of high emotions and being focused in low tasks types of coping had been related to behavioral and emotional problems. The stress perception and avoidant or emotional coping had been associated with problems in adjustment among the old adolescents of age bracket 10-14 years. However, avoidance oriented strategic coping style among adults had been lower among a major group of depressed individuals as compared with the healthy controls. The styles of coping are have been reported to mediate the connection between mental health and events of stress in life partially among the adolescents.

Conclusion

            Depression as a disorder that is associated with the brain functions affects the feelings, actions and thoughts. It causes one to develop feelings of sadness and lack of interest in activities that one had been enjoying previously. It is associated with several factors which have been discussed in the paper above including anxiety, social factors, drug abuse, lack of enough exercise, early bipolar conditions, cognitive factors like difficulty in schooling and loss of parents either single or both of them. There is also lack of parental warmth, stressful life events, physical or sexual abuse. There are several ways of reducing depression as discussed in the paper above. Some of them include; physical care like regular exercises, good sleeping patterns, hydrotherapy, yoga and regular water intake. One would also engage themselves in spiritual matters like prayers and meditation. Setting goals, relaxation, music therapy and setting time for personal beauty are some of the lifestyle habits that would play an important part in reducing stress. There is also aspect of engaging oneself with social groups, friends, pets and therapists. The Student Mental Health in California is a campaign that had been aiming at dealing with the issues that disturb the minds of the students. It had been enabling the California Mental Health Services Authority in impacting them with knowledge concerning the efforts that they were being expected to put into practice in order to improve the mental health of the students. There has been discussion in the paper above concerning the coping strategies by the families that have been affected by depression. Emotion-oriented, task-oriented, mal-adaptive, high emotion and low task-focused and avoidance oriented coping mechanisms.

Reference

Bădescu, S. V., et al. (2016) "The association between Diabetes mellitus and Depression."           Journal of medicine and life 9.2: 120.

Bloch D..& Bloch. D. (2009). Healing from Depression: 12 weeks to a better mood : a body,        mond, ND spirit recoverly program. Fort Worth, FL: Nicholas-Hays,inc

Kaufman, J.H. Seelam, R., Woodbridge,M.W., Sontag-Padilla,L.,Osilla, K. C., ., &           Stein,B.D.(2015) Student Mental Health in California’s K–12 Schools

Williams, J., & Hill, P. D. (2012). A handbook for the assessment of children's behaviours.           Oxford: Wiley-Blakcwell.

Undheim, A. M., Wallander, J., & Sund, A. M. (2016). Coping strategies and associations with   depression among 12-to 15-year-old Norwegian adolescents involved in bullying. The             Journal of nervous and mental disease, 204(4), 274-279.

Health and Human Services (HHS) Action Plan to Reduce Racial and Ethnic Health

                                    Disparities Report

Introduction

Health disparity can basically be defined as the variance that signals underprivileged social groups. A good example of this are the poor and other marginal groups in the society who have continually experienced social drawbacks and they also experience inferior health threats as compared to other more privileged social groups. When the term is practically used in an ethnic viewpoint, it describes the augmented existence and brutality of certain illnesses and poorer health consequences as an outcome of struggle in attaining health care services for some races. Though these methodical obstacles in the health care sector are preventable, they still continue to be vibrant and they have come to be generally known as health variations. As a local public health professional, I believe that understanding the routine in which race, culture, geography, education and revenue influences a person’s admittance to health services can significantly offer valuable perceptions to health policy specialists as well as supporters.

HHS Action Plan to Reduce Racial and Ethnic Health Disparities Report

The report by the US department of Health and Human Services (HHS) that was published in 2011 converses the issue of racial health disparities and effective actions plans that can help to reduce the issue. HHS report summaries some of the objectives as well as engagements that will be taken by HHS to aid decrease and also eradicate both racial and ethnic inequalities within US and realize one of its aims of transforming heath care. This report is a good illustration that US government recognizes these element that the health of the subgroups within the US endures to delay behind as associated to that of the whites something that is ethically wrong. It is important to note that even though racial and ethnic subgroups only signify a third of the US population, more than half of 50 million uninsured citizens of US are all from ethnic subgroups which is a good illustration of the ethnic health disparities within US (Williams & Purdie-Vaughns, 2016). The HHS report does a great job at describing the concept of ethic health disparity and the range to which it exists in US citing specific examples. A good illustration of this is the fact that African Americans happen to be a third less likely to have a bypass surgical procedure as compared to the whites, the African American child are less likely to receive asthma drugs than the white children all because of the race differences (Williams & Purdie-Vaughns, 2016). The report indicates that ethnic minorities have poorer overall health and they tend to experience more severe forms of ailments for instance cardiovascular diseases, diabetes, asthma and kidney failures among others those results in shortened life spans for them (HHS, 2011). I find the facts presented by these report valid, cardiovascular diseases for instance in current day accounts for the largest proportion of inequality life expectancy between African Americans and whites. Studies that have been conducted in relation to life expectancy between various races show that African Americans, the Hispanics, the Asian Americans and the American Indians among others have a higher mortality rates as compared to the whites in the US.

Contributors to ethnic health disparities and HHS action plan to resolve them

Language barrier

One problem that is reflected in the HHS report that contributes to the ethnic health disparity is the issue of language barrier. It is estimated that over 24 million adult Americans have limited proficiency in the English language that is widely used in the medical sector (Williams & Purdie-Vaughns, 2016). This is a problem because it makes the 10 to 15 minutes doctor’s consultation often less effective and it can hence results in harm to the patient and it also leads to increased health system costs. This issue also creates a system in which the minority populations do not get reached, informed or even encouraged to seek the correct preventive measures or even the required medical treatment for various health problems. In regard to this problem, the HHS plans to create an online national registry of interpreters that can be used by hospitals and the physicians to help deal with the patients that cannot effectively communicate in English (HHS, 2011). This is an effective strategy given that it will involve trusted local people who will act as the community health workers and they will greatly help the patients to navigate the online system and also adhere to the various treatments that are given. As a local public health professional, this will be very beneficial for me because most of the problems that I observe in the society is the way that doctors, nurses and other health staff struggle to communicate with patients both at the hospitals and even when they are doing their rounds in the society. Sometimes they find it very difficult to communicate with some of the patients because they cannot explain their symptoms or health problems in English. Most of the programs that I have tried to develop to deal with the issue of language barrier have not been effective because it always involve engaging people who are not medically trained to take up the role of interpreters. I believe that having trained interpreters in the public health facility will make it much easier not to mention ethically upright to attend to the society irrespective of the ethnic differences.

Another strategy that have been indicated by HHS to help deal with the issues of ethnic health disparities in regard to the above raised issues is the training and recruitment of more individuals from the minority groups within US into both medical and public health sectors because they are very few at the moment. As of the year 2008, the population rates of Hispanic physicians were only at 6% even with the population of the Hispanics in US being 16% all through the US (Weinstein & García, 2017). This is a very effective strategy that will greatly help to reduce the disparities because with a reasonable percentage of medical professionals, it will ease the issue of communication a well as education on the minority groups. Having more physicians coming from the minority groups will make it much easier and convenient to educate the minority groups on issues of health and it will also be easy for them accept and relate to what they are taught given that it comes from one of their own. This will motivate the minority groups to go for frequent check-ups which will help reduce mortality rates since it is always easier to treat a condition at its early stages instead of waiting up until when it’s too late.

The HHS is effective in its plan on helping to reduce the health disparities based on ethnic back grounds. The strategies that it has put in place for instance the plan to recruit and train more people from the minority groups is effective because it will motivate the minority groups to take more concern in matters of health. In reference to this recruitment the report indicates that financial plans will be put in place including loan offers as well as scholarships for students from the minority groups that wish to pursue medical related courses.  This is an effective plan because most of the minority suffer in poverty not having enough funding for their education as compared to the whites which greatly contributes to the ethnic health disparities (Weinstein & García, 2017). Having more medical experts coming from a range of ethnical diversities will be very beneficial to the whole course of eliminating ethnic health disparities. It will help increase the range of patients that we as the medics are able to attend to in a day not to mention that it will help to ease the issue of communication between the patients that cannot fluently communicate in English because the physicians from various ethnicities can easily communicate with the patients that do not understand English.

Insurance coverage

The reports greatly acknowledge the issue of insurance coverage as a great contributor to the ethnic health disparity. Health insurance coverage greatly varies between racial and ethnic groups within the US (Williams & Purdie-Vaughns, 2016). African Americans as well as the people from the Hispanic origins tend to have lower insurance coverage rates as compared to the whites. This issue of insurance coverage rates is a great contributor to the ethnic health disparities where the minority races are less likely to be insured all throughout their adulthood as compared to the whites who are the majority groups (Bolnick, 2015).  Without the insurance coverage, the minority groups face great barriers in receiving the health care services because most of the health care providers require insurance coverage from their patients.  Most of the minority populations that lack insurance coverage are as a result of being unemployed and also as a consequence of language barrier and immigration rules that prevent the immigrants that are not documented from enrolling in any public plans and this includes insurance coverage.

 To help deal with this issue the HHS report plans to offer subsidies that will help the lower income earning families that happen not to have employer benefits affordable private insurance plans. This is effective because it will help to expand eligibility beyond children as well as the medically needy and it will eventually help to reduce the insurance rates among the low income adults from the minority ethnic populations (HHS, 2011). The report illustrates that policies will be put in place for insurance coverage in both private and public sectors to expand eligibility regardless of whether one is a student, employed, or ethnical backgrounds which will greatly help to increase enrolment among ethnic minorities. Education is an important toll in helping to deal with the issue of insurance coverage and hence every insurance coverage agency will be required to offer grants to various selected organizations that will help establish navigator programs that will help raise awareness in matters of health insurance (HHS, 2011). The navigators will help provide information to the general population in a manner that is culturally and linguistically appropriate to the needs of the population that is being served. This is a very strategic approach because by first educating the society about insurance covers, it will help them understand the importance of insurance covers and the process of acquiring these covers because the largest population lack the insurance covers because they do not know the process and the importance of these covers (Bolnick, 2015). It will also greatly impact us as the health service providers because we are not left with the bad choice of not attending to a patient all because they do not have an insurance cover and they cannot afford to pay for their hospital bill. The insurance covers for all people regardless of their race will help ease medical services and help improve overall society health.

Access to primary care

Some of the main reasons that have contributed to the great ethnic health disparities rates as indicated in the HHS report include lack of access to primary care and also low quality care in minority populations. This fact is true and it is disturbingly even reflected in infant outcomes where the racial disparities in infant mortality, still births and preterm births within the US have remained to be consistent over the past 50 years. The stillbirth rates in African Americans is double that of the whites and the African American new-borns are more likely to die in the rate of 1.5 to 3 times more as compared to the whites (Price et al., 2013).

The report indicates that access to timely primary care is major issue that also contributes to the racial and ethnic health disparities. Access to medical facilities in some areas is very difficult because of their locations, people have to travel long distances just to get to a hospital which is really discouraging. The report plans to provide support for the establishment of new health centres in the areas that are still underserved which will greatly improve comprehensive, culturally competent primary and preventing health care services (HHS, 2011). The report also indicates that it will offer loan repayments for the medical practitioners that offer to go and work in these underserved regions which will act as a motivation strategy. This is a very effective strategy because by offering this incentive, the medical practitioners will be encouraged to go and offer their services in these regions that are always underserved will play a great role in reducing the ethnical disparities in health.

Community and environmental factors

The HHS report acknowledges that health disparities are also driven by both community and environmental factors. Environmental factors for instance air and water are significant determinants of the health and well-being of people in the society. his environmental factors can lead to disease as well as health disparities when the places that various people stay, go to work, go to school and play are troubled with social discriminations (Price et al., 2013). The social inequities can basically be defined to be the differences among individual behaviors, cultural impacts, admittance to health services, economic prominence and levels of education.

These environmental health disparities are relevant in the ethnic health disparity because they exist when minority communities are exposed to a combination of poor environmental quality and social inequities. This leads them to have more sicknesses and diseases as compared to the superior communities that live and dwell in less polluted communities and settings (Price et al., 2013). The report understands the effects that environmental factors have on ethnic health disparities and plans to improve the vaccination rates by ensuring that grants are offered to help support community level efforts to deliver culturally appropriate immunization interventions. The report also indicates that plans will be made to ensure that disease prevention programs are implemented placing special emphasis reaching the people that experience the greatest burden of death, disability and suffering from chronic diseases (HHS, 2011). The programs will address a broad range of risk factors and conditions including poor nutrition, use of tobacco which will help to reduce cases of heart attacks, cancer and strokes among other health issues that greatly affect the minority.

Transparency and accountability

It is important for any program that relate to the wellbeing of the society to be transparent and also accountable in order to help all members of the society to feel secure and to trust the system. At the moment, the largest population of the minority groups have lost trust in the health care system because they have experienced the high discriminative rates of the system (Williams & Purdie-Vaughns, 2016). The society does not understand what happens in the health sector and why some people get easy access to treatment while others do not because the public is not given a chance to air their thoughts on the health system and its performance. HHS reports support the culture of information sharing and this includes tracking the performance measures that are existent and other government data that is on the health system indicators and ensuring that they are made available for the public (HHS, 2011). I believe that this is a very strategic plan that will help the health sector to be more responsible and conscious of any of their actions that could be biased and leading to the ethnic health disparities.

Recommendations to Local Health Officer

This report is very beneficial for us as the local health department who are charged with the role of ensuring that every individual irrespective of their race acquires maximum medical care without any form of biasness. Race and ethnicity should not really be a pre-existing health condition issue within the US. The government of US and us as the local health department need to ensure that all citizens irrespective of race are offered equal opportunities to help reach their full health potential and this report can help to achieve this.

Limitations to the report

One limitation that can be pointed out in regard to this report is in the issue of finances that will be required to implement all this plans. The report has not really given a monetary figure for all the strategies that have been proposed and this is inclusive of the grants that are devoted to the health of ethnic minorities. The report needs to give some financial overview of how all the plans that have been cited will be accomplished in order to help eliminate ethnic health disparities effectively. Another limitation to the report is that it only acknowledges the fact that health disparity is a complex issue that is linked closely to the social, economic and environmental disadvantages without really giving any viable solutions. One of the best ways that this issue can be tackled is through a collaborative effort with other governmental sectors for instance the education sector.  A big emphasis should be put on education because research has persistently shown its link with overall health. At the moment, the lowest income US communities consistently have the lowest determinants as well as educational scores.

References

Bolnick, D. A. (2015). Combating Racial Health Disparities through Medical Education: The

Need for Anthropological and Genetic Perspectives in Medical Training. Human Biology, 87(4), 361–371. https://doi.org/10.13110/humanbiology.87.4.0361

HHS Action Plan to Reduce Racial and Ethnic Health Disparities: A Nation Free of

Disparities in Health and Health Care. (2011). PsycEXTRA Dataset, 1-46. doi:10.1037/e553842012-001

Price, J. H., Khubchandani, J., McKinney, M., & Braun, R. (2013). Racial/Ethnic Disparities

in Chronic Diseases of Youths and Access to Health Care in the United States. BioMed Research International, 2013, 1–12. https://doi.org/10.1155/2013/787616

Weinstein, J. M., & García, R. (2017). Reducing Health Disparities and Promoting Health

Equity. Parks & Recreation, 52(5), 40–41. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=hjh&AN=122852023&site=ehost-live

Williams, D. R., & Purdie-Vaughns, V. (2016). Needed Interventions to Reduce

Racial/Ethnic Disparities in Health. Journal of Health Politics, Policy & Law, 41(4), 627–651. https://doi.org/10.1215/03616878-3620857

Problem Behavior: The Misunderstandings Of Pica Related To Iron Deficiency An Child Development
Amber Perry
University Of Memphis-Lambuth

Introduction

Pica is a common psychological disorder which is characterized by a person eating a large amount of substance that is non-nutrient such as paper, stones, paint, metal, and even soil.  Pica is one of the disorders that affected 25%-30% of the children in the United States (Marchi, 2016). It is a common disorder that is characterized by children or pregnant mother eating nonfood things. Reports show that 67% of pregnant women tend to crave for much nonfood substance as they believe it will boost their appetite 2016). On the other hand, most of the children have the behavior of putting things that are not edible in their mouth. Such types of behaviors are referring to as pica. With the increased cases of pica disorder, the government has tried to educate society on the best ways of dealing with that disorder.  It is important to note that there are various signs and symptoms related to pica. However, the common one is associated with equally eating nonfoods substance. It is not a must for s person to slow such nonfood particles. Some only prefer chewing it they throw it away. However, it can result in various diseases since the nonfood substance might react with the body of the person, especially to young children. To understand pica, various researches have been conducted to establish its causes, symptoms, and impact to both the children and adults.

According to DSM 5, lack of proper mineral deficiency is associated with Pica. However, it tends to vary depending on the immune system of the person. Some people tend to develop the disorder while they are only a few weeks old and the disorder will affect them until they are fully grown. In some cases, the child might develop it but later get better while he/she grows up. However, most of the children who develop the disorder while they were young are usually affected until they are fully grown. Low hemoglobin is another factor that is associated with pica 2016). This refers to the lack of red blood cells in the body that is responsible for carrying oxygen around the body. For pregnant mothers who develop that type of disorder, they are likely to be diagnosed with anemia.  More recent studies have indicated that pica is rated to obsessive-compulsive spectrum. Some people argue that pica is a common disorder that does not require a lot of attention. Such people argue that it is normal for children to eat nonfood substance since that re prone to put things on their mouth. However, reports show that this behavior is not normal and should be reviewed.

Methods

The use of survey is one of the methods of collecting data regarding pica. Since the discovery affects almost 25% of the children around the country, proper research needs to be conducted about it (Parry-Jones, 2017). By using a survey, it will entail collecting data from a large sample of people. Also, to ensure that the collected data is analyses well, the use of quantitative design would be appropriate. This type of research design will include sampling data from other researches and comparing it with what other authors have written about that discover. It is noted that the use of quantitative designs enables the researchers to monitor and even evaluate the preceding of these surveys. The purpose of questionnaires is another method of collecting data. Since it will require getting information from the mothers, the use of interviews will provide detailed information about the behaviors if such mothers.

Table 1 Types of Common forms of Pica

TABLE 2

Reported consumption of pica substances in a cohort of pregnant adolescents (n = 158)¹

Open in a separate window

¹Adolescents could report ingesting >1 pica substance.

²This percentage includes 1 adolescent who only reported olfactory cravings and, therefore, was not included in the pica group.

Table 3  Eating habits Questionnaire

By definition, Pica is an unusual eating disorder that makes people develop a craving for both edible substances as well as those that are not designed for human consumption. For years the condition has been discussed in journals since it was first discovered after a woman was diagnosed with the condition (Tisman & Khan, 2010). Since then, a lot of pica patients have been reported having ingested ice cubes, clay, chalk, starch, paste, cigarette butts and laundry starch out of the box. The condition mostly affects people with developmental disorders and it has also been observed in people of all ages and ethnicity but is widely spread in lower socioeconomic classes. About 25 to 33 percent of Pica documented cases are on small children while about 20 percent of people diagnosed are pregnant women, some of whom also have iron deficiency anemia (Tisman & Khan, 2010). The high cases of Pica are mostly because doctors are yet to truly identify the cause and trigger that pushes patients to consume the non-food substances especially because they have no nutritional value.

Pica poses major health risks that require medical attention. These patients are prone to suffer from electrolyte and metabolic disorders, lead and mercury poisoning, parasitic infections, intestinal obstruction and various problems of the gastrointestinal tract. Although the exact cause of pica is unclear but is associated to iron deficiency anemia (Khoshnevisasl et al, 2017). Most doctors also believe that pica to be an effect of iron deficiency rather than its cause. However, most of primary care physicians are not familiar with the signs and symptoms of pica. While Pica and iron deficiency anemia are not as serious as the various disorders that children and pregnant women can suffer from, their side effects, especially in the long run raises enough cause for alarm (Khoshnevisasl et al, 2017). Although iron deficiency does not always lead to death, its impact has significance especially due to the millions of children that suffer from irreversible brain injury caused by improper nutritional practices.

            Iron deficiency is a multi-system disorder with major effects on the central nervous system. Studies conducted over the last two decades have clearly shown the effect of iron deficiency on mental health and often on motor functioning as well. The lack of enough iron, for example, leads to reduced activity of iron containing enzymes in the central nervous system and it results to deficits that appear, based on animal studies and examining young children, to be irreversible despite of iron therapy (Khoshnevisasl et al, 2017). It is thus possible that the main effect of preventable loss of IQ in children suppresses the more clinically understandable intellectual and motor deficits resulting from disorders such as phenylketonuria and congenital hypothyroidism. Due to the adverse effects that iron deficiency has on children, it is important that pediatricians and caregivers pay closer attention to what children consume and keep better records of their iron intake especially in the ages of between 18 and 24 months (Khoshnevisasl et al, 2017). Doing so will ensure that they have acceptable amounts of iron in their systems and that they are less likely to be diagnosed with Pica.

            The difficulty in managing Pica lies mostly in the lack of a better understanding of the disorder as well as how lack of adequate iron leads to the disorder. Arguments have been made regarding the correlation between iron deficiency and pica but none is yet to identify an agreeable explanation (Tisman & Khan, 2010). Pica remains an unexplainable and mysterious disorder especially because the unusual eating disorders it causes disappear once the patients with the disorder receive iron supplements. Researchers trying to understand the disorder have tied it to various factors such as age, religion, gender and culture, to name a few, as well as others that affect a person’s mental development such as stress (Tisman & Khan, 2010). Often times, the disorder is also considered to be a symptom of specific deficiencies rather than their cause as is the case with Pica that results in consumption of clay.

            The advancement in technology also plays a major role in helping to understand Pica and its cause and symptoms. A good example is the understanding that practitioners had in relation to patients that had developed the habit of consuming ice cubes (Tisman & Khan, 2010). This disorder was initially said to be caused by excessive ingestion of ice cubes from the ice tray and also ingestion of the ice scraps found on the wall of the freezer. With the introduction of ice cube makers and automatic defrosters, pagophagia has changed as people have more creative ways of getting ice for ingestion and/ or sucking of the ice cubes (Tisman & Khan, 2010). The ice cubes are often consumed in various beverages such as super-sized McDonald like cups also from frozen bottled water. Iron deficiency anemia has also been attributed to the chewing of rubber band while patients with sickle cell anemia have been known to consume foam rubber.

            Since glossal pain is one of the side effects of iron deficiency, it has been suggested that patients ingest ice with the hope of reducing the discomfort associated with the disorder especially because ice has analgesic properties. However, since rubber foam and rubber bands lack any analgesic properties, it disqualifies the idea behind why they are consumed by patients with the disorder (Pignatti & Zanella, 2016). It has also been suggested that consumption of the non-food substances was done to compensate for lack of zinc and iron, the idea did not hold any ground especially because most of the substances consumed do not have any nutritional value. While stress, obsessive compulsive disorder and psychological problems have been suggested as triggers for Pica, there is no direct correlation between stress and the items patients choose to consume (Pignatti & Zanella, 2016). Some patients have even attested to enjoying the crunch experienced when eating Argo starch from the box or clay cookies.

            Another challenge that makes it difficult to find a permanent solution for Pica disorder is that it affects patients left unsupervised and also because they are less likely to mention the symptoms to their caregivers. The symptoms therefore go unnoticed and since doctors are unaware, patients can go on with the behavior without being aware of the side effects (Beyan et al, 2009). The cases of Pica are thus difficult to manage and in cases where pregnant women are diagnosed, it puts them at a disadvantage especially because the disorder is easier to control in the early stages.

Results

Results showed that 1-10 pregnant women are likely to be diagnosed with pica. For children, almost 45% of the children develop the disorder while they are young but learn to live with that condition. However, it will require close monitoring of the parent to train the child on how to live with the condition. That is why parents are encouraged to seek medical help once they discover their child is suffering from that condition.

Discussion

Psychology currents estimate that 43% of the institutional population is diagnosed with pica (Parry-Jones, 2017). Majority of this number are pregnant women while the rest are children. The disorder is not very common among men.  This is based on how society perceives the male gender. Most of the people believe that such behaviors are for young children and they will try to discourage the men on those behaviors. Before the doctor makes a diagnosis of pica, there are various factors that the specialist will have to evaluate. First, it is the blood level of the patients. Also, in some cases, the previous history of the patients is reviewed. It is noted that the disorder is heredity although not applicable to every person (Parry-Jones, 2017). In that way, it will be important for the medical doctor to identify the cause and the effect of that disorder on the patient.

Given the risk of medical complication, one of the ways of treating pica is through close monitoring of the behavior of the patient. It might take a much more extended period since it relates to the behavior of that individual. Additionally, collaborating with another mental health team in treating the disorder is also applicable.

References

Borgna-Pignatti, Caterina & Zanella, Sara. (2016). Pica as a manifestation of iron deficiency.             Expert Review of Hematology. 9. 10.1080/17474086.2016.1245136.

Khan, Y., & Tisman, G. (2010). Pica in iron deficiency: a case series. Journal of medical case             reports, 4, 86. doi:10.1186/1752-1947-4-86

Khoshnevisasl P, Sadeghzadeh M, and Sadeghzadeh S, (2017) “The relationship between Pica     and iron deficiency in Zanjan, Islamic republic of Iran: A case control study” World    Health Organization

Marchi, M., & Cohen, P. (2016). Early childhood eating behaviors and adolescent eating disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 29(1), 112-117.

Parry-Jones, B., & Parry-Jones, W. L. (2017). Pica: symptom or eating disorder? A historical assessment. The British Journal of Psychiatry, 160(3), 341-354.

yan C, Beyan E, Ifran A, and Kaptan K, (2009) “Pica: A frequent symptom in iron deficiency             anemia” American Journal of Medicine