The Effect of High- Intensity Inspiratory Muscles Training (High-IMT) Vs. Sham Inspiratory Muscles Training (S-IMT)

Based on the recent reports more than 64 million persons globally have been diagnosed with Chronic Obstructive Pulmonary Disease (COPD) condition while more than 3million have died of the illness.  Respiratory muscles offer individuals with the ability and authority to breathe effectively.  However, individuals with COPD are subjected to expiratory and inspiratory muscles weakness (Hill et al, 2014).  COPD is a lung condition that normally comes up due to smoking and it is known to affect older or middle aged persons.  It is predicted by WHO that COPD may become the third leading cause of death by the year 2030 globally.  In this context, most individuals would benefit from inspiratory and expiratory specific muscle training and this would be essential in lowering the potential of the illness in the future.  It is suggested by recent studies that the loading of restricted training leads to the gaining of more advantages.

The primary aim of this paper is to offer a description and illustrations the impact of breathing exercises in strengthening muscles of persons who are characterized by COPD.  This will be achieved by basing the concept of the paper on the effect of High- intensity aspiratory muscles training (High-IMT) Vs. Sham aspiratory muscles training (S-IMT).

The study’s hypothesis is that breathing exercises normally strengthens respiratory muscles for patients characterized by COPD.  Acquired data from random trials that are based on inspiratory muscle training (IMT) effectiveness with COPD patients demonstrates some evidence regarding the training benefits on respiratory muscles.  The study concludes that high concentration training of inspiratory muscles improves the functioning of inspiratory muscles in the context of COPD which yields significant reductions in fatigue and dyspnea (Hill et al, 2014).  The use of loads on the respiratory muscles during the contraction offers adequate chances of   increasing the strength thus causing an increase in the ability to conduct physical exercises and lower the breathlessness condition.  IMT has additionally, been associated with the minimization of the use of healthcare services which services as an economic and a social benefit.  COPD individuals have myopathy and despite the fact that it does not affect all muscles respiratory muscles are mostly affected.  In addition, COPD individuals additionally experience in comprehensive breathing over the volume of the lungs where aspiratory muscles are characterized by weaknesses.  Excessive breathing saddens the diaphragm dome, lowers it fibers and pressures it to operate effectively.  The primary respiratory issue among different persons is that it is associated with a mechanical difficulty that originates from hyperinflation (Hill et al, 2014).

COPD persons normally experiences increased respiratory muscles actions demand. Exercises lead to increased breathing to significant levels. Dyspnoea is a condition where the patients experience breathing discomforts and it is caused by a combination of numerous environmental, social and physiological factors.  Respiratory muscle weaknesses lead to poor performance in physical exercises and Dyspnoea in COPD patients. It is hypothesized that high-intensity aspiratory muscles ( H-IMT) would permit a high training load  to tolerate the yielding of increased  aspiratory muscle  endurance and strength  thus reducing Dyspnoea and development  of exercising capacity (Hill et al, 2014).

Description of the Clinical Issue and the Importance of Solving It

COPD is a severe and a major health issue in the modern society with a significant impairment of life’s quality, Morbidity, and death.  The effectiveness of  Pulmonary rehabilitation programs on the capacity of exercises, health related life’s quality and the lowering of hospitalization has been  seen in  COPD patients and thus rehabilitation programs that promotes respiratory muscles strengthening are recommended in the management of  COPD (Beaumont et al, 2015). IMT tends to be more efficient when utilized alone and has thus been recommended for patients with weaknesses in inspiratory muscles which is an added advantage as the general body training adjunct is one to be doubted.  IMT holds the capability of lowering Dyspnoea through improving patient’s capacity in sustainment of high ventilation levels and a decrease of hyperinflation (Beaumont et al, 2015).

Specific inspiratory muscle training is important for COPD people’s rehabilitations programs. In that, it leads to a prolonged mechanical ventilation origin to the respiratory muscles weaknesses which consequently holds increased risks with respect to the failure of weaning.  SIMT is responsible for improving lungs functions for persons with ventilator reliant.  However, despite the fact that Specific Expiratory Muscle training offers increased benefits to patients characterized by COPD its effectiveness is much lower than that of SIMT. Inspiratory and expiratory muscles can be trained effectively which results in increased strength and continued existence (Beaumont et al, 2015).

It is highly argued by some health professions that COPD patients inspiratory  muscles fails to adapt well to the continuous  loading and thus the  respiratory trainings fail to demonstrate any responses (Marco, 2013).  However, IMT is essential as it increases external intercostals muscles fibers. COPD patients are characterized by a reduced chest diameter based on the presence of weakened muscles of the respiratory which leads to ventilation decrease.  This, therefore, justifies that breathing activity such as those of balloon blowing and feedback breathing activities with a rest that exceeds one minute is effective in strengthening and empowering muscles.  In that, the exercises improve pulmonary actions for COPD individuals. The use of different training strategies like recreational, balloon blowing and other teaming activities are essential in developing muscles strengths (Marco, 2013).

Training exercises are essential in lowering dyspnea and fatigue in COPD patients.  Training offers fitness which is essential in lowering physical disability of mobility issues which comes with aging (O'Sullivan, Schmitz, & Fulk, 2014).  Through exercises, the ability for the patients to breathe without breathlessness is lowered since the muscles are equipped with more strength of withstanding fatigue and prolonged exercises.  Attaining increased loads is of much benefits as it improves the functioning of inspiratory muscles which are dependent on inspiratory load magnitude.  In addition, increased dyspnea improvement and exercises capacity can be achieved following IMT activities which achieve increased gains in the functioning of inspiratory muscle (O'Sullivan, Schmitz, & Fulk, 2014). In the context of COPD, attaining high training loads is challenging with continuous training activities which may be influenced by the dyspnoea inception intolerance (O'Sullivan, Schmitz, & Fulk, 2014).

Description of Methods and Experimental Design

In the analysis and assessment of systematic reviews findings quality AMSTAR will be utilized as a measurement tool. AMSTAR refers to A Measurement Tool to Assess Systematic Reviews.  As a measurement tool, it is reliable that offers the opportunities of selecting literature reviews in a random manner (Holly, Salmond & Saimbert, 2017).  This is a reliable tool because it works on ensuring that biases do not occur while selecting the systematic reviews to be utilized in supporting the hypothesis and research objective.  The tool additionally, is objected at ensuring that the feedbacks generated from the reviews are consistent and accurate to enhance objectivity of the study.  Through the tool, the study can utilize measurable information in the formulation and uncovering of the reviews patterns (Holly, Salmond & Saimbert, 2017).

In addition, the tool’s validity is justified by its general ability to increase systematic reviews number by providing high capacity content that is required in supporting the hypothesis.  The study design will mainly be utilized in testing the reliability, agreement, feasibility and construct validity through the comparison of several studies.  Literature analysis with being performed together with statistical analysis through the utilization of SPSS.  A random selection of 10 systematic reviews was chosen from the acquired database.  The systematic reviews will be obtained through data searching with the utilization of the study’s keywords to ensure that the obtained reviews support the study.  The tool can be categorized as moderate because despite its effectiveness it is associated with several drawbacks.  Despite the fact that the tool offers several improvements needs that are based on a few features the tool is valid, reliable and offers an easier way of utilization for the quality methodological systematic reviews assessment (Chiappelli, Brant & Cajulis, 2012).

Mojazebi et al. (2014), in their review of evaluating the psychometric instruments, measure properties for COPD patient’s daily lives made the contribution.  The instruments are utilized in the measurement of COPD ADL that is essential in evaluating the conditions of the patients, their rehabilitation and treatment outcomes and their life’s quality while leaving with COPD.  However, the instrument is characterized by a limitation due to the lack of ADL explanation for the COPD patients prior to the development of the tool and the theoretical framework presentation that can be categorized as rigorous.  This implies that the tool can be utilized in caution by the researchers.

Laurendeau, Pribil, Perez, Roche, Simeoni and Detournay (2009), study validation in regard to BDI scores stated that BDI/TDI offers breathlessness measurements and the effects of daily COPD patient’s activities.  The study established that BDI/TDI scores can be categorized as valid tools for measuring Dyspnea in COPD patients.  They stated that there are three approaches that can be utilized in assessing Dyspnea. Leidy (1999) established that FPI is made of a measure of subjective dimensional performance that is based on patient’s experiences analytical framework.  The procedures can best be utilized in the maximization of validity for psychometric testing.  This makes it very important based on that FPA can be utilized as a measurement tool for COPD patient’s functional performance.  The quantification of Dyspnea can best be achieved through the utilization of BDI which represents Baseline Dyspnea Index.

The training of inspiratory muscles can be utilized in strengthening the intercostals and external muscles.  This strength can best be accomplished with  a reduction of the efforts that is  required during breathing which  brings a positive change in  regard to the breathing experience by ensuring that discomfort is eliminated (McConnell, 2013).  Training leads to the reduction of the time that is required in inspiration which to relaxation after exhaling.  High intensity in training leads to improved outcomes in regard to creating respiratory strength and reducing the presence of breathlessness and the associated fatigue. IMT proves to be more effective in regard to moderate COPD since the condition differs in abilities based on the specific stage due to the shortening of the hyperinflation and diaphragm (McConnell, 2013).

IMT necessitates training schedules on their specific programs that are based on respiratory training of the muscles prior to the development of breathlessness (Pryor & Ammani, 2008).  However, one of the major issue is that complying with the practices at home settings may prove to be challenging which may result in biased implications in the exercises that are objected at controlling breathlessness (Hough, 2001). Moreover, the electrical stimulation implementation on muscles lowered   breathing discomfort by increasing the capability of the COPD patients to tolerate exercises and improve the quality of living. Despite the fact that the benefits of electric stimulation have highly been studied and discussed in the recent it is usually very challenging to make the implementation in practically (Main & Denehy, 2015). 

The system is characterized by an inhalation valve that controls the respiratory gasses flow to the COPD patients thus imposing pressure during the inhalation procedure.  High-intensity breathing by the patients   leads to the strengthening of the inspiratory muscles which reduces pain and fatigue in the given muscles (Pokorski, 2015).  The attachment of IMT to the standard rehabilitation breathing program is not associated with any significant development of the functioning parameters and Dyspnea for patients with COPD. However, most studies states that IMT can be utilized as a controlling component in the activities for the patients to prevent fatigue (Monjazebi, Dalvandi, Ebadi, Khankeh, Rahgozar, & Richter, 2014). Despite the  important  developments that  are created  to the  inspiratory  functioning  it is unlike  that IMT even they are optimized  and subjected with the ventilation  limitation  in the  process  of exercise which results in  the production of meaningful  development  in the exercise  COPD capacities (Monjazebi, Dalvandi, Ebadi, Khankeh, Rahgozar, & Richter, 2014).

            References

Beaumont, M, Mialon, P, Ber-Moy C, Lochon, C., Peran, L., Pichon, R., Gut-Gobert, C., Leroyer, C., Morelot-Panzaini C., & Couturaud, F. (2015). Inspiratory muscle training duringpulmonary rehabilitation in chronicobstructive pulmonary disease: A randomized trial. SAGE. Pdf

Chiappelli, F., Brant, X. M. C., & Cajulis, C. B. (2012). Comparative effectiveness and efficacy research and analysis for practice (CEERAP): Applications in health care. Berlin: Springer.

Ester Marco, Alba L. Ramírez-Sarmiento, Coloma A., Sartor M., Josep Comin-Colet, Vila J., Enjuanes C., Bruguera J., Escalada F., Gea J., Orozco-Lev, M. (2013). High Intensity vs. Sham Inspoiratory Muscle Training For Chronic Patients. Retrieved from http://www.medscape.com/viewarticle/808455_4

Hill, A., Jenkins, S.C., Phillippe, D.L., Cecins, N. Shephard, K.L., Green, D.J., Hillman, D.R., & Eastwood, P.R. (2006). High Density Inspiratoty Muscle Training in COPD. ERS journals Ltd. Pdf

Holly, C., Salmond, S. W., & Saimbert, M. (2017). Comprehensive systematic review for advanced practice nursing.

Hough, A. (2001). Physiotherapy in respiratory care: An evidence-based approach to respiratory and cardiac management. Cheltenham: Nelson Thornes.

Laurendeau, C., Pribil, C., Perez, T., Roche, N., Simeoni, M. C., & Detournay, B. (2009). [Validation study of the BDI/TDI scores in chronic obstructive pulmonary disease]. Revue des maladies respiratoires, 26(7), 735-743.

Main, E., & Denehy, L. (2015). Cardiorespiratory Physiotherapy: Formerly Physiotherapy for Respiratory and Cardiac Problems. Saintt Louis: Elsevier Health Sciences UK.

McConnell, A. (2013). Respiratory muscle training: Theory and practice. Edinburgh: Elsevier/Churchill Livingston.

Monjazebi, F., Dalvandi, A., Ebadi, A., Khankeh, H. R., Rahgozar, M., & Richter, J. (2014). Psychometric properties of instruments measuring activities of daily living in Patients with COPD: A systematic review. COPD, 100(1980).

O'Sullivan, S. B., Schmitz, T. J., & Fulk, G. D. (2014). Physical rehabilitation. F.A. Davis Co.

Pokorski, M. (2015). Body metabolism and exercise. Cham: Springer.

Pryor, J. A., & Ammani, P. S. (2008). Physiotherapy for respiratory and cardiac problems: Adults and paediatrics. Edinburgh: Churchill Livingstone.

Meat Inspections Steps

Meat inspection is carried out to ensure that normal animals are slaughtered and abnormal animals are separated from healthy ones. In addition, it is done to ensure that meat is safe and will not cause risk to heath (Herenda, 1). To ensure that meat is safe for human consumption, the following steps are followed in official meat inspection.

Antemortem Inspection

This is supposed to be done within 24hours; emergency slaughter and veterinary examination are included in this inspection. The key things to observe are animal behavior, nutritional status and abnormality signs. This step is performed to ensure that all animals destined to slaughter are screened. Clinical information is extracted for disease diagnosis (Herenda, 1).  This inspection is also done to separate the dirty animals and diseased animals for the purpose of reducing contamination.  Suffering and injured animals are treated humanly and they receive emergency slaughter. Antemortem inspection is done to avoid killing floor contamination through separating reportable animals (Herenda, 1). In the slaughter house, the inspection makes sure that there is cleanliness.

Postmortem Inspection

 In this step, organs and carcass portions are inspected to detect abnormalities.  This step is serious and it requires technical knowledge in order to conduct viewing, palpation, classify the lesions, and coordinate antemortem and postemorten findings among other roles (Herenda, 2). In inspecting organs and carcasses, carcass judgment is done through identifying abnormal and affected carcass. An important point to note is that carcass judgments are done from two conditions; the first is localized condition -where animal defense mechanisms lead to localized conditions such as jaundice. Second is generalized condition where the animal’s defense mechanism causes the spread of diseases due to lymphatic systems (Herenda, 2). This condition leads to lesion in kidney and other areas, abscesses and   join and lymph node inflammation.

Work cited

Herenda, Drago C. Manual on Meat Inspection for Developing Countries. Rome, 1994. Print.

Core measures of nursing care plan of pneumonia

Patient number 5964-5-2, my patient, is an elderly person of 69 years, on his arrival, I did an examination, and the patient was suffering from community-acquired pneumonia. Community-acquired pneumonia is a type of pneumonia that is developed by a patient who has no or little contact to any health facility (In Deutschman, & In Neligan, 2015). Therefore, to make the practice more evidence-based upon arrival, I drew out blood culture before administration to any form of antibiotics.

Pneumonia is an infection that normally inflames the air sacs in the lungs due to bacterial infection. It is characterized mainly by a cough with pus or phlegm and mostly attack young children and older people of 65 and above. Assertively, I conducted a fact-finding interview in my physical assessment and found out the following; the patient maintained chest pain during breathing, coughing, fever, and change in mental awareness or confusion, shaking chills and sweating.

During my physical assessment, I almost confused community-acquired pneumonia with influenza. The two respiratory diseases manifest and portray more or less similar signs and symptoms. Some of those sign and symptoms includes a cough, fever or chills, fatigue or feeling tired. The assessment was only confirmed after a blood culture was cured out with the result showing a strong blood culture.    

When it comes to diagnostic test is so controversial, since the most common and most applicable diagnostic test of community-acquired pneumonia is Streptococcus pneumonia other than X-rays and laboratory test. Blood culture is the best confirmatory test of this disease, and the strongest indication of blood culture in the process denotes a severe community-acquired pneumonia or CAP and a clear indicator of those patients with inability to remove bacteria. The patients who fall in this category include those that suffer from terminal illnesses such as cancer, inactive spleen, liver disease, or complement deficiencies. Moreover, sputum specimen for culture and Gram stain may be recommended to certain patients with other kinds of pneumonia (Godshall, 2010).

A different organization such as the infectious disease society of America has unleashed comprehensive guidelines of CAP management in adults. The evidenced based outlines are very effective in shortening the time needed to switch to various activities such as switching from I.V. oral antibiotics, the length of stay as well as the time required to achieve clinical stability.

The data obtained from my patient after an examination of the Chest radiology shown that my patient was having a heart rate of 115, respiratory rate of 27. In addition, in the diagnostic process, reading from the x-ray image, I realized an increased volume of the air sacs and the lungs not centered at the hilum. Notably, the majority of pneumonia patients have a hyperdynamic respiratory response, which is featured by the low cardiac output abnormally vast difference in arteriovenous oxygen. The above diagnostics data were shown from the examination results, and these confirm the condition of my client.  

Comparatively, the treatment I rendered to my patient qualify to be evidence-based practice since its core measures were in tandem with the terms of the evidence-based nursing practice. In my practice, I carried out blood culture before the first dose of antibiotic, which is a confirmatory test even for severity of the disease. The initial dose of antibiotic I administered in the first four hours of arrival were antibiotics of choice depending on the result and examination data obtained (In Goldstein, & Morrison, 2013).

In addition, during the first step of diagnosis I carried out an oxygenation assessment within the 24 hours or a day of arrival, this was to test for the abnormal arteriovenous oxygen imbalance or difference. In my few periodic checkup within the first day of arrival, I did counsel the patient on the on the implication of smoking o his health and the significance of leading a healthy life leaving a life free from drugs. Moreover, owing to the fact that my patient was aged and prone to a subsequent attack of the same disease I carried out a pneumococcal vaccination as well as influenza vaccination before his discharge using the contraindication documentation.  

Collaborative interventions are very imperative in the nursing profession and very use full disease examination and treatment. Observing on body temperature, warmth, discharge since on the onset of infection, the immune system is stimulated, and many signs of infections appear. Periodic assessment and record keeping of body temperature is important because some patients do not produce enough inflammatory response (In Fleisher, 2013). In a case, where body temperature is the key determinant for treatment, the source of data for decision-making, it is advisable to use mercury or electronic thermometer to assess temperature with electronic and mercury thermometer with well-established accuracy. Moreover, is important to take note and report laboratory values and results of a different specimen such as blood, serum protein, white blood cells count, and cultures since they are essential for client’s immune function, physical examination, and health history (Melnyk, & Fineout-Overholt, 2011).

In comparison, my care plan for my patient was consistent to some of the existing Nursing care plans, which posit that upon arrival the nurse, should carry out physical assessment and interview, diagnostics and nursing interventions and yes I did meet the care plan.

In conclusion, evidence-based nursing practice is the best way to go in the nursing profession since it gives a clear outline of and timeline for good nursing care plan.  

Reference list

Godshall, M. (2010). Fast facts for evidence-based practice: Implementing EBP in a nutshell. New York: Springer Pub. Co.

In Goldstein, N. E., & In Morrison, R. S. (2013). Evidence-based practice of palliative medicine. Philadelphia: Elsevier/Saunders.

In Deutschman, C. S., & In Neligan, P. J. (2015). Evidence-based practice of critical care.             Philadelphia, PA: Elsevier, [2016] ©2016

In Fleisher, L. A. (2013). Evidence-based practice of anesthesiology. Philadelphia, PA: Elsevier/Saunders, 2013. ©2013

In Goldstein, N. E., & In Morrison, R. S. (2013). Evidence-based practice of palliative medicine. Philadelphia: Elsevier/Saunders.

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Political action paper

Representative: Senator Gerand Cardinale is a Republican member of the New Jersey Senate, representing District 39.

Health issue: Health effects of tobacco use

 The issue of tobacco use is an issue of concern as it is the leading cause of death in U.S., and young people are vulnerable to smoking related disease. Tobacco use is the risk factor for many diseases and it is second major cause of mortality in worldwide. Not only tobacco users are affected by the effects but also people who are vulnerable to environmental tobacco smoke.  The Center for Disease Control and Prevention’s Office on Smoking and Health reported that young people aged 18 and below are addicted to tobacco use (Slovic, 2001). On the same note, about 434,000 Americans die each year due to tobacco use. This is an issue of concern where public health tragedy and intervention programs are required to prevent deaths of young people and improve their lives. The main reason of introducing this topic to the senator is to understand the tobacco effect on health, effect of environmental tobacco smoke and how people can quit smoking (Slovic, 2001). By understanding these issues, it will be easier to implement measures which can eliminate tobacco use.

On the issue of tobacco use, Senator Cardinale supports the Family Smoking Prevention and Tobacco Control Act which is capable of regulating tobacco sales and marketing and implements actions for reducing death from tobacco use. He also participates in federal laws and policies to ensure that children and young people are protected from tobacco use, harmful effects are reduced and people are assisted on quitting. His first priority as a senator is to ensure tobacco control programs and a comprehensive approach for reducing death and illnesses and negative effects of tobacco.

Questions

1. What are some of the short and long term effects of tobacco

Addiction to nicotine, bad breath, shortness of breath and impaired lung function are short-term effects. In addition, people who are addicted developed chronic cough asthma and respiratory system damage (Fong, 2006). Long-term effects include serious health risk such as heart problems. A high percentage of people who use tobacco have long-term illnesses like hypertension, heart attack, and other related illnesses which lead to death.  Cancer is also a long-term effect. Types of cancer such as lung cancer, mouth, throat and cervical cancer are found in smokers (Fong, 2006).  Tobacco users also develop lung disease where lung airways changes in size and cause infections. Young people get long-term effect in reproductive damage, menstrual disorder, miscarriage, premature birth, stomach ulcers, weakened immune system and more (Fong, 2006).  

1. What are the dangers of environmental tobacco smoke, or second hand or passive smoking?

Environmental tobacco smoke (ETS) cause health risks. Passive exposure contributes to mortality in children since they are the vulnerable population (Larson, 2000). Passive smoking is dangerous because the exposure to smoke affects both children and adults. Particularly when nonsmokers are in enclosed places, they inhale irritants and toxins chemicals which cause many types and cancers and other diseases. In addition, second-hand smoking, especially paternal smoking increases the fetal exposure and develops preterm birth, prenatal mortality, neurobehavioral problem and more (Larson, 2000). There are 4,000 toxic chemicals found in tobacco smoke. ETS has toxic chemicals and a particle which penetrates to the airways and children develops health issues.ETS exposure to children leads to problems in lung function, asthma, bronchitis, pneumonia and other illnesses (Larson, 2000).  Adult also develop health risk when they inhale second hand smoke. On-smokers or secondhand smoking leads to heart cancer, lung cancer, and premature death.

1. How do people successfully quit?   

People can successfully quit through following these steps

• Creating a quit plan and making a call- a quit plan is important as it will build confidence in you, motivate and help you stay focused (Brizer, 2003). There are also quit programs and therapy which people use in quitting. After creating a plan, making the call means that people should say enough is enough and intermingles with other people in the community who had a similar experience so that they can assist. In addition, people need to search for help through education and media and other tools of information since they will act as a weapon in the quitting process (Brizer, 2003).
• After deciding to quite, think of My New, Health Self- this is known as visualizing and it is a powerful tool which helps people in achieving their goals. Thinking about the renewed life and cleaning the conscience, it will be easier to avoid the unhealthy life and focus on building a health life and eliminate the unburdened conscience (Brizer, 2003).
• Find quitting aids- quitting smoking is tricky and the nicotine withdraw can lead to physical and psychological problems. Strategies such as a nicotine replacement therapy will assist in behavioral change and achieve success. There are also smoking cessation programs where smokers get information and support in quitting smoking (Brizer, 2003).
• Get a fresh start- a fresh start means that after quitting, people should set goals of who they want to be. They may set educational goals, financial goals, career goals and more (Brizer, 2003).

I was impressed by the representative because he answered the questions in a deeper manner. As a  senator, he  has  the necessary  knowledge on this areas  as he  understand the trend in  tobacco smoking  and its effect to the population. I was impressed to hear that even nonsmokers are affected by tobacco use through exposure. In addition, I understood that tobacco use has long-term and short-term and both can lead to death.  I have gained important knowledge on tobacco use and I can help people quit through following the guidelines given.

Reference

Brizer, D. A. (2003). Quitting smoking for dummies. Hoboken, NJ: Wiley.

Slovic, P. (2001). Risk, perception & policy. Thousand Oaks, Calif: Sage Publications.

Fong, C. B. (2006). Smoking and health research frontiers. New York: Nova Science.

Larson, R. (2000). Health effects of exposure to environmental tobacco smoke: The report of the. Place of publication not identified: Diane Pub Co.

Growth and change in the practice of nursing

The current healthcare system is criticized since it is focused more on providing solutions to acute illnesses rather than focusing on prevention measures and wellness. The healthcare system mainly focuses on episodic care which has disadvantages on people (Debisette & Vessey, 2011). Health providers in most cases do not put into consideration the social background and other relevant information concerning patients. Patients who have chronic diseases are vulnerable to these disadvantages since they have to spend so much money. In addition insurance companies only cater for the first expenses rather than helping out patients through the entire periods they are sick. Therefore this paper will focus on the analyzing the growth and changes in the practice of nursing considering concepts such as continuum of care, Accountable Care Organizations, medical homes and nurse managed health clinics. Through the Accountable Care Organizations (ACO), doctors and nurses have been able to provide quality care to patients in the least expensive ways possible (Debisette & Vessey, 2011). The ACO brings together the needs of patients such as homecare, primary care and other useful services that will ensure patients receive attention from the medical officers. The ACO ensures that patients do not get each care separately but in deed get all the care they need integrated which ensures all their needs are catered for. Nurse managed health clinics are community based clinics which ensure that healthcare is provided to patients at standardized costs. Healthcare has been a burden to patients because of the increasing costs which deter patients from getting quality healthcare services. The problem of cost related healthcare concerns is solved by the nurse managed clinics which ensure quality healthcare services reach the common people (Debisette & Vessey, 2011).

Through the Continuity or continuum of care, the nursing field has and will continue evolving in the continuity of care management since patients need to be handled with care. The nursing filed continue evolving in the integration of systems that will ensure continuum of care takes place. The continuum of care can be defined as a system which is patient oriented that takes place over a life time, composed of all mechanisms and care services, tracks and guides patients throughout with the help of a comprehensive health care, mental care and other important services that ensure patients are able to survive (Murray, 2017). The continuum of care provides a number of services such as acute care, wellness programs and other services needed by patients. Due to its nature of providing all services to the patients, the continuum of care cannot be seamless. Community based programs, diseases management techniques, health information systems and case management services are examples of services initiated by the continuum of care in ensuring patients are well catered for (Paschke, 2017). The nursing industry is currently shifting from the episodic care system to the flawless continuum of care which will ensure doctors and nurses provide follow up services to the patients. Through introduction of the medical homes patients are able to get enough health care since the patients satisfaction is enhanced and healthcare costs reduced. The healthcare sector is currently supporting all the mechanisms that will ensure medical homes successful since patients need care from doctors and nurses. Primary care is provided by nurses and doctors in the medical homes in an efficient manner that allows patients are well catered for.

Part B

Nurses are pushing to continue their education since the healthcare sector is reforming thus needing more qualified medical personnel that will adapt to the changes and reforms (Buerhaus, 2016). Nurses feel that they need more knowledge concerning healthcare as the sector continues to grow so that they cannot be left behind. The online nursing degree programs have come up which allow nurses to gain knowledge on the changes that have come with healthcare. The nurses continue to practice nursing while earning higher education levels. Nurses feel they need to gain more knowledge in order to provide quality healthcare to the patients. For the nurses to achieve meeting the changing demands of patients, they need to increase their levels of education and training. There are increasing job opportunities for nurses since some nurses have opted on going back to school without practicing nursing which have been a challenge in the healthcare reform (Buerhaus, 2016). Nurses feel that they need the modern skills in the nursing field for them to provide quality medical care to patients. the increasing numbers of patients will lead to increased numbers of nurses thus institutions have come up in provision of modern training in nursing that will ensure nurses are qualified and in line with the new requirements. Nurses have to keep in line with the increasing technologies in the healthcare field. Nurses are required to remain sharp in learning how to use new equipments and machines that will enable chronic diseases get cured (Buerhaus, 2016). Electronic health record systems have been introduced as well as other new technology such as remote monitoring devices which nurses have to learn how to use. Apps have been introduced which enable nurses to know when they are learning late. These are new reforms that will ensure the healthcare sector improves. Through implementing these changes and reforms, quality healthcare at reduced costs will be made possible. 

Nurses help patients stay at the most favorable level of wellness. Nurses feel that it is their responsibility to give optimum care to patients since they have been trained to do that. Nurses keep away complication from patients through taking care of them and whatever they need. The current sick model ensure nurses check patients and ensure they are progressing on well (Buerhaus, 2016). Nurses act as the primary care setting in the healthcare systems thus know and understand patients. The nurse is the first person patients see and is the one who determines whether the patients are in the health illness continuum (Slatyer et al, 2016). Nurses ensure that patients get care since the nursing field is all about wellness programs and prevention. Nurses are well prepared to see the healthcare reforms take place since they will ensure their services are provided in the best way possible using the modern facilities. Nurses ensure they provide chronic care management, homecare, school care and other services that ensure people remain healthy (Buerhaus, 2016). Nurses are taught on community based programs where they learn how to take care of the community’s heath. Acute care will still be important but community care will be of more importance since nurses will provide healthcare to the community. The aging population is current on the increase which means that nurses will require being competent in that sector so that they can take care of the aging population (Buerhaus, 2016). It is the concern of nurses that through the healthcare reforms, the patient numbers is expected to increase. The fear most nurses have is that hospitals will not add more nurses thus they will have to overwork.

Nurses feel that most people who initially did not afford medical care will flock in the hospitals which mean that it will be hard for current nurses to handle the increasing populations. Hospitals will need to employ more nurses who will be able to handle the high populations. The heath reform law focuses more on rewarding quality healthcare unlike quantity meaning that hospitals have to employ more workforces (Slatyer et al, 2016). The reform law focuses on providing community care to the community people at affordable costs. The mortality rate has been on the rise due to unaffordable heath cost which the heath reform needs to minimize. The law basically supports provision of healthcare services in the communities. Nurse managed heath clinics, school based clinics, homecare and rural healthcare services are some of the improvements the heath law is advocating for (Slatyer et al, 2016). The programs are basically ensuring that healthcare is provided to the community. The healthcare reform is ensuring healthcare is provided to the community so that people can easily afford. In addition, the reform is advocating for certain services to be provided in hospitals. Such services include; disaster prepared services, trauma care services, wellness and prevention programs among many other that will ensure people are catered for in an all-round system (Slatyer et al, 2016). The healthcare reform, from nurses’ point of view will ensure nurses are trained in the best way possible so that they can provide quality services to the patients. Nurses are basically involved in ensuring quality and safety thus ensuring patients satisfaction.

References

Debisette, A. T., & Vessey, J. A. (2011). Nursing workforce issues. New York: Springer.

Murray, E. J. (2017). Nursing leadership and management for patient safety and quality   care.

Paschke, Susan M. 2017. "American Academy of Ambulatory Care Nursing Position        Paper: The Role of the Registered Nurse in Ambulatory Care." Nursing             Economic$ 35, no. 1: 39-47. Academic Search Premier, EBSCOhost (accessed         March 29, 2017)

Buerhaus, P. I. (2016). Data Watch. Recent Changes in the Number of Nurses Graduating            from Undergraduate and Graduate Programs. Nursing Economic$, 34(1), 46-48.

Slatyer, S., Coventry, L. L., Twigg, D., & Davis, S. (2016). Professional practice models for nursing: a review of the literature and synthesis of key components. Journal   Of Nursing Management, 24(2), 139-150. doi:10.1111/jonm.12309

Milestone 1

A Looming Mental Health Crisis and Psychiatrist Shortage in Concord City, New Hampshire

1. Description of the Concord,NH community.      

Access to quality and affordable health services is every person’s right in the United States. Concord City is experiencing difficulties to find the mental practitioners who will offer services to the citizens who are in dire need of these services.  The problem frequently arises due to the fact that the government is unable to pay these practitioners a salary that commensurates the current marketing standards. As a consequence, they are unwilling to work in these facilities at such a salary (Rich-Kern, 2016).

2. Identification of a specific population.

The case in Concord, New Hampshire is critical since there are acute crises of the mental specialist’s shortage.  Due to this problem, the Depart of Health in the region is unable to provide mental health services to the city residents based in the area as there no enough practitioners to offer these services.

3. A problem statement that includes 1. – Scientific evidence about the impact of the particular condition and 2.- The impact of this condition in the Concord,NH population.

The shortage of the mental specialists has been so acute that it has led to the closure of the mental medical facilities that were once set up to address the problem.  For instance, inpatient was shut down in 2010. This has resulted in the under the provision of the mental medical services to the young children with the psychotic symptoms which linger in the pediatric wards for a long period of time (Solomon 2016).  The number of the hospital beds meant for the psychiatric patients in New Hampshire has also been declining gradually over the time. For instance, in 2010, there were about 189 psychiatric beds for the potentially dangerous patients who are normally admitted involuntarily.  Nevertheless, this number has declined to 158 by 2016 leading to the loss of 30 beds (Rich-Kern, 2016).  Due to the mental practitioner’s shortage in the region, the mental facilities available are highly congested, and in some cases, the patients are discharged before they have stabilized (Nesnera & Alle, 2016).

4. What is currently being done in the Concord community for the NH population.

Currently, the NH citizens’ health inventiveness, is recruiting more primary care givers as well as health specialists into the initiative of learning collaborative that will integrate behavioral health into the primary care program. This integration will over time will improve on the patients’ health and the overall health outcomes as they implement the evidence based practice. In other cases, the facilities have been opened up, but due to the shortage of the psychiatrist nurses, the operations have been delayed for a long time even for up to a period one year.

5. In relation to problems that Concord face, how is data different in Concord NH than the rest of the state?

            Despite the fact that mental specialist problem is a serious problem in the country, the problem seems to hit hard some regions such as Concord as compared to other areas.  The problem is exacerbated by the fact that there is increased need of these services in the country, but their provision is limited by the number of qualified medical staffs available to offer the behavioral health services.  The current health statistic reveals that one individual out of the five citizens lives with a mental condition (Rich-Kern, 2016).  This clearly depicts how bad the situation is in this region.  

6. How Concord is different than the rest of the state

Other populations are offering and delivering quality services to the mental health departments as compared to Concord. Lousiana for instance, have improved their training by extending this training to the metal care providers while other parts of the country offer mental health outreach programs for instance in Wyoming (Szabo 2013) It is thus evident that some populations of the US country have well organized and managed mental health programs with adequate mental health specialists and housing facilities for the mentally ill patients. This is not the case in Concord and as there are shortages of mental care providers.

7. OBJECTIVE data and OBSERVATION DATA

            It is clear that 25-30% of the visits that are made for primary medical care in Concord, either originate from behavioral health aspect. Patients tend to have depression and anxiety with some signs of chronic medical condition. These signs increase the cost as they require more attention from mental health specialists. In conclusion, There is a need for the government to respond to the mental health crises in the city and act swiftly to alleviate the problem so as to ensure all its citizens have access to the health services that are not only of high quality but which are also affordable all the time.  

References

RICH-KERN, S. (2016). Psychiatric Services Gap Widens in NH. Business NH Magazine, 33(9), 31.

Solomon, D. (2016, July 21). Growing Pains for State Hospital's Crisis Unit. New Hampshire Union Leader. http://www.unionleader.com/health/Growing-pains-for-state-hospitals-crisis-unit-07222016

Nesnera, A.. & Allen, D.E. (2016). Expanding the Role of Psychiatric Mental Health Nurse Practitioners in a State Psychiatric System: The New Hampshire Experience. Psychiatric Services 67:5, May 2016.

Szabo L (2013). State Report Card on Mental Health Care. Retrieved from: www.usatoday.com/story/news/nation/2013/01/07/states-mental-health/1805023/

Campaigns for Health & the Environment

Introduction

My anti-text-driving campaign will engage Drexel university students as the target audience.  The target audiences were chosen based on analyzing their text driving habits and the motive behind the conduct.  Drexel university students and all students in general have the tendency of arriving to class late which is mostly influenced by individual’s lifestyles, peer pressure and peer beliefs.  As  youths  they  are  highly engaged  in directing messaging and  the  addiction  cannot  be  avoided  even  while  driving.  Most of the students  drives speedily  to school  to catch up with  the  class  progress which they  are  already  late for.  In the case of  driving  and  texting they are  likely to be engaged  in  accidents  since text driving can best be  categorized  as  blind driving (Richtel 1). The  goal  of the  campaign is therefore  to  demonstrate to the  students that  text driving  is not a form  of competence but rather  than ignorance.

Test-driving Issue and Facts

Road accidents deaths and damages are on the rise currently and most of the cases reports states that the victims were texting actively while driving (Richtel 1).  Texting can wait since most of the conversations are just based on not emergency or justifications (Richtel 1). The problem is that despite the increased campaigns to warn youths about text driving the tendency   has not stopped.  The campaign is aimed  directly  at transforming the  general  attitudes of students towards text driving  but illustrating how  it  can affect their  lifestyles and that  of the loved  ones. The objective of the campaign is to ensure that text driving accidents among students is reduced drastically. This will be achieved through offering education on the activity’s danger on road users to obtain a positive attitude.

Social Norm Theory and Its Application in the Campaign

Social norms theory is mainly utilized  in the description  of different  situations that  individuals  or peers utilize and the general community  which  differs from their unique beliefs despite knowing  that  it  is not  good (Schneider, Gruman and Coutts 75).  Most of the assumption that the individuals utilize are directly related to risky and problematic conducts in regard health and the surrounding.  The  theory  was  utilized in the campaign in analyzing why  Drexel students  choose to text drive despite the fact that they understand  it’s  not  right  and  it is a risk.  It was established that it was because of the peer pressure. In that, text  driving  to most youths  is  assumed  to  be  a form of  expertise and  everyone  wants  to show  case that they  can.  This is however not true based on the involved risks and   it is not a form of profession since if it was it should have acquired a place in learning.  With the rise of countless campaigns against the act students understand that it is not right since this is a dangerous engagement. After  developing  awareness  of the issue among the target  audience  based on the  theory  individuals should be left in order to  make theory personal changes  in regard to settling for the right beliefs rather  than  popular misconceptions (Schneider, Gruman and Coutts 76).

In order  for efficiency to  be achieved  from the campaign  the  students were  challenged  to  make an analysis of the text driving benefits  which there was  none as compared to the  severe implications.  Those that were against the campaign based on their peer beliefs were the primary priority as a change of attitude was highly required.  This was achieved through target sampling or segmentation that was based on demographic details encompassing age, gender, attitude, preferences and behaviors.  This  strategy  was  adopted to ensure that  all the significant students demography  that  was essential  in the case was  captured  to ensure that  those that desire  to text drive and those  who  actively and positively do it are  involved.

Formative Process

Data collection  was achieved  through  interviews as well as  questionnaires  since the tools are  characterized  with  fast  collection  speed, efficiency, reliability, cost  efficiency  as  well as the capability  to maximize  the  collected information.  The utilized formative assessment was based on impact, outcome and the campaign process.  This involved  measuring the perception of the  students   about the  issue, the  reach of the campaign, the capability  to affect  changes  in  social norms, attitudes  or  their  beliefs  and whether  the  objective of the campaign  had been  obtained.  The formative assessments tools included self evaluations, conversations and analyzing during data collection. The results  indicated  that  students engages in text driving  due to peer  force  and  the  need  to  fit in the  group. The  effectiveness of the campaign  was  thus established  as  the students attitudes  transformed  gradually  by  establishing  that  it was more  beneficial  not  to text  drive  in saving  persons  lives. The campaigns plans were however, limited by funds time and the willingness of individuals to fully participate in the campaign.  This  slowed  down the  timeline since  much  effort  in  convincing and  persuading  audiences  was a major  necessity.

Campaign Implementation

Based on the 4P’s strategies, the  products  utilized  in  the  campaign  are  blogging, partnership,  public report, picture  competition, Facebook, twitter and website  posting.  The budget  was  1560 dollars  for all the  products  with  promotion  being achieved  using  email marketing,  video marketing, direct messaging, search engines and  public relations.  In order to  appeal  full to the  target  audiences  the  primary campaign event occurred  during  the  orientation  week  based on the convenience. Negative  attitude and the uneasiness  of  students to  make their participation  as the primary  barriers were  utilized in  aligning  the objectives, benefits and  limitations for  maximum gain.

            Work Cited

Schneider, Frank W, Jamie A. Gruman, and Larry M. Coutts. Applied Social Psychology: Understanding and Addressing Social and Practical Problems. Los Angeles: Sage, 2012. Print.

Richtel, Matt. Trying To  Hit  The Brake On  Texting While Driving. 2014. Retrieved from https://www.nytimes.com/2014/09/14/business/trying-to-hit-the-brake-on-texting-while-driving.html

Richtel, Matt. In Study, Texting Rising Crashes 23 Times Higher. 2009. Retrieved from http://www.nytimes.com/2009/07/28/technology/28texting.html?mtrref=www.google.com&gwh=A803E945B16757356B7351387E223CC8&gwt=pay

Research

A brief history of the OSHA standard

OSHA standards are based on Blood borne Pathogens and these standards were issued in 1991. Exposure to blood borne pathogens has affected the working environment in health care facilities and health care workers face health care risks (Acello & Brenda, 2). The OSHA standard has precaution guidelines for preventing and protecting workers from pathogens infection. All employees in health care facilities are protected by the standards. OSHA was passed by the Congress in 1970 and it was amended in 1990(Acello & Brenda, 2). The OSHA standard was improved and it adopted the principles of Needlestick Safety and Prevention Act.  The Centers for Disease Control and Prevention confirmed that Blood infectious materials cause health risks through transmitting diseases. HIV and HBV have caused a big threat to the health care workers and this condition has increased the attention for prevention and control (Acello & Brenda, 3). The purpose of the law was to protect the American workers from hazards which may affect life. The OSHA polices were made to ensure that  employees work in a  safe environment  and it was concluded that safety can be fostered  if; employers  create safety program which will assist in reducing health hazards,  If both employees and employers have responsibility in  maintaining a health working conditions,  If the secretary of labor in U.S  creates a  commission and mandatory rules and if new innovative methods  for dealing with safety problems are developed (Acello & Brenda, 5).

The Blood borne standards state that;

• Employers must create a control plan and use the technological control in preventing occupational exposure which has affected employees.
• Employers must offer education and training programs to assist employees understand the occupational risks and methods of control (Acello & Brenda, 3).
• Employers should provide medical evaluation, clothing and equipment after exposure.
• Employers should allow employee take voluntary HBV vaccine and should provide them with precautions for HIV and HBV prevention.
• Employers should ensure products have warning labels for hazard identification.
• Employers should maintain a high level of confidentiality with employees’ information and keep safe employee training and medical records (Acello & Brenda, 3).

The standard for food service warehouse

 OSHA standard for food service warehouse state that food and beverage in a warehouse should not be consumed if they are stored in place where there are toxic substances. According to OSHA, toxic substances are materials inside a warehouse (Kulwiec, 664). For example, the picnic tables found in warehouses are illegal and it is recommended that warehouse management should follow OSHA regulations and design areas for food services. Areas with warehouse food services have vending machine and OSHA regulations state that there should be separate facilities for every person and the distance should be approximately 200ft from the main facility (Kulwiec, 665). In addition, there should be good warehouse layout to ensure effective warehouse operations, material accessibility, labor efficiencies and security. Standard for food service warehouse are provided to create a good housekeeping, to ensure quality economic storage, effective handling of materials and to maximize utilization of space (Kulwiec, 665).  The standards also states that the methodology for warehouse layout should be as a follows; identify the location obstacles such as utilities, elevator shafts and more before planning the layout. Second, receiving and shipping areas must be set for maximizing efficiency. Third, areas for material storage should be set for labor efficiency, material storage and space maximization.  Fourth, storage location should be set in the layout for effectively planning the alternative layout for other activities (Kulwiec, 665). Last, warehouse evaluation should be done to assess the desired objectives.  

Work cited

Kulwiec, Raymond A. Materials Handling Handbook. New York: Wiley, 1985. Print.

Acello, Barbara, and Brenda Goodner. The Osha Handbook: Guidelines for Compliance in Health Care

Facilities and Interpretive Guidelines for the Bloodborne Pathogen Standard. Clifton Park, N.Y:

Thomson/Delmar Learning, 2002. Print.

            Reflection Journal

From the course, I have learnt that there is a heavy burden of communicable and non-communicable diseases and this is a great threat to the global health. This burden has increased the level of poverty and has negatively impacted the economic development (Skolnik, 2012).  Non-communicable diseases (NCD) are influenced by unplanned urbanization and unhealthy lifestyles. I have learnt that lower-income countries are vulnerable to risk of non-communicable diseases and this becomes a big challenge as they are unable to implement control measures.  Health transition has caused demographic dynamics and   the change has impacted the health financing decision due to the fact that many people need health services despite the limited resources (Skolnik, 2012). What surprised me is that the higher level of morbidity and mortality is a result of epidemiological transition. This is because, it affects the health needs of the population and the health system faces challenge in implementing technologies and approaches to meet health needs (Skolnik, 2012).The Global Burden of Disease Study states that there are health challenges facing the world in 21^st century. In addition, many developing countries are facing health transition and this is causing both demographic and epidemiological changes. The change has a profound effect on health service in terms of health care cost (Skolnik, 2012).

 The lessons from global healthy will apply in my future career. This is because; I will apply this knowledge in different areas such as infectious disease management, community outreach and more. Having the knowledge and skills on global health, I will help the public prevent from the risks of non-communicable and communicable diseases (Evert, Drain & Hall, 2014).  In addition, the lesson learnt from epidemiologic transition will assist in helping the vulnerable immigrants’ communities in disease control and prevention. Due to demographic changes, I will use evidence-based decision making to implement prevention and control programs and  find strategies for maximizing the resource utilization diseases (Evert, Drain & Hall, 2014). In my career, I also feel that the technology will play role in global health arena in order to improve the health care system and eliminate the burden of disease. First, Low-income countries need health-related technologies such as medical devices. Medical devices are not medicines but rather they are used for prevention and control diseases (Evert, Drain & Hall, 2014). World Health Organization states that medical devices such as low-cost infant warmers, portable low-cost ventilators among many other are important in health care services. Other point is that road-traffic injuries are causing higher rates of death in low-income countries. Limb-immobilization device should be implemented for improving care. Mobile applications should also be used in community in providing preventative measures diseases (Evert, Drain & Hall, 2014). In addition, the government should eliminate the burden of diseases through implementing an integrated action.

Reference

Skolnik, R. L., & Skolnik, R. L. (2012). Global health 101. Burlington, MA: Jones & Bartlett Learning.

In Evert, J., In Drain, P. K., & In Hall, T. L. (2014). Developing global health programming: A guidebook for

medical and professional schools.

Community Needs Assessment in New Hampshire

Milestone 1

A Looming Mental Health Crisis and Psychiatrist Shortage in Concord City, New Hampshire

            Access to quality and affordable health services is every person’s right in the United States.  The government and other agencies have the responsibility of ensuring that citizens can easily access health services without much strain in every part of the country by ensuring there are enough facilities that are well equipped and adequately staffed with highly qualified practitioners.  However, this is never the case in Concord, New Hampshire where there are acute crises of the mental specialist’s shortage.  Due to this problem, the Depart of Health in the region is unable to provide mental health services to the city residents based in the area as there no enough practitioners to offer these services.

            Despite the fact that mental specialist problem is a serious problem in the country, the problem seems to hit hard some regions such as Concord as compared to other areas.  The problem is exacerbated by the fact that there is increased need of these services in the country, but their provision is limited by the number of qualified medical staffs available to offer the behavioral health services.  The current health statistic reveals that one individual out of the five citizens’ lives with a mental condition (Rich-Kern, 2016).  This clearly depicts how bad the situation is in this region.  Concord City is experiencing difficulties to find the mental practitioners who will offer services to the citizens who are in dire need of these services.  The problem frequently arises due to the fact that the government is unable to pay these practitioners a salary that commensurates the current marketing standards. As a consequence, they are unwilling to work in these facilities at such a salary (Rich-Kern, 2016).

            The shortage of the mental specialists has been so acute that it has led to the closure of the mental medical facilities that were once set up to address the problem.  For instance, inpatient was shut down in 2010. This has resulted in the under the provision of the mental medical services to the young children with the psychotic symptoms which linger in the pediatric wards for a longperiod of time (Solomon 2016).  

Due to the mental practitioner’s shortage in the region, the mental facilities available are highly congested, and in some cases, the patients are discharged before they have stabilized (Nesnera & Alle, 2016). It is clearly observed that these mental ill health patients in New Hampshire have no access to adequate and quality services and this has attributed to the rose in the number of mental disorders.

It is also observed that the number of the hospital beds meant for the psychiatric patients in New Hampshire has also been declining gradually over the time. For instance, in 2010, there were about 189 psychiatric beds for the potentially dangerous patients who are normally admittedinvoluntarily.  Nevertheless, this number has declined to 158 by 2016 leading to the loss of 30 beds (Rich-Kern, 2016).  In other cases, the facilities have been opened up, but due to the shortage of the psychiatrist nurses, the operations have been delayed for a long time even for up to a period one year. 

           There is a need for the government to respond to the mental health crises in the city and act swiftly to alleviate the problem so as to ensure all its citizens have access to the health services that are not only of high quality but which are also affordable all the time.  Low payment of the psychiatrist has been the deterrent factor, and there is a need for the responsible institutions to take charge and review salaries that are offered to these practitioners upward (Rich-Kern, 2016).

References

RICH-KERN, S. (2016). Psychiatric Services Gap Widens in NH. Business NH Magazine, 33(9), 31.

Solomon, D. (2016, July 21). Growing Pains for State Hospital's Crisis Unit. New Hampshire Union Leader. http://www.unionleader.com/health/Growing-pains-for-state-hospitals-crisis-unit-07222016

Nesnera, A.. & Allen, D.E. (2016). Expanding the Role of Psychiatric Mental Health Nurse Practitioners in a State Psychiatric System: The New Hampshire Experience. Psychiatric Services 67:5, May 2016.

Milestone 4

Program Evaluation for Public Health Intervention for the Mental Health Crisis and Mental Shortage in the Concord, New Hampshire

Interventions

            Collaborative intervention program for the management of the depressive disorder is one of the recommended strategies that are appropriate for dealing with the mental disorders in Concord. This is an evidence based approach that is efficient in improving the symptoms of the depressed patients, their adherent to the treatment, their response to the treatment and the reduction and recovery from the depression. Based on the weight of the evidence that is acquired from the cost and benefits, it is clear that these collaborative model care interventions offer good economic value. This intervention program is also a health care system level intervention that utilizes case directors to connect primary care providers the patients as well as the mental health specialists. The intervention aims at improving the regular screening and diagnosing of the depressive disorder (Community preventive service task force n.y).

            This intervention program has been effective to the community as it have enhanced the support of the primary care givers through their case managers to perform functions such as providing the patients with education, making up follow ups so as to track depression outcomes and the observance to their treatment. They are also able to adjust treatment strategy for those patients who fail to respond well and fail to show signs of improvement (Community preventive service task force n.y). The use of the technology based resources such as the electronic medical data, telephone records and contacts and some of the provider reminder methods enhance the intervention to be a success as these mental specialists will be able to make an easier follow up on the patients.

            Collaborative model intervention program will thus be very vital in mental health sector in Concord as all the relevant care givers and other managers will be involved in ensuring that mental health crisis that is caused by the psychiatrist shortage is addressed. This gap that is in existence in New-Hampshire should be bridged through the collaborative initiative where the primary givers and case managers who are available are offered education and assistance from the few mental health specialists in the country. This will help in the division of labor amongst all these people thus allowing them to be able to treat the increasing number of people who are suffering from the depression disorder. They will also be able to offer and deliver timely treatment and follow ups on the patients as they the load of patients will be divided amongst all the collaborators. As the government also offers the resources and the funding of this program as they are also collaborators they will enhance these specialists to be able to meet the needs of all the case managers, the mental health specialists and the primary care givers. Hence they wil be able to function effectively and deliver quality services to their patients as they will be motivated to work in unison so as to attain a common goal of averting the mental disorders that face the citizens in Concord, New Hampshire.

            This intervention program is cost effective as compared to the usual care and other collaborative care that includes the pharmaceutical treatment. According to the other studies as well it is important to note that, it is vital to carry out training as well as background of the core members of the collaborative team. This should be integrated with more research on the effectiveness of the collaborative care that has been undertaken in the area and in other areas so as to be able to have strong information concerning the field on the practicality of this intervention for the management of the mental ill health so as to have a continuous improvement.

References

Community preventive service task force (n.y). Improving Mental Health and Addressing Mental Illness: Collaborative Care for the Management of Depressive Disorders. Retrieved from:

https://www.thecommunityguide.org/sites/default/files/assets/Mental-Health-Collaborative-Care.pdf

Improvement in the Manufacturing Versus the health care industry

Introduction

Health insurance has risen in the past few years making it unaffordable to most US citizens. The affordable care act passed during March 2010 has not cut the expensive costs of health care and insurance despite being passed to cut the increasing costs in the health care sector. Health care services are seen to rise but in proportion with the increasing costs of other goods and services in the manufacturing industry as well.  Due to the inflation gap, many have argued out that medical expenses continue to become high thus need to be curbed. There is need to cut the medical costs for average Americans since the costs of other goods and services are not as high as the medical expenses. The health of people is important compared to the manufacturing goods such as vehicles thus medical care needs to be affordable. This paper will therefore look at the improvements in the manufacturing industry compared to the healthcare industry. The healthcare industry need to be improved and made affordable to the all Americans including those poor Americans.

To begin with, the increasing medical expenses are attributed to a number of factors that need to be considered when cutting off the expenses. Financial greed from the medical hospital and pharmaceuticals has been cited as one of the factors that contribute to the increasing medical expenses (Burns, 2012). Medical providers such as nurses and even doctors have been greedy since they want more money therefore charging more expenses on the patients. The healthcare industry through new technology has come up with various improvements that treat diseases such as cancer that claimed many lives before. Doctors have taken the advantage of new technology to charge patients high medical bills. Those who are not able to afford the high bills are left to suffer which is becoming a concern since health care need to become affordable. Health care cost is seen to increase in high rates compared to the increase in the rest goods and services. It is therefore a concern since healthcare should not be high compared to other products. Hospitals are making more profits since the cost charged is way above the cost of other products. Healthcare productivity is seen to glow at a slow rate compared to growth in other industries which means that medical costs will continue being high compared to other sectors (Burns, 2012).

Most people in the medical field argue out that the industry is the most complex industry to manage since it deals with the lives of patients directly (Kros & Brown, 2013). Health care industry has some few differences with other sectors but can still learn from other sectors such as the manufacturing industry. Toyota manufacturing industry for instance was the most successful company in 2010 when the rate of accidents was high (Burns, 2012). The company ensured that it provided high quality vehicles for its customers in order to ensure the customers remain safe and satisfied as all the time. The company ensured it delivered vehicles to customers at all the time in a manner the customers want at affordable costs without waste. This was a system used by the Toyota industry and later spread to other industries even the healthcare industry. The health care industry introduced the Lean system which saw the hospitals provide healthcare to patients at all the time which led to improvement in the healthcare field (Chalice et al, 2007). However the healthcare sector did not ensure that its services were affordable to all people while they should be affordable in order to curb the increasing mortality rates among the American people. Lean techniques have been successful in other industries with the exemption of the health care industry which insinuates that the healthcare sector is expensive.

Patients’ safety should be enhanced since people cannot be compared with the automobiles. The sector should ensure that patients are well catered for without discrimination. The healthcare industry has been considered as one of the fragile industries since it focuses on the life of patients. The industry needs to be vigilant and ensure its increases the quality of its services and ensure the customer service is the best. The industry needs to gain the trust of the patients and ensure patients are not charged high expenses which they end up failing to afford (Burns, 2012). Healthcare sector faces many safety and quality concerns. The industry is now a competitive industry where all the clinical officers in different hospitals they provide the best medical care to their patients (Chalice, 2005). Most of the clinical officers measure quality on their own and end up concluding they are providing the best services. This a key challenge in the healthcare sector therefore people should conduct a measure on the quality of care so that clinical officers can rate themselves. Clinical officers therefore need this data in order to ensure they check on the areas they need to improve on. The healthcare industry need to improve its quality and raise its quality since it will be one way of minimizing the healthcare costs.

Unlike the manufacturing industry, healthcare industry is complex and fragile since it deals directly with the life of patients. The industry should be affordable to all people since life is basic unlike automobiles which people can survive without. Currently, the hospitals are looking for ways of ensuring they provide quality healthcare services and cut costs as well in order to ensure healthcare is made affordable (Chalice, 2005). Hospitals are also looking for ways of eliminating the wastes that ensure healthcare services are expensive. Most hospitals have opted on using the manufacturing lean techniques which ensure healthcare will be provided affordably and the same time waste is eliminated. The progressive and successful hospitals are those using the lean techniques since they provide quality services to patients, ensure the patients are safe and waste is eliminated (Chalice, 2005). The healthcare industry grows at a slow pace compared to the manufacturing industry thus the difference in the rate of improvements and costs. The manufacturing industry moves at a faster pace with technology thus tends to provide quality services and goods to customers at affordable costs. The healthcare industry needs to move at a faster rate in proportion with the manufacturing industry so that the lean techniques can become successful in the industry.

Conclusion

The healthcare industry has lagged behind compared with the manufacturing industry from the above discussion. The healthcare industry needs to increase its pace so that the lean techniques can ensure the costs of healthcare are reduces and the quality of the healthcare services improved. Healthcare is an important sector since it directly deals with the life of patients therefore need to improved, quality of services increased and made affordable. Therefore hospitals and clinical officers need to ensure they come up with ways of reducing the costs of medical care and eliminating wastes that lead to high medical expenses.

References

Burns, L. R. (2012). The business of healthcare innovation. (The business of healthcare    innovation.) Cambridge: Cambridge University Press.

Chalice, R. (2005). Stop rising healthcare costs using Toyota lean production methods:    38 steps for improvement. Milwaukee, Wis: ASQ Quality Press.

Chalice, R., Chalice, R., & American Society for Quality. (2007). Improving healthcare   using Toyota lean production methods: 46 steps for improvement. Milwaukee,            Wis: ASQ Quality Press.

Kros, J. F., & Brown, E. (2013). Health care operations and supply chain management:   Strategy, operations, planning, and control. San Francisco, Calif: Jossey-Bass.