Systematic Review in Public Perceptions of Pharmacists and Pharmacy Services

            ABSTRACT

            Background: One of the significant and fundamental factor that will in the present days and in the future, in the pharmaceutical industry is a clear comprehension of the public needs, also depicted as the consumers, expectations, and as well as satisfaction. The systematic review will categorically aim establish the perception of the public and patients with the functions and services given by pharmacists and pharmacies.

            Key words

            Pharmacists – are also established as druggists who are professions in health and practices in pharmacy which is a heath science field and bases their focus on effectiveness of the use of medications.

            Pharmacy- is the technique and science which is utilized in dispensing and preparing drugs. This is thus a profession of health sciences which utilizes chemicals with the main purpose of ensuring effectiveness and safety in the utilization of pharmaceutical products.

            Differentiation- is the process of making products distinct from all the other similar products.

            Abbreviations

NHS- National Health Service

CASP0- Critical Appraisal Skills Program

RCTs- Randomized Controlled Trials

            Acknowledgement

            Following, an intensive research period, writing my note of thanks is the completing touch of my thesis. This has been an intense learning period for me both in the research arena and at an individual level. Writing this research has thus made a huge effect on me.  I would therefore, wish to mirror on the individuals who assisted and supported me throughout the whole period.

            First, I would wish to thank all my colleagues from school for their great and lovely collaboration. It would be an ungrateful act to assume thank you supported me because you had too. Your support is well appreciated and it was of great help to me as you were all willing to help me at all times. In particular I would wish  to single out my research professor and supervisor, I want to thank you so much for your reliable  cooperation, support and for the general opportunities that you provided for me to perform my research and also to further my research project.

            Additionally, I would wish to thank my tutors, for offering their valuable knowledge as well as guidance.  Definitely you were great to me because you provided me with the necessary tools which I mostly needed in selecting an accurate direction.  This gave me the power to complete my research thesis without worry as the knowledge and power of working everything out was well exposed.

            Moreover, I wish to thank my parents for their general wise support, counsel as well as the sympathetic ear that they always landed to me. I would not have made it without your support as this is all that I needed during this period.  Finally, I cannot be done without thanking my friends. We did not only offer deliberate support to each other over the issued that we shared as well as findings but we were additionally involved in happy talks in regard to general things in exemption of the papers which made a huge impact based on the generated happiness.

To everyone, I say thank you.

            Funding

            This research did not receive any particular funding grants from agencies in commercial, public or from the profit generating sectors.

            Methods: All relevant articles examining and identified published from January 2000 until December 2015 were searched using various search engine, bibliography searches and authors’ libraries. Studies were included if they: 1) quantitative and qualitative primary research papers, 2) any papers based on public perception of pharmacy services.

            Results and Discussion: Forty percent (10 out of 25) of studies conducted in developed countries while sixty percent (15 out of 25) of studies conducted in developing countries. In both developed and developing countries, 60% (15 out of 25) of studies demonstrated the satisfaction of public perception towered pharmacists’ activities and pharmaceutical services while 40% (10 out of 25) of studies illustrated the dissatisfied of public expectation overlooked pharmacists’ role and pharmacy services.

            Conclusion: The majority of the public in the review had a positive perception regarding the services offered to them by the pharmacist as well as perception towards their profession. It is, therefore, a good suggestion that there is is need to educate the public about the role of pharmacists and the services that should be delivered to improve the patients-pharmacists relationship and develop the pharmacists’ role and the services provided by pharmacies in this manner enhance the fulfillment of clients.

1. INTRODUCTION

            Health and life sciences is a critical area, mostly given its connection with the daily lives of people. In that line, Pharmacists have been much about connecting with the individuals in matters relating to their well-being. In a more general perspective, the role of the pharmacists is the role of being as health enhancers. However, the use of pharmaceutical services has been on the rise in the last few decades. The shift experienced has been from a typical view of a pharmacist being mere medication vender to a position where the public now a visions them as doctors. Revisiting the case of the changes of roles in the pharmaceutical environment, it is clear that the public perceives their services in a different point of view.

            Guirguis et al., (2005) postulates that further studies support the increasing involvement of pharmacists in the broader healthcare setting will demand transitions in behaviour by pharmacists and the general public as a whole. Other researchers continue to show and support that attitudes, beliefs and views made a dominant part of practice as postulated by Jose et al., (2015).  In that case, there was a need to look at the attitudes of consumers on the healthcare setting mostly pharmacists and pharmacy in addressing persons medical needs.

2. OBJECTIVES

            The main objective of the review was to scrutinize and observe the ideas, viewpoints, perspectives, and beliefs of the public concerning pharmacy as a field and pharmacists as having medical roles. This systematic review identified that consumers and the pharmacists do have significant roles and specific responsibilities in their relationship, also depicted as a patient pharmacist professional relationship. It is at this point that the satisfaction of the consumer has been an essential component healthcare service.

3. METHODS

A systematic review of the current research evidence addressed the question ‘What are the public perceptions of pharmacy, pharmacists and pharmacy services?’ using the descriptive analysis method. Three electronic databases used in this review MEDLINE (PubMed), Scopus and the Cochrane Library. They identified all relevant articles published in English from January 2000 until December 2015. The search engine Google Scholar, which provides a broad search of academic articles from sources including theses, books and abstracts used to identify the papers published online that are not identified by the databases.

            SEARCH STRATEGY

            The following combination of search terms used in the search strategy with each database: (“public” OR “consumers” OR “patients” OR “clients” OR “customers” OR “users”) AND (“perception” OR “belief” OR “attitude” OR “view” OR “satisfaction” OR “expectation” OR “opinion”) AND (“pharmacy” OR “pharmacist” OR “pharmaceutical service”) AND (“pharmacist” OR “pharmacists”) AND (“hospital” OR “community).

3.1.   INCLUSION CRITERIA

The inclusion criteria was: quantitative and qualitative primary research papers, papers related to pharmaceutical services perception, papers written in the English language, full text available and human adults studies.

3.2.   STUDY SELECTION AND DATA EXTRACTION

Two techniques were used in examining the articles. First, the author identified, screened articles that retrieved from searching database, and scanning the title and abstract: The headings and conceptual screened adjacent to the enclosure criteria. Studies excluded based on titles, abstracts and removal of duplicates that did not related to the public perception of pharmacists and pharmacy services. Finally, the number of articles used and include in the systematic review was 25 articles in total (figure 1).

Figure 1: Study selection process.

1.1.   ASSESSING QUALITY

            To assess the quality of selected articles in this review, papers screened against the appropriate CASP checklist and tools that have been authenticated, in ensuring that the studies evaluated and appraised. There were 10 studies in developed countries assessed and critically appraised based on Critical Appraisal Skills Programme (figure 2) while 15 studies in developing countries assessed and critically appraised based on CASP tools (figure 3).

Figure 2: Quality appraisal of 10 studies in developed countries based on CASP.

Y= “Yes available” ; N= “Not available” ; V= “Valuable” ; NV= “Not valuable

Figure 3: Quality appraisal of 15 studies in developing countries based on CASP).

Y= “Yes available” ; N= “Not available” ; V= “Valuable” ; NV= “Not valuable”

2. RESULT

            The results of the systematic review about Public perception of pharmacists and pharmacy services are developed through quantitative and qualitative research methods in both developed and developing countries. There were a total of 37 studies which evaluate the pharmacists’ role and pharmacy services and met the design criterion; however, 12 articles that equivalent (35%) of these did not report any public perception of pharmacists’ role and pharmacy services thus were not included in the review (figure 1). The outcomes of the research on the attitude of the public on pharmacy attendants and pharmaceutical service in developed and developing counties are obtained through structured, semi-structured or across sectional study techniques.  

2.1.   STUDY DESIGN

            In the study design of the twenty five studies, 32% of studies used to derive the outcomes through qualitative approach while 68 % of studies used to derive the outcomes through quantitative approach. In developed countries, the study design used to derive the outcomes was through 50% of studies quantitative approach, 40% (4 out of 10) of studies qualitative approach and 10% of studies mixed method. In the developing countries, the study design used to derive the outcomes was through eighty percent of studies quantitative and twenty percent (3 out of 15) of studies qualitative approach (figure 4).

2.2.   STUDY AIM

            In the study aim of the twenty five studies, six studies (24%) assess pharmacists’ role and pharmaceutical services, eight studies (32%) evaluate pharmaceutical services as health care provider and eleven studies (44%) evaluate pharmacists as having medical roles. According to the study aim used to assessing pharmacy services and pharmacists’ role, there were 40% of studies conducted in developed countries while 13% of studies in developing countries.

2.3.   PUBLIC SATISFACTION

            The articles outcome was expressed based on the satisfaction, expectation and perception of the customers and patient towered pharmacists’ role and pharmacy services in developed and developing countries. In both developed and developing countries, 60% of studies demonstrated the satisfaction of public perception towered pharmacists’ activities and pharmaceutical services while 40% of studies illustrated the dissatisfied of public expectation overlooked pharmacists’ role and pharmacy services. However, the fulfilment of public expectation towered pharmacists’ role and pharmacy services in developed countries was 40% of studies while 73% of studies in developing showed the public fulfilled. On the other hand, the dissatisfaction of public perception overlooked pharmacists’ role and pharmaceutical services in developed countries was 60% of studies whereas 27% of studies in developing revealed the public dissatisfied.

Figure 4: study design, aim and finding of 25 studies included in the systematic review

Table 1: systematic review for the 25 studies

3. DISCUSSION

            The level of relevance attached to pharmacy and pharmacists seems unexpectedly not in tandem with the global acceptance and usage of health services when an evaluation is made to determine the perception people in developed and developing nations have regarding pharmacists’ role and pharmacy services. Key objectives of this paper are to help improving the pharmacists’ role and pharmacy services, the patients-pharmacists relationship, and the overall healthcare systems. The question is what are the public perceptions of pharmacy, pharmacists and pharmacy services?

            In the developed countries the percentages of qualitative and quantitative studies were almost equal.  They assessed public perception by statistical and psychological methods to cover their whole perception. However, 80% of the studies were quantitative and 20% qualitative in terms of the developing countries. There is a possibility that the quantitative methods are higher in developing countries due to illiteracy and the rapid rhythm of life for the population (Al-Arifi, 2012).

            It is important to understand that some developed countries may have proper health care system but may have lack proper channels to administer the services (Latif, Boardman, & Pollock, 2013; Saramunee et al., 2015). In the developing countries, the satisfaction levels were high (73%) due to the pharmacists quality services.Interaction created leads to the build-up of the new opinions which in the long run is crucial in promoting the quality of the service provision.

3.1.   STRENGTH AND LIMITATION

            The main strength of this systematic review is the first review conducted in field of public perception of pharmacists and pharmacy services nationwide. However, the differentiation from country to others in health care system, education level of resident, public culture and status of life may consider as limitation.

4. CONCLUSION

            The systematic review demonstrates public perception on pharmacists and pharmacy services across the globe. It has reveals the majority of public had positives perception regarding the services offered to them by the pharmacists as well as perception towered their profession although suggests that steps and initiatives to improve clinical skills and social relationships. Satisfaction, on the other hand, comes to the act pharmacies embracing new actions which make the services better such as the counselling. Lastly, the case on the expectation as highlighted on the paper is connected with a factor of attitude. Therefore, there is dire need for public awareness that seek to educate populations on different aspects of pharmacist roles and functions. This type of research would provide a solid foundation for future research in professional or stockholder perception of pharmacists and pharmacy services.

Response paper

Student Post 1: C.V.

 Both adults and children in America are at risk for health problems which is contributed by obesity.  It is clear to say that this is a bad news but   there are better resolutions to curb the risks.  For the last several years, Americans changed their lifestyle and the changes have highly contributed to obesity In addition, deadly diseases in both adults and children in American have increased as a result of lifestyle and in particular eating unhealthy food.  For example, heart diseases, diabetes, asthma and others are major diseases which have caused the high risk (Oliver, 2006).  Therefore, healthy lifestyle has become a concern in America and many people have made health choices which can help them to eliminate obesity and related diseases.  Among the health choices, American people have considered a healthy eating plan (eating healthy food), doing exercises, being active and decreasing screen time.  With this, the demand of healthy food has increased as consumers demand for natural ingredients.  Food manufactures   are also using natural ingredients and they have stopped using modified ingredients (Oliver, 2006). 

Student Post 2: S.W.

U.S federal government   has taken Action Plans in implementing certification standards. High health care cost from diet-related ailments has made American people to put a great concern on health food.  Weight has become a heath concern and consumers’ health and wellness have become a primary factor which is influencing the demand (Vaidya, 2006).  New programs are set to help organic producers   with necessary resources which can help them comply with USDA standards.  Americans are much concerned with improving their weight and they have learned the health benefits   from organic food.  A high number recommend organic food as they are rich in nutrients.  According to USDA, there are significant changes in consumers’ attitudes regarding nutritious food.  This has resulted to a higher rate of consumption of organic food and an increase in demand.  American people have gained an adequate knowledge that health foods have little saturated fats, moderate sugar and fewer calories (Vaidya, 2006).  In addition, health foods contain fruits and vegetables, seafood, whole grains and other nutrients.

Reference

Oliver, J. E. (2006). Fat politics: The real story behind America's obesity epidemic. Oxford:

Oxford University Press.

Vaidya, V. (2006). Health and treatment strategies in obesity: 10 tables. Basel [u.a.: Karger.

Business of Healthcare

Health finance touches many aspects of healthcare institutions including the mobilization of funds, allocation of budget and the mechanisms that run the centers as well as the income of the centers. From a broader perspective, health is a universal necessity and is dependent on age, sex and heredity of the population as the main factors (Finkelman & Kenner, 2016). The choices made with regard to these determinant factors also remain to be core and critical aspects to the health centers. Factors that affect health including the environment and social factors have a direct impact on the financial stability of a healthcare center. Government interference and support have also potential impacts on the wellness of financial institutions with much of the influence being on insurance coverage for healthcare services. Basing the discussion on factors that affect health and the healthcare institutions, health care institutions experience financial fluctuations depending on a number of factors (Cleverley & Cameron, 2007).

First, social economic factors have a direct interaction with the healthcare financial status. This implies that an improvement of social economic factors may lead to improvement in the healthcare sector because they are linearly dependent. For instance, citizens who earn very little incomes often lack the required resources that may allow them to access nutritious diet, proper housing and proper working conditions that promote health. As a result, health complications such as high blood pressure are likely to befall on this people (Finkelman & Kenner, 2016). In such circumstances, the government of the United States passed the Affordable care act which aims at reducing the costs of healthcare services and covering all Americans with healthcare insurance. This has been the answer to the problems of the less fortunate in America in the healthcare sector. Unlike those who earn adequately they will lack even treatment funds for these complications (Cleverley & Cameron, 2007).

In general the degree to which health status are valued has a direct effect to their well being and hence the status of the financial status of the healthcare centers. From a community perspective, the structure of the society which include the availability and distribution of resources, the culture and the population at large affects the health status of the locals (Finkelman & Kenner, 2016). From a recent research, some of the health complications such as mental disorders, obesity and low literacy are deep rooted by the way of life right from childhood. The role of nurses in fiscal responsibilities would have demanded them to improve the conditions of the working environment because they have what it takes to get this right. From this analysis, it is clear that social economic factors have a direct impact on the health and the healthcare centers (Cleverley & Cameron, 2007).

Secondly, the level of technology has an effect on the financial status of a healthcare center. This is because the credibility of the technology determines the quality of services and the efficacy to which the tasks are accomplished. Spending growth and savings are regulated with increase in technological advancement. Medical databases have improved the accuracy and speed of the filing of patient’s progress records failure to which a healthcare center would invest a lot of time and resources in getting the same job done. From the costs analysis studies done to assess the cost saving advantage of medical technology, the health economists have estimated 40-50% percent of the annual costs has resulted from the deployment of the technology.

 The other potential factor is the demographics as well as the characteristics of patients. It is evident that aged people are prone to health problems compared to the young and therefore a country with large number of aged people requires more investment in treatment than that of young people. Gender also matters because the healthcare needs for women are very different from those of men. The amount of a healthcare spending is therefore dependent of the demographic factor which counts for the populations and insurance coverage of the patients. In connection with this factor, insurance coverage is also a determinant factor because it to some extend holds the population jointly (Finkelman & Kenner, 2016). Insurance coverage for a family with few members cannot be the same with that of many members. The emphasis put on health insurance coverage’s by the government greatly contribute to the well being of the financial stability of the healthcare centers. It was alarming that 33 million Americas did not have a health insurance cover in 2014 which means that the OECD does no0t recognize universal care. Even though many people consider health care to be a right, it is evident that it is a social responsibility and not the role of the government. For instance, the recent trend by which the insurers and the employers are placing fiscal duties on patients’ shoulders has significantly brought down the growth rate of the financial status of healthcare centers (Finkelman & Kenner, 2016).

It is also important to note that the kind of products and services a healthcare deals in has an effect on the financial well being. For instance some hospitals that have specialized in a specific type of service may experience some fluctuations if the kind of service comes to an end (Cleverley & Cameron, 2007). The kind of product or service determines the investment cost as well as the income expected for the future of the center. In addition, the kind of service affects the marketing power of the healthcare. It has been evident that marketing power carries forward the expenditure and the savings of the center. For instance, healthcare providers, physicians and other specialists can merge together to improve their market power over that of insurers. This confirms the fact that consolidations can lead to an increment of the hospital prices by up to 5% (Cleverley & Cameron, 2007).

In conclusion an ideal world would uphold equality and consider human health as the top most welfare to consider. Factors mentioned would not be something to consider because uniformity would fill the gaps between accessing the healthcare services due to social-cultural differences. Finally, the financial status and stability of a healthcare are dependent on a number of factors. First, the level of the financial stability is determined by the credibility of the technology. The number of health insurance coverage and the marketing power of the healthcare also affect significantly (Finkelman & Kenner, 2016). The demographics and the characteristics of the patients is also a factor because it affects the spending of a hospital. The kind of services offered is also contributing factors to the financial status of a healthcare center. These are just a few of the many factors that shall be detailed in this paper to deliver a quality analysis.

Reference

Top of Form

Finkelman, A. W., & Kenner, C. (2016). Professional nursing concepts: Competencies for quality leadership.

Top of Form

Cleverley, W. O., & Cameron, A. E. (2007). Essentials of health care finance. Sudbury, Mass: Jones and Bartlett Publishers.

Bottom of Form

Bottom of Form

Addiction prevention program

The effectiveness of prevention programs has been proven and appreciated by families and the society at large especially when it comes to rehabilitating the youths from the bondage of drug addiction. Adults are the most affected by drug addiction but these results from the initial steps taken by a youth during his or her school life (Hanson, Venturelli & Fleckenstein, 2015). In this regard, intervening early before high school is critical because the high school students is the population that is steeply inclined towards the risk of drug addiction more than any other group in the current generation (Hanson, Venturelli & Fleckenstein, 2015).

Bearing in mind that youths in general are the main target which drug addiction aims at, this prevention program will therefore articulate all the social, biological and psychological consequences of drug addiction to the students at high school (Chang et al, 2015). Parents, educators and the community leaders have got a giant task o handle because their influence is a determinant factor towards the effectiveness of the prevention program from addiction against drugs for the high school students. In addition, a recent research has confirmed that parents who talk to their children about the issues of drug addiction on regular basis have children who at a lower risk of falling into the addiction. This prevention program will act as an aid for parents who are determined to build a strong foundation for their children (Chang et al, 2015).

It is surprising that children often start by experimenting of a variety of activities and substances. Among the mostly experimented drugs include tobacco, cocaine and other club drugs which soon becomes an addition. It is important to note that teens are unconsciously getting into smoking bang and using marijuana while at school away from their parents. Having identified the actual drugs most teenagers get to it would be easier to analyze the possible impacts that result from the drugs (Rogers, Sebastian, Cotton, Pippin & Merandi, 2016).

The actual impacts are gradually signaled by the change of behavior for the teen drug abuse. Signs such as moody swings, violent behavior loss of interests for the activities that the child is favorite in and poor hygiene are just a sample of the long list of signs of a teen under drug abuse. The effects are actually felt when the student is totally addicted and develops a full dependence such that nothing can operate normally before getting a dose of the drug (Rogers, Sebastian, Cotton, Pippin & Merandi, 2016). Drug abuse through injection attracts the risks of getting blood-borne diseases such as hepatitis B and C among other diseases (Rogers, Sebastian, Cotton, Pippin & Merandi, 2016). More contritely, brain damage is another potential impact which results from drug addiction. Serious mental disorders and the damaging of the central nervous system could affect the learning abilities of the student, impaired reasoning and the change of sexual desires. The end results would be a crushed generation full of poverty and illiteracy and people who are less or not productive to the society.

The society is in the hands of the interest groups which have come up strongly to create more awareness to the youths against drug addiction. Even though much more is yet to be achieved, UNODC has recently marked  26 June of every year as an international day against drug abuse and illicit trafficking which would has indeed come to the rescue of the young generation. The programs aims at supporting the prevention programs such as this based on establishing the well being of the families, the youth and the community at large. The National Executive Committee of the African National Congress Youth League has intensified the campaigns against drug abuse with a concrete message of decisive interventions and similar programs. Generation Rx Project is another project that campaigns against the misuse of prescribed drugs and much more campaigns have been run with an aim of saving the youths from the tragedy of drug addiction (Ayumi, Yuki, Norito, Toshihiko, Tomohiro & Takashi, 2016). In addition school programs are hastened to deliver the intervention strategies and addressing the core factors that affect additions for their students. Among the awareness topics covered in high schools include self control, peer pressure and the academic support in trying to eradicate the perceptions of students that drugs are the solution to their problems (Ayumi, Yuki, Norito, Toshihiko, Tomohiro & Takashi, 2016).

With a full knowledge of the prevention program and what it focuses on for the high school student intervention, the best time to carry out the program is during the days that rhyme with the international campaigns against drug addiction. This would best facilitate the emphasis on awareness and present the concrete and substantial reasons of why all students ought to abstain from drugs (Elton, Smitherman, Young & Kilts, 2015). The prevention program aims shall aim at large crowds as well as individual levels. In order to access as many students as possible, the implementation of this program will be based majorly in schools with the help of the schools’ management. The program will also target churches and community centers during holidays through the organization and support of the community and religious leaders (Elton, Smitherman, Young & Kilts, 2015). Personal or individual interventional would only be done to special cases in their homes, with the contributions from parents and guardians. The program will extend its interventions to the addicted students to convince and show the necessity of getting into rehabilitation programs for the purpose of long-term outcome. In this regard, quantity and quality interventions strategies shall be scheduled to ensure schools and homes are well saturated with the awareness of drug abuse and prevention (Elton, Smitherman, Young & Kilts, 2015).

Since socialization is the most powerful tool for social change, the social media will therefore be our stronghold in reaching the students. High school students like exploring using FaceBook accounts Twitter, and Instagram among the numerous social sites. The prevention program will utilize the already existing websites so as to reach the online users in high schools (Elton, Smitherman, Young & Kilts, 2015). For the purpose of keeping the program on toes, it will incorporate publishing pamphlets and small handouts that contain prevention message of drug abuse. As much as support from the social media and other directional bodies are assured, government support will be the cornerstone of our funding. In connection to this knot, the program will work with the current bodies to fund the projects, campaigns and publishing and interventions. To evaluate the success of the programs the prevention program will majorly rely on statistical data collected during the pre and post intervention implementation. Testimonies and experiences from the teachers, parents and the members of the school committees will be gathered using questionnaires which are believed to work best for this kind of an assessment. Data concerning the number of students who have rehabilitated and the general response of the students shall be analyzed (Elton, Smitherman, Young & Kilts, 2015).

References

Hanson, G., Venturelli, P. J., & Fleckenstein, A. E. (2015). Drugs and society.

Chang, F., Chang, Y., Lee, C., Lung, C., Liao, H., Lee, S., & ... Zeng, W. (2015). Effects of a school-based drug use prevention programme for middle-school students in Taiwan. Drugs: Education, Prevention & Policy, 22(1), 43-51. doi:10.3109/09687637.2014.952271

 Rogers, J., Sebastian, S., Cotton, W., Pippin, C., & Merandi, J. (2016). Reduction of immunization errors through practitioner education and addition of age-specific alerts in the electronic prescribing system. American Journal Of Health-System Pharmacy, 73(11), S74-S79. doi:10.2146/ajhp150311

Ayumi, T., Yuki, M., Norito, K., Toshihiko, M., Tomohiro, S., & Takashi, S. (2016). Web-based cognitive behavioral relapse prevention program with tailored feedback for people with methamphetamine and other drug use problems: protocol for a multicenter randomized controlled trial in Japan. BMC Psychiatry, 161-12. doi:10.1186/s12888-016-0793-x

 Elton, A., Smitherman, S., Young, J., & Kilts, C. D. (2015). Effects of childhood maltreatment on the neural correlates of stress- and drug cue-induced cocaine craving. Addiction Biology, 20(4), 820-831. doi:10.1111/adb.12162

Clinical Significance

Confidential intervals have a great clinical significant as they are able to permit and allow a more supple and nuanced approach in analyzing the clinical data of a research. Confidential intervals do allow the investigators test hypotheses of the data. They are also considered more informative due to the important traits and characteristics of the sample size and the accuracy of the estimates relating to different association and groups (Lindmark et al, 2016). They are also useful as they are able to interpret studies relating to small samples which allow the consumers and the researchers who are of scientific literature to come up with more meaningful findings about the significance of the clinical studies (Lindmark et al, 2016). Through the increased use of the confidence intervals journal editors and the researchers have paved way for better understanding of the confidence intervals that has seen the clinician’s willingness to help individuals in order to avoid unnecessary inflexible explanation of the clinical research as there has been some great steps towards evidence based practice.

Controversies surrounding the issue of clinical significance and statistical significance have been an ongoing debate. One of the issues that have caused ranging debate is why clinical significance has received little discussion considering its magnitude of benefits which includes respective profiles, relative costs, patient’s preference and the comfort of new therapy. Statistical confidence has not been able to provide clear information on the practical information of any research but it has gained popularity (Lindmark et al, 2016). It would be true to say that there is a crucial point that has been missed relating to clinical significance compared to statistical significance as it has a likelihood of finding a chance that do not hold future replications.

Reference

Lindmark, A., van Rompaye, B., Goetghebeur, E., Glader, E., & Eriksson, M. (2016). The Importance of Integrating Clinical Relevance and Statistical Significance in the Assessment of Quality of Care –Illustrated Using the Swedish Stroke Register. Plos ONE, 11(4), 1-13. doi:10.1371/journal.pone.0153082

How to prevent pressure ulcer

            Pressure ulcer refers to skin injuries and underlying tissue that result from prolonged pressure on the skin or a combination of pressure with shear. This condition develops when a large quantity pressure is applied to a given area of skin within a shortest period. This condition can be prevented in the following ways. One of the ways to prevent it is frequent change of body positions (Stonelake, 2015). When this is done frequently, less pressure will always be applied on the skin hence reducing on the risk to develop pressure ulcer. Repositioning of the body is a good idea and it should be done in every couple of hours for instance after lying on the back for some time, one may turn to the side. It is also important to keep one’s skin clean and dry. A clean and a dry skin is less likely to develop pressure ulcer. Another way to prevent it is through use of pillows between parts of the body. It is recommendable that people should use a pillow under tailbones, heels, shoulders and elbows (Stonelake, 2015). Physical exercise is also another way of preventing pressure ulcer. Performing a number of motion exercises can help the risk of pressure ulcer. Nutrition is also another factor that may help in the prevention of this disease. A healthy feeding with a balanced diet containing enough protein, variety of vitamins and minerals can help in preventing skin damage. Finally, it is important to check on one’s skin regularly for any signs of pressure ulcer for instance discoloured skin (Stonelake, 2015). Checking for such signs may also help one to deal with such a condition before getting the infection.

References

Stonelake, K. M. (2015). Skin Care Pocket Guide to Reduce the Incidence of Pressure Ulcers. MEDSURG Nursing, 1-8.

Case Study 2: Plain View, Open Fields, Abandonment, and Border Searches as They Relate to Search and Seizures

            The structure amendment that would oversee officer Jones engagements would be the fourth amendment. This is because it protects people and not places and it is usually applicable in places outside homes (Vishny 2012). This amendment can be applied anytime a person has a judicious prospect of privacy in a certain location regardless of whether or not it is that individual’s home. Thus it is through the administering of this amendment, that Officer Jones actions will be determined (Putman 2010).

            According to the constitutions’ fourth amendment, there is no anticipation for any item that is abandoned and any police officer is allowed by law to seize as well as search the items freely (Vishny 2012). Trash that is placed in a curb is regarded as abandoned and for the purpose of the fourth amendment, it is open for examined by any person. Therefore officer jones actions were valid according to the fourth amendment that is the constitution and the fact that the trash was already abandoned means that officer jones had a right to examine the property. Permission was not needed for Jones’ deeds and there was no anticipation of a right of secrecy since none of the open-field and the abandonment examination.

            Police Officer Jones deeds were acceptable in the abandonment policy. The abandonment policy can be concluded since the perpetrator purposefully and perpetually uninhibited his assets through giving it away and retaining it outside sideways of curb so as to be picked up by garbage firm consequently permitting Jones to have the lawful right to examine his assets which he had thrown away without a search warrant.

Reference

            Vishny D. (2012). Still the American Frontier: Forth Amendment Litigation.retyrieved from:

http://wispd.org/attachments/article/220/Still%20the%20American%20Frontier-%20Fourth%20Amendment%20Litigation.pdf.

Putman, W. H. (2010). Legal research, analysis, and writing. Clifton Park, NY: Delmar Cengage Learning.

How to prevent pressure ulcer

PICO (T) Elements                  characteristics                                          explanation

P                       Patient, population or problem                - the problem in this case is pressure ulcer    

                                                                                                                    Which refers to skin injuries and                          

                                                                                                                    Underlying tissue that results from

                                                                                                                   Prolonged pressure on the skin or a

                                                                                                                   Combination of pressure with shear.

• The condition develops when a large quantity pressure is applied to a given area of skin within a shortest period
• The problem is observed in the following stages; it starts with signs of impending ulceration, followed by partial loss of skin, thereafter a large volume loss of skin, then a long depth of the wound that cannot be appreciated.

        I                            Intervention, factor, risk, assessment                - treatment of this disease starts with

                                      tool, or prognostic factor                                  reducing pressure that caused it. This

                                                                                                                    can be done through repositioning and

                                                                                                                    use of support surfaces.

• The clinician is also required to clean and dress the wound.
• A clinician is also required to remove damaged and infected tissue from the wounds.

            C                      Comparison intervention                              -       other interventions include pain

                                                                                                                       Management, management of

                                                                                                                        incontinence, healthy diet and

                                                                                                                        negative pressure therapy.    

            O                           Outcome                                                        - this condition can be prevented in a

                                                                                                                 number of ways;

One way to prevent it is frequent change of body positions such that there is less pressure entering the skin

• It is also important to keep one’s skin clean and dry
• Another way to prevent is through use of pillows between parts of the body. It is recommendable that people should always use a pillow under tailbones, heels, shoulders and elbows.
• It can also be prevented through physical exercise. One should perform a number of motion exercises.
• Nutrition is also another factor that helps in the prevention of this disease. One is required to have a healthy feeding containing all recommended food values.

         T                               Time                                                                     None

References

Stonelake, K. M. (2015). Skin Care Pocket Guide to Reduce the Incidence of Pressure Ulcers. MEDSURG Nursing, 1-8.

California's smoking age change policy

Introduction

Smoking of tobacco is extremely harmful to body health. As there are many regulations there is no safe way to smoke. People try to make it safer by replacing the cigarettes with a cigar, pipes or even hookah but that does not the health risk associated with tobacco products. One cigarette contains about 600 different ingredients that produce more than 7000 different chemicals when burnt (Abreu-Villaça et al, 2015). The reason for trying to regulate these chemicals is due to the fact that they are poisonous.  Some of the poisonous chemicals produced cause cancer. Smoking of cigar is more harmful to the body as they contain ingredients that have a high level of carcinogens, tar, and toxins compared to a cigarette. When hooked pipes are used they produce many toxic compounds which expose the people to more carbon monoxide. Therefore the use of hookah produces second-hand smoke that is harmful to the non-smokers. Regulations of smoking in California have been brought about by the numerous disadvantageous effects they have on the human health.

Smoking regulation in California declared smoking of tobacco is a health hazard for the general public in the state. The local government has regulated smoking in a manner that is consistency with the law. The laws regulating smoking are enhanced as there are non-smokers who should do not have adequate means of protecting themselves. The law recognizes the damage that is inflicted upon the non-smokers who involuntarily inhale the poisonous gas emitted by the smokers (Messer, & Pierce, 2010).  The legislatures understand the need to have regulation of smoking in a public place in order to safeguard the health, welfare, comfort, safety and the environment for non-smokers. This has led to the inaction of this law which aims at achieving the welfare of non-smokers. The law also prohibits smoking of tobacco in public transportation vehicles.

The law governing smoking has also prohibited smoking at various designated areas which are publicly owned. According to the section of the law, it prohibits indoor rooms smoking, indoor places such as the assembly and the chambers while conducting public business. In areas where public anticipation is required and forms not less than 50 % of the total area of the room the room is declared a non-smoking area (Yule et al, 2016). The law also says that such an area should have sufficient signs displayed as a non-smoking area while the meeting is still in progress.

The code of regulation in California regulates smoking at workplaces. The law prohibits an employer from allowing any smoking activity of tobacco to take place in the working premises that are an enclosed space. The law also requires the employers to take reasonable steps that prohibit nonemployees from smoking in the premises (Yule et al, 2016). The law also says that such signs should be placed at entrances places and at very visible points stating that smoking is prohibited in the building except for the designated areas. The employers should also urge nonemployees to refrain themselves from smoking at enclosed workplace.  The law has also extended at restricting smoking of tobacco in restrooms, lobbies, and lounges, waiting areas, stairwells, and elevators (Yule et al, 2016).

The law also governs smoking at health facilities and clinics to comply with certain procedures and make reasonable efforts in assigning patients to rooms according to smoking preference. The health facilities are also supposed to prohibit smoking in the cafeteria and the dining area that is occupied by more than 50 people or not less than 20% of the area is occupied should be declared a non-smoking area (Yule et al, 2016). Signs should be displayed stating there is no smoking in such areas (Yule et al, 2016). The law also allows health facilities to ban smoking in the entire area in order to safeguard the interest of the majority.

In a publicly owned building that is open to the general public for purposes such a music recital, stage drama, motion pictures, and others should have signs that prohibit tobacco smoking in certain designated areas. The signs should be sufficient and readily visible to the people. This law only applies to buildings that open for the public and not in the indoor sporting events. The law prohibits smoking in restaurants and retail food production that during the hours that they are open to the public and when the capacity is more than 50 people (Yule et al, 2016). The provision does not apply to areas set aside for employees smoking as they are not open to the public.

 The smoking law also mandates that all the transportation services should have designated areas where there is no smoking. This should also be made available in waiting room for all the passengers. It is mandatory that 25 % is the maximum area that can be set aside for smokers (Yule et al, 2016). The prohibition extends to all persons waiting to purchase a ticket within the area of a building. However, the law does not prevent any local ordinance from being more restrictive on the benefits of the nonsmokers. The law allows any person to apply for an injunction to compel a public entity to comply with requirements regarding smoking.

The purpose of the law governing smoking of tobacco became law due to the effects that tobacco has on the human body. Smoking policy was made into law in order to safeguard the majority. This includes women, children and also men who do not smoke. According to the research carried out the risk associated with smoking mostly affects nonsmokers than it does to the smokers.  The inaction of the policy to the law was mostly because of the health complications and increase in mortality levels (Messer, & Pierce, 2010). The policy was made into law in order to regulate smokers by age and at different places. This was done in order to make sure that the young people such as the under-aged citizens do not engage in smoking (Webster, 2016). The policy was also made into law to make sure that smoking by the tobacco smokers was regulated at all time and they never violated the non-smokers freedom by assigning designated areas for them to smoke.

The risk associated with smoking was and is diverse hence the need for some regulation (Duarte et al, 2013). This facilitated the process of making the policy into law in order to curb the smoking menace. More deaths were reported as a result of smoking hence there was the need of regulation. Despite how safe one may consider smoking tobacco will still remain harmful to the entire body. Smoking of tobacco is associated with various health complications (Messer, & Pierce, 2010). A puff of smoke is considered to be a mood stimulant. When the body is used to smoking in order to stimulate moods a person body cannot stimulate the moods natural which leads to addiction. Due to the smoking, one may experience poor eyesight. Smoking leads to malnutrition as it suppresses the appetite. Smoking eliminates the urge of eating which results to a weak immune system that cannot fight small diseases. People experience a lot of anxiety and irritability when they have used to smoke (CALLISON, & KAESTNER, 2014). This causes addiction which makes them smoke even more resulting in deterioration of health. Smoking of tobacco also causes coughing as the body is incapable to toxins sufficiently resulting into some toxins being trapped in the lungs. This makes breathing difficult and increases the risk of respiratory infections, flu, and colds. Apparently, the whole body systems are affected including the reproductive system (Eisner, & Iribarren, 2007). When pregnant mothers are exposed to second hand smoking they give birth to children who are underweight. There are also birth defects and asthma attacks due to difficulties experienced during smoking (CALLISON, & KAESTNER, 2014).

The law changed policy as a result of inadequacy to deal with the rising number of smokers and the increase health threats exposed to the general public. The law changed a policy because it allowed smoking for any person who had attained 18 years (McGreevy, 2016). The policy aimed at raising the age in order to reduce the number of smokers (CALLISON, & KAESTNER, 2014). The law had no rules and regulations governing the use of electronic cigarettes in public places which the policy aimed at regulating. The policy aimed at regulating smoking in public schools by making them non-smoking areas in which the current law did not recognize. These adjustments aimed at tightening the smoking menace and the existing law in order to create a conducive environment

Another factor that contributed for the law to change into policy is to have the approval of the local taxes charged on tobacco to pay for all the medical cases that are as a result of tobacco-related illness (McGreevy, 2016). California being one of the states that have the lowest cigarette taxes sought the inaction of the policy in order raise the age of smoking for the current 18 to 21 years. The aim of rising the age that could allow people to smoke was to save more lives (Webster, 2016).  According to the governor, the aim of having this policy was to disrupt the chain tobacco addition to the adolescent. This was because of the significant number of the young people that was engaging in smoking. The policy was to be more expansive in order to control the use of tobacco in the country. The policy of the bill aimed at changing the approach of tobacco in California State (Berlinger, 2016).  The policy also considered the use of tobacco and how to reduce astronomical costs that relate to health care. The policy has strategies that will safeguard the interest not only for the current generation but also for the future generation. This was because of the deadly impact that is associated with the use of tobacco that the law did not recognize. The initial bill that was the law argued that 18 years was individual was old enough to make the right judgment. The new policy also had a stipulation of an active duty to the military personnel who are on duty (Berlinger, 2016). These are some of the factors that made the law change into policy.

As the policy suggested that tobacco taxes to be used to cater for all medical bills that are associated with all tobacco related illness. The illnesses include cancers and other respiratory diseases that are medically expensive to treat will mean that the tobacco companies will have more to lose. This is because catering for such medical bills the rate of tax will be an increase in order to cater for the bills in full (FALLIN & GLANTZ, 2015). As a result of the increase in tax the stakeholders in the tobacco business will have lesser profits. This will translate to a reducing of a number of staffs will be on the losing edge as they will not have any source of employment income. Increase in the taxes in order to cater for the medical bills will mean that the consumers of the tobacco will have to dig dip into their pockets in order to purchase the product. The consumers will strain to buy the product but an increase in price will not mean that they will not purchase as they are addicted to tobacco (FALLIN & GLANTZ, 2015).

On the other hand, non-smokers will greatly benefits as their health is safeguarded due to the new regulations. The regulation will mean that less growing individuals will be allowed to smoke. The mortality levels will go done with the new inaction of the electronic cigarettes and its use in public places. Families of the patients affected by the use of tobacco will also benefit as they will not cater for the medical bills (Rose et al, 2015). This means that they can use their resources for other things to benefit them. The medical association will benefit together with the medical insurances as bills will be paid in full for all the medical costs and they will not have to incur medical expenses for the patients of tobacco illness respectively.

The strategic triangle analysis has been used to hypothesize a more explicit definition of the smoking concept and explore the inner logic of the policy and the dynamic propensities to help in the conceptual framework that will help emulated past developments and focus on future prospects that will be more comprehensible.  The analysis made relating to smoking are substantive valuable as there aim at achieving what is best for the majority and not for the minority. They are valuable as they add value to life (McGreevy, 2016). This is because the policy aims at making life better and more comfortable for every person. The analysis has been able to show the importance of human life through the various ways of safeguarding it.

Legally the strategic triangle analysis will be sustainable as it indicates great improvement towards health. By signing of the bill to the law will be beneficial to many humans. Despite the procedural trick used to make the qualification of a referendum the restriction of the electronic cigarettes and increasing the age of smoking will yield positive results (McGreevy, 2016). By reclassification of vapor products to be the same as tobacco and banning them in most public places through the signing of the policy into law will be legally sustainable because there will be a penalty for those who break the law. The strategic triangle analysis will not be politically sustainable because the policy is more advantageous to many. This means that the policy will have formed some political division among the politicians but it will not sustain them due to the science and the evidence that lies in the analysis.

The policy is administratively and operationally feasible as there other nations that aim at endorsing the same law in their country. Administratively the policy needs many stakeholders to work together in order to make it effective. It is operationally feasible as the regulatory process has approved special sessions relating to healthcare in order to make it more effective. The policy has a chance of becoming more effective as it has numerous advantages over the previous existing tobacco law. This is greatly supported by the fact that tobacco has remained the leading cause of deaths that can be prevented (Eisner, & Iribarren, 2007). The policy will become more effective when different stakeholders such as the heads of public schools and the sellers of the electronic cigarettes work together and according to the policy in order to achieve its objectivity (Rose et al, 2015).

Conclusion

The use of tobacco is dangerous to the human health hence the need to safeguard all people either smokers or nonsmokers. The new law has clearly stated that e-cigarettes are just but another system of toxic and addictive nicotine hence it aims at protecting public health. Smoking of tobacco is addictive hence there is the need to regulate the way in which the young people follow suits of picking up of these devices. There is the need to close all smoking loopholes as there is the need to save more lives and reduce preventable deaths.

Reference

Abreu-Villaça, Y., Filgueiras, C., Correa-Santos, M., Cavina, C., Naiff, V., Krahe, T., & ... Ribeiro-Carvalho, A. (2015). Tobacco smoke containing high or low levels of nicotine during adolescence: effects on novelty-seeking and anxiety-like behaviors in mice. Psychopharmacology, 232(10), 1693-1703. doi:10.1007/s00213-014-3801-1

Professional Development of Nursing Professionals

            After the recognition of the challenges that the nursing profession was facing towards the fulfillment of the promise of a transformed health care system and meeting the state’s health needs, the Robert Wood Johnson Foundation move towards suggesting for partnership with the institute of medicine. The main objective of this partnering was to change the nursing profession. The committee that was formed from this partnership was responsible for the production of a report that was to be used to recommend for actions that were to be implemented in nursing profession to ensure that the changes are made so as to impact the future nursing career (Committee on the Robert 2010). This paper therefore will focus its argument on the various impacts that the IOM has on the nursing education, their practice especially in primary caregiving, changes to be implemented in their practice and their role as leaders.

            There are various impacts that would result from the IOM report on nursing. As these recommendations that are in the IOM report are implemented so many effects are likely to occur as there are changes that would occur hence changing the education system of these nurses.  Increase in competence is one of the effects of the IOM report since the report recommends and advocates for high quality education for nurses when being educated (Committee on the Robert 2010). According to IOM report, the education system for nurses should also integrate the teaching of emerging health issues and as a result of this the nurses are well competent with skills that would help to address any emerging health issue.

            Another impact is on the methodology in which the education is transmitted onto the nursing students by the nursing teachers. The report advocates for an integrative approach method of teaching where the students are taught using the best teaching methods.

This has contributed towards improvement in inter-professional quality where they are able to even improve on their projects.

            Another impact from the IOM report is on the increment of government support through funding that has greatly attributed to education development for nurses. This report has widely shown on the need for government support through offering of scholarships to nurses, loans which will enhance a large number of students to get knowledge and they will be able to graduate. This support has also attributed towards the upgrading of knowledge where the nurses in the hospitals are able to advance their knowledge hence making them more competent. Their support has also helped in the development of knowledge through research centers where the nurses are able to carry out researches hence they are able to acquire more knowledge (Committee on the Robert 2010).

            Nursing practices are viewed to cover a wide range of health promotions, disease prevention and primary care. According to the report, the improvement in the nursing practices as per the report will ensure that nurses gives out quality care to patients as they expand and fulfill their potential as primary care providers across their nursing practice settings basing on the high level of education and competence they get from the education that they have attained.

As a result of this the report the nurses will be able to develop new competences that would be developed in the future so as to bridge the gap between the coverage and access so as to organize increasingly complex care so as to cover a large number of patients so as to fulfill their potential (Committee on the Robert 2010).

            This would help them in experiencing a full extent of the education and nursing training that they have attained and they would be able to implement changes that would enhance growth of body of evidence that support the linking of nursing practices to fundamental advancements in safety and quality care provision. This will also impact their full economic value of their contributions across their nursing practice. Nursing requires great commitment and so as to meet the goals of IOM, I believe that in expanding nursing practices will enhance more efficiency and competence (Cronenwett et al 2006). Assuming of more and more leadership roles in the daily practices will enhance me as a nurse me to be a better leader who can decide what best for the people and the health care. Integration of technology and more research will help in increasing my knowledge base as a nurse and this will enable me to be limitless when giving safety and quality healthcare (Stevens 2013).

            According to the report of IOM on the leadership of nurses it is clear that nurses are leaders. As nurses develop in their careers they develop leadership skills that enhance them to be leaders hence they are able to become full partners where they are in charge of leading the health care into achieving  a better health care system (Committee on the Robert 2010). Some of the experiences that they get in their direct interaction while giving primary care, their communications with relatives on health status as well as administering of medications as prescribed and their desired results make them fit to be leaders in health care facilities. Thus when leaders are given the chance to lead they ate able to redesign the health centers so that quality services are given to patients.

References

            Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., ... & Warren, J. (2007). Quality and safety education for nurses. Nursing outlook, 55(3), 122-131.

            Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing, 18(2).

            Committee on Robert W.J (2010). The Future of Nursing: Leading Change, Advancing Health. The national Academic press, Washington, Dc.

            Ewing’s Sarcoma

            Introduction

            Ewing’s Sarcoma is described as a primary cancer of bones that mainly affects children as well as adolescents.  This type of cancer is one of those that are as a family lump. Ewing’s disease is the subsequent familiar nature of bone disease in youthful children although is relatively uncommon. Ewing’s Sarcoma only accounts for 1% of the established childhood cancers (San-Julian, 2016).  Despite the fact that it can occur during any given age this type of cancer rarely occurs in children individuals aged thirty.  Due to the fact that most diseases are caused by similar symptoms which are similar to those of Ewing’s Sarcoma the diagnoses is mostly missed during the early stages. Early diagnoses and treatment are, however, necessary because the disease holds the greater capability to spreading to other body organs. In most of the presented cases, fifty to seventy-five presented cases are treatable. Ewing’s Sarcoma is referred to a primary cancer of bone because it is developed from bone cells (San-Julian, 2016).  The other way in which cancer can develop in the bones is after spreading to different parts in the body. Based on recent research it claimed that Ewing’s Sarcoma starts in particular primitive cells types.

            Ewing’s Sarcoma Pathophysiology

            In all the families of Ewing’s Sarcoma tumors, a transformation takes place in the cells in moving the gene that is referred to as EWS on the number twenty-two chromosome which is next to a DNA section on one of several other chromosomes which are responsible for the turning on of EWS gene.  This is therefore not inheritable because it occurs after the birth of the child. The gene changes can be tested by utilizing biopsy specimen in order to confirm the diagnosis (Vogl, Reith, & Rummeny, 2016).

            Ewing’s Sarcoma Risk Factors

            There is around two hundred Ewing’s Sarcoma that is diagnosed in America every year. Ewing’s Sarcoma mostly involves those individuals who are older than ten years, adolescents, teens as well as adults in young stages. The disease is slightly higher in boys that prone to girls.  For non-established reasons, the disease occurs often I individuals who are white and therefore rare cases have been established in Asian American and African Americans children (Vogl, Reith, & Rummeny, 2016).  In comparison to cancers that affect adults, the risks of getting childhood cancers can never be influenced by developing lifestyle transformation. Ewing’s Sarcoma has additionally not been linked to any environmental or social risks. However, several genetic transformations appear in individual cells that are diagnosed with Ewing’s Sarcoma. This genetics changes, however, occurs after the child is born because they are not inherited. There are no established risks factors of Ewing’s Sarcoma and they cannot be changed either and there is no effective screening test t diagnose the disease effectively.  For the individuals who are prone to the development of the disease, there is no strategy to prevent its occurrence (Vogl, Reith, & Rummeny, 2016).

            Ewing’s Sarcoma Manifestations

            Several things which range from accidental injuries to infections may cause symptoms which assemble the symptoms that are caused by Ewing’s Sarcoma.   One of the major symptoms is swelling and pain which is most commonly experience in a leg, chest, pelvis or back.  The pain continuous to grow as it fails in subsidizing as time progresses.  Swelling which may not generate a warm sensation is also experienced, limited emotions ranges, rapid fever without established reasons and a breaking bone that occurs without an apparent cause.  Children with the disease are bound to experience bumps and lumps when they participate in plays and those lumps and bumps fail to disappear. When the tumor develops and spreads to other parts of the body the child may experience fatigue as well as weight loss.  If it spreads to the lungs the child may, therefore, experience challenges while breathing.  Those tumors which develop around the spine may result in weakness of flexibility and movement issues.  Paralysis at this point is bound to occur. The development of Ewing’s Sarcoma inside the child’s chest wall generates the possibility of the tumor progressing continuously without viewable and accurate symptoms until that period when it has developed to a larger size thus spreading to other parts of the body (Provenzale, Nelson, Vinson, & Duke University, 2010).

            Nursing Assessment

            Soreness and bulge of the growth position, Pathologic rupture at location of lump, Fever
Bone gentleness, unexplained weight loss, limping, exhaustion, Symptoms connected to courage solidity, such as deadness, tickly, and paralysis.

            Ewing’s Sarcoma can be confirmed via the performance of tumor biopsy and the genes and cells changes can be observed in the child’s DNA. The doctor is necessitated to perform a range of tests as well as procedures for diagnosing the disease (Provenzale, Nelson, Vinson, & Duke University, 2010).  If cancer is confirmed the generated results will help in determining the stage of cancer and the most appropriate treatment that is available and suitable for the patient.  The doctor begins by conducting a physical examination as well as checking the history of the patient in regard to medics in order to establish the symptoms and other related health challenges.  If there are the presence of abnormal white and red cells this will assist the doctor in determining whether the tumor has been distributed to the bone cells.  Several tests may additionally be conducted if the doctor establishes lumps development. This tests may therefore include computed tomography, X-rays in identifying and locating possible bone tumor,  bone scan  in identification of  possible cancer spots and PET scan which utilizes  the materials of radiotherapy as well as specialized camera  in identification of other body spots that may contain the tumor (Provenzale, Nelson,  Vinson, & Duke University, 2010).

            Ewing’s Sarcoma Medications

            Ewing’s Sarcoma that is localized in normally treated by starting with chemotherapy sessions in order to gain the capability and shrink the tumor because the afterward treatment with radiation as well as surgery (Vigorita, Ghelman, & Mintz, 2008).  The chemotherapy treatment utilizes the anticancer medicines which hold the capability of reaching all the body parts as they are able to get into the blood stream.  Therefore the treatment is additionally intended to ensure that all the cancer cells are killed before they get the opportunity to broaden to additional components. After eight to a range of twelve weeks after the beginning of chemotherapy treatment, several imaging tests are performed in determining whether the established tumor can thus be removed using surgery.  If surgery proves to be ineffective or it cannot be done radiation is utilized in killing the cancer cells which is then followed by chemotherapy sessions in order to kill the cells that might have developed. In treating Ewing’s Sarcoma chemotherapy is usually the first treatment stage (Vigorita, Ghelman, & Mintz, 2008). The treatment using chemotherapy single medicines lasts for about 9 months. This involves the utilization of cyclophosphamide, doxorubicin, vincristine, e-topside and Ifosfamide doses. The concentration of the doses is critical in the tumor treatment and maximum doses are utilized.

Nursing management

The psychosomatic modification to Ewing’s sarcoma is classically less shocking than it is for osteosarcoma as of the defense of the pretentious extremity.  Many families admit the identification with logic of liberation in expressing that this form of fillet cancer does not impose deduction, and primarily they may not be sentient of the destructive sound effects on the irradiated position. As a result, they require training for the diverse analytical tests, counting bone marrow ambition and surgical biopsy, and sufficient clarification of the handling regimen.  High-dose radiotherapy frequently causes a skin response of dehydrated or humid desquamation tracked by hyperpigmentation.  The youngster should wear baggy garments over the irradiated region to diminish extra skin annoyance.  As of increase compassion, the region should be sheltered from daylight and abrupt alteration in temperature, like heating pads or ice packs.  Persuade the child to utilize the boundary as endured. Sporadically the corporal psychotherapist may arrangement and vigorous train plan to safeguard utmost function. Submit the patient as well as their family for proficient therapy if designated. Submit the patient for achievable home fitness record care, if designated.
Educate the patient concerning the significance of maintenance follow-up arrangements.

Medical management

The treatment is dependent on phase, which embraces, chemotherapy, operation, and radiation.In verity, patients of Ewing sarcoma habitually necessitate limb-sparing operation where  the ill joint and bones are detached and reinstated with steel endoprosthesis, as an amputation alternative’” (The Children’s Hospital of Philadelphia, 2016). Based on the age of the patients, overall fitness, and medical account, grounded on the degree and position of the growth, established by patient's patience to prescriptions, measures, and therapies.

            Medications: chemotherapy conference, which incorporated “the amalgamation of cyclophosphamide (IV infusion 1200 mg/m²), VDC, vincristine (IVpush 1.5 mg/m²), and, doxorubicin (IV infusion 37.5 mg/m²)” (World Health Organization, 2016).

            After Treatment Effects

            After the child is treated for cancer situations may emerge afterward which may have been developed by the treatment (Orkin, 2009).  The effects, therefore, vary as they mainly depend on the type of treatment that the child received.  Normal cells may be damaged by chemotherapy drugs and radiation and this may affect the brain thus causing learning difficulties. Several other effects may impair the capability to see, develop and heart which may additionally affect the respiratory system, the heart as well as other body organs (Orkin, 2009).

            In conclusion, Ewing’s Sarcoma is treatable when diagnosed early. Proper treatment will, therefore, result in reduced after treatments effects.  Due to the rising number of Ewing’s Sarcoma, it is, therefore, essential for children to undergo the treatment early enough to prevent the spreading of the tumor to other regions of the body. Despite the fact that Ewing’s Sarcoma is among the most common childhood cancers it holds the highest capability for treatment. This, therefore, prevents the occurrence of other complications like disability and impairments of movements, vision, and hearing.

    Conclusion

    While the patients in the present learning were pleasured productively in stipulations of ongoing an antagonistic growth, the high obstacle charge in this assembly of continuing survivors is remarkable and designated that long-term transcribe should be compulsory.

            References

Orkin, S. H. (2009). Oncology of infancy and childhood. Philadelphia: Saunders Elsevier.

            Provenzale, J. M., Nelson, R. C., Vinson, E. N., & Duke University. (2010). Duke             radiology case review: Imaging, differential diagnosis, and discussion. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.

San-Julian, M. (2016). Cañadell's pediatric bone sarcomas: Epiphysiolysis before excision.

Vigorita, V. J., Ghelman, B., & Mintz, D. (2008). Orthopaedic pathology. Philadelphia: Lippincott Williams and Wilkins.

Vogl, T. J., In Reith, W., & In Rummeny, E. J. (2016). Diagnostic and interventional radiology.

Specializations and Professional Associations

Why I chose the specialization I did

My specialization is a psychologist specialized in mental health. There are a number of reasons why I chose this specialization. These reasons are both personal and social in nature. Firstly, I had an aspiration since my childhood to work in the health department thus in my time of specializing, I had to choose this particular one. I also loved to deal in the mental health of individuals so as to improve on their quality of life. Importantly, this particular program covers most key areas of psychology for instance social, biological, developmental, and individual differences (Bayne & Horton, 2003) and since it was my desire to explore psychology in details, I had to opt for this specialization. This specialization shows me a direct positive impact I have on an individual.

How this specialization fits my personal and professional goals

My goal in the profession of psychology right from the beginning was to be able to provide expert treatment and support those with mental problems such as anxiety, depression, disorders, etc. I desired to be one of the consultants and specialists responsible in evaluating patients using various tests and assessments. I also desired to be in position to address various mental problems that are affecting people today and through this specialization, I will be able to achieve my personal and professional goals. I have a goal to have a good and a favorable dealing with those having mental problems and provide a suitable solution to their problems. I would also like to have many discoveries as far as mental health is concerned. And I believe, through this specialization, I will be able to achieve all these goals.

The opportunities for professional association available in my specialization

Mental health is a broad field with a wide range o career choices and opportunities (Melcher, 2011). Professionals who are allowed to provide psychological assessments and therapy include clinical psychologists and school psychologists. Clinical psychologists are required to have a doctoral degree from mental health program while with school psychologists; an advanced degree is required (Bayne & Horton, 2003). There are professionals who are specifically trained to provide counseling but cannot prescribe medication and they include licensed professional counselors, mental health counselors at a masters degree. There is also an opportunity of a nurse psychotherapist trained in diagnosis and counseling. Marital and family therapist is a counselor with special training and education in family matters (Bayne & Horton, 2003). He or she is trained to diagnose and provide group counseling and must have a masters degree. There is also a peer specialist who is required to have lived experience with mental health. There also health professional recommended to prescribe medication but should not provide therapy and they include psychiatrists who have special training in diagnosis and treatment mental and emotional illnesses (Melcher, 2011). Psychiatrists are also alienated into child or adolescent psychiatrists and psychiatric practitioner.

How to involve myself in the profession with my intended specialization

As per my specialization, I will ensure to spend a lot of my time in the field, work with various specialists in the field for example doctors so as to acquire meaningful experience that will help me in the practical time. I will train myself to schedule the work hours in order to accommodate the needs of the patients. I also need to involve myself in thorough and continuous research as far as the field of mental health is concerned and this will help me achieve my intended goals in the profession.

References

Bayne, R., & Horton, I. (2003). Applied psychology: Current issues and new directions. London: SAGE Publications.

Melcher, T. P. (2011). Foundations of professional psychology: The end of theoretical orientations and the emergence of the biopsychosocial approach. Amsterdam: Elsevier