Critical thinking in nursing

The nursing profession usually favors those people who have been gifted with nurturing abilities and those who have the desire to help among other traits. However, critical thinking is a very important skill which many professionals tend to overlook. It involves the know how to identify a problem, getting the most excellent solution and implementing it using the most effective methods. With this regard, there are various ways that someone can use to demonstrate the critical thinking concept while he or she is undertaking various roles of the nursing profession (Cazzell & Anderson, 2016).

First, one can demonstrate by solving complex problems especially those that require a deeper understanding of the nursing profession.  This is because the practical application of the intellectual skills in handling sophisticated issues would indeed demonstrate the ability to use the critical thinking skills. Some of these intellectual skills include gathering information, organizing, integrating as well as evaluating to get the required outcome (Cazzell & Anderson, 2016).

Secondly, critical thinkers are able to act as the advocates of their patients. This means that they are able to listen and empathetically enter into the shoes of the diseased. Understanding the situation and the pain of the patient is a critical thinking skill which all the nurses ought to learn (Cazzell & Anderson, 2016).

The other way of demonstrating is by expressing reasoned judgments. Critical thinkers are always disposed to suspend their judgments until fully and comprehensively articulate their position and that of others before making any decision.

Finally, nurses who are critical thinkers have self confidence in their sound reasoning. This results from the fact that they are truth seekers who are very sensitive in realizing a misleading action that may portray biasness (Cazzell & Anderson, 2016).

References

Cazzell, M., & Anderson, M. (2016). The Impact of Critical Thinking on Clinical Judgment During Simulation With Senior Nursing Students. Nursing Education Perspectives, 37(2), 83-90. doi:10.5480/15-1553

            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).

            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). 

            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.

            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.

            Deep Vein Thrombosis

            Deep vein thrombosis is the blood lump formation within a vein that exists profound mostly in individual’s legs where a larger vein runs via the muscles to the thighs. DVT can lead to swelling and pain in the legs and this may result in complications like pulmonary embolism.  The condition occurs when blood clot parts get into the blood stream thus blooding one of the lungs blood vessels (Aggarwal, & Yadava, 112). 

            DVT is characterized by various symptoms which may include, swelling, tenderness and pain in one leg, a very heavy ache especially o the areas that are affected and having a warmer skin on the part where clotting has taken place. In addition, one may experience a red skin at the lower part of the knee on the back side (Aggarwal, & Yadava, 98). DVT is mostly established to affect a single leg although not in all the circumstances.  The pain gets worse at that point when individual bens their knee on the upward side. DVT can affect individuals from all age brackets but it affects mostly individuals who are above 40 years.  Several other factors may result in DVT which includes holding a blood clot family history, inactivity for long periods, damages of the blood vessels, pregnancy, obesity, and various treatment conditions (Aggarwal, & Yadava, 102).

            DVT can be diagnosed through ultrasound scan, D-dimer test, and venogram.  These tests are effective in detecting blood clots within the veins and blood streams.  An ultrasound scan is more reliable because it is accurate as other tests are bound to change after the operation as blood flow must continue.  DVT is therefore identified through slowed blood flow within the affected area. The capability of blood to clot is reduced by taking anticoagulant medicines (Blann, 9).

            References

            Aggarwal, Bharat B, and O P. Yadava. Deep Vein Thrombosis: A Multispecialty Approach. New Delhi: Elsevier, 2010. Internet resource.

            Blann, Andrew. Deep Vein Thrombosis and Pulmonary Embolism: a Guide for Practitioners. London: M &    K Update Ltd, 2015. Print.

            Color Doppler Rolls In Imaging Of the Lower Extremities Venous System

            Color Doppler imaging is a technique that allows medical providers to view and evaluate the flow of blood through the veins as well as arteries within the different organs of the body like the kidney and liver (Bhargava, 196).  The procedure is conducted in order to establish blood clots, especially in the organs veins.  The imaging strategy combines anatomical data derived by utilizing ultrasonic echo techniques with the data of velocity which is derived by utilizing Doppler techniques in generating colored images. Doppler imaging is therefore utilized in deriving information in regard to velocity (Bhargava, 196).

            Color Doppler helps in generating the capability of rapid localization of occlusions, arteries as well as in the identification process of those veins that fail to work. Color Doppler scanners help in detecting and displaying moving structures as they superimpose color onto the image scale (Mostbeck, 153).  Whenever the Doppler scanner detects any moving structure in the veins or in the flow of blood it superimposes color.  The flow of blood, as well as the velocity, is therefore indicated by the color Doppler through color superimposition.  The color additionally helps in interpreting the volume rate of blood flow and this is helpful in identification of high velocity which is linked with important arteries narrowing.

            Color Doppler is utilized in displaying the blood flow of venous.  The flow of blood is slower in the veins and therefore distinct settings are utilized. The velocity of blood flow ids additionally detected and indicated by the color Doppler scanner through the utilization of pulses.  This helps in the identification of blood clot as well as the direction of velocity flow while imaging lower extremities system of the venous (Bhargava, 199).

            References

Bhargava, Satish K. Textbook of Color Doppler Imaging. , 2010. Print.

            Mostbeck, Gerhard H. Duplex and Color Doppler Imaging of the Venous System. Berlin [u.a.: Springer, 2004. Print.

Mental health care

In the institutional care of the earlier days, the mentally ill patients were cared for in the state hospitals, which were often referred to as asylums and gave the patients a way of life together with total psychiatric and medical care.  The institutions were self-contained communities and villages. At the beginning, the hospitals gave hope, treatment and refuge to the mental patients and offered state-the-art treatment in what the management believed was a compassionate and humane ways. Being self-contained communities, the hospitals operated by furnishing their own medical care (Bazemore, 2005). The main principle of rehabilitation was emphasized through work in two areas, farming and the Cottage industries.  In the cottage industries were the weaving chair seats, sewing, stencilling, woodworking and upholstering.  Many of the sate asylums raised pigs and cows. The institutions also provided classes to their patients. The care involved various ways of addressing the social and entertainment needs of their patients which included pool tables, swimming areas, beauty parlours, picnic areas and libraries and patient dances.  The hospitals also encouraged community involvement and interaction, and this was possible because they were located in or near populated areas rather than in the country sides. The fact the creation of the graves was done on the grounds shows the possibility of family abandonment and prolonged hospitalisations which further led to patients being buried simple graves that were only marked by numbers (Bazemore, 2005).

Fast forward to the current moments the focus of mental health endeavours turned to deinstitutionalisation. Gradually the state hospitals begun acquiring patients’ services from the community at large. In the current times, many of the state hospitals entered into agreement with general hospitals that are supposed to give acute and emergency medical care to their patients (Bazemore, 2005). This change culminated with the nationwide movement for Community Mental Health Care that was based on different hospitals. The first principle involves the designation of local centres for mental health to be excusive agents, and were given responsibility for a particular population.   The focus in the community based care services is directed to prevention and offering early intervention so as to reduce the demand for the services in the long-run. Unlike the institutional care, the new approach emphasized on treating mentally ill persons in their home communities where the environment is least restrictive. In addition the community based care is based on providing a variety of care, which includes the provision of services required by the Departments of HealthCare so as to meet the consumer needs in the groups targeted by the department, and other services to adults with severe mental ailments   , youth and children with emotional disorders and traditional prevention, counselling services and early interventions.  However both of these approaches to mental health care apply the principles engaging a variety of professionals while at the same time engaging the community so as improve interactions or tap on the intervention skills of the specialists (Ahr, 2005). 

The community based health care offer better services than the institutional care. The health care service is provided by the health centres as exclusive agents which makes it possible to focus on prevention and intervention early enough. Moreover, treating the patients in their communities eliminate the restriction and abandonment observed in the earlier approach. The patients are thus able to do normal functions and be full participants in the community (Oss, 2004) .The effectiveness of the services was evidenced by the decreasing population to the state hospitals.  The provision of institutional care to persons with persistent mental health problems basically has no ground as long as the individual’s case can be handled in community health care system. It should be handled in the community by behavioural health professionals who might be able to eliminate stigma and advocate parity legislation (Edwards, 2005).

References

Ahr, P. R. (2005). Community Mental Health Principles: A 40-Year Case Study. Behavioural Health Management, 25(1), 15-17.

Bazemore, p. h. (2005). When state hospitals were communities. Behavioural health management, 2

Oss, M. E. (2004). All Roads Lead to Community-Based Care. Behavioural Health Management. p. 6.

Edwards, D. J. (2005). THE BEHAVIORAL HEALTH INDUSTRY? Behavioural Health Management, 25(3), 49.

Fire Warning and Suppression System (FWSS) Use Case 

 The black circle represents the incident of fire in the aircraft which triggers the sensor and the sensor communicates to the alarm which is raised all over the aircraft. However, there are other alternatives that can be used instead of using the normal flow. For A1, instead of fire triggering the sensor, the fire can trigger the alarm which will inform the fire department. Additionally, the fire can trigger the sensor and the sensor raise an alarm directly to the crew of the aircraft. 

PART 2

There are numerous key traits that system engineering managers need to possess to be successful. The three very major traits include a deep understanding of how things work, the trait of being exhaustive and methodical in all approaches and lastly being updated on any ongoing analysis. Within a very short period of working with a team of engineers who mean to be successful, it is easily noted that they have a special kind of developer that gives regard to not only knowing how to do what is expected of them but how to perfect it too.

First, system engineering managers are supposed to have a clear and deep understanding of the way things work. This to mean that they really need to understand all that is happening in the background to make all magic promising in a different level (Blanchard, 2008). This meant decades of researching to me to get this clear understanding of the concepts that are involved. To me, I spend quite considerable time to get an understanding of how the fire warning and suppression system works. In addition to the time spent learning of how it works there is still more that remains for research with the new technology each day.

Secondly, a team of engineers who are successful needs to be set for thorough and methodical approaches. Despite time run out successful engineering system managers take time to finish a perfect work ensuring there is time for all tests that are necessary before any major step is taken. Successful engineers understand that it cost an extra time spent and order to do things in their right way and present them as perfect (Blanchard, 2008). This only comes by writing exhaustive test and ensuring super monitors which ensures these things are up perfectly.

Thirdly, it is important for successful engineers to analyze how they perform even as they pursue perfection (Blanchard, 2008). A successful team needs to be purely updated on any refactoring and upgrades and apply them regularly to keep their system growing and remain healthy. A system of successful engineers is keep on doing all it takes to make themselves perfect in curbing issues of fire and whichever field they serve. They take great pride in their work and have a great desire to their engineering profession.

Reference

Top of Form

Blanchard, B. S. (2008). System engineering management. Chichester: John Wiley & Sons.

            Educational Preparation

            Introduction

            Nursing is the optimization, protection, and promotion of the abilities and healthy, illness prevention human treatment and care advocacy of the general population (Fitzpatrick, & McCarthy, 2014).  A nurse educational level makes contrasts in the practice of nursing.  This is despite the fact that the definition of nursing does not state who is supposed to provide health care based on the two programs. This is because both programs ensure that the nurses acquire the required training into the program in the provision of healthcare to the general population.  Based on research and surveys conducted to illustrate the competency level in the provision of quality health care between the BSN and ADN nurses baccalaureate degree has emerged as the best.  This is because the results of the research indicated that BSN is associated with the lower mortality rate, higher positive impacts and fewer errors in medical practice.  Nursing is constantly evolving in the current world in different directions of the field of health care (Fitzpatrick, & McCarthy, 2014).  At the start, nursing was more based on expanded educational models.  In order to become a registered nurse, one goes via several stages which include general training, prerequisites, Baccalaureate degree, nursing masters, a doctoral degree. Therefore one has several considerations on the type of degree to acquire.  This paper will, therefore, focus on establishing the disparities amid BSN and ADN and nurses fitness.

            Competencies Dissimilarities amid BSN and ADN Nurses

            There is a huge contract in competencies between ADN and BSN nurses. ADN is more preferred because the nurses are able o complete the courses within a short time period of between two to three years while those that partakes BSN consumes a minimum of four years (Finkelman, & Kenner, 2016).  However despite the fact that both programs hold the capability of providing the necessary knowledge to the nurses in passing the required minimum test entry into the practice of nursing BSN holds a higher competence level than ADN.  Based on the current research that has been conducted on the competence level of the two programs Baccalaureate program level has been established to be providing the nurses with much higher, advanced, creative capabilities, analytical, stronger skills of assessment, higher capability in knowledge application, workflow confidence as well as professional medical skills. This is contrary to the associate level of degree which mainly focuses on providing the nurses with technical knowledge and skills which help the nurses in providing only direct health care (Finkelman, & Kenner, 2016). The program, therefore, provides less complex and restricted nursing level because it focuses on the nursing activities that are more technical thus eradicating chances for advancement and development.  The nurses who undertake BSN program are characterized by a lack of increased knowledge and skills because the program denies the capability of developing essential skills. Additionally, they nurses do not have the stronger ability in applying the acquired knowledge since the  program fails in providing broader details since it is based on a shorter time program.  The program fails in developing stronger skills of assessment and communication which are essential in the provision of medical care. On the other side, BSN ensures that the nurses acquire developed skills that are linked to diverse knowledge and advancement (Finkelman, & Kenner, 2016).

            The ADN program fails to priorities theoretical knowledge as it is mainly based on technical skills which are purposed to ensure that the nurse students passes the board exam.  This is therefore proffered because it allows individuals to be engaged in work early thus earning money within a shorter period span (Finkelman, & Kenner, 2016).  BSN is based on both theoretical and technical skills this ensuring that the students have the capability to provide quality care to the health care patients.  Their competence level is more recognized and therefore more institutions prefer to employ them.  Patient safety is more considered by the nurses who have acquired ASN because the program helps them in incorporating all the health elements when treating the patients. On the other side, the ADN program is base on ensuring that the students acquire basic knowledge in health care provision.  However, the BSN program prepares the nurses based on a broader knowledge scope at an advanced professional practice level. BSN ensures that the nurses acquire knowledge that is based on the general nursing education as well as clinical education in helping them to become more effective nurses.  BSN, therefore, holds a higher level of competency because it works in ensuring that technical knowledge is linked to effectiveness (Finkelman, & Kenner, 2016).

            Patient Identification Situation

            For instance, the patient is admitted to the intensive care unit and is thus required to undergo a surgery immediately in order to solve the condition. The patient is however diagnosed with blood pressure issues. It is, therefore, necessary to monitor the level of blood pressure before conducting the surgery. This is to ensure that the safety and health of the patient are ensured.

            The nurse is required to conduct frequent blood pressure monitoring on the patient. A nurse who has acquired BSN will be able to conduct sensory necessities in providing accurate treatment and care to the patient (Huston, 2014).  This is mainly because he or she has the ability to gather information from the acquired knowledge, discriminating the information, changing knowledge analyzing it and applying it through logical reasoning. The ability to make those decisions will, therefore, differ from an ADN nurse since the lack the ability to make critical decisions.   The nurse is bound to make use of a certain level of critical thoughts which will not be analyzed based on evidence or the current situation.  The nurse will, therefore, fail in utilizing the different methods that are available in solving the issue because the program provides solutions that are not linked t thinking critically which is essential in health care practice. Critical thinking is essential as it helps in generating the necessary changes in the clinical a practice approaches (Huston, 2014).

            Based on the situation in which the patient is in a critical condition the ADN nurse may not be able to observe the safety of the patient. This is because the acquired knowledge is more technical and therefore the nurse may consider conducting the surgery directly.  The situation, however, requires consideration of other conditions.  The BSN nurse will be able to utilize the acquired skills in ensuring that the patient is in a god condition.  This is by incorporating clinical and technical skills in analyzing the situation in order to develop appropriate solutions (Huston, 2014).  BSN nurses will apply critical reflection in making clinical decisions based on the situation of the patient.  The practice will, therefore, incorporate both technological and scientific knowledge while an ADN degree nurse will utilize technical research (Huston, 2014).  The ADN nurse may generate clinical errors during the treatment due to lack of strong reflection as the program does not provide the students with the ability to develop the acquired knowledge. Their decisions may, therefore, differ because a BSN diploma nurse is bound to make more effective decisions based on broad knowledge scope.

            References

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

            Fitzpatrick, J. J., & McCarthy, G. (2014). Theories guiding nursing research and practice: Making nursing knowledge development explicit.

Huston, C. J. (2014). Professional issues in nursing: Challenges & opportunities.

            Public Health Policies

            The health of any population is mainly influenced by both the economic situation around it as well as the social circumstances with the inclusion of the health care services that it provides (Kim, Farmer, & Porter, 2013).  Lack of quality health care access is a global health issue for obesity patients as despite the health developments taking place most individuals have not been able to access proper care.  Many individuals have proper access to quality health care which enables them to profit completely from the national system of health care. However, other individuals face barriers that hinder them from obtaining basic care services. This is thus illustrated by extensive research which confirms that ethnic and racial minorities and individuals from low economic levels are represented disproportionately among the individuals with health care access issues.  Accessing poor health care comes at societal and a personal cost as this raises the burden of diseases for the society in addition to the burden that is subjected to individuals bearing the disease (Kim, Farmer, & Porter, 2013). This, therefore, necessitates the implementation of health policies which will work to ensure that the individuals are well accessed to medical care.

            Several health policies can be utilized in ensuring that health care quality and access is distributed among every member of the society.  This, therefore, requires additional capital in the health care system which may be utilized in the distribution of programs.  The following policies will ensure that the demand and accessibility of health care are increased in order to solve the access issue.  Extending individual insurance coverage is crucial as health insurance makes a big difference in determining whether individuals access necessary care, where they receive it and their ultimate health status (Jha, Larizgoitia, Audera-Lopez, Prasopa-Plaizier, Waters, & Bates, 2013).  Those individuals who are not insured are likely to forgo health services and the general consequences are thus severe especially when those conditions that can be cured are not detected. Additionally, this results in diseases being recognized at advanced stages which make treatment complex, expensive and increases the mortality rate.

            Health care financing via pocket payments strengthens the limitation effect on the present price and income on utilization. The limitation is tightened further by the lack of opportunities to borrow. Insurances coverage is mostly limited to the formal employment which thus excludes individuals from other sectors who are mainly from the low socio-economic sector (Jha, Larizgoitia, Audera-Lopez, Prasopa-Plaizier, Waters, & Bates, 2013).  Insurances covers should be extended and this should not include extending insurance covers to those individual that are poor directly but this can be achieved by granting health covers that are grounded on several characteristics like age which is directly correlated with the level of poverty.  The policy can thus help in increasing the health care utilization thus reducing the disparities between the poor and the rich individuals (Jha, Larizgoitia, Audera-Lopez, Prasopa-Plaizier, Waters, & Bates, 2013). The financing system will additionally ensure that the government utilizes less capital in health care provision budget through setting up financing schemes in all communities.

            Price subsidies are an effective policy that will work to ensure that health care provision and access is increased. Health care prices are the major Deterrent to health care demand.  The cost of living has gradually risen over the recent years and the income still remains low thus limiting individuals from accessing care.  In addition health care is characterized by high cost which is distributed among the general population without the distinction of social classes.  The national government is therefore required to subsidize the health care prices to ensure that services are offered at reduced prices to increase demand. Additional medicines are highly priced especially for those suffering from chronic illness. Chronic diseases health care services should be waivered to ensure that the access difficulties are eliminated and the mortality rate will thus be lowered since most disease will be identified at early stages (Bauer, Briss, Goodman, & Bowman, 2014).

            Cash rewards should be utilized in addition to lowering the distance barrier.  This involves ensuring that services are provided to individuals or they are taken to the services (Bauer, Briss, Goodman, & Bowman, 2014). Price and insurance subsidies weaken the financial limitations to the access to health care.  The effectiveness of this policy, therefore, depends on the significance of health care pricing.  If education, poor knowledge, and cultural factors are the major influences of lack of health care access the barriers should be eliminated. Cash rewards can be utilized in inducing changes in seeking behavior of health (Bauer, Briss, Goodman, & Bowman, 2014).

            An ethical policy can be defined as a written guideline set that is subjected by an organization to the management and the workers to ensure that they conduct their actions in regard to the ethical standards and primary values (Gostin, & Milbank Memorial Fund, 2010).  An ethical policy is a theory that relates to the things that make actions of an organization right or wrong morally. The policy is aimed at raising awareness and the desire to access health care among the poor Individuals thus encouraging positive results (Gostin, & Milbank Memorial Fund, 2010).The proposed health policies are ethical because they are aimed at ensuring that health organization conducts their actions based on the things that are right morally.  Additionally, the policies provide guidelines on how their actions should define the impacts on the general health of organizations. This will, therefore, ensure that the health care facilities are guided by the good-being of individuals regardless of their racial, ethnic or social economic status. The policies are additional ethical because they define the importance of how those that are within the organization should interact with each other as well as with the patients.

            The policies may, however, be hindered by federal law, government policies and health policies.  Federal law holds the authority of assessing whether proposed policies are effective by evaluating the benefits as well as the disadvantages.  Since the policies require a high budget in the implementation the federal, as well as the national government, may hinder their progress if the budget is unmanageable. Ethical and legal concerned in implementing health policies may include, whether the policies will generate positive results, legal regulations as well as the general effects of the proposed policy (Turnock, 2012).

            References

            Bauer, U. E., Briss, P. A., Goodman, R. A., & Bowman, B. A. (2014). Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. The Lancet, 384(9937), 45-52.

            Gostin, L. O., & Milbank Memorial Fund. (2010). Public health law and ethics: A reader. Berkeley, Calif: University of California Press.

            Jha, A. K., Larizgoitia, I., Audera-Lopez, C., Prasopa-Plaizier, N., Waters, H., & Bates, D. W. (2013). The global burden of unsafe medical care: analytic modelling of observational studies. BMJ quality & safety, 22(10), 809-815.

            Kim, J. Y., Farmer, P., & Porter, M. E. (2013). Redefining global health-care delivery. The Lancet, 382(9897), 1060-1069.

            Turnock, B. J. (2012). Public health: What it is and how it works. Burlington, MA: Jones & Bartlett Learning.

GROUP THERAPY INTERVENTION

Psychodynamic groups

Introduction

Trauma is basically a medical term which occurs in an individual as a result of the extensive exposure to some sort of inescapable stressful events which overwhelms his or her coping mechanisms.  It can also mean a situation-specific, stressful, or severe disruption or violation which ultimately has a serious psychiatric consequences to a person either soon or later after such an event. Despite that one, it should be noted that trauma usually occurs in the context of society experiencing crime, accident, natural disaster or some sort of terrorism attacks.

Conversely, there is the need of understanding trauma mainly through the context of the settings in which it happened. The reason for this is because it remains to be a complex interaction response amongst individuals, events, or environmental factors which induces it. Trauma affects an individual in variety of ways for instance sadness, embarrassment, depression, loss of dignity or pride, denial, disbelief and so on.

Client population

For this group intervention therapy, the adults who have undergone trauma will be the one who will be subjected to a particular treatment as dictated by each stage. Thus the group replacement will mainly really on its goals and structure as well as the characteristics of an individual under consideration. The reason for this is due to the fact that individuals who have been subjected to trauma are usually more vulnerable to overwhelming effects hence developing the tendency of dissociating themselves from the therapeutic techniques to be employed.

Regardless of the above considerations, the rationale for this group will be the provision of opportunities to all individuals with historical traumas so as to make us of the protected supportive therapeutic of this group. The effectiveness of it is that it will aid all the individuals in not only learning about but also changing their interpersonal selves so as to reconnect with their community as a whole person and to be part of human society. Consequently, the goals of this group will be dealing with things like helping the members in developing awareness of as well as the capacity of expressing feelings in the here and now, providing opportunities for each member when it comes to learning the manner in which he or she affects other individuals or him or her via the exploration of group interventions. Additionally, it will act as an avenue of enabling its members to learn about the various forms of distortions which they do bring into their interactions through the examination or understanding transference reactions to their leader and the members.

Steps for the intervention

The steps to be involved in this intervention include the formation phase, reactive phase, mature phase, and the termination phase. The formation phase will deal with the development of trust, seeking ways of joining the group, development of norms, introduction of members to the group through various ways and the discouragement of premature disclosure. In the reactive phase, members will be given the opportunity of becoming aware of the differences or the reactions that exist between themselves or their group and the norms to be tested. Moreover, the leader will be absorbing any disappointments or negative feelings of group and addressing the agreements consistently in return with much curiosity and thoughtfulness. Therefore, the goal here will be retaining a sense of cohesion, differentiation, and belongings in the group.  It is the group confidence which will ultimately manage anxiety as well as deal with any problems to be encountered.  The last stage which is the termination phase will only happen whenever a member leaves the group. Thus it will be essential for the group to be having successful termination so as to act as an example to others.

Client responses

The general outcome or client responses indicates that majority of these individuals may not be readily willing to address the emotional aftermath they experience after the trauma. They can only do so after the numbing and decreasing of the shock. Although not all individuals who are exposed to trauma do end up developing diagnosable conditions or require treatment, some of them may experience sudden decline of trauma symptoms hence does not develop long-term psychological symptoms.  In return, they will be able to draw on both internal as well as environmental resources which will assist them in coping up with trauma experiences and finally resuming their previous levels of functioning.

Contradiction

Regardless of this group intervention therapy, the contradicting part of this intervention is that at times the leader might encounter some difficulties in handling or tolerating the behaviors of some members or the conflicts amongst the members. Furthermore, the group members might also experience the lack of some structure anxiety- provoking or difficulties in expressing themselves about the trauma whenever there will be the lack of structure.

Conclusion

To sum up, basically, the objective of this intervention will be directed at obtaining a diversified knowledge which assists in not only diagnosing a broad spectrum of trauma responses in adults but also identifying the situations through which the various group interventions for adult trauma are indicated.  Moreover, it will be an opportunity of acknowledging the various ways that needs to be modified so as to meet the needs of such a population. In the long-run it will also help in selecting the appropriate group which is suitable for each stage of treatment hence defining its structure as well as interviewing prospective members.

Adjuvant chemotherapy

The administration of adjuvant chemotherapy to breast cancer patients goes a long way in preventing the recurrence of the disease especially any distant recurrence. The recommendation for chemotherapy may be done where the breast cancer is invasive, has prognostic factors that are unfavourable, is a particular size or its spreading has reached the nearby lymph nodes. It can also be recommended if the patient is relatively young when the cancer was diagnosed since there is a high possibility of recurrence as they advance in age. Adjuvant chemotherapy refers to the approach of treating cancer that involves combination of different kinds of healing. It aims at destroying cancer cells that remain after treatment but which are usually undetectable. The purpose of this paper is to show the benefits of adjuvant chemotherapy treating breast cancer using more than one drug¹.

The combination of more than one drugs is referred to as combination chemotherapy. The basis for any combination chemotherapy is the usage of drugs that function through diverse mechanisms so that to decrease the likelihood that there will be development of resistant cancer cells. When the combination of drugs with different effects is done, each of these drugs can be useful when given as optimal dose without severe side effects that are intolerable. After surgery is done to remove breast cancer that is in the early stage, many patients especially women are treated with a combination of various drugs². The treatment given after the surgery usually aim at lowering the recurrence of the cancer coming back especially the postmenopausal women. Studies have showed that women who are in the postmenopausal age and are diagnosed with early-stage breast cancer that is hormone-receptor-positive and whose spreading has reached the lymph nodes have better chance of survival after the administration of adjuvant chemotherapy. In fact, after they were given the combination of adjuvant chemotherapy and adjuvant hormonal-therapy, the risk of recurrence was lower and they were more likely to live longer than women who were given hormonal therapy alone. Also, giving administering hormonal therapy after doing chemotherapy was better than administering chemotherapy and hormonal therapy at the same time².

Thus to avert the recurrence of breast cancer after surgery, it is necessary to use adjuvant chemotherapy using more than one approach in order to attain the maximum benefit of it. For any cancer, the optimal approach is to combine surgery, chemotherapy and radiation therapy. Radiation or surgery therapy is useful in treatment of locally confined cancer , while adjuvant chemotherapy kills the cancer cells that  have with time spread to locations that quite distant. Combination chemotherapy is the best attempt by medicine to avert the mutation of the cells or any resistance. Through the combination of various drugs or chemotherapeutic agents, there is usually an achievement of cells’ kill that is more complete. The cancer cells are destroyed by more than one drugs by use of collaboration by creating disruption at various phases of the cycle of cell reproduction cycle. The body cells pass through five stages in the reproduction cycle⁴. Most drugs for chemo work at a particular stage of the cycle only, while others are not specific for a certain stage. Attacking multiple stages of the cycle in cell replication is logical, so that to avert a mutation or resistance from happening or the recurring of the cancer after radiotherapy or surgery. The treatment of breast cancer using adjuvant chemo with different drugs can be compared to other treatments. A good example is the use of chemo therapy combination in the treatment of cancer of the lung. An accepted method of treatment for lung cancer cells that are small using etoposide and cisplatin together with external radiation. These two drugs form a good combination because they have distinct action mechanism but divergent toxicities. Cisplatin creates disruption during cell replication through cross-linking of the strands for the DNA. The drug is an effective killer of cancer cells, although it’s known for high renal toxicity³.

A great strategy is applied by oncologists in the development of various combination of chemotherapy drugs or agents. The first strategy is to ensure that drugs will be effective in the treatment of cancer type. Moreover, every drug attacks the cell malignancy using a mechanism of action that is different. For instance, a drug may cause the disruption of replication process for the DNA while another drug cause interference to the synthesis of proteins. By using more than one drug which have various action mechanisms, the possibility of evolution of a mutated cell-line is reduced. The combination of these drugs consider the toxicity. To achieve effectiveness in adjuvant chemotherapy, the combination of the drugs will aim at avoiding a second insult to the affected organ. Every drug’s effect on the liver, bone marrow or renal function should be put into consideration. The toxicity of the drug can result to additive effect. Combining the therapy aims at obtaining synergy in the killing while at the same time avoiding the additive toxicity².

The triumph in empirical combination in chemotherapy was developed in the 1960s in the treatment of lymphoma and leukaemia and sometime later for tumour type in adult that were drug resistance which resulted in the promulgation of several principles of developing therapy regimens for multiple drugs⁴. The criteria applied was using a combination of drugs that are normally active when used as single agents with doses and schedule where the activity of single agent had already been approved. This resulted in the incorporation of drugs having different types of toxicity in a normal tissue. The cycle of the cell and drug action biochemical consequences were also regarded as necessary and therefore the combination of drugs with distinct action mechanisms and action site in the replication cycle were considered favourably. The attention later turned to the significance of drug resistance and the mechanism involved in the resistance, and the investigation of non-cross-resistant drug function combination was done. The results recommended selection of drugs that have similar methods of action but separate resistance mechanisms⁴.

Therefore, surgery aims at removing all the cancer that is visible, while adjuvant chemo is aimed at killing any breast cancer cells that may have remained but are invisible even after imaging tests are done. If the growth of these cells is allowed, new tumours would form in other body parts. Combination of various drugs in adjuvant chemo can lead to reduction of the risk of any recurrence. The use of a single drug is very unlikely to lead to reasonable cure, especially taking into account that there is a possibility of the cancer cell developing resistance.

References

Ponder,A. Waring ,M.(2012). The Science of Cancer Treatment.41-42

Breast Cancer org. (2009). Research Continues to Show Benefit of Chemotherapy after Breast Cancer Surgery. Retrieved from: http://www.breastcancer.org/research-news/20091212b

Motzer RJ1, Sheinfeld J, Mazumdar M, Bajorin DF, Bosl GJ, Herr H, Lyn P, Vlamis V.(1995).Etoposide and cisplatin adjuvant therapy for patients with pathologic stage II germ cell tumours.

 DeVita, V., Chu E. (2008). A History of Cancer Chemotherapy. Retrieved from: http://cancerres.aacrjournals.org/content/68/21/8643.full

            Analysis of Costs, Risks, and Benefits

            Behavioral interventions in reducing the risks associated with HIV are efficient and should thus be disseminated largely (Mayer, & Pizer, 2009).  Addressing the issue is beneficial as it helps in realizing the potential of the authoritative strategy which exposes individuals to risks that are unnecessary.  The risks that are involved in addressing the HIV issue is the legislative barriers which prevent and discourage the efficiency of programs. Addressing the issue will work at ensuring that the issue is fully addressed and safer behaviors of having sex will be developed.  The major risk that is involved in addressing the issue is cost inefficiency as the programs are characterized by high risk.  The risks are mainly associated with the emerging risk groups especially individuals from minority groups and those from the gay society (Mayer, & Pizer, 2009).

            The behavioral interventions are the right approach to addressing HIV as a major health issue. This, therefore, involves the provision of education to the public by informing them of the risks involved.  This must, therefore, ensure that legislative barriers are fully eliminated to acquire efficiency.  Additionally halting of funding the drug abuse programs of treatment should be emphasized because based on the recent research the programs have been established to major influences in decreasing risky behaviors of abuse of drugs (Mayer, & Pizer, 2009).

            Ethical issues that should be observed are associated with autonomy. The autonomy theory suggests that persons have the full rights in making decisions that are out of pressure or influence (Ivanov, & Blue, 2008). This, therefore, involves informed consent and monetary incentives.  Informed consent is effective in ensuring that autonomy is maintained where the individuals are assured of protection.  Monetary incentives are in regard to the ethical considerations in regard to the general target population (Ivanov, & Blue, 2008).  

            References

Ivanov, L. L., & Blue, C. L. (2008). Public health nursing: Leadership, policy, & practice.           Australia: Delmar Cengage Delmar.

Mayer, K. H., & Pizer, H. (2009). HIV prevention: A comprehensive approach. Amsterdam:             Elsevier/Academic Press.

OBESITY

            Obesity is a medical state in which the body fats accumulate excessively to a point where it has a negative effect on the person. Once a person has a BMI that exceeds 30 then one is considered as an obese. This is measured by the use of the Body mass index (BMI) where the measurement is gotten from dividing the weight of a person by the square of the height of that person. This disease is mostly confused with being overweight but the reality is, obesity is caused by accumulation of so many calories in the body while being overweight indicates that a person is weighing way too much than normal. The overweight may be as a result of many factors such as accumulation of so much water, bone fat or even muscle. However both overweight and obesity has one thing in common in that the person has more weight than the one he/she is supposed to have hence this is medically considered as unhealthy. This paper therefore will narrow down its argument on the childhood obesity.

            Childhood obesity has become a major concern to all nations across the world. This is because it has widely affected the lives, education and social-economic status of their lives. These children majorly face stigmatization from the society, emotional, social and psychological challenges. Over the years since 1980s the health disorder has been increasing widely resulting to it becoming an epidemic.  As a result of the long term effects of this medical condition in the young generation, most of the public health practitioners have vowed to help curb this condition so as to create a healthy generation (MORENO et al 2013). Also this would help ensure that the obese children are free from becoming obese adults thus they are able to live longer lives full of health.

Causes of childhood obesity

            The origin causes of childhood obesity are rather complex and uncertain but it is rather clear that children often turn out to be obese when they eat too much and they exercise very little. To add on that, most of these children end up making poor food choice, unhealthy choice of eating and a lot of snack eating than the consumption of healthy vegetable and fruits. not having calorie burning exercise is another contributing factor towards obesity health condition. The maternal excessive consumption rate of fatty foods by the mother during the pregnancy period may lead to the overeating behavior of the child (Flamenbaum 2006). This factor is based on the psychological view that the fat consumption by the mother at her pregnancy program may have induced changes within the mind of the fetal brain. This results to the stimulation of appetite thus high production of peptides. After birth these peptides continues to produce more throughout the life of the child hence ending to the obesity condition.

Signs and symptoms

            There are different symptoms that may occur to different children; however there are common symptoms among the children. One of the symptoms is the occurrence of stretch marks on the hip and abdomen area with a dark and soft skin around the neck area. They also have fatty tissues especially for the boys around the breast area (Flamenbaum 2006). They also have psychological symptoms such as having a low self-esteem, eating disorders while they also tend to be chitchat and abusive. They also have a breathing problem especially when they are active physically and snores a lot at night. They also have gastro esophageal reflux with constipation problems. They also reproductively mature early as the girls experience an early puberty with irregularity in menstrual cycle in the young girls (Flamenbaum 2006).

Whereas in the boys they experience delayed puberty while their genitals may seem to be small in the young males. They also tend to have flat feet with painful knock-knees and hip dislocation. Some of the common signs of childhood obesity involve weight increase, increase of appetite and inactivity. Other signs may include, the emotional eating habit as well are boredom, nervousness and depression (Flamenbaum 2006). Lack of interest in physical playing activities and more interest on computer games may be another least sign of obesity.

Risk factors

            Basically, the life of an infant may be at risk of obesity from birth or the early life of the infant to an age of seven years. However, some of these risk factors may appear at the start or simply before the birth of the infant.  However some of these risk factors which occurs by the time the child attains the age of seven years includes, higher weight of the infant during birth. Another risk factor is the parental obesity and rapid increase of weight especially in the first years of the Childs life (Flamenbaum 2006). The act of spending much of the time while watching the television or playing video games while at three years that is much more than 8 hours.  Spending of fewer hours for a three years child that is less than ten and a half hour per night is another risk factor. The early development of child body fatness before reaching the age of 5-6 years is risky as this should be the time when the fat content in the body should be increasing. Another risk is the rapid cat-up growth of the child between his/her birth and two years.

            This disease can however be considered as contagious since it can greatly be influenced by the entire society. The family in specific can influence the eating habits of a child and they can contribute to overeating behavior as the parents may poorly feed them.  

The parents also determine the choice of foods for their children as they are the ones who provide the food type to the children. Peer pressure is another influence towards the Childs obesity since the choice of food by the peers may result to the child being influenced to take the same choice of foods.  The friends are also influencers as they may influence each other to stay indoors and totally fail to do exercises as they play video games. The culture in general may influence the childhood obesity condition as any culture has their food preference over the others and it is this food preference that may cause the obese condition to the young generation due to the environment they are raised in (Flamenbaum 2006). these patterns are quite tempting and they are progressive from one generation to another unless a good prevention is strategized and implemented so as to curb the result of the whole society suffering obesity.

PREVALENCE

            The occurrence of childhood obesity has tripled over the years and currently researchers’ are estimating that in one child in every five children in the United States has obesity condition. Prevalence of the obesity condition in childhood is basically different in different nations with the highest prevalence of 16%in Hispanic, followed by 19% in African America, 35-40% prevalence in Native Americans. The obese children in preschool is rapidly increasing with likelihood that these children will become five times more likely to be obesity adults (MORENO et al 2013).

Transmission

            This kind of condition may be transmitted to the children from the parents. Most of the children from obese parents tend to be obese themselves.  

This is because there is the existence of the inherited component that is transmitted to the child from the parents and hence results to the child acquiring the obese disorder. Parental obesity may also create an environment where it promotes excessive eating with insufficient physical activity. Also this disorder may be transmitted from parents who have poor nutritional behaviors and who lead sedentary lifestyles. This creates an environment that is unsuitable hence may cause obesity condition.

Treatment

            This majorly aims at reducing the fat content in the body by reduction of food consumption and also aims at removing the causative agents of obesity. However, reduction of causative agents may be difficult especially for emotional and psycholo0gical causes. Medical supervision is one of the treatment where the patient is supervised so bas to reduce weight to normal by reducing the intake of calories. Dieting is an important treatment which is quick in producing results without so much effort and this ultimately results to reduction and maintenance of weight at a normal level that is healthy (Flamenbaum 2006). Increased physical activity is important as it will help burn calories. Dietary changes are also efficient and it involves reduced calorie intake with the substitution of fruits together with vegetables for carbohydrates.

Community Impact

            Prevention of obesity in children is a concern to the community as it extends beyond the individual or the family and beyond the geographical boundaries. This therefore brings people with the same interest together and shares the same values in promoting healthy lifestyles. So many factors within the community setting influence the health of the children (Flamenbaum 2006).

The core goal of a community is to ensure that the children within the society grows healthy and are mentally and physically productive. Hence the community must be capable to foster social norms so as to support both energetic and physical activeness in their lives.

Implications for the teacher

            The teachers can encourage the young students to consume water instead of sweetened beverages and they should ensure that the water is freely provided and that they access the water while in school. They should also ensure that they provide these students with food that do meet the dietary recommendation at lunch meals such as fruits and vegetables. They should also adopt a curriculum where their students are vigorously engaged in physical activities during the physical lessons. They should also implement the addition of health education into their curriculum so as to create awareness on the importance of healthy living and dietary requirement and its significance.

            A parent or the teacher can enquire more on healthy guidelines from the following sources retrieved from the internet:

https://www.health.ny.gov/prevention/nutrition/resources/obparnts.htm

http://www.heart.org/HEARTORG/HealthyLiving/HealthyKids/ChildhoodObesity/Preventing-Childhood-Obesity-Tips-for-Parents-and-Caretakers_UCM_456118_Article.jsp#.V17-tDUcRkg

References

Flamenbaum, R. K. (2006). Childhood obesity and health research. New York: Nova Science      Publishers.

Hawkes, C. (2007). Promoting healthy diets and tackling obesity and diet-related chronic diseases: what are the agricultural policy levers?. Food and nutrition bulletin, 28(2     suppl2), S312-S322.

MORENO, G., JOHNSON-SHELTON, D., & BOLES, S. (2013). Prevalence and Prediction of   Overweight and      Obesity Among Elementary School Students. Journal Of School     Health, 83(3), 157-163.