Advanced Nursing Role: Family Nurse Practitioner

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Introduction

Advanced practice nursing encompasses many different kinds of roles in nursing. At the master’s level of education in nursing, a few roles include nurse practitioner, nurse informatics, nurse educator, and nurse administrator. It is essential to have knowledge and understanding of these advanced practice nursing roles and how they are different and similar. This final written assignment we are going to discuss what I discovered about the different advanced practice roles and scope of practice found in the master nursing curriculum I am pursuing the advanced practice nursing role of the family nurse practitioner. My involvement in future leadership roles and participation in professional organizations will also be discussed.


Advanced Practice roles in Nursing

Advanced Practice Nursing is a function of educational and practice preparation and a constellation of primary criteria and core competencies. Direct clinical practice is the central competency of any APN role and informs all the other competencies. The advanced role means that the traditional nursing role is advanced into new territory through a graduate-level education that prepares the nurse for one of four APRN roles: nurse practitioner (NP), certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), or a clinical nurse specialist (CNS). All APRNs are educated and prepared to provide a range of services across the health wellness-illness continuum, but each role varies in the emphasis and implementation of these services (NCBSN, 2008, p. 8). Advanced nursing practice should not be confused with advanced practice nursing (APN), which includes all other nurses with a master’s degree who in some form, practice advanced nursing practice, but do not fall in any of the four roles of APRNs.


Clinical Practice

As far as clinical practice goes, the roles between the nurse practitioner, nurse educator, nurse administrator, and nurse informaticist are very different. The nurse practitioner is responsible for direct patient care, seeing patients every day and diagnosing and treating their health care concerns. The nurse educator in a clinical practice setting such as a hospital is typically in a role where they evaluate, suggest, create, and incorporate programs to improve medical practices for patient’s safety. The nurse administrator, in a clinical practice setting, is responsible for a large group of departments or units within the health care facility. They are expected to monitor and address issues with staffing and patient satisfaction. The nurse informaticist, in a clinical practice setting, is responsible for the development and evaluation of applications, tools, and processes that assist nurses with the management of data when providing care to patients.


Primary Care

The nurse practitioner can act as a primary care provider as a family nurse practitioner in an outpatient setting providing direct care to patients to manage their health care plan. The nurse educator can work in the primary care setting by educating patients in their homes or at the doctor’s office in regards to general health care issues or specializations such as lactation and diabetic education. The nurse administrator in a primary care setting could include managing the nurses providing care to a community of home health care patients. The nurse informatics is still essential and needed in a primary care setting which would serve the same job description as the clinical practice just on a smaller scale so instead of a hospital, it would be more like an outpatient doctor’s office.


Education

The nurse practitioner works every day to educate their patients they see in order to promote the patient’s health care plan and meet their goals. The nurse educator’s whole job is based on the education of nurses, patients, and staff working together to promote patient safety and prevent health deterioration. The nurse administrator also plays a huge role in education as they are responsible for providing written and oral materials and presentations to diverse audiences on nursing, health care topics, and organizational issues (American Organization of Nurse Executives, 2015). The nurse informaticist educates nurses providing direct patient care on better ways to utilize computer technology and the charting of collected patient data.


Administration and Research

When it pertains to administration, the nurse practitioner, educator and informaticist do not play a significant role in this area. The nurse administrator works directly in and with the administration in their place of work and is responsible for a large group of staff and patients and must have a working knowledge of policies, procedures, budgeting, business, and legal issues. As far as research goes, the nurse practitioner, educator, administrator, and informaticist are all responsible for basing their practice off of evidence-based practice through research in order to ensure that they are practicing in the safest most effective way.

They are several advanced nursing practices, Family Nurse Practitioner is the one that I enrolled at South University. Family Nurse Practitioner is an advanced practice registered nurse who works autonomously or in collaboration with other healthcare professionals to deliver family care. Family Nurse Practitioner offers healthcare services that involve a family unit, from health promotion and disease prevention to direct care and counseling across life. Who influenced me to choose FNP was the emergency room department, where I currently have three years of experience. I have seen many people died because they do not know how to take care of their condition. I am aware of the lack of education that our patients have, and I will like to take care of my patients, help them believe in them, educate them and lead them to a healthy life. My nursing philosophy is that I am a faithful believer that God always works for good that is why my goal for the patient is always to keep the faith and confront the situation been favorable. I believe in bringing empathy to patients and always carry a smile for them. I always keep in mind one quote of an unknown patient “Remember, I’m not usually this needy or scared. I am here because I trust you, helping me stay confident.”


Advanced Practice Role: Family Nurse Practitioner

I interview Evelyn Reyes that is an FNP that currently work in the Emergency Department about eight months ago, but she also has experience working as FNP in an outpatient clinic. She works under multiple Doctors in the ED. The emergency department that she worked offer services to all ages. Evelyn has always loved the medical field, but she decides to pick a career where she was able to treat and diagnose patients but not to go to school for that long. She states that the most challenging part of being a Family Nurse Practitioner would be the lack of full autonomy. She chooses this specialty because she thinks it is a good starting point that helps you build a good foundation.


Regulatory and Legal Requirements

A family nurse practitioner scope of practice represents the full range of practice privileges allowed by certification and licensure. However, all NPs must complete al that master’s program. The American Nurses Association defines the scopes of practice as the ‘’who, what, where, when, why and how of nursing practice’’ There are five primary practice standards for patient care: assessment, diagnosis, development of treatment plans, plan implementation and plan evaluation. In Florida, the advanced registered nurse practitioner may perform acts of nursing diagnosis and nursing treatment of alterations of health status. They may also perform acts of medical diagnosis and treatment, prescription and operation defined by the Board of Nursing. Nurse practitioners do not perform complex surgical procedures; they can perform some invasive treatment procedures. They are going to need a Registered Nurse License and be nationally certified and state licensed to practice as NP. For Accreditation, they will need                Accreditation Board for specialty nursing certification, The National Commission for Certifying Agencies, Commission on Collegiate Nursing Education (CCNE) and National League for Nursing Accrediting Commission (NLNAC). Family Nurse Practitioners need to be certified; the certification is called F family Nurse Practitioner-Board Certified.


Professional Organizations

For the family nurse practitioner, numerous professional organizations can be joined. The American Association of Nurse Practitioners (AANP), Doctors of Nursing Practice, contributing to the political action committee (PAC), Alliance of Nurses for Healthy Environments (ANHE), American Academy of Nurse Practitioners (AANP), American Association for the History of Nursing (AAHN), American College of Nurse Practitioners (ACNP), National Nursing Centers Consortium (NNCC), and National Organization of Nurse Practitioner Faculties (NONFP). Becoming a member of a professional organization is vital for connecting with professionals within your field, networking, job opportunities, and continuing education. Many of these organizations hold annual conferences.


Required Competencies

As a family nurse practitioner (FNP), you are prepared to care for families and the individuals that make up those families, across the lifespan (National Organization of Nurse Practitioner Faculties (NONPF), 2013). The role of an FNP includes patient assessment, diagnosis, and treatment of acute and chronic illness, and preventative healthcare for families and individuals (NONPF, 2013). The commitment is to family-centered care by understanding the relevance of the community in order to deliver family-centered care. The National Organization of Nurse Practitioner Faculties identifies the following core competency areas of a family nurse practitioner; scientific foundation, leadership, quality, practice injury, technology, and information literacy, policy, health delivery system, ethics, and independent practice (NONPF, 2013).


Future Workplace

Once a become a Family Nurse Practitioner, I am thinking I want to work in an outpatient clinic or working with a specialist doctor. The colleagues I would be working with will more than likely also nurses, FNP and doctors.


Leadership Attributes of the Advanced Practice Role

A democratic leader is a type of leadership in which members of the group take a more participatory role in the decision-making process. This type of leadership likes to allow everybody participates, ideas are exchanged freely, and discussion is encouraged. This is the type of leadership that I am.

Democratic leaders possess honesty, intelligence, courage, creativity, competence, and fairness. These are specific traits that I always use at my job. I like to inspire trust and respect among followers. I used to be a charge nurse in a Medical Surgical Unit, and my team tends to feel inspired to take action and contribute to the group because good leaders also tend to seek diverse opinions and do not try to silence voices.


Transformational Leadership

“Transformational leadership is, in essence, a relationship of mutual stimulation and elevation that raises the level of human conduct as well as the aspirations of both the leader and those led, and thereby has a transforming effect on both” Burns (1978) A collaborative approach is the essence of transformational leadership and under this leadership style, change is the result of a collective conscience nurtured by a self-aware leader. This leadership style is most appealing to this author as the author values rapport, empathy, transparency, honesty, communication, and fairness.

Transformational strategies in this author’s leadership practice are to establish productive, interprofessional communication, to advocate for improved quality and cost-effective healthcare, to practice sufficient conflict resolution by listening and valuing the opinions of others, and to collaborate on the development and execution of advanced practice initiatives. This author’s strengths are focused on organization, effective communication, team-building, clinical skills, relationship-building, and advocacy. Advocacy will be an underlying current in this author’s approach towards change at the individual, community, organizational and policy level. As an FNP, transformational leadership will guide my practice through the implementation of these strengths, with quality patient outcomes always being the highest priority. Advocacy for the APRN profession will also be a priority, as the scope of practice restrictions “have undermined the nursing profession’s ability to provide and improve both general and advanced care” (IOM, 2011). Scope of practice advocacy is therefore essential to useful leadership competencies.


Health Policy and the Advanced Practice Role

Value-based care is a contractual model of paying providers that compels greater alignment and collaboration between health plans, providers and, in many cases, employers to focus more holistically on patients and populations as well as the healthcare system that serves them. The proliferation of value-based care means we need to focus not only on patients’ clinical needs but also their life outside the physician’s office and its impact on their health outcomes, and increasingly to anticipate patients’ future health events and intervene to mitigate them.

Value-based care offers the possibility of increasing quality time with patients and ultimately helping to restore the joy of medicine; the physician may increase at organizations during the transition. Value-based care we have a fighting chance, the best chance to improve costs, quality, and outcomes for individual patients and populations as a whole.

The state of Florida is one of the most restricted states, requiring physician supervision or delegation, instead of collaboration, for NP’s to provide care.  Florida is one of only two states that do not allow NPs to prescribe controlled substances.

For effective change, the APRN must be knowledgeable and lead by example by actively taking part in the change process. Talking about the APRN role, contacting state legislators, and becoming a member of supportive associations are all ways the APRN can actively participate in support of the trend toward higher practice authority for APRNs. The impact of the APRNs attempts in transforming the current healthcare system can only be realized through strong leadership and consistent effort.


Conclusion

Advanced Practice Registered Nurses are highly qualified clinicians with graduate-level nursing degrees, who are taught to provide a broad range of services in relation to the expertise and knowledge acquired within their specialty.  The APRN must be a leader, a collaborator, an innovator, and a policy-changer. The framework for this role is reflected in the advanced educational requirements, the expected core competencies of the advanced practice nurse, and the legal requirements and scope of practice set forth by each state’s practice act. It is up to the APRN, individually, to decide the leadership style that fits best and then to practice in a manner that is consistently aligned with quality patient outcomes.


References

  • Hamric, A. B. (2014).

    Advanced practice nursing an integrative approach


    .(5



    th



    ed).

    Saunders. ISBN 9781455739806
  • American Organization of Nurse Executives. (2015). AONE Nurse Executive Competencies. Retrieved from http://www.aone.org/resources/nec.pdf
  • Page, A. (Ed.). (2004). Transformational leadership and evidenced-based management. In Page.
  • Editor. (Ed.), Keeping Patients Safe:

    Transforming the Work Environment of Nurses

    . (pp. 108-161). Retrieved from file:///C:/Users/Computer_one/Downloads/108-161.pdf
  • Burns, J. (1978). Leadership. New York, NY: Harper and Row.
  • Cherry, K. (2016).

    What’s Your Leadership Style? Learn more about your strengths and weaknesses as a leader

    . Retrieved from

    https://www.verywell.com/whats-your-leadership-style-3866929

Fructose 1-6 Bisphosphatase (FBPase) Deficiency

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Novel Fructose 1,6 bisphosphatase gene mutation presenting as recurrent vomiting in an Indian child


Abstract:

Fructose 1,6 bisphosphatase(FBPase) deficiency is an autosomal recessive disorder of gluconeogenesis resulting in severe metabolic attacks of hypoglycaemia and lactic acidosis. It often presents as recurrent life threatening hypoglycaemic episodes in infancy. We here report a sixteen month old girl who presented with recurrent episodes of vomiting, fast breathing, lactic acidosis, hyperuricemia and hypertriglyceridemia. The initial episodes were however not associated with hypoglycaemia, which developed during the later episodes. Genetic analysis revealed a novel compound heterozygous mutation in FBP1 gene confirming the diagnosis of FBPase deficiency. Mutations in FBP1 gene have been previously described from various ethnicities but there is limited data available from Indian population, hence the importance of this case.


Introduction:

Fructose 1, 6 bisphosphatase deficiency is a rare enzymatic defect first described in 1970 by Baker and Winegrad (1). It is characterized by episodic spells of hypoglycemia, ketosis and lactic acidosis and is often lethal during neonatal period and infancy. Fasting and febrile infectious diseases are known to trigger these symptoms [2]. Fructose-1,6- bisphosphatase, which catalyzes the splitting of fructose-1,6-bisphosphate (FBP) into fructose 6-phosphate and inorganic phosphate, is a key enzyme in the regulation of gluconeogenesis [2]. The enzyme is most active in the intestine and liver. Human FBPases are coded in 2 distinct genes, namely FBP1 and FBP2. Since Kikawa et al [2] identified 3 mutations of FBP1 responsible for FBPase deficiency in 10 Japanese patients, other FBP1 mutations have been reported in patients with other ethnic backgrounds. Here we describe a novel compound heterozygous germline mutation in FBP1 gene responsible for FBPase deficiency in a young Indian girl.


Case report:

A sixteen month old girl child, born out of non consanguineous marriage, presented to our hospital with complaints of vomiting and fast breathing for 1 day. There was no associated history of fever, cough, loose motions, abdominal distension, jaundice or lethargy. There was a significant history of recurrent hospital admissions in the past with similar signs and symptoms starting at 6 months of age. Prior to that, her neonatal and early infancy period was uneventful. The physical examination on admittance revealed her weight and height to be at median centiles, with dry mucosa, tachypnea, acidotic breathing, hepatomegaly and lethargy. The laboratory workup showed normoglycemia with high anion gap metabolic acidosis, high serum lactate, slightly raised alanine aminotransferase(ALT) and elevated serum triglycerides. Urine analysis was positive for ketonuria but did not show presence of any organic acids on gas chromatography (GCMS). The patient responded to intravenous glucose infusion and sodium bicarbonate with marked clinical and biochemical improvement within 48 hours. Further work-up for lactic acidosis was planned and patient was discharged. The patient was lost to our follow-up for one year as she had gone back to her hometown. She gave a history of 3 similar episodes during this one year each of them associated with normoglycemia and lactic acidosis as documented on her discharge papers. In between the episodes she was well and growing normally. There were no features suggestive of hepatic failure, no specific aversion or precipitation of illness by any particular food. At two and a half years of age she presented with one episode of convulsion, not associated with any fever or vomiting. There was a significant history of prolonged fasting for 8-10 hours prior to this episode. During the present episode, she was found to be severely hypoglycaemic along with hyperuricemia in addition to her previous findings. A diagnosis of fructose1,6 bisphosphatase deficiency was suspected and genetic study for mutation analysis was planned. The molecular analysis of FBP1 gene revealed a novel compound heterozygous mutation IVS4-1G>A in exon 3 and mutation c.611_614delAAA in exon 6, confirming the diagnosis. The patient was managed with intravenous fluids and sodium bicarbonate infusion. The patient was advised avoidance of fasting and restriction of fructose and glucose in diet. On follow-up, she was found to have normal growth and development for her age with normalization of her metabolic parameters and a decrease in the size of her hepatomegaly.


Discussion:

Fructose 1,6 bisphosphatase is a focal enzyme in gluconeogenesis which permits endogenous glucose production from gluconeogenic amino acids (eg, alanine and glycine), glycerol, or lactate, via its conversion of fructose 1,6-diphosphate (FDP) to fructose 6-phosphate (F-6-P). This gluconeogenic pathway is extremely important for maintaining glucose homeostasis in newborn period and during fasting, starvation, low carbohydrate diet and exercise in more advanced ages. Clinical signs have been reported to manifest within the first week of life in 50 % of affected children and within the first year of life in the remaining patients (3). In the neonatal period, it manifests as life threatening episodes of hypoglycemia, metabolic acidosis, hyperventilation, convulsions and coma. Undiagnosed, the outcome is usually fatal and it has been suggested that a significant high proportion of deficient FBPase have been misdiagnosed as sudden infant death syndrome or Reye’s syndrome.(4)

The classical presentation in older children consists of recurrent attacks of hypoglycemia and metabolic acidosis complicated with hyperventilation, apnea, ketosis and glyceroluria. Though hypoglycemia has been described as a classical finding, rarely these children may present with normoglycemia (as seen in initial episodes of our patient) or even hyperglycemia with acidosis (5). The physical findings include mild transient hepatomegaly during metabolic crisis, which promptly resolves on administration of intravenous dextrose. Patients experience normal health in between attacks which tend to decrease with age. With early diagnosis and preventive therapy, majority of cases exhibit normal somatic and psychomotor development with case report of a successful pregnancy in one of the affected patients (6).

The confirmatory diagnosis is usually based on the low hepatic enzymatic activity assay on liver biopsy specimens. Recently enzymatic activity assay have also been reported from cultured monocytes or leucocytes (2). However it has now been replaced with mutation analysis of FBP1 gene following its recent identification on chromosome 9q22.2-q22.3 in 1995(7). FBP1 gene consists of 7 exons, spanning more than 31 kilobases, and expresses a 362–amino acid protein, mainly in the liver. Homozygous and heterozygous mutations have been determined in various studies, with 1 bp insertion in FBP1 gene defined as the one most commonly encountered (21, 7,8,9). In our case the mutation identified is a compound heterozygous mutation not defined previously in any of the studies.


Conclusion:

Long term prognosis of FBPase deficiency is excellent underlining the importance of early recognition of clinical signs, prompt diagnosis and avoidance of fasting in this disease. our study highlights the natural course of this rare disease along with a compound heterozygous mutation determined by FBP1 analysis, which has not been previously defined making itthe first reported novel FBP1 gene mutation in our country.

Interview Discussion

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1) In 4-6 lines describe your own perceptions of health.

2) Ask a patient (or family member) for his or her perceptions of health. Then compare your personal perceptions with the perceptions of those interviewed. 

3) Discuss the importance of Comprehensive Health Assessment in providing quality patient care. 

Student must post (1) substantial initial post with a minimum of 250 words  All posts and replies must contain at least (2) professional references, one may be the course textbook, properly cited in the current APA format.  

What public health data would have been used to determine the need for such a program?

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What public health data would have been used to determine the need for such a program?

Imagine that you are a public health nurse, and you and your colleagues have determined that the threat of a deadly new strain of influenza indicates a need for a mass inoculation program in your community. What public health data would have been used to determine the need for such a program? Where would you locate public health data? What data will be collected to determine the success of such a program? How might you communicate this to other communities or internationally?

Imagine that you are a public health nurse, and you and your colleagues have determined that the threat of a deadly new strain of influenza indicates a need for a mass inoculation program in your community. What public health data would have been used to determine the need for such a program? Where would you locate public health data? What data will be collected to determine the success of such a program? How might you communicate this to other communities or internationally?

 

Nursing Informatics; its Effect on Healthcare and challenges for IT.

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Nursing Informatics; its Effect on Healthcare and challenges for IT.

Abstract on pg. 2 which is a complete summary of paper about 150 words.
Body of the paper begins on pg. 3 with an Introduction, then body, then conclusion. This is page 1 of 5.
Introduction should include a thesis statement.
Focus of paper should be in literature review style with minimum 5 sources
After the literature review, describe how the topic affects my social responsibilities, service to others, personal and business needs, culture and beliefs.
This paper should reflect the nursing side of informatics and the IT side of informatics.

Issue of Vaping in Schools

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Issue of Vaping in Schools

Vaping or e-cigarette usage seems to be all over the news recently.  We have seen and heard about teens that now have health issues related to their vaping.  In this paper I am going to give a brief history of vaping and the mechanism of how the e-cigarette works.  I will also explore how the manufacturers are exploiting their target audience, middle and high school students, by making the products seem healthier than smoking cigarettes and making the advertisements visually appealing. I will also be addressing the health implications.  Schools are also providing education and utilizing vaping prevention initiatives.

The first patent of the e-cigarette was given to Joseph Robinson in 1927.  It was never advertised and there is no clear cut evidence that a prototype was even made. Other people had created other versions of the e-cigarette.  One, by Herbert Gilbert, was patented in 1965 and he never advertised it but did have prototypes.  In 1979 Phil Ray and his personal physician Norman Jacobson did create the first commercialized version of the e-cigarette.  This version was not electronic but depended upon the evaporation of the nicotine. The device did not go anywhere but the inventors did coin the verb “vape”. In the 1990’s there were numerous patents for nicotine inhaler apparatuses by inventors and tobacco companies.  Few resembled the modern e-cigarette that is on the market now.  A major tobacco company requested that the FDA approve an early version of an e-cigarette around 1998. They were denied on the grounds that it was not an approved drug delivery device.  It has been theorized that this is the reason that no further attempts to commercialize the e-cigarette arose again until the early 2000’s.  The re-emergence of the e-cigarette was in 2003 and originated from China.  From 2003 until now the e-cigarette has gone through many changes and uses.  It was deemed useful for those to quit smoking cigarettes, less harmful, not useful to help people quit smoking and it banned in several countries (“A Historical Timeline of Electronic Cigarettes”, 2019).

E-cigarettes use nicotine, chemicals, and flavorings that are heated by battery and produce an aerosol. The added ingredients are heated and then inhaled into the persons lungs.  When the individual exhales, the aerosol can also be breathed in by the surrounding bystanders.  They can also be used to partake in other drugs via inhalation (“Quick Facts on the Risks of E-Cigarettes for Kids, Teens, And Young Adults”, 2019).

So far, studies have shown that the different flavors have made the e-cigarette more appealing to our youth.  Many youth have reported that they started using the e-cigarettes due to the variety of flavors and the sleek advertising that has been used.  Lower cost of the product verses cost of cigarettes is also a factor in usage by middle and high school students.  The use if these products have also risen due to the fact that the youth feel that are less harmful than traditional cigarettes. The widespread marketing targets the high and middles schoolers via social media.  This also makes it seem less harmful that it actually is (“Quick Facts on the Risks of E-Cigarettes for Kids, Teens, And Young Adults”, 2019).  One example is the “diffuser” that promotes sleep.  This product uses melatonin, lavender, and chamomile. This is promoted via Instagram.  It has been noted that because “something doesn’t taste like tobacco doesn’t mean it is safe”,Konkel (2017).  It has been shown that flavors, for example cinnamon, can be more harmful when heated and inhaled.  A suggestion has been made to eliminate all flavorings could be one way of dissuading our youth from trying e-cigarettes (Konkel, 2017).

The health risks of vaping are very prominent in the media. It has been noted that among those who vape, they have noted bleeding mouths and throats.  These areas seemed like they were also slow to heal.  It has been shown that vaping inflames the cells in the mouth that can lead to gum disease.  Gum disease has the potential to damage the tissue surrounding teeth.  This can lead to tooth loss.  Research over the last few months has shown that vaping can impair a person’s immunity, leading to “smoker’s cough and slow healing sores. There are also potentially harmful things in e-cigarettes.  Some substances that are in e-cigarettes are meant to be ingested and not inhaled. The mucosa of the stomach and intestines are meant to absorb these substances, lung tissue does not have that function and it can cause harm to that tissue.  Another point, with the intensity of vaping, it makes it harder for the lungs to repair the damage that has been done.  It has been shown that there can be many chemicals that are harmful in the vaping devices.  One of these is formaldehyde and acetaldehyde.  It has also shown tiny particles of metal.  More specifically nickel, chromium and manganese.  Even though these metals occur naturally in nature, when inside the body nickel and chromium can cause cancer and manganese can impair the nervous system. It is evident that more research is needed to fully explore the long term health effects of vaping (Konkel, 2017). The other component in e-cigarettes is nicotine. Most e-cigarettes contain nicotine which is addictive.  It has been shown that nicotine harms the developing brain.  Normally the brain continues to develop until the age of 25. Specifically, the parts of the brain that are harmed include the parts that control mood, impulse control, attention and learning. By using nicotine at a young age may increase the likelihood of future addiction.  Another face to ponder, 50% of all calls to poison control regarding to e-cigarettes are for children 5 years old and younger.  You can be poisoned by breathing, swallowing, or absorbing the e-cigarette fluid via the skin. Using e-cigarettes seems to be the gateway to future cigarette smoking amongst teens and you adults (“Quick Facts on the Risks of E-Cigarettes for Kids, Teens, And Young Adults”, 2019).

With the rise of vaping in schools, administration and educators are now attempting to educate the student and also their parents about the dangers of vaping.  Giving information and education has been shown to be a better approach than punishment.  We need to alter the perception that vaping is harmless. One of the educational tool used is from a nonprofit CATCH My Breath.  It provides schools free curriculum for high and middle schoolers  about the perils of vaping and the effects on the human body. Another approach used by educators is a social and emotional learning(SEL) method.  This incorporates problem solving, self regulation and communication that can help the students when they feel peer pressure to vape.  This method is used in connection with Tobacco Use Prevention Education (TUPE).  When a student has been found vaping, a TUPE trained staff member will talk with the student  to try to help them figure out why they were vaping and to help them make better future choices. Schools are also using vape detectors in the restrooms and having the students face stern consequences for vaping.  They are also helping students start anti-vaping educational programs geared towards their peers and creating school wide public service announcements to be used during the morning announcements (Korbey, 2018).

In conclusion, vaping or e-cigarette usage is very prevalent in the middle and high school scene. The centers for Disease Control and the Prevention, as of October 2019, has had recorded more than 1,600 lung injuries and over 34 confirmed deaths (Treisman, 2019).The students have mistakenly been lead to believe that inhaling vapors into your lungs is relatively harmless.  They do not realize that inhaling seeming innocuous and all natural ingredients is somehow safer than nicotine.  This is untrue.  It is also a fact that most e-cigarettes do have nicotine as an ingredient.  The flavors just make it seem less harmful.  Even parents have no idea about how harmful they can be.  They are still less harmful that traditional cigarettes, just less harmful. The marketing tools used to target the youth make them curious and lull them into a false sense of security.  The pods are cheaper, easy to order online, and can be easily hidden (Korbey, 2018).  A push to educate the students and their parents seem to be the way to go.  Prevention is the key and it is a lot easier than treatment.  Schools and peers can play a huge role in prevention and that can potentially save lives. Vigilance is still key and helping students make good long term choices with the knowledge to back it will still help in the long run.

References

Write a two to three paragraph summary indicating what you suggest looking for when selecting a quality nursing home.

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Write a two to three paragraph summary indicating what you suggest looking for when selecting a quality nursing home.

Visit the American Health Care Association’s website . This organization provides information and advocacy for people needing long-term care. Medicare’s website also has valuable information regarding long-term care. You may also wish to visit other websites related to long-term care to help you with this assignment.

Scenario

Imagine that you are faced with finding a nursing home for an elderly family member. What are some things that you should look for when choosing a quality nursing home?

Write a two to three paragraph summary indicating what you suggest looking for when selecting a quality nursing home. Cite your sources using APA style guidelines. For assistance with APA, please visit your college’s Online Library which is accessible through the Resources tab.

Whistle-Blowing in the Federal Government Workplace

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Whistle-Blowing in the Federal Government Workplace

Summary of the Topic

Whistle-blowing involves informing the public or a person in authority concerning illegal and dishonest activities taking place in a government workplace, companies, or in private or public organizations (Bouville, 2007). Potential forms of whistle-blowing at the federal workplace include gross mismanagement, fraud, abuse of authority, and violations of law and regulation. Whistle-blowing leads to serious implications; therefore, the whistle-blower must have a reasonable belief and be certain that the disclosure is accurate. In case an employee observes an unlawful practice and chooses to remain silence, he or she is considered a potential accessory to the unlawful practice through letting it to go on without reporting anything (Carson, Verdu, & Wokutch, 2007). There is a general consensus that whistle-blowing is ethical if the provided evident is relevant and significant. Most employees in public administration observe a number of unlawful practices committed by their bosses and intent to do what is ethically right through reporting their employers. However, there is an increasing concern about their safety after reporting such incidences (Grant, 2002). The decision to blow the whistle and report unethical practices is not hard; however, there are significant challenges because whistle-blowers face the risk of retaliation by their seniors. There are rampant cases reported whistle-blowers have been suspended or terminated. Retaliation against employees who disclose unlawful acts is illegal according to Title VII of the Civil Rights Act of 1964 (Grant, 2002). Irrespective of these laws that discourage retaliation, whistle-blows have reason to fear the effects of disclosure and even face punishment for doing what is morally right by reporting the unlawful practices of their supervisors.

These dangers pose the question of whether it is worth for employees at a federal workplace come forward when they witness an illegal act, or should they maintain silence to evade the probable costs and time, and potential retaliation that could damage their careers. Therefore, there should be adequate protection from employees who come forward when they witness an unlawful practice at the workplace. There are different viewpoints concerning the benefits of whistle-blowing, with some authors conceding that whistle-blowing is not effective in fostering change. For instance, Near and Michael (1996) argues that whistle-blowing does not benefit anyone and harms many, even the whistle-blower is a potential victim of retaliation. Near & Michael (1996) maintains that whistle-blowing should be the last resort only after it has been established that that the desired results will be achieved. For all the controversy surrounding whistle-blowing, it is evident whistle-blowing is beneficial to organizations and societies, but these benefits are not appreciated because of the controversies involving incidents of whistle-blowing. Numerous studies have affirmed the benefits of whistle-blowing at the workplace. A study involving federal employees in the US revealed that whistle-blowing was an effective tool for initiating procedural, policy and personnel changes. The study also pointed out that whistle-blowing resulted in congressional ad internal investigations that facilitated the conviction and criminal indictment of the perpetrators of the unlawful acts (Carson, Verdu, & Wokutch, 2007). Other studies have reported the benefits of whistle-blowing, which include changes in the policy agenda of the government, significant changes in public policies, and changes with regard to the organizational and bureaucratic procedures. These observations serve to validate the advantages of whistle-blowing as an effective tool to implement changes in public organizations and society. As a result, there is the need to ensure adequate protection of whistle-blowers and encourage the practice among federal employees (Rothschild & Miethe, 1999). This topic is important because whistle-blowing can be used as a tool for enhancing the effectiveness of public governance. The following literature reviews show the findings that will be used for deriving conclusions.

Literature Review

A study by Alford (2007) affirmed that whistle-blowing usually imposes negative consequences on the whistle-blower. Irrespective of legislation to protect whistle-blowers from employer harassment and retaliation, employers still have various opportunities to retaliate. Further, the study reported that, in cases involving theft, corruption, and environmental and health hazards that are likely to hurt the public good, whistle-blowers are often receive the support of tax payers. The whistle-blower perceives his or her actions as ethically right whereas the employer views such actions from a different perspective (Alford, 2007). As a conventional rule, there is comfort is upholding one’s ethical values; however, whistle-blowing imposes practical outcomes that impede the decision to come forward. Therefore, employees must scrutinize their motives for whistle-blowing. If whistle-blowing is motivated by personal agendas, then whistle-blowing is not the most suitable alternative. However, it is for public interest, whistle-blowing is the best alternative irrespective of the probable negative consequences for the employee.

Ayers & Kaplan (2005) conducted a study to illuminate the motivating factors that encourage employees to come forwards when whistle-blowing, which was helpful in coming up with a model for reporting unethical practices witnessed by employees. They deployed an experimental approach and identified four considerations that influence the whistle-blowing behavior, which include the perceptions about the seriousness of the unethical act, personal costs, judgments relating to moral equity, ad individual responsibility about the witnessed wrongdoing. Ayers & Kaplan (2005) further suggested that measures should be set up to encourage the whistle-blowing behavior among employees.

Bernie (2007) conducted a study on legal cases to determine the extent to which legal cases provide protection against retaliation on whistle-blowers by employers. Bernie (2007) reviews the case of Garcetti v. Cabellos, wherein the US Supreme Court decalred that public employees lack entitlements to the First Amendment protection from retalation when they comment to their official responsibulities at work. In the case, Cabellos, a county deputy in the District Attorney’s office, came forward after finding out that a sherriff had alied about search warrant application. Cabellos was later dired, and the 9th Circuit Court of Appeal maintained that the First Ammendment Protected Cabellos’ rights. The Court held that Cabellos came forward as a citizen in regard to matters of pubic concern, which was considerable different in the case of speaking for personal interests. Nonetheless, the US Supreme Court revesed the decision and declared that Cabello’s rights to freedom of speech were not protected because he did not speak as a private citizen, but as an employee.

Drachsler (2008) reviewed the impacts of a court’s decision on the future cases involving retaliation. According to Drachsler (2008), the decision in Garcetti v. Cabellos case implied that in future cases, whistle-blowers lacked protection. The outcome of the case implies that a comment made by a public employee that is considered part of his or her official duties, and not as a citizen, does not warrant the First Amendment protection. Even when a public employee comes forward about an unethical practice at the workplace, the employer can still retaliate at the employee through firing and disciplining. The author provides another case of Casey v West Las Vegas Independent School District, wherein the court held that the First Amendment right to free speech of the superintendent was not protected when he came forward. The court held that the superintendent comments were factual, that the school had embarked on enrolling children from families that did not meet the requirements for the Head Start programme. Nevertheless, the court maintained that because the superintendent speech was not carried in the context of her official duties, she did warrant a protection according to the whistle-blower law.

Lavan & Katz (2006) reviewed a judicial case whereby the jury awarded an employee because of retaliation from the employer after blowing the whistle. The Jury awarded a whistle-blower $ 500,000 in the Schutts v. Feldman in damages because of the interference from his employer on his rights of speech. Schutts came forwards after his employer abused his power by agreeing to take an unacceptable donation because of the strings that the donor attached. Lavan & Katz points out that that Schutts was denied a merited promotion because of his whistle-blowing acts. Schutts make a public comment by writing to newspapers criticizing the decision of his employer in accepting the donation. The jury awarded Schutts monetary damages for retaliations against whistle-blowing by his employer. Lavan & Katz (2009) use this case study to advocate for incentives at federal workplaces to cultivate the whistle-blowing behavior.

According to Neil (2005), the Equal Employment Opportunity Commission reports an increase in workplace retaliation for employees who come forward after they witness unlawful acts. For instance, in 1991, there were about 7900 cases of retaliation filed by the commission; however, the number has increased to approximately 22600 cases by 2003. Neil argues that retaliation is illegal according to the Civil Rights Act of 1964. The study by Neil reveals that retaliation is extremely difficult to prove because employers have devised methods to get around the legal system for their benefits (Neil, 2005). An example is the 8th Circuit Court of Appeal in St. Louis that declared that retaliation filed after six months of discrimination cannot hold up in a court of law. The suspected retaliation must be related to the complaint of discrimination, unless the retaliation is clear, six months is an extremely long time to file a case. Therefore, employers wishing to retaliate and are knowledgeable of the six months rule can buy their time to avoid being sued. Neil (2005) advocates for strict legal provisions to address the issue of retaliation against whistle-blowers.

Nigro, Nigro, & Kellough (2007) undertook a study on legal cases to examine the relationship between the legal provisions on freedoms of speech and whistle-blowing, which is a fine line that is open for controversy. In the case, Pickering v. Board of Education, the US Supreme Court maintained that public employees must not be forced to surrender their rights of speech as private citizens; however, the state have the right to control employee speech in matters relating to public concern (Nigro, Nigro, & Kellough, 2007). The Supreme Court has handled numerous cases relating to retaliation against employees; an example is the Rankin v. McPherson case, wherein an employee was a victim of retaliation because of exercising his freedom of speech. In this case, McPherson provided a negative commentary about the attempted assassination of President Regan, and was later fired for the commentary. The Court held that the firing was illegal on grounds that free speech is protected at the workplace if it is not disruptive. Nevertheless, in the event a whistle-blower causes disruption, but protects the public interest, the Court can rule in favor of the employee.

A report by the Congressional Research Service (2007) reveals that the Whistle-blower Protection Enhancement Act of 2007 broadens the scope of the whistle-blower law to provide adequate protection against retaliation to employees of government contractors, workers in the national security, and other people who come forward to reveal the unethical practices in the federal government. Initially, the CIA and FBI were excluded from whistleblower protections. The 2007 Act also included employees reporting government waste, abuse of tax payer funds, and fraud. The passage of this Act had the main objective of encouraging a system that rewards whistle-blowers instead of retaliating against them. The Act has strengthening the whistle-blower law by providing whistle-blowers with the right to dispute reprisals made by the Federal Court. There is the likelihood that the Act will encourage whistle-blowers to come forwards without fears of retaliation (Congressional Research Service, 2007).

Egan (1990) undertook a study to determine the value of whistle-blowing to the society. Whistle-blowers receive various praises from the public for various reasons. Egan (1990) reports that whistle-blowers make ensured that employers adhered to rules and refrained from unethical practices because of the fear that they were under watch. In addition, whistle-blowers offered information to the public regarding their employers that could be helpful for the public good. Egan (1990) affirms that the whistle-blower is the only source of information to the public concerning the unlawful practices at the workplace such as misappropriation of taxpayer funds. However, they normally suffer from the retaliation by their employers through demotion, harassment, termination and other discriminatory acts. Despite the fact that there are laws to address retaliation against whistleblowers, the employment-at-will doctrine has stopped many potential whistle-blowers. In addition, there is public policy exception. Egan (1990) advocates for whistle-blowing practices and argues that the whistle-blowers must be rewarded for their ethical behaviors instead of being punished because they protected the public good.

Fuance & Jefferys (2007) initiated a study to evaluate the ethical foundations of whistle-blowing. Fuance & Jefferys (2007) consider whistle blowing as an ethical behavior that should be nurtured in federal workplaces. The study reported that whistle-blowing is an effective tool to bring to an end wrongdoing at the workplace. Whether whistle-blowing is motivated by either personal or public interests, the goal is the same and serves to bring to light an unethical practice within the workplace. The advantages of whistle blowing provided an appropriate framework for arguing in favor of whistle blowing.

Jackson, Peters & Luck (2010) conducted a study to investigate the reasons why employees decide to blow the whistle and to offer insights to the experiences of whistle-blowing. The authors conclude that whistle blowing behavior is associated with the belief that employees are acting according to the duty of care. Employees usually serve as public advocates and feel obliged to report any wrong doings to the public. Jackson, Peters & Luck (2010) argue that there is the need to establish clear guidelines that provide opportunities for employees to voice their concerns.

Oliver (2003) provided an overview of the benefits and drawbacks associated with whistle-blowing. The article provided a summary of the pros and cons of whistle-blowing behavior among employee, and cites that whistle-blowing contributes significantly to public safety and moral responsibility. On the other hand, whistle blowing faces significant challenges associated with the risks of retaliation and conflicts of interest. Overall, Oliver (2003) concluded that whistle-blowing is an effective instrument for improving public governance.

Parsons (2004) provided a framework for effective whistle-blowing. Parsons (2004) reported that whistle-blowing results in serious implications; as a result, it is imperative for whistle-blowers to have a reasonable belief and be sure that their disclosures are accurate. In the event an employee witnesses an unlawful practice and opts to remain silence, he or she is perceived a potential accessory to the unethical practice by letting it to go on without reporting anything. There is a general consent that whistle-blowing is ethical if the provided evidence is relevant and significant.

(ansey & Keheller (2004) maintain that whistle-blowing behavior in organizations does not help in establishing avenues for effective help lines. There are a few organizations that encourage whistle-blowing; in the light of this view, the authors question the effectiveness of whistle blowing in public administration and federal workplaces. This resource advocates for other alternatives to whistle blowing such as effective help lines characterized by anonymity for employees reporting such actions.

Irrespective of laws aimed at protecting whistle-blowers, a significant number of employees who come forward are likely to suffer from various forms of employer retaliation such as demotion, termination and suspension. Egan (1990) maintains that if the public interest is at stake and a federal employee observes an unethical practice, then the employee has an ethical obligation to blow the whistle. There is a contentious debate involving whistle blower laws in state courts and the Supreme Court, this is evident by the fact that there are some cases whereby whistle blowers who are victims of retaliation are sometimes protected by the law whereas in other situations, such whistle-blowers suffer from employer retaliation especially when courts do not rule in favor of the whistle-blower.

Bruce (2007) points out that the time and money used in a court of law after whistle-blowing may discourage a potential whistle-blower from coming forward. The contradictions in the whistle-blower laws and provisions of the First Amendment are also a significant barrier against whistle blowing. Nevertheless, there are cases where whistle-blowers have received monetary rewards from the court in the form of damages. Lavan & Katz (2006) point out the case of Schutts v. Feldman wherein the employee received a monetary reward worth $ 500,000 in the retaliation claim. Bernie (2007) points out another case, Garcetti v. Cabellos, wherein the Court maintained that the employee did not have the right to speak against the unethical act if it was not related to his official responsibilities at work. The outcome of this case impeded the effectiveness of whistle-blowing because employers can circumvent the legal system to avoid retaliation claims.

However, the new legislation passed in 2007 has helped in widening the scope of Whistle blower protections to include all federal employees and contractors working for the government. The 2007 legislation also expands the existing laws; for example, the 1964 Civil Rights Act protects whistleblowers from retaliation if they report discrimination from their seniors. Irrespective of these laws, when a potential whistle-blower is considering the decision of coming forward, one should take into account whether a potential retaliation from the employer is a fine idea. Even in cases wherein whistle-blowers act out of good faith and public interest, there is the probability that the whistleblower can be harmed by the employer, have his reputation damaged and spend a significant amount of time and money in court to guarantee a favorable outcome. On the contrary, if an employer’s actions are clearly unlawful and retaliation is noticeable, it is highly likely that the courts will rule in favor of the whistle-blower.

It is apparent that whistle-blowing warrants protection from the law; however, in reality, they do not receive adequate protection from the law. Employers usually have an upper hand to initiate retaliatory acts against whistle blowers; for instance, if they are careful, they might not get caught. In addition, employers can wait after a given time duration has elapsed and initiative retaliatory actions without any consequence (Neil, 2005). The at-will doctrine also increases the difficulty of proving retaliation. Additionally, employers are more informed with regard to whistle-blower laws than their employees. Neil (2005) suggests that potential whistle-blowers should seek advice from an experienced attorney before embarking on the decision to come forward.

Dori (2011) conducted a study to investigate the benefits of whistle-blowing. The findings from the study revealed that whistle-blowing does not benefit anyone and harms many individual, including the whistle-blower who is likely to a victim of retaliatory acts by their employer. Dori maintains that whistle-blowing should be the last resort only after it has been established that that the desired results will be achieved.

Conclusion

The primary advantages of whistle blowing include moral responsibility and public safety. One of the primary reasons why employees decide to come forward on illegal acts is to protect the public from potential risks. In addition, employees have a moral responsibility to report such actions provided they have reasonable evidence. However, they face the risk of retaliation and conflicts of interest. It is essential to note that there are federal protections aimed at encouraging whistle blowing; however, they offer little support against hate and resentment from workmates, which has the potential of damaging working relationships.

References

Alford, C. (2007). Whistle-blower narratives: The experience of choiceless choice. Social Research (74), 223–248.

Alford, C. (2001). Whistleblowers: Broken lives and organizational power. New York: Cornell University Press.

Ayers, S., & Kaplan, S. (2005). Wrongdoing by consultants: An examination of employees reporting intentions. Journal of Business Ethics , 121-137.

Bernie, A. (2007). A principled limitation on judicial interference: Garcetti v. Ceballos, 126 S. Ct. 1951 (2006). Harvard Journal of Law & Public Policy , 30 (3), 1047-1058.

Bouville, M. (2007). Whistle-blowing and morality. Journal of Business Ethics , 1-8.

Bruce, B. (2007). Speechless: The erosion of free expression in the American workplace . San Francisco, CA: Berrett Koehler.

Carson, T., Verdu, M., & Wokutch, R. (2007). Whistle-blowing for profit: An ethical analysis of the federal false claims act. ournal of Business Ethics , 1-12.

Congressional Research Service. (2007). Congressional Record Volume 153, Issue 44 . Washington: U.S. Government Printing Office.

DeGeorge, R. (2005). Business ethics. Englewood Cliffs, NJ: Prentice Hall.

Dori, M. (2011). Whistle-blowers: Threat or asset? . International Business Ethics Review , 452.

Drachsler, D. (. (2008). public employee whistleblowers after Garcetti v. Ceballos. Labor Law Journal , 59 (2), 201-208.

Egan, T. (1990). Wrongful discharge and federal preemption: Nuclear whistleblower protection under state law and section 210 of the Energy Reorganization Act. Boston College Environmental Affairs Law Review , 17 (2), 405.

Faunce, T., & Jefferys, S. (2007). Whistleblowing and scientific misconduct: Renewing legal and virtue ethics foundations. Journal of Medicine and Law , 26 (3), 567–884.

Grant, C. (2002). Whistle blowers: Saints of secular culture. Journal of Business Ethics (39), 391–399.

Jackson, D., Peters, K., & Luck, L. (2010). Understanding whistleblowing: qualitative insights from nurse whistleblowers. Journal of Advanced Nursing , 66 (10), 2194–2201.

Lavan, H., & Katz, M. (2006). Disciplining employees for free speech, whistle blowing, and political activities. Journal of Individual Employment Rights , 12 (2), 126.

Martin, M. (2000). Meaningful work. Oxford: Oxford University Press.

Near, J., & Miceli, M. (1996). Whistle-blowing: Myth and reality. Journal of Management (22), 507–526.

Neil, M. (2005). A trap for employers. ABA Journal , 91 (8), 20-21.

Nigro, L., Nigro, F., & Kellough, J. (2007). The new public personnel administration (6th ed.). ThomsonWadsworth: Belmont, CA.

Oliver, D. (2003). Whistle-blowing engineer. Journal of Professional Issues in Engineering Education and Practice , 246–256.

Parsons, P. J. (2004). Ethics in public relations: a guide to best practice. London: Kogan Page.

Rothschild, J., & Miethe, T. (1999). Whistle-blower disclosures and management. Work and Occupations (26), 107-128.

Tansey, L., & Keheller, A. (2004). A global perspective on whistleblowing. International Business Ethics Review , 1-7.

Werhane, P., & Freeman, R. (1998). The blackwell encyclopedic dictionary of business ethics. Malden, MA: Mass Blackwell Publishers.

Transcultural Nursing Reflective Essay

/in /by

  • Rose Bonanno


‘Transcultural nursing is a comparative study of cultures to understand similarities (culture universal) and difference (culture-specific) across human groups’ (Leininger, 1991).


Introduction

Transcultural Nursing is an area in nursing practice that focuses on how the ideals and principals of particular groups influence their behaviour when they are sick. Diverse cultures may express dissimilar kinds of needs when they are ill, (Gulbu, 2006). Clients will be more willing to accept their treatment when the health care professional can understand their cultural rules, (Pagliuca, Rodrigues, 2012). Being cultural competent is having the approach, awareness and ability to provide appropriate care to different populations, (Loftin et al., 2013). A patient’s perspective has to be seen within the whole context. Community dynamics such as social status and knowledge, distinguish individuals within racial groups, (Weiner et al., 2013). Whether we are French or Canadian, African or Norwegian, straight or gay, Catholic or Muslim, we are a mixture of cultures. Nursing students need to cultivate social skills to care for patients in a multi-cultural world, (Torsvik, Hedlund, 2008). Both the views of others and ourselves are equally essential in the understanding of illness (Simon et al., 2010).


Incident

Since I was a very young child I have always been aware that there are ‘different’ people. This was due to the fact that I always remember the British soldiers that used to roam the street and I could always realise that they spoke a language which at the time I did not understand, they wore shoes and clothes which were much different than the few that me or my family had. However in my child’s mind I always associated them with the good things, because although they were different they were of the same skin colour that I was and so it was no big deal if they stopped to talk to me or one of my friends. My parents would not mind when they would stop to say hello or to offer us sweets. As I grew older I realised that although there were differences between the way that we spoke and behaved there were also a lot of similarities. But seeing a coloured soldier was all too different. I would not even lift my eyes to talk to them let alone smile at them. This was due to the fact that my parents used to tell us dramatic stories where the bad guy was always black and so this implanted in me a certain fear of black people.

Growing up and travelling around made me aware of the different races that inhabit our world. In time I became used to seeing different coloured people, different races. However they were just a part of the world around me and I would never give it much thought until the first boat of immigrants started to come to our shores. Since most of them came from African countries, they were mostly dark coloured and ‘different’. And then the unthinkable happened. I had to nurse a ‘black’ patient. The first time that I walked on the ward and saw this black person, sitting in bed, between two white sheets, the first thing that comes to mind is the contrast. And then the problems start coming to mind. He must be dirty, he must carry a lot of infectious diseases, and he must smell.

Secondly come the more rational questions. How am I going to communicate? How is he going to communicate back? How can we understand each other? So I did my best to ignore him all day. Luckily I was allocated duties in another part of the ward and so I could continue working without any bother. But my ‘luck’ ran out when one of my colleagues needed to go home early. And so it was now my turn to care for the patient. At some point he needed some water and since he had nothing on his bedside table he had to ring the nurse call. I remember walking up to him a little cautiously as if he might jump on me. I still remember that feeling of adrenaline rush that causes the fight-or-flight reaction after all these years. And then I arrived at his bedside and in low quiet voice, without raising his eyes, he asked for some water. Although I tried not to show it I was surprised. He had spoken to me in English!! That was the first surprise that I had from this thin-looking dark-coloured man. In return I voiced my surprise and asked him where he had come from. He told me that he was from Ethiopia. Although I had met the country in my geography lessons, way back when I was still at school, I hardly knew anything about the country. All that I knew was there somehow there was always a war there and that its capital was called Addis Ababa. I remember recalling Addis Ababa when he told me that his name was Addis.

Addis was a quiet man, softly spoken and of course by himself most of the time. He did not eat me, he did not kill me, and he did not smell foul. Seeing that we could communicate in English, I asked him about his story. He told me that he had run away from his country and that he had left a wife and two sons behind him. He said that he intended to find some work so that he could send money back to his family. He said that he was Orthodox Catholic, which again was another surprise for me. He always bowed his head when I would approach him and I thought that this was because he was shy. Another surprise was that he never ate meat on Wednesday, (and on Fridays as well, I got to know later). I was curious to know whether he missed his family and of course he did. He said that he usually phones them once every month, which again was a surprise to me, and he started telling me the how his wife travels a long distance to go to the city so that he can talk to her.


Reflection

Encouraging logical reflective thinking is stressed in studies emphasising the benefits of using nursing stories in the course of learning (Torsvik, Hedlund, 2008).

The first experiences that I had with this patient made me stop and think. Why do we think that being somehow different in colour, beliefs or behaviour makes us superior? All in all if we think about people, no-one is really as different from one another as we make out to be. The trend for people to classify others on the basis of their ethnic group, or perceived physical appearance, and then assign social or educational importance to them – whether they are of high class or sub-standard status- is a fact that is well known in the Western culture,(Naylor, 1997). All people have feelings and families who they love. We all bleed when we are hurt, and no matter what colour we are, black or white, yellow or blue, our blood is always red. The idea that had been installed in me when I was young was very wrong and it is alright to accept diversity. Diversity makes the world a more colourful, richer place. However I remember vividly that I did notice at the time that I had never been taught anything about other cultures. The subject was sort of taboo. I feel that we are not prepared about different cultures and different religions. It is very important to know about these different cultures so that we become aware of how we can see to their needs if ever we are nursing them. I used to feel embarrassed when Addis used to bow his head to me. I thought that it was funny; I never knew at the time that it was a sign of respect. When we used to play and pretend that we are the queen did we not bow our head? Adding everything up now, it does make sense. Just like we bow to the queen, Addis was showing me a sense of great respect.


Analysis

I feel that we are not prepared about different cultures and different religions. Studies show that although transcultural nursing studies and knowledge has been increasing, there still remains an absence of proper schooling methods in regards to this subject,(Mixer, 2008). It is very important to know about these different cultures so that we become aware of how we can see to their needs whenever we are nursing them. I used to feel embarrassed when Addis used to bow his head to me. I thought that it was funny; I never knew at the time that it was a sign of respect. When we used to play and pretend that we are the queen did we not bow our head? Adding everything up now, it does make sense. Just like we bow to the queen, Addis was showing me a sense of great respect. Some sort of national background can help evade misinterpretations and assist help-care professionals to deliver improved care, (Galanti, 2000).


Action plan.

In my opinion there is a need for a Cultural Consultancy Committee. Members would constitute a representative of the ethnic groups which are mainly found on the island. This committee would meet and discuss issues pertaining to their groups. They could also set up policies regarding the issues of communication and other problems that may arise whenever a person from their group is in hospital.

The committee might also be able to organise an annual conference in which information, maybe even in the form of leaflets in given to stakeholders.

They could also create a strategy, to have faith and community centred voluntary groups to whom a person can turn to in case of difficulty.

In its

Action Plan to Reduce Health Disparities

, (2010), the American Department of Health and Human Services, (DHHS) suggested that ‘activities may include language services, community outreach, cultural competency training, health education, wellness promotion, and evidence-based approaches to manage chronic conditions’.


Conclusion


‘Racial and ethnic minorities often receive poorer quality of care and face more barriers to seeking care, (DHHS, 2010).

Language and lack of education could be a strong barrier to communication. Perception and generalisation might also be tough obstacles. Respect and concern for people who are diverse from us will only be likely when people cultivate a better consciousness, compassion and empathy to others who are unlike us (Nayler, 1997). In a world where working with so many different people is no longer something out of the ordinary, it helps to have an ability to perceive the difference in cultures. Stimulating one’s awareness about gesticulating, the meaning of touch and private space, especially between different sexes and individuals with diverse beliefs, conceding that the quality of voice tone and facial expressions can either scare or comfort a person, will have a positive healing effect on people who are culturally different,( Papadopoulos,2012). Diversity can also be beneficial. It is a store for different ideas on how things are done and a chance to meet people with different thoughts and answers. Culturally experienced health care professionals guarantee patients fulfilment and optimistic outcomes, (Maier-Lorentz, 2008). For health care providers and specifically nurses, the necessity to make suitable and expert care available is acknowledged as vital l in view of the increasing variety among persons that they care for, (Loftin et al.,2013}.


References;

American Department of Health and Human Services ; A Nation Free of Disparities in Health and Health Care, 2010, PG 17,

http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf

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http://dx.doi.org/10.1155/2013/289101

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Pagliuca, L. M. F., & , Rodrigues, M. E., (2012). Competency to provide cross-cultural nursing care for people with disability: a self-assessment instrument. Revista Brasileira de Enfermagem, 65(5), 849-855. Retrieved June 19, 2014, from

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. 10.1590/S0034-71672012000500020.

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The nursing shortage, patient care, and ethics

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The nursing shortage, patient care, and ethics

Order Description

Details:

Prepare a critical analysis of a quantitative study focusing on protection of human participants, data collection, data management and analysis, problem statement, and interpretation of findings. The quantitative research article can be from your peer-reviewed article.
Each study analysis will be 1,000-1,250 words and submitted in one document.
Refer to the resource entitled “Research Critique Part 2.” Questions under each heading should be addressed as a narrative, in the structure of a formal paper. You are also required to include an Introduction and Conclusion.

Prepare this assignment according to the APA guidelines. An abstract is not required.

This assignment uses a rubric.Introduction is well-organized, fully incorporates the structure of the critique, and piques the interest of the reader to learn more.The study tools are thorough, clear, and accurately critiqued using research terminology. Ethical issues are addressed for quantitative design.Data collection methods are fully critiqued, and potential biases are addressed. Potential ethical issues, interview and/or data collection processes are critiqued.The critique of the problem statement meets all criteria of writing guidelines in a detailed and comprehensive manner while demonstrating deeper understanding by incorporating prior learning or thoughtful reflection.Data analysis is accurately critiqued and linked to research questions. Significance and nonsignificance are explained; generalization and implications to nursing practice reviewed. Conclusions are tied back to purpose of study and literature review.Strengths and weaknesses of the study are fully summarized from critique, with discussion of clinical implications of findings. Credibility of study is addressed.Implications for the nursing practice and future research are addressed and explained in detail, including specific suggestions.Conclusion summarizes utility of the research from the critical appraisal, knowledge learned, and the importance of the findings to nursing practice.Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.Writer is clearly in command of standard, written, academic English.All format elements are correct.In-text citations and a reference page are complete. The documentation of cited sources is free of error.
You are required to submit this assignment to Turnitin.
Submit the assignment along with an electronic version of the article used for the analysis. If an electronic version is not available, submit a clean unmarked copy of the article.