How is Christian worldview displayed by leaders through trust, openness, shared responsibility, and interdependence to achieve expected results?

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How is Christian worldview displayed by leaders through trust, openness, shared responsibility, and interdependence to achieve expected results?

 

Psychology of Leadership
Guidelines:
1. This is two-part question. Please refer to the article attached to each question for in-text citation.
2. Each question part should contain at least 150 words response.
a. What assumptions can be made and substantiate in the literature about the future of leadership? Article reference:
Sherman, R & Pross, e. (2010). Growing future nurse leaders to build and
sustain healthy work environments at the unit level. Journal of Issues in Nursing,
15(1), 1-15.
b. How is Christian worldview displayed by leaders through trust, openness, shared responsibility, and interdependence to achieve expected results? Explain. Article reference:
McMaster, J.S. (2013). The influence of Christian education on leadership development. Journal of Applied Christian Leadership, 7(1), 68-84.
Please let me know if you have any questions.
Due date: Friday, November 11, 2016.
Attachments:
art_sherman_pross.docx
art_mcmasters.pdf

Identify the problem statement or statement of purpose of the article.

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Identify the problem statement or statement of purpose of the article.

Please select any nursing research article from any one of the scientific journals found in the Nursing-Related Databases and Journals list. Select an article from an area that you are interested in or from the field you are working in. Using the article selected, construct a critique of the article, 6 to 10 pages (including cover page and references).

The critique should

  • identify the problem statement or statement of purpose of the article

  • describe the participants being studied, stating inclusion and exclusion criteria

  • discuss the sampling issues, such as probability or nonprobability and number of subjects used

  • identify the study setting—where data collection occurred

  • discuss informed consent—whether the participants were fully informed, how their consent was obtained, and any other ethical considerations

  • identify the hypothesis or research question

  • identify the research design—for example, experimental or nonexperimental; descriptive, exploratory, explanatory, or predictive?

  • identify research variables, both independent and dependent

  • comment the on article’s literature review—how the study data were analyzed (what statistical measures were used)

  • describe the results of the study and appropriateness of the methods used; include study limitations

  • accurately critique comments on level of evidence used, nursing theory, and implications for nursing practice or research

  • discuss how the research findings can be applied to the clinical area

The following resources provide helpful guidelines for constructing a critique of a nursing research article.

Video

Articles

A Critical Review on Ghanas Health Insurance Policy: Systemic Barriers

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Ghana is one of the first African countries to aim for universal coverage (Skolnik, 2016).  The National Health Insurance System was developed in 2003 as an attempt to address the financial barriers for Ghanaians to access health care services (Ministry of Health, 2004; Skolnik, 2016).  The National Health Insurance Policy (NHIP) was created in 2004 to make the National Health Insurance System happen (Ministry of Health, 2004).  This policy did not quite accomplish what it was set out to do.  This critical analysis will discuss why NHIP was created, its overall effectiveness, and explore systemic barriers it has created that causes Ghanaians not to be able to access health care services fully.  The systemic barriers that will be discussed are accessibility and culture.  Future implications for each systemic barrier will also be discussed.

Thesis statement: This critical analysis will analysis the NHIP, explain its effectiveness and explore systemic barriers it has created towards accessing health services.  Accessibility and culture barriers are systemic barriers that will be discussed.


Before National Health Insurance Policy

Ghana is a lower middle-income country that has a checkered history in financing health care (Ministry of Health, 2004; Skolnik, 2016).  When Ghana was under colonial rule, health care was mostly catered to colonials and their workers (Mcintyre et al., 2008).  When Ghana became independent, the health care system switched to providing health care “free” to all Ghanaians through tax revenue (Ministry of Health, 2004).  The health care system struggled because the economy was beginning to decline and there were other competing forces for the tax revenue resource (Ministry of Health, 2004).  Ghana by 1985 introduced user fees for those who received services from the health system (Ministry of Health, 2004; Skolnik, 2016).  The implementation of user fees became known as the “cash and carry system” in Ghana (Ministry of Health, 2004; Skolnik, 2016).  The “cash and carry system” created a financial barrier for the poor to access health care services (Ministry of Health, 2004).  About 18% of Ghana’s population requires health care at any given time (Ministry of Health, 2004).  Only 20% out of the 18% mentioned can access health care services (Ministry of Health, 2004). This indicates that around 80% of Ghanaians cannot afford health care if needed (Ministry of Health, 2004).


National Health Insurance Policy

The National Health Insurance System was developed in 2003 to replace the “cash and carry system” to take down financial barriers (Ministry of Health, 2004). The NHIP was developed in 2004 to make the National Health Insurance System happen (Ministry of Health, 2004).  The NHIP’s vision is to develop health insurance schemes that can guarantee unbiased and universal access to health care for all Ghanaians (Ministry of Health, 2004).

The National Health Insurance System is financed by different sources (Alhassan, Nketiah-Amponsah, & Arhinful, 2016). Taxes on certain goods and services, a small amount from Social Security, and the National Insurance Trust help finance the insurance system (Alhassan et al., 2016).  The National Health Insurance System also gets funding from premiums, donor funds, grants, donations, gifts, and interest from investments (Alhassan et al., 2016).  The money collected funds the health insurance schemes that the NHIP’s implements (Ministry of Health, 2004).

There are three health insurance schemes that the NHIP developed that Ghanaians can choose to be a part of (Ministry of Health, 2004). The three health insurance schemes are District Mutual Health Insurance Schemes, Private Mutual Health Insurance Schemes, and Private Commercial Health Insurance Schemes (Ministry of Health, 2004). The District Mutual Health Insurance Scheme makes every district develop a health insurance scheme to recruit residents to register as members (Ministry of Health, 2014).  This health insurance scheme is a not for profit and is a decentralized system that is owned by the members of a district (Ministry of Health, 2014).  Any surpluses made at the end of the year will be put back into the health insurance scheme to reduce contributions or enhance the benefit package (Ministry of Health, 2014).  The District Mutual Health Insurance Scheme receives subsidies from the government (Ministry of Health, 2014).

Private Mutual Health Insurance Scheme is where any group of Ghanaians can develop their own health insurance plan (Ministry of Health, 2004).  Such groups that can develop their own health insurance plans can be religious groups, occupational based groups, or community-based groups (Ministry of Health, 2004).  Private Mutual Health Insurance Schemes do not receive subsidies from the government (Ministry of Health, 2004).

Private Commercial Health Insurance Schemes are owned by companies and are made to make a profit (Ministry of Health, 2004).  The calculated risks for groups or individuals that are part of this health insurance determines the cost of premiums (Ministry of Health, 2004).  Companies can offer different health insurance plans and benefit packages with the Private Commercial Health Insurance Scheme (Ministry of Health, 2004).

The National Health Insurance Council will coordinate, facilitate, and regulate health insurance schemes to implement the NHIP to make the National Health Insurance System a success (Ministry of Health, 2004). The National Health Insurance System and the NHIP, however, have been under critical review.  The following section will discuss the effectiveness and systemic barriers in relation to the NHIP.


Critique


Effectiveness

The NHIP that implemented the National Health Insurance System in 2004 has made notable achievements in making health services more accessible by addressing financial barriers (Gajate-Garrido & Owusua, 2013; Ministry of Health, 2004).  Less than 1% of the Ghanaian population was enrolled in an insurance scheme when there was no National Health Insurance System

(Gajate-Garrido & Owusua, 2013).

Seven years after the creation of the National Health Insurance System the number rose to 33% of the Ghanaian population enrolled in an insurance scheme (Gajate-Garrido & Owusua, 2013).  The number of health facilities rose from 1,672 to 3,344 between 2008 to 2011 (Gajate-Garrido & Owusua, 2013).  The use of outpatient care services increased from 0.6 million in 2005 to an impressive 25.5 million in 2011 (Gajate-Garrido & Owusua, 2013).  Inpatient utilization care services also rose from 28,906 to 1,451,596 in between 2005 and 2011 (Gajate-Garrido & Owusua, 2013).  The National Health Insurance System made a significate change in reducing the impact of financial barriers on accessing health care services.

Different trends were observed in Ghana between 1995 to 2014 when Ghana started putting more money into health care (Adua, Frimpong, Li, & Wang, 2017).  Ghana’s life expectancy between 1995 and 2014 rose from 60.7 to 64.8 years of age


(Adua et al., 2017).

The positive changes with increased life expectancy can be traced to the health system in place but also aspects such as education, social structures, income distribution, and lifestyle changes (Adua et al., 2017).  The infant mortality rate in Ghana decreased from 72 out of 1000 live births to 44.2 out of 1000 live births between 1995 and 2014 (Adua et al., 2017).  The mortality rate of children under five reduced from 111 out of 1000 live births to 78 out of 1000 live births in Ghana between 1995 and 2014 (Adua et al., 2017).  Decreased mortality rates can be linked to the health system and the implementation of different policies (Adua et al., 2017).

The NHIP contributed to Ghana’s improvement in life expectancy and mortalities rates.  Unfortunately, despite the contributions by the NHIP and the National Health Insurance System to life expectancy and mortality rates, Ghana is doing poorly compared to first world countries (Adua et al., 2017). For example, in 2014 Canada had a life expectancy of 81.96 years which is impressively higher than Ghana’s 64.8 years (Adua et al., 2017).  Canada’s under-five mortality rate and infant mortality rate are five out of 1000 live births and four out of 1000, respectively (Adua et al., 2017).  Ghana had an infant mortality rate of 44.2 out of 1000 live births which is high compared to Canadas five out of 1000 live births (Adua et al., 2017).  Canada’s under five mortality rate is four out of 1000 which is significantly lower than Ghana’s 78 out of 1000 live births (Adua et al., 2017).

The NHIP helped many Ghanaians overcome financial barriers to access health services.  Despite the NHIP’s accomplishments, there are weaknesses in coverage, health care quality, and financial sustainability (Alhassan et al., 2016).  The benefit package covers diagnostic testing, specialist care, most surgeries, hospital accommodations, oral health treatments, maternity care services, emergency care and some drugs (Blanchet, Fink, & Osei-Akoto, 2012).  The benefit package, unfortunately, excludes coverage in some expensive surgeries, treatment for most cancers, organ transplants, and dialysis (Blanchet et al., 2012).

The NHIP may have improved access to health care but it did not improve the quality of health care (Alhassan et al., 2016).  After the implementation of the NHIP, the health system has created more pressure on the staff and health infrastructure (Alhassan et al., 2016).  This extra pressure caused longer waiting times and non-adherence to professional standards (Alhassan et al., 2016).  The staff also started to charge illegal fees on patients because of the extra pressure on the system (Alhassan et al., 2016).

The NHIP is not financially sustainable (Alhassan et al., 2016).  More than 60% of people in the National Health Insurance System are not paying for premiums because they are in the exemption category (Alhassan et al., 2016). The NHIP is not financially sustainable because of the high number of people not paying for premiums and the increasing costs of medical supplies and health service delivery (Alhassan et al., 2016).

The NHIP weaknesses are it has a limited benefit package, created negative pressure on the health system, and is not financially stable (Alhassan et al., 2016).  The NHIP has weaknesses and has created and has systemic barriers such as accessibility and culture.  These systemic barriers impact the older adults, the poor, and women.


Systemic Barriers


Accessibility.



One of the principles in the NHIP is equity (Ministry of Health, 2004).  The principal equity states that all Ghanaians regardless of socioeconomic status should have access to health insurance and those with health insurance should never be denied access to health services (Ministry of Health, 2004).  Despite such a promising principle the NHIP failed to make health insurance accessible to older adults especially older adults living in rural areas (Van der Wielen, Channon, & Falkingham, 2018).  The NHIP does exempt individuals over aged 70 and over from paying premiums but the exemption is moot if the benefit package does not address health needs of older adults and if health care services are not physically accessible (Van der Wielen et al., 2018).  Emergencies, oral health, eye care, and maternity care are some services that are covered in the benefit package (Van der Wielen et al., 2018).  Dentures, home care, and hearing aids are health services that older adults need but are unfortunately not covered in the health benefit package (Van der Wielen et al., 2018). The NHIP needs to make a benefit package more applicable to older adults to provide beneficial health care (Van der Wielen et al., 2018).

Health care services need to be physically accessible to older adults.  The enrollment rates older of adults in rural areas are low because of transportation and mobility issues (Van der Wielen et al., 2018).  Older adults in rural areas are more likely to be enrolled in health insurance if they live within five kilometers of a health care facility (Van der Wielen et al., 2018).   To improve the accessibility for older adults to health care services, the NHIP should consider improving health care services in rural areas and consider providing home treatment (Van der Wielen et al., 2018).

In the NHIP there is a heavy focus on equity (Ministry of Health, 2004).  The policy states that regardless of socio-economic status, everyone should be able to have access to health insurance (Ministry of Health, 2004).  Cross-subsidization is another NHIP principle that indicates that insurances schemes will be paid by premiums that are based on how much a person can pay (Ministry of Health, 2004).  To provide health insurance to the poorest segment of the population exemptions to paying premiums were applied in an attempt to provide health care services to them (Ministry of Health, 2004).  Ironically, the policy failed to provide health insurance that is accessible to poor Ghanaians (Kotoh, & Van der Geest, 2016).   A study found that richer Ghanaians have a higher enrolment rate than poorer Ghanaians (Kotoh, & Van der Geest, 2016).  Two reasons for the low enrolment rates in poorer Ghanaians are poverty and the lack of commitment by policy makers to implement the NHIP equity goal (Kotoh, & Van der Geest, 2016).  The poor cannot pay for the yearly premiums because many of them are not able to afford them due to unstable incomes (Kotoh, & Van der Geest, 2016).

The poorest of the population are not getting exceptions because the criteria outlined excludes them (Kotoh, & Van der Geest, 2016).  The criteria state that the poor people that can be excluded from paying premiums are those who are unemployed and do not have a permanent residence (Kotoh, & Van der Geest, 2016).  In Ghana, the poorest of the population do have residences and jobs (Kotoh, & Van der Geest, 2016).  However, the residences are with friends, family or poor housing and the jobs are seasonal, menial, or lacking (Kotoh, & Van der Geest, 2016).  The criteria outlined excluded almost every poorest person in Ghana (Kotoh, & Van der Geest, 2016).  The reason why policy makers had this in the criteria is that in 2011 about a third of Ghanaians were below the poverty line (Kotoh, & Van der Geest, 2016).  The government would have to pay 35 million dollars a year to cover all the premiums of people living in poverty (Kotoh, & Van der Geest, 2016).  The criteria were set there by policy makers to make it look like to voters that the government was providing health care to the poor and to lessen the financial burden (Kotoh, & Van der Geest, 2016).

If policy makers were serious about implementing the NHIP to target the population living below the poverty line they would change the exclusive criteria to the community’s definition of core poor (Kotoh, & Van der Geest, 2016).  The District Mutual Health Insurance Scheme is not addressing its poor in communities like it is supposed to (Kotoh, & Van der Geest, 2016).  The District Mutual Health Insurance Scheme staff are not enrolling people because the staff does not get paid to enroll the exempt group and the concern for not getting revenue to support the exemption groups (Kotoh, & Van der Geest, 2016).  The staff’s attitudes and the policy’s criteria are barriers for the poor to access health insurance (Kotoh, & Van der Geest, 2016).  To overcome these barriers, it is recommended that the District Mutual Health Insurance Scheme staff get paid when enrolling the exempt group so that there is not a focus on revenue generation (Kotoh, & Van der Geest, 2016).  It is also recommended to policy makers to invest in the District Mutual Health Insurance Schemes because of the economic cost of prolonged illness that will affect the country’s future development (Kotoh, & Van der Geest, 2016).


Culture.

The NHIP failed in addressing cultural gender roles (Dixon, Luginaah, & Mkandawire, 2014).  Women and men in Ghana have distinct culture roles that impact their choices in reenrolling for health insurance every year (Dixon et al., 2014).  A Ghanaian woman’s main responsibilities are fending for her children and family (Dixon et al., 2014).  Women are more likely to drop out of the National Health Insurance System if they are food insecure and do not have reliable incomes (Dixon et al., 2014). Cultural norms for women with lack of resources dictate that feeding and caring for children and family has a higher priority than reenrolling for insurance (Dixon et al., 2014).  Despite that the National Health Insurance System provides free enrollment for children under 18, women still need to pay for processing and renewal fees for their children (Dixon et al., 2014).  Women are expected to pay for processing and renewal fees for each of their children every year and are also likely to be responsible to pay for school uniforms and food and other basic family needs (Dixon et al., 2014).  These extra financial responsibilities can pressure a woman to not reenroll for health insurance (Dixon et al., 2014).

Men, on the other hand, are more likely to drop out of the National Health Insurance System if they are not satisfied with the health insurance scheme (Dixon et al., 2014). Ghanaian men are not as influenced by socio-economic factors as much as women are in choosing to drop out of the National Health Insurance System (Dixon et al., 2014).  Men in Ghana are more financially independent and are pressured less to pay for the daily needs of the family (Dixon et al., 2014).  Gender roles play a huge part who spends on what resources (Dixon et al., 2014).

The NHIP must take into consideration the gender roles in society to fulfill its principle to provide universal health care.  To address the extra financial responsibilities that Ghanaian women have, policy makers should be finding ways to help poor women to continuously stay enrolled in health insurance (Dixon et al., 2014).  Such ways to keep poor women enrolled in health insurance are flexible payment plans or changing payment exemption statuses (Dixon et al., 2014).


Conclusion

The NHIP did not quite accomplish breaking down financial barriers for all Ghanaians.  More and more Ghanaians since the NHIP came into effect have been enrolled in an insurance scheme (Gajate-Garrido & Owusua, 2013).  Unfortunately, the NHIP had weaknesses and shortcomings.  The weaknesses were the benefit package did not provide the full needs of the population, poor quality health care, and the health system is not financially stable (Alhassan et al., 2016). NHIP’s shortcomings were the systemic barriers that it created the prevented certain parts of the population from accessing health services.  Ghana has made big leaps to provide health care to the people and with research and teamwork, Ghana can keep working on providing universal health care to all Ghanaians.

References


  • Abiiro, G., & McIntyre, D. (2012). Achieving universal health care coverage: Current debates in Ghana on covering those outside the formal sector.

    BMC International Health And Human Rights

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    12

    (1). doi: 10.1186/1472-698x-12-25
  • Abiiro, G., & McIntyre, D. (2013). Universal financial protection through National Health Insurance: A stakeholder analysis of the proposed one-time premium payment policy in Ghana.

    Health Policy and Planning,


    28

    (3), 263-278.
  • Abuosi, A., Domfeh, K., Abor, J., & Nketiah-Amponsah, E. (2016). Health insurance and quality of care: Comparing perceptions of quality between insured and uninsured patients in Ghana’s hospitals.

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    (1). doi: 10.1186/s12939-016-0365-1
  • Adua, E., Frimpong, K., Li, X., & Wang, W. (2017). Emerging issues in public health: a perspective on Ghana’s healthcare expenditure, policies, and outcomes.

    EPMA Journal

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    (3), 197-206. doi: 10.1007/s13167-017-0109-3

  • Alhassan, R. K., Nketiah-Amponsah, E., & Arhinful, D. K. (2016).

    A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

    PLoS ONE

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    (11), e0165151. Retrieved from http://link.galegroup.com.uml.idm.oclc.org/apps/doc/A471845754/HRCA?u=univmanitoba&sid=HRCA&xid=ba20143d


  • Blanchet, NJ., Fink, G., & Osei-Akoto, I. (2012).

    The Effect of Ghana’s National Health Insurance Scheme on Health Care Utilisation.

    Ghana Medical Journal

    . 46(2):76-84.

  • Bonfrer, I., Breebaart, L., & Van de Poel, E. (2016). The Effects of Ghana’s National Health Insurance Scheme on Maternal and Infant Health Care Utilization.

    PLOS ONE

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    11

    (11). doi: 10.1371/journal.pone.0165623

    • This study provided an insight on how the policy impacted mothers and infants and poor families.

  • Dixon, J., Luginaah, I. N., & Mkandawire, P. (2014).

    Gendered inequalities within ghana’s national health insurance scheme: Are poor women being penalized with a late renewal policy?

    Journal of Health Care for the Poor and Underserved, 25

    (3), 1005-1020. Retrieved from http://uml.idm.oclc.org/login?url=https://search-proquest-com.uml.idm.oclc.org/docview/1629327013?accountid=14569


  • Fenny, A., Enemark, U., Asante, F., & Hansen, K. (2014).

    Patient Satisfaction with Primary Health Care – A Comparison between the Insured and Non-Insured under the National Health Insurance Policy in Ghana.

    Global Journal of Health Science

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    (4). doi: 10.5539/gjhs.v6n4p9


  • Gajate-Garrido, G., & Owusua, R. (2013).


    The national health insurance scheme in


    ghana


    : Implementation challenges and proposed solutions:

    St. Louis: Federal Reserve Bank of St Louis. Retrieved from

    http://uml.idm.oclc.org/login?url=https://search-proquest-com.uml.idm.oclc.org/docview/1698100980?accountid=14569

  • Kotoh, A., & Van der Geest, S. (2016). Why are the poor less covered in Ghana’s national health insurance? A critical analysis of policy and practice.

    International Journal for Equity in Health

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    (1). doi: 10.1186/s12939-016-0320-1

  • Mcintyre, D., Garshong, B., Mtei, G., Meheus, F., Thiede, M., Akazili, J., . . . Goudge, J. (2008).

    Beyond fragmentation and towards universal coverage: Insights from Ghana, South Africa and the United Republic of Tanzania.

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    86

    (11), 871-6.

  • Ministry of Health. (2004).

    National health insurance policy framework for Ghana

    .  Ghana.  Retrieved from

    https://www.ghanahealthservice.org/downloads/NHI_policy%20framework.pdf

    • This reference is used because this is the policy document that is being critiqued.
  • Skolnik, R. (2016).

    Global


    health


    101

    (3rd ed.). Burlington, MA: Jones & Barlett Learning.
  • Van der Wielen, N., Channon, A., & Falkingham, J. (2018). Universal health coverage in the context of population ageing: What determines health insurance enrolment in rural Ghana?.

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Hypertension Prevalence in the African American Community

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Hypertension Prevalence in the African American Community

Abstract

Hypertension (High Blood Pressure) is both common and detrimental to African-Americans than any other ethnic groups. According to the 2005–2006 National Health and Nutrition Examination Survey (NHANES) data, the current prevalence of hypertension in African-Americans is 39.1%, which is well above non-Hispanic whites at 28.5%. This disease is a current and progressive health problem contributing to significant morbidity and mortality among African Americans. With all the research and trials to help better understand the difference of Hypertension amongst Blacks and other ethnicities they still are struggling to fully control and reduce high blood pressure in the African American community. There are preventable treatments and ways to reduce chances of developing high blood pressure through lifestyle management, yet most African Americans have a low prevalence of engaging in hypertension prevention self-care behaviors. Genetic make-up, socioeconomic status, environment, obesity, smoking, and increased BP sensitivity to salt ingestion continues to be postulated as leading causes to developing hypertension (high blood pressure).

Keywords:  Hypertension, High Blood Pressure, High Prevalence, African Americans, Detrimental, Risk Factors, Lifestyle Management.

Hypertension Prevalence in the African American Community

Genetic factors in African Americans are main precursors to developing hypertension. Today, we are making a step towards better medicine and prevention programs to help inform the African American community about ways to reduce chances of high blood pressure and help control/manage it if already developed.  Even though this has been a known health problem amongst all ethnicities, still African Americans suffer the most and require different and more rigorous treatment. Researchers have uncovered some facts: In the U.S, blacks respond differently to high blood pressure drugs than do other groups of people. Blacks in the U.S. also seem to be more sensitive to salt, which increases the risk of developing high blood pressure. Studies and trials on hypertension in African Americans show evidence of possible differences in etiology; such as obesity. Obesity is a major contributing factor to hypertension. Genetic make-up of African descent is commonly blamed for one becoming obese. With African Americans already at a disadvantage it is our generations job to help teach and promote free and affordable health awareness/prevention programs, support groups, ways to manage the disease if already developed, and more importantly put a stop to differences of treatment due to racism.

African American Descent, Genetic Make-Up and Different Etiologies

History of the African American culture is centered around the abuse and hardships they faced during the slave era. These times were very stressful and detrimental towards their health.  They were treated poorly mainly feeding off their owner’s scraps and finding new ways to make food fill the bellies of every man, woman, and child. The food they ate was very high in sodium (pork, lots of lard, salt) which can cause water retention weight in your body. Many African Americans who are interested in science today like to blame their ancestors for why they are sensitive to salt, aka survival of the fittest (genes surviving through multiple generations).  Wilson and Grimm experimentally determined the difference in the incidence of hypertension among African Americans and Africans as evidence of gene distribution. They measured the blood pressure in a West African village whose salt intake resembles that of African Americans. Hypertension rates in Africans living today in the regions where North American slaves originated are about 7 times lower than the rates for African Americans (Fackelmann, 1991). In my opinion, after researching and understanding this topic, the only difference between past and present in the African Americans is change in exercise not diet. They were forced to work strenuous jobs keeping them “healthy” and “active” allowing their bodies to consume the high sodium foods. Today, we must pay a fortune for healthy food and a decent gym to stay on track of a healthy lifestyle. Not everyone can afford a gym membership or healthy low sodium intake food. I know I for sure cannot afford that and I am a White female. The food I normally buy is the cheap 1-5$ frozen meals so I can have enough for two weeks at a time, and we all know how much sodium is in canned, frozen, meat, and soup/rice food. So yes, I do feel it is appropriate for me to say that even though we have come so far in trying to make everyone equal we still see African Americans falling victim of hypertension because of racial inequality, economic status, and the different treatment they receive.

The data in figure 1 on page 9 in my paper shows the high rates of hypertension in African Americans compared to whites from 1988 to 2010. The data is alarming, showing that even after twenty-two years of change in our world, more resources available, advance in medicine and technology, hypertension still is rising in the African American community. Studies are showing that preventative drugs used to reduce high blood pressure, prevent heart attacks and strokes, are correlated with significantly worse cardiovascular outcomes in hypertensive African Americans compared to whites, according to a new comparative study conducted by the Department of Population Health at NYU Langone Medical Center. The study, published on September 15, 2015, in the Journal of the American College of Cardiology (JACC), “is unique, the authors say, in that it evaluates racial differences in cardiovascular outcomes and mortality between hypertensive black and white patients whose treatment was initiated with angiotensin-converting-enzyme (ACE) inhibitors, outside of a clinical trial”. (NYU Langone Medical Center) Due to the worse side effects from the drugs in African Americans in this study, then looking at figure 1 (trends in hypertension) I can infer that throughout the twenty-two years it looks like the ACE inhibitor was widely prescribed by doctors who ignored ongoing research data and did not apply it in the clinical setting. This would scare anyone away from seeking medical treatment if they saw the data showing negative outcomes of African Americans health. Do not let that stop you from seeking medical help if needed, because there are still very helpful drugs out there such as; Diuretics. “The ability to cause loss of fluids in the body has made diuretics useful in the treatment of a variety of conditions, particularly excess fluid (swelling) states and hypertension”. (Jay Harold Health) Rather than focusing on medical treatment being the only option to helping prevent hypertension, let me tell you about effective and affordable ways to minimize the percent chance of high blood pressure.

Non-Medical Preventative Ways to Reduce Chances of Hypertension

Economic status can be very stressful, especially if it affects one’s ability to live a healthy lifestyle. The media constantly talks about obesity rates and how America is very unhealthy from all the processed foods being consumed, but the government and food businesses never seem to care and switch gears in helping African Americans and all races in general to obtain healthy food. Many do not have the resources or funds to afford healthy food, so they get what they can afford; which is fast food, canned and frozen food. Instead of accepting this I decided to look into ways for low-income families to learn and adopt healthy habits and so they can teach their children and even community. During our HPP project which is the same topic I got to speak to an accountant at an OKC YMCA. YMCA which is a gym branched all throughout the U.S. is willing to work with anyone suffering financial hardships. They require the applicant to come in and pick up a membership price reduction form, fill it out, and show their tax statement proving low-income status.  YMCA said they usually grant anywhere from 10 to 60 percent off of membership fees and have in extreme circumstances granted 100 percent free of charge.  They are strong believers in everyone being able to live a healthy lifestyle no matter where they come from.  This gym provides classes, pool, gym, daycare, intramural sports and much more.  Not all YMCA’s have the same facilities, but you are allowed at any! If one still thinks it will be too much of a strain on their life, then they can do simple exercises at home and even get out and walk a little bit a day. Even going up your stairs at a home or apartment complex is a good workout! Also, drink plenty of fluids and avoid sugar intake from sodas and juice!

Sodium, sugar, carbs, and meat are all very much enjoyable. No one wants to cut out bread forever or skip on salt creating a tasteless dish. Also, alcohol is known to cause high blood pressure, so lowering alcohol consumption greatly helps. Foods containing potassium, magnesium, and fiber, on the other hand, may help control blood pressure. “Stick to whole fruits and veggies. Juice is less helpful, because the fiber is removed. Also, nuts, seeds, legumes, lean meats, and poultry are good sources of magnesium”. (Webmd) Apples, sweet potatoes, kale, spinach, and tuna are just a few of the healthy foods to help reduce hypertension and are very affordable! Accepting etiological differences and being empowered to change an unhealthy diet to a healthy one is a great first step towards reducing your chances of high blood pressure. Willpower to want to make a change, now that is the most crucial part towards a healthy life.


Hypertension Wrap Up

Hypertension is known as one of the highest health problems for millions throughout the Country.  Drugs are not enough to help reduce high blood pressure as one can infer from recurrent data being tested and proven. African Americans unfortunately have the bad end of the deal, because their biological makeup reacts differently to drugs prescribed to all races. They suffer negative outcomes with beta blocker, but Diuretic is very effective in reducing water swelling of the joints and body. One would think that if a certain race has a higher prevalence of a disease they would focus on trying to reduce it, but others have different ideas and strongly believe African Americans are underrepresented and mistreated due to racism. Aside from racial beliefs, socioeconomic status plays a huge part in being able to get proper medical help. Not everyone can afford health insurance, and even if acquired certain tests and drugs are not covered or super expensive. With that said, many African Americans must look for alternative approaches to help aid in lowering chance of developing hypertension. Walk around your house, do jumping jacks like I did in class, jog in place, drink plenty of water, and reduce canned and processed meat intake. These little changes added to your diet and daily routine are very affordable, accessible, and attainable, but only if you have “within you the strength, the patience, and the passion to reach for the stars to change the world” (Harriet Tubman) and better yourself, and others around you!

References

  • (2014). Racial differences in hypertension: implications for high blood pressure management.

    The American journal of the medical sciences

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    348

    (2), 135-8.
  • Peters, R. M., Aroian, K. J., & Flack, J. M. (2006). African American culture and hypertension prevention.

    Western journal of nursing research

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    28

    (7), 831-54; discussion 855-63.
  • Answers Ltd. (2018, November 22). Hypertension In African Americans And The Middle Passage. Retrieved from https://www.ukessays.com/essays/history/hypertension-in-african-americans-and-the-middle-passage-history-essay.php
  • Management of Hypertension in African-Americans. (n.d.). Retrieved from https://www.uscjournal.com/articles/management-hypertension-african?page=1
  • New Black American High Blood Pressure Guidelines. (2016, February 04). Retrieved from https://jay-harold.com/african-american-high-blood-pressure-guidelines-2013/
  • Popular Hypertension Drugs Linked to Worse Heart Health Outcomes in Hypertensive African Americans Compared to Whites. (n.d.). Retrieved from

    https://nyulangone.org/press-releases/popular-hypertension-drugs-linked-to-worse-heart-health-outcomes-in-hypertensive-african-americans-compared-to-whites
  • Peters, R. M., Aroian, K. J., & Flack, J. M. (2006). African American culture and hypertension prevention.

    Western journal of nursing research

    ,

    28

    (7), 831-54; discussion 855-63.
  • Starting A Few New Food Habits. (n.d.). High Blood Pressure Diet. Retrieved from

    https://www.webmd.com/hypertension-high-blood-pressure/high-blood-pressure-diet#1
  • US Cardiology – Volume 6 Issue 2;2009:6(2):59-62

Figure 1: Hypertension rates between Whites and African Americans

Figure 1.

Prevalence of hypertension (percent of adult population). U.S. 1988-94 and 1999-2004

Adapted from: Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ. Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rates in United States Adults Between 1988 –1994 and 1999 –2004. Hypertension. 2008;52:818-827; and Guo F, He D, Zhang W, Walton G. Trends in prevalence, awareness, management, and control of hypertension among United States adults 1999 to 2010. J AM Coll Cardiol 2012;60:599-606

Nursing policy questions

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Nursing policy questions

Answer each question. Every question should have at least 1 reference less than 5 years old. The policy in question is nutrition education and childhood obesity.
1. Look up the five key policy areas and the problems and unexpected obstacles encountered in an effort to strategize your policy plan (policy plan is education about better eating and childhood obesity. What are possible etiologies and solutions for these problems?
2. Given the power of the media, discuss how you would use an opinion editorial, a personal interview, websites, texting, Facebook, Twitter, and/or blogs to influence public opinion relative to your policy priority. What issues about media and electronic social networking do you need to consider? Why?
3. Discuss an example of a healthcare partnership in your community and specifically cite examples that show how nurses, both individually and collectively, influenced the care provided. What obstacles were/are confronted, and what strategies were/are employed in order to effectively overcome them? Relate aspects of your policy priority to this community partnership and its goals, barriers, strategies, and political issues.
4. Describe the purpose and effectiveness of a nursing organization to which you belong or with which you are familiar. What leadership role are you currently performing or would you like to perform in this organization? What is your next step within the organization or its partners to enhance your professional development?
5. Select an international healthcare policy issue and describe strategies nurses can employ to influence change. How can you “think globally,” but act locally to impact this specific international healthcare policy? Express your thoughts concerning healthcare policy and its application to professional nursing.

– Describe how the Nurse Executive “leads the charge” for transformational leadership in an organization where you work or have done prelicensure clinical experiences

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– Describe how the Nurse Executive “leads the charge” for transformational leadership in an organization where you work or have done prelicensure clinical experiences

Review Appendix A, Sections I–V in Finkelman (2016).

Select one of the sections and share how your chief nurse executive demonstrates expertise in these competencies. Your comments should be about the “highest nursing leader” in your organization. Typically this is the leader who represents nurses and nursing to the governing board.

In your own words, explain the differences between a transactional nursing leader and a transformational nursing leader. What one is more like your Nurse Executive?

Describe how the Nurse Executive “leads the charge” for transformational leadership in an organization where you work or have done prelicensure clinical experiences.

Discuss the various health care system models and compare the systems in England, Canada, France and China to that in the U.S.

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Discuss the various health care system models and compare the systems in England, Canada, France and China to that in the U.S.

Healthcare Management

1. Discuss the various health care system models and compare the systems in England, Canada, France and China to that in the U.S.

2. Identify the primary components of, and compare, the Population Health Model to the Medical Model, and discuss the social determinants on health behavior and health outcomes.

Healthcare Management

1. Discuss the various health care system models and compare the systems in England, Canada, France and China to that in the U.S.

2. Identify the primary components of, and compare, the Population Health Model to the Medical Model, and discuss the social determinants on health behavior and health outcomes.

“Dengue Fever and Outbreak Investigations” Please respond to the following:Suppose you have been tasked with accessing the Centers for Disease Control and Prevention (CDC) for information on an outbreak of Dengue Fever in your recently flooded state.

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“Dengue Fever and Outbreak Investigations” Please respond to the following:Suppose you have been tasked with accessing the Centers for Disease Control and Prevention (CDC) for information on an outbreak of Dengue Fever in your recently flooded state.

Propose key steps in compiling a report to your local County Health Department. Be specific.Report on the key problems facing a researcher seeking data from the CDC and other sources in an outbreak investigation. Propose at least three (3) methods for overcoming these problems.

“Dengue Fever and Outbreak Investigations” Please respond to the following:Suppose you have been tasked with accessing the Centers for Disease Control and Prevention (CDC) for information on an outbreak of Dengue Fever in your recently flooded state. Propose key steps in compiling a report to your local County Health Department. Be specific.Report on the key problems facing a researcher seeking data from the CDC and other sources in an outbreak investigation. Propose at least three (3) methods for overcoming these problems.

After watching Good Will Hunting address the unethical practices of the therapist.After watching Good Will Hunting address the unethical practices of the therapist.

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After watching Good Will Hunting address the unethical practices of the therapist.After watching Good Will Hunting address the unethical practices of the therapist.

A description and evaluation of the practices you observe from this film, their legal, ethical, and clinical implications, followed by recommendations for improvement and/or alternative strategies. You should take into consideration relevant laws and ethical codes, usual and customary standards of clinical practice, as well as new developments and evolving technology.

c++ programming 1. Implement an Array-based Stack to compute linear time algorithm to compute span days (slides 25 ~ 27 from lecture note 7). Program in lecture note 7 (P. 26 ~ 27) uses STL stack- but

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c++ programming

1. Implement an Array-based Stack to compute linear time algorithm to compute span days (slides 25 ~ 27 from lecture note 7). Program in lecture note 7 (P. 26 ~ 27) uses STL stack, but you should implement your stack data structure in this assignment. a. Download historical data for any stock of your choice b. Compute Span for each data point

2. Implement BubbleSort 1 and 2 a. You will need to implement NodeList and Sequence b. You will need to implement Iterator in NodeList as well as Sequence c. Finally, you can use the functions on the previous slides from lecture note 8 to test your implementations