Health Care Access for Maori and non-Maori

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Health care access and opportunities for Maori and non-Maori

Assessment 1 individual

INTRODUCTION

It can be said that; ‘Of all form of inequality, inequalities in health care the most inhuman of all’. This assessment is concerned with social, economic, political and historical factors which contributed to health status of Maori and non-Maori. Inequalities and disparities in health status comes are considerable. So there is a dramatic difference between Maori and non-Maori health status due to many reasons such as poor nutrition, lowest income, inappropriate education system, culture, language, loss of lands, unhygienic foods and many more. The recommendation in this assignment focus on different factors related to health of Maori and non-Maori people. In which to identify the biggest causes the poor health status and better understand the casual path linking of social, political, economic and historical factors. There is wide disparities in health exist among people in New Zealand.

Treaty of Waitangi

The treaty established a British governor of New Zealand, which recognised Maori ownership of their lands and other properties. The treaty of Waitangi is first signed in 6

th

February 1840 by British crown. Around 530-540 chiefs, at least 13 of them women, signed the treaty of Waitangi. The English and Maori version of treaty different, so there is no consensus .the Maori believed they ceded to the crown a right of governance for protection without giving up their authority to manage their own affair.

There is following views which contributed to inequalities and disparities in Maori and non Maori health status;

Social Review

Social status is based on occupation, education and life style of Maori and non-Maori people which is key determinant of health. There is a combination of materials like poverty in which includes poor housing, poor nutrition and stress caused by low social health status results in health inequalities. As a social factor, lifestyle is most dominant cause of inequality because the Maori has different lifestyle than non-Maori. In which cancer is single biggest cause of death in Maori due to taking of smoking and exposure to second hand smoke. Apart from this, it is noticed that the Maori women were twice as likely to smoke as women of non-Maori population. so the excessive smoking may lead to lung and breast cancer in Maori people. Moreover other associated factors are excessive alcohol consumption and more exposure to sun which contribute to bad health status. In addition nutritional habits also put great impact on health status of Maori and non-Maori. The Maori has poor nutritional take and also more obese than non-Maori. So obesity is very dangerous for health that may lead many other health problems and dangerous diseases which may even lead to death. Furthermore heart diseases and genetic components are major factors that associated their lifestyle in which Maori people has low physical activity and poor nutrition intake influence the health.

In addition to it, the use of mental health services served in 2002 was more in Maori rather than other islanders. Maori have high admission rate to mental hospitals and the diagnose and aetiology behind the mental disorder was related to their lifestyle like alcohol and drug consumption because drugs are directly affecting on brain nerves and a person becomes mentally week which can make is mind unstable and he is a way of any understanding due to the effect of drugs.

Moreover unsafe sexual habits, gambling and participate in dangerous activity are also a case of bad health status on Maori people.

In brief social conditions are particularly important in determining health of people because when a social environment is supportive then great influence on health. At last it can be said that poor nutrition, bad lifestyle, disruption, urbanisation, inappropriate education and poor nutrition intake lead to inequalities and disparities between Maori and non-Maori population.

Economic Review

There are number of survey has been done to recognise the economic factor that contribute to the health status of Maori and non-Maori. The economic level is very different of Maori and non-Maori people that may affect the health of both populations. It has been showed that non Maori men have more income than Maori. The low income people have not sufficient money for the treatment of disease because in new island income inequalities have been increased in late 1980 and 1990. This standard of living is some degree of hardship and fall in unemployment. Beside this loss of shelter, food and land are important determinant that may lead bad health effect on Maori people. The Maori population has no access of telephone, not receiving a man texting benefits, low income, illiteracy, overcrowded housing and even not living in their own home. So in this way Maori health status is very low as compared to non-Maori. It is also suggested that inequalities in income also contribute in death rates. Furthermore, decline of Maori population in 18

th

and 19

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century of colonisation. It is also believe that impact of colonisation in such a way like loss of land, houses, food, culture and language may lead to bad status on health 0of Maori people. Furthermore, racial factor is also contributed in inequalities. It can be understood by low qualification rate of Maori people because western education system was not appropriate for Maori.

Maori and the reason behind this was other cause is unemployment in which seen that Maori have high rate of unemployment than non-Maori were lived in rural and natural places.

Last but not the least cause under economic factor is poor health delivery care service to Maori people. So at the end it can be include that colonisation, loss of land, literacy, and overcrowded housing leaded negative effect on Maori health status.

Historical view

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In view of history the Maori people lived in rural areas or small town. The ancestor of Maori was illiterate and had no value of education. So in this way their children have also not went to school and unaware about value and need of education. The rate of school completion in 2001 was very low in Maori group (30.5%) as compared to non-Maori (52.4%).as a result of rate of unemployment was twice than European part.

Apart from this, from a decades and century the Maori was very prone to many ischemic heart disease, lung cancer, liver cancer and diabetes which all diseases may be seen in hereditary form also.

In addition, most of Maori was prone to physical disabilities that may put great impact on Maori health. The other reason behind inequalities of health status in Maori and non-Maori people was old education system. Before 1840s, the Maori children only learnt language, skills in fishing, mat-making, hunting, gardening, cooking and many more which only related to Maori. But after 1840s many schools were established by European missionaries and forced Maori children to attend ordinary schools. But Maori children did not reach an acceptable level of European education and consequently, Maori students leave the school early. So in this way they were illiterate and unemployed which resulted that they were not participated in health care services and self-health care that may lead to high mortality rate in Maori population than non-Maori.

In addition, bad and negative perception regarding hospital was one of reason of inequalities in Maori and non-Maori. There was hospital system proven ineffective in Maori population because nonetheless, thirteen Maoris patient were died from 1849-1851 and these deaths had negative effect on Maori perception. They concluded that ‘hospitals had a bad name among Maoris, they were thought of as places where one went to die’.

Political view

The politics has great impact on Maori and non-Maori health during the 1990s there was broad agreement between major political parties that settlement of historical claim was appropriate, in recent years it has become the subject of heightened debate.

According to have Mann (1999) in 1848 -1863 the whole land of South Island by unscrupulously purchasing land from Ngai tahu tribe’s .but consequently this leaded to invasion in Waikato and tahini tribes.

In case of question about the responsibilities of central government ,more than 80% respondent thought it should be the government role to maintain the standard of living and standard of health so in this way ,it was the government responsibility’s to provide jobs and reduce the income inequalities between Maori and non-Maori during the 1990s there was broad agreement between major political parties that settlement of historical claim was appropriate ,in recent years it has become the subject of heightened debate.

According to have Mann (1999) in 1848 -1863 the whole land of South Island by unscrupulously purchasing land from Ngai tahu tribe’s .but consequently this leaded to invasion in Waikato and tahini tribes.

In case of question about the responsibilities of central government, more than 80% respondent thought it should be the government role to maintain the standard of living and standard of health so in this way, it was the government responsibility’s to provide jobs and reduce the income inequalities between Maori and non-Maori.

Housing
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The structure of housing is different in Maori and non-Maori population. The Maori people lived in rural areas where all facilities in home were not reached properly. so in asthma.

In 2001 air pollution from home heating was associated with almost 1100 premature deaths. so because health status is largely determined by socio economic factors the improvements are mainly influenced by housing quality.

Health care access and opportunities for Maori and non-Maori

The Maori journeyed to New Zealand via pacific approximately 1000 years and the first recorded accrued in 1769 at the time of James cook from Britain.

There is increasing evident that Maori and non-Maori differ in term primary and secondary health care services .in which the Maori less likely to preferred to surgical care and specialist services .other one is the Maori received lower level of health care than expected level of quality hospital. The Maori obtaining necessary care only from local areas as compared to non-Maori.

There is another evident from previous study which reported the barrier to assessing the diabetes among Maori and Maori got unsatisfactory care rather than non-Maori population.

Moreover, the cost involved for a treatment is also a significant barrier to Maori access to health services.

Rights of others and legitimacy of difference

This way the Maori people has not proper ventilation and exhausted fan in house which leaded respiratory problems in Maori population. The Maori houses are cold, damp and polluted which leads many problems.

The all human being in this world has their own rights according to their culture and religion. So it is important to understand the different rights of others. The first which one is absolute rights which must never be limited in any way even a state of war or emergency. Moreover the right is not to be tortured in an inhumane way. Other one is non- absolute which can be limited in certain circumstance. Under this right the all people have right to liberty can be limited include being sent to jail if commit any crime. In which non- absolute the qualified right is that to respect for private and family life, right to freedom of expression, thought, and religion.

LEGITIMACY; is a popular acceptance of an authority. It is a value whereby something or someone is recognised and accepted as right and proper. In which include different people has their different rational values, customs and habits.Morover every person have their own ideas or charisma of leader. Apart from this, government institution establishes and enforces law and order in the public interest. The legitimacy of intergroup status differences has profound effects on attitude, emotions and behaviour.

In 143 hospitals organization noticed the effects in two forms managerial and technical. Results shows that both the managerial and technical forms provided notable improvement in survival chances.

The power relationship in healthcare;

The health care providers and practitioner play a vital role in power relationship .they are the persons which provide the health care in all level of health and all category of people either poor and rich, Maori and non Maori there was a strong evidence of a dose –response relationship between Maori and non Maori and racial discrimination in health care centres. The Maori was 10 times more likely to experience multiple type of discrimination as compared to Europeans and others. These results highlight the need for racism to be considered to eliminate ethic inequalities in health care.

In health care setting the nurses identifying the power relationship between the services provider and the people who use the services. the care provider must an emphasis health gains and positive health outcome because all people has different in age, gender, sexual orientation, occupation and socioeconomic status, ethnic origin or migrant experience, religious or spiritual belief, disability. The nurse accepts and sorts alongside others after undergoing a careful process ofpower relationship .the health care provider concern about quality improvement in service delivery and consumer rights.

Moreover health care provider resolves any tension between the cultures of nursing and the people using the services. Beside this, accepting the legitimacy of difference and diversity in human behaviour and social structure. So at last but not least it must needed to understand that such power imbalances can be examined, negotiated and changed to provide equitable, effective, efficient and acceptable service delivery, which minimises risk to people who might otherwise be alienated from the service.

Conclusion

All above review has been evident for disparities and inequalities in health care between Maori and non-Maori. There is complex factor complex of factors associated with historical, social, economic, housing, and political views for access to The all above review has been evident for disparities and inequalities in health care health care that also underpinned by racism which leads ethics inequalities. Although study has reported how the uses of health care services in Maori and non Maori population at the different level and different way. So it is a combination approaches which meet the different views and cultural safety is one of the indigenous nursing approach which response to inequalities for Maori.

References

The British Institute of Human right.(2013).

Human right tool kit. Different right –a balancing act?

London ,U.K.Retrived from

www.bihr.org.uk/human-right-in-action/chapter-3-different-rights-a

balancing act.

Jansen,P.,Bacal,K.,&Crengel,S.(2008).He Ritenga Whakaaro:Maori experience of health services.Retrieved from

http://www.nzdoctor.co.nz/media/6399/He-ritenga-Whakaaro.pdf

.

Jansen ,P.,& Smith,K.(2006).Maori experience of Primary healthcare:Breaking down the barriers.New Zealand Family Physician,33(5),298-300.Retrieved from

http://www.rnzcgp.org.nz/assests/documents/Publications/Archive-NZFP/Oct-2006-NZFP-Vol-33-No-5/JansenOct06.pdf

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Pyelonephritis : Pathophysiology- Etiology- Signs and Symptoms

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Pyelonephritis is a kidney infection and is a form of a urinary tract infection (UTI). Urinary tract infections (UTIs) is one of the most common kinds of viruses prone to everyone. In the United States, about six million Americans and results in more than 100,000 hospitalizations yearly (Kornusky & Cabrera, 2018). Urine is where microorganisms start their growth. Pyelonephritis is a virus of the upper urinary tract. Infections may ascend, arise from organisms in the perineal area and transport in the urinary tract along the continuous mucosa to the bladder and then along the ureters to the kidneys (VanMeter & Hubert, 2017).  Blood-borne contamination may cause urinary tract infection before becoming severe enough to cause pyelonephritis.

Escherichia coli is a common causative organism to pyelonephritis infection. Other causative organism includes Klebsiella, Proteus, Enterobacter, Citrobacter, Serratia, Pseudomonas, Enterococcus, coagulase-negative Staphylococcus, Chlamydia, and or Mycoplasma. Escherichia coli is more present as a contributing factor in the urinary tract because it is a resident flora in the intestine. It can survive by sticking to fimbriae or pili in the bladder mucosa without being washout when the bladder empties (VanMeter & Hubert, 2017). This lead as a medium for growth of infection in the intestine and kidney.

Pathophysiology of pyelonephritis is when infection form in the ureter into the kidney. It may include renal pelvis and medullary tissue. Both kidneys may be infected. The infection spreads, causing the kidney pelvis and calyces to fill with purulent exudate and cause the medulla to inflame. Abscesses and necrosis form in the medulla and may extend through the cortex to the surface of the capsule. In a severe infection, the exudate compresses the renal artery and vein, which then hinder urine flow to the ureter while bilateral barrier may cause acute renal failure (VanMeter & Hubert, 2017). Recurring, severe, and bilateral infection cause fibrous scar tissue to form over a calyx and may result in loss of tubule function, hydronephrosis, and chronic renal failure.

Etiology of pyelonephritis. Women are more susceptible to infection than men because of the short length and width of their urethra, its closeness to the anus, and the frequent irritation to the tissues (VanMeter & Hubert, 2017). Individual who practice improper hygiene practices during sexual activities, feminine hygiene products, defecation, menstruation, and incontinence are at risk for urinary tract infection. Those with incomplete bladder emptying, urine retention, and any obstruction to urine flow will also have an increased risk for urinary tract infection. Children with congenital abnormalities have an increased risk for urinary tract infection. The Elderly population also have a higher risk for infections due to incomplete bladder emptying, retention, reduced fluid intake, the impaired blood supply to the bladder, and immobility. Pregnancy, scar tissue, and renal calculi or kidney stones increase the risk for infection due to urine and contaminants not flowing freely or out of the system. Instruments or catheters may cause bacteria to grow in the bladder and cause an infection as well.

Signs and symptoms of pyelonephritis vary for everyone. Diagnosis of pyelonephritis depends on the severity of the infection, complications, and the overall physical condition of the patient (Kornusky & Cabrera, 2018). Pyelonephritis may include signs of cystitis, such as dysuria. Other signs and symptoms are pain that can be in the abdominal, back, side, groin, and or flank. Chills, fever, nausea, vomiting may be present. Observing urine abnormalities such as cloudy, dark bloody, or foul-smelling is possible signs of pyelonephritis.  The infection can cause ones to have urination abnormalities such as frequent, urge, and or painful urination.

Goal treatment for pyelonephritis is to provide symptomatic relief and to decrease progressing risk of complications. Treatment includes medication and fluid. Treatment for pyelonephritis means curing urinary tract infections. The process will consist of an antibacterial remedy, such as trimethoprim-sulfamethoxazole, nitrofurantoin, cephalosporins, carbapenems, amoxicillin, and or Fosfomycin. Drinking more fluid is also encourage, and cranberry juice are suggested. Having patient compete medication regimen is necessary even after signs and symptoms subside. It is also recommended to recheck pyelonephritis patient’s urine culture after medication regimen for the presence of the infection and to see if the treatment worked.  Depending on the severity of pyelonephritis infection, ones may require hospital treatment. With recurring kidney infection, a kidney specialist or urinary surgeon may necessitate for evaluation. Surgery may be necessary to repair abnormality. After starting antibiotic medication treatment, most pyelonephritis patients start seeing improvement, and the body responds positively to the treatment within 48 hours. In the united stated, there is more drug resistance nowadays, with no development after 48 hours of having antibiotic therapy would indicate that the treatment fails (Kornusky & Cabrera, 2018).  The patient will need to repeat a urine culture, regimen or surgery.


References

Analyse and compare administrative based data and clinical based data.For this unit assignment, identify a reputable website or scholarly article and discuss the following:

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Analyse and compare administrative based data and clinical based data.For this unit assignment, identify a reputable website or scholarly article and discuss the following:

1. Describe what a standardized healthcare data set is.
2. Compare and contrast at least three data sets used in electronic health records.

What are the data sets used for?
Where are the data sets stored/housed?
Are the standards governing the data sets used as part of the Department of Health and Human Services
meaningful use regulations?
3. Analyse and compare administrative based data and clinical based data.

Your response must be at least three pages in length, double spaced. You are required to use at least one outside source. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying APA citations.

Discuss how the authors support the claim that the meth phenomena is a social problem

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Discuss how the authors support the claim that the meth phenomena is a social problem

 

 

Psychology
Project description
or this assignment, read Brownstein’s article titled “Home Cooking: Marketing Meth” located in Doc Sharing (RAC article: Meth Cooking) which discusses the meth phenomenon. As you read this paper, note how the authors make, and/or support, the claim that meth is a social problem and how they discuss the problem and its broader implications.

Applying the format for analyzing a social problem, answer the following three questions based on your critique of the article.

To write it as an essay, begin with an introductory paragraph which tells the reader what you are going to do. Then clearly answer each question, answer them in the order listed and use an appropriate subheading for each question. End your essay with a conclusion and summary paragraph.
___ (Q1)Discuss how the authors support the claim that the meth phenomena is a social problem
___ (Q2)Discuss how the authors, either explicitly or implicitly, suggest that the values and/or quality of life of society are threatened

___ (Q3)Discuss how the authors, either explicitly or implicitly, suggest why the problem exists. In your discussion, note how the author’s explanation’s relates to, or reflects, any or all of the theories discussed in this course.

NURS 5051 – Week 1 Discussion

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Please see attached document with complete instructions  

To Prepare:

  • Reflect on the concepts of informatics and knowledge work as presented in the Resources.

1. https://www.youtube.com/watch?reload=9&v=fLUygA8Hpfo

2. See attached articles – 

  • Consider a  hypothetical scenario based on your own healthcare practice or  organization that would require or benefit from the access/collection and application of data. 

Your scenario may involve a patient, staff, or management problem or gap. – I work in a psychiatric unit. 

Instructions:

1. Post a description of the focus of your scenario. 

2. Describe the data that could be used and how the data might be collected and accessed. 

3. What knowledge might be derived from that data?

4. How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

** USE AT LEAST 3 REFERENCES**

Explain the various roles that a physical therapist serves within the healthcare model.

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Explain the various roles that a physical therapist serves within the healthcare model.

Topic: Explain the various roles that a physical therapist serves within the healthcare model.

Below are some roles that Physical therapist serve within the healthcare model today: The information below was copied from the internet, Please do not copy word for word because of plagiarism. I will be checking the completed essay on turnitin.com. Thank you.

Physical therapists are health care professionals who diagnose and provide care for those with medical ailments or health-related issues that limit movement or abilities in everyday activities. As the medical field advances, however, the role of the physical therapist is expanding to include other aspects of health care.

While most associate physical therapists as the treatment providers to patients with issues that prevent or limit mobility, the responsibilities of a physical therapist have become much more than that in recent years. Today, physical therapists must be prepared to perform as a fundamental member of any health care team. Additionally, practitioners must be comfortable with and able to perform as a consultant, educator, administrator or clinical scholar.
Consequently, the traditional entry-level education and previously required preparation for physical therapists has become outdated. Physical therapists now need more training, education and experience to perform at the same level as other key health care professionals.

Physical therapists are now expected to do much more than just provide treatment to patients with issues limiting mobility. Physical therapists are expected to be fundamental health care team members who tackle prevention initiatives, such as decreasing falls for the elderly and the prevention of athletic injuries. Additionally, they are tasked with preventing movement and flexibility issues that can be brought on by chronic diseases or other debilitating health conditions.

In Rehabilitation
•  Physical therapists are leaders in rehabilitative services that allow individuals with injury, disease or chronic health conditions, impairments in body functions and systems, activity limitations, and participation restrictions (disabili- ties) to return to productive lives.
In Prevention and Wellness
•  Front line providers—including physical therapists—should be included in health care reform prevention initiatives.
•  Physical therapists are educated to provide insight and in- terventions to increase physical activity among appropriate patients to reduce excess body mass, improve health status, and reduce associated chronic disease risk. For example, for patients who are obese, physical therapists develop programs that can balance the progression of exercise with the need for joint protection and safety.

Health promotion is a growing part of the physical therapy field today. While, the idea is still not fully integrated into the practice, it is well on its way. From the overview and results we are able to see where not only specific health models, such as the Social Cognitive Theory and the Health Belief Model, but also other basic principles of health promotion can be beneficial to physical therapists.
Another aspect of health promotion not previously discussed that therapists and other health care professionals should focus on is health literacy. Patients may not always fully understand their diagnosis and treatment. As a result, they may not follow through with their home health care programs, medications or preventative care. Health literacy is defined as “the degree to which individuals have the capacity to obtain, process and understand basic information and services needed to make appropriate decisions regarding their health (Vanderhoff, 2005)
According to the Institute of Medicine (IOM), “90 million America’s, nearly half of all adults, have inadequate health literacy” (Vanderhoff, 2005). Much progress has been made to enhance health literacy. The providers’ competency is paramount to successful patient education. As such, The Commission of Accreditation in Physical Therapy Education has made patient education an accreditation requirement for PT education programs (Vanderhoff, 2005). The best way to ensure that health education and health promotion are being utilized in physical therapy is to ensure that it is taught to students and in continuing education courses.
The utilization of the PT has continued to grow over the years specifically in the hospital-based outpatient wound clinic (HOPD), primarily as it relates to implementing healing strategies that impact offloading, positioning, range of motion, and maximizing overall function and quality of life among those living with chronic, nonhealing wounds. The PT can also be a resource for recommending therapies and assistive devices that improve strength, ambulation/mobility, and overall wound healing. Furthermore, impediments to wound therapy may be reduced or even eliminated when the PT is involved in a collaborative approach to care.
The PT provides “application of therapeutic procedures and modalities that are intended to enhance wound perfusion, manage scar, promote an optimal wound environment, remove excess exudate from a wound complex, and eliminate nonviable tissue from a wound bed.

: Why is traditional couples therapy considered potentially dangerous in the treatment of cases involving marital violence? What are some of the arguments in favor of treating violent partners together in couples therapy?

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: Why is traditional couples therapy considered potentially dangerous in the treatment of cases involving marital violence? What are some of the arguments in favor of treating violent partners together in couples therapy?

Why is it important for a clinician to develop a therapeutic hypothesis, and what are some of the elements that such a formulation should include?

Why is traditional couples therapy considered potentially dangerous in the treatment of cases involving marital violence?

What are some of the arguments in favor of treating violent partners together in couples therapy?

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Reflective Practice Relevent To Developing Clinical Skills Nursing Essay

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Reflective practice has been defined as “Involving self, a process that is undertaken in response to a positive or negative event that may be initiate consciously or subconsciously, that requires to provide an answer” (Chapman, Dempsey et al. 2009). It has also been defined as “Paying critical attention to the practical values and theories which inform every day actions, by examining practice reflectively and reflexively, this leads to developmental insight” (Clouston, Westcott 2005). Reflective practice is a process to which a person dissects their internal reactions to certain situations, and how they dealt with the cause and effect. It is only through this reflection that an individual can comprehensively understand and learn from their previous decision making mechanisms. Reflective practice gives the opportunity for a health professional to look back at their clinical skills used in given situations, and assess how these skills could be amended to better their professional practice. It is a method of learning from experiences, using experiences to analyze why problems occurred, and then to find a solution to these problems (Taylor 2010).

Reflection has been defined by Dewey (1933) as “active persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusion to which it tends” cited by (Mann, Gordon et al. 2009). Boud (1978) reinforces Dewey’s assessment of reflection, however, he aligns himself with an overtly emotional assessment of personal experience. Boud defines reflection as “a generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to a new understanding and appreciation” cited by (Mann, Gordon et al. 2009).

There is a gap between academia and good professional practice. Although a student may have a very good understanding of theory, this does not necessarily teach them about good professional practice (Baird 2008). Knowledge is something that is to be challenged and reinforced. Gaining knowledge through clinical experience and reflection is key to being a reflective practitioner (Clouston, Westcott 2005). This can be obtained at university level within Radiography through clinical placement, positioning classes and a personal development system (PDS) (Baird 2008). These classes give the student an opportunity to challenge, discuss, but more importantly reflect on the theory which they have learned. It is through problem solving that a student can reach below the purely scientific understanding of processes and procedures, and can delve into the deeper, and one could argue, the more complexities of clinical practice. Through these teaching methods a student can learn that the theory of practice is not always going to work in given situations, and through reflection they can amend their knowledge to give the result of better clinical skills and professional practice (Baird 2008). It would be nieve to assume that every patient, every ailment, should reprieve a standard set method of treatment. The PDS is an online resource which provides a student with a key initial starting block to which they can build a more successful, productive, and ultimately professional methodology to explore key skill and developmental needs (Rowland 2006).

A study of students found that reflective exercises proved successful, and that they thought it could be a valuable part of their professional careers within the health service. Students realised that reflective practice can help to deal with any similar issues arising (Cronin, Connolly 2007). Another study found that student nurses gained confidence in decision making through journal writing also stating that they believed more, that writing could be used to learn (Epp 2008). Both studies show that reflective practice is a beneficial tool that can be used to enhance professional practice. However the first study is seemingly over crediting the usefulness of reflective practice on a ‘one size fits all’ basis. Students must not become fully dependant on the benefits which reflective practice may bring, and must leave room for ingenuity, and adapt these procedures to specific circumstances. The second study reinforces the benefits which reflective practice can bring to a student’s confidence in their own professional expertise.

The introduction of key performance indicators (KPI) into healthcare departments increased awareness among staff and gave an obligation to staff to fulfil certain tasks (Abujudeh, Kaewlai et al. 2010). Through KPI’s in individual can highlight areas of strengths and weaknesses, however more importantly can develop a systematic and detailed plan to improve their continual personal development. There are methods incorporated into KPI’S to encourage reflective practice, Continual Professional Development (CPD) and life long learning (LLL) (Chapman, Dempsey et al. 2009). Within radiography these two strategies are used to develop reflective practice. LLL was implemented with the intention for individuals to continually re-educate themselves on advances within their field of work. CPD is a resource which is discussed in detail with, the relevant line manager. If CPD is used properly reflective thinking is encouraged in the practitioner (Chapman, Dempsey et al. 2009). This reinforces the relationship which exists between CPD and the development of reflective practice. The society of radiographers has invested in an exclusive CPD tool which gives advice to members on how to reflect and learn. The CPD plan outlines that reflective practice can be carried out in a number of ways. Firstly by writing a reflective journal about personal experiences in the workplace or secondly in an educational environment through health professionals attending courses, to learn better ways of becoming a good reflective practitioner (Kelly 2005). It is only through implementation of all of these methods that a continual and productive mode of reflective practice can be achieved through the CPD plan. Writing a reflective journal helps a health professional keep a record of their practice, remind themselves of good and bad practice, why it happened and how they overcame or will overcome the problem (Clouston, Westcott 2005). A study found when a group of radiation therapists gathered to write journals together that their motivation, confidence, professional knowledge, critical thinking and professional practice all increased ensuring the CPD of staff (Milinkovic, Field et al. 2008).

It is vital for reflective practice to be a success, all individuals within an organisation must be wholly committed to the belief that reflective practice is a worthwhile and productive tool. Things which hinder reflective practice occur in workplaces where there is no emphasis put on it by line management.. The pressures placed on professionals in the clinical environment mean that the health professional may feel that time spent on reflective practice may seem wasted (Mann, Gordon et al. 2009). It is a well known fact that as the health professional spends more time in the profession, it is found that less of their time is spent reflecting. It has been said that barriers to reflective practice include lack of time and space, negative preconceptions, organisational culture, fear, the risk of routine and not fully understanding reflection (Clouston, Westcott 2005). A study found that the use of a facilitator within a healthcare team to guide people and help promote reflective practice was very beneficial to the team. The time spent on reflection was said to have enhanced critical thinking, professionalism, making decisions and being able to challenge things they were not in full agreement with (Mann, Gordon et al. 2009). The use of a reflective practice facilitator provides a systematic and constant reminder to practitioners of the importance and benefits which this tool can give in work life. The facilitator provides an outlet for relevant and knowledgeable advice in what a practitioner may perceive as being a difficult circumstance. This study suggests that reflective practice has a positive impact on clinical skills and professional practice. Another study found that within the format of a meeting environment consisting of health professionals, reflective practice was influenced by five factors. The first factor which influenced reflective practice was that too much structure in a meeting lowered the ability to reflect. Secondly the level of interest a professional has in reflection, the more interested being better reflectors. Meetings in which people have certain roles and consist of tasks do not provide ideal for reflection. A pressurised environment where a professional is obliged to complete tasks, was shown to prevent reflective capabilities also (Heel, Sparrow et al. 2006). It would be nieve and absurd to remove structure from this mode of reflection, as the KPI targets reinforce good reflection methods. .

Reflective practice has been proven to be an important tool in developing clinical skills and professional development. All studies had a similar agreement that reflective practice is good but the method of reflecting varied. Reflective practice has to be carried out from student to professional level. Reflection was said to increase confidence, decision making, motivation and professionalism (Clouston, Westcott 2005). There were no studies found that measured the effectiveness of reflective practice, perhaps this is an area where more research is needed. Another area that no research was located on was bad experiences of reflective practice. Further study into these areas could give more insight into how beneficial reflection is.

Identify a public health program you believe has been impacted in a negative manner because of the current economy? How do you think the issue could be resolved from a health policy standpoint?

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Identify a public health program you believe has been impacted in a negative manner because of the current economy? How do you think the issue could be resolved from a health policy standpoint?

 

healthcare
Respond to the prompt below.
You are the Health Information Manager for Castello Community Hospital and after having submitting a request for proposal (RFP) for a new major database information system and having it approved, you must now consider site preparation. You have expedited the RFP because there have been some technical problems of late with the out- of-date system. Several division managers have expressed interest in having the main system set up in their department. Provide a rationale for placing the main frame in the department. Option A: Human Resources. 6 employees. Only one small cubicle of space available but the location of the HR Department is the most central location in the hospital.

Paragraph #2
Respond to the prompt below.
Some people would argue that economics often guides health policy. Identify a public health program you believe has been impacted in a negative manner because of the current economy? How do you think the issue could be resolved from a health policy standpoint? Do you think the issue could best be settled from a public or private perspective, and why?

The Issue Of Medication Compliance

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Patient noncompliance is a major medical problem in America. Consequently, numerous studies and reports have been performed to articulate the meaning of the problem and to suggest improvements. The literature however, in its effort to explore all facets of the current compliance situation, has produced a complex construct, making it exceedingly difficult for clinicians and researchers to understand the problem. This report was undertaken to unify the current spectrum of compliance literature, to make sense of the adherence situation. A variety or research methods was used, including MEDLINE and PubMed searches, university medical library searches, general Internet searches, and clinical text reviews. The result was a categorization of the literature into six segments, including articles identifying adherence as a problem, identifying the causes of noncompliance and exploring possible solutions, analyzing adherence with respect to specific ailments, and exploring the patient’s role, the pharmacist’s role, and the physician’s role with respect to compliance. After the exploration and synthesis of the current literature, we suggest that future research concentrate on the practitioner for a better understanding of the compliance situation and the creation of a universal method of ensuring compliance.

Introduction

Over the past 25 years, literally thousands of articles have been published on the issue of medication compliance, also known as adherence, approaching the issue from various angles and ending in confused conclusions. The multiplicity of studies focusing on adherence has resulted in conflicting data and contradictory results. Areas of research on this issue include identifying adherence as a problem, identifying the causes of noncompliance and exploring possible solutions, analyzing adherence with respect to specific ailments, and exploring the patient’s role, the pharmacist’s role, and the physician’s role with respect to compliance. Traditionally, research has concentrated on recognizing why patients are noncompliant and the strategies that various providers can use to increase compliance. After more than 25 years of research on this issue, we still have yet to outline an optimal approach that insures high compliance levels. However, it is crucial that we improve our understanding of the issue because at the very least, costs as a result of patient noncompliance are estimated at $100 billion a year and are the result of adverse outcomes such as hospitalization, development of complications, disease progression, premature disability, or death.1-8 What follows is a summary of the current status of adherence research, in other words, what we do know.

Methods

The analysis of the current literature was undertaken in a variety of ways. We began our research by exhausting online medical journal search engines such as Medline and PubMed. We included all articles, regardless of publication date, so that we could understand the progression of compliance research. We spent considerable time collecting and reviewing journal articles in order to gain an understanding of the current situation as seen from other medical researchers. We then moved to a broader Internet-based search to include articles and information specifically for patients and practitioners. We then studied medical texts concerning patient compliance, such as the American Heart Association’s Compliance in Healthcare and Research and Achieving Patient Compliance, by M. Robin DiMatteo and D. Dante DiNicola. When we believed that we had exhausted all avenues of compliance research, we began the arduous task of synthesizing the information into a review of the literature as a whole. This report discusses that review.

Analysis of the Current Literature (Results)

Identification of Noncompliance as a Major Medical Problem

Much of the research concerning patient compliance deals with the identification of adherence as a medical problem. This area of research aims to convince the reader that something needs to be done about the current patient noncompliance situation. As expected, much of the data behind this type of study exists in the form of factual and numerical information. The following is a list of typical compliance statistics:9

-Approximately 125,000 people with treatable ailments die each year in the USA because they do not take their medication properly.

-Fourteen to 21% of patients never fill their original prescriptions.

-Sixty percent of all patients cannot identify their own medications.

-Thirty to 50% of all patients ignore or otherwise compromise instructions concerning their medication.

-Approximately one fourth of all nursing home admissions are related to improper self-administration of medicine.

-Twelve to 20% of patients take other people’s medicines.

-Hospital costs due to patient noncompliance are estimated at $8.5 billion annually.

Noncompliance is typically cited as occurring in from 50% to 75% of patients. In other words, in the United States, 50% to 70% of patients do not properly take prescribed medication. The rate of noncompliance is even higher in patients with chronic illnesses.10 This is because the drug regimens for these patients are often long-term, complex regimens that alter existing behavioral patterns. In addition, children are less likely than adults to follow a treatment plan because of their dependence on an adult caregiver.11 Clearly, the research has proven that noncompliance is a serious medical issue. It is a major medical problem that may lead to death and elevated costs, both for patients and providers.

Noncompliance in Regard to

Specific Ailments

Both complexity of regimens and rates of compliance differ with respect to specific ailments. Part of the body of research conducted on drug compliance deals with rates of compliance and reasons for noncompliance for specific diseases and medical conditions. Perhaps the most commonly studied condition in relation to patient compliance is hypertension.

Hypertension is a chronic condition that may result in stroke and heart failure. Researchers estimate that 58.8 million Americans (one fifth of the population) have some form of cardiovascular disease.12 Noncompliance is a major factor in the increasing number of deaths related to cardiovascular disease. According to a recent study by a team of researchers from the University of Lausanne in Switzerland, “as many as half of ‘failures’ of treatment to bring elevated blood pressure down to normal levels may be due to unrecognized lapses by patients in taking antihypertensive drugs as prescribed.”13 Clearly, noncompliance with regard to hypertension is a major medical problem. But the question is why hypertension patients do not take the prescribed medical regimens? The major problem for compliance and hypertension is that patients often do not feel any adverse physical effects. Because of this, patients do not experience any physical improvements due to the strict compliance to the medical regimen. The most commonly cited reasons for noncompliance include, not being convinced of the need for treatment, fear of adverse effects, difficulty in managing more than 1 dose a day, or multiple drug regimens.14 The recommendations for improvement of patient compliance are even more numerous and nonspecific as the reasons for noncompliance themselves. The following is a list of recommendations given to physicians in an effort to improve compliance:12

-Make it clear to patients that they themselves perceive the medication as being important.

-Provide clear instructions.

-Tailor the drug regimen to the patient’s individual schedule.

-Review the importance of compliance with patients.

-Teach patients to self-monitor.

-Establish regular contact with patient.

-Provide cognitive aids for the patient.

-Ask the Patient to buy and use a medication container.

The list continues with countless other recommendations. Clearly, both the reasons for and the methods of improving treatment and compliance with regard to hypertension are complex.

Another example of this type of research relates to diabetes. Diabetes affects 17 million people or 6.2 percent of the American population.16 Diabetes is a chronic illness, like hypertension, which involves a complex, long-term medical regimen. Researchers estimate that 95% of diabetes care is performed by the patient.17 The treatment plan for diabetes involves more than simply taking prescribed medication. Patients must adhere to strict diets and exercise plans as well as properly taking doses of insulin or drugs. Again, it is noted that the complex nature of the medical regimen for diabetes leads to high rates of noncompliance. Because patient involvement in the treatment plan is so high, the most common suggestion for improvement of adherence is for physicians to take a patient-centered approach to treatment.

AIDS, a worldwide epidemic effecting millions of people, is another disease with an extremely complex medical regimen. There have been recent breakthroughs in the effectiveness of AIDS treatments including HAART (highly active antiviral therapy), which provide the possibility of significantly controlling the effects of AIDS. Unfortunately, adherence acts as the Achilles’ heel of AIDS treatment. In clinical trials, the HAART treatment resulted in low or undetectable viral load levels in as much as 85% of the patients in the study.17 But out of the laboratory and in the real world of AIDS treatment, only 50% of patients were positively affected by the HAART treatment. The explanation for this alarming disparity of results was that “the main reason for these ‘failures’ was poor adherence to HAART regiments.”17 AIDS is a very complex disease, and it is certainly true that many patients simply do not understand the importance of adhering to the medical regimen. Patients may also believe that the negative side effects of AIDS medications outweigh the life-lengthening effects and may decide to discontinue treatment. Again, the literature suggests that physicians should make sure that patients understand both the seriousness of the disease and the importance of strictly adhering to the medical regimen.

Clearly, adherence significantly affects the results experienced by patients with these diseases. Among the current literature are seemingly countless articles identifying adherence as a problem as it relates to a specific disease. Other examples not mentioned in this article include, asthma, schizophrenia, and disabilities. But what does this all mean? What is tantamount in all of these articles or studies is that adherence is a problem. Most of these articles identify the problem of adherence and provide suggestions for improving adherence. The great majority of articles suggest that physicians pay more attention to the patient and place more emphasis on adherence.

Proposed Solution to the

Adherence Problem

Another type of article on adherence is geared toward physicians looking for either solutions to adherence problems or ways of protecting themselves against patients who do not adhere to medical regimens. A rising concern among physicians is that patients will sue them for poor outcomes of medical treatment.18 Physicians worry that they may still be sued, even if failed treatment is the result of the patient’s noncompliance. Because of this concern, part of the adherence literature focuses on ways for physicians to safeguard themselves against patient noncompliance. Experts suggest that physicians keep careful documentation of patient activities such as missing appointments because this can be used as evidence of patient noncompliance.19 Other suggested methods of improving patient compliance and limiting physician liability include patient reminders such as telephone calls or mailed reminders to make an appointment or to pick up a prescription. Repeat RX and RepeatVisit are two available nationally operating programs for patient reminders. For a fee, these programs will contact patients for physicians and pharmacists. Other articles however, suggest that patient reminders are wholly ineffective. One article claims, “one of five patients who were frequently reminded did not take their medication as prescribed.”20

Although these articles discuss adherence issues and possible solutions, they do not provide any useful information on attacking the adherence problem as a whole. For example, one typical reminder research study21 consists of a summary of the results of 5 clinical trials examining the effect of using patient reminder cards, patient education, an incentive for patients, help from peer group or community, and intensive self supervision. The study concluded that all of these factors improved compliance but that none was significantly exceptional.

The Role of the Patient and Compliance

Much of the current literature on noncompliance concentrates on the patient’s role in determining adherence to treatment. Being “compliant” encompasses the patient’s “active participation in his or her own health care: seeking medical advice, keeping appointments, following implicit and overt recommendations concerning life style, diagnostic investigations, and medical and surgical regimens.”19 Noncompliance is typically associated with a patient characteristic. The most common examples or reasons for noncompliance deal with the patient’s behavior and include the following:21

-Failure to take medication: This includes missing doses, premature cessation of therapy, and ineffective methods of taking medications.

-Taking too much medication: Some patients, hoping for additional benefit, increase the number of doses or the amount taken each time, incorrectly assuming that if some is good, more must be better.

-Taking a drug for the wrong reason: This may arise from confusion about the purpose of using a drug, particularly if several drugs are being used.

-Improper timing of drug administration is more likely to occur if the medical regimen is complex: the administration of numerous medications at frequent or unusual times during the day.

These patient behavioral factors may or may not be perceived by the physician. A real problem exists when physicians do not recognize noncompliance because they will inevitably increase prescription dosage. Physicians will increase the dosage, thereby increasing the risk of side effects and even worse compliance. In this sense, the cycle of noncompliance can be represented as a downward escalating spiral.

Although the patient noncompliance literature contains many contradictions, one piece of information is both crucial to adherence understanding and unanimously agreed on. This is that “none of the common demographic factors such as age, marital status, living alone, sex, race, income, occupation, number of dependents, intelligence, level of education, or personality type have been shown to be consistently related to noncompliance”.21 Examples of patient-centered compliance studies are discussed in the following sections.

Physician-Delivered Smoking Intervention Project: This study, funded by the National Cancer Institute in 198622 found that the patient-centered approach was more effective than physicians simply giving personal advice to patients. Patients were randomized into three groups: those who received advice, those who received the patient centered approach, and those who received the patient-centered approach plus a Nicorette prescription. The results were that 9% of those receiving advice quit smoking, 12% receiving the patient-centered approach quit, and 17% of those receiving the patient-centered approach in combination with medication quit.

Review of financial incentives to enhance patient compliance:23 This article includes the results of 11 studies performed in an effort to determine the effect of financial incentives (cash, vouchers, lottery tickets, or gifts) on compliance with medication. Ten of the 11 studies found improvements in patient adherence with the use of financial incentives.

Review of trials to improve antihypertensive drug adherence:24 This article summarizes the results of 29 blinded and unblinded clinical trials undertaken to determine the effect of worksite care, physician education, an electronic vial cap, patient cards, and calendar packaging. The article described insufficient evidence to support the effectiveness of mailed reminders alone, according to unblinded trials. Adherence results were conflicting for patient education and inconclusive for patient counseling. Self-monitoring was deemed ineffective according to single-blind trials.

The Role of the Pharmacist

A new trend within the noncompliance literature is to examine the role that the pharmacist plays in determining patient compliance. Furthermore, articles suggest that pharmacists, having direct contact with patients while patients are engaged in their medical regimen, have a better ability to detect compliance problems. A new trend that is being proposed to improve patient compliance is to implement a system around the community-based pharmacist. A community-based pharmacist is one that has direct involvement in a patients treatment plan, has direct and frequent contact with physicians, and has an active role in changing or altering a patient’s medical regimen.25 The community-based pharmacist can improve compliance because “the pharmacist is often the only member of the health care team who has access to information about all of the patient’s drugs”.25 The community-based pharmacist shares this information with the physician to improve patient care and compliance.

IMPROVE (Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers:)25 An example of a pharmacist-based study, this study looked at the influence that the pharmacist has on determining patient compliance. This study included 78 ambulatory care clinical pharmacists who documented 1,855 contacts made with 523 patients over 12 months. The pharmacists were responsible for adjusting patients’ drug regimens as well as identifying and preventing drug-related problems. The study found that this type of pharmacist intervention improved patient adherence.

The Role of the Physician

There is a whole area of compliance research dedicated to examining the role of the physician and compliance. Articles within this body of research suggest methods for physicians to use to improve patient compliance. The great majority of these articles focus on doctor-patient communication.

There are limitless theoretical models for medication compliance including social cognitive, reasoned action, planned behavior, stage models, self-regulation, and the patient centered approach among others. These models for compliance improvement share at least one common thread. These models deal specifically with the doctor-patient consultation process as it is divided into three sections, “the patient’s input, interaction (both verbal and non-verbal) in the consultation, and the doctor’s verbal output”.21 With all of these models, the basic idea is that through an increased understanding of the consultation process, doctors are able to manipulate consultations in such a way as to increase compliance. Perhaps one of the biggest problems facing physicians is that patients often remember little of the information disseminated during a given visit.

On average, patients forget approximately 40% of what they are told.21 Furthermore, patients often do not fully understand the information that they do remember. The literature suggests that the main method physicians can use to combat the comprehension situation is through better communication. Some of the techniques that physicians can use to increase compliance include “the use of primacy and importance effects, explicit categorization, simplification, repetition, and the use of specific advise statements.”21 Although these techniques have proven somewhat successful, a study done by the University of Sydney found that these methods resulted in a mean percentage of improvement in recall ranging from 19% to 219%. Rather than discuss each theoretical doctor-patient communication model, it would be useful to discuss the two leading and most cited models, patient-centered approach and the social cognitive model.

The basic premise of the social cognitive theory as it applies to compliance is that the patient’s perceptions of vulnerability, severity, treatment effectiveness and costs could be assessed, and it should then be possible in theory to devise messages for that patient which alter perceptions in a compliance-conductive direction.24 This model deals primarily with the fact that a patient’s compliance is a factor of his or her comprehension of information during the consultation as well as their perception of the effects of not taking medication. Furthermore, these factors will play out unconsciously and will determine the patient’s level of satisfaction with the drug regimen. In a recent study, Ley et al.26 found that giving practitioners suggestions for improving communication led to increases in patient’s recall of what they are told.

Another commonly used method for improving patient compliance is the patient-centered approach. As the title for this model suggests, the patient-centered approach places the patient at the center of the treatment. The first step in this approach is for physicians to “accept the patient where she is”27 In other words, the physician must first accept the fact that the patient may be noncompliant without blaming the patient. Rather, the physician must talk with the patient to understand the reasons for noncompliance. The basic premise of this theory is that the physician does not have all of the treatment answers. In actuality, the patient has a better grasp of the situation and therefore possesses vital information to be used by the doctor. The basic outline for the patient-centered model is as follows:

-Accept where the patient is.

-Accept what you do not know.

-Acknowledge that the patient has the answers.

-Build self-efficacy.

-Set realistic expectation for self and patient.

-Share responsibility.

These are two examples of many of the theoretical models available for physicians to use to improve patient compliance. Although useful, these theories are in some way disconnected from the real world of patient compliance. To get a better grasp of the efficacy of these theories, we must examine the literature for studies related to patient compliance.

For example, one physician-centered study28 summarizes the results of 153 studies published between 1977 and 1994 that evaluated the effectiveness of interventions to improve compliance with medical regimens. These studies essentially tested different theoretical models of the physician-patient relationship to find the most effective model. The results were that compliance interventions had a weak to moderate statistical effect on indicators of patient compliance, but represented generally efficacious interventions in practical terms. No single intervention strategy appeared consistently stronger than any other. Direct education, group processes, familiar support, behavioral modalities, and provider interventions showed no advantage over one another. The more comprehensive the program, the more effective the outcome.28

Conclusions

Currently, the field of medication compliance research is replete with articles on many different aspects of the compliance problem. As summarized in this report, the literature centers on identifying adherence as a problem, identifying adherence solutions, analyzing adherence with respect to specific ailments, and exploring the patient’s role, the pharmacist’s role, and the physician’s role in relation to patient compliance. After studying the literature, one can only conclude that there is still no real consensus concerning the most effective way to improve patient compliance. The research shows that adherence to medications is not routinely measured in clinical practice and a universal standard that can easily be implemented does not exist.1-7,29-32

The vast majority of the compliance literature focuses on patient variables, but since we still do not know a great deal more, perhaps it is reasonable to shift our focuses to the other side of the patient diad: the practitioner. From the literature, we know that the there exists an almost overwhelming amount of information on ways for physicians to improve compliance through establishing better communication techniques. We also know that among the many different communication techniques proposed, none clearly stands out as a clear method for improving patient compliance consistently. We know that the more time physicians give to improving their patients’ compliance, the more effective their efforts are. We know that an increase in the role of the pharmacist improves compliance. We know that telephone and mail-card reminders alone show no real significant improvement in patient compliance. Perhaps this is a far more complex construct than is expected. Perhaps the univariate studies in the past are not enough. Even though it is a complex matter, it is still crucial for health care providers to understand compliance triggers and related variables. The cost and trauma are too great without it.