3. Describe the factors that contribute to muscle hypertrophy. When designing a training program to optimize muscle hypertrophy, what steps can you take to make sure that each factor is accounted for?
Today, the work of labor and delivery nurses (L&D nurses) is extremely important and responsible because the quality of their work affects consistently the quality of health care services delivered to women and newborns. In this regard, it is important to remember that, today, many women have problems with labor and delivery because of their age, health problems and other factors that make the natural process of labor and delivery difficult. In such a context, the role o L&D nurses can hardly be underestimated because their qualification and experience may be crucial for the successful delivery. At the same time, in the contemporary health care environment, the job of L&D nurses is basically similar to the job of other nurses in terms of qualification, education, skills and wages. In such a situation, human resource managers often face problems with motivation of L&D nurses. This is why human resource managers should focus on the use of non-material motivators, which may be very effective. On the other hand, they should pay a lot of attention to training and education of L&D nurses because their qualification plays crucial role in the provision of proper and effective health care services to women and newborn in the course of the labor and delivery. Therefore, L&D nurses should have a wide range of nursing skills and abilities, high qualification and solid education background, whereas human resource managers should keep them motivated to carry on their professional development and provide nursing care services of the high quality.
On analyzing specificities of the job of L&D nurses and their workplace environment in terms of human resource management, specialists (Limentani, 1999) argue that education affects consistently the performance of L&D nurses and the effectiveness of their work. In this regard, it is possible to dwell upon basic educational requirements L&D nurses should meet in the contemporary health care setting.
First of all, L&D nurses should have the Bachelor degree because the essential education for L&D nurses is the Bachelor of Science in Nursing. However, the bachelor degree is a minimal requirement, whereas often a Master of Science in Nursing degree is needed. The high qualification is one of the essential conditions of the successful professional development of L&D nurses because they need to have a solid educational background and profound knowledge in labor and delivery nursing. Naturally, the experience of L&D nurses is also very important but they acquire their experience as they carry on their education and professional development. The Bachelor and Master degrees are very important because they provide L&D nurses not only with certain status but also and mainly they provide them with basic education on the ground of which they can elaborate the strategy of their professional development and keep growing in professional terms.
Furthermore, L&D nurses should have a registered nurse license from their state board of nursing (Ryan and Ray, 2004). This is another important requirement L&D nurses should meet because the registered nurse license is a sort of guarantee of the current professional level and competence of L&D nurses. Registered nurses cannot work without license but L&D nurses should strive to obtain the license because the license opens new job opportunities for them and, what is more, contributes to their further professional development.
In such a context, many specialists (Benoff & Grauman, 1997) place emphasis on the fact that L&D nurses should take training and get involved in courses in a L&D nursing program. In actuality, a large number of training programs is available to L&D nurses and it is one of the major tasks of human resource managers to motivate L&D nurses to participate in training programs. They should explain L&D nurses positive effects of training programs for their professional development. In fact, training programs increase the professional level of L&D nurses and, therefore, increase the quality of nursing care services they deliver to patients.
However, sometimes L&D nurses have poor motivation and they need the assistance from the part of human resource managers to participate in training programs. This is a case of experienced L&D nurses mainly because they feel confident in their professional skills and abilities, they have extensive experience, and they believe they do not need training courses anymore. This is exactly where human resource managers should work closely with L&D nurses to motivate them to carry on their professional development and to participate in training courses.
At the same time, along with training, job competences for labor and delivery nurses are extremely important for effective performance of L&D nurses and the high quality of nursing care services they deliver to patients. Job competences required for L&D nurses normally coincide with job competences required for other nurses. Nevertheless, human resource managers should pay a particular attention to the development of basic job competences in L&D nurses. In this regard, L&D nurses should have well-developed professional skills above all. This means that they should be professionals, who have extensive knowledge and experience and who are capable to implement their knowledge in practice in their regular work in the real health care setting.
Along with specific professional skills and knowledge, L&D nurses should develop other competences, which are crucial for their regular work. In this regard, specialists (Miller, et al., 2003) point out that L&D nurses should be able to make quick decisions at critical times. To put it more precisely, they should be able to respond fast and properly to any challenge they face in their work. In fact, this is one of the fundamental requirements L&D nurses should meet because the fast decision is a key toward the delivery of nursing care services of the high quality. The delivery of nursing care in time may be crucial for the life and health of patients of L&D nurses. Therefore, they should pay a lot of attention to the decision making process because often L&D nurses have to take decisions on their own and they do not have time to ask for assistance of other health care professionals. In such a situation, the promptness of L&D nurses’ decision making may be crucial for the health and life of women and newborns.
At the same time, L&D nurses should have good physical stamina and general good health. The work of L&D nurses needs significant physical forces and physical stamina and general good health are essential for them. Otherwise, L&D nurses could not afford physical pressure they are vulnerable to in the course of their work. At this point, specialists (Limentani, 1999) place emphasis on the fact that L&D nurses should always stay focused and concentrated on their work, whatever the time they have been already working. Even if they grow tired, they still have to stay focused on their work because there is no margin for error and L&D nurses are responsible for outcomes of their work. The attention and concentration on the proper performance of L&D nurses comprise an integral part of their training and human resource managers should develop stamina of L&D nurses through stressing the importance of their own health for the provision of health care services to patients.
Furthermore, L&D nurses may face a number of serious problems in the course of their work. This is why many specialists (Ryan and Ray, 2004) insist on the development of problem solving techniques in L&D nurses. It proves beyond a doubt that the development of problem solving techniques is very important because, if L&D nurses face a problem and are panic-stricken, they cannot work effectively and they cannot deliver essential nurse care services to patients. In stark contrast, L&D nurses, who are experienced in problem solving, stay cool even in the most difficult situation. Instead of falling in panic, they start applying a problem solving technique they believe to be the most efficient in the specific situation. On the ground of problem solving techniques, L&D nurses can use their professional knowledge, skills and abilities to work effectively in the most extreme environment.
At the same time, specialists (Limentani, 1999) argue that L&D nurses should come prepared to face conflicts in the course of their work with both colleagues and patients. In this regard, human resource managers should stimulate the development of conflict management to help L&D nurses to prevent the emergence of conflicts and minimize their negative impact on patients and health care professionals, in case conflicts have emerged. In the contemporary health care environment, the conflict management is one of the most important competences of L&D nurses because conflicts affect not only psychological state of patients as well as nurses but also their physical state. In case of L&D nurses and their patients, any significant deterioration of psychological state or physical health may be dangerous for patients.
In addition, many specialists (Miller, et al., 2003) recommend developing counseling strategies in L&D nurses. Counseling is very effective, when L&D nurses deal with patients, who have significant problems with their health. Counseling helps patient to recover in post-operation period as well as in situations, when they have some difficulties and need the assistance of L&D nurses.
At the same time, specialists (Ryan and Ray, 2004) point out that economic implications of L&D nurses’ work are also very important in the contemporary health care environment. In fact, the median annual wage of L&D nurses meets the average wage level of nurses in the US (Limentani, 1999). The following table shows the wage of L&D nurses depending on their certification:
Job
National Hourly Rate Data (?)
$0
$10
$20
$30
Registered Nurse (RN)
$25.64
Certified Nurse Assistant (CNA)
$10.99
Licensed Practical Nurse (LPN)
$16.43
Registered Nurse (RN), Emergency Room
$25.86
Charge Nurse (RN)
$29.12
Licensed Vocational Nurse (LVN)
$17.88
Registered Nurse (RN), Operating Room
$28.82
Country: United States | Currency: USD | Updated: 17 Feb 2011 | Individuals Reporting: 6,542
Source: Skill & Labor: Delivery, Birthing/Hourly Rate. (2011). http://www.payscale.com/research/US/Skill=Labor_%26_Delivery,_Birthing/Hourly_Rate
In such a way, L&D nurses basically meet average standards in the industry. Therefore, human resource managers can hardly count for the high level of motivation of L&D nurses, if they use material motivators solely. Bonuses and increase of wages may be effective but they will not bring positive effects always. In a long-run perspective, other motivators are needed to stimulate L&D nurses to work better.
In such a context, specialists (Miller, et al., 2003) suggest different strategies and solutions human resource managers can use to increase the effectiveness of work with L&D nurses, minimize the risk of conflicts and stimulate the professional development of L&D nurses. First, L&D nurses need to stay motivated, regardless of their experience, skills and abilities they have developed in the course of their professional career. Second, L&D nurses should be confident of their responsibility for outcomes of their work. Human resource managers should inform L&D nurses about consequences of professional negligence from the part of L&D nurses and their legal liability. At the same time, human resource managers should motivate L&D nurses to improve their professional skills and knowledge through participation in training programs. For instance, human resource managers can promote L&D nurses, who are particularly successful in training or who are eager to participate in training programs. In addition, human resource managers can use the knowledge sharing management strategy, which helps to share knowledge within a health care organization using the experience and knowledge of health care professionals working in the organization. For instance, more experienced L&D nurses can share their knowledge with newcomers, whereas physicians can share their knowledge with experienced L&D nurses. In such a way, health care professionals working within the health care organization will share knowledge and develop new skills and abilities. In addition, human resource managers should help L&D nurses to improve communication with patients and to use effective strategies and techniques of problem solving, conflict management and counseling.
Thus, taking into account all above mentioned, it is important to place emphasis on the fact that L&D nurses are responsible for their work and they should provide nursing care services of the high quality because health and life of patients are in their hands. In this regard, the effective human resource management can be an effective tool to improve the quality of nursing care services being delivered by L&D nurses to patients.
Midwifery is said to be a discipline that uses the hands, the mind and the heart. Research this topic and discuss this statement in relation to working with women in childbearing. Use a range of academic literature (books and journal articles) to support your argument. A minimum of 15 references is required from 2008 onwards. Please include in text citation in essay for each statement used and a full reference list at the end. Please ensure that the essay includes reference to code of ethics, professional code of conduct and national competency standards for the midwife
The title of the essay is the “Art, Science and Ethics of Midwifery”. But the question is Midwifery is said to be discipline that uses the hands, the mind and the heart. Research this topic and discuss this statement in relation to working with women in childbearing. Use a range of academic literature to support your argument. A minimum of 15 references is required. Please follow the American Psychological Association 6th edition referencing guidelines. The essay must have in-text citation after every completed sentence.
Useful references Textbooks:
Myles textbook for Midwives 15th edition
Heart and hands – a midwife’s guide to pregnancy and birth Elizabeth Davis 3rd edition
Fundamentals of nursing and midwifery – a person centered approach to care – Dempsey et al
Midwifery preparation for practice 2nd edition – Pairman et al
Professional ethics in midwifery practice – Foster and Lasser
The art and soul of midwifery – Lorna Davies
Articles:
National competency standards for the midwife – Australian college of midwives
Personal and professional values grading among midwifery students – Ozcan, Akpinar & Ergin, 2012
Ethics on the run – Joanne Kinnane
Protecting the perineum: have we been duped by HOOP – Rosemary McCarthy, 2009
Lady’s hands, lion’s heart, a midwife’s sage, 2009
Giving birth – unveiling birth: the wisdom, science and heart, 2008 Deanna Broxton
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Genetics is very important in medicine today, with over 30,000 new diagnoses of genetic disorders being diagnosed in the UK each year, as reported by Genetic disorders UK (2017). The knowledge of genetics today offers the opportunity to modify, delete and insert genes to cure and relieve symptoms of certain genetic conditions. Using vectors, it has been made possible to improve the lives of a lot of people and the possibility to improve more with new techniques such as CRISPR/cas 9. In this essay I’m going to talk about what cystic fibrosis is, how it’s caused, it’s symptoms, the types of gene therapy that are possible and the benefits of these methods and also the ethics and religious viewpoints behind the different gene therapies if they were to be used in the UK now.
Cystic Fibrosis is a genetic condition caused by a faulty gene which a person is born with. However the condition can be diagnosed at any age, most commonly within the first 3 months of being born, from stats by Genetic Disorders Trust (2017). It makes the mucus in the airway thicker which can lead to many complications such as chronic infections caused by mucus blocking the airways. This condition is inherited through a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, which controls the movement of chloride ions between the cell linings of the respiratory tract. It is necessary to prevent mucus from becoming too thick, as chloride controls the movement of water within tissues. Symptoms of cystic fibrosis include persistent coughing, wheezing or shortness of breath, difficulty gaining weight and difficulty with bowel movements. There are quite a few treatments that exist for cystic fibrosis that don’t involve changing genes. Firstly, there is manual chest physiotherapy which allows gravity to move the mucus from the smaller airways to the larger ones. Secondly, the active cycle of breathing technique (ACBT) has 3 phases that help to clear mucus from the lungs through breathing control, chest expansion exercises and coughing or huffing. Finally, a high-frequency chest wall oscillation is a vest that vibrates when it’s inflated, and the vibrations help to loosen the mucus from the airways.
In order for an individual to inherit cystic fibrosis, both parents must be a carrier of the CFTR gene. However, the parents won’t know they are a carrier, this is because normal cystic fibrosis genes will be dominant over the recessive CFTR gene. The child will have a 25% chance of inheriting cystic fibrosis as there is a 1 in 4 chance during genetic crosses that they will inherit two CFTR genes leading to cystic fibrosis. If only one parent is a carrier it is possible for the child to also be a carrier. Genetic testing can determine if individuals are carriers of a faulty gene such as CFTR. Cystic fibrosis carrier testing (CFCT) is a test which can test for cystic fibrosis once the baby has been born. The advantages of this test are that the parents could get some relief if they know they are carriers of this disease and their child does not have a genetic disorder. However, if the baby does have cystic fibrosis, genetic testing could cause anxiety and worry for the patients. Therefore, a good option would be for the parents to undergo genetic counselling. This would mean that they would fully understand the condition and its symptoms. It is also important that the parents understand the treatments available to treat the symptoms and that the genetic condition cannot be prevented.
Gene therapy is a technique used to place normal genes into faulty genes, as Dr. Darryl R. J. Marcer (1990) explains in the book shaping genes “It is like fixing a hole in the bucket, rather than trying to mop up the leaking water”, pg. 272. There are two types of gene therapy that can be used; somatic and germline. Somatic gene therapy treats the tissues of a person with the genetic condition in order to relieve the symptoms e.g. bone marrow cells. This type of gene therapy means that the individual is a carrier for the defective gene and could still pass it onto their children. Somatic gene therapy is successfully being used with genetic conditions today. However, this procedure doesn’t last forever as cells will get replaced, so the process will need to be performed regularly. Germline therapy changes the genes either in sex cells or in the early embryo. This means that the individual will never carry the faulty gene as it’s been replaced and will never experience the condition. This method can also be a lot easier because during in vitro fertilization the cells are more accessible than body cells in order to be changed. Therefore, gene delivery isn’t as much of a problem as it is in somatic gene therapy. However, this form of gene therapy was banned in the UK because of the risks associated with it, the unknown long-term side effects and because of the moral and religious viewpoints people may have towards it.
In order to insert new genes into the target cells vectors are needed such as viruses, plasmids or liposomes. Vectors are molecules used to carry genetic material to the desired place in a new cell in order to alter the genetic material present. Which vector is used depends on the area needed to be treated and whether the treatment is for somatic or germline gene therapy. Six common vectors include the, Adeno-associated Virus, Adenoviral vector, Retroviral vector, Herpes Simplex Virus, Liposomes and Naked DNA. Each virus has a different function and structure. Retrovirus vectors infect only dividing cells and has a max length of inserted RNA 8,000bp whereas the Adeno-associated virus infects both dividing and non-dividing cells and has a max length of inserted DNA 5,00bp. The vector responsible for altering the CFTR gene in somatic gene therapy most commonly has been the Adenoviral vector as it targets cells in the airway epithelium and targets both dividing and non-dividing cells. However, this method isn’t the most effective as the defensive system can prevent the virus entering the cells. A new method that’s been developed is the CRISPR/Cas 9 which is the simplest and most precise way to edit DNA currently. This is because the cas 9 enzyme acts as a pair of ‘molecular scissors’ which cuts the DNA at the right location nearly 100% of the time. Therefore, meaning that CRIPR enzyme can correct the faulty gene rather than having to add more genes in or take the faulty gene out.
Cystic fibrosis could be chosen as a focus for germline gene therapy because the gene that causes it is known rather than just the target tissue and also because this gene is only a single-gene hereditary disorder. Therefore, germ-line gene therapy could eliminate/repair the faulty CFTR gene. So, cystic fibrosis wouldn’t be present in the individual anymore. There has been research carried out in 2013 by cell stem cell. This research used cultured intestinal stem cells from patients with cystic fibrosis and then introduced the Crispr gene to these cells, which then replaced the faulty CFTR gene by homologous recombination (which exchanges nucleotide sequences between similar DNA). Although this is an example of somatic gene therapy it proves that Crispr could also work for germline gene therapy. Research from the 2017 registry annual data report for cystic fibrosis revealed that the average person with cystic fibrosis will live till the age of 31. This is very young compared to the average life expectancy stated by the office for national statistics in the UK which in 2017 was 79.2 years for males and 82.9 years for females. So therefore, if cystic fibrosis was considered for germline gene therapy this condition could be completely avoided and the individuals affected could live longer and would never experience the symptoms.
When considering whether germ line gene therapy should be allowed in the UK it is important to remember the different moral and religious viewpoints that some people may have. A survey conducted by the welcome trust in 2005 said 92% agreed with somatic gene therapy, 80% agreed with germ-line gene therapy. According to this survey a lot more people agreed that somatic gene therapy should be allowed because at this point it would be the individual’s decision to carry out the gene therapy and they would know the risks and also because it could make the individual live a better quality of life. However, germline is more controversial because the individual would not have a say in the therapy it would be up to scientists and the parents. On one hand some people might think that morally that germ-line gene therapy should not be allowed at all such as Robert Sparrow from the pharmaceutical journal (2015) said “There is too much at stake. Just because we have the capability to perform enhancement it does not mean we should proceed” he explained that because of the effects that could occur when carrying out germ line gene therapy and its unknown long-term effects which isn’t fair to put a child through. He also mentioned that with the capability to change genes how far it would go leading to what some people would call ‘designer babies’ for example making a child stronger and how fair this would go in the future. He also mentioned how fair it would be as not everyone could afford this type of gene therapy. On the other hand, some people might think that morally germ-line gene therapy should be allowed in certain cases such as Glenn Cohen also from the pharmaceutical journey (2015) says “Do not block a technology that could benefit people. Genetic enhancement should be looked at on a case-by case basis – a blanket ban on the technology will do us no favors” who explains that there is a difference between treatment and enhancement. Treatment to correct a genetic condition should be allowed because this allows a person to have what every other person has, such as a normal working pair of lungs. Compared to enhancement which gives someone something above everyone else which isn’t natural e.g. extra ability for strength. He believes this could then eventually lead to a competition by simply not having genetic enhancements would lead for an individual to fall behind which is morally wrong. Peoples moral view points on gene therapy, as explained by the BBC, can also be influenced by religious viewpoints that they are taught. Such as Christians who believe somatic cell therapy is right because stewardship would mean that if it’s effective against a lot of genetic conditions so should be done in order to help others but should be careful that we are not trying to play God. The views on Germ line gene therapy are that the embryo doesn’t have full human status till 14 days old so it’s right to carry it out, so the individual won’t suffer later on in life. But they also believe it’s wrong because it would be expensive and therefore it’s not right for only the wealthy to potentially benefit from this type of treatment as this isn’t justice
To conclude, I believe that germ-line gene therapy could be the way forward for treating this condition in our society today and in the future. I believe this because as good as Somatic gene therapy is becoming in relieving symptoms, this has to be repeated often and so would cost a lot of money and females could still pass this onto their child while men would be infertile. The benefits of germ-line gene therapy means that individuals who have inherited this condition would never have to know the symptoms meaning they could have a higher quality of life and would also increase their life expectancy a lot. But, if this form of gene therapy was to be allowed I believe it should be monitored very closely to ensure what Robert Sparrow said about ‘designer babies’ not coming true and to ensure that this treatment is not done for enhancement purposes like Glenn Cohen said. If this was the case and germ-line gene therapy became legal I think it should first be done on a smaller scale first so that long-term side effects could be monitored and then offered to everyone so it’s fair to all potential individuals and not done based on wealth. This would also deter from the idea of ‘designer babies’ as cases would be looked at carefully and could lead to a bright future where cystic fibrosis and other genetic conditions could be prevented.
References
Essay on the theme of stigma in the movie Philadelphia
Philadelphia (1993) was an American motion picture released in 1993 which was directed by Jonathan Demme. The movie provides the backdrop to the HIV/AIDS crisis in the United states of America (USA) circa 1993. Movie opens with a competent and promising attorney Andrew Beckett, who gets terminated by his employer under a pretence of ‘work related incompetency’, which Andrew considers as a wrongful one and considers the termination to be a result of the homophobic and stigmatising mentality of the law firm’s board. This essay examines the stigma associated with sexual orientation and health conditions such as HIV, which has afflicted the protagonist of the movie. While examining the thematic contents and the protagonist’s introspective narratives in the movie, it will be parallelly examined through the lens of the sociological theories like Erving Goffman’s theory of stigma (1963); review of Goffman’s theory by Carnevale (2007) and several other qualitative studies.
There have been some changes in the public’s attitudes towards people living with HIV/AIDS (PLHA) when compared to early 1990s. In early years of the HIV/AIDS epidemic in Australia; the social conservative and religious fundamentalists demonised the gay cohort by accusing that illicit drugs use, and sexual nonconformity led to the emergence of the HIV epidemic (Robinson & Gelden 2014). In a qualitative study done by Robinson and Gelden (2014) among two generations of 56 gay men in Australian, three themes emerged; such as self-regard, sexual self, and self and others. With regard to one of the themes “self and others” and its relevance to the character, Andrew Beckett, who was wrongfully terminated and was determined to fight against the injustice and while doing so, he got support from his partner, his other homosexual friends and most importantly his family; which created a “protective capsule” for him. Goffman (1963) argues that families can create such protective capsule in home, where a child can feel that they are no-less than a normal family member. Participants of the Robinson and Gelden’s (2014) qualitative study mentions that, they found support from the members of the gay society and liberal community amidst the HIV/AIDS epidemic; which they believed invigorated the gay communities.
The protagonist, Andrew Beckett is a homosexual male, but he has closeted himself from this identity and does not want its shadow to cast over his professional life, until a board member notices a lesion (a Kaposi Sarcoma, KS- lesion) on his forehead, which is a visible symptom which appears as the HIV progresses. In the analysis of a qualitative studies related to HIV/AIDS and stigma by Chambers et al., (2015), they have identified
visible health
as one of the dimensions of HIV related stigma, where the visible symptoms of HIV seropositivity is seen among the survivors. According to the qualitative study by Brener, Callander, Slavin & de Wit (2013); they conclude that having visible symptoms, often appears to make PLHA more vulnerable to perceiving stigma and evoking the feeling of shame, rejection, awkwardness and blame. Theoretically, Goffman (1963) uses the term
‘discreditable’ and ‘discredited’
to define these attributes, according to him, discreditable are those person who possess a stigmatising characteristics; but had not yet been discredited because such discrediting attributes has not yet been revealed, however, to Andrew, KS lesion in his forehead made him vulnerable and exposed, as he could be discredited due to a visible symptoms of the illness and discreditation could mean getting marginalised and socially judged by his surrounding world.
In another qualitative study of Social meaning of HIV/AIDS by Judgeo & Moalusi (2014); one of the theme was
‘to tell or not to tell’
, where his participants were shrouded with dilemma on whether to reveal or conceal their HIV status as there could be an ominous implication and repercussions arising from two serious issues, first, it would be about managing the information about one’s own failing and the second would be on managing the tension when making social contacts. Their findings showed that the coping mechanism used by some ‘discreditable’ individuals included non-disclosure; while those who are discredited asserted that they have a fundamental right to be treated with human dignity and respect as any other individual. When Andrew’s illness is revealed and gets terminated; he comes to a conclusion that he was terminated under a false pretence and thus files a law suit to remedy it, this was his way of asserting that he has a fundamental right to be treated with respect and dignity like any other colleague.
Since the beginning of HIV/AIDS epidemic; gay people with/without HIV/AIDS were cornered and stigmatised. Initially termed as acquired immunodeficiency disease, it soon was colloquially termed as Gay related immunodeficiency disease (GRID) (Altman, 1982), even though many other affected were heterosexual people. Susan Sontag (1978) in her seminal book ‘Illness as Metaphor’ writes that giving meaning to a disease is punitive, a measure which is unparalleled to anything. Similar social backlash was evoked against the PLHA (especially homosexuals), who were already a minority and a vulnerable group and tagging them with HIV/AIDS, further alienated them. To protect oneself and one’s ego from such punitive and scrutinising measures concocted by the society, the ‘discreditable’ individual/s often resorts to a self-protecting tactics, which Goffman terms as
“Passing”
, he argues that person who has stigmatic quality controls the information or even manipulates them, so that they can fully or partly ‘pass’ as a normal individual, as being normal is often rewarding, while doing this, they often resort to living a double life. Andrew does the same, when Walter inquiries about the lesion in his forehead, Andrew immediately lies and says that he was ‘whacked in the head by a racket ball’; Andrew takes help of his friend to mask his lesions with different cosmetic foundations and his friends also happened to be sexual minorities. Andrew’s public life is portrayed as a meticulous, successful lawyer who recently got promoted as a senior associate, he is trusted by his bosses and these bosses represents the cultural elite of the USA, educated, white and heterosexual, but Andrew finds sanctuary and support amongst his friends as they share the same stigma and according to Goffman (1963), these close and trusted circle can provide instruction on ‘tricks of the trade’ as being a discredited/
discreditable
person themselves; they can help in finding a way to navigate through the society; this circle of trust is a only social sphere where they can feel ‘normal’; or friends with whom to commiserate. Andrew also adapts using some
‘disidentifiers’,
for example, he smiles at the sexist and homophobic remarks/jokes made by Charles at the spa. According to Goffman (1963); obtrusiveness of the stigmatic qualities is often reduced by using these ‘
disidentifiers
’. In a qualitative study by Daftary (2012); among people living with both HIV/AIDS and Tuberculosis (TB), he found that PLHA-TB resorted to “passing” to hide their HIV/AIDS symptoms by aligning themselves to the more socially acceptable TB only identity; while dissociating themselves from the much more stigmatised PLHA status; this strategy can also be viewed as the use of ‘disidentifiers’.
After refusal by 9 different lawyers to represent his case in the court; Andrew visits Joe Miller, who is a homophobic and is initially anxious of contracting HIV. Miller refuses to represent him saying that he does not have a strong case. The same evening, he expresses his homophobic intents and thoughts to his wife. Miller later accepts to represent Andrew’s case; when he sees him being discriminated by the librarian. Though Andrew doesn’t experience stigma from Miller after he starts working in his case, but many people under similar circumstances do. Goffman (1963) calls this a
courtesy stigma
,
now popularly known as ‘stigma of association’ (Ostman & Kjellin, 2002; Reeder & Pryor, 2008) where a person do not have stigmatising attributes themselves, but are associated with the people who have such attributes and might feel that their association with stigmatised person might bring shame on to them. A qualitative study involving nursing students (n=20) in an Australian Institution by Pickles, King and de Lacey (2017) identified three major themes which emerged from their study such as
othering, blame and values
, not majority but substantial participants (n=6) had a perception of PLHA as promiscuous, homosexual and a ‘bad person’ and these negative attitudes were thought to be underscored by their cultural belief and construction of othering where someone is perceived as having different attributes and is liable to socially ostracise them and blaming them for bringing the ‘disease on themselves’.
Pryor and Reeder (2011) mentions institutional stigma as one of the manifestations of stigma. Institution relates to the Government agencies or other organisation which has its own /rules/regulations. Often these institutions enforce laws which could put a group or division of people into a disadvantaged situation. In the movie; the law firm is an institution, whose board terminated Andrew under a false pretence, with the covert reason being his sexual orientation and their knowledge of his HIV/AIDS status. Eight themes emerged from the qualitative study conducted by Nadal et al., (2011) in USA among sexual minority youths. One of the themes that emerged was, endorsing of heteronormative behaviour and culture in the workplace; participants reported that they were expected to act as heterosexuals and were often not treated positively in the workplace, public circles, family gatherings and experienced lot of subtle aggression or microagression. This study was done almost 18 years after the release of Philadelphia, but still; many forms of stigma exists in the workplace and society for the sexual minorities. In another qualitative study by Grossman et al., (2009) done among LGHBT youths in their school; they also came up with several themes, the most important being, the
absence of goodness of fit
between them and the school; the school as an institution helped very rarely to cater their needs and address the issues like homophobia, heterosexism, transphobia and biphobia which according to them were rampant in both the society they lived in and in school, which were supposed to be a sanctuary and a place for learning to them.
Characteristics of the protagonist:
Andrew was very ambitious; meticulous and career-oriented lawyer; he was very focused on winning the case for the Charles Wheeler law firm; but when he got terminated under false pretences; he got determined to sue them for the wrongdoing, but he did not sit back; giving up his life and watching the un-justice being done. As discussed earlier; he had a supportive family; Andrew’s mother once says
“I didn’t raise my kids to sit in the back of bus”
; we can presume that he grew up in a family where he grew normally and without any prejudice; as opposed to the young participants from the Grossman et al., (2009) study. We can also presume that Andrew had a secure attachment with his care giver/s. According to Bosmans and Kerns (2015) when a child is securely attached; they can use the relationship with their caregiver as a secure base and safe haven at the times of distress. The child develops the cognitive pattern of the primary caregiver as loving and nurturing and views oneself as worthy of love. Despite all the adversities and stigma in Andrew’s life, he was resilient to it and determined to fight against the injustice done to him by the institution. He never took himself to be any different and/or less capable than the normal heterosexual people. When nine other attorneys and Joe Miller refused to represent his case in the court; he went to the library to refer to the legal treatise, so as to prepare to represent himself, doing which would require a deep credence in oneself.
Conclusion:
Stigma has different types and is manifested differently in different epoch of times. Nurses have a unique role to play in medical and community settings to identify and put an end to all types of stigma and microaggression against the people who are of gender/ethnic minorities and those who have illnesses or attributes for which they are stigmatised.
References
The American Nurses Association defines nursing as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (American Nurses Association, 2013, p. 1).
Robert-John Santos
Over the past few years, I have noticed a culture change in terms of being healthy. It is represented in social media and public platforms of how more and more people are focused on taking care of their bodies by participating in physical activity. Examples of this are people posting pictures of themselves at the gym or what they are doing to keep their body healthy. But despite this entire obsession of taking care of our bodies, are people actually doing the right things to stay physically fit? Besides the fad of exercising and workout techniques, there are other factors to being healthy. One important factor is proper dietary consumption. What people eat has a huge impact on their body both short and long term. With the current trend of being a fitness buff, people are not aware of the importance of proper dietary intake before and after a workout. Many people make the mistake that what they eat before, during, and after exercise is important when they should actually be paying attention to the amount their body needs. In addition, it is common for these people to be confused about what they should consume to enhance performance and fitness to reach body weight goals. The main issue is that a lot of people that exercise are not meeting the dietary requirements and recommendations that their body must have in order to live a healthy lifestyle.
No matter the intensity of the exercise or the duration, proper nutrition is still an overlooked by many people who exercise regularly. For example, in the article “Acute effects of exercise on energy intake and feeding behavior” by Pascal Imbeault, Sylvie Saint-Pierre, Natalie Almeras, and Angelo Tremblay, they hypothesized that short-term high-intensity exercise causes a suppressing effect on the amount that someone would consume compared to low-intensity exercise. The result of the study was that energy intake was lower after high-intensity than low-intensity. Based on the result of the study, this could promote significant negative energy balance, which is not healthy long term (Imbeault, 1997). In order to address this issue, people who exercise regularly need to be educated on the importance of following specific dietary recommendations.
A number of solutions could be implemented such as some type of treatment or a change in how health is being advertised and how it is very important to eat healthy. According to the article “Fueling for fitness: Food and fluid recommendations for before, during and after exercise” by Nanna L. Meyer, Melinda M. Manore, and Jacqueline Berning, the community of people who participate in exercising regularly need to consider visiting health professionals who specialize in the field of nutrition; specifically a sports dietitian or certified specialist in dietetics. These exercise enthusiasts need to realize that even though they believe that can take care of themselves, it does not hurt to get input from people who spent their lives studying the subject of nutrition. In addition to seeking advice from health professionals, another solution could be provided from local sport clubs and commercial gyms by aggressively promoting a meal plan that their gym members can follow in order to sustain health.
As mentioned before, one of the first steps that can be made to solve this problem is to seek advice from a sports dietitian or a certified specialist in sports dietetics (Meyer et al., 2012). This first step is important because both of these health professionals can offer specific recommendations to their client’s nutrient and energy needs, fitness goals, and weight sustainability. For example, from the article “Nutrition and athletic performance” by Nancy R. Rodriguez, Nancy M. DiMarco, and Susie Langley, these registered dietitians make recommendations of what people should be eating before, during, and after exercise. Before exercise, they recommend some sort of snack or meal that would: help to maintain hydration, be low in fat and high in carbohydrates to maximize maintenance of blood glucose, and not contain too much protein (Rodriguez et al., 2010). During exercise, it is suggested that people should aim to replace lost fluid and to provide carbohydrates to sustain blood glucose levels (Rodriguez et al., 2010). After exercise, a person’s meal should consist of sufficient fluids, electrolytes, carbohydrates to guarantee recovery, and protein to repair muscle tissue (Rodriguez et al., 2010). In addition to dietary goals after exercise, carbohydrates in particular, people need to have a carbohydrate intake during the first 30 minutes after working out and again every two hours for about four to six hours to replace glycogen stores (Rodriguez et al., 2010). Other examples of dietary recommendations are mentioned in the article “You Asked: Should I Eat Before or After a Workout” by Markham Heid. He reports the importance of nutrition before and after a workout. To find the answer to this question, Heid asked the head of the department of nutrition at the University of Massachusetts, Dr. Nancy Cohen, and she mentions that dietary intake is the same for a majority of people who exercise. Dr. Cohen then adds on by saying that ‘“you’ll want to eat a meal high in carbs and protein and low in fat roughly three to four hours before you exercise; whether you’re trying to shed pounds or build muscle’” (Heid, 2014). Heid later describes that people who are looking to lose weight should avoid eating a meal with too many carbohydrates prior to exercising and should consume foods such as whole grains, beans, and fiber known as complex carbohydrates. Dr. Cohen later explains the importance of eating protein, during and after exercise, that has the amino acids that would replace the muscle cells that have been broken down from the workout (Heid, 2014). Lastly, for those who want to build muscle, Dr. Cohen recommends a diet with even more protein an hour or two as a post-workout meal. Furthermore, one of the factors that would interfere with proper dietary intake of an individual is not being properly educated. For example, many people associate fast food as unhealthy and bad for human health; but those people are unaware that fast food can actually be an option as a post workout meal. In the article “Post-exercise Glycogen Recovery and Exercise Performance is Not Significantly Different Between Fast Food and Sport Supplements” by Michael J. Cramer, Charles L. Dumke, Walter S. Hailes, John S. Cuddy, and Brent C. Ruby, these authors address the idea of eating fast food after exercising. Cramer et al. (2015) reports that studies have shown that fast food can actually be as effective typical post-workout meals such as protein shakes, supplements, or energy bars. He and his colleagues had 11 male athletes to participate in their experiment. For this study, the researchers had the participants to fast for four hours and then asked the athletes to exercise on a treadmill for about 90 minutes (Cramer et al., 2015). After the workout, half of the athletes were given typical post-workout meals such as Gatorade, chewable energy cubes, organic peanut butter and power bars while the other half were given food known to be provided by fast food restaurants such as Coke, fries, hamburgers, hashbrowns, and hotcakes (Cramer et al., 2015). About two hours later, the athletes had to ride on a stationary bike for 12.4 miles as quickly as possible. The athletes then repeated the experiment on the opposite diet a week after (Cramer et al., 2015). When the experiment was over, the results showed that glycogen blood levels were higher after eating fast food in comparison to eating healthy food and the athletes claimed that they did not feel any different after the experiment (Cramer et al., 2015). In general, the study does not encourage people to eat more fast food after a workout, but it is not bad to eat it once in a while.
Another solution for regular exercisers would be to follow some sort of meal plan that would list dietary recommendations that could be adopted by any lifestyle which would be provided by the sport dietitians, certified specialists in dietetics, and the commercial gyms that people would utilzing. For example, in the article “Rebuilding the pyramid: The government’s new food pyramid replaces “one size fits all” with a customizable eating and exercise plan,” it mentions the food pyramid that was introduced in 1992, which gives dietary advice for all ages and lifestyles. This food pyramid was later called “MyPyramid” in 2005 and a few changes to the original such as customizable to certain ages, gender, and activity level (“Rebuilding the,” 2005). In addition to what people should be eating, the meal plan would also list the benefits of certain foods so that they can be properly educated in dealing with nutrition and its relationship to health. This idea is presented in the article “Principles and issues in translating dietary recommendations to food selection: A nutrition educator’s point of view” by Helen A. Guthrie. In this article, Guthrie explains the importance of proper nutrition and that society should not overlook the significance of it. She describes that before they figure out whether or not they should change their dietary habits, people need to be educated on what dietary practices would be appropriate for their lifestyle (Guthrie, 1987).
Although some people are not meeting their proper dietary needs before, during, and after exercising, there are still some positives to this issue. One positive is that people are close to meeting the dietary intake that their body needs. In the article “Dietitian-Observed Macronutrient Intakes of Young Skill and Team-Sport Athletes: Adequacy of Pre, During, and Postexercise Nutrition” by Lindsay B. Baker, Lisa E. Heaton, Ryan P. Nuccio, and Kimberly W. Stein, the study focuses on proper nutrition practices and the amount of macronutrients that young athletes should incorporate into their diet. Participants consisted of about 22 males and 7 females ranging from ages of 14 to 19 years old. These participants were observed for a 24 hour period by registered dietitians at a sports training facility and the athletes were asked to report their dietary intake and their participation in team sports throughout the whole day. According to sports nutrition experts, athletes who participate in high- intensity exercise for about one hour should consume about one to four carbohydrates per kilogram before exercising, about 30 to 60 grams of carbohydrates per hour during exercise, and about one gram of carbohydrates per kilogram and hour and 20 to 25 grams of protein right after their workout is over (Baker et al., 2014). In terms of the results, the researchers found that before exercising, about 73% of the male participants and 57% of the female participants met the recommended amount of carbohydrates per kilogram. During exercise, 18% of the male participants and 29% of the female participants met the recommendations of carbohydrates per hour. After exercising, about 68% of carbohydrates per kilogram and 73% of protein for the males met the recommendations; while for the females, only 43% met the recommendations for both carbohydrates and protein about an hour after exercising (Baker et al., 2014). Although the carbohydrate and protein intake of the male athletes compared to the female athletes were somewhat closer to the recommendations, it is still a concern that they fell short of the optimal amount of carbohydrates recommended in order to fully thrive in overall health; but this can be considered as only a minor setback. In order to measure success, similar to this study, percentages would be recorded to see if progress has been made towards reaching dietary recommendations.
The solution mentioned before will be helpful to the community of people who participate in exercising regularly, sports dietitians, certified specialists in dietetics, and commercial gyms. All of these stakeholders have common goals: to ensure optimal health and to promote a healthy lifestyle. This issue is important to the sports dietitians and certified specialists because their job is to make sure that their patients are living a healthy lifestyle. As for the people who exercise regularly, this issue is important because it is about them and they care about being in good physical shape. Commercial gyms benefit from this solution because they would be providing these dietary meal plans that people should be following and this would be emphasizing the importance of overall health. The benefits are greater than the costs because people simply being advised to visit health professionals and directed to follow dietary recommendations that would allow them the regular exercisers to reach optimal health.
Baker, L., Heaton, L., Nuccio, R., & Stein, K. (2014, January 1). Dietitian-Observed
Macronutrient Intakes of Young Skill and Team-Sport Athletes: Adequacy of Pre,
During, and Postexercise Nutrition. Retrieved April 27, 2015, from
http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=8f10b519-c3f6-4143-a61c-
a3a67ed3edee@sessionmgr4004&vid=14&hid=4106
Cramer, M., Dumke, C., Hailes, W., Cuddy, J., & Ruby, B. (2015, February 5). Post-exercise
Glycogen Recovery and Exercise Performance is Not Significantly Different Between
Fast Food and Sport Supplements. Retrieved April 27, 2015, from
http://journals.humankinetics.com/AcuCustom/Sitename/Documents/DocumentItem/Hail
es_ijsnem_2014-0230-in press.pdf
Guthrie, H. (1987). Principles and issues in translating dietary recommendations to food
selection: A nutrition educator’s point of view”. Retrieved May 8, 2015, from
http://ajcn.nutrition.org.libaccess.sjlibrary.org/content/45/5/1394.full.pdf
html
Heid, M. (2014, September 17). You Asked: Should I Eat Before or After a Workout? Retrieved
April 10, 2015, from
http://time.com/3387314/eat-before-or-after-workout/
Imbeault, P., Saint-Pierre, S., Almeras, N., & Tremblay, A. (1997). Acute effects of exercise on
energy intake and feeding behaviour. Retrieved May 8, 2015, from
http://journals.cambridge.org/download.php?file=/BJN/BJN77_04/S0007114597002109a.pdf&code=3c99ec6281ea343391f4e05f6aebbcf2
Meyer, N., Manore, M., & Berning, J. (2012, May 1). Fueling For Fitness: Food and Fluid
Recommendations for Before, During, and After Exercise. Retrieved May 8, 2015, from
http://web.b.ebscohost.com.libaccess.sjlibrary.org/ehost/detail/detail?sid=045b390b-eff9-470f-99c5
913b07ae220e@sessionmgr115&vid=0&hid=107&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ==#db=ccm&AN=2011588793
Introduction
Healthcare has always been a crucial business that offers care based on value to many people all over the world. This industry is growing very fast and has turned into a prime revenue earner for several countries. In the United States, the revenue from healthcare is approximately $1,668 trillion. The United States spends more on healthcare than most other countries in the world. Value, Outcome, and Quality are three keywords that are always linked to healthcare, these are promises that most specialists and stakeholders in the healthcare industry are looking to live up to.
With the rise of more and more applications using machine learning in the healthcare field, we are able to see a future where innovation and data analysis work together. We can expect the future healthcare systems all over the world to be a combination of Machine Learning based application with real-time data. This could increase the effectiveness of treatment options which are not available today. One of the most commonly used Machine Learning applications in the healthcare field is to identify and diagnose diseases that are hard to discover otherwise. This includes diseases such as cancer, which are difficult to identify in their initial stage.
Major Section
Mrunmayi Patil, Vivian Brian Lobo, Pranav Puranik, Aditi Pawaskar, Adarsh Pai et al (2018) have used support vector machine to understand and predict lifestyle diseases that an individual might be susceptible to. The have simulated an economic machine learning model as an alternative to deoxyribonucleic acid testing that analyzes an individual’s lifestyle to identify possible threats that form the foundation of diagnostic tests and disease prevention, which may arise due to unhealthy diets and excessive energy intake, physical dormancy, etc. After research, they found that if a parent has a particular disorder, it does not necessarily mean that a child would develop the same. However, there could be a possibility of high risk of developing the disorder (i.e., genetic susceptibility), and for such a possibility where it cannot be a sure occurrence, but risk prevails
Naresh Khuriwal and Nidhi Mishra (2018) have used adaptive ensemble voting method for diagnosed breast cancer. They have used Logistic Regression and Neural Networks to analyze their data. After conducting multiple experiments, the authors found that the artificial neural network approach with logistic algorithm achieved 98.50% accuracy, much higher compared to the other machine learning algorithms (Khuriwal, 2018).
This research closely related to a study conducted by Madhuri Gupta and Bharat Gupta (2018) aims to present machine learning techniques in cancer disease by applying learning algorithms on breast cancer. They have made the use of Linear regression, Random Forest, Multi-layer Perceptron and Decision Tree algorithms to analyze the data. After conducting the experiment, the authors found that performance in terms of accuracy, MLP is better as compared to other techniques. MLP technique also performs better than other techniques when Cross Validation metrics is used in breast cancer prediction
One major similarity between the two above papers is that they have only considered Wisconsin data. Had the authors picked up data which was not centralized to one specific location the results may vary. The results may even show a completely different picture if dataset were from other parts of the world. Data could be gathered globally and compared with the results to see if this is only a local issue or it has the same effect worldwide, this could be an angle to analyze for future enhancements. However, one major difference between the two studies is that in the first study the authors used only logistic regression and neural networks, whereas the authors of the second article have evaluated many more techniques.
Another study performed by Moh’d Rasoul Al-Hadidi, Abdulsalam Alarabeyyat, and Mohannad Alhanahnah (2016) proposed a method if the patient had to detect the breast cancer or not with high accuracy. The method used consisted of two main parts. The first part made use of the image processing techniques to prepare the mammography images for pattern and feature extraction. The extracted features are utilized as an input for a two types of supervised learning models. The algorithms used were Logistic Regression and Backpropagation Neural Network. After research, they obtained a good regression value using Backpropagation Neural Network that exceeded 93% with only 240 features (Al-Hadidi, 2016).
This research closely related to a study conducted by and Bita Shadgar (2010). They make use of support vector machines, K-nearest neighbors and probabilistic neural networks classifiers are combined with signal-to-noise ratio feature ranking, sequential forward selection-based feature selection and principal component analysis. This information is then taken to carry out feature extraction to distinguish between malignant and benign and tumors. The authors were able to achieve 98.80% and 96.33% respectively using support vector machines classifier models against two widely used breast cancer benchmark datasets (Osareh, 2010).
Yet another study on breast cancer was conducted by Arjun P. Athreya, Alan J. Gaglio, Junmei Cairns, Krishna R. Kalari, Richard M. Weinshilboum et al. (2018). They try to identify a few genes among the 23,398 genes of the human genome to establish new drug mechanisms. The authors have used different types of clustering techniques to identify the results, Hierarchical Clustering and K-Means Clustering. Based on their analysis they concluded that methods can augment the drug and disease knowledge of pharmacogenomics experts by identifying biomarkers of novel drug actions. On limitation to this experiment is that the authors have only used 2 types of clustering techniques. They could enhance their work by also implementing more clustering techniques, such as, GMM, Mean-Shift clustering and DBSCAN to see if they obtain similar results.
Another study conducted on lung cancer by Wasudeo Rahane, Himali Dalvi, Yamini Magar, Anjali Kalane, and Satyajeet Jondhale (2018). They explore efficient methods to detect lung cancer and its stages successfully. The techniques applied are Support Vector Machine and Image Processing. After analyzing the data, the authors were able to conclude that Support Vector Machine classifier, classifies the positive and negative samples of lung cancer images in the system.
Another article on lung cancer by Qing Wu and Wenbing Zhao (2017) uses a neural-network based algorithm to detect small cell lung cancer from computed tomography images. For the training set they have used CT images of ten patients, five of which have been diagnosed with small cell lung cancer and five others without it. After training the model and analyzing it, they were able to makes 10 false positive predictions and missed 6 cases when the patients actually have small cell lung cancer detection.
Though both of the above articles have conducted studies on lung cancer, the first article uses support vector machine and image processing to identify if the images are positive or negative for lung cancer. Whereas, in the second article the authors have used neural networks to do the same and have used a much larger data set.
Sangman Kim, Seungpyo Jung, Youngju Park, Jihoon Lee, and Jusung Park (2018) conducted a study to find useful markers from sensor arrays which have massive sensing points and diagnose liver cancer. The techniques they applied in their research was Neural Network and Fuzzy Neural Network. After the research was completed, they were able to detect liver cancer with the accuracy of 99.19 % by average use of 132 aptamers based on neural network and 98.19 % by average use of 226 aptamers based on fuzzy neural network (Kim, 2018). Though the accuracy achieved is very high they authors could have also used convolutional neural network to check the accuracy of their research as another comparison algorithm.
Lastly, Joseph M. De Guia, Madhavi Devaraj, and Larry A. Vea (2018), present the existing technology of microarray gene expression and classify the cancer genes using machine learning algorithms. The algorithms that they have using for this presentation are Gradient Boost and Support Vector Machine. After conducting the study, the authors for that the performance accuracy for Support Vector Machine was 58% and for Gradient was 64% (Guia, 2018). This is a very low accuracy level. The authors could try to implement other types of algorithms such as, Decision Tree and Random Forest to see if the accuracy would increase.
Conclusion
Analyzing the different types of diseases and then trying to diagnose them using machine learning is a complex task. However, using ingenious machine learning algorithms as well as medical knowledge and methods, it has been possible to identify and diagnose certain types of diseases.
Past research shows the use and results of various methods and experiments using various data sets and algorithm. For the purpose and scope of my research, I propose to mingle the methods used by other experts according to my needs and attempt to build an application that will identify and diagnose diseases in healthcare. Fuzzy Neural Network and Backpropagation Neural Network seem to be the most proficient for the purposes of this study.
A. Discuss health information data measurement by doing the following:
1. Explain the differences between discrete and continuous data in health information research.
2. Provide one example from healthcare of each of the following scales of measurement:
• nominal
• ordinal
• interval
• ratio
B. Using the scenario, provide the following information by utilizing statistical formulas from the “Task 1 Formulas” attachment:
1. Calculate the average length of stay (LOS) of discharged patients for the months of May and June.
2. Calculate the death rate of patients discharged for the months of May and June.
3. Calculate the average daily inpatient census report for the hospital for the months of May and June.
4. Create a chart or graph showing your findings.
C. Using the attached “Felder LOS Data,” perform a regression analysis on 20 patients with an average length of stay (LOS) of four days and average charges above $27,000. Submit the “Regression Analysis Calculations” spreadsheet as an attachment to your submission.
Note: The Regression Analysis function is found in the Data Analysis Toolpak. The Analysis ToolPak includes the tools described in the following sections. To access these tools, click Data Analysis in the Analysis group on the Data tab. If the Data Analysis command is not available, you need to load the Analysis ToolPak add-in program.
D. Explain how Felder Community Hospital could use the statistical data calculated in parts B and C to improve healthcare delivery.
E. Using the American Health Information Management Association (AHIMA) code of ethics, do the following:
1. Describe how the code of ethics relates to HIM professional conduct.
2. Explain how principles from the AHIMA Code of Ethics regarding collection and reporting of HIM data should be applied to the scenario.
3. Discuss how HIPAA regulations should be applied to the research performed in the scenario.
F. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.
G. Demonstrate professional communication in the content and presentation of your submission.
Let’s have a debate!!! Is nursing theory important to the nursing profession? If you believe that it is important, explain why it is useful. If you do not believe that it is useful, explain why nursing theory is not necessary to the profession? Be sure to provide an example that demonstrates your opinion and a scholarly reference (not using the required textbook or lesson) which supports your opinion.
The diversity movement suggests that there is strength in our differences and that our differences enhance each other. At the same time, the movement insists that our differences should not have economic, social, or political consequences. We are entitled to the same access to resources and opportunities regardless of our differences. The human suffering from Hurricane Katrina and the images of victims has stimulated the debate about differential access to resources.
Read the report Women in the Wake of the Storm: Examining the Post-Katrina Realities of the Women of New Orleans and the Gulf Coast. On the basis of your reading, create a report, answering the following:
• Discuss the prominent dimensions of diversity revealed as a result of the Hurricane Katrina disaster.
• Discuss factors that specifically influenced women’s vulnerability to Hurricane Katrina. While answering, consider the primary dimensions mentioned in the lectures as well as the secondary dimensions such as parental and marital status, income, educational level, military experience, geographic location, work background, and religious beliefs.
• Describe the implications for healthcare organizations as a result of the disaster.
• Discuss at least of two of the policy implications that are outlined in the report. If you were given the task to add another policy recommendation what would it be and why?
Medical Indications: The Principles of Beneficence and Nonmaleficence
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of various treatment options?
5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Patient Preferences: The Principle of Respect for Autonomy
1. Has the patient been informed of benefits and risks, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
6. What are plans and rationale to forgo life-sustaining treatment?
7. What is the legal and ethical status of suicide?
Contextual Features: The Principles of Justice and Fairness
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
6. Are there religious issues that might influence clinical decisions?
7. What are the legal issues that might affect clinical decisions?
8. Are there considerations of clinical research and education that might affect clinical decisions?
9. Are there issues of public health and safety that affect clinical decisions?
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?
