Health care in the Amish culture

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The religious and cultural beliefs of the Amish culture have led to variations in health care practices that are different from main stream American culture. The Amish have a health care belief system that includes traditional remedies passed from one generation to the next. Amish families are without health insurance and though concerned about paying medical expenses, most of the time the extended family, friends, and the church help pay for the expenses. For example if a female infant of the Amish family is in the hospital for an extended period of time the biological and extended family visit frequently and bring in their own food in bags. The grandmother and neighbors would gather the children in the hospital waiting room to feed and entertain them while the mother would visit her baby daughter in the neonatal care unit. The father would most likely visit on weekends. The family would speak Pennsylvania Dutch among themselves but use English in speaking with the health care providers. The children in the family are dressed like undersized replicas of their parents. They are in distinctive clothing that is subdued and devoid of any designs of flowers, figures or animals on the material. The little girls wear long dresses and head coverings, while the little boys wear trousers with suspenders. Some of the older boys wear broad-brimmed hats. All are very polite and well mannered. This Amish family appears to come from another time, another place. In an instant the Amish family came into another world, the world of high tech health care. One may well surmise the “cultural – shock” of this encounter.

AMISH HERITAGE

The Amish are a conservative Protestant group who emerged after 1693 as a descendent of the Anabaptist movement that originated from Switzerland and spread to neighboring Germany. The Amish parted ways with the larger Anabaptist group, now known as the Mennonites, over a doctrinal dispute, (Hostetler 1993) and immigrated to America in the 17th & 18th century after experiencing religious persecution in Europe.

The diverse subgroups of the Amish Culture have distinctive beliefs, values, and behaviors). Today the Amish stand somewhere between the parent body, the Mennonites, and the four groups of Amish: Swartzentruber (ultra conservative), Andy Weaver (conservative), Old Order (conservative), and the New Order (less conservative). The New Order leads a more progressive path that diverged from the Old Order in 1968 (Blair & Hurst 1997). The New Order of Amish attempts to balance distinctive rituals and practices against accommodations. Over time the Amish have adapted to some change but at their own pace.

In various rural regions of the United States, especially in Indiana, Ohio, and Pennsylvania, there are large settlements or communities of Amish families. About 75% of the estimated Amish total population of over 130,000 is concentrated in Indiana, Ohio, and Pennsylvania. In these areas good farmland can be purchased reasonably as agriculture is the main stay of their economy. Holmes County in Millersburg, Ohio has the largest population of Amish in the United States as compared to the more widely known areas of Amish settlements in Lancaster, Pennsylvania or Elkart, Indiana. The population in Holmes county is 38, 943 and about 18,000 of that are of Amish descent (Holmes County Chamber of Commerce 2002).

Amish Mutual Network

The Amish community has a very strong network of mutual support and assistance for its families. Amish “barn raising” is one example where several hundred men from many church districts gather to build a new barn. The Amish women plan and prepare the meals for the workers and take the food to the site. Smaller networks with projects called “frolics” occur when several neighbors and extended families and friends gather to help build a small building such as a shed or corn crib. Another example of Amish mutual aid is the harvesting of crops.

A serious illness or accident brings an immediate response of both emotional and financial support from their community. In Holmes County, Ohio, for example, a cooperative effort by both Amish and non-Amish people resulted in the formation of the Rainbow of Hope Foundation. This foundation assists all families in the area with health care costs affecting infants and children. Bake sales, benefit auctions, and private donations assist in raising the needed funds. There is a genuine ritualistic response to human troubles in the Amish close knit family environment.

Family Roles

The Amish father is responsible for providing for his family through farm work or by employment in the local community. Many Amish men are working away from the farm with the declining availability of farmland. Many Amish men work as carpenters, masons or laborers in factories. Some have home based businesses such as furniture making, harness repair or the shoeing of horses. Amish culture teaches girls to serve and please others such as their parents, husbands and relatives. An Amish wife is identified by using her husband’s name, eg. Eli Katie means Eli’s wife, Katie. The social life for an Amish woman is centered around church, funerals, quilting bees, baking, barn raising and frolics. Amish families usually have many children. Amish women raise on average seven children. On the family farm, parents and older siblings model work roles for the younger siblings. Children are an economic asset to the family as they assist with farm chores, gardening, mowing of lawns, housework or work in a small family business. These activities involving children serve to strengthen family ties and promote survival of the Amish life-style.

Genetics

Intermarriage among the Amish culture has resulted in the presence of a large number of recessive disorders, many of which are unrecognized outside of the Amish population. Consanguinity (relatives marrying relatives) accounts for the transmission of these various disorders. When a group of individuals mates only among themselves allele (alternate form of a gene) frequencies may change as a result of chance sampling from a small pocket of a population. This change of allele frequency is termed genetic drift. The founder effect is a common type of this genetic drift. A founder effect is when a community of people have descended from a few founders and have their own collection of inherited disorders that are rare in other areas (Lewis 2001). Amish couples are not deterred from having more children when they have a child with a hereditary defect. An abnormal child is referred to as a special child and is accepted as God’s will (Julia 1996). http://dw.com.com/redir?tag=rbxira.2.a.10&destUrl=http://www.cnet.com/b.gif

CONCEPTION, PRENATAL CARE, AND BIRTH Babies are a welcomed gift in the Amish culture and are viewed as a gift from God. The Amish view fertility as a family and community gift. They nurture these children in preparation for eternal life (Purnell 1998). Most Amish couples do not use birth control to limit their family size, since it is believed that use of birth control would be interfering with God’s will. Therapeutic abortions, amniocentesis and other invasive prenatal diagnostic testing are also not acceptable. Amish folk wisdom is an integral part of their prenatal practices, for example: walking under a clothesline will result in a stillbirth or crawling through a window or under a table will cause the umbilical cord to be wrapped around the baby’s neck.

Lamaze classes are usually held in a church close to the Amish community to ease transportation barriers. Prenatal care is started in the first trimester for a first pregnancy and much later for subsequent pregnancies if the mother has no problems. The distance to the doctor and cost of care can influence the number of prenatal visits and how soon prenatal care is started.

Complications such as pregnancy induced hypertension and diabetes is low in the Amish culture most likely due to the well nourished state of the mother (Julia, 1996). Typically prenatal visits are scheduled every eight weeks, rather than every 4 weeks, during the first two trimesters to reduce the expenditures of money and time for prenatal care. Amish express their preference for prenatal care that promotes the use of nurse midwives, lay midwives, home deliveries, and limited use of high technology. The Amish desire culturally congruent and safe health care services.

In preparation for childbirth a five week formula (5-W) is sometimes used in the last five weeks of pregnancy. It is thought that the herbs in this formula tone and calm the uterus, quiet the nerves, ease pain, and help make labor easier and on time. In addition, it has been known to help with menstrual disorders, morning sickness and hot flashes. The herbs included in this formula are:

Red Rasberry Leaves: This herb has been used as an old friend to treat diarrhea, vomiting and the flu. It is used for similar purposes of relieving nausea and pain in labor. Red raspberry capsules and red raspberry teas are also used.

Butcher’s Broom Root: This herb is used for hemorrhoids, varicose veins, and thrombosis. In addition, it is a diuretic, anti-inflammatory and improves circulation. This herb contains pseudo steroidal saponins which cause blood vessels to constrict and blood to thin. During the final months of pregnancy women may have circulatory problems such as varicose veins; therefore this herb is considered important.

Black Cohosh Root: This is a hormonal herb. It has an estrogenic effect because it contains compounds which mimic the effects of estrogen; therefore it is contraindicated in the early stages of pregnancy as it could bring on premature labor. This herb has a nervine effect which relieves spastic muscles, dilates peripheral blood vessels and helps reduce blood pressure. These actions aid the uterus and other muscles during labor. The anti-cramping effect of black cohosh is thought to help reduce pain during delivery. Black cohosh is also used to treat menopausal and PMS symptoms and menstrual cramps. Because black cohosh may minimic the action of estrogen, anyone who has had a cancer that’s estrogen sensitive, such as breast, endometrial or ovarian, should avoid using it. Since this root contains a blood-thinner, it should not be taken with bloodthinning medications (such as coumadin or heparin).

Dong Quai Root: The anti-inflammatory and diuretic effect of this herb is used for treating swelling prior to labor. During labor it eases smooth muscle contractions and gives a general sedative effect. This herb, in Chinese medicine, is considered a blood building tonic as it is high in iron, magnesium, and niacin. This Chinese herb is sometimes referred to as a female ginseng and is used extensively in China as a postpartum tonic.

Squaw Vine Root: This herb is used to prepare the uterus for childbirth and is also used to speed up delivery and encourage regular contractions. It has an antispasmodic action. (Pederson, 1987; Willard, 1991; Tarr, 1984, Block, 1984).

The Amish have no major taboos or requirements for labor and delivery. The women labor in soft pastel colored gowns. Men may be present and most husbands choose to be involved. Delivery may be at home with a midwife, at the birthing center, or at a hospital.

VISITING THE AMISH COMMUNITY

Their simple life style practices numerous social controls to avoid modernization. However, interaction with the outside world often occurs in the health care arena when an Amish person requires hospitalization for medical care. To better understand the Amish culture related to obstetrical care several nursing faculty visited an Amish Birthing Center in Indiana called the “New Eden Care Center” which is located in the beautiful countryside of Topeka, Indiana. An adaptation by the Amish to modern medical and nursing practices are the Amish Birthing Centers (Kreps & Kreps 1997).

This Amish Birthing Center was built in 1997, not from local, state, or federal government funds but from private subscriptions and donations mainly from the surrounding community. This facility is designed to be an alternative for those who prefer not going to the hospital for the delivery of their babies but who recognize the need for skilled care before, during, and after delivery. New Eden Care Center is a place where the physician or midwife can bring their patient for delivery in a more relaxed, home-like environment (Philosophy of New Eden Care Center). Since this facility provides services for the low risk population, all women are screened by their physician or nurse midwife before their arrival. Admission to the facility is opened to anyone upon recommendation and approval of their physician or nurse midwife. The need for this birthing center came from the fact that many of the people in the area are Amish and do not have commercial insurance or coverage for obstetrical care. Thus the Amish prefer not to go to the hospital with its high cost. This center features a plain relaxing decor with no television sets or phones in the patient’s rooms, and no separate nursery or delivery room. Labor, delivery and postpartum care are all given in the patient’s room, better known as LDRP rooms. Newborn babies stay in the room with the mothers.

Fees for the use of the New Eden Care Center cover current expenses, repairs, and maintenance of this facility. A flat fee is charged for the birth itself and 72 hours of care starting from the time of admission. There are additional fees for extra supplies such as PKU screening, intravenous solutions, and medications. The nurse midwives and physicians fees are separate from the birthing center fees. At times the fees are bartered for. For example, one of the nurse midwives had a new front porch put on her home to cover for her fee. In addition meats have been given for payments.

Services of the birthing center included general nursing care, housekeeping, and meals brought in during the patient’s stay. Families bring in food for the delivering mother and often eat together in the large home-like kitchen area provided at the birthing center. The center includes 3 MSN prepared nurse midwives and 9 physicians. No prenatal classes are offered by the center but the classes are provided by a staff RN from the center at a nearby church. Prenatal care is provided by the midwives either at their offices, located at the center, or in the homes of their patients. Many of the mothers prefer coming to the midwives offices for the prenatal classes as they enjoy the private and quiet time. The care center provides “hitching posts” with special parking areas for the traditional horse and buggy as well as a barn for overnight lodging of the Amish horses. Since there are no phones in Amish homes, a red bag tied to a large hook placed on the top of the barn is used to signal neighbors whenever additional help is needed in the center (cleaning and laundry).

All of the midwives, upon request, will do home deliveries. Suction, oxygen, and IV equipment are a few of the supplies they routinely take with them. One of the midwives described her experience following a home delivery. “It was a very foggy night and it took me awhile to get to the Amish home. It was well worth the difficult drive when following the delivery a great peace seemed to take over in the still of the night as I listened to the singing of the dad to the newborn, the creaking of the dad’s rocking chair, and the hum from the kerosene lantern. Where else could one hear such beautiful, peaceful sounds”.

Culture exerts a great influence on the prenatal family and determines the appropriate interventions to be given to provide competent nursing care. It is increasingly necessary to understand the cultural and behavioral patterns of the individuals whom we serve in our practices. Rapid growth of the Amish population and diverse geographical locations augment the probability that health care practitioners may care for Amish families. Health care practitioners can tailor their delivery of care for Amish families if they understand the Amish cultural practices and modify their services to keep it simple.

This Amish Birthing Facility, New Eden Care Center, is an example of wonderful adaptation by the Amish people to modern nursing and medical practices while at the same time maintaining their values of simplicity, low cost and accommodation to the use of their horse and buggy. Here the Amish can remain separate from the wider “English” society while still interfacing with it when health care is involved in “birthing babies”. Obstetrical Amish health care can be of excellent quality, with licensed medical and nursing personnel, at a reduced cost to both the Amish and the “English” society. This is an important consideration in today’s ever increasing health care costs.

Write a 3-part nursing diagnostic statement for this patient.

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Write a 3-part nursing diagnostic statement for this patient.

The RN is developing a plan of care for an 86-year-old patient who was admitted after falling at home. The patient is confused to place and time and has a right hip fracture that will be repaired tomorrow. The patient has an intravenous infusion of normal saline infusing at 100mL per hour, and is NPO after midnight. The patient’s vital signs are stable. The RN has included these nursing diagnostic labels in the plan of care:

Acute pain
Acute confusion
Impaired bed mobility.

Initial Discussion Post:

Identify a strategy to cluster the assessment data.
Describe how you used the identified strategy to cluster data for one (1) of the identified diagnostic labels.
Write a 3-part nursing diagnostic statement for this patient.

Analyze and critically appraise evidence-based literature to support the solution to the identified problem

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Analyze and critically appraise evidence-based literature to support the solution to the identified problem

Analyze and critically appraise evidence-based literature to support the solution to the identified problem and possible solutions, discuss your appraisal of the literature that addresses the problem, present the proposed practice changes from the integration of the findings, from the following article: (NINJA SEE ATTACHED PDF FOR ACTUAL ARTICLE TO BE APPRAISED AND IDENTIFY PROBLEM WITH POSSIBLE SOLUTIONS)
Alcohol-based hand rub versus traditional surgical scrub and the risk of surgical site infection: a randomized controlled.
https://eds.a.ebscohost.com.lopes.idm.oclc.org/ehost/detail/detail?vid=51&sid=1c35c38b-acf7-4d09-abab

While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

1
Unsatisfactory 0-71%
71.00%
2
Less Than Satisfactory 72-75%
75.00%
3
Satisfactory 76-79%
79.00%
4
Good 80-89%
89.00%
5
Excellent 90-100%
100.00%
80.0 %Content

10.0 % Identifies a nursing practice problem
Does not clearly describe a nursing issue.
Describes a nursing issue but lacks reliable sources.
Describes a nursing issue with a few reliable sources.
Articulates a nursing issue; uses supporting information from reliable sources.
Clearly articulates a relevant issue to nursing practice. Supports issue with current research.

35.0 % Critically appraises research to address the problem
Does not critically appraise research for a nursing practice issue.
Appraises research but missed key components of the design/methods that would support a solution.
Appraises two research studies supporting a solution to a nursing practice issue.
Appraises components of three to four research articles supporting a solution to a nursing practice issue.
Thoroughly, critically appraises key components of four-five research articles that support a solution to nursing practice issue.

35.0 % Proposes an evidence-based practice change
The content lacks a clear point of view and logical sequence of information; includes little persuasive information. Sequencing of ideas is unclear.
The content is vague in conveying a point of view and does not create a strong sense of purpose. Includes some persuasive information.
The presentation slides are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.
The solution is written with a logical progression of ideas and supporting information exhibiting unity, coherence, and cohesiveness; includes persuasive information from reliable sources.
The solution is written clearly and concisely. Ideas universally progress and relate to each other. The project gives the audience a clear sense of the main idea.

15.0 %Organization and Effectiveness

5.0 % Language Use and Audience Awareness (includes sentence construction, word choice, etc.)
Inappropriate word choice and lack of variety in language use are evident. Writer appears to be unaware of audience. Use of ‘primer prose’ indicates writer either does not apply figures of speech or uses them inappropriately.
Some distracting inconsistencies in language choice (register) and/or word choice are present. The writer exhibits some lack of control in using figures of speech appropriately.
Language is appropriate to the targeted audience for the most part.
The writer is clearly aware of audience, uses a variety of appropriate vocabulary for the targeted audience, and uses figures of speech to communicate clearly.
The writer uses a variety of sentence constructions, figures of speech, and word choice in distinctive and creative ways that are appropriate to purpose, discipline, and scope.

5.0 % Evaluating and Documenting Sources (in-text citations for paraphrasing and direct quotes, references page listing and formatting, as appropriate to assignment and style)
, no references section, and no correctly-cited references within the body of the presentation.

References section includes sources, but many citation errors. Citations are included within the body of the presentation but many errors are present.
References section includes sources, but they are not consistently cited correctly. Citations are included within the body of the presentation but some errors are present.
References section includes correctly cited sources with minimal errors. Correct citations are included within the body of the presentation.
References section includes correctly cited sources. Correct citations are included within the body of the presentation.

5.0 % Mechanics of Writing (includes spelling, punctuation, grammar, language use)
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.
Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.
Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.
Writer is clearly in command of standard, written, academic English.

Review the literature and current evidence and discuss the most effective recommended management of the issue according to the evidence

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Review the literature and current evidence and discuss the most effective recommended management of the issue according to the evidence

 

Major depressive disorder Current management and how it relates to a major australian emergency department Choose one mental health problem you are interested in exploring (e.g. schizophrenia; major depression; agoraphobia, etc.). Review the literature and current evidence and discuss the most effective recommended management of the issue according to the evidence. Critically explore the implications of the recommended management of this mental health problem in relation to your own nursing practice in the emergency department ORDER THIS ESSAY HERE NOW AND GET A DISCOUNT !!!Major depressive disorder Current management and how it relates to a major australian emergency department Choose one mental health problem you are interested in exploring (e.g. schizophrenia; major depression; agoraphobia, etc.). Review the literature and current evidence and discuss the most effective recommended management of the issue according to the evidence. Critically explore the implications of the recommended management of this mental health problem in relation to your own nursing practice in the emergency department ORDER THIS ESSAY HERE NOW AND GET A DISCOUNT !!!

answer in number 11 and 12

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answer in number 11 and 12

Bus 5112: marketing management- discussion assignment unit

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Imagine you have inherited a company. Choose a product that the company manufactures and sells. Assume that traditionally, the company has sold to commercial users such as restaurants, supermarkets, or food distributors. You have decided to expand your customer base to include non-commercial users (Consumers). For this discussion, you will:

Identify the product(s) that your company manufactures and sells

Develop a statement of your target market(s)

Develop a statement of your competitor’s target market(s)

Develop a value proposition statement.

Nausea and vomiting

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Nausea and vomiting

The nurse doses not speak Spanish. Discuss what th

Nausea and vomiting

Mr. jenaro is a 61 year old Spanish speaking man who presents to the emergency room with his wife Dolores. Mrs. Jenaro is also Spanish speaking, but understands some English. Mr. Jenaro complained of nausea and vomiting for two days and symptoms of confusion. His blood glucose is 796mg/ml. intravenous regular insulin ( Novolin R) is prescribed and he is admitted for further evaluation. He will request teaching regarding his newly diagnosed diabetes.Case StudyMr. Jenaro is newly diagnosed with diabetes. His hemoglobin A1C is 10.3%. Mr. Jenaro is slightly overweight. He is 5ft 10 inches tall and weighs 174 pounds ( 79Kg). He reports no form of regular exercise. He does not follow diet at home. He states, I eat whatever Dolores put s in front of me. She is a good cook. For past few months, Mrs. Jenaro has noticed that her husband has been very thirsty and been up and down to the bathroom a hundred times a day. Neither can recall how long it has been since there changes in Mr. Jenaro began. Dolores states, It been quite a while now. It just seem to be getting worse and worse. . Question1. The nurse doses not speak Spanish. Discuss what the nurse should keep in mind to facilitate effective communication using an interpreter. What is the difference between the role of a medical interpreter and that of a medical translator?2. Describes the following serum glucose tests used to help confirm the diagnosis of diabetes mellitus. Casual, fasting, postprandial and oral glucose tolerance test?3. When evaluating Mr. Jenaro s postprandial result, what is important to consider regarding his age and tobacco use?4. Explained what a hemoglobin A1c (HbA1C) lab test tells the health care provider?5. How might the nurse briefly explained what diabetes is diabetes is in lay terms to Mr. and Mrs. Jenaro ?6. Explained the difference between type 1 diabetes and type 2 diabetes and who is at increased risk for developing each type. Base on this understanding, which type of diabetes dose Mr. Jenaro have?7. Discuss the prevalence of diabetes and the potential long term complication of diabetes?8. List five nursing diagnose appropriate to consider for Mr. Jenaro? . 9. Discuss Mr. and Mrs. Jenaro s learning needs. Consider the communication preferences of Mexican Americans?10. Discuss the dietary recommendations for a diabetes based on the Food Pyramid?11. Discuss how culture may influence Mr. Jenaro s diabetes management in terms of food choices, diet and exercise, and use of alternative health care provider?12. Discuss the information the nurse and /or diabetes educator should include when teaching Mr. Jenaro about proper foot care.13. Discuss the lifestyle considerations the nurse and/or diabetes educator should discuss with Mr. Jenaro and his wife14. Discuss what Mr. Jenaro should be taught about how to manage his diabetes on days that he is ill ( e.g, if he were to have a stomach virus15. Mr. Jenaro meets his friend at a local bar once a week for a beer or two. What impact dose alcohol have on a diabetes? Should he discontinue this social activity? .

Impact of Oral- Inhalable- and Injectable Salbutamol Formulations for the Treatment of Asthma

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Impact of Oral, inhalable, and injectable salbutamol formulations for the treatment of asthma


Asthma is a common lung condition caused by inflammation of the airways (Lallemand Pharma, 2018), which includes bronchial hyperactivity and bronchospasm due to hyper responsiveness of tracheo-bronchial smooth muscle, resulting in narrowing of the air tubes. There is about 334 million people who suffer from asthma worldwide. Salbutamol is used to relieve symptoms of asthma, which are coughing, wheezing and feeling breathless (nhs.uk, 2018). It works by relaxing the muscles of the airways into the lung which makes it easier to breathe (nhs.uk, 2018). It is the most widely used short-acting relief from sudden or unexpected attacks of breathlessness. It is a white crystalline powder, readily soluble in water, which is available as an inhaler, tablet and injection. Depending on the asthma action plan of the patient, doctor will advice how to manage one’s asthma. In this essay, it will be explained how oral, inhalable and injectable salbutamol formulation helps to relieve asthma.

Salbutamol is a bronchodilator drug used alone or in conjunction with inhaled corticosteroid. The way that salbutamol work depends on the method the drug is administered. For example, if it is administered orally, it resists the acid of the stomach and enzymatic attack, it absorbed across gastrointestinal membrane through pharmacokinetics, that is what the body does to the drug. At the end, salbutamol is excreted in the urine as a mixture of unchanged drug and most of the drug is recovered in the urine (Bergés et al., 2000). Salbutamol is an inhaled form that plays an important role in the management of bronchial asthma and the most widely prescribed drug in this class. The common salbutamol side effects are feeling shaky which soon passes, headache for which a painkiller can be used. The most serious ones are nervous tension, muscle cramps and being aware of the heartbeat. However, if they are troublesome, the doctors must be informed so that the latter can look at the pharmacokinetics and set up a patient care plan that can help to facilitate decisions for dose amount and the impact of drug interaction. In the lungs, salbutamol is not fully metabolised, the proportion of drug metabolism depends on the amount swallowed.

Oral tablets which are solid dosage. It is one of the methods of administrating the drug to achieve better patient compliance. When the tablet is placed on the tongue, it disintegrates instantaneously, and the drug is released within a few second without the need of water. This mode of administration is useful for dysphagia adults, pediatrics, geriatrics and mentally ill patient. The drug is absorbed from the mouth, pharynx, oesophagi as saliva passes the stomach, therefore has a good bioavailability. Salbutamol is a β2 adrenergic receptor. The stimulation of the drug via increased cyclic adenosine monophosphatedan formation in bronchial muscle cell, which cause relaxation (KUMAR and SAHARAN, 2017). Its action starts within 15 to 20 minutes and can last up to 4 hours. Hence, it is an efficient method to terminate attacks of asthma. Each tablet contains 2.4 mg of Salbutamol Sulfate. For an adult, the effective dose is 4 mg for three to four times a day and for children, the doses should be administered depending of the age, for example for a child from 2 to 6 years old is 1 to 2 mg, 6 to 12 years is 2 mg and over 12 years is 2 to 4 mg (Medicines.org.uk, 2018). The advantages of oral tablet are that fast dissolving tablets enhance safety and efficacy of the drug molecules, the tablet can be administered without water and accurate dosage compared to liquids and easy portability. Further benefits are in terms of patient compliance, rapid onset of action and increase in bioavailability. The disadvantage for this is that some patients have trouble in swallowing the drug due to large size, shape and taste.

Figure 2 shows how asthma attack is formed in the body (Britannica.com, 2018).

The second method of administering salbutamol is using inhaler, which can be in the form of aerosol inhaler, auto-inhaler or powder inhaler. Salbutamol being a bronchodilator medicine dilates the airway and opens the air passages of the lungs so that the air can flow

into the lungs more freely and hence helps to relieve symptoms of asthma. The action starts within a few minutes after administered and can last for 3 to 4 hours (nhs.uk, 2018). Salbutamol inhalers are known as ‘reliever’ inhaler or blue inhaler. It is important to note that they relieve breathlessness, but do not prevent the breathlessness from happening. Doctors may give a space device to use with an inhaler when patient struggle to co-ordinate breathing or young children. The space role is to help the medicine to travel to the lungs. Salbutamol inhalers must be kept in cool and dry place, away from direct heat and light. Adults and children need to use 1 or 2 puffs of salbutamol when needed and up to a maximum of 4 times in 24 hours. In case of sudden attack, then up to 10 puffs can be used (nhs.uk, 2018). The advantages of salbutamol inhaler are that it is safe and effective with few side effects. It gives quick relief from breathing problems and it is also safe to use in pregnancy, and while breastfeeding. The main disadvantage for this is that asthma patient can have allergic reaction to salbutamol and for patient with digestive disorder of galactose intolerance.

Injection is an effective route in the therapy of asthma. It is usually given by the doctor or nurse. The drug is administered under the skin or directly into the vein or muscle. The usual dose for an adult is 4 μg/kg body weight and it is not suitable for children under 12 years old (Medicines.org.uk, 2018). Patients receiving injections have a more rapid recovery time (Tobin, 2005). The advantages are that injection help to relieve chest tightness, wheezing and cough, and used to treat severe breathing problems. The disadvantages are increasing in heart beating rate, hyperactivity, shaky and building up of acid.

The essay highlighted the importance of salbutamol in the treatment of asthma, the amount of the drug reaching the airways to relieve asthma, how the patient uses the formulation effectively and the appropriate dosage that is not complying with prescription can result in high incidence of non-compliance and ineffective therapy. An oral tablet is a promising approach with a view of obtaining faster action; however, a good balance of the thickness of the tablet, hardness, friability, disintegration, and wetting time must be considered. Inhalation being a very old method of drug delivery is still a mainstay of respiratory care to relieve asthma. The inhaled formulation allows placing the drug directly to the target organs, which relief the asthma attack faster. The inhalation route also lower the systemic drug levels and has less adverse effect. Injection of salbutamol is used during the treatment of acute attack of asthma both in domiciliary and hospital practice. It is usually used as the second line of treatment after response to inhalation is unsatisfactory. There is a limited evidence that a combine treatment using the three types of formulations would have a better impact in asthma and the potential side effects of systemic salbutamol.


References:

1)     Lallemand Pharma. (2018). Lallemand Pharma. [online] Available at: http://www.lallemandpharma.com/334-million-people-suffer-from-asthma-worldwide/ [Accessed 27 Oct. 2018].

2)     Gsk.com.au. (2013). PRODUCT INFORMATION VENTOLIN® CFC-FREE INHALER. [online] Available at: http://www.gsk.com.au/resources.ashx/prescriptionmedicinesproductschilddataproinfo/2119/FileName/92D70EAE0A4BE2920AEA28CA603BEC79/Ventolin_CFC_Free_Inhaler_PI_003_03_Approved.pdf [Accessed 27 Oct. 2018].

3)     NHS.UK. (2018). Salbutamol: inhaler to relieve asthma and breathlessness – NHS.UK. [online] Available at: https://beta.nhs.uk/medicines/salbutamol-inhaler/ [Accessed 27 Oct. 2018].

4)     nhs.uk. (2018). Salbutamol: inhaler to relieve asthma and breathlessness. [online] Available at: https://www.nhs.uk/medicines/salbutamol-inhaler/ [Accessed 2 Nov. 2018].

5)     Bergés, R., Segura, J., Ventura, R., Fitch, K., Morton, A., Farré, M., Mas, M. and Torre, X. (2000). Discrimination of Prohibited Oral Use of Salbutamol from Authorized Inhaled Asthma Treatment. [online] Clinical Chemistry. Available at: http://clinchem.aaccjnls.org/content/46/9/1365 [Accessed 2 Nov. 2018].

6)     KUMAR, A. and SAHARAN, V. (2017). A Comparative Study of Different Proportions of Superdisintegrants: Formulation and Evaluation of Orally Disintegrating Tablets of Salbutamol Sulphate. The Turkish Journal of Pharmaceutical Sciences, [online] 14(1), pp.40-48. Available at: http://www.turkjps.org/archives/archive-detail/article-preview/a-comparative-study-of-different-proportions-of-su/15531 [Accessed 2 Nov. 2018].

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Assignment: Reaction paper based on an unresolved issue

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Assignment: Reaction paper based on an unresolved issue

Assignment: Reaction paper based on an unresolved issue

Students will write one reaction paper based on an unresolved issue found in a reputable publication (i.e., The New York Times, USA Today, scholarly journals, Newsday, etc.).  Acting as though you have been brought in to solve the problem/issue identified in the article you must:

1.      Provide an introduction,

2.      Briefly summarize the article and identify the main issue

3.      Discuss two (2) viable solutions based on the information presented in the article

4.      Choose one of the two solutions and discuss why you believe it is the best choice

5.      Outline what you would do to put the solution into action

6.      Provide a conclusion.

The paper should be two (2) type written, double-spaced pages, using Times New Roman, 12 pt. size font. Criteria for grading will include: content and the writing quality of your paper including organization, grammar and spelling. Students must submit the reaction papers and a link to the article.  The selected article must be dated from May 1, 2016 to the present.




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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.


Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.


Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.


The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

Palliative Care Nursing Reflection

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INTRODUCTION

The Healthcare Quality Strategy for NHS Scotland (Scottish Government 2010) was a further development from ‘Better Health, Better Care’ (Scottish Government 2007). In this reflective account I wish to concentrate on the peoples priorities for the people of Scotland outlined within this document, the ultimate aim is to provide the highest quality of care. It has as their objectives that care given should be consistent, person centered, clinically effective and safe and equitable with patients receiving clear communication with regards to conditions and treatment (Scottish Government 2010). Hubley and Copeman, (2008) state communication skills are paramount in healthcare to ensure that tailored advice is delivered effectively.

This reflective account is based on an experience from my 3rd year management placement. Using Gibbs’s Reflective Model (1988) I aim to outline what occurred throughout the incident which involved providing clear communication and patient centered care and how this can be linked to the Quality Strategy in relation to the people’s priorities. This reflective model has been selected as it enables reflection on practice in a structured way allowing one to identify critical learning and development from their experience to enhance future practice (Bullman and Schutz, 2008). This scenario will consider how this incident will aid in my transition from student nurse to staff nurse.

To comply with patients’ rights to confidentiality and in accordance with the Nursing and Midwifery Council (NMC), (2010) I will use the pseudonym Mrs Wade.


DESCRIPTION

This reflection involves a 78 year old lady Mrs Wade who was an inpatient on the ward for 10 days after being diagnosed as having a cerebral haemorrhage. This had left Mrs Wade with a left sided weakness and aphasic. It was during this time it was established that Mrs Wade was also suffering from a perforated bowel and after discussion with her family from the medical staff it was decided that Mrs Wade was for no further active care and was to remain in the wards single room for

palliative care

.

Feelings

During my three years as a student nurse I had been involved with the care or palliative patients. However, I felt I still lacked confidence in this situation in communicating with patients and families. I had been involved in Mrs Wades care from admission as I had been her admitting nurse and I felt I had established a good patient / nurse relationship which in accordance with the Nursing and Midwifery Council (2008) allows for patient centered care. This is a difficult time for the Wade family and as stated with in The Healthcare Quality Strategy for NHS Scotland (Scottish Government 2010, p6) I would strive to provide care that was both caring and compassionate.

Evaluation

The negative aspect of this situation was that I was dealing with a palliative care patient and that it was inevitable that my patient would die.

The positive aspect that I could draw from this was I was being put in a situation as a 3rd year student on my final placement and this would give me an experience that I could learn from.

Jones (2012) advocates that it is essential in nursing to have good communication skills. This is also advocated by Dougherty and Lister (2008) who states that communication is an integral part of maintaining a high quality of record keeping which is regarded as a vital standard of practice by the NMC (2008). Communication and written care records aid to establish a continuity of care. A holistic approach for continuity of care is exceptionally important when caring for palliative care patients as nurses have a crucial role in care provision (Hill, 2011). It is important to note that any information that is given to Mrs Wade and her family is given in an open and honest manner and to ensure that they understand and give opportunity to ask questions (NMC, 2008). As Mrs Wade was a palliative care patient it gave rise to effective teamwork within the multi-disciplinary team to ensure all Mrs Wades needs were met as well as her families to ensure continuity of care whilst showing clinical excellence.

Analysis

The World Health Organisation (nd) describes palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

A holistic approach was taken in planning Mrs Wade care incorporating physical, psychological, social, emotional and environmental needs. These needs are not only imperative to the patient but also had to include all Mrs Wades immediate family in who she had requested to be involved (Dougherty and Lister, 2008). Within the ward I worked active care plans and patient care plans are reviewed daily and updated accordingly to ensure the patient receives the best possible care (NHS Greater Glasgow and Clyde, 2014)

Jones (2012) states that it is essential in nursing to have good communication skills. This is also reiterated by Dougherty and Lister (2008) who states that communication is an integral part of maintaining a high quality of record keeping which is regarded as a vital standard of practice by the NMC (2009). Communication and written care records aid to establish a continuity of care. Communication also incorporates the ability to listen and support and ensure understanding (NMC 2008).

In addition to caring for Mrs Wade I was also given the opportunity to be involved in meeting with the multi-disciplinary team which in Mrs Wade’s case involved the palliative care team for the hospital. This again reiterated the importance of good communication skills and accurate record keeping to ensure that all participants in Mrs Wades care knew exactly what was happening (SIGN 20??). In terms of communication I felt I was gaining confidence especially with the family members as I had built up a rapport which was both professional whilst being friendly and trusting (MacLeod et al 2010).

Mrs Wade as well as any patient within our care should receive care outlined by the people’s priority. Patients receiving palliative care should be made comfortable and pain free and to be cared for in a safe and clean environment (Scottish Government, 2010 p6).

Reflection from this incident has made me aware of the level of involvement each member of staff from health care assistants through to consultants play in the care of patients. This was shown through the numerous times I was involved in multi-disciplinary meets, re-assessment of care plans to ensure the highest standard of evidence based care was given to Mrs Wade (NMC 2009).

CONCLUSION

The outcome was positive in the aspect that a holistic approach to Mrs Wade’s care was taken in accordance with The Scottish Government’s Initiative (2010) on patient centered care. I felt empowered by incorporating the use of the SBAR framework in effective collaboration with the multidisciplinary team aided clear communicating in accordance with The Scottish Government (2010). This resulted in a consistent continuity of care for Mrs Wade.

ACTION PLAN

A result of this significant event was that it gave me the experience of dealing with a delicate situation. As stated by Scheffer and Rubenfeld (2000) “Critical thinking in nursing is an essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Critical thinkers in nursing practice the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge”. I was also given the opportunity afterwards to reflect on my role and the role each member of the team took in the care of a palliative care patient.

I feel for future development I will take responsibility for my own learning in areas where I felt I lacked knowledge. In this situation I had assumed that Mrs Wade was recovering from her CVA, however I was unaware that the effect a CVA has on the brain can result in continence issues and result in bowel perforation. I believe that in the future and with more experience I will be aware of complication resulting from a CVA and although I would not expect to be an expert I would be better equipped to deal with similar situations in the future (RCN 2013).

OVERALL CONCLUSION

On reflection of my own experience and in using this to aid in my transition from student nurse to staff nurse I feel I have enhanced my own knowledge on palliative care (Dougherty and Lister, 2011) whilst reiterating the importance of good communication skills. It also highlighted the importance of having the confidence to acknowledge one’s own lack of knowledge and be able to admit to this and where to seek guidance to ensure that the correct protocol is followed to ensure patient safety at all times and to provide continuity of care. I feel that the care given to this patient is in line with the initiative of The Scottish Government’s Healthcare Quality Strategy for Scotland (2010).

In relation to how this incident reflects on my transition it shows that on graduating as a staff nurse I will immediately assume the role which includes leadership, delegation and supervision. Once NMC registered, a host of expectations are placed upon you. The RCN (2010) reported that newly qualified staff nurses feel unprepared and overwhelmed by their new responsibilities, making the period of transition very stressful rather than exciting and truly enjoyable. However, I hope to overcome these feelings by immersing myself in the knowledge that I will adhere to all policies and guideline by The Scottish Government (2010) to ensure the best possible care and service to all.

References

McLeod Deborah L, Dianne M. Tapp Moules, N., Campbell M E Knowing the family: Interpretations of family nursing in oncology and palliative care European Journal of Oncology Nursing Volume 14 issue 2 April 2010 Page 93-10

http://www.sciencedirect.com/science/article/pii/S1462388909001124

NHS GGC

http://www.nhsggc.org.uk/content/default.asp?page=s1458