INTRODUCTION

This project is designed to illustrate the effects of prescription and over the counter drug abuse. It will not only show a comparison between the effects of illicit drugs and prescription drugs but it will also serve to show the significance of the prevalence and effects of prescription drug abuse.

“There is an erroneous belief that because these are medicines, whether prescribed by physicians or over-the-counter, that they are safer,” stated by Nora D. Volkow, MD, director of the National Institute on Drug Abuse (Kheun, 2007). Teenagers and young adults have the concept that prescription or over the counter drugs are not harmful even if consumed in extreme doses. This is due to the fact that they are legal and are created and designed by pharmaceutical and medical professionals. This is quite contradictory because it has been noted by researchers (Ford & Rivera 2008) that these drugs, when abused have very serious and even fatal consequences. Some of which include increased heart rate, hallucinations and other alterations in mental state. Though not highly publicized, these “every day” drugs such as Ritalin, OxyContin, Vicodin and Dexedrine can cause all of the aforementioned symptoms (Arkes & Iguchi 2008).

The effort of research in this area however, does not parallel the gravity of the problem and it has been noted by The International Narcotics Control Board that prescription drugs are about to become as much of a problem as illicit drugs (Zarcosta, 2008). Nevertheless, little or no research has been done in this field of prescription drug abuse and the seriousness of its effects as it relates to teens and young adults. With the research that this subject so rightfully deserves, all vulnerable persons (young persons, parents, teachers and health care providers) should become aware of the following:

The types and examples of prescription drugs commonly abused.

Ways in which these prescription drugs can be abused.

Who is at a higher risk of prescription drug abuse?

Signs and symptoms of prescription drug abuse.

The consequential effects of abusing prescription drugs.

Avenues in which one can seek help for this type of drug abuse.

This project’s intention therefore is to give enlightenment on all these areas, create awareness on the relevant and ubiquitous issue of prescription drug abuse and most importantly research the effects of prescription drug abuse.

HYPOTHESIS

Abuse of prescription drugs is as hazardous as the use of illicit drugs.

RESEARCH DESIGN

This research will take on both forms of qualitative and quantitative designs therefore it will be a mixed design. It will be qualitative in order to include statistics about the prevalence of prescription drug abuse. However it will quantitative in order to include reasons and effects of prescription drug abuse on young adults.

LITERATURE REVIEW

While rates of illicit drug abuse among teens in the Unites States continue to decline, abuse of prescription drugs in this age group is increasing at an alarmingly high rate. Recent anonymous survey results show that the one in every 10 high school seniors had used the painkiller Vicodin in the last year without a doctor’s orders (Arkes & Iguchi,2008 as cited by Johnston, O’Malley, Bachmen &Schulenberg, 2004). Even though, there is research done on the prevalence, causes and risk factors associated with prescription drug abuse, there is a lack of information on the effects. The aim of this literature review is to provide sufficient information for researchers to conduct further research on the effects on the prescription drug abuse. This literature review will explain the following topic questions:

• How prevalent is prescription drug abuse?

• What are the major causes/reasons of prescription drug abuse?

• Who is at a higher risk?

How prevalent is prescription drug abuse?

The abuse of prescription drugs in the USA is a growing problem. Prescription drug abuse is as prevalent as the abuse of illicit drugs. There has been a significant rise in the nonmedical use of prescription drugs in the US over the past 15 years. In 2004, an estimate of 2.4 million Americans aged 12 years or older initiated prescription opioid abuse within the past year, which exceeded those who were abusing illegal drugs like cocaine ( 1 million) or marijuana ( 2.1 million) ( McCabe, S.E., West, B.T., Morales, M., Cranford, J.A., & Boyd, C.J., 2007). The debate as to whether prescription drug abuse is as prevalent as illegal drug abuse is interesting and. The commonly abused prescription drugs are painkillers, sedatives, tranquilizers, opioids and stimulants (Levy, M.S., 2007).

In the United States, the abuse of prescription drugs especially opioids is a major health concern. In 2005 a study was carried out and it was found out that approximately 227,000 Americans were abusing and highly dependent on illicit drugs like heroine whereas 1.5 million Americans abused and were highly dependent on prescription opioids (Wu, Li-Tzy, Blazer, D.G., Stitzer, M.L., Patkar, A.A., & Blaine, J.D., 2008) Additionally, in 2006, it was established that the nonmedical use of prescription drugs especially pain relievers actually surpassed that of illicit drugs. (Wisley et al)There has also been an alarming increase in the number of deaths associated with accidental overdoses of prescription drugs compared to those of illegal drugs. Statistics state that in 2002 it was established that the number of fatal heroine poisonings increased by 12.4% while shockingly the number of fatal opioid analgesic poisonings increased by 91.2% in the same population (Wunsch, M.J., Nakamoto, K., Behonick, G., & William, M., 2009). This information further concretes the fact that there is a drastic increase in prescription drug abuse.

Statistics in 2001 reveal that approximately 3 million youths aged 12 to 17 and almost 7 million young adults aged 18 to 25 years had misused prescription drugs in their life-time. (Kelly, B.C., & Parsons, J.T., 2007).

In conclusion, prescription drug abuse is on an alarming increase amongst the youth. With this increase, come various causes that will influence one to begin abusing prescription drugs.

Definitions

1. Prevalence- Existing very commonly

2. Abuse- Use of a drug to get pleasure, or to improve a person’s performance of an activity, or because a person cannot stop using it.

3. Dependence- To need something all the time especially in order to continue existing or operating.

4. Prescription drugs- Also known as over-the-counter drugs.

What are the major causes/reasons of prescription drug abuse?

With the way you are brought up and other environments, one develops values that in turn influence personal choices. Even though most illegal drugs are easy to access (Califano, 2002 as cited by Finley, 2007), an increasing number of youth prefer to use prescription drugs for non-medicinal purposes. In an article by Youth Trade, 2005 (cited by Finley, 2007) Students in high schools and colleges are having ‘pharming’ parties, where they shift responsibility for bringing the prescription drugs. This in-turn makes them appear ‘cool’ and up-to-date with the times as another teen had explained once her school mates found out that she had prescription drugs.

Some opt to use prescription drugs out of boredom, often times along with illegal drugs, with others choosing to use Ritalin as a stimulant because it works like caffeine. Others actually believe that since prescriptions drugs are safe to use under prescription, then it must be safe for them without doctor’s orders. In the case study by Finley (2007) as stated by Birhanemaskel (2005) prescription drugs do not have the give-away smell as marijuana, yet give the same effects; more youth prefer prescription drugs to get high. This thought is generally upheld by girls making them less prone to use marijuana. Also young females prefer to use prescription drugs because of the expectation that they would help them slim down thus fitting in better with the other girls (Monarch Avalon, 2005 as cited by Finley, 2007).

In a study (Lankenau et al., 2007), participants gave stories of how their first experiences of non-medicinal use of prescription drugs. One man mentioned that his first prescription drug was Ritalin which he used to help him stay up so he could be able to study. He would then use Xanax to help him get to sleep. This all helped keep balance of his school, athletics and social life. Another student mentioned that he began using prescription drugs to get the same feeling of a heroin high by taking 2 Xanax pills and alcohol simultaneously when he was curbing his heroin addiction. Also, some admitted to using Adderall as they were cheap; each pill was about $0.90. Finley (2007) also suggested that having parents that use prescription drugs to help them get up in the morning could also encourage teenagers to recreationally use prescription drugs. By parents allowing teenagers to take cough syrups, for instance, and not inquire about shows ignorance and leniency which leaves the teenager to believe there is nothing wrong with misuse of prescription drug abuse (Gavin, 2004).

Even with these significant causes, some youth are at more ‘attracted’ to prescription drugs than others.

Who is at a higher risk?

Teens themselves being very vulnerable to prescription drug abuse have certain factors which could put them at an even higher risk. These include teens:

1. A history substance abuse.

The quest for more pleasure, diminished anxiety, the relaxation of time, quickening of insight, deepening mythic awareness are the major reasons why teens repeatedly use substances like illicit drugs and alcohol and before they realize, they get addicted. It becomes nearly impossible for them to live without getting high or feeling highly ecstatic.

The addiction rises to an extent that they start to engage in illegal activities to obtain these substances.

However, now they have found a new ‘legal’ way to do this. As stated, prescription drugs are much easier to obtain and less expensive than other substances. Teens with a history of substance abuse use this as an advantage and now they have an easier means to get high. The annual study by the National Institute on Drug Abuse, conducted by the University of Michigan, showed as many as one in every 14 high school seniors said they used cold medicine “fairly recently” to get high. A student, during a study that included an in-depth interview conducted by Lankenau, S.E. et.al said, “[My mother] used to get a whole lot of [OxyContin] and she would just bring them home and I’d see it all laid out. You take 20 milligrams and its like dope [heroin]. It’s really like dope.”

2. With Adverse childhood experiences.

Adverse Childhood experiences are common and destructive. It includes abuse (physical, mental or sexual), neglect, domestic violence and other forms of serious and interrelated household dysfunction. They can determine the health and well-being of a person. The associated problems are painful to recognize and difficult to cope with.

The study by Anda, R.A et.al shows a direct relationship between adverse childhood experiences and prescription drug abuse. Teens with adverse childhood experiences may have feelings of helplessness, chaos, and impermanence and may have problems self-regulating affective states. Thus, prescription drug abuse may serve as an avenue to escape or dissociate from the immediate emotional pain, anxiety, anger that likely accompany such experiences.

3. Homeless youth.

A common stereotype of the homeless population is that they are all alcoholics or drug abusers. The truth is that a high percentage of homeless people do struggle with substance abuse but addictions should be viewed as illnesses and require a great deal of treatment, counseling and support to overcome. Substance abuse is both a cause and a result of homelessness, often arising after people lose their housing. (Substance abuse and homelessness, July 2009).

People who are homeless often turn to drugs and alcohol to cope with their situations. They use substances in an attempt to attain temporary relief from their problems. With the increasing use/prevalence of prescription drug abuse over other substances, the homeless population is also starting to use more prescription drugs. Lankenau, S.E. et.al and Sander, B et.al proved a high percentage of prescription drug abuse among the homeless from their studies.

In conclusion, there is a large number of youth abusing prescription drugs for various reasons. This number is rapidly increasing especially amongst the sample age with the major causes and risk factor highlighted above. The easy accessibility, inexpensiveness and the belief that prescription drugs are safe to use has resulted in the youth change their usual use of illicit drug to prescription drug as their means to get high, to fit in and in their struggle to balance their social and academic life . Even though, the youth themselves are a very prone population for prescription drug abuse, there are certain risk factors which make them more vulnerable. This includes a history of substance abuse, adverse childhood experiences and the homeless youth. Researchers around the world should consider the severity of this prevalence and its serious consequences. Further research needs to be conducted on the effects and ways to control and prevent prescription drug abuse.

DATA GATHERING INSTRUMENT

The following are the data gathering instruments that will be utilized in this project.

Questionnaires: This will be a combined questionnaire which will contain a series of thirty (30) close ended and open ended questions. The questionnaire will be of a structured non disguised format in which the respondent will be informed of the purpose of collecting the information. The data will then be quantified.

Interviews: These will consist of personal interviews which are discussions between an interviewer and an interviewee in order to obtain in-depth information about a particular issue or research question. The interviews will take the unstructured format.

Focus Groups: This involves a group of participants who share their thoughts ideas and feelings on a specific topic. Hence the parents/guardians and the youth will be allowed this time to express themselves.

Observations: This is a research method used to give an objective view on the verbal and nonverbal behaviors of the participants. Hence the interviewees will be observed by this method.

DATA GATHERING PROCEDURE

Surveying: The questionnaire will be distributed randomly to various educational institutions. The actual distribution of the questionnaires within the schools will be done by the school administration. They will have approximately one week to administer and collect all questionnaires which will then be collected by the relevant authorities.

Interviews: Private interviews will be held with patients of selected Drug Addiction Rehab Centers at the center itself.

Focus Groups: This will be held with the parents/guardians and health care providers of the patients.

Observations: While they are interviewed the same patients will be observed by well reputed psychiatrists/psychologist through a one way mirror. Also the behaviors of the patients will be observed for approximately two weeks by the same psychiatrists/psychologists.

APPROPRIATE SAMPLING TECHNIQUE

In this project random sampling will be utilized. Six rehabilitation centers for substance abusers will be randomly selected. Sixteen individuals (eight males and eight females) within the age group of thirteen to eighteen (13-18) and sixteen individuals (eight males and eight females) within the age group of eighteen to twenty five (18-25) will be utilized. Eight schools will be randomly selected in which one hundred and sixty questionnaires will be distributed. Eighty will be distributed to students within the age group of 12-15 ( forty for females and forty for males). The remaining eighty will be distributed to students between the age group of 16-18(forty for females and forty for males).

ETHICAL CONSIDERATIONS

With each research, there are several ethical considerations. The following is a list of the ethical concerns considered in this study:

Before an individual becomes a participant, he/she will be fully informed of the aims, methods, harms, and benefits of the research: Each participant has the right to be fully informed about the research project in which he/she will be potentially participating, so that he/she has a full understanding of the project. If participants experiences any harm during the study, however, he/she will be compensated.

The individual has the right of voluntary participation. Individuals will not be coerced to participate in the research project as participation will be strictly voluntary. This includes bribery offers, threatening or any kind of direct/ indirect pressures.

He/she has the right to terminate his/her participation at any time. Participants will not be forced to continue with the project if he/she chooses to end his/her participation, neither will he/she be chastise for not continuing with the project. If the reason for terminating his/her is due to physical or psychological harm, participants will be compensated.

The confidentiality of his/her responses. The information gathered will not be made available to any persons who are not directly involved in study. All the information will be kept in a vault in which only the primary investigator will know the combination.

He/she remains anonymous throughout research: Participants will not be required to place their names on the questionnaires and if it is done, the questionnaire will be disregarded.

The teenager will not be allowed to participate without his/her parent’s consent. Any youth who is under twenty one (21) will not be interviewed unless there is written consent from his/her parent.

ANTICIPATED RESULTS

The anticipated results of this research proposal are as follows:

There will be a higher than expected prevalence of prescription drug abuse.

It is just as easy to get addicted to prescription drugs as it is to get addicted to illicit drugs.

The effects of prescription drug abuse can be as detrimental as the effects of illicit drug abuse.

CONCLUSION

The research project was aimed to discover the effects of prescription drug abuse and incorporated both qualitative and quantitative methods. The quantitative method consisted of questionnaires while the qualitative consisted of focus groups, interviews and observation methods. The sample would consist of students between the ages 13-18 and patients of rehabilitation centers ages 18-25. The delimitations of the project were the number of schools, the number of rehabilitation centers and the number of individuals from which information would be gathered. It would serve to bridge the gap of the insufficient research on the effects of prescription drug abuse and also as an informative tool to the society.

Section 1

: Healthcare Standards

This group of sources relate to the health care of Nigeria. The grouping consists of sources that deal primarily with the difficulties with achieving a positive health care model and sources that serve dual purpose in discussing the challenges and moving forward to policies and tactics. These sources will target low-income individuals as well as specific places.

Aliyu, A. A., & Amadu, L. (2017). Urbanization, cities, and health: The challenges to Nigeria – A review.



Annals of African medicine, 16



(4), 149–158. doi:10.4103/aam.aam_1_17

The author takes an academic approach to writing. The diction is measured and purposeful, relying heavily on scientific terminology while still using a tone that conveys the direness of the issues in Nigeria in regards to urbanization and health. The author is claiming that the urbanization of Nigeria and various aspects such as the environment, water supply, settlements, the population, and sanitary processes that accompany it have contributed to the health crisis as they have been managed poorly. He directs the various issues he highlights to those in power, specifically, the government as he proposes steps they (the government) could take. The author uses qualitative data, intertwining it with historical trends.

The author, Alhaji A Aliyu, is a qualified and credible individual evident in his credentials. Throughout the article, the author employs various numerical facts derived from census data and information available to the general public. Additionally, he purposefully integrates ideas and agreed upon factors such as previously performed studies and historical knowledge to back up his claims and make it difficult to insist he is partial or influenced in some way, shape, or form. The author engages various reliable figures and statistical data to such as in describing the capital income of Nigeria while conveying the environment as a central feature of the urban health crisis in Nigeria.

My argument will derive the parts of this source that deal directly with addressing the elements of urbanization. Since I intend to discuss, causes for the subpar health system in Nigeria, it is important to discuss forces that promote diseases. Furthermore, since the end goal is to discuss policies to improve the quality of life in Nigeria, to put it broadly, the aspect of urbanization since it deals directly with the people is important.

Bright, T., Felix, L., Kuper, H., & Polack, S. (2018). Systematic review of strategies to increase access to health services among children over five in low- and middle-income countries.



Tropical Medicine and International Health, 23



(5), 476-507. doi:10.1111/tmi.13044

The research question, in this case, would be phrased as an assessment of various strategies and their effectiveness in promoting access to health services. The goal was to study the response from the target population, the young in low-and middle-income countries, to different “interventions” to increase access to health services such as education, incentives, outreach, process indicators, and SMS appointment reminders. The results show a relationship, but there were not concrete enough to allow for specific conclusions.

This study addresses the problem of looking at different and distinct ways to improve access to health care services principally in the younger population of low and middle-income countries. The solutions proposed are those that do not require intensely drastic measures but are quite simplistic in theory but warrant additional effort. There is limited evidence due to the lack of information. Certain uncontrolled variables are present but there appears to be a relationship because groups are affected by the changes made. The sample size was not as large as I, nor they, would have preferred, as they wisely note when discussing the results and providing an explanation of why they cannot draw certain conclusions.

This source is useful for the non-hospital heavy and politics reliant suggestions made in increasing health access to younger children in lower and middle classes Nigeria. These ideas gave me a new outlook on the various means and solutions one can propose that can aid in beginning the process of a higher number of individuals being able to and taking full advantage of the resources available to them. Since the end goal is to look at policies, there are propositions to target increasing health system awareness.

Eboreime, E. A., Idika, O., Omitiran, K., Eboreime, O., & Ibisomi, L. (2019). Primary healthcare planning, bottleneck analysis and performance improvement: An evaluation of processes and outcomes in a nigerian context.



Evaluation and Program Planning, 77



doi:10.1016/j.evalprogplan.2019.101712

This research deals with analyzing the outcomes of using participatory action research (PAR), which works on supervising changes that target real-world issues, as they relate to the success of a health plan that involves “bottleneck identification and analysis.” Bottleneck analysis involves looking at the flow of a specific process through various stages and which stages. This study made use of data from Chikun LGA in a state in Nigeria, Kaduna. The implemented design was made use of in different areas in tandem with PAR.  In the different areas assessed there were changes in the improvement that were measured using percent mean values. This change was not consistently positive, but there were some improvements. The design used, known as Diagnose-Intervene-Verify-Adjust, appears to behave positive effects on promoting health system success.

The problem was identifying which areas in health systems can be better maximized for the success of proposals to gather more individuals into the health programs. It is important in the sense that those in charge must access weak areas of the health system both internally and in compelling the general populous into health programs. The results were convoluted and did not easily make clear whether or not their assertions were supported.

In all honesty, I did not find this source as useful as I thought it would be. From the title, I had hopes of discussing ideas about performance improvement, but although this source does not directly help with this idea it does provide areas in hospitals that can be maximized for greater efficiency, which will help choose areas that policy changes can affect in a positive light.

Umeh, C. A. (2018). Challenges toward achieving universal health coverage in Ghana, Kenya, Nigeria, and Tanzania.



International Journal of Health Planning and Management, 33



(4), 794-805. doi:10.1002/hpm.2610

The goal of this investigation was to look at the specific challenges facing different sub-Saharan African countries, including Nigeria, and propose changes to aid in increasing health access. Information from the World Health Organization, World Bank, and data regarding the national health insurance of these countries went through analysis.  An examination of the aforementioned revealed various potential challenges including, an enormous percentage living in poverty, few individuals with insurance, a high rate of individuals leaving insurance plans, and a lack of funding in primary health care. The author goes on to discuss the need for proper funding and proper use of funds. The author discusses the need to focus on the population in need. These are those that are uninsured, in rural areas, or make up the lower-class.

This paper assesses the relevant area of what obstacles are present in health access and which population needs to have the attention of funds. This is important because as often, the areas of issue with the health system is often given to hospital, but this source discusses the importance of focusing on the population itself and making health an accessible tool. The results do support the assertions made. The data came from very reputable sources, so the numbers and results supported the suggestions made by the author.

This reference strikes a healthy balance between numeric data, political policies, and conclusions drawn from them. This source ties together the two prior sources on hospitals and policy by addressing related to health care plans and the inability of lower-class individuals to afford them. In this research, I plan to look at policy changes that are needed, and this source identifies the target populations that I will discuss.

Section 2



: Unemployment Assessment

This group of sources relate to unemployment in Nigeria. The grouping consists of sources that deal primarily with the growing unemployment rates in Nigeria and areas that may be contributing to this continuing increase. Some of these sources also recommend ways to improve the proportions by targeting the outlined issues.

Bamidele M. Ilo. (2015). Capital market and unemployment in Nigeria.



Acta Universitatis Danubius: Oeconomica, 11



(5), 129–140.

This research was analyzing the effects the Nigeria capital market is having and is continuing to have on the unemployment recently.  The researcher, Bamidele, takes advantage of unemployment focused numerical data from the time frame 1986 to 2012 as well as figures from the Central Bank of Nigeria. Analyses of the data involved the Johanson cointegration vector error correction technique.  The results derived from the data and the analysis model support a connection between the rising unemployment rate and capital market. The results also reveal that steps taken to limit the capital market’s involvement with unemployment have been futile as there was a little to no reduction.  Therefore, it is critical, according to Bamidele, that effective changes that result in positive goals such as increasing job opportunities. He concludes by addressing the government directly and their need to build up and strengthen the weaker parts of the economy, which are currently the labor-intensive sectors.

This study addresses the capital market specifically and how that relates to the unemployment rate. This is important as there are various reasons, researchers attribute the medal of causing the increase in the unemployment rate. However, this specific reason deals with the day to day encounters of individuals in Nigeria, and how lack of work is affecting the economy. The methodology seems sound. Of course, it is difficult to understand as it uses techniques that are specific to fields, but the study includes data from sources such as the Central Bank of Nigeria. The results support the findings, but not in an infallible manner. There is an increase in unemployment with poor market capitalization, but this increase is not as drastic.

This research provides a potential reason for the unemployment rates in Nigeria found in the capital market and its favoring of certain parts of the population. Furthermore, the data includes some comparison to other developing countries, which leads to offering examples of systems that are more productive than Nigeria. Since I will, be discussing the lower-middle-income class, this source identifies labor-intensive areas of Nigeria as being undervalued and under targeted and how that relates to the economy (market) thus tying in with the section and discussion about the economy of Nigeria.

Isiaka Akande Raifu. (2017). On the determinants of unemployment in Nigeria: What are the roles of trade openness and current account balance?



Review of Innovation and Competitiveness, 3(



4), 5–30.


https://doi.org/10.32728/ric.2018.34/1

This study begins by stating the lack of focus on account balance and how it correlates with unemployment rates in addition to “trade openness.” With an emphasis on the short and long term effects of trade openness and current account balance, the researchers employed a statistical analysis. The researcher’s found that trade openness increased the unemployment rate drastically and over time.  The findings prompted the researcher to suggest successful management of trade to gain a handle on its dire effect on unemployment rates. Furthermore, he suggests augmentations to the branch of economics that analyzes the behavior and performance of an economy that will increase the competitiveness of business firms to increase access to jobs.

This study addresses two problems simultaneously: the lack of research in a specific area and the umbrella issue of how trade openness and current account balance affect unemployment rates. This research is extremely important as it deals with both internal and external contributions to increasing and decreasing unemployment rates. Therefore, this research brings attention to a potential positive point. A vast amount of time is set aside to define and explain pre-existing literature and theories. Also, this research relies heavily on qualitative calculations that can grow cumbersome at times.

I found this research useful in the suggestions it makes during its concluding remarks about targeting the issues they were analyzing. I plan to discuss ways that external forces and aspects may be augmented to help Nigeria’s employment issues and this source does a great job of weaving the international aspects of trade with the internal aspects of businesses and asserting how a harmonious relationship needs to be formed to increase job opportunities.

Ogbeide, F., Kanwanye, H., & Kadiri, S. (2016). Revisiting the determinants of unemployment in Nigeria: Do resource dependence and financial development matter?



African Development Review, 28



(4), 430–443.


https://doi.org/10.1111/1467-8268.12222

This research analyzes potential causes of unemployment in Nigeria with a focus on 1981 to 2013. The researchers used statistical modeling. The tests revealed that banks that became more dependent and grew in private credit reduced unemployment opportunities drastically. Moreover, trade openness and reductions in exchange rates lead to substantial reductions in unemployment. This research heavily emphasizes the need to manage natural resources, carefully cultivate the taxing process, foster a positive macroeconomic area that will promote proper and lasting investing, which will increase “economic competitiveness.”

This study looks at analyzing how resource dependence and financial development may influence unemployment in Nigeria. This research is relevant as unemployment can be directly related to the business and bank-centric field. It analyzes how certain priorities or decisions impact a specific aspect of the economy, and this change may influence unemployment. The findings are supported by the evidence, to a certain extent. Some results were not statistically significant, but an undeniable correlation is present. This alludes to the point that other factors, such as exchange rate reduction and trade openness, contribute.

This study will be useful for analyzing the internal and business structures of Nigeria. I intend to highlight the relationship between banks and unemployment in Nigeria. Furthermore, since the government is involved, to some extent, with regulating the bank and cash flow in and out from both citizens and foreign influences, this source will prove useful as it connects these areas with that of fostering economic prosperity, including taxation which impacts the middle-lower class and the upper class in different ways.

Philip Nwosa. (2016). Impact of macroeconomic policies on poverty and unemployment rates in Nigeria, implications for attaining inclusive growth.



Acta Universitatis Danubius: Oeconomica, 12



(2), 114–126.

This paper serves the dual purpose of looking at the issues surrounding unemployment rates and poverty rates when economy behavior policies are concerned. The author discusses the social aspect of economic growth and how, despite the increase in it in recent years, macroeconomic policies fail in capping and reducing the unemployment and poverty rates. This investigation used the Ordinary Least Square (OLS) technique, which works by attempting to estimate unknown values from known and predicted values. This research added exchange rate to ineffective macroeconomic policies as affecting the unemployment rate. The results assert the ineffectiveness of the policies in Nigeria and the need to strive for inclusive economic growth that promotes employment, which in turn would result in a reduction in poverty rates.

The research works on, through various calculations, providing evidence regarding exchange rate, “fiscal policy,” and inflation rate and their respective impacts on unemployment and poverty rates.  This is important as it highlights weak policies as being one of the main contributors to the notable increase in unemployment and poverty rates. The data used in this study is based on qualitative information, however, statistical models are not certain and therefore, concrete assertions cannot be made.

This investigation will be incredibly useful when it comes time to formulate political-related propositions about what is not working currently with the policies in place. In this source, the lack of inclusiveness in the current policies is a major weakness. As a result, this will serve the discussion of my target population which is the lower-middle-class as they need to be considered in macroeconomic policies.

Section 3:



Foreign Aid, Government, and Economy

This group of sources relate to the government and foreign aid of Nigeria and how both areas affect the economy. The grouping consists of sources that deal primarily with the pros and cons of foreign aid and the contributions to the lack of economic growth. Also, these sources provide explanations and suggestions that relate foreign aid and government action to areas such as poverty alleviation and, likewise, unemployment rate reduction.

Elijah, S., & Musa, A. B. (2019). Dynamic impact of trade openness on the economic growth in Nigeria.







International Journal of Engineering and Advanced Technology,








8



(5), 609-616. doi:10.35940/ijeat.E1087.0585C19

This investigation studies the varying consequence of trade openness on the economy in Nigeria. The researchers employ data from the Central Bank of Nigeria Statistical Bulletin in addition to performing various statistical tests, including unit root test and error correction model, and cointegration test. The results provide more support for “trade openness,” having adverse effects on the economy. The results attribute a great deal of responsibility to the government in monitoring trade in the realm of imports and exports. Additionally, the researchers suggest the government work with “private sectors” in promoting the exportation of specific products as well as regulate a policy known as the “Treasury Single Account” to remove loopholes that only benefit the few and leave out the masses.

This study addresses just how badly an effect trade openness has on the economy of Nigeria. The information the study provides is specific and deals directly with the import and export balance and how the government should regulate such and who the government should assist in regulating. The methodology is sound in the sense that the data the researchers use is factual and not biased. Also, they employ statistical tests, and the results tended to fall within the realm of significant.

This source was helpful to me as it clarifies the information in the sources from the unemployment section. Those sources stated that trade openness negatively impacted unemployment rates (there was an increase). This source presents the effects on the economy. Since I plan on discussing the government’s roles in the realm of trade openness, this source identifies exports as an area of immediate concern and the specific areas that should be regulated (private sectors).

Fashina, O. A., Asaleye, A. J., Ogunjobi, J. O., & Lawal, A. I. (2018). Foreign aid, human capital and economic growth nexus: Evidence from Nigeria.







Journal of International Studies,








11



(2), 104-117. doi:10.14254/2071-8330.2018/11-2/8

The investigation focuses on a potential connection between foreign aid and human capital in improving economic growth in Nigeria. The researchers use two models known as the Engle-Granger and Vector Error Correction Models. The first model helped in assessing the efficacy of the “medicine model” in Nigeria, while the latter analyzed the effect on the economic growth of both aid and capital. The data shows that foreign aid in excess in regards to the medicine model may have negative consequences and that human capital has an effect on economic growth, but this is not the case for aid shock. The results reveal that the decisions of countries receiving aid plays a huge role and that entirely aid-dependent countries are not forging a path towards economic growth.

This study addresses the problem of is there such a thing as too much aid. This is important as it addresses that countries may be providing aid, but the sensitivity of recipient countries may be contributing to lack of desirable results, which, in this case, is economic growth. This study relies heavily on scientific and statistical modeling and equations that are quite cumbersome, which may be a pro as the results depend on factual numerical data.

This source was helpful as it is one of the first sources that outlines the potential for cons in foreign aid, which is especially useful for the discussion regarding what developed countries should continue and limit. Since I intend to discuss policy changes, especially in rural areas, this study talks about the importance of education in rural areas striving to economic growth. Also, this study supports the existence of connections between investments from foreign countries, trade openness as the data provides statistically significant results.

Omodero, C. O. (2019). Government sectoral expenditure and poverty alleviation in Nigeria.







Research in World Economy,








10



(1), 80-90. doi:10.5430/rwe.v10n1p80

This study investigates how the amount of money the government spends in certain areas is affecting the poverty in Nigeria. The researchers used a statistical test known as the ordinary least squares technique to analyze data from 2000 to 2017. The results from the statistical test showed that the amount of money for specific areas such as agriculture, building, construction, education, and health was not supporting less severe poverty standards. The researchers conclude that the government should consider raising the funding to the sectors to aid in reducing the intensity of poverty.

This study addresses the amount of money that the government is allotting to relevant sectors. Knowing the amount of money is essential as it guides making assertions about the lack of funding to certain areas and can lead to exposing misused reserves. The methodology is sound as the researchers use a statistical test based on data from the Central Bank of Nigeria Statistical Bulletin. They also used information from the World Bank. The results provided in the figures and graphs show the need for the government to consider all aspects of the economy. These aspects are essential to the success of the economy.

This study is helpful as it directly ties in information regarding funds and the apportioning of these funds. Furthermore, in contributing to the overall proposal I plan to make of government changes, this source provides recommendations that point out the need for more funds toward agriculture, educational, and health sectors. The latter two sectors tie in directly with health standards and education monitoring.

Shitile, T. S., & Sule, A. (2019). Reassessing the efficacy of foreign aid and grants in poverty reduction in Nigeria.







Asian Economic and Financial Review,








9



(4), 450-460. doi:10.18488/journal.aefr.2019.94.450.460

The investigation’s goal was to assess the usefulness of grants and foreign aid in alleviating poverty in Nigeria. The researchers used data from various sources, such as technical cooperation grants (TCG), official development assistance (ODA), Grants (GRTS), and External Loans. The statistical test used was the Autoregressive Distributed Lab bounds. The results provide support that TCG and ODA have adversely affects poverty reduction while GRT and EXL, in the long run, have positive effects. Vice-versa is the case for the aforementioned in the short term. Therefore, foreign aid and grants that are from TCG and ODA do not have positive relationships with alleviating poverty in rural areas.

This study addresses specific grants and their purpose, which is essential because, in idea, foreign aid and grants are useful. It is crucial, however, to assess which grants are beneficial and to what extent. The methodology focuses on statistical analysis and uses numerical values to assess areas such as “poverty reduction.” Furthermore, the study highlights the need for policy implementations that will aid in making foreign aid and grants effective in improving the economy.

This source helped discuss specific grants which I will use when talking about the origin and forms of foreign aid. As I plan to discuss foreign aid, it is essential to know the forms which are beneficial and what common qualities can be marked as being responsible, potentially, for their success.

This essay will focus on a patient encountered while on placement. The patient was 64-year-old male named Jim who was diagnosed with drug and alcohol induced paranoid schizophrenia thirty years previously.

Jim is an excessive smoker of cigarettes. This has resulted in Jim having a diagnosis of Chronic Obstructive Pulmonary Disorder (COPD) and this presented as being Jim’s main nursing problem because without treatment symptoms can deteriorate quickly and become life threatening. (Brooker et al 2013) Jim is presenting with breathlessness, a chesty cough and ongoing wheezing. The main nursing problem therefore involved interventions being put in place to ensure Jim’s breathing problems were stabilised and that his safety was ensured. The secondary nursing problem that was evident when caring for Jim related to his dysphagia which caused Jim significant difficulties with swallowing certain foods.

The rationale for the choice of this patient was made due to the extent and range of Jim’s support needs. It also gave the nurse the chance to research Chronic Obstructive Pulmonary Disorder and how this impacted on the patient and what nursing interventions were used to ensure high quality care. The additional care needs related to dysphagia provided the opportunity for the nurse to gain insight into specific nursing interventions that were used. A further rationale is that both nursing problems impacted significantly on Jim’s quality of day to day life. Jim’s nursing problems will therefore be based on the FOCs focusing on Jim’s breathing problems FOC 7 and 3, and Jim’s eating and drinking issues (FOC 9)

These symptoms clearly link to the Fundamentals of Care (FOC) that were introduced by the Welsh Assembly Government. (WAG 2003). The FOC consist of 12 principles which are as follows:  1) Communication and information, 2), respecting people, 3). Ensuring safety, 4) Promoting independence, 5).Relationships,  6) Rest and sleep, 7) Ensuring comfort, alleviating pain, 8) Personal hygiene, appearance and foot care, 9) Eating and drinking, 10) Oral health and hygiene, 11) Toilet needs, 12) Preventing pressure sores.

These principles were introduced across Wales to ensure equality of provision and to provided patients in different settings with information about the quality of care which they could expect to receive. (WAG 2003)

The FOC will be used in conjunction with the nursing process.  The nursing process has been introduced as a system that consists of 4 key stages assessment, planning, implementation and evaluation. (Hamilton and Price 2013).  The purpose of this framework is to ensure that patients receive the highest quality of care at all times, and that this is evaluated.  Kozier et al (2012) state  that the use of the nursing process is the  most effective way for identifying the needs of patients, which will then enable nurses to recommend the most appropriate nursing interventions.  The nursing process is of paramount importance in keeping patients safe and can be used to ensure patients receive the best quality nursing care. (Alfaro- Le Fevre 2006). Furthermore, Howatson-Jones, Standing & Roberts (2015) claim that critical thinking is central to the nursing process in order for care and treatment plans to be put in place and reviewed.  This continual process of evaluation will allow nurses to improve the quality of care they give and also learn from reflective practice.

This assignment will therefore apply both the nursing process and FOC to Jim’s condition focusing mainly on the main and secondary nursing problem. The main focus will be on the assessment and implementation stages of the nursing interventions that were used.   The assessment tools will include Care and Treatment Plans, Medication plans, risk assessments, news charts etc. These frameworks will enable a more comprehensive assessment of patient outcomes and will also allow any risks to be highlighted when using the nursing process.

In accordance with the Nursing and Midwifery Council (NMC 2018) to maintain confidentiality all names used within this essay will be pseudonyms and locations have been changed.

PEN PICTURE

Jim is a 64 year old patient with a diagnosis of schizophrenia. He has resided in a nursing home for seven years and has been diagnosed with Chronic Obstructive Pulmonary Disorder and has dysphagia. Jim also has difficulties communicating. He has a history of alcohol and drug abuse, and also smoking which have contributed to his condition. Jim also has a soft diet in place due to difficulties with swallowing. Jim receives few visitors and has no meaningful contact with his family. His condition significantly impacted on the quality of his day to day life, which is linked to the Fundamentals of Care FOC 3, 7 and 10. (WAG) (2003)

Assessment stage of nursing process.

The first stage in the nursing process is assessment. During this stage it is essential to gather information from the perspective of the patient and any other previous support plans, For example in the case of Jim, he already a risk assessment and also care and treatment plan for when he was experiencing difficulties associated with his Chronic Obstructive Pulmonary Disorder This plan outlined the nursing interventions that were recommended to be used in order to safeguard the wellbeing of Jim in regards to his breathing problems These assessment tools are vital to ensure that Jim had access to effective and safe care ( Barret et al 2012)

Pathophysiology of COPD

Chronic obstructive pulmonary disease (COPD) is a condition that causes serious breathing difficulties that is related to lung function. (Dougherty and Lister 2015)  Symptoms include coughing and wheezing due to damage to the lining of the lungs. Smoking increases the risk of contracting COPD and is responsible for it in 90% of cases. (

www.nhsdirect.wales.nhs.uk

)

The News chart is an important tool used within the assessment stage of the nursing process and is used to identify acutely ill patients. The National Early Warning Score (NEWS) is a tool developed by the Royal college of Physicians. The purpose of the tool is to provide a standardised system to monitor early warning signs of acute illness and has been introduced across the NHS to help nurses to quickly identify a deteriorating patient/ condition. This was intended to improve patient safety and standards of care by allowing nursing interventions to be tailored to the specific needs of the patient (Hughes 2013). It will provide the nurse with up to date information on respiration rate, oxygen saturation rates, and systolic blood pressure, pulse rate, level of consciousness and temperature. (Kelly 2018) The NEWS chart is an essential part of patient assessment as it provides an indication of the degree of care that is required, it also monitors any deterioration and improvements with the patient’s symptoms. (Abbott et al 2015). Furthermore, the NEWS chart enables the nurse to identify the level of risk to the patient through numeric assessment. (0-2 no risk, 3-5 threat of acute illness, 6-8 likely to deteriorate quickly, 9 the patient has an immediate life threatening condition)

http://www.1000livesplus.wales.nhs.uk

In the case of Jim the News chart indicated the following that his respiratory rate was 22 beats per minute which scored 2 points on the NEWS chart. Jim’s temperature was 37 degrees which scored zero points as this is within the normal parameters. Jim’s pulse rate was recorded as being 43 beats per minute which scores one point on NEWS chart, Jim’s systolic blood pressure was assessed as being 111 which again scored one point on the NEWS chart. Jim AVPU score was zero as Jim was fully alert and responsive during observations of the nurse. Therefore, in this instance, the overall score documented within the NEWS chart was 6 indicating that he was likely to deteriorate quickly.

Pathophysiology of related


dysphagia

Every patient within the NHS has a legal right to have a care and treatment plan. The care and treatment plans are an individualised plan to provide holistic care. (Barret et al 2012) It is formulated by a multidisciplinary team and includes nurses, social workers, patient and can also include the patient’s family.  It is particularly important where possible to involve the patient involving their health in line with FOC principles as this ensures that the patient is treated with dignity, respect, it promotes inclusion which enhances independence ( FOC 1,2,4) Jim’s care and treatment plan stated that his main care needs were breathing (due to his COPD) and dietary. The care and treatment plan indicated that Jim had been diagnosed with dysphagia. Dysphagia is a condition which affects a patient’s ability to swallow. (Dougherty and Lister 2015) This condition is often linked to COPD and can affect the mouth, throat and oesophagus. Dougherty, L., Lister, S., & West-Oram, A. (2015). However, in the case of Jim it was limited to his throat meaning he was at high risk of choking.  (FOC 3, 7, 9)  Jim had been assessed on the malnutrition universal screening tool (MUST) which indicated that he was at serious risk of malnutrition due to scoring 2 which indicated a weight loss  and that there were risks to his health unless support was planned and implemented.  (Scott 2008)

Planning stage of nursing process

The second stage in the nursing process is the planning of nursing care. This uses a problem-solving cycle to meet the patients’ needs in a person centred manner.  (Hall & Ritchie 2013, p 87).  Ballantyne (2016) stresses that this stage is vital in allowing nurses to plan care interventions and affords them the chance to discuss these with the patients. This planning often relies on the care and treatment plan which allows the nurse to provide holistic care and to discuss the ongoing treatments with the patient, their family, and the multidisciplinary team.

In the case of Jim, the nurse had spent considerable time establishing a therapeutic relationship. This was important as it enabled the nurse to communicate effectively with Jim regarding his condition which is essential within the assessment stage of the nursing process as it allows the nurse the chance to assess and react to patients’ physical, social and psychological needs, which ensures that the needs of patients are prioritised as outlined by the Nursing and Midwifery Council (NMC).  (Feo et al 2014) Furthermore, a good therapeutic relationship will allow the patient to develop trust and will result in the patient being more likely to open up about their support needs. This will enable the nurse to better understand the patient and also to implement effective nursing interventions more quickly to improve patient outcomes. (Kourkouta, L., & Papathanasiou 2014). A therapeutic relationship was essential to promote patient autonomy and independence and ensure respect at all times during care and treatment. (NMC 2018)  This also ensures that patient’s needs are individualised, it also promotes professionalism and trust and ensures that information can be recorded in detail so that safe interventions can be offered. (NMC 2018)

Mansel and


Bradley-Adams (2017) support the mnemonic The Mental State examination (MSE ‘I AM A STAR’.) They stress that this method is an excellent and effective tool that can be used when assessing the holistic needs of patients. The MSE can be used by the nurse to present an overall assessment relating to the patient’s current presentation, which will allow the nurse the opportunity pass on information where appropriate if any concerns arise and commence a risk assessment if necessary.

The two main risks related to Jim’s condition are his COPD and his dysphagia as these are both potentially life threatening conditions, it is therefore essential that these are prioritised within the planning stage of the nursing process. (FOC 3) Risk assessments were therefore necessary with regards to both his breathing and eating and drinking and risk of choking due to swallowing difficulties. This process of assessing immediate risks is vital to ensure a patient safety. Dougherty, Lister and West-Oram (2015) it was important for Jim that risk assessment was part of his care and treatment as he was susceptible to infection based on finding on the NEWS chart. . It was also important because it was deemed that Jim was a deteriorating patient (NEWS chart) and therefore he required control measures such as inhaler to improve his breathing.

Regarding his COPD the nurse will need to be aware of the risks of infection, heart problems, collapsed lung (Pneumothorax) and rapid deterioration Dougherty and Lister (2015). The main risk associated with his dysphagia is choking and putting interventions in place to ensure that he has enough nutrients within his diet as recommended within his care and treatment plan.

Implementation stage


of nursing process

The third stage of the nursing process involves the nurse putting into action the care and treatment plans and recommended interventions that have been formulated within these plans. (Hall and Ritchie 2013)  Peate and Wild (2018) suggest that it is important at this stage to ensure that the patient is involved in their treatment so that they feel they have some control and are autonomous regarding their health and wellbeing.  This will impact positively on patient outcomes because it will result in the patent feeling more respected and promotes independence as indicated in the principles of FOC 1, 2, 4)( Barrett et al 2012). Displaying positive body language was very important as this encouraged Jim to engage and reassured him that the Nurse was there to help. It was important to show patience and compassion especially when he was experiencing symptoms relating to his mental health that hindered his ability to rationalise, and communicate effectively

.



Related to FOC 1

.

(McCabe & Timmins 2013). Maintaining this relationship whilst focusing on the main nursing problems was important as it enabled the nurse to assess Jim’s support needs  better and gain a better understanding of Jim’s needs in order to provide person centred care in a holistic way. (Koizer 2008).

Jim’ care and treatment plan advised that in order to treat him effectively he required medication. Including inhalers, the nurse will therefore need to work with Jim on the use of these devices to ensure safety and effectiveness of treatment.  The nurse will also need to liaise with Occupational health with regards to breathing exercises and techniques that can clear the airways and ensure that Jim practices these where required to improve his breathing if required. Lister, S., & Dougherty, L. (2015) Additionally, because he is deteriorating the Doctors have prescribed Jim with Theophylline tablets. These tablets will also require regular blood test to monitor the volume of medication within bloodstream. It will be essential to closely monitor Jim to observe for possible side effects, which could include insomnia and or irregular heartbeats which may require additional nursing interventions. (Jilani & Sharma 2018) Based on Jim’s COPD the nurse will need to ensure that Jim has enough fluid intake as dehydration can lead to a decrease in blood pressure and an increase in heart rate which could lead to organ failure. (Sumnall 2007) It was therefore important to commence a fluid balance chart immediately and monitor the colour of his urine because monitoring urine output is an indicator of infection and can be used to measure whether Jim was having sufficient fluids. (Lupi 2018). Furthermore, the observations needed to be increased and the nurse in charge needs to be informed of any changes in heart rate, respiratory rate, systolic blood pressure, level of consciousness, oxygen saturation, temperature, which could be triggers to potential sepsis and other critical health conditions.

The care and treatment and risk assessment plans therefore advised that Jim should be given feeding and drinking aids to ensure his safety. It was also advised that Jim’s food and fluid consumption should be recorded due to the risk of malnutrition. It was also pinpointed within the care and treatment plan that treating Jim’s dysphagia was essential to reduce the risk of him aspirating and to ensure that he had focused support to maintain a high level of nutrition safely. (Potter and Perry 2016) As Jim had serious problems linked to his dysphagia such as difficulties swallowing, chewing foods, it was strongly recommended that his diet was modified to reduce the risk of choking, this involved a recommendation that Jim was to only be fed in an upright position. Furthermore, Jim’s care plan clearly specified that Jim was to only be given a soft diet. This was to ensure Jim’s safety in eating and drinking.  (FOC 3 and 9.)  The nurse’s role will therefore involve supervising his eating ensuring that he is fed in an upright position and liaising with the cook and dieticians to make sure he has a nutritional diet that is safe to eat according to the recommendations of the dietician. One advantage of this was that the dietician had extensive knowledge and skills that could be used to ensure that Jim’s nutritional needs were met. For example, one of the side effects of some medication is a loss of appetite, this was observed in the case of Jim,  the nurse recommend a medication review and the dietician was liaised with who then  modified  Jim’s diet to ensure he had sufficient nutrients after  (Leaker 2013). This ensured Jim was safeguarded from risks of malnutrition as much as possible.

It will be important for the nurse to put in place fluid and food charts to record fluid and nutritional intake. In this instance, the all wales food chart was used. This food chart is essential so that all nursing staff are aware of the needs and potential risks of the patient and so that patients can monitor quickly any deterioration with the patient such as unexpected weight loss.  (Leaker 2013). The nurse must communicate with dieticians when required to ensure the patient’s diet incorporates enough protein and micronutrients, as this would more likely result in pressure ulcers not forming which would ensure that the nurse can adhere to (FOC 12). Furthermore, ensuring enough micronutrients are available within a diet would also improve the chances of a wound healing. (Leaker 2013)

The nurse will need to employ initially feeding aids such as cutlery and nosey cups. It will be important to ensure that food and drinks are not left for too long as thickener that is used within drinks will become adversely affected. It will also help if the Jim is fed when he is not tired and that he is not distracted while eating as his poses a further risk of choking. The dietician had advised three particular nutritional drinks for Jim that were chosen by Jim. These drinks were chosen to avoid potential calorie deficit.   (Schneyder, 2014), recommends that nutritional drinks are a useful part of managing nutrition in older patient’s because it safeguards them from malnutrition. On issue hat confronted the nurse was the fact that some of the meals appeared unappetising which   meant that Jim was reluctant to eat them. This required the nurse to encourage Jim which was often time consuming but was essential to his recovery and wellbeing.

Evaluation stage of nursing process

The fourth stage of the nursing process is evaluation. At this stage the nurse has to evaluate whether the care and treatment plans have been effective in meeting the needs of the patient. (Hamilton and Price 2013).  This process of evaluation needs to be ongoing as the patient’s condition and needs can change day to day and is important that the nurse bases the care on the nursing process and fundamental of care. Hall and Richie (2013). As Jim was a patient encountered on placement it was impossible to evaluate the effectiveness of interventions. However, if Jim improved significantly it would be important for the nursing staff to address lifestyle changes such as stopping smoking, breathing techniques, eating healthier diet and exercising. It would be important at this stage to involve the multi-disciplinary team and continue to adhere to and update risk assessments and care and treatment plans.

Conclusion

In conclusion, this essay has enabled the student nurse to gain considerable insight into two common medical conditions.  The primary condition was COPD and frequently related to this condition is dysphagia. It was interesting that both the main condition and the secondary condition were potentially life threatening unless interventions were put in place to address the adverse effects of both conditions.  The nursing process became essential in implementing a person centred and systematic approach to planning Jim’s care and implementing nursing interventions. The NMC (2018) support that the nursing process this is an important facet of nursing care.  It provided the cornerstone to provide safe and effective care to serious medical conditions.   Hall and Ritchie (2013), Hall and Ritchie further state that this process ensures high standards of patient care when applied appropriately.

The importance of the assessment stage became apparent when caring for Jim in order to gather information so that a care and treatment plan could be drawn up which was essential for the planning and implementation stages of nursing process. It also enabled a plan which included the fundamentals of care to provide holistic care for Jim. (WAG 2003) A holistic nursing process is essential to make sure the needs of patients are met in the best way possible, as assessments involving a multi-disciplinary team approach are intended to ensure that all areas of a patient’s care are explored in detail to result in better health outcomes for the patients. (NMC 2018) This was particularly important for Jim as he had two potentially life threatening conditions and there was an overlap in his care. FOR example fluid intake monitoring was essential for both COPD and eating and drinking issues. Although not the main focus of this essay the fundamentals of care became important in the treatment of his underlying condition of schizophrenia.

This emphasises the importance of the fundamentals of care and of taking a more holistic approach rather treating conditions in isolation. This case study has also highlighted the importance of the assessment tools and the necessity for nurses to gain information about their use. In Jim’s case one essential tool was the care and treatment plan which is an ongoing framework that used to meet the varied support needs of Jim. From the nurse’s perspective it is an essential guide for daily nursing care.  Additional tools included fluid and food intake charts, risk assessments, medications, multi-disciplinary input, it was interesting to use Jim as a case study as it was insightful to learn about the range of nursing tools involved when caring for a critically ill patient.

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