Apply the concepts of epidemiology and nursing research to a communicable disease

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Apply the concepts of epidemiology and nursing research to a communicable disease

In a written paper of 1,200-1,500 words, apply the concepts of epidemiology and nursing research to a communicable disease. Communicable Disease Selection Choose one communicable disease from the following list: 1.Chickenpox 2.Tuberculosis 3.Influenza 4.Mononucleosis 5.Hepatitis B 6.HIV Epidemiology Paper Requirements Include the following in your assignment: 1.Description of the communicable disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence). 2.Describe the determinants of health and explain how those factors contribute to the development of this disease. 3.Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. (The textbook describes each element of the epidemiologic triangle). 4.Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up). 5.Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organization(s) contributes to resolving or reducing the impact of disease. A minimum of three references is required. Refer to “Communicable Disease Chain” and “Chain of Infection” for assistance completing this assignment. Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center. Use Communicable Disease Chain

Mental Health Study Report: History- Causes and Impacts

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Mental health is the condition of an individual with regards to their psychological and emotional well-being.  According to mental health charity Mind (England and Wales) there are approximately 1 in 4 people in the UK who will experience a mental health problem each year.  In England 1 in 6 people report experiencing a mental health issue in any given week.  Mental health is a huge issue within society with many sufferers roughly 16.5 million people are affected in the UK (2017 figures).  There are various types that include depression, anxiety, schizophrenia and Post Traumatic Stress Disorder to name but a few.  These conditions are categorised under the umbrella term of ‘mental health’.  According to figures in 2016 mixed anxiety and depression is the most common disorder affecting 7.8 in 100 people in the UK.  According to Dr Lucy Acheson (A chartered counselling and coaching psychologist) ‘insecurity is a form of anxiety – a fear of the self; and although symptoms are sometimes milder than those of ‘conventional’ types of anxiety, I think that insecurity can be more debilitating and have a greater impact on the quality of our lives’.

Depression is a mental disorder that causes many symptoms which include loss of interest in something or feelings of guilt or self-worth to name but a few.  According the mental health foundation of 70 years, in 2013, depression was the second cause to those with a long-term disability.  Due to a GP conducted survey this has shown that mental health tends to affect those who live in the North of England, particularly Liverpool, Halton and Knowsley more than those in the South East including more affluent areas such as Surrey Heath.

The cause for mental heath issues is unknown, however, there are many likely reasons such as unemployment, as figures from 2011 to 2015 suggest the highest unemployment was in the North of England (particularly the North West) whilst the lowest was in the South East.  Unemployment can be the cause of varying mental health issues, when people don’t have a job to go to or nothing to get out of bed for and no routine as well as no fixed income they then can turn to alcohol and drugs as a way of escapism, If this leads to long term abuse depression can kick in.  In the North East after the closure of the steel industry and coal mines this resulted in mass unemployment and depression became a huge problem, some individuals were unable to cope with this and took their own lives.  Generally, the south east of England is more affluent area with better opportunities and higher paid jobs providing a better quality of life, this has an impact on mental health in a positive way.  However, there are other factors including homelessness, being unable to get the right care and treatment when needed.  With no fixed abode, obtaining benefits or registering with a GP is extremely difficult.  Having no money, no food and living outdoors can have a massive affect, not only on mental health but also on physical health, well-being and hygiene.  Homelessness also has strong links with alcoholism and drug use or dependence.  Drug users generally suffer with mental health as a result of long-term abuse.

(North East prescribes twice the number of antidepressants per person as the South East and London)

Mental health has always been around, however, it is more openly discussed now.  Today there are greater demands and pressures in a much faster pace of everyday life causing more and more people unable to cope.  There are more facilities for mental health in the south of England, thus reflecting the allocation of funding being received greatly in the south of the country i.e. the more affluent areas of England, where perhaps it is not necessarily needed as much.  A survey that was conducted by the worlds university rankings shows that the north west of England has the highest percentage of students who are so worried about their finances and how they are going to survive financially that it is having an effect on their mental health, compared to the lowest in the south west of England.  According to 2014 figures, 19.7% of people in the UK who are 16 plus showed symptoms of anxiety or depression, which has risen by 1.5% since 2013 and was higher among females (22.5%) compared to males (16.8%).

The awareness of mental health started in the 1600’s but not fully developed until around the 18

th

century.  More recently records were found by the National Health

Service which proved that in 1670 that ‘madhouses’ existed.  In 1774 the madhouse act was put into place and was the legal structure behind the way they were run and to regulate and legalise them. As research into mental health developed doctors began looking at the functioning of the nervous system and the brain to try and establish reasons as to why people suffered with mental health and to help them find a solution or appropriate treatment for their patient.  Mental health affects so many people today, the aim of this assignment is to look in more depth as to the reasons behind it and how it has developed and the different factors that contribute towards the mental health of an individual.  According to studies of the house of commons library briefing papers, mental health is on the rise and has been since 1993, this is thought to be partly as more people have the courage to step forward and admit that they have a problem and that they need help.  Financial problems, social media and one’s sexuality are all thought to contribute to the rise of mental health.  Research by the BBC suggests that mental health campaigners and psychiatrists are questioning social media and if this is increasing social bullying and peer pressure.  Figures show that females aged 16-24 declare their mental health issues, however, males are more likely to commit suicide, this is the biggest killer in men up to the age of 49.  There are 6000 suicides in the UK every year, problems sometimes start as a child maybe from a trauma, physical/emotional abuse and develop as life goes on.  It is extremely important that we look after our mental health and that of others.  There are many charities that have been set up that support people with mental health issues, there are dedicated helplines, online chats and drop in centres where anyone experiencing a mental health issue can attend.

Mental health is extremely relevant to the Paramedic profession, not only for the patient in question but is also that several Paramedics may be able to relate to themselves due to the nature of the role.  The role of a Paramedic has changed along with the changes in society.  There is a massive increase in the amount of mental health cases that are regular part of an everyday workload.  These situations can be extremely challenging and sometimes dangerous as Paramedics are usually the first on scene, this can compromise the safety of the crew if the patient is suffering from an acute mental health episode.  Often these patients can be agitated, violent and occasionally carrying a weapon, Paramedics must be aware of their surroundings, alert and ready for any quick change in eventuality.  Cases can be time consuming whilst trying to build a rapport with a patient who may be hallucinating or hearing voices, this can take a long time trying to keep them calm and reassured also finding the correct care pathway for that patient.  There maybe situations where a Paramedic must liaise with a GP or mental health worker this can then have an impact on the resources being used over a longer period than usual and sometimes contact not being made if it is an out of hours case.  A survey was conducted by the College of Paramedics, it revealed that Paramedics across the country do not feel confident that they have the skills and knowledge necessary when dealing with a mental health patient and the services that are set up are not effective.  98% of paramedics believe there should be more training and education of how to manage a mental health patient effectively and safely. 83% of Paramedics stated they are put at risk when dealing with patients with a mental health illness and 94% believe mental health cases are on the rise.  Ambulance staff including call handlers are more susceptible to mental health issues usually Post Traumatic Stress Disorder due to the traumatic things they have witnessed or heard during an emergency call.  Blue light champions in partnership with mental health charity, Mind, has been put into place to help those staff that need to talk to someone about their feelings after all they are only humans too.

Unfortunately, there is still an underlying stigma attached to mental health and those who suffer with it making much more difficult to manage.  People can be discriminated by society and in all areas of their life this can lead to things like unemployment, homelessness, being socially excluded and relationship problems, this can make people feel trapped or isolated and can have a massive impact.  The social needs of mental health sufferers can be made worse by the press or media as people can be assumed as violent, dangerous or evil, this can lead to social isolation as nobody wants to be linked to these people. There is a law in place that to discriminate against those with mental health is illegal which is the equality act 2010.    There are community mental health teams in place that help with supporting individuals with mental health disorders, these include social workers, community mental health nurses and psychiatrists that go out to visit patients in their own home or the patient can drop into a GP surgery or outpatients department.  There are various charities set up including Mind and Rethink, which offer advice and guidance to those in need either online or over the phone and can put them in touch with the relevant departments they need.  They also do a fantastic job of raising awareness of mental health, without these charities there would be so much more pressure on the NHS.  On a national level the government has failed in providing promised budgets to the NHS and in turn the best care possible to mental health patients.  According to figures, NHS England planned to spend 11.9 billon on mental health 2017/2018, the NHS five-year forward plan was written in February 2016 and has advised that there will be key improvements in mental health by 2020.  The mental health workforce will be expanded gradually and will be rising to 1500 by March 2019.  There will be a reform of health which will allow a redirection of funding of around 350 million, more support and an increased access to specialised peri natal care, reduction in the out of area placements making the provision of care closer to home and relatives, increased access to crisis care liaison services in emergency departments and on patient wards and suicide prevention.  Between 1955 and 1994 roughly half a million patients were discharged from mental health hospitals as they were closed by the state resulting in many people left untreated and going on to live with severe mental health issues.

As previously stated, mental health disorders affect many types of people and one of the biggest contributors to accessing health services are language barriers.  Many migrants that enter the UK suffer with mental health problems as they do not speak English this will then require an interpreter, which in turn, costs more money.  This is the same scenario for people who are deaf, according to Sign health, deaf people are twice as likely to experience mental health issues such as depression compared to hearing people, this makes it harder for services to be accessed.  Sign heath began a therapy service for the deaf, using fully trained therapists who are also deaf and able to sign to the patient.

It is clear there is an ever-increasing demand on the NHS services to provide adequate acute and long-term care for all.  Providing up to date service and solution for patients suffering from many different physical and mental health problems.  However, the workload could be greatly alleviated by fast tracking mental health patients through the required immediate mental health care that they are known to.  The system in place, however, only allows them to be directed through the usual Accident and Emergency department route before they can be filtered through to the relevant, available mental health team, even then they can only be offered the service or treatment that is available as apposed to their long term mental requirements.  The only obvious answer seems to be increased funding in all areas of the National Health Service, especially the mental health budget where by perhaps patients were treated quickly and long term in an environment that is sufficient for their needs which looks back to the now closed established care in the community supervised housing or hospital rather than leaving the most vulnerable people alone and fending for themselves often without family in an ever increasing ignorant and thoughtless society.  At the moment, It is a sticking plaster that is trying and failing to stem the flow of a massive wound, however, the proposed NHS five year forward plan proposes that 2.3 billion pounds per year by 2023/2024 will be spent on mental health services, it will be interesting to see if this is successful and gives patients with mental health disorders the treatment they deserve.



References

  • Brown, M (2014).

    Should we change the Mental Health Act 1983 for emergency services?.



    . .: Journal of Paramedic Practice, Vol 6, issue5 . p226-227
  • Carl Baker. (2018).

    Mental health statistics for England: prevalence, services and funding.

    Available:

    https://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN06988 . Last accessed 08Jul2019

    .
  • Carla Minsky. (2016).

    UK students’ mental health affected by financial worries.

    Available: https://www.timeshighereducation.com/student/news/uk-students-mental-health-affected-financial-worries#survey-answer. Last accessed 08Jul2019.
  • Claire Murdoch, National Mental Health Director. (2017).

    Mental Health Five Year Forward View Dashboard.

    Available: https://www.england.nhs.uk/mental-health/taskforce/imp/mh-dashboard/. Last accessed 08Jul2019
  • College of Paramedics . (2014).

    Paramedic Curriculum Guidance. 3 rd edition. Bridgwater. The College of Paramedics..

    Available: https://collegeofparamedics.co.uk/downloads/Written_Evidence_from_the_College_of_Paramedics.pdf. Last accessed 08Jul2019
  • DR Lucy Acheson (2009).

    anxiety attacks, conquering your insecurities, anxiety and fears



    . .: DR Lucy Acheson. p29
  • Evans, J., Macrory, I., & Randall, C. . (2016).

    Measuring national wellbeing: Life in the UK.

    Available: https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/measuringnationalwellbeing/2016#how-good-is-our-health.. Last accessed 08Jul2019.
  • Ferrari, A.J., Charlson, F.J., Norman, R.E., Patten, S.B., Freedman, G., Murray, C.J.L., … & Whiteford, H.A., . (2013).

    Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease study 2010. PLOS Medicine, .

    Available:

    https://www.mentalhealth.org.uk/statistics/mental-health-statistics-depression. Last accessed 08Jul2019

    .
  • Helen Pidd. (2019).

    Depression This article is more than 2 months old Most depressed English communities ‘in north and Midlands.

    Available: https://www.theguardian.com/uk-news/2019/may/06/most-depressed-english-communities-in-north-and-midlands. Last accessed 08Jul2019.
  • .. (2014).

    19th Century Mental Health.

    Available: http://www.ashfordstpeters.nhs.uk/19th-century-mental-health. Last accessed 08Jul2019
  • Kate Dale. (2018).

    physical/mental health project lead .

    Available: https://www.nice.org.uk. Last accessed 08Jul2019
  • McManus, S., Meltzer, H., Brugha, T. S., Bebbington, P. E., & Jenkins, R. (2017).

    Adult psychiatric morbidity in England, 2007: results of a household survey.

    Available: https://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems#.XSOMdehKjIU. Last accessed 08Jul2019
  • McManus S, Bebbington P, Jenkins R, Brugha T. (2017).

    Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014..

    Available: https://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems#.XSOMdehKjIU. Last accessed 08Jul2019.


Risk Factors in Venous Thromboembolism Risk Assessment

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Introduction

Venous thromboembolism, commonly known as VTE is a condition in which a blood clot develops mostly in deep veins of the leg, groin or arm and travels in the circulation and lodging in the lungs, called pulmonary embolism (PE). VTE generally occurs after major general surgery and if not taken care of on time, it might become life threatening (Laryea and Champagne, 2013). Therefore, proper risk assessment is essential.

Waterlow score, also known as Waterlow scale, provides an estimated risk for the development of a pressure sore in a patient. This tool was developed in 1985 by Judy Waterlow, a clinical nurse teacher (Thorn et al., 2013). Waterlow score is often used for risk assessment in surgical patients. Therefore, it is of great use for risk assessment for VTE since surgical patients are more vulnerable to develop it, as stated before. This too, is helpful for the patients to evaluate the risks and benefits of the surgery as a part of the informed consent. It is also used for identifying elective and emergency patients who would benefit the most from the management in ICU setting. The purpose of the risk assessment is to identify the extent to which the surgical patients are at a risk of developing VTE so that measures can be taken in advance to this is a preventable health issue (Henke and Pannucci, 2010). The Waterlow tool uses seven items for assessing the risk of developing a pressure ulcer. Those scoring 10-14 are at risk, those scoring 15-19 are at high risk and patients are at very high risk if they score 20 and above (Healthcare-Improvement-Scotland, 2009). In case the risk assessment is not undertaken, the patients would develop VTE that might be difficult to be treated. This, in turn, would cost huge to NHS as treating patients suffering from advanced stage of VTE involves a lot of expenditure. At the same time, this would have a severe physical and psychological impact on the patients. This is because the treatment is not only long terms, but such patients might be discriminated although VTE is a non-communicable disease.

Discussion

The different risk factors included in the risk assessment and explain their relevance

As already stated above, the Venous Thromboembolism is about clotting of blood in the deep veins of leg, groin or arm (Thachil and Bagot, 2018). The very definition of the issue highlights the involved risks that patients suffering from it tend to face. As a result, a timely and careful risk assessment risk assessment process is something that is required to be undertaken in order to manage its progress further. However, as with any other risk assessment process, it is always essential to identify the risks involved in the circumstance, which in this case is Venous Thromboembolism or VTE. In a study conducted Henke and Pannucci (2015), the risk factors involved in VTE depend on multiple factors of which inherited risk factors including the deficiencies of natural anticoagulant proteins (e.g. Antithrombin), genetic abnormalities such as factor V Leiden or prothrombin 20210A, and/or the other miscellaneous hypercoagulable states such as anti-phospholipid syndrome could be involved. Patients exposed to these inherited risk factors might have no actual way of avoiding this issue. Besides, with these inherited risk factors they tend to become more vulnerable to contract VTE if they undergo surgery, infection, trauma, etc. In other words, their chances of acquiring VTE increase to a great extent than those with no inherited risk factors.

Other than genetic and hereditary factors, VTE also involves external risks factors, which are also known as the acquired ones, including history of VTE, age, obesity, presence of malignancy, etc (Henke and Pannucci, 2015). In a study conducted by Johnson and Kumar (2015), it has been stated that in Europe, VTE is considered to be the third most common cause of vascular death after myocardial infarction and stroke and mostly people contract it during and after hospitalisation for surgery and acute medical illness. The period of healing process in the post-surgical scenario is pivotal, as it is during this time that patients’ immune system tend to work at a slow speed, which increases their chances of being attracted by infections. The contraction of VTE therefore, can give rise to other co-morbidities like malignancy, as the issue is closely related with deep venous thrombosis (DVT) and pulmonary embolism (PE) (Smith et al., 2014). Seen from another perspective, the existence of risk factors (the co- morbidities) like tumour-induced hypercoagulability, vascular injury from surgical treatment, chemotherapy, radiation, and venous stasis, etc can help the health care professionals to give attention on the patients’ vulnerability to contract VTE, which in turn can lead to early intervention process to prevent it or address it. Another risk factor, which although remained understudied, is increasingly being associated with the deaths associated with VTE, is renal cell carcinoma (RCC). In the study of Smith et al. (2014), the association between RCC and VTE has been shed light upon, as the authors argued that “among newly diagnosed patients with RCC who had localized disease, occurrence of VTE has been linked to increased risk of death within 1 year of cancer diagnosis”. A deep study about the association between RCC and VTE can be relevant for the patients as they can be prescribed with thromboprophylaxis to prevent the clots for forming in the veins.

Actions that could be implemented to reduce these risk factors, including any multi‐agency involvement

After identifying the risks associated with VTE, the next step is to assessing and managing those. As already stated, VTE is a preventable disease; therefore the practitioners need to choose their actions judiciously. A common action that is often undertaken by the professionals is prophylaxis, which acts to reduce the clotting of blood in the veins, thereby helping the patients to get rid from swelling or inflammation. In the study conducted by Nwulu et al. (2014), patients with the risk of contracting deep venous thrombosis (DVT), undergoing colorectal procedures, are often prescribed the use of preoperative prophylaxis, as it reduces the chances of DVT. Therefore, it can be stated that the professionals, after consulting with the patients, their family members and the other team members can decide whether to prescribe the patient with preoperative or post-operative prophylaxis. The same study have also stated that a combination of intermittent pneumatic compression (IPC) devices with pharmacological methods tend to give better results in managing the issue of VTE than either method alone. Therefore, actions can be taken to include IPC along with pharmacological interventions to relief the patients from swelling and deep venous blood clots by squeezing their legs and increase blood flow through the veins (Laryea and Champagne, 2013). This action can be adopted in the case of DVT of leg or thighs. However, this action can lead to certain side effects, which can be relevant for the patients’ level of discomfort, as they may involve skin breakdown, injury due to pressure, damaging the nerves, discomfort, etc. Hence, it is essential for the care professionals to involve only specialists to handle the cases of VTE and take consent from the patient and/ or the family members before its application. In this regard, it can also be stated that patients with DVT and the history of colorectal surgery, can specifically be provided with thromboprophylaxis along with low-dose heparin (Laryea and Champagne, 2013).  As far as sole pharmacological interventions are concerned, the professionals can consider prescribing low-dose unfractionated heparin (LDUH) and low-molecular-weight heparins (LMWHs). Another action that can be undertaken by the professionals to diagnose the level of risks patients are involved in is the usage of risk assessment tools like “Roger Score” “Water Low Score “and “Caprini Score”, among others to be specific, the usage of the Water Low Score before operating a patient can help the professionals to diagnose the risks, if involved, in developing of the pressure sore after the surgery (Laryea and Champagne, 2013). If the Roger Score is >10 and Caprini Score = 3-4, then decisions can be taken in behalf of prescribing pharmacologic or mechanical prophylaxis with IPC.

In the health and social care sector, multi-agency working plays an important role. This is because people suffering health issues often require various types of services. The need for multidisciplinary team working is growing rapidly. This is because of growing co-morbidities and growing complexities of care. Time has gone when GPs and nurses would solely delivery the needed care service. In today’s health care context, it has become essential to ensure professionals belonging to various health care occupations work together to deliver optimum quality and wide variety of care services under one roof. This is even more important for certain health issues and diseases and Venous thromboembolism is one such disease. Treating Venous thromboembolism requires skilled nurses. This is because they are responsible for injecting drugs such as heparin or low molecular weight heparin, or tablets such as apixaban, dabigatran, rivaroxaban, edoxaban and warfarin.  These medications are prescribed for quite a few numbers of months. In case VTE occurs after a provoking factor like pregnancy, surgery, trauma and/or hormone therapy etc. such medications are given for relatively longer time period. Therefore, engaging a GP for such a long time is not feasible. The role of nurses would be important in prophylaxis since it involves treating the patients orally to help them in getting rid of inflammation and swelling.

Surgical procedures are often adopted for treating VTE. This might involve placing a filter in the largest vein of the body, i.e. inferior vena cava in order to prevent blood clots from travelling to the lungs of the patients. It might also involve removing a large amount of blood clot from the vein or injecting clot-busting medicines in the vein or lung artery (Heart.org, 2019). This requires the involvement of the nurses as well as GPs. This is because surgical procedures require expert knowledge and skills, considering the risk factors involved in case of incorrect procedure performed. At the same time, the nurses are also required for carrying out certain basic activities like injecting medicines, supplying the tools and equipments to the GPs etc. Unless the GPs and nurses work together it would not be possible to undertake a surgical procedure for treating VTE effectively.

As stated earlier, VTE has high chances of leaving a strong physical and psychological impact on the patients. Thus, there is a need for counsellor also apart from GPs and nurses. The counsellor would be responsible for making the patients understand that they are not suffering from any communicable disease that would isolate them from the rest of the society. At the same time, effective counselling would enable them to reduce their physical pain out of VTE and its treatment. Apart from this, there is a need for physiotherapy and psychologist. The physiotherapist would be responsible for the physical movements of the VTE patients after their surgery and the psychologist would be responsible for developing an understanding of the patients’ current state of mind since its has a direct impact on their physical health and well-being.

Conclusion

The above discussion, therefore has been successful in bringing out few facts clearly, like VTE, although a major issues tend to occur in patients undergoing surgery, is a preventable condition, if the practitioners use both mechanical as well as pharmacological interventions judiciously. However, while undertaking any action to prevent the condition or manage it , it is mandatory to make a wise usage of various assessment tools like Waterlow Score, Roger Score, etc, in order to diagnose the involves risk factors and the patients likelihood to develop the issue. Multi-disciplinary team plays a vital role in treating VTE. This is because th patients of VTE require various types of services. Treating VTE is not an easy task. It requires trained nurses who have proper knowledge of medication as they would be responsible for injecting medicines to the patients’ body while supplying essential medical equipments and tools to the GPs during surgery. One the other hand, GPs play the most important role as they are the ones who actually perform a surgery and prescribe medications for VTE. There is a need for psychologist, physiotherapist and counsellor also. This is because after the surgery the VTE patients often feel restricted physical movements and, on the other hand, they are at a risk of developing psychological issues due to feeling inferior than others in the society.

References

  • Healthcare-Improvement-Scotland (2009)

    Adapted Waterlow Pressure Area Risk Assessment Chart

    , [Online], Available:

    Adapted Waterlow Pressure Area Risk Assessment Chart

    [20 May 2019].
  • Heart.org (2019)

    Prevention and Treatment of Venous Thromboembolism (VTE)

    , [Online], Available:

    https://www.heart.org/en/health-topics/venous-thromboembolism/prevention-and-treatment-of-venous-thromboembolism-vte

    [20 May 2019].
  • Henke, P. and Pannucci, C. (2010) ‘VTE Risk Factor Assessment and Prophylaxis’,

    Phlebology

    , pp. 219-223.
  • Henke, P. and Pannucci, C. (2015) ‘VTE Risk Factor Assessment and Prophylaxis’,

    Phlebology

    , vol. 25, no. 05, Jun, pp. 219-223.
  • Johnson, O. and Kumar, S. (2015) ‘Risk assessment and prophylaxis of venous thromboembolism in surgical inpatients: improving adherence to national guidelines’,

    BMJ

    , vol. 04, no. 01.
  • Laryea, J. and Champagne, B. (2013) ‘Venous Thromboembolism Prophylaxis’,

    Clin Colon Rectal Surg.

    , vol. 26, no. 03, Sep, pp. 153-159.
  • Laryea, J. and Champagne, B. (2013) ‘Venous Thromboembolism Prophylaxis’,

    Clin Colon Rectal Surg.

    , pp. 153-159.
  • Nwulu, U., Brooks, H., Richardson, S., McFarland, L. and Coleman, J.J. (2014) ‘Electronic risk assessment for venous thromboembolism: investigating physicians’ rationale for bypassing clinical decision support recommendations’,

    BMJ Open

    , vol. 04, no. 09, Sep.
  • Smith, A.B., Horvath-Puhó, E., Nielsen, M.E., Lash, T.L., Baron, J.A. and Sørensen, H.T. (2014) ‘Effect of comorbidity on risk of venous thromboembolism in patients with renal cell carcinoma’,

    Urol Oncol.

    , vol. 32, no. 04, May, pp. 466-472.
  • Thachil, J. and Bagot, C. (2018)

    Handbook of Venous Thromboembolism

    , John Wiley & Sons.
  • Thorn, C.C., Smith, M., Aziz, O. and Holme, T.C. (2013) ‘The Waterlow score for risk assessment in surgical patients’,

    Ann R Coll Surg Engl.

    , pp. 52–56.

Week 3 project ts jr

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Part A. Research Component: Software and Hardware Solutions

For Enterprise X to adopt a more strategic business model and embrace the inevitable paradigm shift to internetworking, it will need to do more than adopt a new Systems Architecture, it will also need to replace the components that make up its IT-Infrastructure. An obstacle for quick adoption of a new strategy is the legacy IT-Infrastructure. Analyze the challenges faced by the IT personnel in replacing legacy hardware and software. Moreover, analyze the pros and cons of the decisions regarding replacement. Bear in mind that there may be data issues and training issues to consider and address. Real-life cases that corroborate your findings and recommendations in this area will be very helpful in gaining acceptance for your plan. You should also analyze the positioning on McFarlan’s Strategic Grid in order to position the relative importance of these components with respect to cost and other factors that you might be able to identify.

To submit your assignment:

Use Microsoft Word to write a 750- to 1000-word position paper that describes your findings and recommendations.

You may include diagrams and illustrations to enhance and/or clarify your position on the technical issues addressed.

Follow APA guidelines to write the report and cite your sources as appropriate.

Save the report as SU_MIS6020_W3_lastname_firstinitial.docx and submit it to the Submissions Area by the due date assigned.

Part B. Presentation Component: IT/IS Models

You have already researched pertinent issues and prepared a Position Paper that will guide you in presenting your proposed strategy for Enterprise X. Now you must also prepare a new part of your strategy proposal for Enterprise X where you will evaluate the trade-offs with respect to costs and importance of the hardware and software components that make up the IT-Infrastructure of the company.

Keep in mind that each week you will work on a new component of your proposal presentation and, combined, these weekly presentations will become your final project proposal that will be published to the class in Week 5. Prepare a PowerPoint presentation with five to ten charts covering the aspects of your strategy described above.

Save your documentation as: SU_MIS6020_W3_Lastname_Firstinitial.pptx and submit it to the Submissions Area along with your Document by the due date assigned.

Note: There should be two documents in your Submissions Area, your position paper in Microsoft Word format and your proposal presentation component in Microsoft PowerPoint format.

Describe a research proposal. What is the purpose of a proposal?

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Describe a research proposal. What is the purpose of a proposal?

Three nursing research questions needed to be answered. Please see information below.

Week 1
Refer to syllabus for requirements of discussion board post. Answer each question with a minimum of 125 words. Please cite textbooks as a reference.
1. Describe a research proposal. What is the purpose of a proposal?
2. What does it mean to replicate a research study? Is replication a good or bad idea in nursing research? Why or why not?
3. What study will you use to replicate in your proposal? Why did you choose to replicate this study for your proposal?

1. Briefly introduce family & basic elements of assessment. Include family form & membership?i.e., who is in the family you are discussing. Information to include:

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1. Briefly introduce family & basic elements of assessment. Include family form & membership?i.e., who is in the family you are discussing.
Information to include:

The family is the Garcia family. They are a middle class family that lives in nice community. The Garcia family consists of a mother, father, and 3 children . Daughter age 20, Son age 13, and daughter age 12 . The oldest daughter (age 20) was from the mother in a previous marriage. The father and mother both work outside of the home. Both parents share decision making and caregiving of the children . Grandmother lives nearby to help when needed. The family is Catholic but does not attend church every Sunday. All family members are in good health.
This is a made up family, please add anything else to this family to support the paper.

2. One type of Family Structure discussion

3. One type of Family Function discussion

4. ONE nursing or non-nursing theory (Include explanation of theory components and application to this family)
The nursing theorist for this paper is: Murray Bowens- family systems theory ( make up anything about the family to support how this theory was applied to this family)

5. Conclusion

Advanced Health Assessment And Diagnostic Reasoning

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EB is a 68-year-old black female who comes in for follow-up of hypertension. She has glaucoma and her vision has been worsening during the past few years. She lives alone and is prescribed four hypertension medications (Hydralazine 50 mg PO Q8H, Metoprolol XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily ). She brings in her medication bottles and she has some medication bottles from the previous year full of medications. She is missing one medication she had been prescribed and says she may have forgotten it at home. Her BP in clinic today is 182/99 with HR of 84.

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Need to be supported by 3 credible sources from the last 5 years.

A synopsis on the perspective of the sampling methodology used in your selected articles related to public health research studies.

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A synopsis on the perspective of the sampling methodology used in your selected articles related to public health research studies.

Sampling Methodology

It is incumbent on the researcher to clearly define the target population. Sometimes, the entire population is small enough to be included in the study. In other instances, the population is too large for the researcher to attempt to survey all of its members. Therefore, a small, but carefully chosen sample is used to represent the population. The sample is the actual group targeted either directly or indirectly and reflects the characteristics of the population from which it is drawn.

Using the South University Online Library or the Internet, research, analyze, and select at least two articles on sampling methodology used in public health research studies.

Note: The articles should not be more than two years old.

Based on the articles identified, create a 2 page Microsoft Word document that includes the following:

A synopsis on the perspective of the sampling methodology used in your selected articles related to public health research studies.
Your opinion on whether the sampling method used in each of your chosen articles is appropriate for its target population. Justify your response.
An explanation of the potential advantages and disadvantages of the sampling plan used in your selected articles.

What are some of the planning strategies that Russ might have used that would possibly have positively affected the outcome of the strategic plan execution?

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What are some of the planning strategies that Russ might have used that would possibly have positively affected the outcome of the strategic plan execution?

 

STRATEGIC PLANNING AT LAST CHANCE HOSPITAL
Read the Case Study below. Answer the following questions:
What are some of the planning strategies that Russ might have used that would possibly have positively affected the outcome of the strategic plan execution?·
Discuss some things Marvelous Marvin could have done differently as CEO in order avoid the current situation?·
What political factors created bias and clouded judgments in this situation?·
Who’s to blame for the bad outcomes of this strategic plan?·
If you were one of the OR Director’s direct reports/managers, what should your involvement in the organization’s strategy have been?·
Guidelines:
Assignment should be a minimum of 5 pages, excluding the title page and reference page.·
Title page and Reference page is required, in APA style format.
Utilize a minimum of 5 references,·
Fully answer all questions above and follow proper APA guidelines.·
Assignments that have a Plagiarism Rate from Turnitin of higher than 30% will automatically receive a 0. I strongly recommend that you submit prior to the due date so you can correct if your rate is higher than this. ·
Last Chance Hospital – Case Study
Last Chance Hospital (LCH) is a 254-bed, community hospital located in a small, affluent suburb, just outside of San Diego, California. The hospital has historically been well-received by the local community, which demographically has a higher concentration of older age groups than most other local areas. The greater San Diego area is densely populated, and over twenty-five, hospitals operate in the larger geographic area. Historically, LCH had always been financially sound, and had managed to remain independent as their local competitors joined larger systems. But that was then, and this is now. About a year ago, Last Chance Hospital undertook a strategic planning process to encompass the next years. At the time, the hospital was doing okay financially, but was starting to dip into their cash reserves more often than the Board of Trustees liked; LCH was in need of an ideal strategy to bring them ahead of the market before things got out of hand.
As the strategic planner for LCH, Russ Newmarket reported indirectly to the CEO, Marvelous Marvin, but his immediate boss was Courtney Graveyard – and she had a lot on her plate. LCH did not have a chief nursing officer, and as COO, Graveyard was responsible for all of the nursing departments as well as surgical services, facilities, and information technology. A nurse by background, Graveyard spent the majority of her time trying to find different ways to recruit much-needed nursing staff.
During the development of the strategic plan, Russ called together the usual group of senior executives, Board members, and key physician leaders. He diligently developed the SWOT using their input and applying their assumptions. During his market research, Russ became aware of some patient-centric trends emerging across the country, but he was also aware
that LCH had always strategically catered more to physicians due to the notion that physicians were the ones who ultimately referred patients to the hospital. Through the strategy development process, it became clear that senior management was stuck on this physician-centric mindset. Russ, ambitious and eager to make a name for himself, found and presented valid information that concurred with management’s mindset. At the end of the planning process, Marvelous Marvin felt confident that their solo, the physician-focused strategy would give them a market lead–the plan was to attract more surgeons–and increase OR volumes. The graveyard was under intense pressure from Marvelous Marvin to make sure the operating rooms were as efficient as possible to handle the planned increase in volume as OR efficiency would be a key recruitment issue for surgeons. The LCH physician recruiter was under the gun as well. The remainder of the executive staff breathed a collective sigh of relief that their areas were not part of the strategic initiative. Russ suspected LCH needed more of a strategy than attracting new surgeons, but he convinced himself that senior management knew best.
After the Board approved the strategic plan, Graveyard immediately met with her OR Director, and charged him with increasing the efficiency of the ORs. She then turned her focus back to her first love, nursing. The physician recruiter hit the ground running, developing an elaborate plan to increase surgeon recruitment. From all appearances, LCH was on a roll.
Over the next several months, the OR Director was able to reduce the OR’s operating budget by 13%, a result that made Marvelous Marvin very happy. At the same time, Graveyard made great strides in increasing LCH’s exposure to and status in the nursing community, and was able to decrease the nursing vacancies by over 6%. In a time of nursing shortages, the Board was impressed with Graveyard’s results. The physician recruiter was having only moderate success at recruiting surgeons, however, and her targeted volume projections were
noticeably under budget. Marvelous Marvin approved her request to increase her staff, adding approximately $250,000 to her budget line. Overall patient volumes were steadily decreasing at what was becoming an alarming rate, and thus the financial picture for LCH was in critical condition. Marvelous Marvin couldn’t help but wonder aloud, “Why isn’t the LCH strategic plan working?”
Answer

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What is the current health status of this minority group? How is health promotion defined by the group? What health disparities exist for this group?

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What is the current health status of this minority group? How is health promotion defined by the group? What health disparities exist for this group?

Analyze the health status of a specific minority group. Select a minority group that is represented in the United States (examples include: American Indian/Alaskan Native, Asian American, Black or African American, Hispanic or Latino, Native Hawaiian, or Pacific Islander.)

In an essay of 750-1,000 words, compare and contrast the health status of the minority group you have selected to the national average. Consider the cultural, socioeconomic, and sociopolitical barriers to health. How do race, ethnicity, socioeconomic status, and education influence health for the minority group you have selected? Address the following in your essay:

What is the current health status of this minority group? How is health promotion defined by the group? What health disparities exist for this group? Describe at least one approach using the three levels of health promotion prevention (primary, secondary, and tertiary) that is likely to be the most effective given the unique needs of the minority group you have selected. Provide an explanation of why it might be the most effective choice. Cite a minimum of three references in the paper.