In the following paragraphs I will be discussing why sexually transmitted diseases are called silent infections. I will also be discussing the topic of urinalysis and its components and how these components may reveal if the body is functioning normally or abnormally. . The information pertaining to these subjects relates to the knowledge I have gained through my readings of The Human Body in Health & Disease, as well as personal knowledge and opinion.

Explain why sexually transmitted diseases are often called “silent infections”, and discuss why this is especially true for women.

The reason sexually transmitted diseases are called silent infections is that many of them are asymptomatic infections which produce no visible or immediate physical symptoms, thus an individual may be infected with an STD and not know it for days or weeks, even up to years because there are no symptoms present. The bacterium called Chlamydia trachoma, which produces the disease Chlamydia, can be asymptomatic for months and up to years. When symptoms occur they may be very minor at first in women, such as: vaginal discharge, frequent urination that may be painful, pain during sex, vaginal itching and burning. Since a yeast infection (candida albicans) can produce these same symptoms in a woman they may just treat it as a yeast infection and not see a doctor till the symptoms progress or are not relieved by current treatment for some time. This may not be the case with men, since the most common symptoms of a yeast infection in men are extreme itching of the penis glands and red sores on the penis, but they may also experience burning while urinating and uncommonly have discharge from the penis. With Chlamydia, a man that shows symptoms will most likely also have burning while urinating and penis discharge. Yeast infections in men are not as common and these kinds of symptoms usually causes a man to go straight to the doctor instead of the drug store. The disease Chlamydia is very common, and if diagnosed early it can be treated very effectively, but left untreated it can cause a number of health issues such as: conjunctivitis, which is an eye infection or pinkeye; urogenital infections such as yeast infections; systematic infections which are infections that are spread throughout the body, and also progress to pelvic inflammatory disease (PID), which causes infertility and sterility, and if untreated may cause death through septic shock. The bacterium syphilis (treponema pallidum) is another good example of a STD that takes a number of months to cause any visible or physical symptoms and has three stages that it may progress through if left undiagnosed and untreated. The first stage, primary syphilis is highly contagious and produces chancre sores on the outside and inside of the vagina, the penis and scrotum and also the mouth. This stage can be treated with antibiotics, and if left untreated it may resolve itself within a month or so, but if this disease is not treated in the first stage it is possible that it will recur later as the second stage. The second stage, is secondary syphilis, is also highly contagious and at this point the disease has spread throughout the body and its organ systems. In this stage the symptoms may include sore throat, fever, headaches and a skin rash on the hands and feet. Also, the individual may develop wart-like sores on the penis or vagina areas. Besides the wart-like sores, all other symptoms may not be recognized as caused by a possible STD since these symptoms are similar to the common cold and allergic rash. So once again, the disease may be silent in it diagnosis and goes untreated so it can progress to the next stage, as well as most likely infecting others. The third stage is called tertiary syphilis and the disease is still affecting the body and its organ systems (systematic stage) throughout. By now many of the organ systems may be showing signs of the disease, and may be developing problems which can cause many serious health issues and possible death. The STD HIV and trichomoniasis are also asymptomatic in most individuals for some time. These are just a few of many STDs an individual may contract that may show no immediate symptoms and can go untreated, and can continue to spread from individual to individual.

The reason STDs are especially silent diseases for women is that they may move to other parts of the body and cause damage of secondary infections/diseases without producing any symptoms. If some symptoms do develop they may present themselves as a common infection, such as, yeast infection or urinary tract infection. STDs that go undiagnosed in women can spread through the reproductive system (cervix, uterus and uterine/fallopian tubes) as well as the blood and other organ systems. The two STDs I discussed above, syphilis (treponema pallidum) and Chlamydia trachoma, are good examples of silent STDS, and both can produce few or no symptoms and are very commonly undiagnosed or untreated, thus causing secondary diseases like pelvic inflammatory disease (PID), which can cause infertility, chronic pelvic pain, ectopic pregnancy and increase the risk of contracting HIV if exposed to the virus; This why I believe that STDs are especially silent diseases for women.

Describe the different components of a urinalysis and discuss what each may reveal about the normal or abnormal functioning of the body. Give specific examples

Urinalysis is the process of examining urine through three specific methods. The three methods used are microscopic, physical and chemical examination. Through the use of these methods, a lot can be determined about how the body is functioning and be a very helpful tool in discovering problems or diseases that may be occurring within the body and its organ systems. The physical characteristics of urine that are examined are; color, odor and specific gravity. The color of urine is normally straw-colored, transparent yellow or amber. This is mainly caused by pigment (urochrome), as well as substances we regularly ingest. There are many things that can change the color of urine or cause it to be cloudy, such as certain food, vitamins, dehydration, bile, blood, bacteria and certain drugs. Thus when urine is an abnormal color it may just be from types of foods the individual is eating or vitamins or drugs, but it could also indicate developing problems such as hepatitis, cirrhosis, kidney stones, urinary tract infection and acute glomerulonephritis. Therefore, when urine appears an abnormal color during an examination, it would be further tested chemically and microscopically to confirm the findings of the physical examination. The odor of urine is normally very minor, and when this is not the case it may indicate such diseases as diabetes mellitus or a bacterial infection of the kidney or bladder. The presences of a strong odor may also just be from B vitamins or food like asparagus, garlic, and curry, so abnormal strong smelling urine would also be confirmed in the same manner as color. The urine specific gravity is the level of chemicals/substances in the urine, as well as water content. If the urine specific gravity is above or below the normal range (1.001-1.035 g/ml) it indicates that there is some type of disease or disorder present. When the specific gravity is increased it may indicate that the individual is dehydrated or has developed kidney stone. Also, diseases such as renal arterial stenosis, congestive heart failure and glycosuria can cause an increase in specific gravity. If the specific gravity is low it may be a sign of such diseases as pyelonophritis (kidney infection), renal failure and diabetes insipius-nephrogenic. It can also be caused by an individual ingesting an excessive amount of fluid. As with the other physical examination processes any abnormal findings would be confirmed through further testing before treatment was performed.

The chemical and microscopic processes are used to look for normal and abnormal substances and the concentration of these substances in the urine such as the pH level and normal and abnormal compounds. The normal compounds that will be found in urine are such things as; mineral ions (chloride, potassium and sodium), urine pigments, nitrogenous wastes (ammonia, creatinine, urea and uric acid) and suspended solids or sediment (bacteria, blood cells and casts). All these substance are normal characteristics of urine that are unneeded waste products that the kidneys have excreted during the reabsorption process. The mineral ions levels of chloride, potassium and sodium in the urine will be influenced by the individual intake of these minerals and the body’s need for them at the specific time they are consumed. The nitrogenous wastes ammonia, creatinine, uric acid and urea are also normal at certain levels. These substances are a byproduct of protein being broken down. If the kidneys do not excrete these nitrogenous waste products they will build up to a toxic level within the body at a very fast rate. If there are low levels of these substances in the urine it may be an indicator that there is a problem with renal function, such as acute or chronic renal failure. This would cause these substances to stay in the blood, instead of being cleansed out by the kidneys and excreted out in the urine. The presence of bacteria, blood cells and casts in urine is normal in some aspects. There are certain levels of hyaline cast that are normal for urine to contain; these are produced by deposits of cells and minerals that have broken free from the walls of the renal tubes into the urine. There are usually very few, if any, red blood cells in urine. The presence of very low quantities of red blood cells is possible in a perfectly healthy individual and especially in women because of menstruation. Urine will most likely contain some bacteria because of contamination during the process of giving the sample, but normally there should be no bacteria present if the sample is not contaminated by bacteria from the vagina or penis. I will be discussing the process used to examine casts, bacteria and blood cells in urine, as well as what abnormal levels of these substances may indicate later in the following paragraph.

Abnormal compounds that may be found are: acetone, albumin, bile and glucose. The presence of these compounds can reveal a problem or disease in the body. For example, the presence of glucose in the urine (glycosuria) is a good indicator that the individual has diabetes mellitus. Diabetes mellitus causes the blood glucose concentration to increase beyond the renal threshold and the kidneys cannot reabsorb the excess glucose, so the excess glucose stays in the urine. Diabetes mellitus is a disorder of the pancreas islet cells that produce insulin to regulate blood glucose levels. When bile is present in the urine it may indicate the common bile duct is blocked, which may be caused by gallstones. It may also indicate other liver disorders such as hepatitis and cirrhosis. The substance albumin (protein) may normally be found in urine at low levels between 0 to 8 mg/dl. If the albumin levels exceed this level it may indicate there is a problem occurring in the kidneys, such as the glomeruli of the kidney may be damaged, causing it to allow protein to leak into the urine during the filtration process of the blood. This could be caused by kidney diseases and other contributing factors, such as diabetes or hypertension. The presence of high levels of the substance acetone in the urine can be produced by factors that involve diabetes mellitus that is not properly controlled. This may be caused by a lack of insulin secretion, which increases glucose supplies in the blood, but less entering the cells to use for fuel. Thus in the body’s attempt to create homeostasis it breaks down fat for energy, and as a result of using fat for energy it produces acetone that ends up in the urine as waste. The pH level can be an indicator of a number of problems that are occurring within the body. The normal pH level should be between 4.6 and 8.0 in urine. When pH level is low, or has increased acidity, it may indicate the individual is dehydrated or has diabetic acidosis, which is caused by uncontrolled diabetes mellitus or respiratory acidosis, which is caused by the retention of excess carbon dioxide in the body. When an individual has a high pH level, or increased alkaline, it may be an indicator of a urinary tract obstruction, which is an obstruction within the urinary tract that may be caused by kidney stone (calculi) or a tumor. Also, it may be caused by chronic renal failure, which is when the kidney starts to fail and does not properly process blood and create urine. These are just a few of the things high or low pH levels may indicate. Some compounds such as suspended solids or sediment (bacteria, blood cells and casts) are examined through the microscopic process after being spun in a centrifuge to push these substances to the bottom of the test tube. These substances at the bottom are then examined for the presence of abnormal cells, as well as high levels of blood cells, which may indicate things, such as bladder infection, kidney infection, bleeding within the urinary tract, and also prostatitis which is inflammation of the prostate gland, as well as other symptoms depending on the type of prostatitis. This process is also used to examine the urine for casts. Casts are tube-shaped particles that are composed of ether minerals, kidney cells, or red or white blood cells that have formed in the renal tubules of the kidneys. Then as the urine passes through these tubules they dislodge from the walls of the renal tubules and flow out of the body in the urine. There are many different types of casts and by examining which type that is in an individual’s urine, it may indicate if there are health issues developing such as chronic renal failure, renal tubular necrosis, bleeding within the kidney, interstitial inflammation and dehydration. As I mentioned in the previous paragraph, it is normal to have some hyaline casts in the urine, but such types as fatty casts, white blood cell casts, granular casts and waxy casts are indicators of problems occurring within the renal system or diseases in other parts of the body.

In conclusion, there are many types of STDs that show no immediate symptoms, and that if left untreated can cause a number of serious health issues and even death. However, many of these STDs are completely treatable with no lasting effects or damage if diagnosed before they progress and affect other organs system of the body. For any individual, regardless of gender, regular check-ups and screening for STDS is necessary; even if safe sex is practiced, it is very possible to contract an STD from another person just through physical contact, such as kissing or just touching their hands when certain diseases are present. It is important for every individual, no matter what age or gender, to have regular physicals to not only be screened for STDs, but also for other diseases that may be developing within the body, and a number of diseases can be diagnosed through the process of urinalysis.

Results

A phenomenological study was conducted to explore the need for a school-based obesity prevention program in rural elementary schools by principals. The face-to-face interviews were various of principals were asked questions guiding the study on demographics, “if the leaders perceived the need for school-based programs, aspects of a prevention program that school officials feel are essential to conducting a successful and effective program, the barriers school leaders encounter in conducting an obesity prevention program” (Armstrong, Harris, & Msengi, 2017, p. 1). They administered the survey to eight rural principals and “four principals were male and four were female; the principals have served in the capacity as a principal from two to nine years” (Armstrong, Harris, & Msengi, 2017, p. 3).

They presented the findings based on the research questions. “All the principals believed that the program designed to prevent student obesity would show an important by-product- that of improving academic performance” (Armstrong, Harris, & Msengi, 2017, p. 5). Result from this study showed that the principals believe that implementing a school-based obesity program would help student health wise and academically. “Evidence for these needs is consistent with the findings of Ogden, Carroll, Kit, and Flegal (2014), that the school is an ideal setting to incorporate childhood obesity prevention measures” (Armstrong, Harris, & Msengi, 2017, p. 7). A concern discussed by school officials were the children going home and still practicing poor eating habits but this study discussed including the parents in the programs to ensure healthy eating practices are implemented in the home. Incorporating the parents proved to be more effective in reducing the obesity rates among school-aged children through encouraging the children to practice healthy eating habits in the home. Because of this study, school officials had to revise the school menu served to children in the cafeteria to remove unhealthy choices to measure the effective of the school-based intervention program. School leaders eliminated unhealthy food and beverages choices inconsistent with the healthy eating model of the school-based intervention program. “ Findings in this study suggest the conclusion that rural principals believe school-based childhood obesity programs have the potential to decrease prevalence of obesity among children and contribute to improving students academic” (Armstrong, Harris, & Msengi, 2017, p. 8). When examining the results from the interviews it showed that the school based obesity prevention program is the key to improving health and academics for school-aged children. “We recommend that school leaders implement obesity prevention programs tailored to the needs of students on their campus” (Armstrong, Harris, & Msengi, 2017, p. 8). This study can be assess though Completing a simple needs assessment of the student to develop either a curriculum based on the needs of each individual school.

Another study conducted at the Children’s Obesity Clinic, Department of Pediatrics from “October 2012 to March 2015, which comprised a physical examination and provided a detailed medical history, including interview-reported information on physical activity and in activity” (Schnurr, Bech, & Nielsen, 2017, p. 798). To measure the overall success of this study each participant was weighed and a one hour interview was conducted with each participant and a parent/guardian which help researchers gather information about the routine. An accelerometer-assessed physical activity which each participant was given at the time of enrollment to track daily activity. “The processing of physical activity data was conducted using ActiLife version 6.13.1, continuous 24-hour accelerometer data was recorded” (Schnurr, Bech, & Nielsen, 2017, p. 800). Participants were required to wear ActiLife physical activity monitor for 4 days a week and one day on the week for a total of 10 hours each day to measure their physical activity. Data was analyzed using the “R software (Version 3.20; Team; 2016). P values of less than 0.5 were considered significant” (Schnurr, Bech, & Nielsen, 2017, p. 801). Demographic information was calculated using the mean, median or frequencies for this study. “For comparison of self reported and accelerometer-assessed PA data, we assessed data for normality of distribution for each of the variables. Accelerometer-assessed PA was normally distributed, whereas the PAS was right skewed”(Schnurr, Bech, & Nielsen, 2017, p. 801). Result from this study showed that children and adolescents enrolled in a multidisciplinary childhood obesity treatment, did not meet the certain physical activity recommendations.

“First it is generally observed that adolescents with overweight or obesity are less active than their normal weight peers, and physical activity differences by weight status. Second, the number of children filling physical activity recommendations may generally be underestimated when using accelerometers, since these physical activity recommendations were based on research findings derived from self-reported physical activity that tend to overestimate activity where time is limited” ”(Schnurr, Bech, & Nielsen, 2017, p. 806).

The use of physical activity can help control being overweight and obesity. When examining results the study recommends professional supporting physical activity to help address obesity.

“The main goal of this study was to compare self-reported and objectively assessed physical activity in children and adolescents with overweight or obesity in a pediatric setting where time is limited and where a questionnaire-based evaluation is the most cost-effective method to estimate physical activity levels” (Schnurr, Bech, & Nielsen, 2017, p. 805).

This study collected and analyzing data on each individual’s physical activity from self reporting in addressing and eliminating obesity in a controlled pediatric setting.

References

• Armstrong, T. D., Msengi, C., & Harris, S. (2017, Summer). The Need for a School-based Student Obesity Prevention Program Perceptions of Rural Elementary Principals. Academic Journal, 38(1), 1-10. Retrieved from http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?vid=4&sid=0c5d4569-b43e-4caa-a4cf-d0a823f38d7a%40sessionmgr101
• Schnurr, T. M., Bech, B., & Nielsen, T. R. H., Anderson, I. G., Hijorth, M.F., Adaahl, Meete, Fonvig, C.E., Hansen, T., Holm., Jens- Christian (2017, Fall). Self-Reported Versus Accelerometer Assessed Daily Physical Activity in Childhood Obesity Treatment. Academic Journal, 124(4), 795-811.Retrieved from http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=16&sid=8ef3095a-1553-42b3-a7ee-e4b74b01d867%40sessionmgr4006

Care of the Confused Client

By Katherine Mahon

The client named William, not his real name for purposes of confidentiality, is 64 and has suffered an acquired brain injury (ABI). An ABI is damage to the brain that was not present at birth and is non-progressive (The Rehab Group, 2014). William has suffered a diffuse axonal injury from a severe head trauma, as a result from a road traffic accident. This is where the axons in the brain were sheared thus damaging parts of the brain. The effects of the ABI on William are that he will require long term rehabilitation, and will reside in a specialised centre for survivors of ABI’s. His multidisciplinary team (MDT), a group of highly trained healthcare professionals that specialise in different disciplines, have assessed William so that a care plan could be developed to provide William with the best care for his individual needs, thus ensuring quality effective practical care to William. The Logan, Roper Tierney model of assessment of nursing care needs was important to determine Williams physical, intellectual, emotional and social needs (Student Manual, 2014). The MUST tool (malnutrition universal screening tool) can be used to check for malnutrition and create a diet plan (BAPEN, 2015).

The MDT meet on a regular basis to discuss Williams progress and make sure his care plan provides him with the best possible chance to maximise his abilities. The impact of ABI in his daily activities are, difficulty with cognitive thought process, memory loss and concentration- causing him confusion. It affects his speech and language, mobility – he has paralysis of the left side of his body. He suffers with dysphagia (difficulty in swallowing) so is on a specialised meal plan. It has affected his personality, where his behaviour can change very quickly in his understanding of situations. His sights visual field has been narrowed, also known as tunnel vision. He requires a healthcare assistant (HCA) at all times to support him in his daily activities.

Maintaining a safe environment for William is crucial in the prevention of accidents or falls. All areas of the building are kept clear, floors, tables (unless in use by another client), spills are cleaned up immediately to prevent slips. He can have epileptic seizures so his bed has padded side rails which are used during the night to prevent him falling should he have a seizure. The bathroom is kept tidy and dry and has railings on the walls to provide him with support whilst moving to the shower chair. Fire safety systems are in place, these are checked as per the Safety, Health and Welfare at Work Act 2005.

William enjoys activities that are quiet in nature most of the time, he is offered any number of activities to partake in, such as looking at books, pictures, magazines- particularly the farmers’ journal. He enjoys group activities that include painting and crafts- of a large nature, making items from clay with assistance from the HCA, he will be smiling for the duration and enjoys these group interactions. Client centered therapies for example, stimulation orientation therapy- such as playing Williams favourite music which happens to be country and western or offering him a country and western movie to watch, are used in support of his daily routine (Work placement, 2014).

To reduce and assess William’s risk of falling, the Morse Fall Scale was used. William uses a walking frame and wheelchair to aid movement and with the correct footwear, with rubber sole to afford grip. Pressure sores are injuries to the skin and can become dangerously infected should they not be taken care of quickly and efficiently, however, pressure sores should never occur and are completely preventable (Tutor notes, 2014) They occur where a person has been lying on a particular area in the same position for a long period of time. The skin area can become red raw, the skin becomes shiny and begins to tear and infection can enter the sore. A good time to check for sores are whilst assisting a client bathing, reporting any skin irritations to the nurse immediately.

As William has an ABI the HCA must take the time to communicate with him respectfully offering him choices and promoting his independence as far as possible, verbal communication is a means to obtain information from William. It is important for the HCA to be able to communicate effectively in both writing, such as updating charts and verbally in order to be able to provide accurate and important information to all members of the healthcare team. HCA’s are the persons working closest with William it is important that changes, for example in behaviour are reported accurately, verbally and if necessary in writing to the CNM. This ensures continuity of care and for daily planning within the team.

William is assisted with all activities of daily living, however, he is encouraged to try himself where he can. When bathing he prefers to clean particular areas himself and allows assistance from the HCA where he cannot reach himself. He needs assistance with dressing for example putting on clothing as he cannot complete this with the use of one hand. William is incontinent and requires assistance with personal care such as changing incontinence pads. Eating can be very challenging for William due to dysphagia, needing to take his time with the food (which is always soft and/or liquidised and all fluids will be thickened) and taken in, in small amounts, which he finds at times, frustrating as he would like larger amounts.

The European Charter of Patients’ Rights, a major piece of legislation (Student Manual, 2014), which legislates in the rights of patients, respect, dignity, independence, choice and positive self-image, must be promoted at all times to the highest quality and to the best of the HCA’s ability. The HCA should be mindful and can promote these by knocking on Williams door, closing it to provide privacy and dignity, gaining consent to assist in tasks and offering him choice in every activity of his daily living, encouraging William at all times should be at the forefront of the HCA’s mind.

With reference to a range of indicators, explain the level of wellbeing of people in your chosen country?

The community of Mexico experience and struggle through a wide range of contrasting indicators including education as well as life expectancy that multiple developed and first world countries would not have to undergo

In Mexico, education is not very accessible due to many children dropping out of school to help support families as they need to survive. The education system in Mexico is divided into their social class. Basic education is divided into three different levels primary school, school and lastly high school. Public schools in Mexico are free of fees and secular from any religious teachings as they have been banned in public education. Textbooks are mainly provided for primary school children but once they have reached high school parents will need to buy textbooks for their children.  Children who want to attend school must reach at least 60% in the nation examination by the end of each school year to advance to the next grade. Schools have a shortage of teachers, textbooks and workspace due to the lack of funding, due to this making the standard education levels very low. On the other side of the spectrum, private schools have a high standard of bilingual education and this well-suites the children. Many private schools in Mexico are concentrated in big cities. Parents who want to send their children to a private school are advised to meet with a teacher and cheek the curriculum to decide if their child is suitable for the school. Private schools will usually ask for a copy of the child’s birth certificate and copy of school records with photo identification.

Life expectancy of Mexican in 2018 was 77.5 years old.  Mexico’s growth overall of average life expectancy has increased by 24% per cent every year. Mexico as a country is still dealing with cases of extreme poverty and violence as its scores are better than the global expectancy. However much more work has to be done to improve the living conditions and ensure higher life expectancy

In conclusion, Mexico experiences and struggles through a wide range of contrasting indicators including education as well as life expectancy that multiple developed and first world countries would not have to undergo.

Evaluate the success of government and/or non-government initiatives in improving the wellbeing of people in your chosen country?

Government organisations are trying to find initiative ways to improve the wellbeing of people in Mexico. Mexico as a country has faced many barriers as a country with improving the way people live their lives on a day to day basis. The country goes through challenges of security and safety, as the frequency of interpersonal violence causes 41 deaths per 100,000 people. To help people feel safe out in public or in there homes, Mexico government have installed CCTV cameras, armoured cars/vans, communication tech and undercover police Mobile tech and internet-connected devices have been spread to the exhilarate security around the country, which has forced many companies to replace old systems to adapt to the new security standards. Safety in the workplace has been a major concern for the Mexican government according to the “Secretary of Labor and Social Prevention with data reported by Mexican Institute of Social Security in 2017, more than 480,000 work accidents and work illnesses were recorded, and 699 workers have died while doing their job”. Industries have recorded that most deaths were because of an accident like transportation e.g driving heavy-load trucks.  Mexico’s Secretariat of the Economy has said, “Mexico has more than four million enterprises, which contribute to micro and small firms which represent 99.8 per cent, and they contribute 42 per cent of GDP and 78 per cent of total employment”. Unfortunately, Mexico’s four million businesses usually underestimate the importance of workplace safety policies making them a less attractive target market. Civil protection is one of thing the Mexican government have invested a lot of time and money into as this has been restrained by government budgets and policy, making this section a less dynamic market than might otherwise be expected. Mexican government need to have protection as they have to deal with earthquakes, explosions, volcanoes, floods, fires and hurricanes. Emergency first aid kits are acquired by many organizations to be prepared as well as emergency drills. On the civilian side, firefighters, rescue organizations, and the Red Cross generally depend on donations for equipment and assistants rather than rely on government budgets. In Mexico, employment is about “61% of people age around 15 to 64 have a paying job lower than the OECD employment average of 81%”. “79% of men are paid workers while only 45% of women are paid. 29% of workers work very long hours”. Mexico has been reported as having one of the worst air quality in the world. As tiny air particles that are small enough to enter and cause damage to your lungs. Mexicans water quality is bad compared to the rest of the world, as 68% of people say they are unsatisfied with the quality of their water.

Bibliography

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We need to be aware that all stress is not negative. Selye a famous psychologist held for two categories of stress, namely good or desirable stress (eustress) and bad or undesirable stress (distress). Eustress is pleasant, or at least challenging, and it always produced maximization of output. It is evident that without this positive inner stimuli no one can be effective in ones life. Distress is something negative and has no capacity to monitor or control a stress filled event in ones life. Here one fails to control oneself and become a slave to stress causing distress and loss to oneself and to the organization he or she belongs. A physical or psychological response is mandatory to occur stress in any living being. (Middleton, 2009).

Occupational stress among the health professionals has been a global problem for years now. It can have an adverse mental and physical health consequences and can lead to decreased satisfaction with one’s job. For a small group of employees it can even lead to a burnout and sick leaves. Job stress thus has not only negative consequences on themselves, but also for the organization they work. Estimates are that 10% of the Gross National Product in European countries is lost due to stress related absenteeism and turnover. Although absenteeism’ in health care is declining the past few years, it is still high compared to other stressful occupational settings such as education, catering industry or transport (Roy, 2010)

The researcher has carried out this study in a private hospital in India named Jubilee Memorial Hospital Thiruvananthapuram. In this study the researcher has focused on the occupational stress of the nurses. This study is an attempt to identify the cause and consequences of occupational stress of the nurses. This study also will identify the need to have an effective stress management strategy to promote quality nursing care in the hospital.

RESEARCH BACKGROUND

Occupational stress can be explained as ‘a discomfort which is felt and perceived at a personal level and triggered by instances that are too intense and frequent in nature so as to exceed a person’s coping capabilities and resources to handle them adequately’. (Perriwe and Gavoster, 2010) Evidence from researches suggests that certain individuals in a variety of occupations are increasingly exposed to unacceptable levels of job-related atmosphere it makes them burnout (Aamodt, 2009). Therefore, Occupational stress can be defined as ‘a harmful physical and emotional response that occur when the requirements of a job do not match the capabilities of the worker’. “This pressure at work can be positive, leading to increased productivity” (Baer, 2006). However, when this pressure becomes too much to handle, it has a negative impact. Here the individuals look themselves as being unable to cope and not to possess the necessary skills to challenge this situation (Griffin & Moorhead, 2009),

Advancements in the healthcare industry combined with latest technological innovations in the medical science have increased the number of people accessing the services of the healthcare industry today. The increased number of nurses in hospitals have proportionately increased their efforts to deliver their best services to the patients. Thus professionals like nurses working in hospitals are exposed to considerable amount of job stress. This in turn is having serious psychological and physical effects on those individuals as well to the patients who seek their services (Baer, 2006).

1.3. SOURCES OF OCCUPATIONAL STRESS

Generally there are various sources of occupational stress such as personal expectations, employment decisions, social pressures, living arrangements, relationships, physical health, information overload, etc (Olpin & Hesson, 2009). Apart from the factors mentioned above there are few important sources that pertain directly to the research topic. The first one among them is Work Overload. It occurs when the job requires excessive work speed, output, or concentration. Secondly Work Under load. It is having work that is too simple or is insufficient to fill one’s abilities. Third one is Underutilization that occurs when workers feel, the job does not use their work related knowledge (Gurung, 2010). Fourthly, Task demands that include the design of the individual’s job, working conditions, and the physical work layout. Again, Role Demands are those pressures placed on a person as a function of the particular role he or she plays in an organization. (Irving et., al. 2010). Role overload is a common grief that expressed when the employee is expected to do more than time permits. Another cause of job stress is Job Ambiguity. It occurs when tasks and requirements are not clearly outlined ( Hales, 2009).

Role Conflict is another important source of occupational stress. For instance, a worker’s job may require excessive overtime that conflicts with the worker’s family roles of spouse and parent or having to play different roles at work simultaneously can cause stress. Another important source of work stress results form workers sensing that they have little control over the work environment and over their own work behavior. Research indicates that providing workers with a sense of control over their work environment, through techniques such as giving them a voice in decision making processes or allowing them to plan their own work tasks, reduces work stress and increases job satisfaction (Kavitha, 2009).

Stress can develop from difficulties in developing and marinating relationships with other people in the work setting. Organisational Change is another source of stress. Some common change situations that lead to worker stress include: changes in work system and work technology, change in company policy and managerial or personnel changes. Some chief executive officers create culture characterized by tension, fear, and anxiety. They even force to establish unachievable to perform in the short run, impose excessively tight control. They even routinely fire employee who don’t measure up. Apart from these above mentioned factors there can also be other individual factors that can cause occupational stress (Middleton, 2009).

1.4. IMPACT OF STRESS IN THE LIFE OF A NURSE

Occupational Stress is a serious ongoing issue in the profession of nursing. Lack of organizational support, increased technological advances, personal and family relationship issues etc., also can contribute to the emotional exhaustion of the nurses. Apart from these, the very nature of the profession, the intense and rigid work routines, exposure to pain and post traumatic events of life, etc. also can lead them to stress ( Wicks, 2006).

The impact of stress in the life of Nurses needs to be dealt with almost importance. Stress of nurses has strong effects on important work outcomes especially in the quality of care in a hospital. Stress always caused decreased work performance and increased absenteeism and turnover in the health care industry. The result of occupational stress that results from overwork can be seen in the condition called burnout among the nurses (Scott, 2009). A nurse suffering from burnout became less energetic and less interested in her jobs. She or he will be emotionally exhausted, apathetic, depressed, irritable and bored. They tend to find fault with all aspects in their work environment, including co-workers, and react negatively to the suggestions of others even to the patients of their care. Here the quality of their work deteriorates but not necessarily the quantity. (Thomas, 2009) The rapid change in medication protocols and the development of new procedures and equipments may frustrate nursing staff when they are not given adequate training and time to incorporate these changes into their profession and work patterns (Middleton, 2009).

1.5. THE PROBLEM STATEMENT

Nursing is a highly stressful profession as they deliver uncompromising services to the patients in a very highly stressful job environment. It combines a number of highly technical tasks requiring expert knowledge and personal engagements with patients requiring empathy and compassion. The nursing profession is becoming very advanced and complex. Increased job stress is prevalent among the nurses and hence the identification of source of stress and effective coping mechanism is very important for health of nurses as well as the profession itself. It can have adverse mental and physical health consequences and can lead to decreased satisfaction with one’s job (Weiner & Craighead, 2010).

The hospital selected for the study is a 250 bedded multi specialty hospital that was established in the year 1975. It was given the award for the best Health Care provider award by the State government in 2002. The institution received the Citizen Award in 2004. There are 115 nurses employed in the hospital. It has different departments like General Medicine, General & Minimal invasive Surgery, Gynecology & Obstetric, Pediatric Orthopedic, ENT, Dental, Eye, Skin Plastic& Cosmetic Surgery, Cardiology, Neurology, Chest Medicine, Urology, Oncology, Psychiatry, Psychology, Physiotherapy, Pathology and Anesthesiology. There is a Nursing School attached to the Hospital that promotes quality nursing education. The hospital thus educates more than 200 students every year through its Nursing and Para- medical education institutions. The hospital has facilities to perform a wide variety of surgeries. The Hospital has an average number of 200 inpatients and 750 outpatients in a day. The hospital conducts health, immunization, and awareness programme in the rural areas of the state fulfilling its social responsibility.

Occupational stress among the Nurses has been a global problem for years now. The researcher has selected Jubilee Memorial hospital for conducting the research because the researcher has been a field work trainee at this organization during his previous studies. Primary observation of the researcher is that there are visible reasons for stress among the nurses in this hospital such as, Prime responsibility and heavy work load, Depleting interpersonal relationships, Conflicts with physicians and other medical staff, Unable to maintain a balance between work and home demand, Constant witness to serious injuries and deaths and so on. Though there are various other stress related issues existing in the hospital, they seem to be oblivious of the of the impact of it. A research in this area will provide adequate awareness of the present situation to the Nurses and the hospital management. The recommendations will be a key to the future interventions to have a better coping mechanism to promote quality care in the hospital.

1.12. LIMITATIONS OF THE STUDY

Since the researcher has limited respondents for his study the generalisation of the study is limited and so it can’t be applied to the whole of Nursing professionals. The prefixed time of the completion of the research is another limitation of the research. The use of self prepared questionnaire and the interview schedule all these were limited by time and availability. It consumed a lot of time, energy and money. The expression through the questionnaire can even be biased and limited.

1.13. OUTLINE AND STRUCTURE OF RESEARCH

The study on Occupational stress of the nurses and its impact is vividly described in five chapters.

Chapter – 1: This chapter is an introduction of the research topic itself. A brief explanation of stress, occupational stress, it’s causes and it’s impact in the profession of nurses, a brief explanation of the organizational profile, research question, aim and objectives and significance of the study is explained here.

Chapter – 2: The second chapter is the review of literature examining the existing body of literature on stress and occupational stress.

Chapter -3: The third chapter will explain the methodology used in the research. Different techniques used to gather data for the purpose of research and its relevance, the problems faced by the researcher to obtain relevant data etc are explained in this chapter.

Chapter -4: The fourth chapter deals with the analysis of the data collected and the findings are included. In this section the researcher will closely examine the connection between the objectives, reviewed literature and the findings.

Chapter -5: The last section of this research report is recommendation and relevant conclusion.

CONCLUSION

In the modern era, nursing profession is a stressful occupation. This study will critically analyse various sources of the occupational stress of the Nurses and its negative impact on their profession. It is definite that future interventions to prevent stress in nurses will be offered as a standard part of a benefit package within all health care organizations. The researcher is optimistic that the Nursing profession will have decreased amount of stress and a well developed increased coping mechanism which will in turn increase job satisfaction and increased quality work performance in Nursing Care.