Analytical memo 1: global perspectives

/in /by

Scenario:

Over the last year, there has been concern about the global response to the Covid19 pandemic as well as it’s long run social, political, and economic effects.  The global economy has experienced a shock similar to the Great Depression.  How can the world come back from this crisis?

Imagine that three important Senators with different perspectives are going to debate on a Sunday TV news talk show.  Your job is to prepare talking points for each of their presentations and debate.

Senator Adama Ricardo-Smith, a Democrat who is a former economist, educated at the University of Chicago and a Classical-Liberal (C-L).

Senator Vladimir Trotsky, an independent, former labor activist, and a Marxist/Structuralist (M/S).

Senator Maria Machiavelli, a Republican and former foreign policy advisor and Realist/Mercantilist (R/M).

Imagine that you’ve been hired as IPE Analyst for the U.S. Congress.  (There are real jobs for IPE experts!) How could you inform their decisions as an IPE intelligence guru?

Your job:

You’ll need to compare and contrast the different perspectives.  For each of the 3 Senators, you will provide a separate analytical memo representing their IPE perspective. (You are writing separate reports addressed to 3 different people.)  Each analytical memo should address:

How does each IPE perspective perceive the situation and inform us about varied concerns around the pandemic and global response?

What are the impacts on key actors of the pandemic and global responses? (Who is affected?)

What are the sources of conflict and potential cooperation from this crisis?

What role should the U.S. government play domestically?  Internationally?

How might their IPE perspective respond to the views of the other 2?

Your job is to provide a convincing analysis/report for each Senator that is consistent with their perspective or IPE paradigm.  What you write for each Senator should sound like what they’d say, written like a script or speech.  You are the speech writer!

Here are a few other articles worth considering:

How the Coronavirus Could Create a New Working Class

A New Front for Nationalism: The Global Battle Against a Virus

Identify Nursing-Sensitive Outcomes Criteria

/in /by

Identify Nursing-Sensitive Outcomes Criteria

 

Identified Nursing-Sensitive Outcomes Criteria

Order Description

see attachments for details instructions.

The Institution have zero tolerance for plagarizm.

THE FALCULTY HAVE ZERO TOLERANCE FOR PLAGIRIZM.

Assignment: Respond to Learning Exercise 23.5 page: 568
Topic: Identifying Nursing Sensitive Outcome Criteria.

Each original posting in a forum requires a citation from TWO ADDITIONAL SOURCES-NOT YOUR TEXTBOOKS, ATI or Abrashofs book.
Must be between 500 and 750 words-NOT INCLUDING REFERENCES.

Special Note: Unlike other courses that encourage using direct quotes, this course focuses on analysis. That is—your thoughts, impressions and opinions taken directly from your review of the literature. Therefore DIRECT QUOTES or using WORD-FOR-WORD phrases, paragraphs, etc. ARE NOT acceptable. Any direct quotes or word-for-word passages provided will be directly deducted from the word count. Any word-for-word passages that are not properly cited, will be considered plagiarism and referred to the office of student conduct for disciplinary action. EACH AND EVERY assignment is checked.

Best Nursing Case Study Writers

Best Nursing Case Study Writers

/in /by
Read more

Auditory processing in Speech Production

/in /by

The integration of auditory feedback from self generated speech sounds into upcoming motor commands is important for the stability and control of speech production. For example, children with profound hearing impairment experience greater difficulty acquiring and maintaining speech than their normal hearing peers (

Campisi, Low, Papsin, Mount, & Harrison, 2006; Kishon-Rabin, Taitelbaum-Swead, Ezrati-Vinacour, & Hildesheimer, 2005; Moeller, Hoover, Putman, Arbataitis, Bohnenkamp, Peterson, Lewis et al., 2007; Moeller, Hoover, Putman, Arbataitis, Bohnenkamp, Peterson, Wood et al., 2007

). Also, adults with acquired hearing loss show a gradual degradation of their previously proficient articulatory ability that is partially restored after cochlear implantation (

Kishon-Rabin, Taitelbaum, Tobin, & Hildesheimer, 1999

). The importance of auditory feedback for speech motor control in normal speakers has been demonstrated via perturbation studies. Various studies have shown the compensatory impact perturbing the volume (

Bauer, Mittal, Larson, & Hain, 2006

), pitch (

Burnett, Senner, & Larson, 1997

), phonetic accuracy (Houde & Jordan, 1998) and timing (

Jones & Striemer, 2007

) of auditory feedback has on the kinematic and acoustic outcomes of speech production in normal speakers. Computational neural network models of speech production have also been used to demonstrate the importance of auditory feedback for articulatory control (

Guenther, Husain, Cohen, & Shinn-Cunningham, 1999; Perkell et al., 2000

).

Perturbing the timing of auditory feedback in people who are fluent is known to induce a variety of articulation disturbances. Specifically, delayed auditory feedback varied between 200 ms and 400 ms during reading aloud results in a reduced number of correct words, increased total reading time, monosyllabic sound substitutions, omissions, insertions and additions including repetitions

(Fairbanks, 1955; Fairbanks & Guttman, 1958; B. S. Lee, 1950; B. S. Lee, 1951; Stuart, Kalinowski, Rastatter, & Lynch, 2002; Yates, 1963)

. Conversely, delayed auditory feedback has been shown to positively influence speech fluency in people who stutter

(Adamczyk, 1959; Kalinowski, Stuart, Sark, & Armson, 1996; Ryan & Van Kirk, 1974; Soderberg, 1968; Stuart, Kalinowski, Armson, Stenstrom, & Jones, 1996; Stuart, Kalinowski, & Rastatter, 1997)

. The degree of fluency enhancement varies depending on a number of variables (e.g. delay duration, feedback intensity), the context and the individual

(Armson, Kiefte, Mason, & DeCroos, 2006; Wingate, 1970)

. As a result of the variable responses reported in the literature, the clinical effectiveness of altered auditory feedback as a treatment tool remains controversial

(Antipova, Purdy, Blakeley, & Williams, 2008; Lincoln, Packman, & Onslow, 2006; O’Donnell, Armson, & Kiefte, 2008; Pollard, Ellis, Finan, & Ramig, 2009; Stuart, Kalinowski, Rastatter, Saltuklaroglu, & Dayalu, 2004; Stuart, Kalinowski, Saltuklaroglu, & Guntupalli, 2006; Wingate, 1970)

.

The basis for the variable response of adults who stutter to delayed auditory feedback is not known. Various theories have been put forward to describe how delayed auditory feedback induces fluent speech in some individuals who stutter. It has been proposed that delayed auditory feedback results in speech improvement by forcing the person who stutters to assume a new pattern of speech movement

(Goldiamond, 1965)

. The new pattern is claimed to be established and maintained via operant learning principles with the delayed auditory feedback functioning as aversive negative reinforcement. As pointed out by

Wingate (1970)

, the conceptualization of this process is unclear and incomplete. However, there is some evidence to support the claim that a new speech pattern is learned

(Ryan & Van Kirk, 1974)

. It has also been proposed that the delayed auditory feedback is corrective in nature thereby improving fluency. However, the contrary that delayed auditory feedback is distorted feedback seems to be obvious

(Wingate, 1970)

. Some authors have posited that the key to delayed auditory feedback’s effectiveness is the reduction of meaningful feedback

(Wingate, 1970)

denying the person who stutters the ability to rely on this potentially inefficient control system. This assertion is somewhat supported by the observation that masking of auditory feedback also induces fluent speech in some individuals who stutter

(Sutton & Chase, 1961; Wingate, 1970)

. Lastly, it has been proposed that delayed auditory feedback is effective because of the tendency of individuals to slow their speech rate, prolong vowel duration and increase vocal intensity and fundamental frequency

(Wingate, 1970).

However, changes to speech characteristics such as a slower rate cannot be the only reason that delayed auditory feedback is effective, as it has been demonstrated to have similar fluency enhancing effects even at fast rates of speech

(Kalinowski et al., 1996; Stuart et al., 2002).

The effects of altered auditory feedback on speech fluency in people who stutter demonstrate the importance of auditory processing in the disorder. Advancing our understanding of the role auditory processing plays in the speech production of people who stutter may begin to elucidate the mechanisms behind fluency inducing altered auditory feedback.


1.5.2


Auditory processing in normal and stuttered speech production

:

Behavioural studies of auditory processing in adults and children who stutter have yielded evidence of central auditory processing differences in these populations relative to fluent age-matched peers.

Rousey, Goetzinger and Dirks (1959)

reported that 20 stuttering children showed below normal performance on sound localization. Lack of sound localization skills may be indicative of temporal lobe disorders

(Jerger, Wekers, Sharbrough, & Jerger, 1969)

. Various studies have employed batteries of audiometric tests to behaviourally evaluate central auditory processing in adults children who stutter.

Rousey, Goetzinger and Dirks (1959)

reported that 20 stuttering children showed below normal performance on sound localization.

Hall and Jerger (1978)

reported that adults who stutter performed poorly relative to fluent adults on a subset of such tests. They concluded that the results suggested the presence of a subtle central auditory processing deficit in adults who stutter.

Anderson, Hood and Sellers (1988)

conducted a similar study and found that adolescents who stuttered performed poorly on only one subtest as compared to a group of age-matched control participants. They similarly concluded that if a deficit exists it is subtle.

Evidence of a subtle central auditory processing deficit has also been demonstrated in children who stutter. For example, children who stutter have been found to have higher thresholds on backward masking tasks than children who do not stutter

(Howell, Rosen, Hannigan, & Rustin, 2000)

. Howell et al. also found a positive correlation between backward masking thresholds and stuttering severity in children who stutter. In a follow-up study

Howell and Williams (2004)

investigated children who stutter on a battery of audiometric tests including backward masking tasks. Based on the profile of performance on the audiometric battery of tests,

Howell et al. (2004)

reached the conclusion that children who stutter had a different developmental pattern of central auditory processing abilities relative to their fluently speaking age-matched peers but they did not specify the nature of that difference.

More recently, central auditory functioning was evaluated behaviourally and with electroencephalography in adults who stutter

(Hampton & Weber-Fox, 2008)

. Behaviourally, adults who stutter performed less accurately and demonstrated longer reaction times in response to the prompt tone in a standard oddball paradigm. However, a small subgroup of adults who stutter was found to be driving the results. The same subgroup of poor performing adults who stutter also demonstrated abnormal evoked auditory waveforms.

Hampton and Weber-Fox (2008)

concluded that this subgroup demonstrated deficient non-linguistic auditory processing.

Objective tests like AEPs are valid and useful measures to study auditory processing in persons with stuttering as they reflect changes in auditory system as stimuli is processed.

A 3.00 kg block starts from rest at the top of a 30 degree incline

/in /by

A 3.00 kg block starts from rest at the top of a 30 degree incline and slides 2.00 meters down the incline in 1.50 seconds. a.) find acceleration of the block b.) find the coefficient of kinetic friction between the block and the incline. c.) find the frictional force acting on the block d.) find the speed of the block after it has slid a distance of 2.0 meters

Brookfields Reflective Model

/in /by

Brookfield’s Reflective Model

Introduction

Brookfield’s reflective model takes a different stance compared to other nursing models, and asks us to
consider teaching practice not in cyclical terms, but from multiple perspectives.

Brookfield’s four lenses of reflection

In Brookfield’s model, we should consider reflection from four perspectives: from our own standpoint,
from that of our learners, from that of our colleagues, and from its relationship to wider theory. Only
from the consideration of multiple points of view can we deepen our reflection. The four lenses
Brookfield suggests may be presented in the diagram below:

brookfield-reflective-model

1. Ourselves

For Brookfield, the autobiographical aspect of reflection, when we look back at our own
experiences and feelings, is central to any valid process of critical reflection. We may draw from our
own past as well as from current experiences which may have provoked the reflective journey.
Brookfield suggests that a thorough inventory is taken, so that we do not merely re-assess the moment,
but that we look back at our pasts as teachers, as trainees, and as learners ourselves, in order to be
able to work towards revealing the full nature and extent of elements of our teaching practice which may
require reappraisal.

2. Our Learners

Students’ perspectives may give insight which might otherwise have been missed
if the focus of the self-reflection had been purely upon the individual themselves. Student-oriented
reflection might encompass looking back at work produced by learners, at their feedback and grades, at
tutorial records and at journals. Survey and questionnaire data on quality of teaching
and of classroom experience might be valuable also.

3. Our colleagues

A further mode of investigation into the self involves going beyond learners and involves taking peers
and other colleagues’ perceptions and observations into consideration. Peer observation and other review
processes can reveal biases and assumptions in one’s teaching, and can bring to light aspects which one
might not consider otherwise.

4. Theoretical contexts

In the Brookfield reflective model, teachers need to be engaged in the investigation of their teaching
practice; the training of teachers does not end with the final assessment of the teacher training course, but is
instead a life-long journey. Engagement with critical reading, with subject scholarship, with the
political and other contexts of contemporary teaching, and with higher qualifications all serve to
deepen and refresh the connections between pedagogy in practice, and with critical engagement with that
practice.

Teachers may also realign themselves with theory through a re-engagement with critical reading, and may
derive fresh insights from their experience of reviewing their practice from an array of theoretical
standpoints. This kind of engagement fosters links beyond the immediate setting, and the knowledge and
experience of one’s peers and out towards broader communities of knowledge. A full investigation of
oneself and one’s practice, then, takes in multiple considerations, and applies them back to one’s
teaching, which can then be informed not only by a subjective response to reflection, but may be
filtered through peer, theoretical, and through learner engagements also.

Evaluation

One advantage of Brookfield’s model as outlined here is that it takes a holistic perspective, and
addresses teaching from a selection of standpoints. It may be thought particularly useful for making
summary observations, for example as part of end of year reviews, or in reflecting on engagements with a
training course. The breadth of observations may be insightful also.

Issues with the model as described may include the point that the model is less useful for making
assessments of teaching in action; it is more suited to summative, rather than live, reflection, and
perhaps is less useful for immediate use as a consequence. In addition, the lenses may be difficult to
articulate, and require not only time-consuming and detailed working, but result in a variable and
skewed picture.

The Effects of Diabetes among Australian Society

/in /by


Introduction

The term “Diabetes” is known widely as a disease which affects people who are overweight; although this disease is a common side effect which comes with being unhealthy, there are many other types of this disease that affect people who have no control over it. Diabetes is a conditon with a group of different sub-conditions where the body cannot regulate blood glucose.

Type one Diabetes symptoms can include Blurry vision, dry mouth, severe thirst, extreme hunger, unintended weight loss, frequent urination, fatigue and weakness, irritability and other mood changes and bed-wetting in children who previously didn’t wet the bed during the night.  This form type of Diabetes is known as an autoimmune form of the disease where the immune system attacks the insulin produced by the pancreas, for this reason, the condition is life long and an individual who has type one needs to take insulin through regular shots or an insulin pump.

The second form of diabetes is type two diabetes, it is the most common and is caused by lifestyle factors and weight gain which causes insulin resistance in the body over time. The prevalence of type two diabetes (based on self-reported data) has tripled between 1989–90 and 2014–15. The proportion of people with diabetes has increased from 1.5% to 4.7%. this trend is only likely to increase due to the ease of access to unhealthy foods and the price of unhealthy food being extremely low compared to buying healthier food. As society is well and truly use to getting what they want instantaneously, the choices Australian society makes is likely to follow that trend into the future.


Historical overview

The History of Diabetes is a long one that goes back around 3000 years when it was first mentioned by the ancient Egyptians. It has been found that they mention a symtoms of the disease we know today as type one diabetes. The symptoms included excessive urination, thirst and weight loss. At the time the writers recommended a diet consisting of whole grains to ease the symptoms. Furthermore in ancient India, people found out that they could use ants to test for diabetes by giving the ants urine. The ants seemed to be attracted to the urine we know now that it is because the urine contained high sugar levels. They called the condition “Madhumeha”, which means honey urine.

The term diabetes came later during the third century B.C.E. when Apollonius ( a Greek philosopher) mentioned the term “diabetes”. This may have been the earliest use of the term. Later in time, Greek physicians would differentiate between diabetes mellitus and diabetes insipidus.

Diabetes insipidus has no link with diabetes mellitus, although the symptoms of thirst and urination are the same, insipidus does not attack the bodies production of insulin. Diabetes insipidus results from a problem with a hormone called vasopressin that the pituitary gland produces.

Approximately in the fifth century, China and India could differentiate type one and type two, they could tell that type two was more common among people that are overweight and wealthy, this indicates to us that at the time people what had more money had more access to food, therefore, ate more and exercised less.

During the middle ages, it was believed that diabetes originated from the kidneys this would have been logical at the time considering that one of the sides effects of diabetes is frequent urination. This theory was later proven wrong in the 18th century by an English doctor who discovered that the disease was frequent among people who had some kind of injury or problem relating to their pancreas.

In 1776, an English doctor named Matthew Dobson became famous for his work on diabetes by publishing an article in the journal Medical Observations and Enquires, in the article Dobson mentions about the fact that people who are affected by diabetes can have sweeter urine than people who don’t carry the disease. He also mentions in his notes that the disease could be fatal in a minority cases but seemed to just be chronic in others, which helped to prove that there was a difference between the two types.

Before the 19th century, there was no record of people living longer than a few weeks to a month once they started showing symptoms, this was caused due to a lack of effective treatments. (Deborah Weatherspoon, 2019)


Current situation

Diabetes Type Number % Registered in Past Year
Type one 119,751 9% 3,360
Type two 1,132,318 87% 60,162
Gestational 41,508 3% 41,508
Other 8,726 < 1% 1,150

Total
 		1,302,303 100% 106,180

(2019)

As shown above, the majority of diabetes is seen within the Type two category, as this is a preventable form of diabetes. As Australian society moves forward into the future these numbers are likely to increase without drastic intervention.

the National diabetes services scheme (NDSS) gives us the information on how many people are affected by diabetes by age group as of 2019 and tells us that the prevalence of diabetes no matter the type affects individuals between the ages of 50-79 years of age the most.

There are 10,580 young Australians aged 10-19 years living currently with diabetes. The majority of these (93%, 9,842) have type 1 diabetes’.


Current practices

The most common practice used to treat diabetes is insulin therapy, whether it is by using an insulin pump or insulin injections it is what people will usually choose to treat the disease. For people with type one insulin is a hormone that is not produced by their body or in very small quantities due to an autoimmune reaction happening in the body, this means that they need to have daily injections. People affected by type two do produce the hormone but it is not effective this can also be called insulin resistance. In some cases, lifestyles changes can be enough to delay the necessity of insulin use but it is normal for the disease to eventually come to the point of needing injections.

As of September 2016, clinical trails commenced for an “artificial Pancreas” also known as a continuous glucose monitor (CGM). This system measures the blood sugar levels of the wearer every five minutes, a signal is then sent to an insulin pump which the individual wears on their body and they work together to regulate blood sugar levels without the need for injections. As the blood sugar returns to target levels, the insulin dose stops. Currently, in 2019  CGM’s are common practice but not always necessary. (Jia, Zhao, Chen & Zhang, 2018) (McMahon et al., 2019) (Dunstan et al., 2002)


Geographical data in Australia

The geographical location of diabetes is widespread throughout Australia. From data collected from the National Diabetes Services Scheme (NDSS) website, which shows a breakdown of diabetes based on type and state. It is shown that type two diabetes has a greater prevalence in dense metropolitan areas, as well as lower socioeconomic areas. This occurs generally because fast food options are cheaper and easier than buying individual items from the shops and cooking them. Healthy options are on average more expensive.

Nowadays, individuals in low socioeconomic areas grow up in a world of connection and information with the ability to order food from a smartphone, the choice is even easier to choose fast food over healthy eating. This allows the rates of type two diabetes to rise.  Based on sources from the NDSS, areas of high socioeconomic status have a significant reduction in the cases of type two diabetes. The question arises as to why that is. Generally speaking, those individuals who live in high socioeconomic areas eat healthier and have the resources and healthcare available to them. People of low socioeconomic/rural areas tend to rent as a pose to buying a house. As these rental houses or flats get smaller the cheaper they get so it can be hard to have the space to prepare and cook healthy meals.

In low socioeconomic areas, the level of knowledge and education regarding healthy eating and the potential for health related illnesses such as diabetes is less well known, these individuals are less likely to see a healthcare professional until the effects of diabetes have hit a critical level. Diabetes isn’t a disease that can be diagnosed from a psychical examination alone so it can be difficult for a person to be aware of the fact they have diabetes. Thanks to the advancements in medicine, the death rate has decreased marginally over the past 10 years from 16.7 to 16.2 deaths per 100,000 people. Prior to 2016, diabetes was consistently the sixth leading cause of death in Australia.

The total national percentage of the population who have registered with the NDSS with type two diabetes in Australia is 1,132,318 people (87%) as compared to the total national percentage of the population with type one diabetes sitting at 119,751 (9%). Over the last 12 months, 106,180 people with diabetes were registered with the NDSS. This equates to 291 new registrants every day, of these new registrants, 165 had type two diabetes, nine had type 1 diabetes and the remaining had either gestational or other diabetes. (NDSS 2019)



NDSS Registants Affected by Diabetes by Type


Type 1

As shown by the above map, individuals affected by type 1 diabetes within Western Australia sits a 9.1% registered with the national average sitting at 8.9%. Due to a majority of the nation’s population living in major city’s the scale shows that a high level of individuals with type 1 lives in a metropolitan area.


Type 2

As shown by the above map, individuals affected by type 2 diabetes make up 87.7% of the registered population in Western Australia, with the national average sitting at 87.1%. This map shows that individuals living all throughout W.A. and nationwide are affected drastically by type 2 diabetes.


Gestational

As shown by the above map regarding gestational diabetes 2.6% of the NDSS registered population within Western Australia is affected by gestational diabetes with the national average sitting at 3.3%, with a high percentage of gestational diabetes sufferers being located in a small portion of New South Wales.


Other

As shown by the above map regarding other forms of diabetes, only 0.6% of the NDSS registrants within Western Australia are registered as having another form of diabetes and the national average of NDSS registrants at a national level at 0.7%.


Resources and public information

Diabetes was declared as a National Health Priority by the Federal government in 1997, and state and federal governments have supported programs to monitor and improve diabetes prevention, detection and management. Nevertheless, diabetes prevalence is still on the rise indicating the need for more to be done.  Government initiatives such as the National Diabetes Services Scheme (NDSS) which monitors the growth of diabetes in Australia and help with the help of diabetes Australia which is the third oldest diabetes association in the world after the United Kingdom and Portugal.

By 1982 there were six diabetes associations or societies committed to the care of people with diabetes in Australia.

•         Diabetes Federation of Australia (DFA) – founded in 1957

•         Australian Diabetes Society (ADS) – founded in 1973

•         Kellion Foundation – founded in 1974

•         Diabetes Research Foundation of Western Australia (DRF of WA) – founded in 1976

•         Diabetes Youth Foundation – (DYF) founded in 1981

•         Australian Diabetes Educators Association (ADEA) – founded in 1981.

In the following years to come the National Diabetes Services Scheme (NDSS) which first came into operation in 1987 helped the government take control of the diabetes epidemic. The aim of the NDSS is to enhance the capacity of people with diabetes to understands and self-manage their condition. Diabetes Australia also seeks to support people with diabetes by providing timely, reliable and affordable access to NDSS services. Registration with NDSS is free and open to all Australians who are diagnosed with diabetes. In order to register the following must apply.

  1. Live in Australia or are visiting from a country where Australia has reciprocal health care agreements on an applicable visa.
  2. Have been diagnosed with diabetes by a doctor, endocrinologist or credentialled diabetes educator.
  3. Plus hold (or are eligible to hold) a Medicare or Department of Veterans’ Affairs card.

    (“Registration”, 2019)


Conclusion

In conclusion, Diabetes affects millions of Australians every year, by current figures, if the prevalence of diabetes continues at the rate it is one in ten people world wide will have diabetes by 2040. Although there hasn’t been a cure found yet, strides are being made towards a cure every year with better and better ways to manage diabetes. Government iniatives such as the National Diabetes Subisity Scheme (NDSS) which has helped to aid the issue with diabetes in Australia by ensuring patients with diabetes are managed appropriately. From a more fundermental point of view, education about food, diet and health should be renforced from the primary age in order to steer the next generation towards a healthier future.


References

•         Deborah Weatherspoon, C. (2019). History of diabetes: early science, early treatment, insulin. Retrieved from https://www.medicalnewstoday.com/articles/317484.php

•         Dunstan, D., Zimmet, P., Welborn, T., de Courten, M., Cameron, A., & Sicree, R. et al. (2002). The Rising Prevalence of Diabetes and Impaired Glucose Tolerance: The Australian Diabetes, Obesity and Lifestyle Study.

Diabetes Care

,

25

(5), 829-834. doi: 10.2337/diacare.25.5.829

•         Jia, P., Zhao, P., Chen, J., & Zhang, M. (2018). Evaluation of clinical decision support systems for diabetes care: An overview of current evidence.

Journal Of Evaluation In Clinical Practice

,

25

(1), 66-77. doi: 10.1111/jep.12968

•         McMahon, S., Haynes, A., Ratnam, N., Grant, M., Carne, C., Jones, T., & Davis, E. (2019). Increase in type 2 diabetes in children and adolescents in Western Australia. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.5694/j.1326-5377.2004.tb06023.x

•         NDSS. (2019). Retrieved from https://www.diabetesaustralia.com.au/ndss

•         (2019). Retrieved from https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/2e06e0f5-11d6-4dd3-83f2-342b4a0ef475.pdf

•         Registration. NDSS (2019). Retrieved from https://www.ndss.com.au/registration

Recognising- Overcoming and Supporting People with Stress

/in /by

The term Stress is well known by most people. But is it truly understood or in some cases even recognized? However, most people will or have dealt with stress at some point. But it could be considered important, that it is in small manageable chunks and that it does not escalate into chronic stress. Different people handle stress in different ways and some people handle it better than others. With that said ideally no one would ever have stress, but in a lot of life situations people will have stress to some extent. Stress can affect people in their professional lives and/or their personal life. There are many professions that have a high level of stress, such as emergency services, senior management and as even a student. There are also examples of stress in personal life, such as bereavement, family separation and financial. What is considered stress for one person may have no effect on others.

With this said; 1) How do we recognize stress? 2) How do we overcome stress? And 3) How can we support people suffering with stress?

Stress comes in many different forms, physical, cognitive, emotional and behavioral. Stress can be described as “a normal response to situational pressures or demands and is a part of everyday life. But chronic stress can lead to mental health problems and medical issues” (CAMH, n.d.). Some physical signs of stress could be clenching jaw, grinding teeth and lack of energy. “Much has been reported about stress and its relationship to other health problems, such as heart disease, blood pressure and depression” (Bressert, 2018). Police officers experience at least one of the forms of stress as they work a job that is highly demanding on their lives. Police officers can show signs of stress in the same way the general public can, after all police officers are human to. Therefore, they must deal with the physical stress just as anyone else would. “The pressures of law enforcement put officers at risk for high blood pressure, insomnia, increased levels of destructive stress hormones, heart problems, post-traumatic stress disorder (PTSD) and suicide”(University at Bufffalo, 2008)

Stress has many negative impacts on a person’s body for example headaches, increased depression and heart burn. If those stress levels stay elevated for too long, it could result in chronic stress. Chromic stress “is stress resulting from repeated exposure to situations that lead to the release of stress hormones. This type of stress can cause wear and tear on your mind and body. Many scientists think that our stress response system was not designed to be constantly activated. This overuse may contribute to the breakdown of many bodily systems” (Police Health Your Health Fund, n.d.). In order to control your stress, you must firstly realize that you are stressed. Many people are unable to realize that they are stressed as often as they are. There are many ways for people to keep stress out of their day to day lives, for example eat healthy and manage their time and activities. However, some people may turn to drugs, alcohol or any other substance. Police officers need to be able to recognize signs of stress in both themselves, colleagues and in dealing with members of the public. They also need to develop the skills to effectively manage stress and avoid being overwhelmed or negatively impacted by its consequences.

Policing can be a stressful job, many officers are regularly dealing with severely stressful situations, which could result in mistakes or accidents. Policing has repeated high levels of pressure; with that pressure it can cause increased levels of destructive stress. “Many police officers, and particularly those working in poorer neighborhoods or those with higher crime rates, experience physical danger on an almost daily basis. The constant possibility of being injured or worse by criminals is something that can weigh heavily on the mind of a police officer and cause a great deal of stress”(Hansen, n.d.). Many people have different stress triggers but for the majority the biggest trigger is work. That isn’t saying that everyone has the same trigger, for some it is from their daily life for example, divorce. When in a stressful situation the body creates a fight or flight response. “When you’re in a stressful situation, you may notice that your heartbeat speeds up, your breathing gets faster, your muscles tense, and you start to sweat”(Goldberg, 2018).

It is important that police officers recognize stress and if they demonstrate signs of it, they take time to seek treatment. However, the following statement suggests that this may not be happening, “Officers are under constant stress and do not take the time to seek treatment. Many times, they deny the stress they are experiencing for fear of being viewed as weak or not being able to handle their job”(Beshears, 2017). Officers have consequences for untreated stress that can lead to members of the public, family, friends or colleagues getting injured as the police officer isn’t fully aware of what is happening as the stress affects their thinking. There are ways for them to reduce the stress and that is for police officers to take regular vacation time or other personal time that allows them to have time away from the stressful situations that they deal with at work, share workload with colleagues and be aware of the hours worked in any given week. However, “Not all stress is bad. In fact, it can be positive. It can help officers get out of dangerous situations and it can also motivate individuals to achieve. However, too much stress can affect your emotional and physical well-being and can cause significant problems in your life at home, work, and school”(Beshears, 2017).

Within policing there are many different high-pressured tasks that are to be done, such as investigating a murder. With that comes a lot of stress as the families of the person who was murdered will want answers and quickly. “Even officers who are mentally prepared and experienced still suffer from stress. There are a multitude of layers of stress – such as the degree of threat and using judgement to shoot, and how the media treats the situation. There are court appearances, the negative attitudes towards police from the larger society, and the lack of rehabilitation agencies”(Police Health Your Health Fund, n.d.). Police officers can be as ready or prepared as they can be but still wouldn’t be able to avoid the stress as stress isn’t a thing that could be picked up and moved. Stress can come to mind at any time of the day even when a person is trying to relax and not think about it. As soon as that person’s mind goes back to blank space the stressor will pop back into the mind.

Police officers must find a way to manage their stress as majority of the community would not want the officer to mentally and physically crash. Some ways that police officers could manage stress is by having a support system. “Though it might be hard to explain your day to family and friends, it is vital that you maintain your support systems outside of the PD”(Flavin, 2018). Another way would be regular exercise, that helps you to take their mind off their daily life and go into a world where there is no stress. If a police officer lets the stress take over their lives, then there is a high risk of the officer making mistakes or even accidents while on the job. As a whole society would not want that to happen to an officer, as then they wouldn’t be able to continue to keep the community safe and there could be a chance of someone getting hurt, that maybe shouldn’t have been hurt to start with.

Police officers have many different training events that they must attend but there is also training that they can do to help to manage their stress. Three training modules that police can take are self-regulation training, relaxation training and resilience training. All three of these modules will help the officer to understand what they could do to relax or take their mind off the stressor that is controlling them. The officer doesn’t always have to do it themselves; Sadulski, 2018 explains that the department can also help by having supervisor training, having supervisor-subordinate meetings, aligning officers’ strengths with their assignment, support police families and create a framework of incentive.  While Borelli, 2017 explains; most if not all police departments have a training offer in place for stress management, as the departments are aware that policing can be stressful and draining on an officer’s physical, emotional and mental health.

Stress can affect everybody’s lives. Police officers need to know what stress effects their specific body. They also need to know how to deal with the stress when it comes, for example knowing to take a vacation or a personal day so that the stress doesn’t get worse. Although policing is high-pressured, police need to realize that they are never alone, if they need to talk with someone there is always someone their willing to listen. Police officers stay in a car with their partner all day and that could be the person that they decide to talk to. Many like to keep all of their thoughts to themselves as they don’t want to show that they could need help, in fact it is better to tell someone what you are experiencing and see If they are able to help or find someone that could help.

In conclusion, most police officers will face stress on many occasions during their professional life but also in their personal life. Stress can affect them physically, mentally and emotionally. Many officers would rather not seek treatment and would deny that they are suffering from stress. Although there are many different courses available to help avoid the stress getting worse, many would rather not tell anyone for the sake of recourse. Officers must find a way to identify and manage their stress either by telling someone or not. Policing can be high-pressured and stressful, however there are many ways to try and address it, such as regular personal time and many resources to keep their stress at a manageable stage.

References

  • Beshears, M. L. (2017, May 30).

    How police can reduce and manage stress

    . Retrieved from PoliceOne: https://www.policeone.com/stress/articles/how-police-can-reduce-and-manage-stress-AThewNlseDwMYCcB/
  • Borelli, F. (2017, March 29).

    Stress Management Training for L.E

    . Retrieved from Officers.com: https://www.officer.com/training-careers/article/12304324/stress-management-training-for-law-enforcement-professionals
  • Bressert, S. (2018, October 8).

    The Impact Of Stress

    . Retrieved from PsychCentral: https://psychcentral.com/lib/the-impact-of-stress/
  • CAMH. (2019).

    Stress

    . Retrieved from CAMH: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/stress?gclid=Cj0KCQiA2vjuBRCqARIsAJL5a-J3RoeogduCi2tI_L3PELr2e1ynfq_hZ27TY16vaLUNDoq1_hopg7IaAgv8EALw_wcB
  • Centre for studies on human stress. (n.d.).

    Acute Vs. Chronic Stress

    . Retrieved from Centre for studies on human stress: https://humanstress.ca/stress/understand-your-stress/acute-vs-chronic-stress/
  • Flavin, B. (2018, May 14).

    Police Sress: 9 Tips for Avoiding Officer Burnout

    . Retrieved from Rasmussen College: https://www.rasmussen.edu/degrees/justice-studies/blog/police-stress/
  • Goldberg, J. (2018, March 11).

    Causes of Stress

    . Retrieved from WebMD: https://www.webmd.com/balance/guide/causes-of-stress#2
  • Hansen, F. (n.d.).

    Police Stress: Identifying & Managing Symptoms of Stress

    . Retrieved from The Adrenal Fatigue Solution: https://adrenalfatiguesolution.com/police-stress-fatigue/
  • Police Health Your Health Fund. (n.d.).

    Police Stress is Unique

    . Retrieved from Police Health : https://policehealth.com.au/police-stress-unique

  • Police Officer Cannabis Training

    . (2018, October 17). Retrieved february 6, 2019
  • Sadulski, J. (2018, February 9).

    5 ways police departments can help officers cope with stress and trauma

    . Retrieved from Policeone: https://www.policeone.com/health-fitness/articles/5-ways-police-departments-can-help-officers-cope-with-stress-and-trauma-D3XeZ7T8oERhjo34/
  • University at Bufffalo. (2008, September 29).

    Impact Of Stress On Police Officers’ Physical And Mental Health

    . Retrieved from ScienceDaily: https://www.sciencedaily.com/releases/2008/09/080926105029.htm

How To Prevent Tooth Decay

/in /by

1. Introduction

Fotek (2012) noted that tooth decay, which is also called dental caries or dental cavities, is a source of infection, causing the loss of mineral salts and devastation of the hard tissues such as enamel, dentin and cementum. It is a result of the bacterial fermentation of the food. If it is untreated, it’ll lead to pain. Nowadays, tooth decay is remain one of the most popular health problems all over the world. In fact, everyone can easily have problems with tooth decay but children are at the highest risk.

Tooth decay has its own long history. University of Illinois (n.d) recommends that over a million years ago, hominid like Australopithecus suffered from cavities. Some evidences found by Archaeologies show that tooth decay is an ancient disease in prehistorically period (University of Illinois n.d). Evidence such as skulls which are excavated through the neolithic period gives signs of caries (University of Illinois). Richards (2002, p.1275) suggests that in South Asia, the growth in caries is related to the rice cultivation. From 5000 BC, Sumerian considered ”tooth worm” as the cause of tooth decay. The proof of this belief has been found in some Asian countries such as India, Egypt, Japan and China (Richards & Norman 1990). A report in the NBC News (4 May 2006) revealed that in Pakistan, a 7000-year-old teeth show nearly perfect the holes from primitive dental drills. Thus, this paper, with the purpose to help people know more about tooth decay and learn how to prevent it.

2. Discussion of findings

2.1. The signs and symptoms of tooth decay

A recent study by Health Promotion Board shows that : ‘A person experiencing caries may not be aware of the disease’. The visual aspect of a chalky white place in the surface of tooth is the earliest mark of a new carious lesion, showing an area of demineralization of enamel (King 2011). As the wound continues to demineralization, it can turn brown but finally will turn into cavity (Clake n.d). In ‘Dental Cavities’ (2012) continues when the tooth enamel and dentine are destroyed, the tooth decay becomes noticeable, the affected area of tooth also becomes vulnerable. Moreover, once the decay passes through enamel and reach to the nerve of the tooth will result in a toothache. Bad breath and foul tastes are also the consequences of dental caries (Clake n.d).

2.2. Causes of tooth decay

There are four main reasons for tooth decay organization: teeth, bacteria, fermentable carbohydrates and time. Smith, B. & Pickard, H. M. (1990) states that the caries process does not have an unavoidable result and different people will have different degrees basing on the form of their teeth, oral hygiene habits, and the content of their saliva.

The first reason that Neville (2002, p.89) stated is that teeth are affected by many diseases that can leave an individual at a great risk for caries. He also said that Amelogenesis imperfect, which occurs between 1 in 718 and 1 in 1,400 individuals, is a disease that the enamel does not form in full or forms in deficient amounts that can fall off a tooth. Therefore, teeth may be more vulnerable because the enamel is not able to protect the tooth in both cases (Neville, p.94). The cause of tooth decay by disease affecting the teeth is not the main reason in almost people. Cate (1998, p.1) indicated that: ‘Ninety-six percent of tooth enamel is composed of minerals’ and when let out to the acidic environment, these minerals will become soluble. Once root surface of teeth are exposed, cavities can develop easily even in a healthy oral environment.

Moving on to the next point, bacteria are present in mouth to change over the sugars and amylum into acids (Priya Johnson 2012). A substance called plaque in the mouth is the combination of bacteria, acid and saliva (Johnson 2012). This compound is sticky and cling itself to the teeth, especially on the surface of grinders and at the edges of teeth fillings (Johnson 2012). Plaque compile within 20 minutes after eating, the time when most bacteria action starts (Johnson 2012). In addition, the more food is consumed, the more plaque is formed (Johnson 2012).

The third reason referred to the fermentable carbohydrates. Bacteria in a person’s mouth convert glucose, fructose into acids like lactic acid via a process called fermentation, when contacting with the tooth, these may cause demineralization (Neville 2002). Fluoride toothpaste can help demineralization (Silverstone 1983). An amount of mineral content may be lost if demineralization keeps continuing so that forming a hole (Madigan & Martinko p.705). The impact like sugars has on the process of tooth decay named carcinogenicity (Madigan & Martinko p.705).

According to British Nutrition Foundation (2004), the oftenness that teeth are exposed to acidic environments affected the likeliness of caries evolution. UCLASD (2006) suggested that after meals, the bacteria in the mouth metabolize sugar that decreases pHs As time goes by, the pH returns normal due to the capacity of saliva and the faded mineral content of tooth surface (UCLASD 2006). During every exposure to the acidic environment, part of inorganic mineral content at the teeth surface can remain dissolved for 2 hours (UCLASD 2006). If the diet is rich in carbohydrates, the carious process can start within days of the tooth erupting into the mouth (UCLASD 2006). Summit (2001, p.75) suggests that the introduction of fluoride treatments can slow down the process. Proximal caries take four years to pass through enamel in permanent teeth because the cementum enclosing the root surface is not as long-lasting as the enamel, root caries attended to progress more rapidly than on other surfaces (Summit 2001).

2.3. How to prevent tooth decay?

Everyone wishes they had beautiful teeth but they do not know how to protect their teeth. Keeping cleaning outside and inside teeth is essential for long-lasting look as well as tooth strength.

Oral hygiene is one of the most important methods to prevent dental caries. Personal oral hygiene care compounds of brushing and flossing everyday (Nguyen 2011). He also suggests that in order to prevent dental caries, people need to brush teeth after every meal. Besides, brush teeth regularly in the morning and evening, or at least once a day after dinner. Brush teeth with a soft bristle brush, brush inside, outside and chewing surfaces (Nguyen 2011).

Using toothpaste contained fluoride, drinking water or salt to supplement fluoride can reduce 30% of dental caries (Nguyen 2011).

Beside oral hygiene, a report in the Helium (2011) revealed that everyone should have the dentist checked every 6 months. If the plaque is found building up between your teeth, note what the dentist says. Listening to what the dentists said can also help to lessen the appearance of plaque.

Finally, dietary alteration also helps people to prevent tooth decay. For dental health, the amount of sugar that is taken in is more important than the amount of sugar used up (British Nutrition Foundation, 2004). Hence, the recommendation of minimizing snacking is brought out because snacking produces a supply of nutrition for acid-producing in the mouth. For children, the American Dental Association and the European Academy of Paediatric Dentistry suggest to reduce the oftenness of drinks with sugar. And not giving baby bottles to babies when they sleep. The guideline of Clinical Affairs Committee (2012) is also recommended mothers not to share utensils and cups with their babies to prevent transmitting bacteria from mother’s mouth.

2.4. Tooth decay in Vietnam

As stated in ‘Dan tri’ (2012), with the parents, the smile of children are always the precious things. However, they do not care much about their children’s teeth or many false views lead to some unpredicted consequences. Parents often think that it is too soon to teach their children how to protect the teeth, and baby teeth will be replaced by permanent teeth; it’s time for children to brush teeth two times a day to avoid tooth decay. In fact, it is extremely wrong if children have tooth decay in the period of baby teeth, they will at risk of tooth decay in adulthood.

Currently, according to the ‘Vietnamese Smile Protection Program’ (2012), about 85% of children aged 6 to 8 suffered from tooth decay; 60 – 90% of children have gingivitis. Not as romantic as the fairy tales that the tooth fairy would make the tooth disappears, they also emphasized that if not treated; tooth decay will lead to pancreatitis and cause pain.

There are many reasons for the alarming number of children’s oral health, including the lack of parental attention to this issue. Parents accidentally support the children’s bad habits such as improper brushing, eating too much sweet.

Oral health status was at risk. According to Hanoi Medical University, up to 90.4% of children were examined with plaque. According to this statistics, tooth decay in ages of 6-8 is 84.9%, permanent caries at ages of 9-11 is 54.6%. This has become the common concern not only of the society but also the dental experts who know most about dental problems as well as the importance of teeth for the development of children. As the result, children need dental care as soon as the appearance of the first tooth, also maintain proper brushing habits will help children learn how to take care of their tooth.

Health Policy on Restraint in Health Care Settings

/in /by


Health Planning and Policy Development: Leadership Issues


  • Jinyi Kim

Health Policy on Restrain

According to the World Health Organization (WHO, 2015), health policy can be defined as the decisions, plans, and actions towards achieving specific goals in health care within a society. They mention that a successful health policy can achieve several things: “it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people” (WHO, 2015). Center for Disease Control and Prevention (CDC, 2015) state that public health policies affect national health strategies, plans, and resource allocations. Restrain have been using the reasons for protection patient from injury, maintaining treatment, and controlling disruptive behavior. It was thought that without the restraint, patients could be in danger of injuring themselves or others. However, it is a legal issue that when and how use the restraints. The overall purpose of this paper is to understand the significant policies of restraint intervention in health care setting and address my position as a future Advanced Practice Nurse (APN).

History of the Restrain Problem

The use of restraint is a widespread intervention in health care in many countries (Goethals, Dierckx de Casterlé, & Gastmans, 2012). According to Strunk (2014), the prevalence of restraint in United States ranges 4 to 85% in nursing homes and 8 to 68% in hospitals. Restraint has been used as a treat intervention for patients or prevent others from harm by patients especially mentally ill patients. Strunk (2014) argue that terms were used to describe mental illness such as “idiots, lunatics, insane, and epileptic” labeling and justifying individual who need restraint for keeping themselves and others from harm in the 18

th

and 19

th

centuries (p. 19). Gerace, Mosel, Oster, and Muir‐Cochrane (2013) state that restraint of elderly who aged over 65 have been utilized to control aggression and prevent falls. Many studies indicate that restraint has been applied for staff centered reasons including lack of staff and organization goals (Goethals et al., 2012; Gerace et al., 2013). Abuse has been widely documented in various articles and journals about the use of restraints (Strunk, 2014).

The United States Food and Drug Administration (FDA) estimated in 1992 that at least 100 deaths occur annually in the U.S. from their improper use in nursing homes, hospitals and private homes. Adverse Effects of Physical Restraints throughout the last decade and there has been an increasing amount of evidence and literature supporting the idea of a restraint free environment due to their contradictory and dangerous effects. According to the College of Nurses of Ontario (2009), about 150 deaths caused by restraint each year and using restraint also cause “pressure ulcer, higher rates of falls, incontinence, bone demineralization, and increase patients’ aggression” (p. 2). These days, many people already recognized the negative effect of restraint; however, it is still using in health care settings for various reasons. There are no clear evidences that restraint to prevent injuries.

Major Policy Makers Involved

Restraint use is regulated by national and state agencies. The major stakeholders in the restraint policies in the U. S are the federal government, health care organizations, and health care providers. Also, each health care facility has its own restraint policy. According to Center for Medicare and Medicaid Services (CMS, 2011), a physician or a licensed independent practitioner who are permitted by state and hospital may order restrains and they have responsibility to assess and evaluate the patient who need for intervention within one hour after the restraint is initially ordered. In addition, the health care facilities should educate and train their staff with direct patient contact and must properly use restrain and alternatives (CMS, 2011). CMS (2011) state that hospital must report to CMS any death occurs while a patient is in restraint.

As noted, internationally many health care facilities have their own restraint policy. The hospital policy manual of New York Presbyterian Hospital (2006) mention that the use of restraints is a patients’ rights issue and the benefits are weighed against the patient’s inherent right to be free from restraint. Maintaining the patient’s rights, dignity and well-being are a primary consideration when restraints are used. The College of Nurses of Ontario (2009) state that restraint will only be used when a patient is in imminent danger of harm to self or others, and nonphysical or less restrictive measures have failed, or are not expected to be effective. NSW Ministry of Health (2012) argues that restraint should be a last option to manage the risk of serious imminent harm because it involves risk to the physical and psychological health of both staff and patient.

Nurses’ Involvement

ANPs and Registered nurses play a crucial role in the restraint reducing by proving the negative effects of restraint. The position statements of American Nurses Association (ANA, 2012) state that using restraint to patients is contrary to the fundamental goal and ethical tradition of the nursing profession. ANA (2012) believes that restraint should be utilized only when no other feasible option is available. In addition, when restraint is necessary, more than one witness should document and treat the patient with preserving human dignity (ANA, 2012). Likewise, the position statement of American Psychiatric Nurses Association (APNA, 2014) about using restraint state that restraint must never be used for staff convenience or to punish or coerce individuals. In addition, restraint reduction and elimination efforts must include a focus on necessary culture change because restraint use is influenced by the organizational culture that develops norms for how persons are treated (APNA, 2014).

Nurses are patient advocator who respect patients’ wishes and have responsibility for ensuring that the patient has received information and consenting to the proposed plan of care. According to College of Nurses of Ontario (2009), nurses have responsibility to understand the patient’s behavior to accurately determining the need of restraint and collaborate and discuss about using lease restrictive restraints if necessary. Consent is crucial to nursing interventions because patients have the right to make decisions regarding their care and treatment (CMS, 2011). In addition, College of Nurses of Ontario (2009) state that although the restraint is necessary, the nurses should regularly reviewing the continued use of restraints is needed or not and documenting the assessment of the patient.

Ethical Issues

Expanding health technologies and increasing demands for cost containment have emphasized the need for ethical decision making by all health care professionals. Health care providers may struggle to balance their responsibility to protect patients’ right of freedom and their obligation about patients’ safety. ANA (2012) state that the most essential ethical concept of nursing is avoiding harm and respect individual’s autonomy and right to make their own decision. In terms of making decisions about physical restraint, it is often difficult to avoid harm both restraining and not restraining could bring about harm. In order to make effective ethical decision about restraint, careful thought of balancing the options is necessary. Health care providers should consider their personal values, professional responsibilities, and patients’ best interest to make appropriate ethical decision (Goethals et al., 2012). As noted, health care providers should try first alternative methods to ensure patient’s safety due to restraints should be used only as last choice and should not cause harm or be used as punishment (CMS, 2011). Even though, the restrain used for good intervention, it is still violate the human rights because restraint may force to immobilize and isolate patient, and do not alleviate their suffering (APNA, 2014). If unavoidably applied restraint to patient, health care providers should check the restraint are not cutting off patients’ blood flow and reassess that the restraint can be discontinued as soon as situation is safe. It is though that health care provider should make decision about restraint following their facility policies and guidelines with multidisciplinary team.

Options for Resolving

There are philosophical debates and questions about the restraint issue in health care settings such as individual rights, ethics, and financing topics include minimize costs and maximize the efficiency of health care delivery (Gerace et al., 2013). One of the strategies to resolve this problem is the creation of awareness on the advantages of the alternatives instead of restraint. Politicians are an obvious stakeholder in this matter. Because the policy encompass decision made at state or national level including funding decision that affect whether and how services are delivered (Gerace et al., 2013). Therefore, policy makers should consequently try to call for allocation of state and federal financing for utilizing the best practices proved by researches.

ANA (2012) argue that educating nurses, other health care staff, and caregivers on the appropriate use of restraint and the alternatives is helpful to reduce restrictive intervention of restraint. In addition, if using restraint is only viable option, ensure sufficient nursing staff to monitor the patient (ANA, 2012). The legal basis consent is required before treatment and the consent to an agreed form of restraint after providing sufficient information include risks and implications (Strunk, 2014). It is thought that the information about alternatives should be provided when patient or family are need to decide write consent about restraint. NSW Ministry of Health (2012) suggests the alternatives to restraints to reduce restraint use through physical modification as below Table 1.1:

TABLE 1.1 Alternatives to Restraints
Alternative Examples
Modify environment
  • Increase / decrease lighting
  • Establish wandering paths
  • Disguise exits
  • Room or bed change
Adapt wheelchairs
  • Wedge pillow
  • Lap buddy
Provide body props / postural enhancer
  • Bed or chair alarm
Install alarm / safety devices
  • Eliminate buzzers
  • Bells
  • Intercoms
  • Television
  • Shut doors
Reduce unnecessary visual or auditory stimuli
Personalize rooms
Use secured unit
  • Med / psych only

Note

: Adapted from NSW Ministry of Health. (2012). Aggression, Seclusion & Restraint in Mental Health Facilities in NSW.

Health care facility leaders and administrators should focus on assistance to quickly identify and address legal and financial risks about the use of restraint. According to NSW Ministry of Health (2012), in order to reduce the use of restraint successfully, executive staffs in clinical settings should have clear leadership to give outlines about the role and responsibilities to all staff members. Strunk (2014) states that performance improvement plan involving collaboration with multidisciplinary team, a broad consultation process, and weekly team meeting to analyze restraint event are key component of this strategy. In addition, collect and use data by an organization is another strategy to identify the successful use restraint prevention practice can be shared (Strunk, 2014).

Health care providers need to intensively educate to make proper decision on this matter. Also, health care facilities and state should suggest accessible guideline and standard to health care providers. Especially, the national standards for use of restraint and accredited training for health care providers are needed to establish by government. Goethals et al. (2012) argue that stimulate and educate nurses are urgently needed for making appropriate decision about the use of restraints. According to ANA (2012), in order to make appropriate decision regarding restraint, clear and nationally accepted standards and guideline should be available to health care providers. In addition, ethical consultation should also available to health care providers in clinical setting to make proper decision to restrain (ANA, 2012).

As noted, providing educational initiatives related to restraint is also good strategy to reduce the use of restraint. It is believed that nationally accepted program for restraint is need such as certification program for restraint. Most of health care facilities require basic life support certification when they hire health care provider. Likewise, the nationally accepted certification program for restraint should be prepared and required to health care provider who directly contact with patients. Many health care facilities have their own strategies and guideline to reduce the use of restraint. For instance, New York Presbyterian Hospital (2006) suggests the manual to make restraint free environment as below Table 1.2:

TABLE 1.2 Steps for Restraint Free Environment
Step Action
1 Obtain an order for restraint from the physician or other LIP prior to application of restraints or immediately after application of restraint.

Reminders:

  • The attending physician must be consulted as soon as possible if the attending physician did not order the restraint
  • Use of a PRN order of restraint use is not acceptable

2

Apply restraints under the direction of a RN, physician, or other licensed independent practitioner (LIP)

3

Obtain an order with each new episode of restraint and daily if patient restrained greater than 24 hours

4

Re-assess the patient every 2 hours or more frequently based on the individual needs of the patient.

Note:

  • Take into consideration
  • Patient’s condition
  • Cognitive status
  • Risks associated with the chosen intervention
  • Type of intervention used
  • Include in the assessment
  • Circulation and range of motion in restrained extremities
  • Nutrition
  • Hydration
  • Hygiene
  • Elimination
  • Comfort
  • Physical / psychological status
  • Readiness for discontinuation of restraints

5

Inform patient, patient’s family or authorized representative about reasons for restraint use

6

Provided an educational handout entitled ‘Understanding Restraints’ as appropriate

7

Update the patient’s problem list

8

Update restraint log


Note

: Adapted from New York Presbyterian Hospital. (2006). Hospital Policy and Procedure Manual.

At first, there is no single remedy to remove restraint in health care settings. There are some options have been suggested to resolve this problem. It is thought that the most effective strategy to resolve this problem is to provide restraint supportive environment and education for health care providers. According to ANA (2012), a systematic approach of assessment, intervention, and evaluation it needed to resolve restraint issue in health care settings. In other word, open communication at the highest administrative levels, including health care providers and community representatives is crucial to implement change. In order to ensure restraint is not used abusively and to support health care providers making appropriate decision, health care organizations, as well as the government intent to promote a reduced restraint environment by sufficient nursing staff to monitor, intention to comply with policies, and environmental designs to facilitate restraint reduction (ANA, 2012). According to College of Nurses of Ontario (2009), health care providers should know the information about restraint in health care settings as below:

(1) Understand what restraint is; (2) Provided person-centered care that minimizes the need for restraint; (3) Understand the legal and ethical frameworks relevant to restraint; (4) Know what to do if they suspect inappropriate or abusive use of restraint; (5) Understand the circumstances in which restraint may be legally or ethically required; (6) Understand how to minimize the risks if restraint is used (p. 11).

Many facilities have been tried to make restraint free environment in their clinical settings (Strunk, 2014; New York Presbyterian Hospital, 2006). Gerace et al. (2013) mention that the applying restraint free environment framework (Table 1.3) support health care providers to make decision about the use of restraint more appropriately. Also, this framework is helpful to assess and manage restraint patients in clinical settings.

TABLE 1.3 Restrain Utilization Decision Tree

Note

: Adapted from Gerace, A., Mosel, K., Oster, C., & Muir‐Cochrane, E. (2013). Restraint use in acute and extended mental health services for older persons. International journal of mental health nursing, 22(6), 545-557.

In conclusion, the restraint is applied to patients for some reasons in health care settings. It is ongoing issue need to discuss and debate due to the use of restraint is frequently challenging and difficult decisions in health care system. Health care providers should consider that the restraint is really needed for their patients, is there any alternatives instead of restraint, and what the most appropriate way to utilize it is through education about clear and ethically accepted guideline and policy. Therefore, educational opportunities and clear guideline to support health care providers in developing the necessary assessment and intervention skills to reduce the use of restraint are critically needed to provide in health care system.

References

American Nurses Association. (2012). Reduction of Patient Restraint and Seclusion in Health Care Settings. Retrieved from

http://www.nursingworld.org

American Psychiatric Nurses Association. (2014). The Use of Seclusion and Restraint. Retrieved from

http://www.apna.org/i4a/pages/index.cfm?pageid=3728

Center for Disease Control and Prevention. (2015). Public Health Policy. Retrieved from

http://www.cdc.gov/stltpublichealth/policy/

Center for Medicare and Medicaid Services. (2011). CMS Manual system. Retrieved from

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R75SOMA.pdf

College of Nurses of Ontario. (2009). Restraints. Retrieved form

www.cno.org

Food and Drug Administration. (1992). Potential Hazards with Restraint Devices. Retrieved from

http://www.fda.gov/MedicalDevices/Safety/

Gerace, A., Mosel, K., Oster, C., & Muir‐Cochrane, E. (2013). Restraint use in acute and extended mental health services for older persons.

International journal of mental health nursing

, 22(6), 545-557. doi: 10.1111/j.1447-0349.2012.00872.x

Goethals, S., Dierckx de Casterlé, B., & Gastmans, C. (2012). Nurses’ decision‐making in cases of physical restraint: a synthesis of qualitative evidence.

Journal of advanced nursing

, 68(6), 1198-1210.

New York Presbyterian Hospital. (2006). Hospital Policy and Procedure Manual. Retrieved from

http://www.hospitalist.cumc.columbia.edu

NSW Ministry of Health. (2012). Aggression, Seclusion & Restraint in Mental Health Facilities in NSW. Retrieved from

http://www.health.nsw.gov.au/Pages/default.aspx

Strunk, L. L. (2014). Seclusion and Restraint Policy and Practice: Are We Doing the Right Thing?

All Theses, Dissertations, and


Other Capstone Projects

, Paper 381.

World Health Organization. (2015). Health policy. Retrieved from

http://www.who.int