5 short questions, 1 problem, and 10 multiple choice based on a textbook that will be sent digitally. need done in 5 hours or less. seriously inquiries only…do not bid if you cannot meet deadline with non plagiarized, grammatically correct work.
2-Determinants of Health and Explanation of How Determinants Contribute to Disease Development:Paper comprehensively discusses the determinants of health in relation to the communicable disease, explains their contribution to disease development, and provides evidence to support main points.
3-Epidemiologic Triangle (Host Factors, Agent Factors, and Environmental Factors):The communicable disease is described thoroughly, accurately, and clearly within an epidemiological model. A visual description of the model and how the components of the model interact is included.
4-Role of the Community Health Nurse:Discussion of the role of the community health nurse is clear, comprehensive, and inclusive of the community nurse’s responsibilities to primary, secondary, and tertiary prevention through tasks such as case finding, reporting, data collection and analysis, and follow up.
5-National Agency or Organization That Works to Addresses Communicable Disease:An agency or organization is identified. A clear and accurate description of efforts to address communicable disease is offered.
6-Thesis Development and Purpose:Thesis is comprehensive, contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.
7-Paragraph Development and Transitions:There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.
8-Mechanics of Writing (includes spelling, punctuation, grammar, language use):Writer is clearly in command of standard, written, academic English.
9-Global Implication:A discussion of the global implication of the disease is clear, comprehensive, and inclusive with a comprehensive description of how this is addressed in other countries or cultures and if the disease is endemic to a particular area. An example is provided.
10-Paper Format:All format elements are correct.
11-Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment):In-text citations and a reference page are complete. The documentation of cited sources is free of error.
Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance completing this assignment.
Communicable Disease Selection
Choose one communicable disease from the following list:
1. Chickenpox
2. Tuberculosis
3. Influenza
4. Mononucleosis
5. Hepatitis B
6. HIV
7. Ebola
8. Measles
9. Polio
10. Influenza
Epidemiology Paper Requirements
Address the following:
1. Describe the communicable disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
2. Describe the determinants of health and explain how those factors contribute to the development of this disease.
3. Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. (The textbook describes each element of the epidemiologic triangle). Are there any special considerations or notifications for the community, schools, or general population?
4. Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).
5. Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organization(s) contributes to resolving or reducing the impact of disease.
6. Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.
A minimum of three peer-reviewed or professional references is required.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
Marisa L. Bishop
The aim of assessment is to ensure all patients receive consistent and timely nursing care. With the healthcare field our assessment skills are our biggest tool in determining patient care. As nurses, one of the first skills taught is a head to toe assessment. Nurses are taught to inspect, auscultate, palpate, and percuss to determine patient’s needs. Structured patient assessment frameworks’ impact direct patient care. Accurate patient assessment is imperative to determine the status and needs of the patient and the delivery of appropriate patient care. Nurses must be highly skilled in conducting timely and accurate patient assessments to overcome environmental obstacles and deliver quality and safe patient care (Munroe 2013). Nurses have multiple different types of assessment like emergency, focused, and continuing assessments to be in different settings to better suit the patients.
It is important to perform a history and do a focused physical exam to be sure that there are not any medical risks that would predispose the patient to a medical emergency during the actual procedure. As a healthcare worker nonmaleficence which means non-harming or inflicting the least harm possible to reach a beneficial outcome is the highest concern (Beneficence 2017). Nurses are focused on patient centered-care along with health promotion. Patient-centered care has been associated with a large variety of positive patient outcomes such as adherence to treatment, improved health, and satisfaction. These tasks ensure the best treatments for patients. Nurses must assess patients quickly and thoroughly to note areas where care is required.
Most commonly an assessment is broken down in two types of interviews, one is conducting a health history which includes the collection of subjective data information given by the patient or patients family members and a physical examination of the patient which consists of evidence based data and objective data. Collecting and documenting accurate information is imperative in providing the multi-disciplinary health team the information to facilitate an effective and well-formed care plan, as well establishing a baseline for following assessments (Wilson & Giddens, 2009). The assessment interview builds the foundation of the nurse and patient relationship, building good rapport with the patient will alleviate any stress, anxiety or discomfort the patient may be feeling. The patient will be asked personal questions and times may not understand or may not want to reveal information about their personal life or situations. As a nurse being open and honest, explaining why this type of information is necessary and asking open-ended questions will help prompt the patient to disclose the facts required, advance the process and be fundamental in performing a competent assessment.
Medication administration is an vital skill taught in undergraduate nursing programs. Students learning for this activity includes not only how to calculate and prepare and administer medications, but also includes interventions such as patient and family teaching (Bourbonnais 2014). This task is most extensive than just handing out medications. In order to maintain nonmaleficence, nurses must understand multiple things like: knowledge of the medications being given including how it is given, when, and how many times daily. A big rule to standby are the rights of medication administration. The standard rights of medication administrations include five basic principles which are right patient, route, time, dose, and drug. There are also more extensive rights that include the previous five basic rights plus right response, reason for giving, documentation, assessment and evaluation, education, expiration, and the right to refuse the medication. Medication administration is driven by orders placed by a physician but guided by the nurses’ assessment. It is the nurse’s responsibility to know their patient from head to toe and can suggest possible needed treatments that care be ordered by the physician if agreed upon. Collaborative, patient-centered care is the new standard in healthcare and is led by nurses intervention and assessments. Which allows the healthcare team to create a patient specific care plan and tailor treatment to match the patients ever changing needs.
References
Beneficence vs. Nonmaleficence. (n.d.). Retrieved February 19, 2017, from http://missinglink.ucsf.edu/lm/ethics/Content%20Pages/fast_fact_bene_nonmal.htm
Bourbonnais, F. F., & Caswell, W. (2014). Teaching successful medication administration today: More than just knowing your ‘rights’. Nurse Education in Practice, 14(4), 391-5. doi:http://0-dx.doi.org.uafs.iii.com/10.1016/j.nepr.2014.03.003
Clayton, M. F., Latimer, S., Dunn, T. W., & Haas, L. (2014). Assessing patient-centered communication in a family practice setting: How do we measure it, and whose opinion matters? Patient Education and Counseling, 84(3), 294-302. doi:http://0-dx.doi.org.uafs.iii.com/10.1016/j.pec.2011.05.027
Munroe, B., Curtis, K., Considine, J., & Buckley, T. (2013). The impact structured patient assessment frameworks have on patient care: An integrative review.
Journal of Clinical Nursing, 22
(21-22), 2991-3005. doi:http://0-dx.doi.org.uafs.iii.com/10.1111/jocn.12226
Introduction
A person is contemplated homeless if there is no roof over his head to live. The statistics, which prevail only, relate to masses that are counted as homeless and meet the requirements for local government aid. The quota of households proclaimed in need of urgent housing in United Kingdom increased by about 25% over the last four years. The enormous numbers of people classified have complicated social, health and psychological requirements, and in the past years a great number of centres have been set up to dispense foremost care to people belonging to homeless group.
Importance of public health
Personal medical services regulation body has made this practicable; earlier, the network of general practitioner (GP) fundholding was a hurdle to chief care for vagrant people with complicated and unsolved issues. The nationally increased general practitioner (GP) agreement will in all likelihood put forward inducements for supervision of vagrant people. The existing obstacles for this group can be seen in suc a way that In a report to the Office of the Deputy Prime Minister, they incorporated the appointment procedures, opening times of surgery, financial disincentives, location and discrimination. Causes for differentiation comprise of impressions that they are violent, antisocial, migrant, or ‘undeserving’. Furthermore, the situation was dealt with some vagrant people face even more risk of being excluded due to their gender, age, sexual orientation or ethnic background. In primary safekeeping, demanding conduct can be a matter of question, but classification of an individual as ‘undeserving’ or ‘deserving’ takes no description of the social elements for example poverty and unemployment, which can conduct to homelessness. Doctors are encouraged by the general media council to permit personal views about patients’ gender, culture, race, age or sexuality to preconceive the idea the safekeeping they get. Because of it a challenge is being placed on clinicians not to eliminate people from health centers because of homelessness or possible drug culture. (Anne, 2005).
Common health problems
Drugs
People without home have a larger proportion of dangerous morbidity and humanity than the other general population. The major health requirement is drug reliance,and the use of illegal drugs, which cause numerous morbidity (including viral hepatitis B and C), septicemia, HIV infection, deep vein thrombosis, abscesses, endocarditis, cellulitis and encephalitis. Adjacent to this, many will be using numerous drugs, mainly heroin and cocaine.Typically for drugs users, principles make these rules. Controlled drugs should be authorized to those patients only who have actually accepted GP, drugs worker and patient. Now there are nations approved results of drug cure,and the policy will rely on those who use drugs independent situations, for example, some drug users will insisted to detoxify from opioids (clearly it is then reasonable to work to an outcome of cessation of drug use).
For disorganized drug users, this outcome is not much sensible at first demonstration and the goal must be to establish health and social obligating’s. This (harm reduction) will involve a reduction in the amount of the drugs used, upgrading in physical health, less sinful action and improved relationships (personal/family). (Phill, 2003)
Alcohol
Many vagrant people have a persistent history of serious alcohol dependence with hepatobiliary, gastrointestinal, cardiovascular, neurological, or metabolic complications. Not to forget that the risk of suicide because of depression is still there.
Frequently the vagrant users of alcohol will come to the extensive practitioner with an appeal for urgent detoxification. This should not be undertaken without sufficient preparatory support and assessment. Particularly, uncontrolled detoxification can conduct to convulsions (mainly in the initial 24 hours), which can cause death. The drug of choice to accomplish removal is chlordiazepoxide. Earlier Clomethiazole (Heminevrin) was taken, but this is more toxic when excessively taken and has larger causing dependency capacity. A treatment of vitamins is used instead which also requires to be recommended large dose of thiamine for a single week followed by prolongation vitamin B blend strong. (Phil, 2003)
Smoking
In the regular population, smoking have decreases since last 30 years. As stated by the General Household Survey, 27% of adult population smokes. One of the government investigation carried out about smoking (among homeless people) was managed in 1996 by Gill. They found that the levels of the smoking were:
Current research in England (southwest) and Wales noted that 94% of Big Issue vendors reported smoking cigarettes. (Hellen, 2003).
Mental Health
The most common health issue in homeless people is drug-induced, psychosis, schizophrenia, depression and anxiety states.The direction of the link with homelessness is uncertain; mental ill health can be a cause and also can be an effect. As compared with the usual population, mental illness is overrepresented in young people (typically rough sleepers), the principal conditions being schizophrenia, affective disorder, psychoses and substance misuse (including alcohol).Dual diagnosis is common and many of the homeless people who are mentally ill have a history of illegal actions. The crimes mainly consist of acquisitive crime or alcohol habit, damage to property or mischief while drunken.
A very less men have a history of violent crime. Almost less than 1/3 of homeless people.For some old people, mental illness is the excess to homelessness.(Richard & Michael, 2008).
Practice organizations
There has many debates conducted on whether primary care is better provided through specialized general activities working with homeless people than through common activities.It has been talked that a specialized extensive pursuit for vagrant people is best to put on these vagrant drug users in doomsday with an excess of health troubles. And as well as stabilizing the severe medical states such applications can direct the vagrant person in right use of basic care. When these results have been attained the patient is motivated to lodge with a normal practice. This change can be hard not just for patients but also for medical practitioners when there is a powerful personal liability. Consequently, we ponder that a specialized performance requires the assistance of a committed GP liaison worker. Specialized common practices for vagrant people are only possible in large areas of the city. For village vagrant inhabitants, the answer lays in increment of existing normal basic healthcare services.
Another problem in basic care provision for vagrant people is the tightness between practice-based work and outreach work. The quarrel for outreach is depended mainly on a wrong supposition that vagrant people are short-lived and do not approach basic care.(James, 1994)
Historically the organized multiagency functioning for the advantage of vagrant people has been hard to attain, for causes comprising lack of lucidity about the correct responsibilities and employments given by differing agencies, problems in sharing information, and nonfulfillment to answer in a coordinated manner.
The Royal College of General Practitioners suggests that homelessness problems should be considered as component of the basic primary care organization (PCO) agenda. In a Statement on Homelessness and Primary Care it says that PCOs should give services for in progress homelessness woks, obtain a fine understanding of the numbers of vagrant people in their region and the issues they face, and should encourage multiagency connections and the sharing of conventions and operating ways that make coordinated care and integrated working easier.
When sick, vagrant people look for the help later than other people. They are over-symbolized in presence at emergency departments and hospital accidents. Whether their lodged complaints would be managed in a better manner in basic care is not evident; the reason behind most of the attendances is intentional self-harm or overdose of medication, so the elevated attendance speed could cast back the high commonness of serious ailment in this category of vagrant people. The GP will wish a vagrant patient with acute disease to stay in the medical care center until fully healthy for discharge, and in vagrant users of drugs this may be assisted by instruction of substitute medication on the hospital rooms. The chief purpose should be to keep the users of drugs in a hospital room and not allow them take their own discharge because of acquiring minimal substitute medication. Because the GP may wish to press on these instructions of doctors even after discharge, practices working with users of drugs require evenly matched connections with services to the inpatients. Present day many users of the drugs taking methadone are liberated out either in the absence of medication or with adequate amount of medicine for just a single day. This puts excessive pressure upon basic care. (Healthy Life, healthy people)
Joint working not only consisted of healthcare associates but also other services providers to vagrant people incorporating social services departments, housing departments, and non-statutory companies. Lastly, and most significantly, GPs should search for to work in association with vagrant people themselves, the ‘consumers.
In trivialized categories, involvement of patients can be an efficient means to better healthcare. In the case of vagrant people, stigmatization, isolation and absence of choice show large hurdles. By implying these patients we can recognize pauses in the work and alter training correspondingly. Similar efforts go some way to respond to the social exclusion, which subscribes to sick-health. The fundamental principle is that all individuals, regardless of status, must be permitted chances to take part in resolutions influencing them. To this end, advocacy groups and self-help will sometimes be of help in finding out the essential requirements.
An experimental study carried out at the NFA (No Fixed Abode) Health Centre for Homeless People, Leeds, focused to decide the most efficient and suitable ways to facilitate and encourage the involvement of patient. 30 patients attending by random selections, appointments fulfilled a structured questionnaire investigating their behaviors to becoming actively counted in the service. The solutions showed that most of them were keenly interested in impacting the run of the health care center and desired to be a part of the decisions, which could change the recipients of future regarding the service. They depicted interest in making a contrast, to pass on their practical knowledge, or to restore something. Some candidates, specifically the ones who were trying to lower their use of drugs, revealed a feeling that participation in the NFA would dispense a perfect chance to focus their lives again. But the desire for participation was not accepted everywhere: some contemplated no requirement for modification or judged the NFA plainly as a service to provide their medical requirements, and a small number of people said they did not get the time.(Health Development Agency)
Health Promotion And Psychological behavior change
Propaganda of health to vagrant people is feared with problems—not because the masses are so diverse. When asked, sellers of theBig Issue(who themselves are vagrant) gave some prime concern to lessening of uncertainty from the injection of drug. Here are few practical means of promotion of health in primary healthcare:
Conclusion
In a nutshell, there are few great models of the foremost care service donation to notify the healthcare of on the streets people. These models have been originated from labouring with vagrant masses as well as composing the best performance evolved from associated fields for instance the use of substance. Basic care health service providers seeking to propose healthcare to vagrant populations have the chance to be the part of swiftly developing circle of healthcare with complexes to carry both the practices of the clinic and continue the development of the professionals.
References
Anne, R. (2005).
Health visiting
. UK: Elsevier.
Bengt, L. & Monica, E. (2006). Contextualizing Salutogenesis and antonovasky in public health development.
Health Promtion International
Vol. 21, No. 3.
Healthy Lives, Healthy People.
Accessed from:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216096/dh_127424.pdf
.
Health Development Agency.
Accessed from:
http://www.nice.org.uk/nicemedia/documents/homelessness_smoking.pdf
Hellen, G. (2003).
People in society: Modern studies.
UK: Nelson Thornes Ltd.
James, C. (1994).
Homelessness and Ill-Health
. UK: Royal College of Physicians
Phil, R. (2008).
Working with young homeless people.
UK: Jessica Kingsley
Richard, W & Michael, M. (2003).
Social Determinants of Health.
UK: WHO library.
Summary of the proposal
Posttraumatic stress disorder (PTSD) is common following trauma, and low-income and minority women are at particularly high risk for both exposure to trauma and development of PTSD. PTSD rates are up to 24% during pregnancy for high-risk women who are racial minorities, teens, less educated or poor. PTSD in pregnancy, even after controlling for demographic factors, increases the odds for poor pregnancy and birthing outcomes, such as ectopic pregnancy, miscarriage, preterm labor, and low birth weight[1]. PTSD is also associated with cigarette smoking while pregnant, a behavioral alteration with adverse perinatal outcomes[2]. A recent study demonstrated the additive effect of smoking and PTSD on the cortisol levels among pregnant women [2, 3]. Though 50% of women quit smoking during first trimester, women with lifetime PTSD who are pregnant continue to smoke because they experience the soothing effects of elevated cortisol on the stress response system that comes with continued smoking.[3]. This proposed program is the first of its kind to address and combat the issue of pregnant women with PTSD and their associated smoking cessation difficulties. Our program proposes to identify PTSD pregnant women smokers with the help of questionnaire and bio-analyte assessment and administer smoking cessation interventions that are trauma-informed. The project will be run initially as a pilot in a public hospital located in Georgia which serves a large proportion of low-income patients. For such a project, more resources will be needed than we can hope to raise. We are sending you this proposal in the hope that you will be able to support our work.
Scope of the problem
Perinatal outcomes are indicative of the health of a society’s population. Maternal psychosocial stress has been implicated as one of five pathways to the adverse perinatal outcome of premature birth, lower birth weight and is also a risk factor in the fetus for early lifespan morbidity and mortality. PTSD is a severe form of psychological stress. In the United States the prevalence of PTSD is twice as high among pregnant women than women generally[4]. The term PTSD appears in a variety of contexts in the literature, including its application with women during the perinatal period (referred to as perinatal posttraumatic stress disorder or PPTSD). In the United States 9% of the women giving birth are diagnosed with PPTSD and an additional 18% are documented as at risk[5]. Recent studies in large prenatal clinic samples showed significant associations of PTSD with preterm birth or shorter gestation, especially in current as opposed to lifetime remitted PTSD, PTSD with depression, and PTSD that is subsequent to childhood maltreatment or military sexual trauma [1, 6]. Three percent to 14% of women entering prenatal care have current PTSD and these women are more likely to be African American, pregnant as a teen, living in poverty, with high school education or less, and living in higher crime areas[4]. PTSD experiences result in alterations of the stress regulation system including the hypothalamic pituitary axis (HPA) and cortisol has been used as a measure of HPA axis functioning. Because in utero elevations in HPA axis hormones are associated with adverse perinatal outcomes slower infant mental development and adverse consequences to lifespan health, cortisol is an important biomarker for perinatal and developmental outcomes[7-9].
PTSD is associated with cigarette smoking while pregnant, a behavioral alteration with adverse perinatal outcomes[2]. As of 2017, 14.0% of adults in the United States reported smoking cigarettes, with somewhat higher rates reported among those who are younger (10.4%–16.5%), identify as non-Hispanic Black or African Americans (14.9%), with an education level of high school or lower (23.1 % to 36.8%) and live in poverty (21.4%)[10]. According to a national survey conducted in the United States in 2017, 10.4% of pregnant women smoke cigarettes with some variation by race, ethnicity and location [11]. Smoking has been associated with numerous adverse pregnancy and birth outcomes, including placenta previa, placental abruption, intrauterine growth restriction, low birth weight, and perinatal mortality. Previous exposure to stressful life events may not be sufficient to increase the risk of cigarette smoking during pregnancy, however, women who have elevated trauma-related symptoms or probable PTSD and smoke before conception may fail to quit after conception. In a study exploring the relationship between PTSD symptoms and prenatal smoking behavior in a sample of low-income, minority women residing in an urban setting, the prevalence of reported cigarette use during pregnancy was 15.6% [12]. Among women who smoke in pregnancy, those with PTSD have the highest cortisol levels thereby leading to adverse perinatal outcome[3]. Women with PTSD continue smoking despite all the pressure to quit during pregnancy because they experience the soothing effects of elevated cortisol on the stress response system that comes with continued smoking. Given that such traumatic behaviors enhance risk for continued tobacco use during pregnancy, a trauma-informed approach to smoking cessation in preconception care may ultimately reduce the likelihood of smoking during pregnancy.
Currently available smoking cessation program in the state of Georgia is the Georgia Tobacco Quit Line which provides free and confidential, professional tobacco cessation counseling services to Georgia adults, pregnant women and teens (ages 13 and older). Screening at-risk pregnant women should include assessment of the individual’s emotional response to potentially traumatizing events as well as severity of posttraumatic symptoms. That smoking before pregnancy is such a strong predictor of smoking during pregnancy and exposure to traumatic life events is sufficient to increase pre-pregnancy smoking suggests that assessment of how smoking may be used to cope with the emotional sequelae of these events should occur in the primary or preconception care of women. Hence, trauma-informed smoking cessation programs seem strongly warranted, especially in the context of maternity care, where the adverse outcomes of smoking are so personally and economically costly to mothers and children.
Program description
The intention of the proposed program is to use the Grady Health System’s obstetrics services to pilot our approach. Grady Health System is the largest public hospital–based health system in the Southeast, providing more than 200 specialty and subspecialty health care clinics. The nucleus of Grady’s service area is Fulton and DeKalb counties in Atlanta, where Grady contracts to provide care for the medically underserved. The Grady Memorial Hospital’s obstetrics services include complete care for pregnant women which is provided in their prenatal clinics.
Three percent to 14% of women entering prenatal care have current PTSD and these women are more likely to be African American, pregnant as a teen, living in poverty, with high school education or less, and living in higher crime areas[4]. Women attending the obstetrics clinic at Grady Memorial Hospital, aged 13 or older, able to speak English without an interpreter, have a confirmed pregnancy less than 28 weeks’ gestation, are Medicaid eligible and willing to participate in the saliva specimen procedure will be invited to participate in this program. Participants will be assessed by trained personnel for PTSD with the Life Stressor Checklist- Revised (LSC-R) questionnaire [13]. The LSC-R is a 30 item index of lifetime trauma exposure developed especially to include life events that are not usually considered but are important stressors in women’s lives. Examples of such items include being unwillingly separated from children and experiencing an abortion or miscarriage. In the LSC-R the number of lifetime trauma exposures is calculated by summing the positively endorsed stressor items. The type of lifetime trauma is determined by the positive report of exposure to the trauma. The LSC-R has demonstrated good criterion-related validity with diverse populations of women and easily understood.
Along with PTSD screening the participating women will also be screened for their tobacco smoking habit with the question: which of the following statements best describes your cigarette smoking? A. I have never smoked, or I have smoked fewer than 100 cigarettes in my lifetime. B. I stopped smoking before I found out I was pregnant, and I am not smoking now. C. I stopped smoking after I found out I was pregnant, and I am not smoking now. D. I smoke some now, but I cut down on the number of cigarettes I smoke since I found out I was pregnant. E. I smoke regularly now, about the same as before I found out I was pregnant [14].
Participants who are identified as self-reported current smokers and has a trauma history according to the LSC-R will be invited to provide a sample of their saliva for cortisol and cotinine testing. Saliva will be collected using the passive drool method. The specimen collection kit will include Salivette tubes (Sarstedt, Newton, North Carolina) and an instruction sheet at seventh grade reading level. After collection we will record the time and date of specimen collection, and attention will paid to keep the samples cold in order to avoid bacterial growth in the specimen. Samples will be refrigerated within 30 minutes, and feezed at or below -20ºC within 4 hours of collection. Collected saliva will be tested quantitatively for salivary cortisol and cotinine using enzyme linked immunoassay kit.
Based on previous literature women who are both diagnosed with PTSD and continue to smoke in pregnancy had the most elevated levels of cortisol (mean = 0.257)[3]. Hence, for our program salivary cortisol cutoff values is set at 0.20 g/dL for pregnant women smokers who have PTSD. Salivary cortisol levels are unaffected by salivary flow rate and are relatively resistant to degradation from enzymes or freeze-thaw cycles. Studies consistently report high correlations between serum and salivary cortisol, indicating that salivary cortisol levels reliably estimate serum cortisol levels[15]. Cortisol production has a circadian rhythm, with levels peaking in the early morning and dropping to lowest values at night. However, levels rise independently of circadian rhythm in response to stress.
The presence of cotinine in biological fluids indicates exposure to nicotine. Because of the long half-life of cotinine it has been used as a biomarker for daily intake, both in cigarette smokers and in those exposed to secondhand tobacco smoke. There is a high correlation among cotinine concentrations measured in plasma, saliva, and urine, and measurements in any one of these fluids can be used as a marker of nicotine intake[16]. Testing the salivary cotinine would help in addressing the issue of social desirability bias that could possibly occur for self-reported smoking status among pregnant women. The optimal serum cotinine in the US population based on National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2004, are set at 3.08 ng/ml for adults (sensitivity 96.3%, specificity 97.4%) and 2.99 ng/ ml for adolescents (sensitivity 86.5%, specificity 93.1%), and for our program we used these levels as our cut-off values for salivary cotinine [17].
For women who are biochemically confirmed to have elevated levels of cotinine and cortisol above the cut-off values, our program proposes the implementation of smoking cessation interventions which should be trauma-informed[18]. PTSD-affected participants will be provided in- person trauma-informed smoking cessation counselling. Use of trauma-informed approaches creates safety, choice, and connection for women who access tobacco reduction and cessation services. In a nonjudgmental way, trained personnel who use trauma-informed approaches build support and awareness about how smoking is often a coping mechanism and offer alternative strategies for growth, healing, and wellness, thereby helping them to experience safety and choice and develop positive coping skills. This approach helps to recognize the links between trauma and violence and tobacco use, identifies the needs for physical and emotional safety and for choice and control in decision making and emphasize women’s strengths and offer personal choice and control over the intervention approach and goals.
Counselled participants on their subsequent monthly prenatal visits will be invited to repeat saliva specimen collection to test for repeat saliva cotinine levels. Participants with successful smoking cessation confirmed by salivary cotinine levels of 0 ng/mL at each subsequent prenatal visit will be given a 50$ CVS gift card as a financial incentive for smoking cessation. In September 2014, CVS Health became the first national retail pharmacy chain to stop selling tobacco products, and hence we chose CVS gift card for our incentive program[19]. Though the approval for paying pregnant smokers to quit may seem to be low among the general public, studies show that smokers are more positive in their views about paying pregnant smokers to quit and its likely effectiveness[20]. In a review of 72 smoking cessation controlled trials it was demonstrated that the most effective smoking cessation intervention appeared to be providing financial incentives, which helped around 24% of women to quit smoking during pregnancy. Studies also show that women offered in person counselling sessions found the personal contact the most important element in the intervention[21]. Therefore we predict that our multi-intervention model will improve the success of smoking cessation among pregnant smokers with PTSD.
Expected benefit
Currently available smoking cessation program in the state of Georgia is the Georgia Tobacco Quit Line which provides free and confidential, professional tobacco cessation counseling services to Georgia adults, pregnant women and teens (ages 13 and older), but it does not cater towards the specific needs of PTSD pregnant women. In the US, we have developed guidelines recommending all pregnant women receive interventions to promote smoking cessation in pregnancy. These guidelines generally incorporate a number of interventions, and are currently based on the “5 A’s”[22]. The American College of Obstetrics and Gynecologists recommends that obstetric health care providers screen all patients to determine whether they smoke, and offer treatment for smoking cessation[14]. Despite evidence of effectiveness of interventions in pregnancy and development of guidelines, widespread implementation of smoking cessation interventions in pregnancy in clinical settings remain the exception rather than the norm. PTSD rates are up to 24% during pregnancy for high-risk women who are racial minorities, teens, less educated or poor, and the prevalence of smoking among these women is approximately 16% [1, 12]. Although many women spontaneously quit smoking during pregnancy, evidence suggests that this is less likely among those with lower socioeconomic status, fewer resources, and less social support which contributes to their PTSD diagnosis. This reinforces the need for more complex, tailored, and intensive interventions for smoking reduction and cessation for PTSD pregnant women. In a synthesis of qualitative research on perceived barriers to the provision of smoking cessation advice, health care providers felt limited in their ability to address social factors, such as poverty, partner and family smoking, and lack of social support, associated with smoking during pregnancy and often believed that in this context, smoking cessation was unlikely to be successful or sustainable[23, 24]. It is clear not only that PTSD women who smoke during pregnancy require more sensitive treatment on a range of intersecting issues but that health care providers require more comprehensive guidance as well. Multi-intervention model program such as the proposed program which incorporates both questionnaire and bio-analyte, improve the sensitivity of the program, and help further address the co-occurring disorders, addictions, psychosocial stressors, poverty, and domestic violence that may make smoking cessation during pregnancy more difficult and coping behavior seem more necessary.
Conclusion
In summary we are requesting financial support from your organization for the training and implementation of our program. This project is specifically aimed at ensuring that every pregnant women suffering from PTSD and struggling with smoking cessation during pregnancy in this country has the social, psychological and material support required to ensure promotion of maternal and fetal wellbeing. We believe that the context in which we are operating makes such a project an imperative. Our intention is to pilot the project in Georgia’s largest public hospital providing care for the medically underserved, as a model for replicability by other agencies. The emphasis on community-based projects makes it likely that the project will be sustainable at community level. Our intervention programs is the first of its kind to incorporates both questionnaire and bio-analyte, further helping us address the co-occurring disorders, addictions, psychosocial stressors, poverty, and domestic violence that may make smoking cessation during pregnancy more difficult and coping behavior seem more necessary.
References
1. Seng, J.S., et al.,
Posttraumatic stress disorder and pregnancy complications.
Obstet Gynecol, 2001.
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2. Lopez, W.D., S.H. Konrath, and J.S. Seng,
Abuse-related post-traumatic stress, coping, and tobacco use in pregnancy.
J Obstet Gynecol Neonatal Nurs, 2011.
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3. Lopez, W.D. and J.S. Seng,
Posttraumatic stress disorder, smoking, and cortisol in a community sample of pregnant women.
Addict Behav, 2014.
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2 DQ 1
Social determinants of health include biological, environmental, social, and economic factors that influence the access and maintenance of health (Green, 2018). For example, those living in low socioeconomic areas may not have the resources to obtain fresh food and will oftentimes rely on fast food chains. According to a study posted by the American Journal of Preventive Medicine (2004), low-income areas had 2.5 times more fast-food chains than those living in more affluent areas. As a result of this many minorities living in low-income areas have a great risk of obesity and comorbidities such as type II diabetes and hypertension. While the study done by the American Journal of Preventive Medicine was more than five years ago the results of their study continue to be prevalent as the Center for Disease Control and Prevention (2018) states children and adolescents are more likely to be obese than their higher-income counterparts. This is an example of how social determinants of health contribute to the development of disease. The child who has grown up with a poor diet is less likely to change their diet habits as adults resulting in fatal health conditions.
Social determinants also contribute to the spread of communicable diseases due to crowding, sanitization, uncontaminated water, and access to health care (Green,2018). The infectious disease process of communicable diseases is represented by the chain model also known as the chain of infection. The chain of infection begins with the infectious organism and describes how the organism reproduces and spreads through contact, droplets, or surfaces. As the nurse taking care of an individual with a communicable disease the simplest and most effective form of breaking the chain is by proper handwashing. The nurse can also contribute to the stop of the chain by wiping down surfaces with the proper cleaning agents, placing the appropriate PPE outside of the patient’s room, and clustering care to avoid excessive time inside of the patient’s room. All of these interventions contribute to the stop of the transmission phase of the chain model.
Using 200-300 words APA format with references to support the discussion.
What are social determinants of health? Explain how social determinants of health contribute to the development of disease. Describe the fundamental idea that the communicable disease chain model is designed to represent. Give an example of the steps a nurse can take to break the link within the communicable disease chain.
Inter-professional education allows students studying to be health professionals to work as part of team on a piece of work and to learn about different health professionals that there is (Barr et all 2005). In this assignment I will use Gibbs (1998) model of reflection (see appendix 1) to reflect on some of the work that the group and myself carried out and ways in which it could be improved.
The aspects of working on the group poster that I enjoyed the most were getting to meet new people and learning about the different health professionals and how they work together. In addition to this I enjoyed thinking and researching which health professionals would help Joe and in what way they would help him. I also enjoyed helping to design the poster itself. A team is a group that work together, you don’t “become a team until you have developed methods of working together and relationships have been formed” (Levin 2004, pp. 7). I agree with this quote from Levin because if relationships haven’t been formed individuals may find it more difficult to put forward opinions and speak in front of others. To work effectively as a team methods of working do need to be put in place. As a team we did do this by making rules at our first meeting. These rules were not followed and I now feel I should have reminded group members about them.
I found keeping in contact with some of the group members difficult. Verbal and non – verbal communication is important between health professionals and between health professionals and the patient. If people do not communicate effectively, it can have a bad outcome. In some cases this may lead to death. “Analysis of 2455 sentinel events reported to the Joint Commission for Hospital Accreditation revealed that the primary root cause in over 70% was communication failure. Reflecting the seriousness of these occurrences, approximately 75% of these patients died.” (Flink et al, cited in Leonard et al 2004, p. 86.) One member of the group in particular, missed a lot of the meetings as although we were sending her the email and texts she never received them. It turned out she had a new number, which she didn’t inform us about. When we did get her new number she did attend more meetings and became more involved in the process of the poster development. In the future I would ask group members their preferred way of me getting in touch with them or I would use web ct to communicate and arrange meetings. However, the internet was not always reliable in halls as it did not work on many occasions. To solve this I had to try and get in contact with my group members by phone. Even though it may be time consuming In the future I would put it on web ct, send an email and a text. After three ways of communicating it would be more likely that all group members would receive the information of when and where the meetings were. The use of web ct would also allow the group lecturer to see that meetings were being arranged.
During the group meeting itself I felt there was quite a calm atmosphere, although group members including myself sometimes got distracted and spoke about something other than the poster; on more than one occasion we spoke about what we were doing at the weekend. I feel this was sometimes due to certain group members being behind in tasks so there was nothing more other group members could do until they had completed their part of the task. When this happened, sometimes we helped each other to complete what another group member may have been struggling with or never managed to get finished because of other course work. We understood this in some circumstances. This shows some of the good teamwork that went on within the group. On one occasion I felt quite undermined by one group member because, as a group we had decided to use a ring of people for the poster but she didn’t like the idea and refused to use it, as a result of this we came up with another idea which we gladly all agreed on and it worked well. If this had happened again and the original idea was a definite favourite of the group I think the group should approach the individual, as the majority liked the idea. To make the meetings more effective we should have kept a note of the main points that were discussed and the individual’s thoughts and feelings towards the discussion (Germov and Williams 2001. PP 127 – 129). This would have been helpful to look back on for writing the group reports, this assignment and in particular the peer group marking.
I feel I was able to contribute my time and effort well to the group. Even though I was on placement for seven weeks I made sure I didn’t miss any of the meetings. I wanted to be able to voice my opinions and to help in every aspect of working towards the poster. According to Belbin (2001) there are many roles you can take on as a group member. These include plant, resource investigator, co-ordinator, shaper, monitor evaluator, team worker, implementer, completer finisher and specialist. (Belbin 2009). I believe my role in the group was clearly a co-ordinator as I along with another group member arranged the meetings and towards the end reminded, people about meetings as this was something I noticed needed to be done for some group members. I promoted decisions by being the one who came up with the idea of the title ‘Help is at Hand’. This was agreed by everyone to be a good heading for the poster. I also put forward my ideas and opinions. I do feel I should have spoken up more when the other co-ordinator in the group decided she didn’t like the idea that the majority of us liked. However as I stated earlier the end result of the poster was not only in my opinion but the group as a whole, positive. In addition to a co-ordinator I also feel I was a complete finisher as I was conscientious enough to get the tasks done in time and checked for errors. A weakness, which I had, was worrying unduly (Belbin 2009). The reason behind this was because some group members were not putting as much work in a myself and another group member; so I felt I would have to lower their score on the peer group marking which would also lower my overall grade. I found this unfair but it was something that had to be done.
There was one member of the group that I got on well with – this was the other co-ordinator. The reason I got on well with her was because she attended all meetings and we worked well as a pair. On one occasion a member of the team hadn’t done the report that they were suppose to do and I realised this late at night and myself and the other co-ordinator had to work on this over the phone to meet the deadline. I wouldn’t say there were members of the group that I found it difficult to work with, but some members didn’t contribute to the task as much as they should have and follow the rules that were made in the first meeting. This annoyed me as they were nice people and I didn’t want to fall out with them over approaching them about attending meetings.
I feel I helped to solve the problem of the team member who wasn’t attending much as I got her new number and also found that contacting her through a social networking site to remind her about the meetings was somewhat easier. I do feel that the ways in which you communicate with people are specific to each individual and everyone has their preferences. In the future I will ask my group members their individual preferred way of communication, even though this may take more time, it will be more effective.
To conclude this assignment, the group were strongly supportive of each other because when one group member was on placement we still kept in contact with her, sending her pictures that we were going to put on the poster and the layouts of the poster to get her opinion on it.
I feel the group had two clear leaders. “A leader is defined as one who influences others to accomplish a goal or objective. This person contributes to the organization and cohesion of a group.” (Wilson 2009). A leader can be beneficial to teamwork as they make sure that the group is on task and that deadlines are met. They will encourage group members and may give information on how to carry a task out. One of which was myself as I mentioned earlier. I think that this helped the group otherwise meetings would not have been arranged and report deadlines would not have been met. One of the occasions when I did this was when I sent a copy of the Harvard referencing guidelines to all group members.
I was very pleased with the overall outcome of the poster as were the rest of the group. The poster stood out well which was good but there was some spelling and grammar errors in it which we would have lost marks for. Next time this should be checked by the whole group to be sure that there is no mistakes and sent to the tutor to have a look at before presenting it.
Reflecting on this assignment I have used a range of sources as evidence for what I have said; these include books, websites and journals.
Analyze the ad (will send separately) for uses of rhetorical devices or fallacies. Explain which devices you see in the ad, making sure to be specific in your analysis. You must clearly identify the specific parts of the advertisement that you find rhetorical or fallacious.
In addition to identifying any rhetorical devices and fallacies, analyze the ad in terms of the following:
Who is targeted in the ad (who is the target audience?)?
What psychological effect does the ad have on the audience?
What subconscious needs or desires among the audience does the ad seem to be playing upon?
The written analysis must be at least 1000 words
Now, create a new ad (actually make the new ad) for the product advertized in the original ad. Your new ad should be targeted toward a critical thinker. Therefore, your new ad should not use any rhetorical devices or fallacies to persuade the audience. Instead, your new ad should present a well-reasoned, well-supported argument for why a critical thinker should buy the product. You will probably have to do research to create the argument. You may also need to change the visual images or pictures from the original add (feel free to use pictures from whatever source you like….just be sure that the images you choose do not have any manipulative rhetorical effect on the audience.).
NRS 440 Difference Between a DNP and a PhD in nursing DQ
DQ1 Discuss current research that links patient safety
outcomes to ADN and BSN nurses. Based on some real-life experiences, do you
agree or disagree with this research?
DQ2 What is the difference between a DNP and a PhD in
nursing? Which of these would you choose to pursue if you decide to continue
your education to the doctoral level?
A DNP (doctor of nursing practice) and Ph.D. in Nursing are vastly different than an MD (doctor of medicine). The former are highly-trained nurses, and the latter is a physician, with all the scope of practice allowances that come with that title.
A “DNP” is an advanced-practice registered nurse who may specialize in the following roles:
The DNP nurse has achieved one of the highest degrees awarded in the field of nursing (next to the Ph.D. in Nursing, which is just as prestigious but has more of an academic focus compared to the clinical focus of the DNP). It demonstrates that the nurse exemplifies clinical expertise and knowledge in the field and that the nurse is skilled in identifying healthcare-related issues and can propose evidence-based solutions in the ever-changing world of healthcare.
An MD is a medical doctor, also known as a physician. While it may be evident that a DNP (or Ph.D. in Nursing) is a nurse and an MD is a doctor, the explanation of the differences goes a little deeper than the title. It’s important to realize that nurses and doctors are trained differently:
RELATED: RN to MD
Both a Ph.D. and DNP are considered terminal degrees for nurses, and both degrees demonstrate that the nurse is a clinical expert in his or her field. However, there are differences between the two.
The main difference is that a DNP is focused more on clinical practice, while a Ph.D. is research-focused. Choosing which degree path to take is based on the career goals of the nurse. MSN-prepared nurses practicing in an advanced role (i.e., nurse practitioner, nurse midwife, CRNA) who wish to expand their knowledge base and achieve a terminal degree to enhance their practice would benefit from choosing the DNP path.
Conversely, those who hope to get into education, research, and leadership would benefit from the Ph.D. path. Nurses with a Ph.D. use evidence-based research to develop policies and procedures and implement workflows that align with standards of care. They are especially involved with improving patient care outcomes based on research findings.
As with the differing roles of the DNP and Ph.D. nurses, the educational curriculum differs as well. DNP students must complete a capstone project that involves identifying an issue in healthcare and proposing evidence-based solutions. While this sounds more aligned with a Ph.D. program, the project should pertain to their specific clinical area. Additionally, the DNP program has an immersive clinical practicum which is required to graduate.
RELATED: Dual DNP/Ph.D. Nursing Programs
The Ph.D. curriculum is more research-based. Students must complete an original research project and complete a dissertation which may also include teaching. The curriculum does not include patient care clinical hours.
Regardless of which path is chosen, both degree options allow for expert nurses and practitioners to make an impact on patient care to improve outcomes.
As the highest degrees in nursing practice, the Doctor of Nursing Practice (DNP) and Doctor of Philosophy in Nursing (Ph.D.) degrees can catapult advanced practice nurses to the top of the pay range. Some prospective students, however, may wonder how the salaries of these different degree types stack up. The short answer is that the differences in salary between nurses who hold a DNP and those with a Ph.D. are minimal, with an average difference of approximately $4,000 per year. However, things such as location, organization, and job title will ultimately determine a salary for a nurse with either degree type.
A DNP operates at the highest level of clinical practice, and the salary average for a nurse with this degree lands at approximately $100,000 per year. This is variable amongst jobs, as a clinician salary is higher than an educator salary. In other words, individuals who work at universities teaching nursing students average less income than those practicing with patients. For example, a DNP practicing as an Advanced Psychiatric Nurse Practitioner averages closer to $110,000 per year. Most DNP-prepared RNs tend to opt for clinical practice careers. Some job titles a DNP may search for include: Advanced Practitioner, Quality Improvement Manager, Healthcare Informaticist, Clinical Educator, Policy Maker, and more.
A Ph.D. prepared nurse spends time researching, conducting analysis and performing scientific studies. They also commonly enter academia as professors and educators. According to Payscale, a Ph.D. educated nurse’s average salary is $96,000 per year. This makes the salary very competitive in comparison to that of a DNP. Similar to a DNP-prepared nurse, there is variability in salary depending on setting and institution. A nurse researcher can expect to earn a yearly salary of approximately $95,000 per year. Some job titles a Ph.D. may search for include: Nurse Researcher, Nurse Scientist, Policy Maker, Academic Professor, Author.
Review the Institute of Medicine (IOM) report: “The Future of Nursing: Leading Change, Advancing Health,” focusing on the following sections: Transforming Practice, Transforming Education, and Transforming Leadership.
Write a paper of 750-1,000 words about the impact on nursing of the 2010 IOM report on the Future of Nursing. In your paper, include:
1.The impact of the IOM report on nursing education.
2.The impact of the IOM report on nursing practice, particularly in primary care, and how you would change your practice to meet the goals of the IOM report.
3.The impact of the IOM report on the nurse’s role as a leader.
Cite a minimum of three references.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
