Alzheimers Disease: Important Issue in our Aging Society

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Alzheimer’s Disease: Important Issue in our Aging Society

Dementia is the most common disease in older adults more than any other age group (Miller, 2019).  Approximately forty percent of those over eighty years old are affected (Mosconi, Berti, Swerdlow, Pupi, Duara, & de Leon, 2010, p. 170).  With that being over five million older adults affected, this is a significant issue to the aging population (Grammas, 2011, p. 26).  In the year 2050, it is expected that approximately thirteen million older adults will be affected which increases the significance of this issue (Bateman et al., 2012, p. 795).  There are different types of dementia with Alzheimer’s disease accounting for approximately sixty to eighty percent of the cases (Miller, 2019).  It is a disease that affects the older adults’ cognitive abilities and causes changes in their personality, memory, and decision making (Miller, 2019).  Alzheimer’s disease has a gradual and insidious onset over five to ten years with symptoms going either unnoticed due to its slow progression or symptoms being attributed to normal factors of aging.  In between the brain’s neurons, there are abnormal deposits of a protein called beta-amyloid plaques which causes disconnections between neurons and cell death.  In time, this causes the degeneration of the brain cells and tissue called brain atrophy (Miller, 2019).  There has been debate on whether Alzheimer’s disease can be attributed to the aging process or a result of inheritance and genetics.  There are multiple research studies done on Alzheimer’s disease that explain the factors that can increase the risk of Alzheimer’s disease occurring, in which case, some are avoidable.  With time, the progression of this disease can cause demands on families as well as the person with the disease.


Inheritance and Genetics

Our genetics determine a lot about us; from our personality to our likelihood to develop certain diseases and possibly transmit them to future generations.  Those who have family members who have Alzheimer’s disease are at an increased risk of obtaining the disease later in life.  Certain mutations in the amyloid precursor protein genes, such as presenilin 1 and presenilin 2, are common mutations in the genes of families with the disease (Mosconi et al., 2010, p. 172).  Both genes are considered autosomal dominant in transmission with presenilin 1 being thirty to seventy percent of the early onset forms of Alzheimer’s disease.  The age of onset in this population of people carrying the disease is between the ages of forty and fifty years of age with rapid progression of symptoms. When compared to presenilin 2, these genes affect less than five percent of the cases of early onset forms of Alzheimer’s disease with the age of onset up to seventy years of age (Mosconi et al., 2010, p. 173).  It is also important to take note that women are more likely to have Alzheimer’s disease.  This is due to maternal transmission of the disease more likely to occur than paternal transmission (Mosconi et al., 2010, p. 178). Children of mothers with Alzheimer’s disease are also at risk for developing symptoms earlier in life such as brain hypometabolism which causes slower thought processes and changes in memory.  Although there may be a maternal link, there are other genes that can affect the diseases occurrence.  More studies will need to occur over a span of multiple generations in order to confirm if this disease is strictly genetically transmitted or just occurs from the aging process.  With this disease being so prevalent in the aging community, the elderly need to understand these risk factors (Mosconi et al., 2010, p. 187).


Cerebrovascular Changes in Aging

The normal aging process does not only cause physical changes but causes cerebrovascular changes.  It is thought that Alzheimer’s disease develops from amyloid-beta concentrations. Changes in those concentrations occurred approximately twenty-five years prior to the onset of symptoms associated with Alzheimer’s disease (Bateman et al., 2012, p. 801).  It is mentioned that the increase in amyloid-beta protein is a result of our genetics, but it is not until this protein increases, followed by the brain atrophy, that one can begin to see the cognitive changes.  This can take up to twenty-five years to even be noticeable depending on its progression (Bateman et al., 2012, p. 802).  These neurovascular changes can be attributed to aging due to the changes in the structure cerebral capillaries in older adults.  With changes in the neurovascular system through aging, such as the twisting and looping of neurons, this can contribute to the build-up of the amyloid-beta protein in between neurons (Grammas, 2011, p. 27).  Aging is unavoidable but there are numerous risk factors that may be associated with these cerebrovascular changes such as cardiovascular issues and chronic inflammation (Grammas, 2011, p. 26).  There is a correlation between those with Alzheimer’s disease or dementia and those with hypertension, hyperlipidemia, diabetes mellitus, and heart disease.  It is hypothesized that those who have vascular damage may also have cognitive decline later in life (Grammas, 2011, p. 27).  Another risk factor that increases the chance of having Alzheimer’s disease is having a family history of the disease.  Alzheimer’s disease can be decreased through remaining physically active, eating a proper diet, and participating in cognitive and social activities according to some researchers (Miller, 2019).


Family and Societal Demands

This disease not only impacts the person, family, and caregivers, but also affects society.  There is an increase in demand of families and caregivers due to the increase in amount of time providing care to the older adult.  This causes more stress in the home.  Some of those with disease may need constant monitoring if the changes have caused them to wonder or become aggressive due to their increased confusion.  The person with Alzheimer’s disease is also impacted due to the increase in confusion which may cause them to become angry or depressed (Miller, 2019).  Alzheimer’s disease affects society with a demand in Medicaid and Medicare by costing approximately $172 billion every year (Grammas, 2011, p. 26).  This is expected to increase to trillions of dollars by the year 2050 if a cure is not found (Bateman et al., 2012, p. 796).


Conclusion and Future Implications

Although genetics abnormalities cannot be reversed or avoided, there are known risk factors that can be understood and therefore treatment can be sought.  With knowing your family’s history of diseases, it is possible to seek early treatment before that disease progresses.  There is an extremely high occurrence and significance in Alzheimer’s disease in the elderly.  Early treatment can possibly delay the signs and symptoms of Alzheimer’s disease and increase the quality of life for that person.  Through numerous tests on the brain, researchers able to determine the significant changes in the physiology of the brain associated in a person with Alzheimer’s disease (Grammas, 2011, p. 2).  Researchers are unable to determine for sure whether the disease can be the result of aging or purely inheritance.  Regardless, it is important to know ones’ familial history when it comes to diseases in order to take measures to prevent or delay these life changing symptoms.  This is especially true in Alzheimer’s disease due to its insidious and slow progressive nature.  It is more important for those whose mother had the disease since it is considered (Mosconi et al., 2010, p. 178).  With the demands that the disease causes on families, more research studies need to be done in the hopes of forming some disease modifying therapies.

References

  • Bateman, R., Xiong, C., Benzinger, T., Fagan, A., Goate, A., Fox, N., . . . Morris, J. (2012). Clinical and Biomarker Changes in Dominantly Inherited Alzheimer’s Disease. The New England Journal of Medicine, 367(9), 795-804. doi:10.1056/NEJMoal202753
  • Grammas, P. (2011). Neurovascular dysfunction, inflammation and endothelial activation: Implications for the pathogenesis of Alzheimer’s disease. Journal of Neuroinflammation, 8(1), 26-33. doi:10.1186/1742-2094-8-26
  • Miller, C. (2019). Nursing for wellness in older adults (8th ed.). Lippincott, Williams, & Wilkins: Philadelphia, PA.
  • Mosconi, L., Berti, V., Swerdlow, R. H., Pupi, A., Duara, R., & Leon, M. D. (2010). Maternal transmission of Alzheimer’s disease: Prodromal metabolic phenotype and the search for genes. Human Genomics, 4(3), 170-193. doi:10.1186/1479-7364-4-3-170

Biomedical Approaches for Understanding Depression

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Research Methods Table for TMA02: Understanding Experimental Design

Rosso, I. M., Killgore, W. D. S., Olson, E. A., Webb, C. A., Fukunaga, R., Auerbach, R. R., Gogel, H., Buchholz, J. L. and Rauch, S. L. (2017) ‘Internet‐based cognitive behaviour therapy for major depressive disorder: A randomized controlled trial’,

Depression & Anxiety,

vol.34, no.3, pp. 236-245 [online]. Available at:

https://doi.org/10.1002/da.22590

(accessed 3 January 2020)

In your own words, describe the aim or objective of the study.


(2 marks)

The aim of the study was to use a version of the Australian Sadness program which was based on internet cognitive behavioural therapy (ICBT) to treat major depression (MD) with a monitored attention control (MAC) group. [36]

What was the independent variable?


(2 marks)

See Book 1, Box 2.1; Book 2, Box 2.2



The independent variable is the ICBT program. [7]

What were the conditions of the independent variable? Note: read the boxes referred to immediately below to check your understanding of the term ‘conditions’ before answering this question.

(2 marks)

See Book 1, Boxes 2.1 and 2.2; Book 2, Box 2.2

There are two conditions: ICBT participants and MAC participants. [9]

What assessment scales were used to specifically measure the dependent variable and when were they measured?


(6 marks)

See Book 1, Box 2.1; Book 2, Box 2.2

The assessment scales used to measure the dependent variable was the Hamilton rating scale for depression (HRSD), the patient health questionnaire (PHQ-9) with a score range between 0-52 and the Kessler distress scale (K-10) with a score range between 0-27. The PHQ-9 was used on day 1 and then all scales were used on day 2 and 3. [59]

What was the null hypothesis for this study? Please ensure you write this in the correct format (see Book 1, Box 2.1) and include the specific detail of the measures used and the groups in the study.


(2 marks)

There will be no difference in major depression disorder between the ICBT participants and the monitored attention control (MAC) participants. [20]

What was the experimental hypothesis? Please ensure you write this in the correct format See Book 1, Box 2.1

(2 marks)

There will be a greater reduction in major depression disorder symptoms in ICBT participants compared to the MAC participants. [19]

Where were the participants recruited from in this study? (

2 marks

)

Participants were recruited from an internet advertisement and community fliers. [10]

List two criteria that were used to determine participant eligibility. (

2 marks)

List two exclusion criteria (

2 marks)

See Book 1, Box 2.2

Two exclusion criteria are current alcohol abuse and lifetime history of bipolar disorder or schizophrenia spectrum disorder. [17]

What type of design was used (was it between or within participants)?

(1 marks)

What problem might arise using this type of design?

(1 mark)

See Book 1, Boxes 2.2 and 3.1

In this study was used both designs: between and within participants. [11]

The problem arises is the allocation of participants randomly into the two conditions. [13]

List two types of demographic data collected.

Were there any significant differences in the demographics of the participants?


(4 marks)

See Book 1, Section 4.2.5

The two types of demographic data collected were age and HRSD. [11]

No, there were any differences. ICBT: n= 37 and MAC: n= 40 as shown in table 2 pp. 241. [19]

Were there significant differences in the baseline HRSD scores between participants?


(2 marks)

Were there any significant differences in HRSD scores after treatment?


(2 marks)

Were there any significant differences in self-reported depression and distress measures following treatment. Provide supporting information to explain your answer.


(3 marks)

No, there is no difference in baseline HRSD scores between participants.  [11]

Yes, HRSD score for the ICBT participants were 9.17± 6.92 while the MAC participants were 14.05 ± 5.34. [18]

Yes. There was an improvement in PHQ-9 scores in the ICBT group than in the MAC group: F (21, 63) = 5.32; P = 0.024, and in the distress levels had a greater  improvement in ICBT than MAC as well, F(21, 62.1) = 9.82; P= 0.003 from fig.2. pp.240. [49]

Decide whether the study has external validity – Yes or No. Clearly state this and then explain your answer.

(4 marks)

See Book 2, Box 3.1

Yes. This study has external validity because it can be applied to a larger scale of population. This is shown in the statement: ‘With its potential to be delivered in a scalable, cost-efficient manner, ICBT is a promising strategy to enhance access to effective care’ (Rosso, I. M., et al, 2017). [51]

Decide whether the study results are reliable – Yes or No. Clearly state this and then explain your answer.

(4 marks)

See Book 1, Section 4.2.4; Book 2, Box 3.1

Yes. This study is reliable because is led by different clinicians and they all have the same results and conclusions. This is shown in the statement: ‘Our result is consistent with prior reports on the efficacy of ICBT for depression generally’ (Rosso, I. M., et al, 2017). [47]

State two ways the researchers tried to prevent or reduce confounding/extraneous variables.

(2 marks)

See Book 1, Box 1.2; Book 2, Box 2.2

ICBT group had CBT lessons and homework assignments, while the MAC group had ‘lessons’ consisting in questionnaires. Both groups received weekly phone calls which were limited. [26]


a)

CBT and mindfulness are described as psychological interventions. Using book 2 describe two similarities and one difference between them.

(3 marks)


b)

In figure 2.12, chapter 2, book 2 psychotherapy (and therefore CBT) is considered in relation to the network hypothesis of mood.   Briefly describe the network hypothesis of mood.



(6 marks)



Both CBT and mindfulness deals with the present and they consist in awareness of negative thoughts replacing them by positive thoughts. They both have affective and cognitive components  (Datta 2010, pp. 92 and pp. 142). The differences between CBT and mindfulness is that mindfulness does not take the social side of biopsychological model in account where CBT does (Held, 2004 in Datta 2010, pp. 145). [65]

The network hypothesis of mood was led after limitations of neurotrophic hypothesis. A healthy brain has a network of neurons that process information, but in depression patients, these networks do not function normally because some neurons are damaged or die. Castre’n (2005) suggests that there are different ways to repair this network of neurons including the ADMs, electroconvulsive therapy (ECT) and psychotherapy (Datta 2010, pp.68). This types of treatments enhance plasticity leading for the recovering of connection in damaged network of neurons (Datta 2010, pp.69). [85]

Suggest two potential improvements to this study and explain why these would be improvements.


(4 marks)

A potential improvement for this study could be to get an ICBT app in the smartphone, as everyone nowadays has a smartphone ICBT could be carry on everywhere. Might be helpful for people with crises anywhere they are, instead of waiting until get home and get into their laptops. The other improvement could be getting a rigorous control group to have more efficacy on the study when compared with the randomized group.  [72]

Words: 655


Question 2


‘What the biomedical approach has contributed to understanding depression’.

At one point in life, some people feel sad, hopeless and use the term ‘low mood’ when they feel depressed. Depression can persist for weeks, months or even years and is one of the most common mental illness. It is an example of many types of affective disorders, which affect areas of the brain such the hippocampus and prefrontal cortex (Datta 2010, pp.1). These areas of the brain are important to explain how depression happen in the biomedical approach, which believes that any disease, even if associated with mental distress will be explained by biological factors (Toates 2010, pp.13). First, let’s see how neurons communicate and what causes these alterations to understand Depression (MD).

Neurons send messages to each other by electrical signals called action potential which is a pulse of electricity that triggers neurotransmitters to pass from one neuron to the other through the synaptic gap (Toates 2010, pp.42). Depression is linked with chemical imbalances in the neurotransmitters serotonin and noradrenaline. Serotonin is involved in the control of sleep, eating and mood (Toates 2010, pp.51) and there is evidence that a decrease in the production of this neurotransmitter causes depression. This led researchers to attempt various hypotheses to explain the causes of disorders in the brain. This all started when medications such as antidepressants (ADMs) were discovered by accident in the 1950s when a drug given to high blood pressure called Reserpine developed depression as a side effect (Datta 2010, pp58a).

The first hypothesis was the monoamine hypothesis. This hypothesis started when researchers found that reserpine reduces the levels of monoamines such as serotonin and noradrenaline in order of stopping them from being taken up by vesicles. For this reason, there was an increase of monoamines in the synaptic gap increasing neurotransmissions. Later in the year, it was discovered that isoniazid used for tuberculosis patients was lifting a pre-existing depression. This drug inhibits the enzyme monoamine oxidase (MAO) which breaks down monoamines. MAO was the first ADMs discovered (Datta 2010, pp. 58b). This finding suggests that decreased levels of monoamines cause depression and increase of monoamines lifts depression (Datta 2010, pp. 59). This has been supported by post-mortem studies where high levels of serotonin was found on the prefrontal cortex of depressed and suicidal patients. However, the relationship between the levels of monoamines and depression is not clear yet, because the response of ADMs to the symptoms of depression can take several weeks (Datta 2010, pp 63a).

With the limitations of the monoamine hypothesis, researchers have questioned if the serotonin levels in the brain raised immediately after taking SSRIs, why would not the mood increase immediately as well? Why the long delays? (Human et al., 1997 in Datta 2010, pp. 63b). Was then proposed that the birth of neurons (neurogenesis) and the growth of connections between neurons which are characteristics of plasticity (Datta 2010, pp.63c) are related to brain chemicals such as brain-derived neurotrophic factors (BDNF) which promotes the growth and birth of neurons. The BDNF works in the hippocampus and prefrontal cortex which is involved in affective disorders as mention previously (Datta 2010, pp. 64a). Post-mortem studies show that the levels of BDNF are low in patients with depression (Martinowich et al., 2007 in Datta 2010, pp. 64b). These findings led to the neurotrophic hypothesis where there is a relationship between the levels of BDNF and depression. Duman et al., (1997, 1999) discovered that the hippocampus exhibits neurogenesis. Such evidence shows that neurogenesis in the hippocampus is susceptible to the effect of stress moreover, the neurotrophic hypothesis is linked with psychological factors (Datta 2010, pp. 64b). Experiments in rats show that the use of SSRIs stimulate the production of new neurons in the hippocampus (Malberg et al., 2000 in Datta 2010, pp.65a), meaning that serotonin stimulates the production of BDNF, so ADM’s treatments prevents or reverses reduction levels of BDNF (Datta 2010, pp. 65b). Santarelly et al., (2003) performed tests in rats to show the efficacy of ADMs, however, there are limitations to prove this in humans, as human brains are more complex than mice.

As suggested, both hypotheses have strong evidence of the biomedical approach, but there is evidence linked with psychological factors such as stress. Stressful or traumatic event triggers depression, so the role of the environment determines the behaviour of a person (Datta 2010, pp.70a). Environment is everything outside the genes. Not everyone under stress develops depression, so this led to a gene-environment model which suggests the interaction between biological and environmental factors (Datta 2010, pp. 70b-71), where vulnerable people are susceptible to develop behavioural disorders and people who are not vulnerable might not develop such behavioural disorders. Interaction between gene-environment can explain depression. There are evidences that the environment can affect the working of genes (Datta 2010, pp.74). This was shown in a study performed by Seymour Levnis (Levine, 1957) where rat pups that had extra maternal care, including licking and grooming showed less stress and anxiety as adults (Datta 2010, pp.75a). Later, in Meaney et al., a study showed that rat pups with low licking and grooming mother had higher levels of corticosterone (a glucocorticoid) than those with higher licking and grooming mothers showing a dysregulation on the HPA axis. Meaney and his team found that maternal licking and grooming behaviours made a difference and that early stressful events can affect animal life (Datta 2010, pp. 75b). This means that using a biopsychological approach is important as well to understand depression.

To summarise, the biomedical approach give us a good understanding of depression looking into the biological factors such as chemical imbalances present in the brain but by looking at the hypotheses and the gene-environment model proposed by researchers is possible to understand that the biological factors are not the only factor to take in account and it does not explain the psychological and social factors involved. Provided that, it is an advantage to understand how does the brain work and how to use medications such as ADMs but this is not always the best approach because it is just taking the biological factor in consideration.


References

  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.1
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.58a
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.58b
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.59
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp. 63a
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.63b
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.63c
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.64a
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.64b
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.65a
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.65b
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.70a
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.70b-71
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.74
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.75a
  • Datta, S. (2010)

    Mood and well-being,

    SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.75b
  • Toates, F. (2010)

    Core Concepts in Mental health

    , SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp. 13
  • Toates, F. (2010)

    Core Concepts in Mental health

    , SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.42
  • Toates, F. (2010)

    Core Concepts in Mental health

    , SDK228 The Science of Mind: Investigating mental health, Milton Keynes, The Open University, pp.51

career planning process.

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Assignment 1: Discussion;  career planning process

Self-assessment is the first step in the career planning process. Career assessments are designed to help you determine the most appropriate career choice and to help you plan your future. These assessments can provide insights regarding your personality, values, interests, and skills and the role they play in your career development and management.
The Internet is increasingly used as a source of self-assessment, career development, and career management. Review the online career assessment tools available in the Webliography. Select and complete three of these assessments.
Prepare a discussion posting addressing the following items. Your responses should go beyond mere surface interpretations to provide depth of self-exploration and self-discovery.
o What do the results reveal about your values, interests, skills, goals, interaction style, etc.?
o How will this information be useful for your career development and management?

Interoperability at the international and national level, What does this mean for Nursing?

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Interoperability at the international and national level, What does this mean for Nursing?

interoperability at the international and national level 1. interoperability at the international and national level. What does this mean for Nursing? 2.Provide the legal record of care 3.Support clinical decision making 4.Capture costs for billing, costing and/or accounting purposes 5.Accumulate a structured, retrievable data base for a. administrative queries b. quality assurance c. research 6.Support data exchange with internal and external systems interoperability at the international and national level 1. interoperability at the international and national level. What does this mean for Nursing? 2.Provide the legal record of care 3.Support clinical decision making 4.Capture costs for billing, costing and/or accounting purposes 5.Accumulate a structured, retrievable data base for a. administrative queries b. quality assurance c. research 6.Support data exchange with internal and external systems

Describing the approach to care of cancer

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Describing the approach to care of cancer

Details: Write a paper (1,250-1,750 words) describing the approach to care of cancer. In addition, include the following in your paper:

1.Describe the diagnosis and staging of cancer

.2.Describe at least three complications of cancer, the side effects of treatment, and methods to lessen physical and psychological effects.

3.Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.This assignment uses a grading rubric. Instructors will be using therubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment

Assignment: Communicable Diseases

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Assignment: Communicable Diseases

Assignment: Communicable Diseases

Choose one communicable disease from the following list:

  1. Chickenpox
  2. Tuberculosis
  3. Influenza
  4. Mononucleosis
  5. Hepatitis B
  6. HIV


Epidemiology Paper Requirements

Include the following in your assignment:

  1. Description of the communicable disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence).
  2. Describe the determinants of health and explain how those factors contribute to the development of this disease.
  3. Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. (The textbook describes each element of the epidemiologic triangle).
  4. Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).
  5. Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organization(s) contributes to resolving or reducing the impact of disease.

A minimum of three references is required.

Refer to “Communicable Disease Chain” and “Chain of Infection” for assistance completing this assignment.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

NRS427V-RS-CommunicableDiseaseChain.doc




ORDER NOW FOR CUSTOM-WRITTEN, PLAGIARISM-FREE PAPERS




You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.


Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.


Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.


The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.


How would each religion interpret the nature of George’s malady and suffering? Is there a “why” to his disease and suffering?

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How would each religion interpret the nature of George’s malady and suffering? Is there a “why” to his disease and suffering?

Details:
The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and acceptance of a diversity of faith expressions.
The purpose of this paper is to complete a comparative ethical analysis of George’s situation and decision from the perspective of two worldviews or religions: Christianity and a second religion of your choosing. For the second faith, choose a faith that is unfamiliar to you. Examples of faiths to choose from include Sikh, Baha’i, Buddhism, Shintoism, etc.
In your comparative analysis, address all of the worldview questions in detail for Christianity and your selected faith. Refer to Chapter 2 of Called to Care for the list of questions. Once you have outlined the worldview of each religion, begin your ethical analysis from each perspective.
In a minimum of 1,500-2,000 words, provide an ethical analysis based upon the different belief systems, reinforcing major themes with insights gained from your research, and answering the following questions based on the research:
1. How would each religion interpret the nature of George’s malady and suffering? Is there a “why” to his disease and suffering? (i.e., is there a reason for why George is ill, beyond the reality of physical malady?)
2. In George’s analysis of his own life, how would each religion think about the value of his life as a person, and value of his life with ALS?
3. What sorts of values and considerations would each religion focus on in deliberating about whether or not George should opt for euthanasia?
4. Given the above, what options would be morally justified under each religion for George and why?
5. Finally, present and defend your own view.

-Examine the Federal Supply Schedule program and Assess the different marketing methods used to market to the federal government

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-Examine the Federal Supply Schedule program and Assess the different marketing methods used to market to the federal government

Explain the six main factors (Social and demographic forces; Economic forces; Political forces; Technological forces; Informational forces and Ecological Forces) that will determine the future change in health care.

Review four separate articles (don’t forget to reference) from the Internet relevant to the future of health care by 2025.

Examine the Federal Supply Schedule program.

Assess the different marketing methods used to market to the federal government.

Compare the support programs available to small-business contractors.

Use technology and information resources to research issues in contract administration and management.

Write clearly and concisely about contract administration and management using proper writing mechanics.

Differentiate between the concepts of criminal law, antitrust, and health care as they apply to U.S. health law in the 21st Century.

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Differentiate between the concepts of criminal law, antitrust, and health care as they apply to U.S. health law in the 21st Century.

Discussion 1

Development of U.S. Health Care in Hospitals Based on the Foundation of U.S. Law” Please respond to the following:

Part 1

From the scenario, relate the basic steps in the development of U.S. health law, leading up to the present, to you or an employer’s need for health insurance coverage in light of the provisions that the Affordable Health Care Act sets forth. Rationalize the fundamental way in which these laws play a pivotal part in understanding the roles that today’s health care administrators play.

Part 2

Analyze the transition of health care from the 18th Century leading up to the 21st Century. Evaluate the degree and quality of care established within 18th Century U.S. hospitals, as compared to the level of care seen in today’s hospitals. Examine the primary roles of progressive health care law in shaping the current modern environments.

Discussion 2

Part 1

Application of Tort Law in Health Care Project Management Protocols” Please respond to the following:

From the scenario, analyze the development of health care project management predicated on tort law. Ascertain the major ways in which tort law provides solutions to health care concerns, in light of the complexities of 21st Century health care administration roles.

Part 2

Analyze the development of tort law from the concept and degree of negligence to the application of the law to strict / product liability. Evaluate the success of tort law in providing solutions to 21st Century health care disputes. Rationalize your answer by using any applicable legal precedents.

Discussion 3

Part 1

“Contracts and Antitrust Protocols Based on the Criminal Aspects of Health Care” Please respond to the following:

From the scenario, differentiate between the concepts of criminal law, antitrust, and health care as they apply to U.S. health law in the 21st Century. Conceptualize the primary ways in which these laws apply to U.S. health care administrators.

Part 2

Analyze the general transition of U.S. health laws based on criminal misconduct in health care to the creation of contract laws, as predicated within the Sherman Antitrust Act. Evaluate the efficacy of the measures that the new contracts in question afford, and rationalize whether or not these improvements have provided optimal solutions to today’s complex concerns of integrity in health care performance.

Psychological Skills Training to Support Diabetes Self-management | Article Critique

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Prepare a critique of one research paper selected from your programme pathway.

Graves, H., Garrett, C., Amiel, S. A., Ismail, K. and Winkley, K. (2016) ‘Psychological skills training to support diabetes self-management: qualitative assessment of nurses’ experiences’, Primary Care Diabetes, vol. 10, no. 5, pp. 376–82.

Research plays a vital role in nursing practice and helps address the key areas in need of development which will improve and enhance patient wellbeing as a result. (Moule and Hek, 2011), cited within (The Open University, 2018a) define research as a process that is organised with the intention of gathering information to problem solving and answering questions with the aim of gaining new knowledge about healthcare. The role of the nurse has progressed significantly through the years with the main goal of being an advocate to patients and thus providing the best quality of care through evidence-based research. The Nursing and Midwifery Council reinforces this by claiming that nurses must make sure that any information or advice given is evidence-based, including information relating to using any health and care products or services. (NMC, 2015) This can be clearly seen in clinical practice through new and up to date information in examples such as wound care and risk assessments.

The aim of this essay is to critique a research paper that I have chosen called, Psychological skills training to support diabetes self-management: qualitative assessment of nurses’ experiences’, (Graves, et al 2016). This will be achieved by using the ‘PROMPT criteria’ which was developed by The Open University and offers a systematic approach to evaluate research (The Open University, 2018b). I will also use the ’critical reading framework’ from Horsley et al, (1983) cited within the Open University, (2018c), During my district nursing clinical placement i was able to shadow the diabetic nurse specialist and one of her greatest concerns was her client’s poor self-management of the condition. This was the reason for choosing this research paper. I hope to gain more knowledge about type 2 diabetes and read other nurses experiences on the management of this condition.

The presentation of this research paper is very clearly defined by the researchers. The title is written in larger font and the length is within recommended standards. According to (Meehan, 1999) the title should be between 10 and 15 words long and should clearly identify the purpose of the study. This captures the reader’s attention as to the fact that it is a qualitative assessment of nurse’s experiences that is being carried out.  The abstract is well laid out and gives the reader a brief description of the overall research study in clearly identifiable headings. The academic text had some areas that were difficult to understand at first. It became clear after a few more attempts at reading and getting familiar with the terminology used. The text is grammatically correct and has avoided any use of jargon. (Polit and Beck, 2006) state that writing style should be written in such a way that it ‘attracts the reader to continue to read further.

The relevance of this paper is very evident as diabetes is a growing health problem and according to the (World Health Organisation, 2016) an estimated 422 million adults were living with diabetes in 2014, compared to 108 million in 1980. It has contributed to 1.5 million deaths in 2012 alone. The research carried out is part of a wider study called the D-6 study. The nature of this study isn’t very clear and could very well cause confusion with the reader. The study was carried out in five of South London’s Bourgh’s, none of which were clearly identified within the study. This is important as some Bourgh’s in South London are very deprived and have a higher ethnic population than others. Deprivation is strongly associated with higher risk of developing Type 2 diabetes.  It is also more common amongst South Asian and Black African Caribbean communities, and 300.000 who live in these Bourgh’s are diagnosed with the condition (DOH 2003). The paper also highlights the need for mental health providers with specialist diabetes knowledge (Graves, et al 2016).  Diabetes UK (2019) recognises that those affected by diabetes are twice as likely to be affected by depression and anxiety related conditions. The cost of treatment for Diabetes and related complications to the NHS is more than £14 billion putting extreme pressure on resources. A recent report by Robertson et al. (2017) cited in (The Open University, 2018d) highlighted how the financial pressures on the NHS are having a direct effect on patient care.

The objectives were clearly set out which were to evidence the efficacy of psychological skills training that nurses are expected to learn so they can support patients’ self-management. (Graves et al, 2016). This was part of a wider Diabetes -6 study which was a randomised control trial. The study is not explained very well and uses phrases like “usual diabetes care” (Graves et al, 2016). Which are not clear for some readers who know very little about what diabetes care is. It also states the nurses were trained in 6 psychological skills but it fails to identify what these actual skills are. The results of the trial were not known at the time of data collection or analysis, which demonstrates less bias in nurse or researcher reporting (Graves et al, 2016). The study was approved by the King’s College Ethics Committee and was funded by a grant for applied research from the NIHR (Graves et al, 2016).

In relation to the number of participants, who took part in the D-6 study the sample size is considered small as there were only 23 nurses. (Coughan et al, 2007). Suggests small samples are more likely to be at risk of being overly representative of small subgroups within a target population. It didn’t specify the nurses background are if they had any previous experience of training which could affect results. The researchers could be viewed as having a naturalistic view to research as they seek to understand their participants’ perspectives through the use of in-depth interviews. (The Open University, 2018e).  (Burns & Grove, 2006) also describe qualitative research as focusing on the human experience through systematic and interactive approaches.  The component skills were drawn from motivational interviews and cognitive behavioural therapy to enable collaborative working between patient and client. This could be open to misinterpretation due to cultural differences and language barriers especially in the diverse society of the South London Borough’s. Primary research was undertaken through Semi structured interviews which were carried out with each individual nurse.  The key questions had been developed prior to the interview which gives an element of structure whilst still probing the answers for more information. Face to face interviews also allows the interviewer to read body language and other nonverbal communication. (Dearnley, 2005) found that the open nature of the questions encouraged depth and vitality, which helped new concepts to emerge. This increased the validity of the study, by assisting them in collecting rich data for analysis. A disadvantage of semi structured interview’s is that the interviewer may lack experience in carrying out interviews. It can also be easy to navigate from the role of interviewer and start presenting their own ideas which could lead to bias and data collection harder to analyse. It states the interviews were audio recorded which helps its validity as it is based upon exact records.

This study was approved by the King’s College Hospital in London (Graves et al, 2016c). It was published in the journal of Primary care diabetes. The names of all five authors are clearly identified on the front page and the online version of the journal allows you to view their profession and qualifications. All five authors involved in this study are very highly qualified in the field of diabetes research and have written other research papers in which many have been published. This adds to the credibility of the article as the reader is assured that the author must have the appropriate clinical and educational credentials for this current research study.

This article was published in 2016 which is clearly documented on the front page. It is a recent article as it has the red cross mark on the front also which indicates the article being current. Nurses need to be aware of new up to date research related to their field of practice in order to carry out effective nursing care. It is evident nurses play a key role in improving the health outcomes of individuals living with diabetes. Nurses empowering people to become partners in their own care. But the conclusion highlights the need for further training and support for primary care nurses in order to facilitate psychological therapies in the future.  Diabetes is a growing problem with more people being affected each year. The findings of this study have reinforced the need for more education and training for nurses. But it has also highlighted the fact that the problem with poor self-management and compliance could be the result of social, economic and financial factors which will require a multi-disciplinary approach to dealing with them.


In conclusion

This essay highlighted the importance research has on nursing practice. Which ensures quality nursing care through effective evidence-based practice guidelines. The PROMPT criteria helped identify the quality of the research papers which ensures they are up to date and reliable. It has also made me aware of the use of bias and helped me to reflect on whether I could be bias in my own writing. Research enables nursing practice to keep up with a fast  moving world in which health care practices must make  continuous  improvements to meet changing demands, patient expectations and requirements (Eastabrooks, 1998).


References