Challenges to Developing Mental Health Policy

/in /by


Identification of Issue

The lack of mental health care providers is an issue in our rural health community. Currently the patients located in the rural communities of Texas do not have easy access to mental health providers (counselors, therapists, psychiatrists, or mental health nurse practitioners). These communities depend heavily on law enforcement and emergency departments to deal with mental health patients that are in an acute crisis situation. Substantial increase of cost is incurred to families, criminal justice system, and society by the limited access to mental health services. The Public Policy Platform of the National Alliance on Mental Illness cites statistics such as:

  • People with mental illness are at an increased risk for other illnesses such as diabetes, heart disease, cancer, respiratory diseases, AIDS, and Hepatitis C (National Alliance on Mental Illness, n.d.).
  • People with mental illness die on an average of 25 years sooner (National Alliance on Mental Illness, n.d.).

The disparities continue to increase over time and certainly demands attention and funds. World Health Organization identifies depression as the leading cause of disability worldwide (World Health Organization. Depression fact sheet, n.d.). These individuals that are seeking assistance must currently do so in our primary care clinics. Those physicians that have not received proper training to treat mental illness are having to prescribe medications for these conditions, 65% of medications used to treat mental health disorders are prescribed by primary care physicians (Grazier, 2016). It is critical to good health and the best possible health outcomes are achieved when residents can access behavioral health services conveniently.


Context of the Issue & Political Feasibility

Health care centers that qualify and receive funding under section 330 of the Public Health Service Act are Federally Qualified Health Centers (FQHCs). These health centers eliminate many of the barriers that patients in rural areas have such as lack of insurance. They provide comprehensive services including primary care, dental care, and including mental health and substance abuse services. Behavioral health is seen in this primary care setting more than any other (Burke et al, 2013). Compared to other primary care clinics, the patients seen in FQHCs are typically below the national poverty level, uninsured, or covered by Medicaid (Burke et al, 2013). The National Survey on Drug Use and Health shows that these patients are more likely to have a behavioral health diagnosis. The current issue is lack of behavioral health providers in the FQHCs that are in rural areas. These patients lack the resources to travel to areas that provide behavioral health care.

The Affordable Care Act has provided many with coverage for behavioral health care, however the lack of providers is an issue. Healthcare reform increased the coverage for services, however how will we provide the caregivers to give the services. There are over 4,000 areas across the US containing 110,000,000 million people that have a shortage in mental health care providers. Texas ranks #50 with the least amount of providers per patients with mental health disorders (

http://www.mentalhealthamerica.net/issues/mental-health-america-access-care-data

).


Stakeholders, Network Evaluation, & Power Sources

The stakeholders for this issue include the underserved residents of Texas, ARPNs,

physicians, insurance companies, state and federal payer programs and professional healthcare

organizations. The stakeholders can be supporters and opponents for providing mental health providers in clinics that receive government funding in rural healthcare centers. Currently some public and private payers do not allow billing for a primary care visit and a behavioral health visit on the same day (Politico Staff, 2016)

.

This prevents patients from receiving care promptly when an issue is identified. The Office for Research on Disparities and Global Mental Health identifies the trends and gaps in the mental health areas and assists in setting goals for grants that could assist in funding a mental health care provider in the rural areas. The Office of Rural Mental Health Research is mandated by congress to coordinate research on mental health needs in the rural area. There are several influential organizations whose support is critical if this rural mental health mandate is to ever succeed. A few of the most prominent groups include the American Psychiatric Nurse Association, American Nurses Association, and National Alliance on Mental Health.


Necessary Resources

The rural areas are frequently not represented to any degree in the political arena. Whenever state governments are considering a budget cut, rural areas often lacks the concentrated political representation necessary to oppose the cuts (Reardon, 2010). To combat these tendencies, local and state representatives who are committed to funding rural mental health initiatives must come forward.

In addition to legislative support, there needs to be adequate clinical space allocated in a way that places the mental health provider in close proximity to the primary healthcare provider. Ideally, the location of this shared clinical space would be a private area, since the stigma of being a mental health patient might prevent patients from seeking mental healthcare. Transportation (or lack thereof) is also a very important issue when considering mental health patients living in rural areas.


Professional Values

It is a priority to address mental health care in the primary care setting by a mental health provider. Healthcare providers recognize the need for improved care for mental health patients. Addressing the mental health issues will decrease ER visits, decrease law enforcement intervention, and will decrease overall inpatient admissions with early identification and treatment. Screening for mental health issues takes place in the primary care setting and a patient should be immediately referred for treatment if needed. A positive finding on a screening for depression could prevent a suicide and this is the goal is early intervention and treatment. The funding is imperative to make this successful. American Psychiatric Nurse Association, American Nurses Association, and National Alliance on Mental Health are organizations that provide much support for the presence of a mental health care provider in rural areas.


Proposed Solutions

There is a need to have mental health providers at facilities in rural areas that provide primary care and receive government funding. Considering the lack of healthcare providers to treat those with mental health illnesses there are several proposed solutions to consider. Outpatient treatment must be readily accessible to individuals in their own community.

Providing psychotherapy is part of treatment regime for patients with mental health illness. Telemedicine is one strategy that rural health care centers are currently using. Although telemedicine for behavioral health has the disadvantage of the patient and provider not being in the same room, it can create enhanced feelings of safety, security and privacy for many patients.

The integration of mental health into primary care is one of the suggested solutions. This implementation has providers that are not specifically trained in mental health providing this care. This solution would ensure that patients get treatments needed to sustain long-term health outcomes. Primary care physicians are the most trusted providers for patients that are seeking treatment for mental health conditions. One of the limiting factors that prevent this from being entirely successful is that primary care providers is the lack of time with patients. The pace of a primary care setting is much quicker than that of behavioral health care settings. This is a disadvantage for the patient needing behavioral health intervention. One other disadvantage to this is that there is a shortage of not only mental health providers in rural areas but there is also a shortage of primary care physicians. There are approximately 68 primary care physicians per 100,000 people in rural areas (Khazan, 2014).

Another option to address the issue is to provide psychiatric advanced nurse practitioners in health care settings in rural communities. Statistics show that that as of May 2017 there was a 26% increase in the enrollment of PMH NP students since 2014-2015 (Delaney, 2017). PMH APNs provide a patient-centered approach that is important in addressing one’s mental health needs. These providers provide a holistic approach and have prescriptive authority to provide the necessary medications to treat their mental health issues. Treating mental health care patients by those specifically trained in mental health is the most reliable care for patients.


Comparison of Results for Proposed Solution versus Current Situation


Mental health care provider at primary care settings (proposed)


No mental health care provider at primary care settings (current)

Decrease in ER visits

Subpar interactions between primary care providers and patients

Decrease in psychiatric admissions

Missed opportunities for immediate psychiatric intervention

Decrease in healthcare costs

Primary care providers providing care for patients that the service is out of their specialty



References

How do social and environmental factors affect teens and young adults making healthy or unhealthy decisions?

/in /by

How do social and environmental factors affect teens and young adults making healthy or unhealthy decisions?

The course textbook An Introduction to Community Health refers to teens and their risky behaviors. The number of single parent households with children under the age of eighteen continues to rise. Unemployment is higher for teens and young adults, especially for minority populations. Health behavior and lifestyle choices are tested during this timeframe, with tobacco use, underage drinking, abuse of prescription illegal drugs, and risky sexual behavior. Teen violence and suicide are also a cause of concern to families and the community.

Based on your understanding of the topic, create a report in a Microsoft Word document answering the following questions: •How do social and environmental factors affect teens and young adults making healthy or unhealthy decisions? How influential is the family environment? •What motivates teens to form groups and how do negative behaviors increase when teens are involved in small or large gangs? •What specific issues does the U.S. minority population face in terms of health issues, lack of healthcare, and risky behaviors? •What specific type of community program would you develop if you were in charge of improving options for teens and young adults? What community members would you seek to speak with about your program proposal and how important is it to include influential community members who can help support legislation, space, or financial services to help a community program succeed? •How will education reduce risk taking behaviors? What type of follow up and evaluation will you do to ensure a successful program?

What are the critical components of healing, such as prayer, meditation, belief, etc.?

/in /by

What are the critical components of healing, such as prayer, meditation, belief, etc.?

The practice of health care providers at all levels brings you into contact with people of a variety of faiths. This calls for acceptance of a diversity of faith expressions.

Research three diverse faiths. Choose faiths that are less well-known than mainstream faiths or are less known to you, such as Sikh, Bahai, Buddhism, Shintoism, Native American spirituality, etc. Compare the philosophy of providing care from the perspective of each of these three faiths with that of the Christian perspective and your own personal perspective.

summarize your findings, and compare and contrast the different belief systems, reinforcing major themes with insights gained from your research. Some of the questions to consider when researching the chosen religions are:

1. What is the spiritual perspective on healing?

2. What are the critical components of healing, such as prayer, meditation, belief, etc.?

3. What is important to people of a particular faith when cared for by health care providers whose spiritual beliefs differ from their own?

4. How do patients view health care providers who are able to let go of their own beliefs in the interest of the beliefs and practices of the patient? Compare these beliefs to the Christian philosophy of faith and healing.

precautionary measures to protect and manage coronary heart disease

/in /by

precautionary measures to protect and manage coronary heart disease

 

Individual Client Health History and Examination: Catherine’s Struggles with Coronary Heart Disease

Abstract

This paper examines the medical history of Catherine, a 59 year old woman with a coronary heart disease. Catherine is a divorced, but is currently living with her younger daughter and three grand children. In addition to coronary heart disease, Catherine has developed kidney problems. However, although her family has a history of heart diseases, Catherine does not take adequate precautionary measures to protect and manage her condition. For example, she is a heavy smoker (at times smokes Marijuana) and drinks occasionally but neither engages in active exercises nor sticks to recommended diets.

Introduction

Catherine’s family history has increased her chances of developing coronary heart disease; nevertheless, her condition keeps on worsening due to her lifestyle. Notably, Catherine’s mother died of stroke at the age of 71 while her father suffered from inflammatory heart disease. Moreover, older people are at more risks of developing heart diseases. This is because the disease results from plaque buildup in the coronary arteries over a long period. As such, the arteries become narrow and rigid thereby lowering the capacity of oxygenated blood to flow into the heart. In other words, the heart is not supplied with oxygen and nutrients, which it requires to function normally. Kokkinos (2010) cites that the cholesterol-laden plaque often start building up from childhood. Therefore, as one gets older the plaque layers increases eventually cutting off the blood supply.

In some cases, plaques release chemicals, which make arteries sticky thereby, allowing more substances such as inflammatory cells and lipoproteins to block the blood vessels. However, in other cases, plaque promotes blood clotting that might completely block the blood supply, causing a heart attack (Kokkinos, 2010). Therefore, Catherine’s age indicates that her health is likely to deteriorate unless she gets appropriate health care. According to Gordon Functional Health Pattern Assessment, Catherine’s history with heart disease can be summarized into 11 factors including:

Health Perception: Despite her condition, Catherine is reluctant to abide by the recommended medical and therapy interventions. She admitted that although she is aware her drinking and smoking habits contribute largely to her present condition, she has not sought professional help. Currently, she smokes a minimum of 20 cigarettes a day.

Nutrition and Metabolism: Given Catherine’s health condition, she should eat healthy foods such as carbohydrates with low sugar contents and low-fat dairy products among other foods rich in high-fiber. However, despite warning from her previous doctor, Catherine sometimes eats food rich in calories. As a result, more fat deposits in her blood vessels further blocking her blood supply.

Elimination: Catherine complains of polyyuria (frequent urination). According to Desilva (2013) Polyuria arise when tiny blood vessels that filter waste from blood in the kidneys are damaged by the plaques. This implies that Catherine’s kidney has been damaged.

Activity and Exercise: Due to Catherine’s weak heart, she has completely withdrawn from active physical activity. In addition, although she sometimes does house hold tasks, she only does light work. However, before Catherine became weak, she loved swimming and jogged for about twenty minutes before leaving for work.

Cognition and Perception: Catherine has not been following prescribed medications because of cultural beliefs. That is, since she comes from Caribbean where smoking marijuana is perceived to be healthy, Catherine believes that she can neither function effectively nor achieve emotional satisfaction without smoking.

Sleep and Rest: Review of Catherine’s’ past medical record shows that she experienced sleep problems. This could be attributed to the likelihood that her blood contains high levels of harmful chemicals such as serotonin and dopamine that cause body dysfunction like loss appetite loss, sleep problems, and inability to respond to stress.

Self Perception and Self-Concept: Due to her weak immune system, Catherine has lost interest in activities, which used to make her happy. Such low self-esteem increases the chances that she would resist prescribed intervention therapies.

Roles and Relationships: Catherine has three children and six grandchildren whom she loves very much. Currently, she is living with her youngest daughter and three grandchildren who have played key roles in improving her health. For instance, she revealed to her doctor that her grandchildren always ensure that she takes her medication in time.

As such, Catherine’s medical condition can be modeled using S-BAR (Situation-Background-Assessment and Recommendation) as follows:-

Situation

Catherine was recently admitted after experiencing a heart attack. She was diagnosed with angina, but after receiving medication her condition stabilized. However, she has started complaining of chest pains and discomfort that lasts for a few minutes then goes away. She is also experiencing shortness of breath and fatigue. Moreover, her ankles, feet, and veins in the neck are swollen (Alfaro-LeFevre, 2014).

Background

Catherine has been living with a coronary heart disease for the past ten years from the first diagnosis in 2003. However, she might have developed the disease in the late 1990s. Her past medical records show that although this was the first heart attack, she has been admitted several times with heart related diseases. Similarly, for the past three days that Catherine has been in the hospital, her heartbeat has been irregular. That is, sometimes her hearts beats faster than normal while sometimes it skips. An electrocardiogram test shows her hearts’ pumping chambers are normal while chest X ray taken few days ago indicates that there are fluids in her lungs. In addition, coronary Angiography done on Catherine revealed that her arteries have been damaged. Moreover, fasting lipoprotein tests showed that her blood high-density lipoprotein exceeded 240 mg/dL (Alfaro-Lefevre (2014). This means that Catherine’s blood contains a high amount of toxic cholesterols that further increases the clogging of the blood vessels.

Assessment

Such symptoms mean she is likely to experience another heart attack or a total heart failure. Particularly, the shortness in breadth indicates that her heart has become weak such that it cannot pump blood around the body. Consequently, fluids have built up in the lungs that make it difficult to breathe.

Recommendation

Catherine needs to take diuretics and Angiotensin Converting Enzyme Inhibitors (ACE) inhibitors. Diuretics would help reduce the fluid buildup in the lungs and the swelling in the legs and neck. However, ACE inhibitors would lower the blood pressure and reduce strain on her heart. In this case, angiotensin are chemicals produced by the body cells which cause muscles surrounding blood vessels to contract which it turns causes the blood vessel to narrow. This implies that, taking ACE inhibitors would stop the production of enzymes, which facilitates the blood vessel narrowing thereby reducing possible future heart attacks.

At the same time, for Catherine to manage her health, she should adopt a new lifestyle. Most importantly, she should quit smoking. This is because; first, cigarette smoking increases heart dysfunctions through increasing fatty acids build ups in the blood stream. Secondly, smoking narrows the blood vessels thereby reducing blood circulation. This is evident from recent studies shows that have indicated that smokers with heart diseases are more likely to experience more complications such as nerve damage and kidney diseases than non smokers. For example, Xiu, Wu and Wakui’s (2009) studies revealed that those who smoke at least 20 cigarettes daily were 61% more likely to develop heart complications than those who do not or smoke less than 20 cigarettes daily. On the other hand, quitting smoking leads to immediate health benefits.

Additionally, Catherine should eat foods that do not contain high cholesterols, high fiber, and carbohydrates with low sugar contents. Such foods include unprocessed fruits and vegetables, whole grains, legumes, fish, and lean meat. Moreover, Catherine should engage more in active physical exercises. Desilva (2013) advices older persons to undertake at least 150 minutes physical activity weekly. This might include walking, gardening, swimming, and jogging.

In conclusion, Catherine’s condition has been deteriorating because she has persistently refused to abide by the prescribed medication. However, she revealed to her doctor that she was ready to go an extra mile to improve her health. In fact, prevention and control of heart diseases depends on one’s choice of lifestyle. Therefore, by eating healthily, exercising regularly, and quitting smoking, Catharine’s health would significantly improve.

References:

Alfaro-LeFevre, R. (2014). Applying nursing process: The foundation for clinical reasoning. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

DeSilva, R. (2013). Heart disease. Santa Barbara, Calif: Greenwood.

Foye, W. O., Lemke, T. L., & Williams, D. A. (2013). Foye’s principles of medicinal chemistry. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Kokkinos, P. (2010). Physical activity and cardiovascular disease prevention. Sudbury, Mass: Jones and Bartlett.

Xie X. Liu, Q. Wu, J. & Wakui, M. (2009). Impact of cigarette smoking in type 2 diabetes developments, Acta Pharmacologica Sinica (30)11: 784-787.

Ethical dilemma in nursing research

/in /by

Ethical dilemma in nursing research

Select one issue that reflects an ethical dilemma in nursing research (i prefer to write about patients confidentiality) . Provide a brief one page outline describing the issue and submit to the professor before starting the paper.
b. In the paper, begin with an introduction that clearly states the issue to be addressed in some detail. Provide an explication of your position.
c. Clarify terms as you progress through the paper and use an appropriate theoretical model from the ethics literature in which you support your position.
d. Investigate the positions reflected in the ethics literature with particular attention to balance regarding your issue.
e. Identify the major counterarguments to your own position and explain why these have or have not been persuasive in your changing your original position to this issue.
f. End the paper with a clear summary that includes a brief reiteration of the issue and the arguments you have made.
g. Use APA throughout the ten page paper. References should be adequate to the task in number and quality and should include your textbooks when relevant. The usual
number of references is typically 12 to 15. There should be a good balance of seminal
articles and contemporary resources. Please note that dictionaries and Wikipedia are unacceptable sources for definitions in your papers in this course. Use ethics texts or other ethics literature resources for definitions and to guide your discussion.

smilesmilePLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING TERM PAPERS TODAY AND GET AN AMAZING DISCOUNT

get-your-custom-paper

The nature of health promotion work in midwifery

/in /by

Health promotion is an essential part of a midwives responsibility; “the nature of health promotion work in midwifery is geared toward promoting the health of the mother and ensuring an optimum environment for mother and baby” (Dunkley, 2000:40). Breastfeeding can be a controversial topic. It can bring about mixed opinions and responses from mothers and midwives. In spite of the message “breast is best” bottle feeding has become part of the culture in Ireland’s society. “Health promotion is predominately a proactive process. It is a process that is done with people not at people, either on an individual basis or within groups. Participation and partnership are key components of the process (Dunkley, 2000:42). This essay will discuss the unique ability of midwives in their contribution to the health promotion of breastfeeding in Ireland.

A general role of midwives is to enthusiastically support and advise a breastfeeding woman. A midwife should help the woman recognise that breastfeeding is a normal life event in every culture. In order to do this a midwife should have a broad knowledge of the anatomy of the breast and sufficient clinical skills. This will ensure the woman receives adequate information and skills on the postnatal ward, or antenatally.

Benefits of Breastfeeding

Firstly the reason for the promotion in regard to breastfeeding is that apart from being economically friendly, it also holds many benefits for the baby and for the mother herself. “Extensive research using improved epidemiological methods and modern laboratory techniques documents diverse and compelling advantages for infants, mothers, families and society from breastfeeding and the use of human milk”. (Chalmers & Kramer 2001). “These advantages include health, nutritional, immunological development, psychological, social, economic and environmental factors” (American Academy of Paediatrics, 1997) Human milk lessens the chances of an infants chance of infections and diseases including bacterial meningitis and respiratory tract infections. This is because breast milk contains anti-infective properties. ” Studies have demonstrated protection from pre-menopausal breast cancer (Buchanan and Sachs, 1998;Enger et al., 1997;Katsouyanni et al., 1996; Michels et al., 1996;UK National Case-Control Study Group, 1993) and pre-menopausal ovarian cancer (Siskind et al., 1997) and a possibility of protection against hip fractures in older age (Department of Health 1998). Breast feeding can also help the mother return to her pre birth weight. “Breast milk has been shown to protect babies against gastrointestinal, urinary, respiratory and middle ear infection” (Howie et al 1990) and atopic disease if there is a family history of atopy” (Burr et al 1989, Oddy et al 1999). Breast milk also contains exactly the right proportion of nutrients a baby requires. From 16weeks gestation the breast will begin to produce a clear fluid known as colostrums. Colostrums is the first feed a breast fed baby will receive. It has higher levels of protein, fat-soluble vitamins and mineral percentages than normal breast milk. It is plentiful in immunoglobulins, macrophages, lymphocytes, neutrophils and mononuclear cells which gives it the high levels of protein. Traditional breast milk holds 90% water with 10% proteins, carbohydrate and fats with vitamins and minerals. “The primary solid constituent is the fatty acid component that provides 50% of the calorific requirements of the newborn.”(Henderson & Macdonald, 2004:595).

Role of the Midwife

The role and responsibility of the midwife is to work with evidence based practice “with good communication to provide advice, support, encouragement and education to facilitate the womans ability to breastfeed (preferably with a ‘hands off’ approach from the midwife” (Johnson & Taylor 2006:346). Support throughout pregnancy can have a long lasting effect no matter the scale the task may be. A good example of this is the midwives role in health promotion and in supporting women in feeding their babies. (Crafter, 1997). “When a woman needs more general sources of advice and social support than those provided through the maternity services, midwives may still play a key role in providing relevant information and advice and referring her to other professionals and organisations for support.”(Cooper & Fraser 2003:939). If the chosen method of feeding an infant is breastfeeding a mother should expect midwives to assist them in the latching on of the child and in the correct way so it is not painful or uncomfortable for the mother. “The baby should be brought up to the breast quickly to ensure correct attachment, rather than the breast brought down to the baby which encourages bad maternal posture and poor attachment” (RCM, 2002). They must also ensure the baby is obtaining sufficient feeds and that water and artificial baby milk is avoided unless medically necessary. If a mother decides to bottle feed she should, however, expect the same level of support and shown how to make up a bottle feed.

Education for a breast feeding mother is essential. In order to prepare the mother for breast feeding, it is more favourable that she understands the process of breastfeeding. The midwife will have a dual role in the first few feeds. First and foremost, she must ensure that the baby is receiving and adequate feed. Secondly the midwife should ensure the mother herself acquires the ability to feed her baby alone. Emotional support by a midwife is important if it is the womans first time breast feeding. Along with physical and emotional support a woman will also require adequate support in the means of information such as leaflets, on a one to one basis, or support groups in the community. A popular support group is La Leche League International. They are non medical breastfeeding counsellors. During the last decade, the average length of hospital stay following birth has been cut almost in half as the health care industry strives to keep costs down; especially in the economic downturn our society is enduring. Women are sent home to grapple on their own and sometimes will not have gotten any advice on breastfeeding from a midwife on the postnatal wards as there is not enough staff and not enough time in the day. “Additional support has a positive effect on the woman’s satisfaction of breastfeeding, demonstrated by a Cochrane database review (Anderson, 1999). La Leche League(LLL) has worked for 35 years offering information and support to women who want to breastfeed, as well as providing continuing education for health care professionals. LLL believes that breastfeeding, with its many important physical and psychological benefits, offers advantages for both mother and child and is the ideal way to initiate healthy family relationships.

Midwives should work within The structure set out in the Ten Steps to Successful Breastfeeding (Saadeh and Akre, 1996: Woolridge, 1994: WHO, 1998) which are as follows:

Have a written breastfeeding policy that is routinely communicated to all the healthcare staff

Train all healthcare staff in skills necessary to implement this policy.

Inform all pregnant women about the benefits and management of breastfeeding.

Help mothers initiate breastfeeding soon after birth.

Show mothers how to breastfeed and how to maintain lactation even if they should be separated from infants.

Give newborn infants no food or drink other than breast milk, unless medically indicated.

Practice rooming-in: allow mother and infants to remain together for 24hours a day.

Encourage breastfeeding on demand.

Give no artificial teats or dummies to breastfeeding infants.

Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospital or clinic.

In 1991 the Baby Friendly Hospital Initiative was set up by UNICEF and WHO, in order for hospitals to encourage and be supportive of breastfeeding women (Ten steps). Mothers should hope to get a high standard of care in all ‘Baby Friendly Hospitals’. Hospitals who wish to receive ‘Baby Friendly’ status must adhere to (WHO 1989). In such a hospital a mother should expect a midwife to assist them in the breast feeding soon after birth. This may occur when skin to skin contact occurs. A baby should remain with his mother at all times. Help given with attaching the baby to the breast soon after birth often results in successful breastfeeding (Hytten,1954).

Conclusion

The way forward to the successful return of breastfeeding as a cultural normality lies in the roots of prenatal and postnatal education. Different approaches to this may be in hospitals, postnatal wards, schools and the community. The keen attitude and involvement of midwives is vital to the promotion and practice of breastfeeding to ensure the best possible development of infant and child health. Breastfeeding like, like childbirth, empowers women. This power is not society’s masculine definition of power meaning authority, money, or material goods. It is the power of nurturance, intimacy and attachment.

Processes and Methods for Parademic Research

/in /by

The purpose of this paper is to discuss and explain the processes involved in research and the methods involved. It will also explore the principles underpinning quantitative and qualitative research.

As part of the paper I will critique an article titled ‘Out-of-hospital cardiac arrests in the toilet in Japan: a population-based descriptive study’ (Kiyohara et al., 2018) using the Coughlin, Cronin and Ryan (2007) critique tool.

The Research Process


































Phase 1: Identify the research question or topic

Deciding what topic or area in which the research is to be carried out forms the first part of the research process (Wood and Kerr, 2011). Identifying areas where processes or procedures, gaps in knowledge can be improved are common when performing healthcare research (Holloway and Wheeler 2010).



Phase 2: Literature review

Once the topic or area of research has been decided a literature review is performed, searching for what research or exploration of the topic has already been completed by others. Repeating research that has already been conducted and published on the chosen area of research could be construed as unproductive (Gerrish and Lathlean, 2015). This in-depth summary completed prior to the reseach taking place shows issues and approaches which have already been published on the same topic (Kiteley and Stogdon, 2014).

Carrying out the literature review shows how others have potentially carried out their research, clarifying any issues and informs the current researcher how similar topics have been formulated (Polit and Beck, 2016).



Phase 3: Research design

Planning the structure of the research needs to be completed before any data is collected or analysed. For example, the decision on whether a descriptive or experimental study is to be performed plus the target population the researcher intends to aim the research at (Bowling, 2014).

The selection of procedures and research tools are decided during the planning phase, for example data may be collected using a variety of methods including observing subjects, questionnaires and interviews (Parahoo, 2014).



Phase 4: Collection and analysis of data

Collecting the data is a crucial part of the process aiding the success of any research performed. False or meaningless data results in poor acquired data (Offredy and Vickers, 2010). Observing, assessing, measuring, analysing, interpreting and finally reporting data forms the processes involved in this phase of the research process (McIntosh-Scott et al., 2014).

When all the data has been collected, analysis needs to take place. Interpretation and analysis must take place in order to make the data presentable (Parahoo, 2014).

Raw data taken from the research tools is not enough to support or disprove/reject the subject of the research. The data is simplified and made easier to interpret to reader enabling better understanding (Offredy and Vickers, 2014).



Phase 5: Presentation and discussion of results

Presenting the results of the research is the culmination of what could be years of work. On completion of the previous stages and steps, the researcher may present their results to various audiences including examiners, commissioning groups or agencies, peer reviewed journals and professional journals (McIntosh-Scott et al., 2014). Further to these publications, relevant textbooks may publish the research findings as educational material (Glasper and Reeves, 2017; Holloway and Galvin, 2017).



Quantitative and Qualitative Research





























Various research methods exist for researchers to choose from. Quantitative, Qualitative and mixed methodology are common in research (LoBiondo-Wood and Haber, 2017).

Rolf (2012) describes how the different methodologies and methods can be applied to research.

Both qualitative and quantitative research aim to answer questions posed, qualitative looks at what, why and how whereas quantitative looks at how much or how many (McCluster and Gunaydin, 2014).

Quantitative research method focuses on the use of numbers and accuracy instead of experiences and perceptions (Polit and Beck, 2016). Quantitative research is defined by Gaskin and Chapman (2014) as a method that collects information in number format to analyse.

Defining quantitative research Yilmaz (2013) describes how data is analysed using mathematical methods before being presented and published. Saunders et al., (2012) describes quantitative research as the backbone of a research study as it allows generalisation of results due to the responses and views of the sample population used for the study.

Advanced statistical analysis packages may be required to calculate the data produced from the research sampling due to the possible high number of results produced by quantitative studies (Curtis and Drennan, 2013). Studies can use a population of millions to a very small survey pool where only minimal technology such as a calculator can be used to produce the results Curtis and Drennan, 2013).

Quantitative research has a long history of use and is a well-respected method (Brannen, 2016). It is stated by Rutberg and Boukidis (2018) that a better structured environment is made by using quantitative research enabling more control over variables. It is further suggested that it is more beneficial as a research method as it allows the researcher to collect and tabulate data in numbers, allowing numerical calculations and interpretation of results (McCusker and Gunaydin, 2014).

In contrast to the stated benefits quantitative research studies can require a large sample size incurring recruitment, authorisation and cost issues (Fagerland, 2012). Where data is being collected regarding customer or patient feedback numerical data is the least reliable instrument in the improvement of services whereas written feedback and opinions (qualitative data) is much more valuable (Macur, 2013).

Maxwell (2013) describes qualitative research as an interactive approach where Hanson, Balmer and Giardino (2013) describe it in more depth and state research data is gathered from words, images and observations. Holloway and Galvin (2016) interpret qualitative research as a social enquiry focused on the way it is interpreted by people.

Qualitative research is an umbrella concept covering group or one-to-one interviews; observing the participants and analysing documentation (Tracy, 2013). It is associated with purposeful searches, processes and investigations, which when evaluated provide information which gains an understanding and knowledge of the focussed study (Carey, 2017).

Research studies benefit from a qualitative approach as the enquiries can be open-ended; they provide the ability to take beliefs, values and assumptions into consideration (Choy, 2014).

Until recently qualitative research wasn’t taken seriously due to having no objectively verifiable results or the inability to verify the interviewer’s skills or knowledge of the subject being researched (Choy, 2014).

Qualitative research when utilised within healthcare develops a patient or relative centred perspective. This enables the researcher to interpret the patient’s experiences of care, communication and interaction (Holloway and Galvin, 2016).

Qualitative research can be a strong tool as it allows researchers to learn about the subject’s society and their personal interpretation of the experience being discussed (Tracy, 2013). Learning from the participants personal experiences enables feedback and improvement of services improving the patient experience (Wang, 2009).

Qualitative research cannot hold the same confidence level as in quantitative research due to its limitations. The wider population used in quantitative research isn’t possible as the data received is not tested to discover whether it is significant statistically or due to change (Wang, 2009).

With limitations to both quantitative and qualitative research methods, a mixed method of research gives better results than one single research tool used on its own (Leppink 2017).



Critical appraisal of article





































From the articles available to critique I have chosen ‘Out-of-hospital cardiac arrests in the toilet in Japan: a population based descriptive study’.

My reason for choosing the article is the title suggests close similarity to a job I have encountered whilst in practice. Also the possible contrast between Japanese and British methods could be interesting.

To critique the article I will follow the tool designed by Coughlin, Cronin and Ryan (2007) as it is clear and has a step by step format ensuring all elements are covered.

Research papers are traditionally written in a third person format due to the impression of the writer being impartial and offering a critical approach (Zhou and Hall, 2016). The article being appraised is written in this third person style for the majority of the paper.

It is stated by Coughlin, Cronin and Ryan (2007) that research papers should be well written, grammatically correct and well organised. The layout of the article is in columns due to it being published in a professional healthcare journal. The layout works well on paper as the whole article can be seen and read in a methodical manner; however this style of presentation is less reader-friendly when viewed on a computer screen or tablet due to scrolling up and down when changing columns. It is suggested by Tondreau (2008) that this format makes passages of text easier to read.

Bold font introduces each section and sub-section making each section clear to understand and can aid quicker searching of specific sections.

As the topic being discussed is of medical nature, the writers have limited the amount of technical medical terms used, there are no unnecessary complex terms which would have a reader of none-medical background misunderstanding or not understanding sections of the paper. As highlighted by Rakedzon et al., (2017) researchers not only present their findings to their peers but also public readers.

The authors of the paper should hold positions or qualifications relating to the topic of the paper. This would indicate their potential knowledge in the subject matter or field. This paper has six research contributors each with positions relating to university hospitals or healthcare facilities.

Focusing on one contributor, Takeyuki Kiguchi holds a Doctorate of Medicine and Philosophy (MD-PhD) and has held the position of assistant professor at Kyoto University Hospital, Japan. He has been credited with contributing to multiple papers published with the out-of-hospital cardiac arrest studies in differing locations such as in a motor vehicle and at home. Currently his research is focussed on stem cell therapy for easing Parkinson disease symptoms.

Coughlin, Cronin and Ryan (2007) ask if the report article is clear, accurate and unambiguous. This study doesn’t have a quick, easy to remember title as it stretches over two lines. However the descriptive nature of it clearly describes what the paper is about.

Looking at the abstract section of the paper, this gives the reader an insight into the aim of the study as well as methodology. It gives a clear detailed description of the study and the conclusion without having to read the full article. It is suggested by Pyrczak and Bruce (2017) that an abstract should be between 150 and 250 words. This paper’s abstract is 248 words long, suggesting to me it has been edited down to fit the 250 word specification.

Continuing through the Coughlin, Cronin and Ryan (2007) critiquing guidelines, the purpose of the study should be clearly identified. The title states quite clearly due to its length that this is a population based descriptive study. Published articles can vary depending on the journals target audience (Gerrish and Lathlean, 2015).  As the article can be read by anyone without a medical background, the sub headings give an indication of what each sub section involves without using jargon.

A literature review is suggested by Coughlin, Cronin and Ryan (2007) however reading through the paper by Kiyohara et al., (2018) it is difficult to see if this has been done. No section or sub heading point to this and there is no mention through the text. Completing a literature review is an essential tool for those who have limited knowledge of the subject of the paper (Dunne, 2017).

The use of a theoretical framework within a quantitative research can be absent if the subject is not linked to any exact study (Fothergill and Lipp, 2014). Coughlin, Cronin and Ryan (2007) tool asks if the researchers have used a conceptual theoretical framework for their work, through the text no mention is made of this as suggested by Connelly (2014).

At the start of the abstract the first line starts with the aims of the study. These two lines explain what the study was about but do not pose any research question or objectives.

The sample size should be clearly described within the text, the researchers state their population target is the 2.7 million people living within Osaka City, Japan. Coughlin, Cronin and Ryan (2007) ask whether the sample size, method and participants were suitable for the study. The sample size is stated within the abstract as suggested by Dale et al., (2019). The eligibility of the participants for the study is stated as being 733 meeting the study requirements of cardiac arrests occurring in the toilet.

Ethical considerations are the centre of more healthcare discussions than ever before Confidentiality is a key principle for researchers to consider (Fothergill and Lipp, 2014).

Patient confidentiality is maintained through the study by anonymising any patient information. The Ethics Committees of Kyoto University approved the study as the researchers state confidentiality has been maintained. Personal details were removed from the database prior to the data being used, as a result of this; informed consent from the participants was not required.

Coughlin, Cronin and Ryan (2007) critique tool asks whether the operational definitions are clearly defined. The title of the paper describes the research as a population-based descriptive study; the population in question being Osaka City, Japan. The concept of the study is described within the abstract.

The critiquing tool by Coughlin, Cronin and Ryan (2007) asks if the research design is clearly identified. No mention of this is made in the text. Data gathering instruments are not mentioned in the paper either. It is stated how the researchers collected their data and what criteria was to be met for the study.

Data and statistical analysis is questioned by the Coughlin, Cronin and Ryan (2007) critique tool. The researchers mention that analysis of data was undertaken by the ‘SSPS Statistical Package’ version 24.0J by IBM. No further explanation of choosing this package is made and why it may be appropriate, relevant or specific to this study.

Coughlin, Cronin and Ryan (2007) critique tool asks what number of the sample took part in the actual research and if there are any significant findings.

The research focuses on out of hospital cardiac arrests (OHCA) that occur in toilets over a seven year period. Within the seven year period there were 18,458 occurrences of OHCA recorded. Filtering of these cases revealed that 849 happened within toilets. Further eligibility criteria reduced this number to 733.

Discussing the research paper as directed by Coughlin, Cronin and Ryan (2007) it asks if the findings of the research can be linked back to the literature review. The researchers have not indicated that a literature review was conducted and this makes it difficult to link the findings back. Previously explained in section two of Coughlin, Cronin and Ryan (2007) critique tool, a literature tool is essential to enable comprehensive understanding of the subject matter. Without this an understanding cannot be fully obtained (Wakefield, 2014).

The study’s strengths and limitations are mainly directed towards the limitations. The participant’s medical history and prescribed medication were unobtainable for the study. The research presumes that all OHCA were the result of a cardiac issue unless there is evidence to the contrary. Due to the lack of information in some cases some participants may have been included when their eligibility could be questioned.

The researchers should acknowledge the limitations of their work to enable the reader to understand and make an informed judgement on the topic being researched (El-Masri et al., 2018).

In addressing if the research is generalizable to the wider public there is no mention of this in context throughout the paper.

Coughlin, Cronin and Ryan (2007) critique tool asks if there is any recommendation for further research. Measures to prevent OHCA in toilets are mentioned and early recognition of the event is needed as is the case with all cardiac arrests.

The Vancouver reference system was used in the writing of the research as requested by the publisher of the paper. The researchers used only 13 references out of the allowed 30 for this publication. Looking deeper at the references several were older than 10 years giving the possibility that some reference data could have been dated.



Evaluation of literature





































Returning back to my reasons for choosing this research paper to evaluate, the title suggests a somewhat unusual topic however my clinical practice experience does draw some comparisons to the research topic. An article from which I can draw comparisons to my own practice I find interesting and gives opportunity to gain further knowledge. The size of the research paper report was not excessively long enabling fairly easy reading without getting lost or losing focus.

Physically the article format is easy to follow being arranged in a double column format. Each section and sub section has clear titles enabling speed reading or being able to jump to a specific section.

Illustrations are limited to a four step flow chart showing how the eligibility criteria filtered those suitable for the trial. A vertical composite bar chart displays the breakdown of data into months showing the highest occurrences being in January and March. This composite bar chart I personally find difficult to understand as data is stacked on top of other data causing me confusion on how to interpret it.

Reading the paper fully several times I found nowhere that it mentioned if the research was qualitative or quantitative in its methods. This could have been mentioned in the title or the abstract. As the abstract was at the upper limit of its word count some other content would be lost.

Within the text, the researchers suggest that differences in room temperature being a warm living areas and a cold bathroom/toilet increases sympathetic nerve tone further causing an increase in heart rate.

Within my own practice I have attended numerous patients considered elderly who keep a very warm living area compared to a cold bathroom with open windows to aid ventilation of steam and moisture. The patients may have gone to the bathroom according to relatives complaining of not feeling well and subsequently suffered a cardiac arrest. Being in a private room they would only be discovered after a considerable amount of time has passed. This knowledge wouldn’t change how we practice as paramedics as it isn’t feasible for relatives to monitor those who suffer cardiac arrests prior to the event in a domestic setting.

Attending elderly patients for any reason advice can be given regarding keeping bathrooms a temperature consistent with the rest of the house. Cardiac history patients who do not live alone could be advised to inform their relatives at home they will only be a short time in the bathroom giving the best chance for assistance if required or commence cardio pulmonary resuscitation (CPR) if needed. For male patients with a cardiac history advise them to exercise caution when shaving due to carotid sinus massage possibly causing syncope or cardiac arrest.

Using the information and knowledge gained through reading the research paper my clinical practice may not change much however the understanding I have of the condition has increased. Advising patients to the risks associated within the study can be a preventable measure easily considered.

Bigham et al., (2013) state paramedics should have more involvement in research and their input can help clinical performance in practice. The research would be more beneficial if carried out by paramedics due to their role specific view.



Reference list












































  • BIGHAM, B., JENSEN, J. and BLANCHARD, I., 2010. Paramedic-driven research.

    Canadian Medical Association

    . 182 (10).
  • BOWLING, A., 2014.

    Research Methods in Health: Investigating Health and Health Services

    . 4th ed. Maidenhead, England: Open University Press.
  • BRANNEN, J., 2016.

    Mixing methods

    . 1st ed. Oxon: Ashgate Publishing..
  • CAREY, M., 2017.

    Qualitative research skills for social work: theory and practice

    . Ashgate, Farnham.
  • CONNELLY, L.M., 2014. Use of theoretical frameworks in research.

    Medsurg nursing: official journal of the Academy of Medical-Surgical Nurses

    . 23 (3), pp. 187.
  • COUGHLAN, M., CRONIN, P. and RYAN, F., 2007. Step-by-step guide to critiquing research. Part 1: quantitative research.

    British Journal of Nursing

    . 16 (11), pp.658-663.
  • CURTIS, E.A. and DRENNAN, J., 2013.

    Quantitative health research: issues and methods

    . Maidenhead: Open University Press.
  • DALE, J.C., HALLAS, D. and SPRATLING, R., 2019. Critiquing Research Evidence for Use in Practice: Revisited.

    Journal of pediatric health care: official publication of National Association of Pediatric Nurse Associates & Practitioners.
  • DUNNE, C., 2011. The place of the literature review in grounded theory research.

    International Journal of Social Research Methodology

    . 14 (2), pp. 111-124.
  • EL-MASRI, M. and FOX-WASYLYSHYN, S., 2018. Writing for Quantitative Research Publication: A Brief Outline.

    Canadian Journal of Nursing Research

    . 50 (3), pp.107-109.
  • FAGERLAND, M.W., 2012. T-tests, non-parametric tests, and large studies-a paradox of statistical practice?BMC medical research methodology.(12) pp 78
  • FOTHERGILL, A. and LIPP, A., 2014. A guide to critiquing a research paper on clinical supervision: enhancing skills for practice.

    Journal of Psychiatric and Mental Health Nursing

    . 21 (9), pp. 834-840.
  • GASKIN, K. and CHAPMAN, S., 2014. Qualitative and quantitative research methodology, their uses and the skills you need to use them.

    Research essentials
  • GERRISH, K. and LATHLEAN, J., 2015.

    The Research Process in Nursing

    . 7th ed. Wiley Blackwell, Chichester, West Sussex, UK: Malden, MA.
  • GLASPER, E.A. & REEVES, C., 2017.

    Nursing and healthcare research at a glance

    . Chichester, England: Wiley Blackwell.
  • HANSON, J., BALMER, D. and GIARDINO, A., 2013. Qualitative Research Methods for Medical Educators.

    Academic Pediatrics

    . 11 (5), pp. 375-386.

  • Healthcare

    . 4th ed. Chichester, West Sussex, UK: John Wiley & Sons, Ltd.
  • HOLLOWAY, I. and GALVIN, K., 2017;2016.

    Qualitative Research in Nursing and Healthcare

    . 4th ed. Chichester, West Sussex, UK: John Wiley & Sons, Ltd.
  • HOLLOWAY, I. and WHEELER, S., 2010.

    Qualitative Research in Nursing and Healthcare

    . 3rd ed. Chichester, West Sussex, UK: Wiley-Blackwell.
  • KITELEY, R. & STOGDON, C., 2014

    . Literature reviews in social work

    . Los Angeles: SAGE.
  • KIYOHARA, K., NISHIYAMA, C., KIGUCHI, T., KOBAYASHI, D., LWAMI, T. and KITAMURA, T., 2018. Out-of-hospital cardiac arrests in the toilet in Japan: a population-based descriptive study.

    Acute Medicine & Surgery

    . 5 (4), pp.369-373
  • LOBIONDO-WOOD, G. and HABER, J., 2017.

    Nursing research

    . 9th ed. St Louis: Mosby
  • MACUR, M., 2013. Quality in healthcare: Possibilities and limitations of quantitative research instruments among healthcare users. Quality and quantity international journal of methodology. Vol 47 (3) pp.1703-1716
  • MAXWELL, J., 2013.

    Qualitative research design

    . Thousand Oaks, Calif.: SAGE Publications.
  • MCCUSKER, K. and GUNAYDIN, S., 2014. Research using qualitative, quantitative or mixed methods and choice based on the research.

    Perfusion

    . 30 (7), pp. 537-542.
  • MCINTOSH-SCOTT, A., MASON, T., MASON-WHITEHEAD, E., Ph. D & COYLE, D., 2014.

    Key Concepts in Nursing and Healthcare Research

    . Los Angeles: SAGE.
  • MERRIAM, S.B. and TISDELL, E.J., 2016.

    Qualitative research: a guide to design and implementation

    . 4th ed. San Francisco, CA: Jossey-Bass.
  • NASSAJI, H., 2015. Qualitative and descriptive research: Data type versus data analysis.

    Language Teaching Research

    . 19 (2), pp. 129-132.
  • OFFREDY, M. and VICKERS, P.S., 2010.

    Developing a Healthcare Research Proposal: An Interactive Student Guide

    . Chichester: Wiley-Blackwell.
  • PARAHOO, K., 2014.

    Nursing Research: Principles, Process and Issues

    . 3rd ed. Basingstoke, Hampshire: Palgrave Macmillan.
  • POLIT, D.F. and BECK, C.T., 2016.

    Nursing Research: Generating and Assessing Evidence for Nursing Practice

    . 10th ed. Philadelphia: Lippincott Williams & Wilkins.
  • PYRCZAK, F. and BRUCE, R., 2017.

    Writing empirical research reports

    . 8th ed.
  • RAKEDZON, T., SEGEV, E., CHAPNIK, N., YOSEF, R. and BARAM-TSABARI, A., 2017. Automatic jargon identifier for scientists engaging with the public and science communication educators.

    PloS one

    . 12 (8), pp. e0181742.
  • RUTBERG, S. and BOUIKIDIS, C., 2018. Focusing on the fundamentals: a simplistic differentiation between qualitative and quantitative research.

    nephrology Nursing Journal.

    42 (2).
  • SAUNDERS, M., LEWIS, P. & THORNHILL, A., 2012.

    Research methods for business students

    . 6th ed. Pearson, Harlow.
  • TONDREAU, B., 2008;2009.

    Layout Essentials: 100 Design Principles for Using Grids

    . Osceola: Quayside Publishing Group.
  • TRACY, S.J., 2013.

    Qualitative research methods: collecting evidence, crafting analysis, communicating impact

    . Chichester, West Sussex: Wiley-Blackwell.
  • WANG, J., 2009. Qualitative and Quantitative Analysis of Map.

    Geo-information Science.

    11 (2), pp.169-175.
  • WOOD, M. and KERR, J., 2011.

    Basic steps in planning nursing research

    . Sudbury, Mass: Jones and Bartlett Publishers.
  • YILMAZ, K., 2013. Comparison of Quantitative and Qualitative Research Traditions: epistemological, theoretical, and methodological differences.

    European Journal of Education.

    48 (2), pp.311-325.
  • ZHOU, X. and HALL, J., 2016. Mixed Methods Papers in First-Person and Third-Person: Writing Voices in Dialogue.

    Journal of Mixed Methods Research.

    12 (3), pp.344-357.

Cannabis and Cannabidiol Policy Proposal

/in /by

Healthcare policy is the public program that identifies specific community goals,  plans, decides, and implements programs and actions to achieve those goals. Healthcare policy determines and selects reference points and targets to measure short term and long term goals. These goals are the foresight of the direction of healthcare which  systematically plans for the future. It summarizes the plan, establishes roles of groups, systematically plans solidarity, and educates communities

(World Health Organization, 2019)

.

Scientific research influences healthcare perceptions and with increased discussions comes increased influences, through lobbying, to sway policy

(Annesley, 2019)

. Special interest groups, when united have the most leverage and the nursing profession, united, can have the most impact on policy reform. According to the United Nations 2030 sustainable agenda

(Rosa et al., 2019)

, nurses are key stakeholders in obtaining and identifying goals. The agenda identified several health areas where attention should be focused. The health needs of the poor, causes and effects of malnutrition, safe water and sanitation, improving diets, education to improve health and equality, clean air and research and development are some of the goals identified. Nurses are in a unique position to lead change as their profession is one of caretaker and firsthand knowledge of inequalities and lack of resources for their patients. Nurses can identify how improved healthy lifestyles and interventions can improve patient outcomes. They protect the patient’s rights and support patients independent and preferred decisions and treatments

(Davoodvand, Abbaszadeh, & Ahmadi, 2016)

.

Nurses as advocates have knowledge that can help shape these goals through empowered policy making and action. The advanced practiced nurse through education and nursing practice has a responsibility to the future of the nursing as a profession, to ensure that their voices are heard and that the health of their communities is prioritized. This can only be accomplished through involvement with agencies and coalitions responsible that influence the implementation of policies

(Goodman, 2014)

. This paper will identify and examine concerns with the administration of medical cannabis and CBD in facilities, the solution policy that can be proposed and implemented, the presentation of the policy proposal to an elected official and conclusion of all aspects of the proposal.


Identification of Selected Healthcare




Concern

The Drug Enforcement Agency (DEA) has classified marijuana as a schedule 1 drug, therefore nurses cannot administer marijuana products to patients as it is federally illegal

(Cambron, Guttmannova, & Fleming, 2017)

. This poses a problem with patients who are in hospitals, nursing and residential long-term care facilities. Many of these patients meet criteria for medical marijuana but are not allowed to bring these drugs onto the premises

(Pettinato, 2018)

. This situation forces many patients to violate facility policy and bring these drugs into facilities and medicate their symptoms without the knowledge of the health care practitioner. In long-term care facilities, family members must bring their family members off-premises, administer the drug and bring them back to their facility. The healthcare professional may not have an accurate medical history of patients’ health, partly due to the legality and partly due to fear patients may be experiencing with their provider.

Individual states do not have impact on the classification of drugs, as the classification of a drug can only be changed by the Attorney General, typically after Health and Human Services files a petition for review. Several states have legalized medical marijuana, but have not provided the guidance for health care professionals in these facilities the protection to administer

(Lee & Mallinson, 2018)

. In fact the adoption of medical cannabis has shown to be more about capital revenue than the medical benefits associated with these drugs

(Lee & Mallinson, 2018)

. The state therefore must act in accordance with their constituents to provide legislation to assist with obtaining medical cannabis .

Patients and residents who reside in hospitals and long-term care facilities with a medical need may not have the necessary access to medical marijuana and CBD products. Cannabis and CBD have been shown to improve pain associated with cancer and chronic conditions

(Ware, Wang, Shapiro, & Collet, 2015)

.  Research has shown improvement with symptoms of pain, anxiety, insomnia, seizures and nausea without the addictive features of current prescribed medications

(Bigand, Anderson, Roberts, Shaw, & Wilson, 2019)

. With the only possibility of relieving symptoms for patients in these facilities is to prescribe narcotics, prescribers, nurses and patients no longer have holistic options to treat. These narcotics have numerous adverse side effects and are highly addictive perpetuating the opioid national epidemic

(Lucas, 2017)

.


Policy Solution to Selected Healthcare Concern

The proposal for this health care concern is for the state of New York, which has a medical marijuana program, to institute a policy that addresses the ability for nurses and facilities to possess, distribute, and administer medical cannabis and Cannabidiol (CBD) oils and edibles to patients who have a medical marijuana certification, without the threat of prosecution to nurses and healthcare professionals. With the ability for patients and residents in facilities to have access, there is an improvement in health outcomes. This will allow for patients to continue necessary treatments while allowing for practitioners in these facilities to have an open dialogue and provide continuity of care and treatment for their patients.

Evidence has shown that medical and recreational use of cannabis has had a positive effect on public health. This is due to the substitution of cannabis for opioids. The increased use of cannabis has shown to reduce the use of alcohol and has reduced the need for the and use of opioids, to treat pain and anxiety. In states that have established medical marijuana programs, there is a reduction in the opioid mortality rate by 24.8%

(Lucas, 2017)

In 2016, it was noted by Medicare, that there was a reduction in the number of prescription for narcotics, anti-anxiety, neuroleptics, anti-nausea and sleep-aids

(Lucas, 2017)

. The reduction in the these prescriptions is paramount in addressing the national addiction epidemic, as many patients receive the necessary pain relief without the addictive side-effects, noted using narcotics

(Lucas, 2017)

. Despite some reported adverse side effects with the use of cannabis, no reported incidents of overdose have been reported, making Cannabis a better choice than prescription narcotics

(Bigand et al., 2019)

.

Numerous healthcare conditions can be benefited by holistic approaches versus pharmaceutical interventions. Cannabis and CBD can meet the need of pain relief, anxiety, insomnia, and various chronic conditions. Legalizing marijuana has been identified as a complex political issue and many states have legalized medical and recreational marijuana

(Cambron et al., 2017)

. This has been a benefit and much needed service to patients who qualify for the use of medical marijuana. This is only advantageous to the patient in a home setting and does not follow the patients should there be an inpatient stay or admission into long-term care. This barrier prevents continuity of care and provides for only one treatment option.

To facilitate this process, if policy is accepted, would be the incorporation of patient specific certificate of need forms for each patient, admitted as an inpatient, in a facility. This ensures that patients and residents have a documented diagnosis for the need of cannabis or CBD. The storage of this drug and the destruction must continue to meet DEA guidelines for current narcotics to safeguard these drugs while protecting public safety. Facilities should have nurses obtain specialized nursing training in the area of cannabis and CBD to assist with the education of these drug therapies to patients and their families and be champions of these program in their facilities

(Elsevier, 2018)

.

The success of these programs can be monitored by the rate of reduction in opioid overdoses and the reduction in prescription rates for traditional narcotics. Patient reporting and observable alleviation of signs and symptoms of pain, anxiety, seizures, and movement disorders can be reported by facilities for the use of research and development. Increased research can offer further study of cannabis and CBD products with nursing interventions captured.

Challenges of implementing this policy can be many. The storage of these drugs in residential facilities, where clinical nurses may not be directly on-sight can be a barrier of safeguarding these drugs. In the facilities that provide services to the intellectual and physical disabilities, the guidance of the office of Persons with Developmental Disabilities (OPWDD) has been that these types of drugs must be kept in fixed and unmovable boxes with keyless double locking abilities

(OPWDD.ny.gov, n.d.)

. These medications must be counted every time medication is administered, combinations  must be changed every time staffing changes and each RN must provide competencies to each staff member that will be handling these drugs.

The stigma by communities and healthcare professionals alike can be a barrier to the implementation of this policy. Many healthcare providers, including nurses do not agree with the administration of cannabis and CBD drugs to treat diseases and disorders. This would require that nurses and healthcare practitioners be educated regarding the benefits of these drugs while maintaining a non-judgmental attitude when treating patients. This can be combated with educational classes that specialize in cannabis and CBD to alleviate the concern of risk versus benefit. As nurse leaders we must always treat our patients in non-judgmental, like how we ourselves, or our loved ones would want ourselves and our loved ones treated. Therefore, continuing to treat each individual with integrity is the backbone of the nursing

(Elsevier, 2018)


Identification of Elected Official

Monica Martinez is the senator for district 3. Monica, as a committee member of   Veterans, Homeland Security and Military Affairs this policy is essential to those living in these facilities

(The New York State Senate, n.d.)

. Veterans suffer from anxiety and depression at a higher rate than other community members. Access to medical cannabis while residing in veteran facilities can treat symptoms of depression and alleviate anxiety, therefore reducing depression from PTSD. This policy can reference similar policies that were passed in Virginia allowing for nurses to possess and distribute medical cannabis to students without being prosecuted for violating federal law

(S. Res. HB 1720, 2019)

.


Conclusion

In conclusion, with the implementation of this new healthcare policy positive change can be seen throughout various communities. The overall long term effect with the proposal and approval of this policy will have a drastic impact on patients who reside in healthcare facilities with the additional protection to the licensed professional.

Questions often arise from patients and their families  admitted to short-term and long-term care facilities regarding the use of medical cannabis to augment current treatment. Community members have difficulty in conceptualizing that treatments aimed at relieving pain, treating movement disorders and seizures are not allowed in facilities despite the patients having medical marijuana certifications. There is often confusion regarding the use of these drugs in facilities versus home settings. The advanced practice is at a disadvantage to providing patients with individualized treatment options for disorders and pain. Patients treated with medical cannabis prior to admission can have difficulty in obtaining similar treatment results from traditional prescribed medications.

Having medication and drug options are within patients’ rights when choosing treatment, as well as discussing these options with doctors and nurses while in the hospital or short-term and long-term care facilities. Nurses and healthcare professionals have an obligation to their patients to respect treatment options. If the nurses or doctor cannot possess nor administer these necessary drugs, patient health will suffer. This is a very important topic that requires contemplation and approval due to the national , opioid epidemic, the overuse and over prescribed narcotics. Nurses who administer these drugs in states that have medical approved marijuana programs should be able to carry out their job function without the threat of federal prosecution and the threat of losing their nursing license.

References


  • Annesley, S. H. (2019). The implications of health policy for nursing.

    British Journal of Nursing

    ,

    28

    (8), 496-502. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=135966436&site=eds-live&scope=site

  • Bigand, T., Anderson, C. L., Roberts, M. L., Shaw, M. R., & Wilson, M. (2019). Benefits and adverse effects of cannabis use among adults with persistent pain.

    Nursing Outlook

    ,

    67

    (3), 223-231. http://dx.doi.org/10.1016/j.outlook.2018.12.014.

  • Cambron, C., Guttmannova, K., & Fleming, C. B. (2017). State and national contexts in evaluating cannabis laws: A case study of Washington state.

    J Drug Issues

    ,

    47

    (1), 74-90. http://dx.doi.org/10.1177/0022042616678607

  • Cannabidiol oil and THC-A oil: possession or distribution at public school, S. Res. HB 1720, 116th Cong., (2019) (enacted).

  • Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses’ viewpoint: A qualitative study.

    Journal of Medical Ethics and History of Medicine

    ,

    9

    (5), 1-8. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=a9h&AN=120285800&site=eds-live&scope=site

  • Elsevier. (2018). Medical marijuana education in APRN nursing programs. In M. Alexander (Ed.),

    Journal of Nursing Regulation

    (9). Retrieved from https://www.ncsbn.org

  • Goodman, T. (2014). The future of nursing: An opportunity for advocacy.

    AORN Journal

    ,

    99

    (6), 668–671. http://dx.doi.org/10.1016/j.aorn.2014.03.004.

  • Lee, H. A., & Mallinson, D. J. (2018). Defiant innovation: The adoption of medical marijuana laws in the American states.

    Policy Studies Journal

    ,

    46

    (2), 402-423. http://dx.doi.org/10.1111/psj.12211

  • Lucas, P. (2017). Rationale for cannabis-based interventions in the opioid overdose crisis.

    Harm Reduction Journal

    ,

    14

    (1), 1-6. http://dx.doi.org/10.1186/s12954-017-0183-9

  • OPWDD.ny.gov. (n.d.). https://opwdd.ny.gov/sites/default/files/documents/health_medmanpharmfaqcontrolled.pdf

  • Pettinato, M. (2018). Marijuana regulatory frameworks in four US states: An analysis against a public health standard.

    American Journal of Public Health

    ,

    108

    (7), 914. http://dx.doi.org/10.2105/AJPH.2018.304401

  • Rosa, W. E., Kurth, A. E., Sullivan-Marx, E., Shamian, J., Shaw, H. K., Wilson, L. L., & Crisp, N. (2019). Nursing advocacy to lead the United Nations sustainable development agenda.

    Nursing Outlook

    . http://dx.doi.org/10.1016/j.outlook.2019.06.013

  • The New York State Senate. (n.d.). https://www.nysenate.gov/senators/monica-r-martinez/about

  • Ware, M. A., Wang, T., Shapiro, S., & Collet, J. (2015). Cannabis for the management of pain: Assessment of safety study (COMPASS).

    The Journal of Pain

    ,

    16

    (12), 1233-1242. http://dx.doi.org/ https://doi.org/10.1016/j.jpain.2015.07.014

  • World Health Organization. (2019). https://www.who.int/topics/health_policy/en

Mandates of Insurance Coverage for Infertility Treatments in Georgia

/in /by

According to Insogna and Ginsberg (2018) 7.3 million women in the United States have sought treatment for infertility. Hence why I chose to look at the mandates of insurance coverage for infertility treatments, specifically for the state of Georgia. As I prepare to speak with Senator Chuck Hufstetler about this, I will use this assignment to look at an overview of this concern as well as my proposed solution, I will identify communication techniques that could be used to discuss this with the Senator, and I will evaluate my video presentation about my topic.


Overview of Healthcare Concern and Solution

According to the CDC, infertility is the inability to get pregnant after one year or longer of unprotected sex (Infertility / Reproductive Health / CDC, 2019). According to a study done by Insogna and Ginsburg (2018) the World Health Organization defines infertility as a disease. Infertility treatments can include ovarian stimulation drugs, intrauterine insemination, and in-vitro fertilization. Infertility treatments follow a three-level standard of treatment.

According to Mastroianni (2016) level one treatments include medications that stimulate the ovaries. This is done for approximately six cycles, in most cases this is accompanied by various labs as well as ultrasounds to monitor the ovaries response to medications. Level two treatment includes the addition of another type of medication an injection to further stimulate the ovaries with the added option of intrauterine insemination, again the options is used for up to six cycles (Mastroianni, 2016). Level two also involves labs and ultrasounds as part of the treatment as well.

Finally, level three involves various types of assisted reproductive technology (ART), most commonly in vitro fertilization (Mastroianni, 2016). In vitro fertilization involves, oral medications and injections as well as labs and ultrasounds, and can include surgeries with additional complications involved. According to Mastroianni (2016) as well as Bitler and Schmidt (2011) the cost of these treatments for level one and two can be anywhere from $200 to $3,000 per cycle (and each can be six or more cycles), level three treatments which may require surgery can range from $10,000 to $15,000 per cycle as well as cost of surgery, potential hospital stay and additional complications. ART procedures have an added layer of additional cost after fertilization due to the risk of multiple births and complicated pregnancies.  In the state of Georgia in 2016 there were approximately 5300 cases of assistive reproductive therapy cycles (IVF cycles) at a cost of anywhere from $12,000-$17,000 per cycle (“Assisted Reproductive Technology”). According to Resolve.org (Number infertile by state, 2014) in the state of Georgia in the years 2006-2010 there were 2,073,006 women who had difficulty getting pregnant or carrying a pregnancy.

This is the reason that I have selected infertility benefits as my healthcare concern for my state. Georgia currently does not mandate insurance benefits for infertility treatments, while currently sixteen states do mandate coverage (“Discover Infertility Treatment”, 2019). According to Mastroianni (2016) of the sixteen states that have already put regulation in place for coverage, there are three types of coverage, first universal mandates that cover IVF treatments, second restricted coverage that only covers specific types of ART, and last there are a few states that only mandate that coverage is offered to the policy holders. Cintina and Wu (2019) simplify the types of coverage a little more into two categories: “mandate-to-cover” (p 562) and “mandate-to-offer” (p 562). Mandate to cover guarantees coverage of infertility treatments as a benefit in all group health plans. (Cintina and Wu, 2019). Mandate to offer just requires that this benefit be available for purchase in some policies (Cintina and Wu, 2019). My selected solution would be a mandate to cover type policy, as I think that it gives the most benefit.

If insurance mandates were put into place in the state of Georgia it would provide more affordable treatment options, therefore granting more access to care for those individuals that cannot currently afford treatment, it also as seen previously would decrease the number of multiple order births associated with IVF due to the decreased need to succeed with the first attempt.


Identification of Communication Techniques

I have selected Senator Chuck Hufstetler to discuss my selected topic and proposed solution with. Senator Hufstetler is a healthcare worker himself, he is a practicing anesthetist.  He also is a member of the Health and Human Services Committee. Senator Hufstetler is also a very financial savvy individual and a previous business owner. I feel like his healthcare background as well as his financial background will help him to easily understand this issue as well as the financial impact this disease has on a family, and how insurance coverage could help ease that financial burden.

There are various communication options available to present this concern and solution to Senator Hufstetler, which could include email exchanges, phone conversations, social media platforms or face to face conversation. While email exchanges and phone conversations have been the preferred method of communication to set up our meeting and to explain the need for the meeting, my preferred communication method for the presentation is face to face communication. We are all busy individuals and are easily distracted when having a conversation via phone or may miss some information in an email exchange. If you are face to face with an individual, you will likely have their full attention and be able to engage in conversation about the topic at hand. Egan (2017) identifies that face to face conversation allows you to drive a conversation the direction you want and gives you the opportunity to ask follow up questions. Egan (2017) also identifies that with a face to face conversation you can assess body language. He also states that face to face or one to one conversation carries a level of trustworthiness and genuineness to it, that does not happen with email or social media exchanges.


Self-Evaluation of Video Presentation

I think that in my video presentation I identified myself and my topic as well as my solution very clearly, I took the approach of using my own personal story to explain infertility treatments and the associated cost. I think that adding that personal touch to this presentation helps to really show the true impact of this topic with real numbers that I experienced myself. I debated whether my personal story should be shorter to allow time for additional data as far as the impact on the State of Georgia, but I believe that I was able to convey both my story and the numbers for the state fairly well. For the method of delivery, I think that my grammar was correct, and I stayed connected with the audience watching my video. I do think that I say “um” and somewhat fumble my words and that I could work on that piece of my presentation. For the style of delivery, I tried to have constant eye contact, I know that I did not do well with this, mainly because I was looking at myself on the screen and I hate seeing myself or hearing myself talk so I tended to look away often. I feel like my appearance was good and that my surroundings were not distracting to my audience. I am not sure that I spoke as clearly as if I was talking to someone in person again because I was distracted by myself on the screen somewhat. I do feel like I speak clearer in person.


Conclusion

In my video as well as this paper, I have presented my healthcare concern of lack of infertility benefit mandates in the state of Georgia and my proposed solution to that concern, mandating insurance benefits. I have discussed choosing Senator Hufstetler as who I would like to present this concern to and why I feel like he is a good choice to discuss this with. I have talked about several communication techniques which include face to face, phone, email and social media and that my chosen method of communication for this presentation is face to face and why I think that is the best method for this. Finally, I have provided a self-critique of my video including both things that were good and things that I could work on.


References

  • Assisted Reproductive Technology (ART) Data Assisted Reproductive Health Data: Clinic | DRH | CDC. (n.d.). Retrieved from https://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicsList&SubTopic=&State=GA&Zip=&Distance=50
  • Bitler, M., & Schmidt, L. (2011). Utilization of Infertility Treatments: The Effects of Insurance Mandates. doi:10.3386/w17668
  • Cintina, I., & Wu, B. (2019). How Do State Infertility Insurance Mandates Affect Divorce?

    Contemporary Economic Policy,37

    (3), 560-570. doi:10.1111/coep.12416
  • Discover Infertility Treatment Coverage by U.S. State. (2019). Retrieved from https://resolve.org/what-are-my-options/insurance-coverage/infertility-coverage-state/
  • Egan, J. (2017). Face-to-Face Communications Is Powerful, Postdigital Communications Tool.

    Natural Gas & Electricity,34

    (2), 21-26. doi:10.1002/gas.22004
  • Infertility / Reproductive Health / CDC. (2019, January 16). Retrieved from https://www.cdc.gov/reproductivehealth/infertility/
  • Insogna, I. G., & Ginsburg, E. S. (2018). Infertility, Inequality, and How Lack of Insurance Coverage Compromises Reproductive Autonomy. AMA Journal of Ethics, 20(12), 1152-1159. doi:10.1001/amajethics.2018.1152
  • Mastroianni, M. A. (2016). Bridging the gap between the “have” and the “have-nots”: The ACA prohibits insurance coverage discrimination based upon infertility status.

    Albany Law Review,79

    (1), 151-181.
  • Number of Infertile by State – RESOLVE: The National Infertility Association. (2014). Retrieved from https://resolve.org/what-are-my-options/insurance-coverage/coverage-at-work/number-of-infertile-by-state/

Hypertension

/in /by

 Hypertension

 

Please review the following documents to complete the below assignment:

Review Part 11 of the Buttaro et al. text and the National Heart Lung Blood Institute article in this week’s Learning Resources.
Reflect on your Practicum Experiences and observations. Select a case from these experiences that involves a patient who presented with a hypertension problem. When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.
Think about the patient’s history including drug treatments and behavioral factors such as diet, exercise, smoking, etc.
Review the National Heart Lung Blood Institute article in the Learning Resources. Reflect on health promotion strategies for the patient. Consider ways to reinforce hypertension management.
— a description of a patient who presented with a hypertension problem during your Practicum Experience.
–Explain the patient’s history including drug treatments and behavioral factors.
–Then, suggest two health promotion strategies for the patient. Include suggestions for reinforcing hypertension management.

Week 3 Discussion
Hypertension
In clinical settings, advanced practice nurses frequently use various strategies to treat and manage patients with hypertension and other cardiovascular disorders. These strategies often include pharmacologic and nonpharmacologic therapies, natural remedies, and/or changes in patient behavior. For hypertension patients, behavioral changes including increased exercise, healthier diet, and smoking cessation have proven to be particularly beneficial. However, it is important to recognize that treatment and management plans centered around changes in behavior often require greater patient commitment. This creates the need for patient-provider collaboration, as well as appropriate patient education. When patients are actively involved in their own care and better understand implications of their disorders, they are more likely to adhere to treatment plans.
To prepare:
• Review Part 11 of the Buttaro et al. text and the National Heart Lung Blood Institute article in this week’s Learning Resources.
• Reflect on your Practicum Experiences and observations. Select a case from these experiences that involves a patient who presented with a hypertension problem. When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.
• Think about the patient’s history including drug treatments and behavioral factors such as diet, exercise, smoking, etc.
• Review the National Heart Lung Blood Institute article in the Learning Resources. Reflect on health promotion strategies for the patient. Consider ways to reinforce hypertension management.
Post on or before Day 3 a description of a patient who presented with a hypertension problem during your Practicum Experience. Explain the patient’s history including drug treatments and behavioral factors. Then, suggest two health promotion strategies for the patient. Include suggestions for reinforcing hypertension management.
Week 3 Learning Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources.
Required Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Readings
• Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.
o Part 11, “Evaluation and Management of Cardiovascular Disorders” (pp. 487–611)

This part explores diagnostics of cardiovascular disorders, including how to differentiate between normal and abnormal test results. It also examines how patient history and physical exams contribute to differential diagnoses for cardiovascular disorders.
Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Mosby.
o Chapter 26, “Recording Information”

This chapter outlines the components of SOAP notes and provides guidelines for writing SOAP notes after patient examinations. Please note: You should have this textbook in your personal library, as it was the required text in NURS 6511: Advanced Health Assessment & Diagnostic Reasoning.
Gagan, M. J. (2009). The SOAP format enhances communication. Nursing New Zealand, 15(5), 15.
Retrieved from the Walden Library databases.

This article outlines the four parts of SOAP notes and examines the importance and effectiveness of SOAP notes in clinical settings.
National Heart Lung and Blood Institute. (2002). Primary prevention of hypertension: Clinical and public health advisory from the National High Blood Pressure Education Program. Retrieved fromhttp://www.nhlbi.nih.gov/health/prof/heart/hbp/pphbp.pdf

This article reviews factors that impact the patient education of hypertension. Hypertension prevention and intervention methods are also explored.
Optional Resources
• American Heart Association. (n.d.). Retrieved November 28, 2012, fromhttp://www.heart.org/HEARTORG/
• Drugs.com. (n.d.). Retrieved November 28, 2012, from www.drugs.com
• Institute for Safe Medication Practices. (n.d.). Retrieved November 28, 2012, fromhttp://www.ismp.org/
• Million Hearts. (n.d.). Retrieved November 28, 2012, from https://millionhearts.hhs.gov/index.html
• WebMD. (2012). Medscape. Retrieved from https://www.medscape.com/