Introduction

The Philippines teenage pregnancy rate has increased by 60% in the year 2000- 2010, according to the Philippine National Statistics Office. This is very alarming. Teenage pregnancy often occurs between the ages of 15-19 years old, often in this age the girls are still studying.

With early pregnancy the girls usually have to abandon their education to give birth or raise their child. Girls who become pregnant are expelled from school especially in a Catholic School like Lourdes College because it goes against the moral teachings of the school thus delaying the chance of earning a degree that will help them in providing for their child. Education becomes a lesser priority and is often delayed until they are able to leave the children at home are financially stable. But there are girls who are studying as well as taking care of their child and they are who we call Student Mothers. The burdens for these girls have double as to they have to take care of school as well as their child at home.

The life of a Student Mother is no easy feat they have to juggle their time between attending their classes, making their requirements, taking care of their child and taking care of the house. They become the primary caregiver of their child and are expected to rear their child well. Many of these student mothers also engage in working part-time to help in the financial burdens of both studying and caring for the child. But, this becomes another disadvantage as it takes up time and effort on the part of the Student Mother.

Statement of the Problem

This study aims to understand how student mothers cope with their situation towards their studies and as well as child rearing. More specifically, what are the problems they have encountered in studying while nurturing their child at home.The study also seeks to find the coping strategy used by Student Mothers in their circumstances.

With these in mind the purpose of the study is to help the readers understand the endeavors experienced by student mothers.

The research will ask the following questions:

1. What are the experiences student mothers?
2. What are the coping strategies used by student mothers?
3. What are the learnings of student mothers from their situation?
4. What has helped them most in their situation?

Scope and Limitation

The study covered three (3) student mothers of Lourdes College Higher Education Department, enrolled in the second semester of S.Y. 2014-2015. The study was mainly focused on the student mother challenges, coping strategies and realizations. These student mothers were classified as students of Lourdes College that have a child under seven (7) years of age.

Significance of the Study

The results of the study will then be beneficial to the following persons and institutions:

Student Mothers. They could gain insight about their situation and be aware of their responsibilities as both parent and student.

Students. They will gain deeper understanding about the reality of student mothers and most importantly for them to learn about the experiences of student mothers.

Researchers. They will broaden their knowledge about the experiences of student mothers in a college.

Guidance Counselors. The findings and observations would provide them relevant data that can be utilized in their counseling interventions.

Administration and Faculty. This will provide them information to promote, enhance understanding and support to programs concerning student mothers to help them cope in their situation.

Literature Review

From 2000 to 2010, the number of live births by teenage mothers in the Philippines rose by more than 60 percent, latest data from the National Statistics Office showed.

Another alarming fact is that the number of teenage mothers who gave birth to their second or third child during their teenage year has increased in the last 10 years. This is according to the data shown in the press conference in Quezon City by Carmelita Ericta, administrator and civil registrar general of the National Statistics Office. ( Ime Morales, July 9, 2013) Teenage preganancy is a global issue and a major contributor to school drop-out among girls. Permanent expulsion was one of the solutions made for teenage pregnancy but this has been proven ineffective and unfair to the girls. Now there is a return to school policy where a student is temporarily dismissed from school due to teenage pregnancy to further pursue their education.(Okeyo, 2012)

As stated by Brown and Amankwaa (2007) “As more female college students are involved in sexual relationships their risk of conception increases. However, when pregnancy occurs it is only the woman who bears the burden and risk of the pregnancy and in most cases child care.“ often these types of pregnancy are unplanned or planned caring for a child becomes a full time job. Having a child while being a student becomes stressful because child rearing consumes time and energy, with a few exeptions the women are the primary care giver of the child. ( Hofferth, Reid, & Mott, 2001 as cited by Brown &Amankwaa, 2007). According to Kidwell (2004), rearing a child while being s full-time student may be daunting and difficult however, it will be easier if she has a partner or a family member who can help her in taking care of the child.

With the increase of higher education students, 10% of this population areparents or mothers who are hoping to give their children a better future and attending to their needs through receiving a degree. These nontraditional students are often Student Mothers and should be given special attention because aside from their role as student they are also mothers and care givers at home. Many see or consider their families a hindrance to their education which is wrong they should see it as a motivator because primarily, Student mother go back to studying because they want to provide for their child. (Wilsey, 2013)

When pregnant students and student mothers are expected to subordinate their needs and desires to those of their children and families, they are forced to grapple with the conflicting roles of motherhood and studentship (Berg &Mamhute, 2013). Brown &Amankwaa, (2007) stated that parenting is a very stressful and some women cannot handle all the tasks involved especially the first time mothers and need help or assistance from the people around them. Although having someone help the mother is good but the expectation of receiving support after giving birth to a baby often causes Stressors that may lead to depression during postpartum period. Many student mothers have expressed feelings of guilt, worry and inadequacy in both as a student and as a mother.( Thompson, 2004)

Though not always does being a student mother have negative effect, it also has positive effects. Story (1999), as cited by Brown &Amankwaa (2007), has found out that student mothers are more responsible than those of regular students. He has seen that girls who were irresponsible before pregnancy has become more responsible after pregnancy and ismore less likely to drop out of College than the regular students.

For women who juggle family and student responsibilities, the lack of time is one of the major issues faced. (Liversidge, 2004) Many student mothers use different coping strategies to adjust to their situation. As stated by Grohman (2009), student mothers depend on time management to handle the many different tasks of a student mother. Another coping cited by Grohman&Renelamn (2009) is managing tasks to handle the things needed to be done as both student and a mother as well as emotional and physical support from both the partner and parents of the student mother.

Okey (2012) has said student-mothers go through a number of challenges as they live double lives as mothers and students. Often challenges are faced like lack of support due to other factors like lack of finances and time being limited.

A study by Boutan (2012) shows the feeling of student mother in regards to lifestyle she said thaGale (her participant) said she juggles multiple lifestyles as a full-time student and a full-time mom. This does make her feel disconnected from campus life.

Due to student mothers’ situation being difficult they have adapted coping mechanism. According to Okeyo (2012), Their coping mechanisms included: problem-focused, avoidance and emotion-focused strategies and the support they received upon resuming studies were spiritual and social support.

It was argued that raising a child involves a great deal of financial, emotional, and practical planning (Kidwell, 2004). it is necessary to make sure that there are adequate child care resources available. This may be very difficult to do if the student is going to school full-time. However, if the student decides to remain in school and take care of the child it may be more fpossibleif she has a partner or family member who will provide additional help to care for the child (Kidwell, 2004). Parenting is very stressful and some women cannot deal with all of the tasks that are involved. It is best if there are people around who are there to assist. Although it is best to have family, friends and spousal support after giving birth to a baby this expectation often causes Stressors that may lead to depression during the postpartum period. (Brown &Amankwaa, 2007)

Methodology

Research Design

In this study a qualitative exploratory design was used, allowing the researchers to get an in-depth understanding of the socio-educational problems faced by Student Mothers. Qualitative research has the advantage of uncovering the lived experiences of individuals by enabling them to interpret and attribute meaning to their experiences and in the process construct their worlds (Merriam and Simpson 2000, as cited in Berg &Mamhute, 2013)

Respondents of the Study

Respondents of the study are the student mothers of Lourdes College, in the second semester of S.Y. 2014-2015. There were a number of three (3) identified single mothers in Lourdes College who volunteered and provided time to participate in this study.

Research Instrument

The primary tool used in gathering data was in a form of a one-on-one interview with the respondents. The interview was focused on the challenges, coping strategies, realizations of student mothers.

Sampling Procedure

In this study, the researcher used purposive sampling in which the researcher chose only student mothers who are caring for a child below seven (7) years of age and are studying in Lourdes College.

Data Gathering Procedure

Prior to data gathering, the researcher prepared an informed consent letter to be given to the respondents of the study, voluntary participation was highly emphasized in the letter of consent.

The data-gathering procedure was done in a form of one-to-one interview in which the researcher took written notes. All interviews were tape recorded. The interviews were informal and open ended, and carried out in a conversational style.

Results

1. Profile of respondents:

	NAME	AGE	COURSE	AGE OF CHILD
Respondent 1	Ione	27	BSSA	4 years
Respondent 2	Dianne	21	BSSW	1 year
Respondent 3	Tepa	23	BSSW	4 years

Experiences of Student Mothers:

For Ione (27), her experiences are that its tiring, struggling with subjects, concentration, especially when at home and doing her homework, and time management.

As for Dianne (21) her experience and struggle is that she struggles to manage her time between school, the child and for herself.

And for Tepa (23), time management is the most difficult part for her. She stated that she needs to wake-up early and prepare especially now that her son is going to school.

Coping strategies of student mothers:

For Ione (27), she copes by focusing on school and home separately another coping is that thinking positive and being optimistic and going with the flow.

As for Dianne (21), her coping is working hard and praying.

And as for Tepa (23) she copes by not getting stressed being optimistic and being welcomed by her child at home.

Factors that helped them:

For Ione (27), her biggest factor that helped her cope being a student mother is her Husband, For Dianne (21),its being accepted by her family and friends. And for Tepa (23) she views her mother as the biggest factor that has helped her.

Learnings of student mothers:

As for Ione (27) she has learned that being a student mother is not easy but challenging. She also learned that a s a mother she needs to learn to set her priorities. And she learned that one should grab the opportunity to learn and study while still single.

Dianne (21) learned that one should not be careless in choosing partners and achieve your goals despite having a child.

And Tepa (23) learned that you should not panic and should be knowledgeable of the consequences of your actions.

Discussion

Time management is seen as the common obstacle for these student mothers. Because the live double lives as a mother and as a student, they struggle to split their time to accommodate all their responsibilities. This is supported by Grohamm (2009) work, student mothers greatly depend on time management.

For coping the respondents commonly rely on being positive and not being stressed about their situation. As for the factors they consider that greatly helped them cope the common factor was the help of family members and husband. This is supported be works of Kidwell (2004), Thompson(20014 and Okeyo(2012) that it lessens the burden on the student mother if there are people around her who can help in caring for the child. This is evident as stated by Ione (27) that when she has things she needs to do at home her husband is the one who takes care of the child and as for Tepa (23) she stated that her mother has helped her both financially and caring for the child at home.

The most common learning of the student mothers is that one should not be rash and should know the consequences of their actions.

Conclusion

Time management is the biggest obstacle of being a student mother as you need to divide your time between school and caring for the child. As for the coping strategy it is seen that the having a positive outlook is effective in handling different situations as a student mother.

References

Yocheved Grohman, Renelamn (2009). Coping Stategies used by student mothers to succeed in Occupational Therapy School.

Donna Mcgee Thompson (2004). A tunnel of Hope: the experiences of student mothers attending Community College based developmental study Program. Students affairs: Experiencing Higher education : P.67

Brown RL, Awankwaa AA. (2007). College Females as Mothers : Balancing the roles of Student and Motherhood.

From:

http://search.proquest.com/pqrl/docview/218901034/fulltext/A9E614CADCC34474PQ/1?accountid=167112

Sharon Liversidge (2004). It’s no Five O’clock World : The lived experiences of re/entering mothers in Nursing Education. Students affairs: Experiencing Higher education : p. 42

ChelseyBoutan (2012). Student mothers: Joys, Hardships, Misconceptions. From:

http://northernstar.info/campus/news/student-mothers-joys-hardships-misconceptions/article_e1502dba-47c5-11e1-a057-0019bb30f31a.html?mode=story

Kidwell, Christine & Professional Staff (2004). “Some facts psychologists know about unplanned pregnancy”. Retrieved March 6, from <

www.psc.uc.edu/sh/SH

Unplanned%20Pregnancy.htm>

Okeyo, LinnahApondi (2012). Schooling challenges and coping mechanisms adapted by student-mothers in secondary schools in Nyando District, Kenya. From:

http://irlibrary.ku.ac.ke/bitstream/handle/123456789/3611/Linnah%20Apondi.pdf?sequence=1&isAllowed=y

When Autism Speaks: Impaired Verbal Communication

Impaired verbal communication is classified as a decreased, reduced, delayed or absent ability to receive, process, transmit, and use a system of symbols (NIH). Verbal communication is conveyed through a vocalization system of sounds that forms into a language. The capacity to effectively learn how to communicate is not solely based on the words that are being formed, but the sending and receiving of the information. According to

the Diagnostic and Statistical Manual of Mental Disorder (DSM-5)

, children with autism are considered to have a neurological and developmental disorder that begins during the early childhood and has the potential to last throughout a person’s life. Autism is a “spectrum” disorder that can affect an individual in many ways such as behavior, interactions with others, learning, and willingness to communicate (NIH).  These symptoms could be related to sensory changes that involve the hearing or vision (Wayne, 2017). Several obstacles may arise when caring for an individual that may be autistic and have impaired verbal communication to express oneself. Often times misunderstandings are conceived. It is the duty of the nurse provide care for these individuals, to establish a care plan that has goals/outcomes, identify what can be assessed, how to intervene, and the capability to educate others on the appropriate way to provide care for these individuals.

What is Autism?

According to

The Nurse Practitioner Journal

, Autism Spectrum Disorder is considered a neurodevelopmental disorder that impairs social communication and social interactions (Weill, 2018). This disorder has no respective of person, however, it occurs more frequently in about one in 42 males and one in 189 females, no matter racial and ethnic group, and across all socioeconomic levels (Weill, 2018). About one in 68 children have ASD. Some of the most common signs and symptoms of ASD and impaired verbal communication are individuals become more focused on a certain object, rarely make eye contact, and fail to engage in typical babbling with their parents (NIH). Children may appear to develop “normally” until around the age of two or three at this point research have shown that there is a disconnect and children begin to withdraw and become socially isolated from groups (CDC). Therefore, when providing care for these individuals and their families, the nurse should find out the appropriate and effective ways to communicate. This will allow the nurse to formulate a plan on how to educate the individual and families about self-care or areas that may need strengthening as well as display the individual’s skills and needs. The environment around individuals with autism that are impaired verbal communicators may affect their willingness and desire to communication (Wayne, 2017). Nurses should be aware of the surroundings.

Goals and Outcomes for Individuals with Impaired Verbal Communication

Sensory deficit is a defining characteristic of an individual with autism that is also impaired verbally (NIH). As a nurse when caring for individuals with impaired verbal communication some common goals and outcomes should be as follows learn ways to decrease anxiety based on the environment around individual and families, be sure they are able to formulate a complete thought in a goal-directed manner, and provide effective opportunities for them to spend time with one or two other individuals while completing a structured activity (Wayne, 2017). This will strengthen the individuals with the understanding on how to provide self-care.  However, in order to complete these goals for individuals that are autistic and have impaired verbal communication nurses have to be able to plan therapeutic nursing related interventions.

Interventions

The nurse should show willingness to learn what the individual needs and pay close attention to any nonverbal cues that are displayed. Autism affects the skill to speak, therefore, the need to set objects within a person’ reach is necessary. Allow time for the individual to respond because remembering that communication is a challenge for these individuals is a plus. The inability to communicate can be frustrating, encourage the individuals when they have done well and acknowledge their frustration.  Frustrations are not only formed for the individual with impaired verbal communication, but also for the individuals providing care.

Providing Care

According to

Journal of Autism and Developmental Disorders

, the development of expressive and receptive communication between a caregiver and a child begins in infancy. (Bottema-beutel, Yoder, Hochman, Watson, 2014). These manifestions persist into adolescence and adulthood (Vogan, Lake, Weiss, Robinson, Tint, 2014). This disorder is identified in “childhood”, but persist into adolescence and adulthood, according to

Family Relations

(Vogan, et al, 2014). The enormous amount of time and energy needed to attend to individuals with ASD that have impaired verbal communication generates high levels of caregiver role strain (Vogan, et al, 2014). Leading to frustrations and confusion for everyone involved in providing care. Finding time for “self” will help with challenges that may arise and provides a safe, inclusive environment for individuals with impaired verbal communication. The nurse should be sure to educate the families about ways to integrate family time and the willingness to set aside “special” time for each person.

Conclusion

Nurses should advocate for inclusion and suggest that individuals be placed in general education settings to reduce isolation (Camargo, Höher, Ganz, Hong, Davis, et al 2014). Find ways to make those with impaired verbal communication feel included in their care and experience. There are variety of ways to provide care for individuals with impaired verbal communications such as speaking with an occupational or speech therapist, knowing what to do about being burnout as a caregiver, and effective ways to communicate.

References

• Weill, V.A., Zavodny, S., Sounders, M. C. (2018). Autism spectrum disorder in primary care.
  
  The Nurse Practitioner,
  
  43(2), 21-28. 10.1097/01.NPR.0000529670.62188.1a
• Bottema-beutel, Kristen; Yoder, Paul J; Hocman, Julia M; Watson, Linda R. (2014). The role of supported joint engagement and parent utterances in language and social communication development in children with autism.
  
  Journal of Autism and Developmental Disorders,
  
  44(9), 2162-74. 10.1007/s10803-014-2092-z
• Vogan, V., Lake, J. K., Weiss, J.A., Robinson, S., Tint, A. et al. (2014). Factors associated with caregiver burden among parents of individuals with ASD: Differences across intellectual functioning.
  
  Family Relations,
  
  63(4), 554-567. 10.1111/fare.12081
• https://searchproquestcom.db23.linccweb.org/nahs/docview/1617952397/7B9354369BB14F42PQ/4?accountid=45774
• Camargo, S. P., Höher, R.M., Ganz, J., Hong, E. R., Davis, H., et al. A review of behaviorally-based intervention Research to improve social interaction skills of children with asd in inclusive settings.
  
  Journal of Autism and Developmental Disorders,
  
  44(9), 2096-116. 10.1007/s10803-014-2060-7
• https://searchproquestcom.db23.linccweb.org/nahs/docview/1552795647/CCCEBB4F1EDD42E0PQ/4?accountid=45774

References

• CDC. Autism Spectrum Disorders- Signs & Symptoms (2019).
• https://www.cdc.gov/ncbddd/autism/signs.html
• Wayne, G. Impaired Verbal Communications: Nurselabs. (2017).
• https://nurseslabs.com/impaired-verbal-communication/
• U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. National Institutes of Health. NIH Publication. No. 19-MH-8084. (2018).
• https://www.nih.gov/news-events/news-releases/baby-teeth-link-autism-heavy-metals-nih-study-suggests

• Autism and Your Family

Accountable Care Organization

Accountable Care Organizations (ACO) improves quality and patient care outcomes whilst reducing the total cost of healthcare (Panning, 2014).  ACOs consist of three programs that assist in obtaining better value for the health care system and for the patient by involving coordination, transition, and patient involvement.  What this means for health care providers such as nurses is providing high quality patient-centered care, and reducing costs at the same time through playing the role of care coordinators, communicators, and quality improvement managers.  This brings on more challenges for nurses, and can affect patients as well.  This paper will examine how health care providers are affected by Accountable Care Organizations, how it affects the patients, the challenges nurses will face, and the role of health care workers changing due to these challenges.

Accountable Care Organization Impact on Healthcare Providers

Accountable Care Organizations (ACO) are a component of the Patient Protection and Affordable Care Act (ACA) created to improve quality and patient care outcomes whilst reducing the total cost of healthcare (Panning, 2014).  The concept is based on the idea that well-coordinated care can help transition patients from acute care to preventative care, provide wellness, and better quality of care while also decreasing duplicate services to reduce medical errors and patient adverse outcomes (Nursing Alliance for Quality Care, n.d.; Panning, 2014; Summers, De Lisle, Ness, Birchfield Kennedy, & Muhlestein, 2015).  ACOs are groups of physicians, hospitals, and other health care providers working together to take responsibility for improving patient quality of care (Summers et al., 2015).  They are patient-centered, and demonstrate improvement in obtaining better value for the health care system and for the patient by involving coordination, transition, and patient involvement (Panning, 2014).  Physicians and providers within ACO coordinate care through the use of Health Information Technology (HIT), effective communication, and care coordination staff to ensure patients get the right care at the right time in the right place (Summers et al., 2015).  The data generated from use of health information technology can indicate improved health care delivery and outcomes (Panning, 2014).  To achieve savings and earn incentives, Panning (2014) states ACOs have to meet quality standards in patient caregiver experience, care coordination, patient safety, and preventative health and elderly health, or at risk populations.  Reimbursement will be issued in a form of a bundled payment from a fee-for-service (Panning, 2014).

ACOs offer three programs; the first ACO program is the Medicare Shared Savings Program, which is expected to “improve beneficiary outcomes and increase the value of care by promoting accountability for care, requiring care coordination across the continuum and requiring investment in infrastructure and improved care processes” (Panning, 2014, p. 113).  The second ACO program is the Advance Payment Model designed for physicians and providers to coordinate high quality care for Medicaid patients (Panning, 2014).  The Advanced Payment Model works by giving upfront monthly payments to selected patients to use towards their care (Panning, 2014).  The third ACO program is the Pioneer ACO Model designed for health care organizations that already have experience coordinating care for patients, and collaborate with private payers to improve quality and patient health outcomes across ACOs while saving costs (Panning, 2014).

How Nurses are Impacted

The role of nurses in Accountable Care Organizations is similar to that of physicians and other health care providers; to provide high quality patient-centered care, and reduce costs at the same time (NAQC, n.d.).  How nurses are impacted and play the part in ACOs are by serving as care coordinators, communicators, and quality improvement managers.  As care coordinators, nurses are required to organize care from physicians, pharmacists, specialists, and other sources to ensure delivery of high quality care to patients (NAQC, n.d.).  Nurses also play the role of communicators as ACOs rely on them to communicate and translate choices of care plans and treatment plans to patients and families because of their skills in health education and communicating information (NAQC, n.d.).  Because nurses are already experts in interacting with patients and families regarding diagnoses, medications, and discharge care instructions, ACOs utilize nurses for these skills (NAQC, n.d.).  As quality improvement managers in ACOs, nurses analyze data gathered from the National Database of Nursing Quality Indicators (NDNQI) to measure nurse care processes and outcomes, and use this data to improve delivery of quality of care (NAQC, n.d.).

Challenges and How the Role of Healthcare Worker Changing

Although nurses play many roles in Accountable Care Organizations, if they practice as advanced practiced registered nurses (APRNs) such as nurse practitioners, certified nurse midwives, and certified clinical nurse specialists, the statute limits patients in Medicare ACOs to seek treatment with primary care physicians only, not APRNs (NAQC, n.d.).  This policy obstacle also prevents nurse practitioners’ patients from being assigned to ACOs, and prevents patients from being counted as beneficiaries if they choose nurse practitioners as primary care providers (NAQC, n.d.).  Another challenge nurses face is the roles nurses are normally assigned might be changed to individuals with less experience and knowledge, which can impede patient care and its purpose of ACOs providing high quality patient care (NAQC, n.d.).

As a result of these challenges, the role of health care workers is changing.  Not only do nurses treat patients at bedside, serve the role of educators, advocate for patients, and collaborate with other multidisciplinary team members to provide quality care, but these challenges are pushing nurses to advance their practice and obtain higher education in order to play some of the roles ACOs contain.  Advanced education and higher practice may indicate added responsibilities for new roles.  Nurses will also have to be knowledgeable about quality assurance, illness prevention, health promotion, and disease management to educate patients, and understand data management from data entry into electronic medical records (EMRs) (Bagwell, Bushy, & Ortiz, 2017).  Because of these challenges, nurses may also need to serve on ACO governance boards to provide insight, develop, and implement policies that impact the community they serve (Bagwell et al., 2017).

Accountable Care Organizations and How it Affects Patients

Accountable Care Organizations impact consumers, who are the patients in ACOs, by rewarding hospitals and physicians for keeping patients healthy rather than being rewarded based on procedures and tests performed (Summers et al., 2015).  Patients can now use health information technology to access their medical information documented in the ACO’s electronic health records.  These patient portals allow patients to check on test results, access educational material, contact their physician, and update patient information (Summers et al., 2015).  ACOs also allow family and patients to be a part of the care team.  Patient and family engagement can provide better health outcomes, improve patient safety and quality care, and help control health care costs (Summers et al., 2015).  ACOs do impact patients, but in a positive way as it aims to focus care around the patient by assisting them in tracking their own health, coordinating care to respective physicians to reduce multiple tests and procedures, and involve them in planning their own care so that they are their own nurses at home.

Conclusion

Accountable Care Organizations (ACO) was created to improve quality and patient care outcomes whilst reducing the total cost of healthcare.  ACOs consist of three programs that assist in obtaining better value for the health care system and for the patient by involving coordination, transition, and patient involvement.  Though the idea is to help patients in the long run, nurses and health care providers are impacted as well by serving as care coordinators, communicators, and quality improvement managers; they coordinate care from physicians, pharmacists, specialists, and other sources to ensure delivery of high quality care to patients, communicate and translate choices of care plans and treatment plans to patients and families because of their skills in health education and communicating information, and analyze data gathered from the National Database of Nursing Quality Indicators (NDNQI) to measure nurse care processes and outcomes, and use this data to improve delivery of quality of care.  The impact on patients is positive as patients can now use health information technology to access their medical information documented in the ACO’s electronic health records to view results, lab work, and update personal information.

References

• Bagwell, M. T., Bushy, A., & Ortiz, J. (2017). Accountable care organization implementation experiences and rural participation: Considerations for nurses.
  
  The Journal of Nursing Administration
  
  ,
  
  47
  
  (1), 30–34. Retrieved from doi:10.1097/NNA.0000000000000433
• Nursing Alliance for Quality Care. (n.d.).
  
  The role of nurses in accountable care organizations
  
  [PDF file]. Retrieved from
  
  http://www.naqc.org/Main/Resources/NursesRole-AccountableCareOrg.pdf
  
• Panning, R. (2014). Accountable care organizations: An integrated model of patient care objectives.
  
  
  
  Clinical Laboratory Science,
  
  
  
  
  27
  
  (2), 112-8. Retrieved from
  
  https://search.proquest.com/docview/1530677910?accountid=34574
  
• Summers, L., De Lisle, K., Ness, D. L., Birchfield Kennedy, L., & Muhlestein, D. (2015). How accountable care impacts the way consumers receive care [PDF file]. Retrieved from
  
  http://www.nationalpartnership.org/our-work/resources/health-care/impact-accountable-care.pdf
  

Take Home Midterm

1.) One example of a mechanical barrier against infection would be the surface layer of our skin. The surface layer of human skin is acidic and very dry, thus making it difficult for pathogens to survive. In addition to this, the surface layer of human skin consists of dead epithelial cells, under which many viruses have difficulty replicating. Moreover, dead epithelial skin cells are frequently being replaced, and thus pathogens that are present on the skin often do not have a chance to cause infection. Therefore, the surface layer of human skin is a very important mechanical barrier against infections.

Sometimes they are circumstances under which the surface layer of our skin can be compromised, thus resulting in infection. Several breaches to the surface layer such as through bites, burns, cuts, or trauma can allow for bacteria to enter into the tissue, thus resulting in infection. One such example of an infection that can result from a breach of the skin is Rocky Mountain spotted fever. Rocky Mountain spotted fever is transmitted from a bite from an infected tick. Rocky Mountain spotted fever is caused from the bacterial organism Rickettsia rickettsii and may cause fever, nausea, abdominal pain, and joint pain. In addition to this, burns to the surface layer of the skin can destroy the protective layer and thus allow for many types of bacteria such as staphylococci to colonize and infect the individual. Thus, the surface layer of our skin is an extremely important mechanical barrier against infection and protects us from surface and environmental pathogens.

Church, Diedre, Owen Reid, and Brent Winston. “Burn Wound Infections.” Clinical

Microbiology Reviews 2nd ser. 19 (2006): 403-34. PubMed Central. Web. 31 Mar. 2010.





.

United States. Centers for Disease Control and Prevention. Division of Viral and

Rickettsial Diseases. CDC, 1 Apr. 2008. Web. 31 Mar. 2010.

.

2.) In recent years, globalization has lead to many issues associated with food borne illnesses. Some of the factors related to this issue are an increase in the amount of food that is traded between countries, international travel and migration of individuals from different countries, and economic and technological advances that have changed the types of foods that individuals eat. In addition to this, the ways in which foods are prepared are changing, and the introduction of new foods to new regions are some of the factors affecting food borne illnesses. Furthermore, dietary habits of individuals are beginning to shift to a healthier diet and more and more individuals are starting to eat more organic and fresh food. To be able to meet these demands, the United States and other countries have to import certain foods on a seasonal basis. For example, according to the CDC, more than 75% of the fresh fruits and vegetables that are available in U.S. markets and restaurants are imported. It has been estimated that the increased demand for fruits and vegetables has nearly doubled the rates of food borne illnesses. Therefore, individuals are at a greater risk to acquire a food borne illness from contaminated food that is imported from other countries.

Currently, one of the largest consequences of globalization and international trading is that when food becomes contaminated it can spread all over the world. In year’s past, food borne illnesses were thought to be local events and it was easier to ascertain the cause of the illness. However, this is no longer the case and takes much longer now that globalization has occurred. One example of a food borne illness that spread to different countries was an outbreak of shigellosis in eight restaurants caused by a common strain of Shigella sonnei that occurred in the United States and Canada between July and August in 1998. It was determined that the illness was associated from the ingestion of parsley. In each case the parsley was found to have been chopped and left at room temperature for several hours before being used. In addition to this, in 6 of the outbreaks it was found that the parsley was traced to a specific farm in Baja California, Mexico. Thus, it was likely that the parsley had been contaminated before shipment. Therefore, as seen from these examples, globalization has had a major impact on food borne illnesses and with changes in dietary habits, the increase in international travel and migration, and an increase in imported foods have been some of the main reasons associated with food borne illnesses relating to globalization.

Angier. “A World in Motion: The Global Movement of People, Products, Pathogens, and

Power.” The National Academies Press. 2001. Web. 31 Mar. 2010.

United States. Centers for Disease Control and Prevention. National Center for Infectious

Diseases. Foodborne Disease Control: A Transnational Challenge. By D. W. Betthcer. 4th ed. Vol. 3. Atlanta: CDC, 2010. National Center for Infectious Diseases. Web. 31 Mar. 2010.



.

United States. World Health Organization. Food Safety and Foodborne Illness. Web. 31

Mar. 2010.





.

3). According to Dr. Nelson El-Amin’s lecture, vaccinations have had a large impact on infectious disease rates. One such disease that has seen a dramatic decrease in the number of individuals affected is Tetanus. According to the lecture, the number of individuals that had Tetanus in 1947 was about 560-570. Since vaccination for Tetanus has occurred in the United States, there has been a steady downward decrease in the number of individuals affected. In 2002, the number of individuals affected with Tetanus was about 10-20. In addition to this, another disease that has significantly decreased due to vaccination is the rates of individuals affected with Diphtheria. According to the lecture, in 1940, the number of individuals affected with Diphtheria was about 16,000. Since vaccination for Diphtheria, the rates of those infected have significantly decreased. In 2000, the rate for those infected with Diphtheria was almost non-existent. And finally, another example that was presented in Dr. El-Amin’s lecture was disease rates for Polio. At one time, Polio was the most feared disease in United States and caused either paralysis or death. Before there was a vaccination for Polio, Polio affected more than 20,000 individuals per year. In 1955, the first Polio vaccination was licensed and had a significant impact on the rates of those affected with Polio. Today, there aren’t any reported cases of Polio in the United States. Thus, as seen from the examples presented in Dr. El-Amin’s lecture, vaccinations have had a significant impact in reducing the disease rates for many infectious diseases, and in some cases, such as Polio, vaccinations have just about completely eliminated Polio in the United States.

El Amin, Alvin N. “The Changing Epidemiology of Vaccine Preventable Diseases.”

PM 527 Infectious Disease Epidemiology Class. Los Angeles. 11 Mar. 2010. Lecture.

4). In 1879, Robert Koch discovered the anthrax bacterium and developed the Koch’s postulates for causation. There are 4 postulates that Koch believed must be satisfied in order to establish causation. The postulates state: the bacteria must be present in every case of the disease, the bacteria must be isolated from the host with the disease and grown in pure culture, the specific disease must be reproduced when a pure culture of the bacteria is inoculated into a healthy susceptible host, and that the bacteria must be recoverable from the experimentally infected host. One such example of an infectious disease that satisfies the Koch’s postulates is Anthrax. Anthrax was the first infectious disease that was discovered by Koch, and it was this disease that gave birth to his 4 postulates.

On the contrary, there are exceptions of certain infectious diseases that do not satisfy all of the Koch’s postulates. There are many infectious diseases in which infected carriers do not show the signs or symptoms of having the disease. These individuals are thus asymptomatic. One example of this is from the Bartonella species of bacteria. Certain species that are infected with Bartonella do not show any signs of symptoms, whereas other infected species do. Therefore, in cases where the infected individual does not show any signs or symptoms, all the Koch’s postulates are not satisfied. In addition to this, certain infectious diseases cannot be grown in pure culture, but rather can only reproduce in living cells. Thus, in cases such as these, the Koch’s postulates are also not satisfied. Other examples of infectious diseases that do not satisfy all of the Koch’s postulates are cholera, typhoid fever, and herpes simplex.

Jacomo, V., and P. J. Kelly. “Natural History of Bartonella Infections (an Exception to

Koch’s Postulate).” Clinical and Diagnostic Laboratory Immunology 9.1 (2002): 8-18. American Society of Microbiology. Web. 31 Mar. 2010.



.

5). According to Dr. Nelson El-Amin’s lecture, there are a few reasons why diseases such as measles and polio have not been completely eradicated even though there are vaccines to prevent these diseases. One of the reasons presented in the lecture for this is due to the fact that some individuals do not receive the vaccination against these diseases out of fear. There are cases of individuals that do not receive measles vaccinations due to concerns that vaccinations have caused certain ailments such as autism. This is evident from a cohort study conducted on unvaccinated children that have not received proper vaccination due to concerns of safety. However, according to the lecture, there is no scientific fact to support the beliefs that autism is associated with the MMR vaccinations. Another reason why certain groups of individuals do not receive vaccinations is because it goes against their religious beliefs and they believe that they do not need to receive a vaccination in order to be protected against diseases.

Some of the characteristics for individuals that have not received proper vaccination are individuals that are young, individuals that do not know their vaccination status, and individuals that have migrated from other countries. According to the lecture, in cases in which individuals have not received vaccination, 76% of those individuals are less than 20 years old. In addition to this, 91% of unvaccinated individuals do not know their vaccination status. And furthermore, 89% of unvaccinated individuals are people that have migrated from other countries. Therefore, the evidence shows that the reasons why certain diseases such as polio and measles have not been completely eradicated are due to the fact that not everybody has received proper vaccination. This is either due from individuals refusing to receive vaccination out of fear or some other belief, certain individuals do not know that they have not received proper vaccination, or certain individuals have migrated from other countries and have not received all their vaccinations.

El Amin, Alvin N. “The Changing Epidemiology of Vaccine Preventable Diseases.”

PM 527 Infectious Disease Epidemiology Class. Los Angeles. 11 Mar. 2010. Lecture.

6). According to Dr. Wohl’s lecture on HIV/AIDS, the distribution of AIDS diagnoses has changed amongst the different race/ethnic groups since the beginning of the AIDS epidemic. For example, in 1985, about 60% of the total AIDS cases were amongst Caucasians, about 27% were amongst Black/African Americans, about 16% were amongst Hispanic/Latinos, about 1% were amongst Asians, and less than 1% were amongst American Indian/Alaska Native and Native Hawaiian/other Pacific Islander. As of 2007, these rates have changed amongst the different race/ethnic groups. For example, for Caucasians the rates have decreased to about 28% of the total AIDS cases. On the contrary, rates for Black/African Americans have increased to about 48% of the total AIDS cases. In addition to this, rates for Hispanic/Latinos have also increased to about 21% of the total AIDS cases. For Asians, the rates have remained constant at around 1% of the total cases, and the rates amongst American Indian/Alaska Native and Native Hawaiian/other Pacific Islander have also remained constant at around less than 1% of the total AIDS cases.

According to the lecture, SHAS examined time intervals between when a person first learned that they had HIV and when they were diagnosed with AIDS. As indicated by the findings, detection rates varied significantly between different racial/ethnic groups. The results showed that Caucasians were more likely than Black/African American or Hispanic/Latinos to have their HIV infection to be detected early (more than 5 years) before their onset of AIDS. Thus, many more Caucasians were more likely to fall into the “early detection” group in comparison to other racial groups. In contrast to this, Hispanic/Latinos were much more likely than any other racial group to have their HIV infection detected very late (within a year) in their progress to AIDS diagnosis. Thus, Hispanic/Latinos were more likely to fall into the “very late detection” group in comparison to other racial groups. Black/African Americans were also very likely to have their HIV infections detected very late prior to coming down with an AIDS diagnosis, however, the rates of Black/African Americans in the “very late detection” group was lower than that of Hispanic/Latinos. The rates between racial/ethnic groups for individuals that had their HIV infection detected between 13 and 60 months prior to AIDS diagnosis (“late detection) was relatively equal between all of the racial/ethnic groups. In addition to these finding, according to the lecture, it was shown that in Los Angeles, individuals that were more likely to be late testers were found to be women, Black/African Americans, foreign born Latinos, U.S. born Latinos, those exposed to HIV via heterosexual contact, young individuals, and less educated individuals.

There are many implications associated with late detection of HIV. Individuals infected with HIV that are diagnosed later in life, are not able to receive proper antiretroviral therapy. And thus, those individuals are more likely to suffer from adverse effects in comparison to individuals that are diagnosed earlier in life who are able to receive the proper medication to help slow down their onset of AIDS. In addition to this, individuals that are detected of having HIV later in life are more likely to affect other individuals, thus spreading HIV to other unknowing individuals and further exacerbating the issue. Therefore, as shown from the lecture, there are many negative implications of late detection, and it has also been shown that the distribution of AIDS has changed significantly amongst racial/ethnic groups since the beginning of the AIDS epidemic.

Wohl, Amy R. “HIV and AIDS: Worldwide, the U.S. and Los Angeles County.” PM 527

Infectious Disease Epidemiology Class. Los Angeles. 18 Feb. 2010. Lecture.

Works Cited

Angier. “A World in Motion: The Global Movement of People, Products, Pathogens, and Power.” The National Academies Press. 2001. Web. 31 Mar. 2010.

Church, Diedre, Owen Reid, and Brent Winston. “Burn Wound Infections.” Clinical Microbiology Reviews 2nd ser. 19 (2006): 403-34. PubMed Central. Web. 31 Mar. 2010.





.

El Amin, Alvin N. “The Changing Epidemiology of Vaccine Preventable Diseases.” Infectious Disease Epidemiology Class. Los Angeles. 11 Mar. 2010. Lecture.

Jacomo, V., and P. J. Kelly. “Natural History of Bartonella Infections (an Exception to Koch?s Postulate).” Clinical and Diagnostic Laboratory Immunology 9.1 (2002): 8-18. American Society of Microbiology. Web. 31 Mar. 2010.



.

United States. Centers for Disease Control and Prevention. Division of Viral and Rickettsial Diseases. CDC, 1 Apr. 2008. Web. 31 Mar. 2010.



.

United States. Centers for Disease Control and Prevention. National Center for Infectious Diseases. Foodborne Disease Control: A Transnational Challenge. By D. W. Betthcer. 4th ed. Vol. 3. Atlanta: CDC, 2010. National Center for Infectious Diseases. Web. 31 Mar. 2010.



.

United States. World Health Organization. Food Safety and Foodborne Illness. Web. 31 Mar. 2010.





.

Wohl, Amy R. “HIV and AIDS: Worldwide, the U.S. and Los Angeles County.” PM 527 Infectious Disease Epidemiology Class. Los Angeles. 18 Feb. 2010. Lecture.