Nursing in the Community: Correctional Nursing

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Jail House Nurse: Correctional Nursing

National statistic show that violent crime decreased from 2011 to 2015, down to about 5 million. Yes, 5 million, this is still staggering and heart-breaking fact or life in America. These crimes include robbery, assault, rape, and murder. A forensic nurse may work in many different environments including nursing homes, home health settings, hospital ERs and correctional settings. As such a subset of forensic nursing is the correctional nurse. Correctional nursing provide care to inmates be they teens, men, or women. More often than not, these people have mental health problems that have not been addressed. Correctional nurses working in a juvenile detention centers and prisons. Correctional nurse is underestimated a lot of the time, but they are highly skilled, and they must be vigilant and always have an exit plan in a high-risk work environment. Regardless of reason a person is in the correctional system they have the same rights to available healthcare and safety as any free person.


Community Setting

Correctional nursing takes a distinct type of nurse, working in a jail requires continued awareness for safety of their self and the inmates. This includes safeguarding equipment and supplies, as they are turned into crude weapons and drugs to be sold on the jail underground marketplace. Correctional nurses work in juvenile confinement facilities, jails and prisons serving adolescents, men, and women. Adolescents are at the highest risk with many being tried as adults, leading to high suicide rates. It is essential that inmates are screened when entering the any correctional place in order to note any and all communicable/chronic diseases. Screening for diseases such as hepatitis, HIV, & TB are a priority because there are higher rates of infections because overcrowding and high turnover of inmates. (Nies & McEwen, 2019) During these screenings many chronic conditions are being treated for the first time in these peoples lives.


Health Promotion Nursing Intervention

The nurse in a correctional setting is in a critical position to advocate for the inmates as they often see the inmate more than other healthcare professional. Even if they are not major swiping changes nurses have the chance to bring positive change to each inmate. For most inmates it is during the health assessment that they are diagnosed and received information about their health risks and preventative care for the first time.

Nurses assess risky behavior, promote healthy behaviors, and teach clients in all settings and is still true in a correctional setting. The provisioning of harm reduction continues to be extremely limited in prison settings, where large portions of the population are people who use and inject drugs. “Numerous studies have found that harm reduction can be safely and effectively implemented in prison settings with evidence of reduced drug injection, needle and syringe sharing, HIV and HCV transmission, and risk of overdose among other positive outcomes.” (Sander, Shirley-Beavan, & Stone, 2019) The delivery of quality and accessible harm reduction should not a just a policy option but a legal human right and a serious public health measure.

Ever states Department of Corrections, D.O.C., have programs that provide alcohol and drug counseling, education and informational classes, volunteers from churches conducting bible studies and services, literacy classes, and even short-term housing and employment programs for after incarceration.


Professional Nursing Organization

National Commission on Correctional Health Care is one of the very few organizations devoted exclusively to the improvement health care in jails, prisons, and juvenile confinement facilities. Many recognized national organizations, like the American Academy of Pediatrics, American Bar Association, American Medical Association, and Academy of Correctional Health Professionals, all support the NCCHC.

The NCCHC was founded in the 1970’s after the American Medical Association specified that the many jails had inadequate, disorganized health services, and a lack of national standard of care (NCCHC, 2019). It supports correctional facilities in developing policies and procedures for managing chronic pain and violence prevention. The NCCHC provides continuing education for nurses, social workers, and physicians, and certifications. One of the best things they have done is that NCCHC and the National Sheriffs’ Association have released a Medication-Assisted Treatment guide to providing evidence-based treatment for inmates with opioid abuse issues.


Summary

As a subset of forensic nursing, correctional nurses served are adolescents, men, women, and often with mental health issues, whom are in jail, prison, or detention centers. They must always be on guard with inmates. Keeping medical supplies and equipment secured at all times is a priority. Misplaced trust or loss of supplies can greatly impact safety of the nurse, inmates and faculty. Every inmate receives a health screening at intake, frequently revealing underlying chronic or communicable diseases. No matter the crimes an inmate has committed, the nurse must always maintain unprejudiced, respectful, and provide care and compassion.


References

  • National Commission on Correctional Health Care, NCCHC. (2019). Retrieved from https://www.ncchc.org/
  • Nies, M. A., & McEwen, M. (2019). Community/Public health nursing: Promoting the health of populations (7th ed.). St. Louis, MO: Saunders/Elsevier.
  • Sander, G., Shirley-Beavan, S., & Stone, K. (2019). The Global State of Harm Reduction in Prisons. Journal of Correctional Health Care,25(2), 105-120. doi:10.1177/1078345819837909

Determine two (2) current needs and two (2) current uses of long-term care services.

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Determine two (2) current needs and two (2) current uses of long-term care services.

 

Needs and Uses of Long-Term Care
1. Determine two (2) current needs and two (2) current uses of long-term care services.
2. Determine the main way(s) the overall needs and uses of long-term care services have evolved over the past fifty (50) years.
3. Predict the main way(s) the overall needs and uses of long-term care services will continue to evolve over the next ten (10) years.
4. Give your opinion as to whether or not people in their 40s and 50s should purchase long-term care insurance
5. Examine the critical role of commercial insurance companies in the financing of long-term services. Take a position as to whether or not insurance companies’ variations in the cost of premiums are justifiable. If justifiable, give at least one (1) justification for these variations. Provide a rationale for your response
6. Take a position as to whether or not nursing homes should have the authority to restrain a resident.
7. Determine who should be held liable if the resident sustains injuries while being restrained. Provide a rationale for your response.
8. Describe the fiscal impact of the growth and aging of the population on long-term care services, and take a position as to whether or not the federal government should continue to provide subsidies to offset the cost to families utilizing long-term care services. Provide support for your response.
Each question must be answered individually, not in essay format. 2-3 paragraphs only including two quality resources

A Critical Analysis of Rebound Tenderness in the Diagnosis of Appendictis

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Abdominal pain is a common presentation within the accident and emergency department [A+E] and specialist nurses working in this environment need to be familiar and confident in dealing with this presentation (Hibberts and Bushell 2007, Pines, Pines, Hall, Hunter, Srinivasan and Ghaemmaghami 2005). Abdominal pain can be associated with a wide variety of surgical and nonsurgical conditions, with the most prevalent cause being acute appendicitis (Lin, Chen, Chung, Ho, and Lin, 2009). The diagnosis of appendicitis is formulated from subjective and objective data including a patient’s history, abdominal examination, laboratory investigations and signs and symptoms. This assignment will critically analyse the clinical skill of testing for rebound tenderness and its relevance to diagnosing appendicitis in children.

The clinical diagnosis of acute appendicitis in children is difficult for many practitioners (Broek, Ende, Bijnen, Breslau and Alkmaar, 2004). Between the years 2008 and 2009 the number of patients presenting to A+E within the UK who were diagnosed with appendicitis was 44,244 (NHS Information Centre, 2009). This equates to almost 0.3% of all presentations in A+E over one year. Approximately 9,300 of this population were between the ages of 0 and 14 years old (NHS Information Centre, 2009). However up to 25% of these 9,300 children with suspected appendicitis have a normal appendix at operation (Smink, Finkelstein, Garcia-Pena, Shannon, Taylor, and Fishman, 2004). Furthermore, the 25% of paediatric negative appendectomies now result in considerable clinical and economic costs to the NHS (Koepsell, 2002). These substantial figures are one of the primary reasons for specifying this assignment on children. In addition, the scope of practice within A+E covers paediatrics for many adult qualified nurses and adult trained nurse practitioners. It is therefore imperative that the knowledge base for all A+E staff encompasses paediatrics at an advanced level as well (Cleaver, 2003).

The overall accuracy for the clinical examination in diagnosing acute appendicitis has been reported to be between 54% and 70% in children (Birkhahn, Briggs, Datillo, Van Deusen and Gaeta, 2006). In addition Whisker, Luke, Hendrickse, Bowley and Lander (2009) suggest that only 4% of children have a miss-diagnosis of appendicitis in specialist paediatric centres, compared to 20% in district general hospitals. Despite the uncertainty of the diagnosis and the cost of miss-diagnosis to the NHS, appendicitis requires urgent treatment (Williams, et al., 2009). This is due to the risk of perforation, which occurs in approximately one third of cases in children (Neilson, et al., 1990). Therefore the need for a good clinical assessment at first contact in A+E is needed to provide a correct management plan and reduce on costs for the NHS.

An abdominal examination should be performed where possible in a warm, well lit room with the patient well-draped and relaxed (Bickley, 2009). Initially the practitioner should undertake inspection, auscultation and percussion of the whole nine sections of the abdomen (Lippincott Williams and Wilkins, 2008). The final aspect of the abdominal examination should be palpation as this has the potential to be the most painful (Allan, 2008). Palpation is a process which should always be commenced away from the site of pain, as this will allow the patient to gain some reassurance from the practitioner and help them to relax (Bickley, 2009, Hibberts and Bushell, 2007). The practitioner should utilise the palmer surfaces of the fingers to identify any abnormal signs (Bickley, 2009).

More specific palpation techniques can help to diagnose appendicitis, such as rebound tenderness (Bickley, 2009). This is performed by pressing slowly and firmly to a specific area and then withdrawing them quickly (Bickley, 2009). Practitioners should observe the patient and ask if pain was worse on pressing or letting go (Hibberts and Bushell, 2007). However, Bickley (2009) suggests that if any of the previous examinations such as light or deep palpation are positive then this should not be undertaken as it will cause undue pain for the patient.

The whole process of abdominal examination in children follows the same system as in adults. However, the causes of abdominal pain in children are often different, encompassing a broad range of acute and chronic diseases (Bickley, 2009). Therefore it maybe pertinent to suggest that more emphasis should be placed special techniques such as checking for rebound tenderness rather than abdominal palpation and testing for rebound.

The initial discovery and accreditation of rebound tenderness (also known as Blumberg’s sign) is credited to a German surgeon called Jacob Moritz Blumberg (1873 – 1955). Many articles make reference to Blumberg’s sign; however there appears to be no relevant literature, research or evidence base to support this surgeon was the gentleman who discovered this sign (Mantzaris, Anastassopoulos, Adamopoulos and Gardikis, 2008).

A study undertaken by (Williams, et al., 2009) showed that out of 98 children who had acute appendicitis 91% had right lower quadrant tenderness on palpation however only 30% had rebound tenderness. Another study by Lin, Chen, Chung, Ho, and Lin (2009) also suggested that 43.4% of the 53 children examined with appendicitis had rebound tenderness. So both these studies suggest that positive rebound tenderness is an indication of an acute appendicitis in children and therefore cannot be ruled out of an initial differential diagnosis.

Golledge, Toms, Franklin, Scriven and Galland (1996) specifically evaluated the “cats eye symptom” (pain going over a bump in the road), the cough sign, right lower quadrant pain to percussion, rebound tenderness and guarding. The data from this evaluation suggested that rebound tenderness had a likelihood ratio of 7.4 compared to the other signs which had likelihood ratios of between 1.1 and 4.1. This data therefore suggests that rebound tenderness is a very useful sign in the diagnosis of acute appendicitis, but that the other signs and symptoms are not (Moyer, et al., 2001). Overall rebound tenderness is useful sign for diagnosing appendicitis when there is a high suspicion of appendicitis and is accompanied with other diagnostic indicators (Moyer, et al., 2001).

Another presentation to be considered in relation to abdominal pain and rebound tenderness is the duration of the pain experienced by the child. A study undertaken by O’shea, Bishop, Alario and Cooper (1988) involved 246 children from 13 to 18 years old who presented to the emergency department with a history of less than one week of abdominal pain. Results showed that the likelihood ratio of pain was greater when the child had the pain for more than 12 hours (Likelihood ratio: 1.3) compared to less than 12 hours (Likelihood ratio: 0.64). Later in the study pain duration was evaluated at less than 24 hours and more than 24 hours, with their likelihood ratios being 0.83 and 1.2 respectively. When compared to Andersson, et al. (1999) study of 502 patients aged 10 to 86 the greatest likelihood ratio was 1.7 at 7-12 hours after onset of pain. Based on both studies it is very difficult to see how duration of pain can lead to the diagnosis of appendicitis. Therefore, practitioners must not allow the duration of pain to prevent any further investigation into the diagnosis (Moyer, et al., 2001).

Another symptom which could possibly indicate the diagnosis of appendicitis is fever (Gwynn, 2001). Cardall, Glasser and Guss’s (2004) study evaluated two hundred and ninety three people aged between 7 and 75 who presented to the emergency department with suspected appendicitis. Temperatures were classed at greater than 99oF or less than 99oF. The study showed that 27% of patients who’s temperature was <99oF had a confirmed appendicitis compared to 37% of patients who had a temperature of >99oF. When the results were analysed in terms of specific temperature intervals, the highest likelihood ratio (3.18) was found in patients with temperatures greater than 102 °F. However, Bergeron’s (2006) study on clinical judgement suggests there is no clinical value with temperature as there is minimal sensitivity and specificity in the diagnosis of appendicitis. Therefore, as with duration of pain duration and levels of WBCC, temperature as a single entity has little diagnostic utility in the diagnosis of appendicitis unless it is combined with other signs and symptoms such as rebound tenderness (Cardall, Glasser and Guss, 2004).

For many years laboratory tests such as white blood cell count (WBCC) leukocytes and C-reactive protein (CRP) have been used to support a diagnosis, but the considerable overlap with other inflammatory conditions accounts for the low specificity and positive predictive value of these tests (Stefanutti, Ghirardo and Gamba, 2007). Recent studies on adult patients who present with clinical signs and symptoms indicating acute appendicitis, show that appendicitis can be excluded if both leukocyte count and C-reactive protein value are normal (Gronroos, 2001). However, Stefanutti, Ghirardo and Gamba, (2007) suggest that only a few studies have been reported in paediatric patients and the role of WBCC and CRP in excluding acute appendicitis in children has not been confirmed. According to Andersson et al. (1999) children who present with signs and symptoms of appendicitis such as rebound tenderness and have a WBCC of < 8000 are at a low risk for acute appendicitis. Andersson et al. (1999) also suggests that a WBCC of between 8000 – 15000 does not significantly change the estimate of risk and a WBCC of >15000 only moderately increases the estimated risk of appendicitis. This therefore shows that only at the extremes of the WBCC does this diagnostic indicator appear useful (Moyer, et al., 2001). Therefore, contrary to adult patients, normal leukocyte count, WBCC and CRP value cannot effectively exclude acute appendicitis in children.

Another usual predictor of appendicitis is vomiting (Bergeron, Richer, Gharib and Giard, 1999). The study by Andersson et al. (1999) calculated the likelihood ratio for appendicitis in a patient with vomiting compared to one with no vomiting to be 1.8. In addition Reynolds and Jaffe (1992) study suggests that a combination of four predictors including; vomiting right lower quadrant pain, abdominal tenderness, and abdominal guarding. More specifically 97% of the 377 children studied who were diagnosed with appendicitis had two or more of these predictors. Therefore, a patient who presents to A+E with less than two of the above predictors is quite unlikely to have appendicitis.

Alvarado (1986) conducted a retrospective study of 305 patients hospitalised with abdominal pain suggestive of acute appendicitis. Signs, symptoms, and laboratory findings were analysed for specificity, sensitivity, predictive value, and joint probability. Their importance, according to their diagnostic weight, was determined as follows: localized tenderness in the right lower quadrant, leukocytosis, migration of pain, shift to the left, temperature elevation, nausea-vomiting, anorexia-acetone, and direct rebound pain (Alvarado, 1986). This scoring system shown below is deemed by many surgeons as an easy aid for supporting the diagnosis of acute appendicitis (Khan and Rehman, 2005).

A study undertaken by Baidya, Rodrigues, Rao and Khan (2007) investigated the diagnostic accuracy of Alvarado scoring system. The results showed that a score of >7 for an appendicitis was 88.2% correct in diagnosis. However, the diagnostic accuracy of an Alvarado score < 6 is only 16%. Khan and Rehman (2005) also studied the accuracy of the Alvarado scoring system and found that only 10 patients out of 64 had negative appendectomies. Khan and Rehman’s (2005) positive predictive for their our study was (83.5%) and is comparable with other literature which reports 87.5%, 85.3%, 87.4% and 85.7% (Rehman and Burki 2003,. Kalan, Talbot, Cunliffe and Rich 1994., Malik, Khan and Waheed 2000., Owe, Williams, Stiff, Jenkinson and Rees 1992). These studies show that clinical scoring systems such as the Alvarado scoring system can be a cheap and quick tool to apply in emergency departments to rationalise acute appendicitis as one of the differential diagnosis (Khan and Rehman, 2005). Its application improves diagnostic accuracy and consequently reduces negative exploration and complication rates (e.g. perforation).

Despite recent advances in knowledge and diagnostic investigations, a population-based analysis in the United States found that the incidence of unnecessary appendectomy has not changed (Flum, Morris and Koepsell, 2001). Therefore to increase diagnostic accuracy, new modalities such as ultrasound scans have been introduced (Broek, Ende, Bijnen, Breslau and Alkmaar, 2004). Kaneko and Tsuda (2004) conducted a 10-year study using ultrasound scans to diagnose appendicitis in children and are convinced that ultrasound scans can identify inflamed appendices with 100% sensitivity and can also determine the severity as well. However Smink, Finkelstein, Garcia-Pena, Shannon, Taylor and Fishman (2004) suggest that the use of ultrasound has not decreased negative appendectomies as similar negative rates were present over a decade ago. Therefore on the basis of the available evidence, patients presenting to A+E with a strong clinical case of appendicitis should be referred direct to the surgeon without an ultrasound.

In addition to the use of ultrasound scanning the use of computed tomography (CT) has been recently studied and evaluated. There are currently two perspectives in the literature regarding the use of CT scan for the diagnosis of acute appendicitis: one supporting its routine use due to the decreased incidence of negative appendectomies, and the other one against its routine use due to the increased cost and delay in surgical management (Ceydel, Lavotshkin, Yu and Wise, 2006). In addition the benefits of imaging eliminating inpatient observation and unnecessary surgery must be weighed against the malignancy risk from radiation, as well as discomfort of rectal contrast administration (Smink, Finkelstein, Garcia-Pena, Shannon, Taylor and Fishman, 2004). Ceydel, Lavotshkin, Yu and Wise’s (2006) retrospective study showed that the negative appendectomy rate was much less in patients who had CT scans (7.6%) compared to the non CT scan group (24%). Therefore clinicians within A+E use their clinical judgement and place emphasis on the importance of routine history and an accurate physical examination utilising CT scans for atypical cases of acute appendicitis (Gwynn, 2001).

Currently within the A+E department there is no specific pathway or tool for ruling in acute appendicitis in paediatrics. In addition Birkhahn, Briggs, Datillo, Van Deusen and Gaeta (2006) suggest that no major medical association or professional organisation currently endorses a standardised pathway for the evaluation of patients with suspected appendicitis. With up to 25 % of children having negative appendectomies it is therefore of clinical and financial value to consider the use of a scoring system to admit or discharge children who present with a possible acute appendicitis. Current systems are in place for other potential conditions such as myocardial infarctions, pancreatitis and pneumonia. These other systems have been audited locally and nationally and are currently working well within the trust, therefore the plans to introduce the Alvarado scoring system will be put forward in the next review of clinical practice meeting between nursing and medical staff.

To conclude, this assignment demonstrates that for an emergency department practitioner in a fast paced A+E setting, the accurate diagnosis of acute appendicitis remains a challenge for the paediatric age group. An accurate history and physical examination, which as highlighted can be challenge in younger patients plays an important role in the diagnosis of early acute appendicitis (Mallick, 2008). Physical clinical signs elicited upon examination provide the practitioner with a good insight to expected diagnosis. However, the usefulness of rebound tenderness as a single examination has minimal clinical value. The whole patient picture which encompasses an accurate history, clinical examination, laboratory investigations and possible diagnostic imaging is therefore vital to providing a correct diagnosis.

The use of clinical scoring systems like the Alvarado score can be a cheap and quick tool to apply in emergency departments to rule in acute appendicitis. This scoring system includes many aspects such as clinical history, rebound tenderness and laboratory investigations. This allows for observation and critical re-evaluation of the evolving clinical picture. Its application improves the overall diagnostic accuracy and consequently reduces negative appendectomies (Khan and Rehman, 2005). In clinical cases where the practitioner is unsure if the actual diagnosis is acute appendicitis other diagnostic imaging studies such as ultrasound and CT may be undertaken. This must only then be considered once a thorough clinical examination has not provided any indication for acute appendicitis and the benefits out way the risks.

Analyze Good Health Hospital’s records and itemize recent nosocomial infections that occurred within the past yea Analyze Good Health Hospital’s records and itemize recent nosocomial infections that occurred within the past year. In your report, categorize the different parameters (i.e., person, time, place, ethnicity, and gender) used in the compilation of data into the information summative.

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Analyze Good Health Hospital’s records and itemize recent nosocomial infections that occurred within the past yea
Analyze Good Health Hospital’s records and itemize recent nosocomial infections that occurred within the past year. In your report, categorize the different parameters (i.e., person, time, place, ethnicity, and gender) used in the compilation of data into the information summative.

Propose at least six (6) questions for the health care administrator at Good Health Hospital, regarding potential litigation issues with infections from the nosocomial diseases. Rationalize, in your report, the logic behind your six (6) questions.

Identify a targeted audience within Good Health Hospital, and prepare an implementation plan based on your hypothetical meeting with the hospital health care administrator. Propose four (4) steps that will be useful in the final implementation plan.

Suggest at least five (5) recommendations to your department head based on the steps taken in the implementation plan. Provide rationale for your suggestions.

Using these approved recommendations, design a safety protocol itinerary that must be placed in public access areas of the hospital.

Select one type cancer and prepare ppt

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Cancer is one of the leading causes of death in the United States. You have been invited by your local community health department to give a PowerPoint presentation on cancers. Your goal is to educate your audience about the definition of cancer, the causes, means for early detection and preventative measures. The meeting will take place at the health department during a community health fair. Be mindful that your target audience will be composed of people from the local community who most likely will not have a background in science or medicine.

Your assignment will be to pick one type of cancer and discuss each of the following:

Introduction to cancers.

Describe to the audience the characteristics of a cancer cell.

What mechanisms does our body have in place to protect us and avoid the development of cancer?

Indicate which cancer is the focus of your presentation.

Identify which tissues and/or organs in the human body are affected by this cancer.

The incidence rate of this type of cancer.

Typical age of onset for this type of cancer.

Explain the risk factors and/or causes of this cancer.

How this cancer is detected and diagnosed.

Pictures and/or illustrations of cancer cells.

The risk of metastasis for this cancer.

How this cancer is treated including the long-term prognosis. What are the survival rates?

Measures that people may take to prevent this cancer both medical and holistic.

Reference page including citations in standard APA format.

Your PowerPoint presentation should be written with your audience in mind. Remember, your audience does not have a science or medical background, so you will need to translate any “jargon” into something that they will understand.

You must write your “script” of what you will say to your audience in the notes section of each PowerPoint slide. Each slide will have a picture and/or bullet points, along with your notes located in the notes section below the slide, with the specific talking points you will deliver to the audience.

The presentation should be between 10–15 slides, not including the title and references slides.

Creating an Effective PowerPoint Presentation

An effective PowerPoint presentation will include:

Have approximately 10–15 slides

An introduction (1-2 slides): bulleted list of background and key points

A body: multiple slides (10-11 slides), each with one key point

A conclusion (1 slide): bulleted list of major points

A reference slide in APA

Include in-text citations (in APA) where applicable,

Use images (with citations),

Ensure that slides are brief and bulleted, and

Include speaker notes below each respective slide, outlining exactly what you would say to an audience as you presented it.

International Healthcare Policy Health And Social Care Essay

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This assignment deals with the impact that social and cultural issues have on attitudes towards healthcare using their chosen nation as an example; I should evaluate healthcare policy in one national context and explain the influences on policy formation, including impacts of funding issues. The comparison should be made to other national policies to show how different national policies arise. I should explain the structure of healthcare delivery in their chosen nation including an analysis of the organisations involved in healthcare and showing how this represents the translation of policy into practice. And also I should analyse practical barrier to the provision of healthcare in their chosen national context. All of these are covered in task 1 of this unit. Under task 2; Student should identify national and international public health campaigns and analyse their impact on the demand for healthcare in their chosen nation. Their analysis should look at the promotion of public health issues and how well this is achieved. And one thing more, student should identify current international or national health issues and assess how national policy accommodates these issues and the practical responses to these issues in their chosen national context. These assignments bring us new insight to the healthcare in the international sector as well as national. The example that I can cite is the issue of tuberculosis in national and international context.

Let me give you a bird’s eye view regarding tuberculosis. Tuberculosis remains one of the most devastating diseases in the world, affecting people of all ages across the globe. Despite rumours of its demise, tuberculosis remains one of the most deadly, and disabling, diseases in the developing world. According to the World Health Organization’s Global Burden of Disease project (Mathers 2002), in 2000 it was the eighth highest cause of death, and the tenth highest cause of disability adjusted life years (DALYs).

Tuberculosis (TB) is a common and often deadly infectious disease caused by mycobacteria, usually ”Mycobacterium tuberculosis” in humans. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air, when people who have the disease cough, sneeze, or spit. Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease, which, if left untreated, kills more than half of its victims. Tuberculosis is most prevalent in developing nations and often coincides with malaria prevalence and acquired immune deficiency syndrome, or AIDS, and human immunodeficiency virus, or HIV, infections. As an opportunistic disease, tuberculosis easily seats itself in carriers with weakened immune systems. When tuberculosis is a secondary infection in those with a primary infection that is as dire as AIDS, HIV or malaria, it is often a fatal disease.

Diagnosis relies on radiology which is commonly known as chest X-rays, a tuberculin skin test, blood tests, as well as microscopic examination and microbiological culture of bodily fluids. Treatment is difficult and requires long courses of multiple antibiotics. Contacts are also screened and treated if necessary. Antibiotic resistance is a growing problem in (extensively) multi-drug-resistant tuberculosis. Prevention relies on screening programs and vaccination, usually with Bacillus Calmette-Guérin vaccine. Tuberculosis has been contagious for a long period of time. The signs and symptoms usually dormant or they called it as latent period. It can stay up to 5 years, until you will experience loss of appetite, weight loss, fever, easy fatigability, night sweat and persistent coughing with or without blood. This said bacteria are treatable if caught in an early stage. But also it is deadly if left untreated. Mostly the treatment is provided by the government; the course of treatment is quiet long and has to take religiously.

Task 1

One of the healthcare policies of the World Health Organisation regarding tuberculosis is to reduce the transmission of TB in households, any information, education and communication activity for prevention and management of TB should include behaviour and social change campaigns. Such campaigns should focus on how communities and, in particular, family members of smear-positive TB patients and health service providers can minimize the exposure of non-infected individuals to those who are infectious. This will ultimately translate into healthier behaviour of the entire community in relation to prevention and management of TB.

Healthcare in the UK is mainly provided by the country’s public health provider – the National Health Service (NHS). Established in 1948, the NHS was the first state organisation in the world to provide free healthcare. Today, it is the largest health service in the world providing services such as hospitals, General Practitioners (GPs/doctors), specialists, dentists, chemists, opticians and the ambulance service. The majority of these are free to those who are entitled (see below), but patients pay fixed fees for prescriptions, sight tests, NHS glasses and dental treatment, unless they are exempt for a particular reason.

The state system is supported by private health providers. These offer the opportunity to receive treatment more quickly, always see an expert specialist and be seen in clean and comfortable surroundings. The private health providers are not paid for by the state but through private health insurance or personally.

Those entitled to free or subsidised treatment on the NHS include:

Anyone with the right to live in the UK and who currently resides there (excluding British citizens who are resident abroad)

Anyone who has been resident in the UK for the previous year

EU Nationals

Anyone with a British work permit

Students on courses longer than six months

In addition, nationals from countries with reciprocal health agreements can also get treatment on the NHS, although this is usually limited to emergencies. (A full list of these countries can be found on the NHS website – www.nhs.uk).

The number of patients using the NHS is huge. On average, it deals with one million patients every 36 hours and each GP sees an average of 140 patients a week. The NHS struggles to cope with these numbers and it is not uncommon to have to wait several months to see a specialist. As a result, many people opt to pay for private health insurance (or have it provided by their employer) to avoid long waiting times for appointments and treatments.

In the UK life expectancy has been rising and infant mortality has been falling since the NHS was established. Both figures compare favourably with other nations.

On the other hand, in USA they have these kinds of free medical services to those who are less fortunate. Medicaid is a highly specific, means-tested health coverage/insurance program. It covers those who are (primarily financially) unable to acquire health coverage. It covers low-income individuals, including children, pregnant women, parents of eligible children, and people with disabilities. Medicaid was created to help low-income individuals who fall into one of these eligibility categories pay for some or all of their medical bills. Medicaid helps eligible individuals who have little or no medical insurance. And for those who are able to pay their insurance they have Medicare which covers wide scope of individual in Unites States. These Medicaid and Medicare are both run by the government. So the government is the one deciding which one is beneficial to their people but they both get a better treatment in terms of healthcare.

As I have discussed TB as my example in healthcare issues again, tuberculosis is an infectious disease. Mycobacterium tuberculosis is the most common tuberculosis-causing pathogen in humans. Tuberculosis impacts society greatly by hindering economic growth in developing countries. Along with AIDS and malaria, tuberculosis is considered one of the three diseases of poverty. Tuberculosis can be extremely isolating for those infected with the disease. During the beginning stages of being a carrier of the active germs, you are required by medical professionals to stay physically isolated for a two-week period while receiving treatment that results in no longer being contagious. For those who are not treated in a timely manner but are aware that they are infected, this isolation may be extended for an inordinate amount of time. This isolation process has created an impact to the society, they become stereotyped that once you are isolated due to the said TB you are contagious for the whole course of treatment. That is why health education in the community, media information and also by giving leaflets are very helpful way to lessen the emotional burden of the victim or the patient.

In the recent study, in Asia India has the highest percentage incident of TB. In a study conducted by the Department of Community Medicine at Maulana Azad Medical College in New Delhi, India, it was shown that tuberculosis patients rated their quality of life as significantly lower than those test cases of non-infected patients. Women, in particular, felt that the effects of being a carrier of the disease were devastating to their romantic lives as well as their abilities to parent their children due to fears of infecting them.

The social determinates of tuberculosis are very clear. Poverty is one of the biggest problems and housing. The impact on women is quite serious because they are at the bottom of everything whether it comes to health services or economic empowerment and whether it is access to food and nutrition. Women are really in the bottom strata of the society, and, coupled with that is the effect of gender discrimination against women. There is no equal opportunity, so it affects a lot of women. Access to health is a big problem for women.

So, tuberculosis is complicated by all of these things and while, yes, it does affect everyone in the society, women tend to suffer a lot more just because their access to healthcare is so low, and it is so difficult for them. In fact, the health-seeking behaviour of women is very poor in the communities, and part of the empowerment process is to help them put their health first and to make them understand that their own health is important. They must begin to put their own health first rather than putting their family first and neglecting their own health. Since the cultural aspect in India are very strong that woman has to take care of the family while the father is the main bread winner; that is why most women tends to ignore their health problem even they were suffering from the said disease. And also one of their cultures is having extended family. In one small house maybe 2-3 families are living together, so the mode of transmission of TB is very evident and that is why increasing number of incident in the said country.

According to the study of British Thoracic Society; in London the cases of tuberculosis have been increasing since year 2000 – 2008 to 37% – 45% roughly estimated. Over 40% of TB Cases are Indian but not born here in London. 65% of new cases are aged 15-44yrs old. And it is common in male which is 55% and female 45%.

Other issues of service user (TB Patient in London) had been determine and it become barrier to the provision of healthcare namely:

GPs slow to recognise and act on symptoms

Non TB staff lack empathy / understanding

TB clinics a source of emotional and social support as well as health care

Advocacy services lacking

Psychological impact on being “isolation inpatient”

Geographic barriers

rural and inner-city health professional shortage areas

Cultural barriers

health beliefs and behaviors, practitioner beliefs and behaviors

Socioeconomic barriers

lack of health insurance, inability to pay out of pocket, poor education

Organizational barriers lack of interpreters, long appointment wait times, referral between hospital departments is troublesome

Combinations of these barriers may occur at the same time

According to the survey, 43% of BTS (British Thoracic Society) respondents gave the Department of Health in England a rating of poor or very poor in the priority they give to TB. The 2007 BTS survey saw 71% poor or very poor so this is a marked improvement. This reflects the increased priority the Department of Health has given TB, with much service improvement attributable to Department of Health funded projects such as Restructuring TB Services ‐ the multidisciplinary team project undertaken by BTS. Since it has given a priority in the year 2008, the incidents of TB are stable. But across England, the number of cases of the illness appears to be on the increase. According to the Health Protection Agency the number of people infected by the illness per year has gone up from 8,496 to 8,679. People who had been affected by the said disease are not the local once but people coming from outside the country like the migrants from Africa and Asia.

In the recent issue in Afghanistan, they begun to work on a $30 million hospital for the treatment of tuberculosis[TB], a disease that health officials say kills more than 10,000 Afghans every year,” VOA’s “Breaking News” blog reports. “The Japanese government is paying for the 80-bed center in the Afghan capital, which will also treat malaria and AIDS patients,” the news service writes, noting, “Japan is the second-largest donor to Afghanistan, after the United States.” VOA adds, “During Thursday’s groundbreaking in Kabul, Afghan Health Minister Suraya Dalil said Afghanistan ranks in the top 20 worldwide for the most TB patients,” and she noted the country has 2,000 centers nationwide that can diagnose and treat the disease. So in this, other first world countries like Japan are helping them to lessen or eventually eradicate the incident of TB and other deadly diseases.

According to the World Health Organisation, tuberculosis is a continuing public problem in developed and developing countries. Due to this, the World Health Organisation had come out with the plan of implementing the DOT or the Direct Observe therapy which started in 2006 and the result were remarkable that is why up to the present they are still using the said method of treatment in tuberculosis. One thing more is the implementation of screening test (chest X-ray) to all migrants who will enter to the specific country like in United Kingdom. They have policy that all migrants who will stay in the country for more than 6 months should have chest X-ray done and have valid reading result. They can bring their result from their own country but if they cannot produce the result in the immigration area, chest X-ray should be done before letting them inn in the country.

TASK 2

First let me define what “Public Health” is? It is the approach to medicine that is concerned with the health of the community as a whole. Public health is community health. And it has been said that it is vital to all of us at all times. Public health professionals are the one monitoring and diagnosing the health concerns of entire communities and promote healthy practices and behaviours to assure our populations stay healthy.

I have read an article about the campaign regarding tuberculosis world wide. It was held last March 2012 the 2012 World TB Day campaign will allow people all over the world to make an individual call to stop TB in their lifetimes. The Department of Health strategy for tackling TB is to help the NHS strengthen TB services in order to detect cases of TB early, and ensure completion of treatment. In addition to developing the TB Action Plan for England has: developed a set of resources, the “TB Toolkit”, on what constitutes a good TB service with advice on how to assess local needs and commission appropriate services in line with National Institute for Health and Clinical Excellence (NICE) clinical guideline. The Toolkit has been presented to Primary Care Trust (PCT) commissioners and their local service providers/public health teams via a series of regional workshops. Provided funding for the BTS (British Thoracic Society) to establish a national clinical advice network, with a multi-disciplinary make-up, offering peer support and best practice advice for the management of TB cases; implemented improvements to the current Health Protection Agency (HPA) surveillance system to enable local services to have rapid, timely and accurate information, allowing them to monitor TB cases and outcomes in their locality; funded an evaluation of the use of mobile X-ray screening in London as a tool for active case-finding. Provided funding for a TB ‘Find & Treat’ programme to support TB services in London in following-up suspected cases of TB, and diagnosed cases who have been ‘lost to follow-up’; introduced X-ray screening equipment in a number of key prisons in order to improve detection of cases among prisoners; Commissioned research on awareness of, and knowledge about, TB among certain migrant groups at higher risk of TB, and among primary care professionals. This forms the basis of further work to raise awareness of TB. For example, the DH is funding TB Alert to develop materials to raise awareness among higher risk groups, and work closely with PCTs to target these materials locally; reduced the cost of TB drugs to patients who would normally pay a prescription charge. A small amendment to the medicines charging regulations allows TB drugs to be given via TB clinics or patient group direction without a prescription charge being levied; held an expert meeting to review the TB Action Plan in England in order to identify gaps and priorities for further action.

On the other hand, tuberculosis impacts society greatly by hindering economic growth in developed and developing countries. The WHO estimates that globally tuberculosis causes $12 billion annual economic loss. Mycobacterium tuberculosis contaminates about one-third of the entire Earth’s society. It is also one of the most averaged single death affecting factors in adolescents.

It is about two point five percent of all the diseases in the world combined, there are huge consequences globally because of tuberculosis approximately two billion people in the world are infected. It is the seventh most death causing disease worldwide. About seventy-five percent of people fifteen years old to fifty-four are afflicted with this disease. In places like South East Asia and sub-Saharan Africa the rates of death caused by tuberculosis can range from ninety-five and ninety-nine percent. There are some productive drugs that sparingly helps prevent tuberculosis, for about 50 years there has been a statistics saying that every 15 seconds, one person dies due to tuberculosis. People say that this statistic is supposed to remain until the year 2020. One person with tuberculosis usually contaminates about ten to fifteen people every year.

It usually takes 1.6 billion US dollars to budget for tuberculosis control for just one severely affected country. Tuberculosis is a huge epidemic in Yemen. The majority of patients in Yemen that are contaminated by tuberculosis between the range of fifteen years old to fifty-four years old, seventy-two percent of that majority of the patients have pulmonary tuberculosis and twenty-eight percent of them have extra-pulmonary. Tuberculosis is transmitted very easily, when a person coughs they discharge a droplet nuclei which holds about ten bacilli. They are then transported by air currents, once they are breathed in they are anchored in the upper respiratory tract. Because the droplets are very small it is easier for them to stay in the air for a long amount of time. The risk of being contaminated with tuberculosis is very high in poor ventilated ares and crowded places.

There are many ways one can be infected by tuberculosis. An exposed victim will have a hundred percent chance of getting tuberculosis if they are in a very small, enclosed place with the infectious person. Poor ventilation can increase the risk because ventilation is used to remove the contagious droplet nuclei. The amount of time that you are exposed is another key factor. If the individual is exposed and is very susceptible that individual will be contaminated. There are many treatments for tuberculosis, one of them is a drug called Isoniazid it is widely used and it is for prevent tuberculosis. Another one is Rifampicin, it is very effective is non toxic. There are many others like Pyrazinamide, Thioacetazone, Streptomycin, and Ethambutol.

In Yemen, there were no studies or research conducted for a treatment for tuberculosis. But there have been many advances around the world in the past one hundred years, like in 1885 Cantan discovers nonpathogenic bacteria that reduce the amount of Mycobacterium tuberculosis. In 1944 the worlds first single anti-tuberculosis drug. Many scientists in Europe have worked hard to find a cure for Tuberculosis and in 1946 they succeeded in creating an acid that resist the bacteria, it is called PAS which stands for para-aminosalycilic acid. Soon after that they started to discover a lot more new drugs to treat tuberculosis; isoniazed was discovered in 1951, in 1954 pyrazinamide was discovered, cycloserine was discovered in 1955, ethambutol in 1962, and rifampicin was discovered in 1963. All of these have helped the spread of tuberculosis significantly lessen.

Even though many anti-tuberculosis drugs exist around the world, tuberculosis is still and epidemic in some countries because of the low economy some of the countries have. Since the countries that have tuberculosis as their epidemic have a low economy, this means that the country could not provide enough money to trade with other countries who have these drugs or the country could not afford money to provide research and studies for prevention of tuberculosis or for a cure. If each country with the anti-tuberculosis drugs would share their information with the other countries maybe tuberculosis can be eliminated from this world, because it affects the society of today’s world.

Conclusion:

Having discussed the issues regarding tuberculosis in national and international aspect; it was an eye opening to the community how to lessen the transmission of disease and at the same time how to get information; give solution to the problem. By identifying the barriers in the issue of tuberculosis such as; GPs slow to recognise and act on symptoms; non TB staff lack empathy / understanding; Psychological impact on being “isolation inpatient”; rural and inner-city health professional shortage areas; long appointment wait times, referral between hospital departments is troublesome. And another thing is the cultural beliefs about healthcare. In these barriers, the NHS is trying their best to intervene and look for a possible and healthy solution.

Further more, the link between tuberculosis and diminished growth suggests that there is a role for health programmes such as DOTS in improving not only the health of those living in the developing world, but also such individual’s wealth. Any policy would need to take into account the problems involved in scaling-up treatments in countries with limited healthcare staff and health infrastructure. Both sets of guidelines appear to support a dedicated programme to treat tuberculosis using community based methods such as those of DOTS, which do not require long periods of hospitalisation or high-level infrastructure.

References:

Future Impact of Tuberculosis | eHow.com http://www.ehow.com/facts_6216508_future-impact-tuberculosis.html#ixzz1vVOEcyBC


TB’s Impact on Women

http://www.livestrong.com/article/202018-impacts-of-tuberculosis/#ixzz1vVNlcgOL

www.news-medical.net/health/What-is-Tuberculosis.aspx

Controlling TB in London, London TB Services and Review

www.ucl.ac.uk/infection-immunity/research/res…/tb…/j_hayward

Barrier to Healthcare

www.amsa.org/programs/barriers/barriers.html

Tuberculosis in UK. What is being done?

www.bma.org.uk/health…ethics/…/Tuberculosiswhatisbeingdone.jsp

The Impact of Tuberculosis on Economic Growth – HEC Montréal

neumann.hec.ca/neudc2004/fp/grimard_franque_aout_27.pdf

Future Impact of Tuberculosis | eHow.com http://www.ehow.com/facts_6216508_future-impact-tuberculosis.html#ixzz28nhrmlUx

Deployment stress | Psychology homework help

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Yerkees-Dodson Law and Stressors

The Yerkes-Dodson Law was developed in 1908 by two psychologists. In a 8-page paper, describe the Yerkes-Dodson Law and discuss how it can be relevant to Service members in deployed atmospheres. Based upon the course materials reviewed, include each of the following areas.

Explain the concept of the Yerkes-Dodson Law.

Examine the ways in which stress can be harmful and helpful.

Discuss the various types of military-related stress and give examples of each.

Describe the impact of military stressors on the health and well-being of Service members.

Explain if, and how the Yerkes-Dodson Law can be helpful when Service members return from deployment.

Include the minimum formatting standards identified below.

Format the 8-page paper in APA style; the minimum page count does include the required APA formatted title page, abstract, and reference page. Include references to a minimum of two (2) scholarly sources in the paper.

Implementing Evidence Based Practice

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Evidence based practice (EBP) is a frequently used term in everyday health-care jargon. EBP is based on research, evidence on best practices, and the consideration of individual patient’s needs and preferences (Bick, 2011). EBP started in medicine as evidence-based medicine (EBM). Professor Archibald Cochrane (1909–1988) was considered a pioneer in this area and can be considered the father of EBM in our era (Collaboration, 2020).

There are many definitions of EBP, one of the most widely cited is by Sackett (1996) and refers to evidence-based medicine, but can also applied to health care in general, ‘Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means ‘integrating the best available research evidence with clinical expertise and the patient’s unique values and circumstances’ (Straus, Glasziou et al., 2011).

High quality, current and valid research is essential to provide women with up-to-date evidence-based practice (Rowland and Jones, 2013). The Nursing and Midwifery Council (NMC, 2018) Code states you must deliver care

‘

based on the best evidence and best practice and ensure any information or advice given is evidence-based’ (Baston and Hall, 2017). World Health Organization (WHO) says that ‘Health systems can benefit directly from EBP through overall improvement in the quality of care; this means better patient outcomes and increased patient safety’ (Jylhä

et al.

, 2017).

  • Within midwifery evidence-based guidelines could appear as a solution to multiple problems: providing a set of practical steps that embody safe and effective care
  • reducing the risk to women and babies
  • setting defensible standards for nursing practice
  • providing direction for newly qualified or recently employed staff and students

Evidence alone is not enough, clinical judgement and patient preference are as important in order to provide the best EBP for both women and their babies (Aveyard and Sharp, 2009).

Implementing EBP is a process that involves locating and applying research findings to clinical practice. This process follows a series of steps commonly known as the five steps of evidence-based practice in which we; ask – formulate a clinical question, acquire – search for the best evidence to answer your question, appraise – critically review the evidence for validity and applicability, apply – implement findings with your patient and assess – evaluate the result. When having assessed the effects, new questions can arise, requiring us to restart the five-step process (CIAP, 2018).

Student midwives should be able to ask questions in order to acquire the evidence to continue and apply the knowledge gained.

As students, we are taught to provide high-quality care. This high-quality care is supported by evidence, which took many years to become guidelines of care through translation from research to clinical practice. Gaining knowledge of EBP and learning strategies for implementation are critical skills for student midwives. As students, we hold a promise of continuous learning, and it is essential to build evidence-based knowledge over time (Salinas, 2017). EBP and research are not the same, EBP focusses on the use or application of knowledge that is often produced by research. Research is concerned with the production of knowledge that is as objective and accurate as possible (Rees, 2012). As students we need to be able to apply all five steps which provide a clear step by step approach, in order to provide safe, effective care to both mothers and babies and provide the best clinical decisions.

When it comes to sources of information and evidence there is ample. While all evidence is classed as information, not all information is classed as evidence. In the healthcare, evidence is considered as high-quality information gained from research-based investigations, which makes it more predictable and reliable. Evidence is often used as a basis for change in healthcare. Every source of information is useful but in the same breath has limitations.

The research method regarded as the most likely to ensure good quality evidence is randomized controlled trials (RCT). RTCs use research methods aimed at reducing bias and are considered the most reliable form of primary research in the field of health interventions. The power of the RCT lies in its objectivity and its freedom from bias and is regarded and the ‘gold standard for comparing alternative forms of care’ ((Enkin et al., 2000) (Marshall

et al.

, 2014). However when relevant research studies have not yet been done on a subject, information can be based on the best available evidence, the experience and expertise of health and care professionals or the personal experiences of patients or service users (Titler, 2008). Disadvantages of EBP include the lack of evidence, the oversight of common sense, and the length of time and difficulty of finding valid credible evidence (

“Evidence-Based Practice: Advantages & Disadvantages.”

, 2017).

Gaining knowledge of EBP and learning strategies for implementation are critical skills for student midwives and other health care professionals, no matter the setting. EBP is important to the professional development, responsibility, and capabilities of student midwives, and it has become an important subject in midwifery and has integrated into daily practice.

Skill

Rationale

Wish to be able to give optimal care to women and babies

Action

How are you going to acquire the skill

Criteria for Success

1.literature searching

Extend my knowledge

Librarian support

2.appraise the evidence

WHY?

Read the literature on it?

Use a model?

PICO model of questioning

Answer or ask a question or be able to find the right sources

  • Aveyard, H. and Sharp, P. (2009)

    A beginner’s guide to evidence based practice in health and social care professions.

    Maidenhead: Open University Press :.
  • Baston, H. a. and Hall, J. a. (2017)

    Midwifery essentials. Volume 1, Basics.

    Second edition. / Helen Baston, BA (Hons), MMedSci, PhD, PGDipEd, ADM, RN, RM, Jenny Hall, EdD, MSc, RN, RM, ADM, PGDip (HE), SFHEA. edn.: Elsevier.
  • Bick, D. (2011) ‘

    Evidence based midwifery practice: Take care to ‘mind the gap’

    ‘,

    Midwifery Journal,

    27, pp. 569-570.
  • CIAP, C. I. A. P. (2018)

    Introduction to Evidence-Based Practice

    (Accessed: 27 February 2020).
  • Collaboration, T. C. (2020)

    About Us

    . Available at:

    https://www.cochrane.org/

    (Accessed: 2 March 2020).

  • “Evidence-Based Practice: Advantages & Disadvantages.”

    (2017): Study.com. Available at:

    https://study.com/academy/lesson/evidence-based-practice-advantages-disadvantages.html

    (Accessed: 3 March 2020).
  • Jylhä, V., Oikarainen, A., Perälä, M.-L. and Holopaine, A. (2017)

    Facilitating evidence-based practice




    in nursing and midwifery in




    the WHO European Region

    (Accessed: 27 February 2020).
  • Marshall, J. E. e., Raynor, M. D. e., Fraser, D. w. o. f. and Myles, M. F. T. f. m. (2014)

    Myles textbook for midwives.

    Sixteenth edition / edited by Jayne E. Marshall, Maureen D. Raynor ; foreword by Emeritus Professor Diane M Fraser. edn.: Churchill Livingstone.

  • The code: Professional standards of




    practice and




    behaviour




    for nurses, midwives and nursing associates .
  • Rees, C. (2012)

    An introduction to research for midwives.

    3rd ed. edn.: Churchill Livingstone.
  • Rowland and Jones (2013) ‘Research midwives: Importance and practicalities’,

    British Journal of Midwifery,

    21(1).
  • Salinas, A. (2017)

    Why evidence-based practice matters to students

    . Available at:

    Why evidence-based practice matters to students

    (Accessed: 2 March 2020).

  • Titler (2008)

    Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

    Rockville: Agency for Healthcare Research and Quality.

Find the ratio of Hoosiers to Buckeyes (people from Ohio). (simplify your answer)

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Find the ratio of Hoosiers to Buckeyes (people from Ohio). (simplify your answer)

Compute the volume, mix, and price revenue variances in nursing treatment

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Compute the volume, mix, and price revenue variances in nursing treatment

 

Analyze the variances in the following scenario: You are the nursing administrator for a medical group that expects a severe outbreak of the flu this winter. You hire additional staff to treat the patients and administer shots. Your special project budget was for 1,000 hours of part-time nurses services at $40 per hour, for a total cost of $40,000. It was expected that these nurses would administer 400 flu shots and treat 1,600 flu patients. The medical group typically charges $50 for a flu shot and $80 for treating a flu patient. Actually, the group had 1,200 patients who received the flu shot and 1,400 who had the flu and received treatment. On average, it was able to collect $55 per flu shot and $70 per flu patient. Compute the volume, mix, and price revenue variances. How did things turn out for the group considering just revenues? How did they turn out from a profit perspective? Use either the approach from chapter 8 or from Appendix 8-A to solve. Clearly label the calculations of the required variances using Excel. Use formulas to calculate the three variances and format the cells to insert a comma if there is more than three numbers and round to the nearest whole number.