Addressing Misconceptions of Alzheimers Disease

/in /by


Introduction

In my research paper I will be addressing the topic of Alzheimer’s disease and dementia related disorders. I chose this topic because it is dearest to me due to my father being diagnosed with this deliberating cognitive disorder at the age of 64, and it was in my intention to learn more about the topic and go further into research about this disorder. Have you thought to yourself that at one point in our lives that we humans will be diagnosed with a disease or disorder that can change the rest of our lives for the worst? Well for my family Alzheimer’s was one of those diseases that steals loved ones away from you. Is Alzheimer’s disease curable or are people who are diagnosed with the degeneration of the brain slowly wearing away with the disease? This is one of the questions that will be answered throughout my research essay.  The main concern of the topic is there a cure to this disease and if not is there a treatment that can slowly progress the symptoms of the disease. The cause of Alzheimer’s disease and dementia are currently unknown. However, extensive studies using new technology had led to new ways of accurately diagnosing Alzheimer’s disease, an understanding way of the mechanism involved regarding the development of Alzheimer’s disease and memory diseases, and the amount of damage it causes in the human brain.

The main focus of this research paper is to address the misconception of the disease and addressing evidence to the contrary which goes into further detail about the deliberating disease which is affecting millions of adults all over the world of which one is my father. This paper looks at the various studies conducted by researchers in an attempt to show the factors attributed to Alzheimer’s disease and dementia. In this paper, I will address research provided by various researchers, health care professionals; psychologists on the environmental, genetic risk factors and lifestyle are attributed to the development of Alzheimer’s disease and diseases related to cognitive dysfunction of memory.


Reflection

In the introduction, I mentioned a brief description, but to go into further detail, what does it mean for a person to have a cognitive disease.  According to the national institute of aging, “Alzheimer’s disease is deliberating and irreversible condition that affects the brain, Alzheimer’s disease is a condition in which it slowly over time progresses and destroys a person’s memory and affects the thinking process, and eventually it can also affect a person’s overall lifestyle and cause the person to undergo cognitive changes which can affect the simplest life tasks such as eating, cooking, bathing and forgetting loved ones”. According to the national institute of aging, “Alzheimer’s disease starts to show symptoms as soon as a person in their late 50’s, also its estimated that almost 5.5 million Americans living in the United States ages 65 are living with some sort of cognitive disorder such as dementia which later progresses to Alzheimer’s disease. It is said to currently be the 6th leading cause of death in the United States in older adults.

As humans age, we tend to naturally form some sort of cognitive decline, as our brain cells age, they input and output less information and our memory tends to slowly decline, but when is line drawn from the natural aging process to being diagnosed with a cognitive declining brain disorder? Individuals whom are diagnosed with Dementia or Alzheimer’s disease start to show problems in memory early on in the prognosis of the disease. Some examples according to the Alzheimer’s association are “memory loss that interrupts an individual’s daily life such as forgetting to turn off the stove, forgetting where he/she placed the house keys, letting the shower run, forgetting to flush after using the restroom, etc. According to the  Alzheimer’s association, “another symptom that distinguishes natural aging from Alzheimer’s cognitive decline is having problems or it becomes a challenge to plan or solve problems that occur is our daily lives for example paying the bills on time, withdrawing money from the bank and forgetting your pin number, forgetting how much the individual has in his/her bank account and all the assets. This is one of the symptoms of cognitive disorder compared to an individual who is aging gracefully and does not suffer from such mishaps.

Another symptom of Alzheimer’s disease is forgetting how to operate certain familiar tasks for example driving, the use of the microwave, oven, riding a bike, the use of a computer. This may be difficult for an individual diagnosed with Alzheimer’s compared to a person aging normally without any major cognitive decline. According to the Alzheimer’s association, the next symptom to me is one of the most important symptoms that distinguishes an aging individual from one that is suffering from Alzheimer’s and that is that the person is confused with time and place. “The individual suffering from Alzheimer’s disease may not be able to tell when it’s dark outside or when the sun is up, may be confused on seasons in the year, time of the year, months and dates and where they are”. One of the struggles my father had was with telling time and the distinguishing the changing of the months on the calendar. He had trouble distinguishing what month and what year we were living in and thought it was the 1990’s still. This was one of the most heartbreaking times when a parent or loved one forgets certain dates such as wedding anniversaries, birthdays of their children, special holidays and more.


Neuropsychology and effects of the disorders

What caught my attention when my father first got diagnosed with the disorder is what if he is being misdiagnosed? how do doctors are really sure that the patient is correctly diagnosed with Alzheimer’s? Well according to Mayo Clinic, “In order to diagnose Alzheimer’s disease or any sort of disease that deals with cognitive impairment, the doctor most likely a neurologist evaluate a person’s signs and symptoms of the disorder. Doctors further address several cognitive tests that help a patient correctly get diagnosed and seek treatment. The tests that doctors use to rule out Alzheimer’s disease are as followed, “Mental status testing in which the doctors use a score system to keep in track of the patient’s cognitive skills such as remembering names, dates, events. The second most common test to rule out Alzheimer’s disease according to mayo clinic is neuropsychological testing which a neuropsychologist tests certain everyday life skills such as if the patient is able to function and maintain everyday tasks such as operating a vehicle, managing finances, and during the clinical evaluation the doctor may interview family members and get details about the lifestyle of the patient. Doctors further evaluate for additional testing, one which is laboratory tests that may be causing dementia and cognitive decline, according to mayo clinic, “certain thyroid disorders and vitamin b12 deficiency may cause symptoms of Alzheimer’s” therefore this is why doctors conduct laboratory tests to rule out any deficiency in blood exams.

Moving forward, there are advance testing’s that look into the brain to determine Alzheimer’s disease in which the scans show the size, neurons of the brain, any mass that may be causing cognitive decline. According to mayo clinic, the most common brain imaging scans used to determine Alzheimer’s disease are magnetic resonance imaging or MRI which use radio waves and magnets which create a detailed view of the brain which helps doctors and researchers take deeper look into the brain. The second imagine is a computerized tomography or a CT scan which a CT x ray machine takes cross sectional images of the brain which can help doctors rule out the disease. There is a more intensive imaging which gives the most detailed imaging of the brain, Positron emission tomography or PET scan which the patient is injected with a radioactive substance in the vein then the patient’s metabolic changes can help doctors determine degenerating brain disease which may help doctors and researchers rule out Alzheimer’s disease.

When it comes to treating Alzheimer’s patient using medication, there are a handful of medications which can help improve memory. In this section of the essay, I will go over pharmaceutical drugs and natural remedy in which interests my research part of the disease. According to the Alzheimer’s association, current medication used for cognitive decline which is approved by the food and drug admistration, FDA approved two medications which treat cognitive symptoms are “cholinesterase inhibitors under the brand name Aricept, Exelon and Razadyne and memantine which sells under the brand name Namenda which help to treat cognitive symptoms which come with the disease such as memory loss, confusion and thinking associated with the disease”.

Further researching the article on Alzheimer’s disease from the Alzheimer’s association, as the disease progresses, this causes the brain cells to diminish and loosing connections in the neurons which causes a person’s cognitive symptom to worsen over time. There isn’t a cure to the disease, but medication has proven to slow the progression of the disease. According to the Alzheimer’s association, “cholinesterase inhibitors help to prevent the breakdown of acetylcholine, which is a chemical location in the brain which is important for learning and memory. There are few side effects associated with the medication, some are as followed, “nausea, vomiting, loss of appetite and increased bowel movement”, according to Alzheimer’s association. The medication discussed above are for early Alzheimer’s disease to mild progression. The next series of medication used which are used for moderate to severe stages of the disease is memantine with a combination of donepezil combination which according to the FDA is “the only treatment of moderate to severe Alzheimer’s.”

When it comes to holistic approaches to treating the disease, there are some proven remedies which help the progression of the disease. Upon researching an article called “Alternative treatments for Alzheimer’s Disease” by Healthline.com, I came across some potential holistic treatments that can help slow down the degeneration of the disease and help the person live a more comfortable life. Although these holistic treatments are not proven to help prevent or treat the disease hence since there isn’t a cure to the disease, these natural remedies may help slow down the progression of the disease or prevent the disease. According to the website, the first holistic approach is the use of coconut oil, coconut oil contains a fatty acid called caprylic acid which the body breaks down the acid into a protein called a ketone, which according to the article, “research has been proven patients who had used coconut oil has better memory performance and had less cognitive decline”.

Another holistic approach alternate to medicine is the use of omega- 3 fatty acids, according to the website healthline.com, “researchers had conducted their study and found out the patient diagnosed with the disease or have been experiencing cognitive decline suffered from reduced cognitive impairment”. There are certain foods which contain omega-3 such as fish, nuts, and taking supplements with omega-3. Further down the article, I came across a mineral called coenzyme Q10 supplements that can prevent or stop the degeneration of the brain cells. According to Healthline, “Coenzyme Q10 is not being studied as a possible treatment for Alzheimer’s disease”. As the disease progresses, patients have a difficult time with sleeping and determining a time schedule. According to the article Healthline, bright light therapy can help patients who have been suffering from cognitive decline or if the degeneration if affecting a person’s circadian rhythm can benefit from bright light therapy. According to the article, “Studies have found out that light therapy helps to restore a well balance to a person’s sleep and wake cycle also known as a person’s circadian rhythm”. With bright light therapy, it’s very simple, at night time, you cover the shades or get specialized darker shades in the bedroom, and when it’s time to take up, you open the shades to reveal the brightness of the sun which indicates the brain that it’s the morning time. A person with cognitive decline may help to determine when its dark outside, it’s time to sleep and when its daytime, it’s time to get up. This may help people suffering from Alzheimer’s disease determine when to get up and when to sleep which may help with their sleep pattern and help then get a good night of sleep. The last holistic approach to helping prevent to naturally treat the symptoms of Alzheimer’s disease or to improve cognitive memory is the use of a supplement called gingko biloba. According to the website Healthline, studies have shown that the use of the supplement “gingko biloba may help people suffering from the cognitive degeneration may benefit from the supplement”. This personally to me is a new innovation for the future of people who are experiencing cognitive decline early on. This makes me delightful that there are certain approaches one can take in order to prevent the disease, which can in hopes help patients and families of people being diagnosed with cognitive decline.


Conclusion

In conclusion, in my paper I have discussed the disease in a research perspective and have gone into detail about the disease and the symptoms of people living with this brain robbing disease. As mentioned in the introduction, after conducting several research articles about the disease, it helped me better understand the stages of the disease which I can apply in my personal life which this disease has affected the most precious person in my life, my father. Like mentioned in this paper, currently there is no cure for Alzheimer’s disease and no treatment will help stop or reverse its progression. As the population of the world continues to age, the number of people suffering from this disease will rise worldwide.

Alzheimer’s disease is a difficult illness to live with; it affects the individual suffering from it and the surrounding family. I hope that in the future, there will be a cure to this devastating disease, which may bring comfort to the people suffering from the illness as well as their families. As a Christian, conducting research on the topic has helped me put my mind in ease, and believe that God will help the people suffering from the condition. He will also educate their family on the disease gain knowledge on the disease and assist them throughout their loved one’s progression. My own personal dream goals are to be geriatric advocate to help older individuals overcome depression and help patients with diseases and symptoms of aging. I feel from a Christian perceptive, being psychology major will help me grow in my career and have the Christian background that comes with religion. It will be beneficial in my career, which I can apply to the real world.


Work Cited

  1. Alzheimer’s disease. (n.d). Retrieved from https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/doctors-departments/ddc-20350457.
  2. National Institute on aging. May 22nd, 2019. Alzheimer’s disease and related dementia. Retrieved from;

    https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet

    .
  3. Alzheimer’s Association. (n.d).10 early signs and symptoms of Alzheimer’s disease. Retrieved from;

    https://www.alz.org

    .
  4. Healthline. Alternate treatments for Alzheimer’s disease. February 7th, 2017. Retrieved from;

    https://www.healthline.com/health/alzheimers-disease/alternative-treatments

    .
  5. Alzheimer’s association. (n.d). Medication for memory. Retrieved from https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory.

Compose a 1,250-1,500 word summary brief that expands upon the elements you addressed in the Risk Management Program Analysis Part One assignment.

/in /by

Compose a 1,250-1,500 word summary brief that expands upon the elements you addressed in the Risk Management Program Analysis Part One assignment.

This assignment builds on the Risk Management Program Analysis Part One assignment you completed in Topic 1 of this course.

Assume that the example risk management program you analyzed in Topic 1 was developed by and is now currently implemented by your health care employer/organization. Further assume that your supervisor has asked you to present a high-level summary brief of this new risk management program to a group of administrative personnel from a newly created community health organization in your state who has enlisted your organization’s assistance in developing their own risk management policies and procedures.

Compose a 1,250-1,500 word summary brief that expands upon the elements you addressed in the Risk Management Program Analysis Part One assignment. In addition, analyze the following:

  1. Explain the Joint Commission’s role in the evaluation of an organization’s quality management processes.
  2. Describe the roles that different levels of administrative personnel play in establishing or sustaining operational policies that are focused on employer-employee organizational risk management policies.
  3. Explain the relationship of risk management programs and compliance with ethical standards.

In addition to your textbook, you are required to support your analysis with a minimum of three peer-reviewed references.

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

Analyze the concepts of leadership strategies in a health care organization. Argue whether leaders are born or made.Give three examples of a great leader whom you admire in the health care field- elab

/in /by
  • Analyze the concepts of leadership strategies in a health care organization. Argue whether leaders are born or made.
  • Give three examples of a great leader whom you admire in the health care field, elaborating on the primary reasons why you admire this selected leader.
  • Discuss two challenges this selected leader faces and how you would successfully tackle these challenges. Provide specific examples to support your rationale from readings throughout your program or from peer-reviewed journal articles.

Reply Quote

Define “evidence based practice”.

/in /by

Define “evidence based practice”.

 

Basing Nursing Practice on Evidence

As research practices evolved, healthcare practices have improved.

Today, some nursing practice is based on evidence, yet not all forms of evidence provide the best outcomes. As noted in this week’s readings and media presentation, scientific research provides the best source of evidence. Evidence-based nursing practice takes into account scientific evidence, clinical expertise, and patient preferences. Using evidence-based nursing practices can improve patient outcomes along with quality and safety of care.

Reflect on nursing practice in general and then respond to the following:

Define “evidence based practice”.

What is the difference between “evidence based practice” and research?

Why don’t nurses use evidence-based findings in their practice?

Based on the reasons you provided above, how could these barriers be reduced or overcome in the agency where you work?

NOTE: If the agency where you work has already addressed this problem, provide information about it and share how well the strategy works.

Support your response with references from the professional nursing literature.References should not be older than 5years.

Required reference:

Course Text: Schmidt, N. A., & Brown, J. M. (Eds.). (2012). Evidence-based practice for nurses: Appraisal and application of research. (Laureate Education, Inc., custom ed.). Sudbury, MA: Jones and Bartlett.

o Chapter 1, “What Is Evidence-Based Practice?”

This chapter defines evidence-based practice (EBP) as the integration of clinician expertise, patient preferences, and practice that is grounded in both theory and research evidence. The authors describe multiple ethical paths that a nurse can take to obtain evidence and improve patient care. In addition, this chapter covers barriers that might prevent the adoption of an EBP such as time or lack of resources.

o Chapter 2, “Using Evidence Through Collaboration to Promote Excellence in Nursing Practice”

Chapter 2 identifies five levels of collaboration that are essential to the promotion of EBP: individual, organizational, regional, national, and international. The chapter also discusses ethical principles, codes, and laws that aim to protect the rights of human subjects.

o Chapter 3, “Identifying Research Questions”

Nurses in practice can help determine those research questions that can lead to improved patient care and changes in practice. The process of identifying research problems and the development of EBP questions are discussed in this chapter. The authors provide guidelines for identifying research problems, narrowing the scope of a research question, and formulating a problem statement.

o Chapter 14, “Weighing In on the Evidence”

“Clinical Practice Guidelines: Moving Ratings and Recommendations Into Practice” (pp. 376–378)

This section of Chapter 14 introduces clinical practice guidelines, which provide nurses with direction on how to incorporate research findings into their daily routines. This selection explains the evolution and use of clinical practice guidelines, which consolidate research findings and seek to resolve a specific clinical problem.

Pathophysiology Analysis of Hyperthyroidism

/in /by

Hyperthyroidism is a disorder that falls under the category of endocrine disorders. The thyroid gland is overactive and produces more thyroid hormones than the body needs. As a result, there is a myriad of symptoms that the patient will encounter. The symptoms can begin to affect a person’s life if not treated. Thankfully, the treatment of hyperthyroidism is easy to utilize and in many cases, it can bring a great amount of improvement and better quality of life for the patient. Even though hyperthyroidism itself is not seen as a life-threatening disorder, it can lead target other things such as the heart, menstrual cycle, fertility, bones, and muscles (“Hyperthyroidism”, 2016). Therefore, individuals who have hyperthyroidism should be proactive with their health and take the disorder seriously.


Epidemiology

Hyperthyroidism has a prevalence of around 1% to 3% in the United States (De Leo, Lee, & Braverman, 2016). With regards to the incidence, there are approximately five individuals for every 100,000 that are diagnosed with hyperthyroidism each year (Capriotti & Frizzell, 2017). Analysis of how hyperthyroidism affects race shows that Caucasians are more susceptible to it than African Americans (Capriotti & Frizzell, 2017). A cause of hyperthyroidism, which is Graves’ disease, has an incidence of fourteen people per 100,000 (Menconi, Marcocci & Marino, 2014). The average age of onset for Graves’ disease is between 40 and 60 years old (Capriotti & Frizzell, 2017). When looking at statistics of those with hyperthyroidism, 15% of them have a family member who also has the disorder (Capriotti & Frizzell, 2017). Females get hyperthyroidism more frequently than males and Graves’ disease has a male-to-female ratio of 1.5 to 10 (Capriotti & Frizzell, 2017).


Etiology

Hyperthyroidism is most commonly caused by a condition known as Graves’ disease (De Leo, Lee, & Braverman, 2016). Graves’ disease is an autoimmune disorder and it is caused by a variety of factors. In Graves’ disease there is an intertwining of genetic and environmental factors and as a result, there is no immune tolerance to thyroid antigens (De Leo, Lee, & Braverman, 2016). This leads to the creation of an immune reaction targeted at the thyroid gland (De Leo, Lee, & Braverman, 2016). Autoantibodies that target the thyroid gland such as antihyroperoxidase and antithyroglobulin are one of the factors that cause Graves’ disease (Capriotti & Frizzell, 2016). These autoantibodies enact thyroid follicular cells by binding to the thyroid stimulating hormone receptor (De Leo, Lee, & Braverman, 2016). As a result, there is an increased production and release of thyroid hormones. Graves’ disease is seen more commonly in patients who have genes HLA-DR, CTLA4, CD40, and PTPN22 which are known as immune regulatory genes (Menconi, Marcocci, & Marino, 2014). Several non-genetic components are thought to cause hyperthyroidism and Graves’ disease. These include smoking, stress, the amount of iodine consumption, and infections (Menconi, Marcocci, & Marino, 2014). As stated earlier, females have a higher chance of acquiring Graves’ disease and it is perceived that this is due to chromosomal influences and sex hormones (De Leo, Lee, & Braverman, 2016).

The next most common causes of hyperthyroidism are toxic multinodular goiter and subacute thyroiditis. Both account for 15% to 20% of all cases of hyperthyroidism (Capriotti & Frizzell, 2017). In toxic multinodular goiter, the thyroid has autonomously hyperfunctioning nodules (Capriotti & Frizzell, 2017). When looking at the elderly population who reside in areas that are scarce in iodine, toxic multinodular goiter is the most common cause of hyperthyroidism (Kravets, 2016). Subacute thyroiditis occurs after exposure to extreme infection or stress and has three phases (Capriotti & Frizzell, 2017). The first stage is hyperthyroidism, the second stage is hypothyroid function, and the final stage is when the thyroid returns to its normal function (Capriotti & Frizzell, 2017).


Pathogenesis

In hyperthyroidism, the thyroid gland releases a high number of thyroid hormones. The immune system creates autoantibodies called thyroid-stimulating immunoglobulin (TSI) and they attach to thyroid-stimulating hormone (TSH) receptor sites on the thyroid gland (Chuma-Bitcon & Gruson, 2016). TSI becomes in a battle with TSH for the ability to occupy the TSH receptors and as a result, TSI begins to mimic the activity of TSH (Chuma-Bitcon & Gruson, 2016). TSI cause the thyroid gland to enlarge and there is a great increase in the levels of T3 and T4 (Capriotti & Frizzell, 2017). This is called primary hyperthyroid disease process. The presence of TSI causes a loss of the negative feedback system that normally oversees thyroid hormone production (Chuma-Bitcon & Gruson, 2016). Due to the low amount of TSH, there is an increased, erratic release of thyroid hormones by the thyroid gland.

A couple of other malfunctions with the thyroid gland and its hormones lead to hyperthyroidism. Secondary hyperthyroidism is when the pituitary gland elevates its secretion of TSH and this makes T3 and T4 levels increase (Capriotti & Frizzell, 2017). Tertiary hyperthyroidism involves the hypothalamus. The hypothalamus has excessive secretion of thyrotropin-releasing hormone (TRH). Consequently, TSH, T3, and T4 are all abundant in number. Secondary and tertiary hyperthyroidism are not as common as primary hyperthyroidism (Capriotti & Frizzell, 2017).


Clinical Manifestations

Hyperthyroidism affects many systems of the body. This will result in the affected individual presenting with a variety of signs and symptoms. Hyperthyroidism causes metabolic activities to hasten and the amount of effort put into energy increases (Capriotti & Frizzell, 2017). Some signs and symptoms result due to an excess of thyroid hormones. This wide array of signs and symptoms in the clinical presentation of the individual can be hand tremors, anxiety and irritability, weight loss with normal eating habits, goiter, sensitivity to heat, diaphoresis, tachycardia, and palpitations (Chuma-Bitcon & Gruson, 2016). A goiter is when the thyroid gland becomes enlarged. During an examination, the provider will be able to palpate the enlarged thyroid gland and hear a bruit while auscultating the thyroid gland (Capriotti & Frizzell, 2017). Women can have an irregular menstrual cycle and men can have erectile dysfunction, gynecomastia, decreased libido (Menconi, Marcocci, & Marino, 2014). The elderly may not present with the aforementioned signs and symptoms or they may be less pronounced. On the other hand, the elderly with hyperthyroidism frequently deal with cardiovascular issues like atrial fibrillation (Menconi, Marcocci, & Marino, 2014).

Other signs and symptoms are specific to the underlying causes of hyperthyroidism. The first sign is ophthalmopathy which is enlargement and inflammation of the orbital tissues (Menconi, Marcocci, & Marino, 2014). This causes exophthalmos, which is protrusion of the eyes, as well as soft tissue swelling (Menconi, Marcocci, & Marino, 2014). Both are the result of venous engorgement (Menconi, Marcocci, & Marino, 2014). The ocular muscles that control eye movement become malfunctioned because of hypertrophy and lead to diplopia (Menconi, Marcocci, & Marino, 2014). Another sign present in the underlying cause of hyperthyroidism is dermopathy. Dermopathy is non-pitting edema that is found in the pretibial regions of the legs (Menconi, Marcocci, & Marino, 2014). Another name for this condition is pretibial myxedema. If the dermopathy becomes severe enough, it can appear as elephantiasis (Menconi, Marcocci, & Marino, 2014). A final sign that can be seen with hyperthyroidism is acropachy. Acropachy is clubbing and swelling of the last phalanx of the fingers and toes (Menconi, Marcocci, & Marino, 2014). This condition is rarely seen in those with hyperthyroidism.


Treatment

The main course of action for treating hyperthyroidism is administering antithyroid drugs. This treatment can be used for all ages as well as for pregnant women who have hyperthyroidism. Antithyroid drugs are used for either long-term treatment of hyperthyroidism or as a temporary treatment until the thyroid gland is removed by surgery or treated with radioiodine (Jastrzebska, 2015). Providers must explain to patients the goal with antithyroid drugs. Antithyroid drugs have proven to be effective in patients with hyperthyroidism.

Once a person undergoes taking antithyroid drugs, the treatment lasts on average around 12-18 months (Jastrzebska, 2015). Dosing of the medication depends on the size of the thyroid gland, how much iodine is present in the body, and how severe the hyperthyroidism (Jastrzebska, 2015). After taking antithyroid drugs for about 4 to 12 weeks, the thyroid gland will have normal functioning and the dose of medication can be decreased (Jastrzebska, 2015). Treatment with the decreased dosage of antithyroid drugs will continue for at least a year and a half (Jastrzebska, 2015). The use of antithyroid drugs can result in remission for about 30% of patients (Jastrzebska, 2015).

Radioiodine therapy is the next type of treatment for hyperthyroidism. It is given after the patient has a normal functioning thyroid gland after administration of antithyroid drugs (Menconi, Marcocci, & Marino, 2014). The purpose of radioiodine therapy is to get the patient to a state of hypothyroidism so that he or she can have a steady remission of Graves’ disease (Menconi, Marcocci, & Marino, 2014). In order to determine the amount of radioactive iodine a patient must be given, a 24-hour radioactive iodine uptake test is conducted as well as finding out the size of the thyroid gland (Menconi, Marcocci, & Marino, 2014). The option of giving a fixed dose of radioactive iodine is also an option (Menconi, Marcocci, & Marino, 2014). Once radioactive iodine treatment is started, around 80% of patients will reach a state of hyperthyroidism in about one to six months (Menconi, Marcocci, & Marino, 2014). Patients who have a large goiter will need repeat treatments of radioactive iodine because just one use is not helpful (Menconi, Marcocci, & Marino, 2014).

The final method for treating hyperthyroidism is surgical removal of the thyroid gland called thyroidectomy. The surgery is usually performed on those patients who have a large goiter (Menconi, Marcocci, & Marino, 2014). There can be a partial or complete removal of the thyroid gland (Menconi, Marcocci, & Marino, 2014). After removal, the patient will be in a state of hypothyroidism and will not have to deal with the return of hyperthyroidism (Menconi, Marcocci, & Marino, 2014).


Biblical Perspective

When people are afflicted with a disease or disorder, many thoughts tend to become present in the mind. Some may think that they are being punished by God for the lifestyle they may be living. On the other hand, others are more accepting of their particular illness and have faith in God. They depend on doctors to give advice and guidance on the course of action. However, they believe that God ultimately controls what will happen regarding their well-being. Pathophysiology can be very complicated but it is essential to understand the process of diseases and disorders. God does not like to see His children going through adversity. This is the reason why He blessed people with knowledge about pathophysiology. He wants healthcare providers to understand diseases in order to be able to care for patients and serve as a source of information for them. When patients understand the pathophysiology regarding their ailment, they can be a blessing to someone else going through the same situation. God may take people through illness as a test to strengthen their faith in Him or to use their story as a testimony to uplift others. Isaiah 40:29 states, “He gives strength to the weary and increases the power of the weak.” Pathophysiology can be looked at as that source of strength given to us by God. It gives the afflicted a better understanding and the treatments available which is providing strength and power.


Conclusion

Hyperthyroidism is a well understood disorder that can be treated aggressively when the appropriate actions are taken. Healthcare providers have the responsibility of teaching their patients about hyperthyroidism as well as ensuring they know about all possible treatment options. The quality of life for an individual with hyperthyroidism is promising. The lack of initiative will be detrimental and lead to acquiring many other health problems. Hopefully those affected will take the information given to them and apply it to the best of their ability.


References

  • Capriotti, T., & Frizzell, J. (2017).

    Pathophysiology: Introductory concepts and clinical perspectives,

    Philadelphia, PA: F.A. Davis.
  • Chuma-Bitcon, V., & Gruson, D. (2016). The role of laboratory diagnostics in patient management for Graves’ disease.

    Medical Laboratory Observer, 48

    (7), 28-33. Retrieved from https://eds.a.ebscohost.com.nexus.harding.edu/ehost/pdfviewer/pdfviewer?vid=1&sid =b4b5f51a-5c7a-4e0a-9965-cab120789950%40sdc-v-sessmgr01
  • De Leo, S., Lee, S.Y., & Braverman, L.E. (2016). Hyperthyroidism.

    Lancet, 388

    (10047), 906-918. doi:10.1016/S0140-6736(16)00278-6
  • Hyperthyroidism (Overactive thyroid). (2016).

    National Institute of Diabetes and Digestive and Kidney Diseases

    . Retrieved from http://www. niddk.nih.gov/health-information/endocrine-diseases/hyperthyroidism
  • Jastrzebska, H. (2015). Antithyroid drugs.

    Thyroid Research, 8

    (1). doi: 10.1186/1756-6614-8-S1-A12
  • Kravets, I. (2016). Hyperthyroidism: Diagnosis and treatment.

    American Family Physician,93

    (5), 363-370. Retrieved from http://www.pdfs.semanticscholar.org/8000/d629a10dbf38665d073a5091c35fc202995f.pdf
  • Menconi, F., Marcocci, C., & Marino, M. (2014). Diagnosis and classification of Graves’ disease.

    Autoimmunity Reviews, 13

    (4), 398-402. doi: 10.1016/j.autrev.2014.01.013

Misuse and Addiction of Opioids

/in /by


Opioids Abuse

Basically, too much of opioid use is harmful. Unfortunately, opioid abuse has affected the healthcare system. Over the years, the healthcare sector has conducted multiple studies to develop new and better treatment methods and drugs for various health problems. These surveys have yielded positive results including the identification of medications that have addressed serious health problems. For instance, the discovery of opioids was a breakthrough in pain management (Lutz & Kieffer, 2013). However, some people realized these drugs could serve other purposes other than medical reasons, thus leading to their abuse. Even though opioids are essential in pain management, they are among the drugs abused widely. The challenge has created a healthcare ethical dilemma regarding whether caregivers should continue prescribing opioids and expose patients to the risk of abuse or discontinue their use by patients.  Therefore, it is important to analyze the issue by focusing on its pros and cons in order to establish the possible impacts and resolutions.


Opioids and their Use in Disease Treatment and Management

Opioids are a class of drugs that include heroin, fentanyl, morphine, codeine, hydrocodone, and oxycodone (Centers for Disease Control and Prevention [CDC], 2017, par. 1). The drugs are derived naturally from the opium poppy plant, though; some opioids like fentanyl are synthetic, since they are manufactured in the laboratory and have the same chemical structure as naturally occurring ones. Some opioids, like heroin are illegal in several countries. However, others like morphine, fentanyl, codeine, hydrocodone, and oxycodone serve medical purposes especially for treating severe pain (Government of Canada, 2018, p. 1).


Pros and Cons of Opioids Use

The primary advantage of opioid use is its medicinal value. Prescription opioids are used for medical purposes especially, in the management of pain. They provide strong analgesia for moderate-to-severe pain during and after surgical operation. The opioids that are used often in pain controlling include oxymophone, hydrocodone, oxycodone, codeine, morphine, and fentanyl (CDC, 2017, par. 1; Government of Canada, 2018, par. 1). These drugs work by triggering the brain to release endorphins, which interact with pain receptors to reduce one’s perception of pain. Therefore, opioids block pain receptors, which prevent the brain from perceiving pain sensations.

The opioids receptors are distributed in the brain, spinal cord, and various peripheral nociceptors. The three receptors include the mu, kappa, and delta. The mu modulates mechanical, chemical, and thermal nociception at a supraspinal level. The kappa modifies spinally mediated thermal nociception and chemical visceral pain. The delta receptors are responsible for modulating mechanical nociception and inflammatory pain opioid agonists, which include morphine, meperidine, fentanyl, sufentanil, alfentanil, remifentanil, hydromorphone, codeine, oxycodone, oxymorphone, methadone, and propoxyphene. The drugs bind predominantly to the mu receptor to activate analgesia (Lutz & Kieffer, 2013, p. 196). This working principle makes opioids highly preferred medications for pain management. To achieve optimal results, the drugs are commonly administered intravenously. However, other common administration routes include subcutaneous, intramuscular, epidural, transmucosal, intrathecal, and transdermal. Owing to their role in pain management, opioids, which are narcotics, are often used by patients who have advanced cancer.

The release of endorphins by the brain relates to some pleasurable feelings. Since opioids stimulate the brain to release endorphins, they have the advantage of relaxing people through a powerful sensation of well-being. Naturally, physical activities and orgasm trigger the release of beta-endorphin, which binds to the mu-opioid receptors to promote positive feeling. Notably, the natural beta-endorphin binds to the same receptors where pain medicines or opioids such as morphine fix. Therefore, taking opioids help in improving the mood to overcome sadness or lowliness feelings owing to the released beta-endorphin. Importantly, the natural beta-endorphin does not cause addiction or dependence, which makes it different from other forms.

However,, the use of opioids has various disadvantages. For instance, prescription opioids have numerous side effects including drowsiness, constipation, sedation, nausea, vomiting, respiratory problems, and urinary retention (Government of Canada, 2018, par. 3). Notably, these side effects are likely to have adverse effects on the patient’s outcomes and satisfaction.

The abuse of opioids is among the significant disadvantages of this drug. As discussed earlier, opioids have a relaxing effect through mood elevation. This aspect encourages people to use these drugs for non-medicinal purposes. Consequently, the prescription and administration of opioids increase the risk of abuse when the patients experience the relaxing effect. The prolonged use creates addiction, dependency, and the risk of overdose, which could be fatal in the long-term (National Institute on Drug Abuse [NIDA], 2018a). The persistent use of the drug for over one year increases the risks by five percent (National Institute of Health [NIH], 2018). Therefore, the statistic implies that about five percent of people who use opioids for medical purposes are at risk of overdose, dependence, and abuse. Fortunately, treating this addiction can be through prescribers monitoring patients and subjecting them to regular screening especially, if the victim has used the drug for over one year (NIH, 2018). These steps are essential to prevent the undesired effects of abuse and overdose.

The misuse and abuse of prescription opioids occur in three forms. First, a patient may take medicine in a different way from how the doctor prescribed (NIDA, 2018a). The type of abuse could happen once the patient experiences the pleasurable feelings associated with the regular use of the drug. Second, the abuse of the prescription occurs when someone takes the medicine that belongs to another patient (NIDA, 2018a). Primarily, it involves stealing or borrowing prescription medicine from another person in order to experience the relaxing feeling. Eventually, the person abusing the drugs prevents the patient from completing the prescribed dose, which deters the medicine from working suitably and achieving their intended results. Third, abuse of opioids can also occur through purchasing and taking the drugs without a prescription to experience the relieving feeling. This form of drug abuse is the most common in society, since people buy these drugs from pharmacies especially, in countries where the sale of opioids is not highly regulated (NIDA, 2018a).

The addicts take opioids in different forms and administration routes. For instance, some swallow the drug in the normal form while others inject the liquid into their blood vessels. The latter usually crush the pills and mix the content with water, and after dissolving, they inject the mixture into a vein for the drug to enter directly into the bloodstream. Some people snort the powder (NIDA, 2018a). Regardless of the administration route, taking opioids without a doctor’s prescription is dangerous and predisposes a person to irreparable harm including death.

In the United States, approximately 115 people die daily due to opioid overdose (NIDA, 2018b). The history shows the severity of the health problem associated with opioids. In the late 1990s, pharmaceuticals increased the prescription of opioids pain relievers with the assurance that addiction was not a health challenge. Consequently, the action had an adverse impact on society, since there was widespread use and misuse before the government and other health-related agencies realized opioids were highly addictive and prone to abuse. The overdose rates were excessively high. For instance, in 2015, about 33,000 Americans succumbed to overdose of opioid like powerful fentanyl that is an artificial opioid (NIDA, 2018b).  Furthermore, about two million people suffered from health problems associated with the misuse of opioids. An additional half a million people had disorders related to the abuse of heroin (NIDA, 2018b). Notably, these statistics reveal the intensity of the disadvantages associated with using opioids for medical purposes especially, relieving pain. Unfortunately, the justified use increases the risks of dependence, addiction, overdose, and health consequences. An overdose happens when one takes the drugs in excess, which slows down or stops breathing, thus leading to unconsciousness or death in case the affected person does not seek medication immediately.

The statistics also show the intensity of the problem in society. Estimations indicate that between 21% and 29% of patients who take opioids for the management of chronic pain misuse the drugs. Notably, 8% to 12% of these patients suffer from disorders associated with opioids use while about 4% to 6% eventually transition to heroin, which is more dangerous (NIDA, 2018b). There is a strong relationship between heroin use and abuse of opioids, since eight in every ten heroin users had a history of misused opioids (NIDA, 2018b). The overdose and abuse of opioids are on the rise globally with the United States experiencing 30% to 54% between 2016 and 2017 depending on the city and state (NIDA, 2018b). Therefore, there is a dire need to address this health challenge and prevent it from harming more people in the society.

The abuse of opioids has serious health complications. For instance, it is linked with neonatal abstinence syndrome (NAS), which occurs when pregnant women misuse opioids during pregnancy. NAS is a health condition whereby the newborn withdraws from the drugs that they were exposed to when in the womb (Government of Canada, 2018). Addictive drugs usually cause this problem. Studies conducted in the United States discovered that children born with NAS increased by five times between 2000 and 2012 and the figures were in line with the dramatic surge in the maternal abuse of opioids (NIDA, 2015). The rise in the incidence contributes to the government’s spending of about $1.5 billion to treat NAS (NIDA, 2015). Therefore, the misuse of opioids misuse has severe health and cost implications.


Possible Resolutions

The health issues associated with abuse of opioids like overdose, dependence, and death, requires a collaborative effort from different stakeholders. Various agencies and healthcare organizations have presented solutions to this issue. For instance, the American Academy of Family Physicians (AAFP) recommends continuing education among the primary caregivers on the safe use of opioids, since they balance between the management of chronic pain and the risks of misusing the drugs (AAFP, 2018). Notably, opioids are essential in pain management thus, it is impossible to discontinue their use without inventing a better pain management system. Therefore, the family physicians and other primary caregivers must assess a patient’s risk of drug abuse before prescribing opioids. In case patients need the drugs, health care professionals must provide education regarding the health consequences of abusing opioids, subject the patients to regular screening, and treat when signs of dependence emerge.

The prevention against the misuse of opioids mainly focuses on five areas. First, the increased access to treatment for drug overdose and dependency alongside recovery services for patients (NIDA, 2018b). The priority concentrates on people who suffer from opioid abuse and dependence. Second, emphasis should promote drugs meant to reverse opioid abuse, misuse, and addiction (NIDA, 2018b). These drugs reverse the adverse effects thus, supporting the patients to overcome the problem. The first two approaches fall under reactive measures category, since the action is taken after the problem occurs. However, proactive and predictive measures would yield better results by preventing the occurrence of opioid abuse, misuse, and dependency.

Health care professionals prevent the occurrence of the problem through improved public health surveillance. The strategy involves continuous monitoring of the risks associated with opioid abuse and implementing appropriate preventive measures such as providing public health and education (NIDA, 2018b). The approach intends to create public awareness regarding the consequences of abusing opioids, as well as the available help in society for people at risk. Consequently, it becomes possible to influence healthy lifestyle whereby people start using opioids according to the physician’s prescription and avoid illegal use.

The persistence of the problem is largely based on the realization that the drugs form the primary management method for chronic pain. Therefore, efforts to addressing the abuse of opioids require the formulation of alternative and highly effective pain management systems. The United States Department of Health and Human Services is already collaborating with research institutions and healthcare professionals to establish improved and safe pain management practices with the aim of lowering the use of opioids (NIDA, 2018b).

Importantly, there are evidence-based non-pharmacological techniques for managing chronic pain. However, the complementary therapies for pain management require skills among caregivers, patients, and family members. Therefore, there is a dire need to promote these non-pharmacological techniques through education and training in the effort to reduce opioid prescription. The approach should focus on available non-pharmacological methods, their effectiveness, applications, and benefits.  Knowledge acquired through training and education of the primary caregivers will empower them to offer non-pharmacological pain management techniques to replace opioids especially, when they realize the increase in the risks of addiction.


Conclusion

Opioids are commonly used for pain management. However, their prolonged use increases the risk of abuse, since they stimulate the brain to produce beta-endorphins that create a pleasurable and relaxing feeling. Indeed, the misuse and addiction of opioids are serious and growing health challenges with severe implications including death from overdose. Therefore, combating this problem requires a collaborative and multidimensional approach that focuses on preventing and curing. Importantly, research is underway to develop better and more effective pain management systems in the effort to replace or lower opioid prescriptions. Furthermore, researchers have established better and improved treatment options for people suffering from opiate abuse and addiction. Moreover, efforts are also required through other methods, especially education. The addiction prevention strategy should concentrate on educating caregivers and patients about the alternative and non-pharmacological approaches for managing chronic pain in an attempt to reduce opioid prescription.


References

  • American Academy of Family Physicians. (2018).

    Pain management and opioid misuse.

    Retrieved on November. 4, 2018 from https://www.aafp.org/patient-care/public-health/pain-opioids.html
  • Centers for Disease Control and Prevention. (2017, Aug. 24).

    Opioid basics

    . Retrieved on November.4, 2018 from https://www.cdc.gov/drugoverdose/opioids/index.html
  • Government of Canada. (2018, Aug. 23).

    About Opioids

    . Retrieved on November. 4, 2018    from https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/about.html
  • Lutz, P., & Kieffer, B. L. (2013). Opioid receptors: Distinct roles in mood disorders.

    Trends in Neurosciences, 36

    (3), 195-206. doi:

    10.1016/j.tins.2012.11.002
  • National Institute of Health. (2018a).

    Opioid addiction

    . Retrieved on November. 4, 2018 from https://ghr.nlm.nih.gov/condition/opioid-addiction#genes
  • National Institute on Drug Abuse. (2018a).

    Prescription opioids

    . Retrieved on November. 4, 2018 from https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
  • National Institute on Drug Abuse. (2018b).

    Opioid overdose crisis

    . Retrieved on November. 4, 2018 from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
  • Schirmer, A. (2015).

    Emotion.

    Thousand Oaks, CA:SAGE Publications, Inc.

Communication Strategies for Therapeutic Relationships

/in /by

This reflective essay aims to refresh critique and develop existing knowledge and understanding of communication techniques and how these transferable skills and approaches can build therapeutic relationships with a patient that lies within the scope of professional boundaries. This essay identifies in a role play video clip the different approaches to building therapeutic relationships and traces the barriers that prevent the nurses from engaging in such a relationship. In addition to the above, it offers an analysis of both vignettes critically reflecting on their therapeutic skills and approaches. It will draw in on my own personal experience from clinical practice and the skills developed with the assistance of Borton’s reflective model.

It is indispensable that nurse’s caring for children, adolescents, adults and their families develop and maintain effective communication techniques as it makes it central to the provision of compassionate, trusting and collaborative therapeutic relationships. Reflecting and critiquing can be viewed as an in-depth examination reviewing an experience so each stage can be described, explored, assessed and be accordingly used to inform and change future practice. Evaluating the main communication skills and approaches to building therapeutic relationships identified in the video, it is clear to distinguish between who is a good nurse and who is not. The nurse’s in the video should serve as client advocates and as part of an interdisciplinary team whose members may have different ideas about priorities of care. The techniques used by the first nurse were poor and her approach created a stressful relationship between nurse and patient. In the beginning, the nurse doesn’t offer any form of recognition which is easy to criticize as acknowledging the patient and indicating awareness of change would have shown that the nurse saw Mrs. Miller as an individual. Giving information such as “Hello, My name is…” can build trust which is key in later on forming a therapeutic relationship and building a better rapport.

Mrs. Miller was “really uncomfortable” as she was left unattended too all night. The nurse exhibited non- accepting gestures such as rolling her eyes and not maintaining eye contact. Non-accepting gestures can create barriers between nurse and patient as it can imply to them that the nurse does not have a genuine interest in their requests and make them feel like the nurse is rejecting not only their communication but also themselves. If she had expressed an accepting gesture towards Mrs. Miller it would have conveyed that the nurse recognised and empathised with her whilst simultaneously following the train of thought. Examples of this include head nodding, eye contact, and non-judgemental facial expressions. A critical component in therapeutic nursing is active listening. The nurse does not fulfill this useful technique as she and the patient seem to continuously talk over each other. When actively listening, a nurse can hear and understand what the patient is saying, which more importantly allows for the proper interpretation and translation of what the patients expressing. Silence can enable this as it allows for the patient to focus on the issues that are of most importance and it encourages the person to put thoughts and feeling into words only if the nurse is listening passively and attentively.

A client and nurse relationship can be characterised as a partnership where both work together to improve the patient health status and fulfil purposeful objectives where they agree about the nature of the problem, develop and implement a plan designed to reach the objectives which in this case is a comfort and pain relief. Reflecting on the dos and don’ts in the video, the nurse shouldn’t have procrastinated the patient’s reasonable request. As a nurse, she didn’t offer herself to help or seem interested in what the person thought. A positive outcome in developing their relationship could have occurred if she had offered her full attention, interest, and desire to understand, without demanding anything from Mrs. Miller, leaving the offer unconditional. When Mrs. Miller expressed “I didn’t sleep all night and I kept buzzing the buzzer and the nurse would not come in”, the nurse didn’t refrain from showing a negative response as she immediately crossed her arms and said, “Well you’re not the only patient I have today”. This is a very defensive and judgemental gesture. Research shows that being defensive prevents the patient from expressing their true concerns and it is a failure in considering the patient’s feelings whilst also making them feel as if they need to defend a position, all while the nurse is just protecting herself from weakness. A therapeutic connection between the nurse and Mrs. Miller in the first vignette did not form as the development of their relationship for the nurse proved a challenge and it seemed she does not have the skills to cope with difficult reactions from her patients.

Each experience linking nurse and patient whether short or extended is an opportunity for healing. Evaluating the second episode for different therapeutic techniques and communication barriers, it was straightforward to highlight the experiences and interactions that enhanced the development of this nurse and Mrs. Miller’s relationship. In the beginning of the vignette, the nurse acknowledged the patient by giving recognition i.e. “Mrs. Miller, you were resting. I didn’t want to disturb you”. You can see that respect for this nurse is crucial to the care and quality of a patient’s experience, where each component of the person is recognised and valued. Almost immediately the nurse sits down offering herself and giving her presence, interest, and desire to understand. The nurse actively listens to Mrs. Miller and indicates an accepting response without inserting her own values or judgements. Listening is a difficult skill as it requires you to eliminate any external noise and focus your attention on all the verbal and non-verbal messages. Mrs. Miller states how she has a biopsy procedure to get done and the nurse effectively plays the role of a functioning resource person by making the information available to her which increased her knowledge of the biopsy procedure and prepared her for what to expect, i.e. “They will put you to sleep with anaesthesia”. This seemed to enhance the wholeness and wellbeing of Mrs. Miller and facilitate in building trust between nurse and patient. Feeling as if she has someone to confide in, Mrs. Miller described an experience she had with a nurse on the night shift as “rude and awful” and when she would come in, “she would just stick her head in” and leave. The nurse passively listens, a skill which involves being present non-verbally, maintaining eye contact whilst head nodding and then she actively listens by reflecting and directing questions back to Mrs. Miller by restating what she had said “so you felt like you weren’t cared for?. This approach conveys to Mrs. Miller that the nurse has listened and understood what the client’s basic message was whilst also allowing for her to get a clearer idea of what she has said. After Mrs. Miller revealed her ordeal in the hospital during the night, the nurse showed compassion towards her by placing her hand on hers and expressed her sincerest apologies, “I am so sorry that happened to you”. A critical component of therapeutic nursing and communication is the act of touch. The laying on of hands and touch can demonstrate care and empathy but it is also central to the idea of healing.

The nurses use of various therapeutic and communication approaches to help Mrs. Miller express her idea’s and feelings in a way that demonstrates respect and acceptance enabled the development of a therapeutic relationship between nurse and patient, which was solely influenced in a positive way by their interactions. It is easy to say that from the video even brief encounters like this one can be therapeutic. Patients can act out when stressed about upcoming procedures or if they are in pain but it requires a mature and patient nurse to transfer their skills and knowledge with the therapeutic use of one’s self to respond in healing ways in less than ideal situations.

My clinical nursing practice experience in Parklands care home provided me with the opportunity to work with real patients, experience a nursing home environment which I may now pursue once I have earned my degree and it offered me the chance to learn how to work with fellow nurses and other members of the healthcare team, but most importantly it presented me with numerous moments to deliver individualised and holistic care by the use of therapeutic touch. Below there will be subheadings based on Borton’s 1970’s Reflective framework, where I have critically reviewed on how I developed the use of therapeutic touch in my placement.



What? :


What I have learned is that there is a required need for other alternatives to pharmacological therapy among older adults with dementia due to their harmful side effects. The therapeutic use of touch offers a non-pharmacological treatment which can decrease behavioural symptoms such as restlessness. What surprised me was how the use of touch can provide a healing effect and make the residents feel my “caring nature” and what I hoped for at Parklands was for the residents to believe that I took into consideration all of their needs.



So what? :


So, the important message I have gained an understanding in during my experience is that touch is a nursing intervention and so, what I have learned is that residents were more responsive to a good listener, touch and a reassuring word as it communicated to them that I cared, especially as the therapeutic use of touch affectionately transmits warmth.

So, what I need to know more about is that with touch there has to be acceptability and that may vary from person to person as I have to take into consideration their culture and background. Experience in completing more clinical practices will develop my self-awareness.

Before I used to believe touch was an invasion of privacy and could be interpreted wrongly as ‘sexual’ to the resident. So, the ideas of what I had previously thought about touch have changed as it can facilitate comfort and healing.



Now what? :


Now what I can do with my new perception is connect with my patients by offering myself with a simple application of touch which portrays a genuine interest. Experience will be beneficial as I will be enhancing my self-awareness and knowledge base around the use of therapeutic touch and this will give me confidence when interacting with members of a multidisciplinary team and patients themselves.

Reviewing both vignettes showed how each experience we have with our patients can be healing and helpful but also harmful and unfeeling. Mastering the skills required for developing a therapeutic relationship is a lifelong process assisted by reflection which can be viewed as an impersonal scrutiny and valued judgement of your work or another’s using an objective approach which is to highlight you or your colleague’s strengths and weaknesses. When engaging a therapeutic relationship and effectively using the different approaches and techniques such as touch, active listening, and recognition you can help your patient achieve harmony, peace of mind, body, and spirit.

PSY 665 PRINCIPLES OF PERSONAL & HUMAN RESOURCE MANAGEMENT – ENTIRE

/in /by

Description

PSY 665 Week 1 Assignment, Hostile Work Environments

PSY 665 Topic 1 DQ 1 and 2

PSY 665 week 2 Assignment, Selection and Hiring Process

PSY 665 Topic 2 DQ 1 and 2

PSY 665 Week 3 Assignment, Equal Employment Laws

PSY 665 Topic 3 DQ 1 and 2

PSY 665 Week 4 Assignment, Employment Performance Project – Part 1

PSY 665 Topic 4 DQ 1 and 2

PSY 665 Week 5 Assignment, Employment Performance Project – Part 2

PSY 665 Topic 5 DQ 1 and 2

PSY 665 Week 6 Assignment, Employee Performance Project-Part 3

PSY 665 Topic 6 DQ 1 and 2

PSY 665 Week 7 Assignment, Organizational Culture Comparison

PSY 665 Topic 7 DQ 1 and 2

PSY 665 Week 8 Assignment, Personnel Termination Process

PSY 665 Topic 8 DQ 1 and 2

Explain how the environmental factor you selected can potentially affect the health or safety of infants.

/in /by

Explain how the environmental factor you selected can potentially affect the health or safety of infants.

Details:

To prepare for this assignment view the following brief video from the American Medical Association titled, “Health Literacy and Patient Safety: Help Patients Understand.” The video can be accessed through the following link:

https://youtu.be/cGtTZ_vxjyA

Part I: Pamphlet

1) Develop a pamphlet to inform parents and caregivers about environmental factors that can affect the health of infants. 2) Use the “Pamphlet Template” document to help you create your pamphlet. Include the following: 3) Select an environmental factor that poses a threat to the health or safety of infants. 4) Explain how the environmental factor you selected can potentially affect the health or safety of infants. 5) Offer recommendations on accident prevention and safety promotion as they relate to the selected environmental factor and the health or safety of infants. 6) Offer examples, interventions, and suggestions from evidence-based research. A minimum of three scholarly resources are required. 7) Provide readers with two community resources, a national resource, and a Web-based resource. Include a brief description and contact information for each resource. 8) In developing your pamphlet, take into consideration the healthcare literacy level of your target audience.

Part II: Pamphlet Sharing Experience

1) Share the pamphlet you have developed with a parent of an infant child. The parent may be a person from your neighborhood, a parent of an infant from a child-care center in your community, or a parent from another organization, such as a church group with which you have an affiliation. 2) Provide a written summary of the teaching / learning interaction. Include in your summary: 3) Demographical information of the parent and child (age, gender, ethnicity, educational level). 4) Description of parent response to teaching. 5) Assessment of parent understanding. 6) Your impressions of the experience; what went well, what can be improved.

Submit Part I and Part II of the Accident Prevention and Safety Promotion for Parents and Caregivers of Infants assignment by the end of Topic 1.

While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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

You are required to submit this assignment to Turnitin.

Does Work Overload Justify Negligence

/in /by

  • Muhammad Qasim


I


ntroduction

According World Health Organization (WHO), Pakistan is one of the 57 countries with acute deficiency of healthcare workforce and with no well-defined human resource development policy in place. The country is facing dual burden of communicable and non-communicable diseases with Doctor to patient ratio of as high as one doctor per 1254 population (WHO, 2013). The health care’s facilities remain overcrowded by patients, specially the public sector, which result in work overload and stress among the healthcare professionals. Medical officers (MOs) and Post graduate trainees have duty hours as long as 90 hours per week. Healthcare professionals under stressful condition and work overload are more prone to commit negligence and medical errors. The consequences of medical negligence range from a minor harm to loss of human life. This paper will discuss medical negligence, malpractice in relation to work overload in the light of ethical principles and theories. Moreover, some recommendation will be put forward to minimize negligence, establish proper reporting system and minimize work overload among healthcare provider.


Scenario

A 27 years old male was admitted to the general surgery ward with gunshot injury. He was on injection Nalbuphine10 mg as per need. This patient was constantly complaining of severe pain. The assigned nurse assessed his pain and informed the doctor about his condition. She also informed that the patient has already received Nalbuphine up to its maximum limit i.e. four doses in the last 8 hours. The doctor was overwhelmed with the workload of ward and emergency unit as well. He told the nurse that the patient and his family are exaggerating the condition. Meanwhile, the doctor visited the patient and informed the nurse that he has reassured the patient and his family. After one hour, the patient developed breathing difficulty and went into respiratory arrest. Patient was resuscitated promptly for twenty minutes, but he did not revive, and hence expired. The family showed a strip of tablets Lorazepam 2mg, and added that two tablets are given to the patient on the advice of the duty doctor. It was found that the drug was neither mentioned in patient’s file nor was it verbally ordered to the nurse. The doctor requested not to report the incidence. Later on inquiry revealed that consequences occurred due to additive effect of concurrent CNS depressants.


Issue Analysis

In the above scenario, the patient was in acute pain, the family was worried about his restless condition. His cries and complaints were disturbing other patients in the units. Doctor was burdened with too many responsibilities and had to manage the patients in ward, recovery room, and emergency department at the same time. Being overwhelmed with too many responsibilities he advised two tablet of Lorazepam 2 mg per oral without mentioning in patient file without considering the prior high deses of Nelbuphine. Consequently, due to the additive effect of the concurrent CNS depressants patient collapsed, and after an attempt of unsuccessful cardio-pulmonary resuscitation (CPR) patient expired. This was violation of ethical principles of beneficence and non-maleficence.

Moreover, the doctor’s intention was not to harm the patient however, he bypassed the nurse, did not indicate the order in patient’s file, and handed over written prescription to the father of the patient. The poor father brought the medicine and gave to the patient, which resulted in fatal consequences. It was breach in his duty toward his patient and violation of Hippocratic Oath (Cruess & Cruess, 2014). It is also evident from the scenario that doctor wanted to just keep the patient calm and get rid of his pain complain. So, he prescribed a high dose of another sedative medicine for the sake of his ease. Though his intentions was not to harm the patient and was also over loaded with too many responsibilities but, my question is, does work overload justify negligence which cost a human life?


Discussion

Malpractice is negligence on part of an individual within a professional capacity. According to Beauchamp and Childress (2001) negligence is the absence of due care either intentionally imposing risk of harm or unintentionally but, carelessly in a given situation.

Principle of beneficence is central to healthcare and healthcare professionals are expected to be beneficent toward their patients in any circumstances. According to Mustafa (2013) “Beneficence refers to the promotion of welfare, denoting acts of mercy, unstinting love and selfless humanity” (p.2). However, in this case the doctor not only failed to be beneficent but also committed such an act which resulted in sentinel event. He prescribed the CNS depressant beside he knew that the patient had already received 40 mg of nelbuphine since morning. It was the commission of a maleficent act on his part which, resulted in loss of a precious human life (Beauchamp & Childress, 2001). Being in the professional boundary of a doctor, he was trusted upon by the patient and family and was expected to be beneficent toward patient in any case.

On contrary, it could be argued that, his intention was not to harm the patient. He just wanted to keep the patient in rest and pain free. In Addition, doctor was overburdened with other responsibilities. He had to take care of other patients so, on the bases of utilitarian theory he was justified to take into consideration the care of other patients as professional obligation. Additionally, it was not only the patient but also the worried family members and other patients in the ward who were disturbed due to his cries and complains. So his decision of prescribing sedative pills was for the benefit of large number of people (Beauchamp & Childress, 2001).

Though, his workload was more than usual, and he had to fulfill too many responsibilities at a time. However, it neither allows him to be negligent in patient care, nor permit him to violate Hippocratic Oath in which, he had promised that “he will lead his life and practice his art with integrity and honor by using his power wisely” (Zafar, 2006). His action was deficient as compared to a reasonable and prudent professional under given circumstances (Burkhardt and Nathaniel). Moreover his act was a serious carelessness and maleficent in nature for the client which cost his life. Such negligence is not justifiable on the basis of any legal or moral grounds.

Secondly, he bypassed on duty nurse who was responsible for the administration of the medication. It was breach of duty on his part to fail to enter the order in patient’s file. Being responsible for patient’s care, and employ of the institute, he was supposed to follow due course of actions of patient care. Moreover, the concurrence of opiates and sedatives would not have occurred if the doctor had followed proper procedure of prescription.

On other hand, it could be claimed that, the ultimate goal of his decision was to relieve suffering of patient. Violating proper procedure of prescription and administration was probably intended to provide prompt relief. However, the nurse could have moved with the doctor in his visit to the patient to argue on the dosage about concurrence. Furthermore, the doctor might have thought about giving prescription to the patient’s attendant will take less time and so prompt relief; he therefore broke the chain of flow of proper protocol.

The society expects professionally and morally sound decisions from the doctors. As a part of healthcare team, they are supposed to follow the policies and abide by the rules of the institute they work in. furthermore, “patients have the right to a quality of care which is marked both by high technical standards and by a humane relationship between the patient and health care providers” (Exter, 2009). In the scenario, the doctor’s noncompliance regarding proper procedure of prescription was below the acceptable standards and violation of his professional obligation. According to American medical association the doctor’s responsibilities include to be ever vigilant for the benefit of patient, and to bear their part in sustaining its institutions and burdens” (Cruess & Cruess, 2014). A large number of doctors’ misjudgments and medication errors are corrected by dispensing pharmacist or medication nurse if proper protocols are followed (Al-shara, 2011).

Finally, his request to the nurse about covering the incidence was a professional misconduct as this was a sentinel event. However, the nurse properly followed the virtue of veracity and dared to report the incident. Resultantly, the inquiry revealed that the additive effect of the concurrent CNS depressants was due to negligence in clinical judgment and careless behavior of the doctor.

It could be argued that the incidence occurred unintentionally, and its reporting could endanger the doctor’s carrier. In addition, reporting of the incidence could have cost his job and even his license of practice. Is it acceptable to take such risks in a country like Pakistan where there is already shortage of doctors?

The negligent behavior of the doctor cost a precious human life, even though he requested the nurse not to uncover the incident. This could be measured a serious misconduct and makes his trustworthiness and moral integrity questionable. According Pakistan medical and dental council the physicians need to attempt highest level of competence and all necessary skills and knowledge, and they will be responsible for their actions (Zafar, 2006).Considering the nature of the event, it was the moral and professional obligation of the nurse to report the incidence promptly. Proper reporting system could prevent future mishaps. Nurse was right in her decision to report the incident on the basis of utilitarian theory for benefit of long number of prospective patients (Burkhardt and Nathaniel, 2008).


Recommendation

Healthcare providers need to be competent, skillful, and vigilant to provide efficient care to the patients. They should comply with the Hippocratic Oath and trust and expectations of the society. Sound knowledge of bioethics and Islamic ethics can make a difference and should be the part of curricula across the disciplines of healthcare. Proper policies, procedures and protocols need to be implemented and monitored for compliance at institutional, provincial and country level. The government must consider the establishment of new institutions and policy for staffing and scheduling of healthcare professional to cater the needs of growing population and minimize work overload. The proper reporting and analysis should be carried out following an incidence.


Conclusion

In the conclusion, malpractice on the basis of work overload could not be justified on any moral or legal grounds. Healthcare professionals should comply with the entrusted expectations of patients and society. They are expected to demonstrated optimal level of clinical and professional competencies and skills to meet challenges of the respective professions. Human life is precious and should always be respected.


References

Al-Shara, M. (2011). Factors contributing to medication errors in Jordan: a nursing perspective. Iranian journal of nursing and midwifery research, 16(2), 158.

Barach, P., & Moss, F. (2001). Delivering safe health care: safety is a patient’s right and the obligation of all health professionals.

BMJ: British Medical Journal

,

323

(7313), 585.

Beauchamp, T. L., & Childress, J. F. (2001).

Principles of biomedical ethics.

(5th ed.). New York: Oxford University Press.

Burkhardt, M. &Nathaniel, A. (2008).

Ethics and Issues in Contemporary


Nursing

(3

rd

ed.) Australia: Delmar

Cruess, R., & Cruess, S. (2014). Updating the Hippocratic Oath to include medicine’s social contract. Medical education, 48(1), 95-100.

Exter, A. (Ed.). (2009). International Health Law and Ethics: Basic Documents. Maklu.

Scheffler, R. M., Liu, J. X., Kinfu, Y., & Dal Poz, M. R. (2008). Forecasting the global shortage of physicians: an economic-and needs-based approach. Bulletin of the World Health Organization, 86(7), 516-523B.

WHO (2007).

Global Health Observatory Data Repository

. Retrieved from World Health Organization website:

http://apps.who.int/gho/data/node.main.A1444?lang=en

Zafar , M. H. (2006). Pakistan Medical & Dental Council: Code of Ethics. Retrieved April 8, 2014, from

http://www.pmdc.org.pk/Ethics/tabid/101/Default.aspx#6