The Reflective Report Audit Trail Nursing Essay

/in /by

I wish to reflect on the whole learning activities that I have been done for this module in this reflective report. I have learned a few strengths and potential weaknesses of myself which would help me in my future journey. I derive five important skills while go through this process which are communication skills, presentation skills, teamwork, time management and critical thinking. All these skills are useful for me to uncover my strengths and weaknesses which I can refer back on my working life.

Communication skills

This is not my first time doing a presentation, but it is the first time I have a group with the international students. Normally, my group members are my Chinese friends. At first, I found it was difficult to talk with my group members and to express my ideas. I did a lot of simple grammar mistakes and I am always the one who talks too little during our discussions. I think my group members are having problem to understand what I am saying. Therefore, I felt distressed and anxious for coming to discussions.

However, they have given me ample opportunities to learn to communicate my points and thoughts. According to Collins and Miller (1994), “self-disclosure is the act of disclosing personal information to another people.” To develop a good communication in a relationship, self-disclosure is one of the important mechanisms. I believed that a good relationship is based on trust so I decided to let my group members to know things about myself. I remember feeling uncomfortable when I did some of the mistakes, but my group members were not judgemental and helped me to solve the problem. After this, I felt that by sharing opinion and thought with each other can really strengthen my confidence. I am glad that the wall which blocking me from communicate with others had been removed and I am able to speak out my opinion now.

As pointed out by one of my lecturer, Mr Mahathir, good communication in the workplace will maximise work efficiency. From his past experiences, I learn that we must not being shy to meet the boss because the boss is the one who evaluate our performance in the workplace. Having good communication might also benefit me in my later on working life as I can ask for help from colleagues when having problems.

Presentation skills

Although I managed to finish my speech during first presentation, I think my performance was not very well. Overall presentation as a group was good because my group members presented confidently and able to provide convincing answers when questions were asked by the tutor. I definitely found that a presenter must have great knowledge of the topic so that he can elaborate it by himself without looking at notes. I had a problem with this in my presentation. I involved all the information in such a limited presentation. I think I should make the information more relevant to the audience in my future presentations.

Besides that, nervousness is a major problem for me. It wasn’t my first time to speak in the public but I still felt nervous and resulted in me left out some parts that I was going to say. I think that it can be solved with experience and confidence. Therefore, I should overcome this weakness. After a couple weeks of practicing, this was reflected during my presentation as I was successful in explaining the proposed solutions to my peers. I made eye contact with the audience, and was able to acquire their attention towards my presentation. Hence, I would say that I think I did above average for my presentation and I am happy with my performance. However, I do believe that there is still much room for improvement such as research more tools (eg Youtube) to use and make it simplistic yet complex.

Since I have had rehearsals for a couple of times, I believed that I was well prepared for my presentation. This resulted in one of the main strengths of my presentation was that my verbal messages were presented quite fluently. Also, I felt that I projected my voice effectively throughout my presentation and this is really the main cause of my satisfaction with my presentation. This is because I have received feedback from my classmates that the volume of my voice was not loud enough when I was speaking. I am glad that I have managed to speak at an appropriate volume. I liked my slides as well, as I felt that its simple layout was easy on the eyes and yet, it still managed to be visually attractive.

I realise that the delivery of the presentation is important for its success and the key to delivering a good presentation is practice, confidence, have an interest and knowledge of the topic, not memorized the whole things. I have reflected on my strengths and weaknesses, and I am ready to perform better in the near future.

Teamwork

Working in group can be more trouble as conflicts may occur during discussion; however, I think it provided an opportunity for us to understand other people’s point of view. This exactly happened in my group as we always discuss the questions together at first. Each of us had different opinions so that the end result will be a combination of best ideas. I am glad that we were able to finish our presentations quickly yet maintain good quality.

I learned that communication, trust and leadership are the three main components of a strong teamwork skill. Good communication enables the group to perform well and each member must trust one another so that progress can be made efficiently. A team without a leader will result in fail. This module has contributed the improvement of my teamwork skills. I have learned to be an effective team member which requires active participation in group discussions. Through the group presentations, I believe that my experience can be readily applied into future working environment because high level of teamwork is important in today’s workplace. Overall it has been very learning experience for me because teamwork allows me to be involved and participate in equal ways. This helps to broaden my thinking to achieve the best outcomes and able to collaborate with others in the future.

Time management

One of the major challenges that I faced is time management. Time management is one of the skills that no one will teach you in school but you have to learn it. I was the worst procrastinator because I would put things off until the very last minute. That turned into me having a lot of late work, or not very good quality work. One of my lecturers had mentioned that, “When it comes to time management it is important to find a system that works for you.” I think that I could improve my time management skills making a schedule. It was very beneficial to keep a schedule. Instead of cramming everything all at once, set a schedule helped me to get better grades.

I believe that as mentioned earlier, having a calendar that states those deadlines will help motivate me because all the deadlines are visibly in sight. I can also track the progress of my assignments by categorizing the tasks and see which stages I am in at the current progress. I have to always remember that we may delay, but time will not. I believe that proper planning is the key to managing my time well. With proper planning, I can prepare to take on the task mentally. Thus, time management is a very valuable skill in today’s society.

Critical Thinking

As for critical thinking, Taylor (1992) stated that “it is a result of reflecting on one’s learning and developing a meta-awareness by reflecting on one’s thoughts, feelings and actions.” Critical thinking is considered to be one of the most important indicators of student learning quality. For me, I learned to think critically when I was doing the report. I analysed the issues and gave evidence to support my opinions. I have learned a lot of critical thinking through doing this report. Although it is not an easy experience but it helped me to understand the pros and cons of every possible outcome and to value them according to the goals that I wanted to achieve.

When I apply critical thinking concepts in the workplace, I will develop more ideas, make fewer mistakes and reach better decision. We know that not only the managers have the responsibility of taking decisions, but people at all levels into an organisation may also call to face and resolve problems. I think it also has a good impact on the relationship between colleagues. By using critical thinking, I can enjoy the benefits throughout my life in the future.

(1500 words)

Why are states experimenting with different models of integrated care?

/in /by

Why are states experimenting with different models of integrated care?

Paper, Order, or Assignment Requirements

Case Study – Health Care Payment and Delivery Reform in Minnesota Medicaid

Read the case study and prepare a paper that addresses the following:
• What is an accountable care organization (ACO)?
• What makes Minnesota unique in terms of a model for health system reform?
• Why are states experimenting with different models of integrated care?
• Are ACOs a viable model to reduce the rate of growth in per-capita Medicaid spending? Why or why not?

Include five current scholarly references (not more than five years old).

Features of Intellectual Disability- and Interventions

/in /by



INTELLECTUAL DISABILITY

C:UsersDELLDesktopIMG-20131206-WA0000.jpg


Mr. Basavaraj S Hukkeri


Assistant Professor

D. Y Patil college of Nursing, Kolhapur

Intellectual disability (ID), once called mental retardation, is characterized by below-average intelligence or mental ability and a lack of skills necessary for day-to-day living. Mental retardation refers to significantly sub average general intellectual functioning resulting in or associated with concurrent impairment in adaptive behavior and manifested during the development period

What is intellectual disability?

Intellectual disability has limitations in two areas. These areas are:


  • Intellectual functioning


    (IQ):

    this refers to a person’s ability to learn reason, make decisions, and solve problems.

  • Adaptive behaviors:

    is defined as the degrees with which the individual meets the standards of personal independence and social responsibility expected of his age cultural group.


Classification

Intelligent quotient is the ratio between Mental Age (MA) and Chronological Age (CA).

Intelligence quotient is measured by an IQ test. The average IQ is 100.


Classification of Mental Retardation based on Intelligent Quotient


TYPE


INTELLIGENT QUOTIENT

Mild(Educable)

50-70

Moderate(Trainable)

35-50

Severe(Dependent)

20-35

Profound(Life support )

<20

To measure a child’s adaptive behaviors, a specialist will observe the child’s skills and compare them to other children of the same age. Things that may be observed include how well the child can feed or dress himself or herself; how well the child is able to communicate with and understand others; and how the child interacts with family, friends, and other children of the same age.

Intellectual disability is thought to affect about 1% of the population. Of those affected, 85% have mild intellectual disability. This means they are just a little slower than average to learn new information or skills. With the right support, most will be able to live independently as adults.


Signs and Symptoms

Generally speaking, the symptoms of mental retardation include delays in oral language development, deficits in memory skills, difficulty learning social roles, difficulty with problems solving skills, decreased learning ability or an inability to meet education demands at school, failure to achieve the markers of intellectual development and a lack of social inhibition.

However, symptoms of mental retardation will vary depending on the condition’s severity. For instance, while signs of mild retardation (i.e., those with IQs of about 52 to 79) may include a lack of curiosity and quiet behavior, signs of severe mental retardation (i.e., those with IQs of about 20 to 35) may include infant-like behavior throughout the patient’s life, and those with profound mental retardation (i.e., IQs of 19 or below) are likely to have limited motor and communication skills and require lifelong nursing care.

The symptoms of mental retardation are broken out by the level of the condition below.


  • Mild intellectual disability

    : From birth to age six, these children are able to develop social and communication skills, but their motor skills are slightly impaired. In late adolescence, they can usually read at a sixth-grade level. They are typically able to develop appropriate social skills, and adults can often work and support themselves, though some of these individuals may require assistance during times of social or financial stress.

  • Moderate intellectual disability:

    Children with this condition who are six years old or younger can talk and communicate, but usually have poor social awareness. Their motor coordination is fair, and adolescents can learn some occupational and social skills. Adults can sometimes support themselves and hold down a job, though they often require guidance and assistance during stressful periods.

  • Severe intellectual disability:

    Young children with this condition have limited speech abilities, though they can usually say a few words. Their motor coordination is mostly poor. While adolescents can communication with others and can learn simple habits, they typically require lifelong guidance and assistance with daily activities.

  • Profound intellectual disability:

    Young children with this level of mental retardation have very little motor coordination of often require nursing care, which can last a lifetime. Adolescents have limited motor and communication skills.


Causes

Intellectual disabilityaffects about 1% to3% of the population. In India, 5 out of 1000 children’s are MR (The Indian Express, 13

th

March 2001) Causes of intellectual disability can include:

  • Infections (present at birth or occurring after birth)
  • Genetic Factors (such as Down syndrome)
  • Environmental (Child Abuse)
  • Metabolic (Wilsons Disease)
  • Nutritional (malnutrition)
  • Trauma (before and after birth)
  • Unexplained (this largest category is for unexplained occurrences)

Diagnosis

To meet the criteria for the diagnosis of Mental Retardation, three areas must be considered.


  1. Onset must occur before 18 years of age.

    In addition, the person must have

  2. Below average general intellectual functioning.

    General intellectual functioning is defined by the intelligence quotient (IQ) obtained by assessment with one or more of the standardized, individually administered intelligence tests. The choice of testing instrument and interpretation of results should take into account factors that may affect test performance, such as sociocultural background, native language and associated communication, and motor and sensory handicaps. Specialized tests may be used to measure other aspects of development. Intellectual impairment is categorized by four degrees of severity. These classifications suggest the types of interventions that would be appropriate and offer clues as to long-term outcome.


Mild retardation:

Mild retardation: IQ level 50-55 to approximately 70 (85% of people with mental retardation are in this category)


Moderate retardation:

IQ level 35-40 to 50-55 (10% of people with mental retardation)


Severe retardation:

IQ level 20-25 to 35-40 (3 – 4% of people with mental retardation)


Profound retardation:

IQ level below 20 or 25 (1 – 2% of people with mental retardation)


  1. Significant limitations in adaptive functioning

    in at least two of the following skill areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health and safety.

Prevention

  1. Genetic counseling: screening during pregnancy
  2. Social Nutrition programs
  3. Preventing exposure to lead, mercury, and other toxins reduces the risk of disability.
  4. Infectious diseases: For example, rubella syndrome can be prevented through vaccination. Avoiding exposure to catfeces that can cause toxoplasmosis during pregnancy helps reduce disability from this infection.


What about School?

Early intervention programs are essential to maximize the children’s potential development. This necessitates early recognition and referral. Teachers have opportunity to evaluate children’s in school. Some of these skills include:

  • communicating with others.
  • taking care of personal needs (dressing, bathing, going to the bathroom).
  • health and safety.
  • home living (helping to set the table, cleaning the house, or cooking dinner).
  • social skills (manners, knowing the rules of conversation, getting along in a group, playing a game).
  • reading, writing, and basic math and as they get older, skills that will help them in the workplace.

Supports or changes in the classroom (called adaptations) help most students with mental retardation. Some common changes that help students with mental retardation are listed below under “Tips for Teachers.” The resources below also include ways to help children with mental retardation.


Tips for Parents

  • Learn about mental retardation. The more you know, the more you can help yourself and your child. See the list of resources and organizations at the end of this publication.
  • Encourage independence in your child. For example, help your child learn daily care skills, such as dressing, feeding him or herself, using the bathroom, and grooming.
  • Parents are taught behavior modification techniques to decrease to eliminate problematic behavior.
  • Give your child chores. Keep his/her age, attention span, and abilities in mind. Break down jobs into smaller steps. For example, if your child’s job is to set the table, first ask him/her to get the right number of napkins. Then have him/her put one at each family member’s place at the table. Do the same with the utensils, going one at a time. Tell him/her what to do, step by step, until the job is done. Demonstrate how to do the job. Help her when she needs assistance. Give your child frequent feedback. Praise your child when he or she does well. Build your child’s abilities.
  • Find out what skills your child is learning at school. Find ways for your child to apply those skills at home. For example, if the teacher is going over a lesson about money, take your child to the supermarket with you. Help him count out the money to pay for your groceries. Help him count the change.
  • Find opportunities in your community for social activities, such as scouts, recreation center activities, sports, and so on. These will help your child build social skills as well as to have fun.


Tips for Teachers

There is now an increase use of more specialist teaching and variety of innovative procedures for teaching language and other methods of communication.



Hints for successful skill training

  • Give the student immediate feedback.
  • Divide each training activity into small steps and demonstrate.
  • Start the training with what the child already knows and then proceed to the skill that needs to be trained.
  • Reward his effort even if the child attains near success.
  • Give the training regularly and systematically.
  • Use training materials which are attractive, appropriate and locally available.

Treatment

  • Environmental supervision
  • Programs that Maximize Speech, language, social, psychomotor, cognitive and occupational skills.
  • Ongoing Evaluation.
  • Parental counseling and supportive psychotherapy.
  • Behavior management.


REFERENCES

  1. Townsend M, Psychiatric Mental health Nursing, 6th ed. New Delhi: Jaypeee Brother Publications ; 2013:chap 4.
  2. The Arc of the United States American Association on Mental Retardation (AAMR)

Discuss how you are able to evaluate current primary research and apply the concepts to your nursing practice.

/in /by

Discuss how you are able to evaluate current primary research and apply the concepts to your nursing practice.

Introduction:

A professional portfolio will showcase your knowledge and skills to prospective employers and will increase your marketability as a baccalaureate-prepared nurse. This portfolio will help you, as a nurse, home in on the concepts, strengths, and critical-thinking abilities that define professional nursing practice. Throughout your time at WGU, you have developed skills and knowledge that distinguish your practice as that of a baccalaureate-prepared nurse. Items that display your skills and knowledge will be showcased in this professional portfolio. You should organize your portfolio around the four areas of professional nursing practice: quality and safety, advanced evidence-based practice, applied leadership, and community health. This portfolio will expand on the portfolio you already created in your Professional Roles and Values course.

When you are ready to submit your portfolio for evaluation, please follow the “How to Submit Your Portfolio for Evaluation” document below.

Requirements:

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. Use the Turnitin Originality Report available in Taskstream as a guide for this measure of originality.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Complete the following, using the Web Folio Builder (in Taskstream) that you used to create your portfolio in the Professional Roles and Values course:

Note: The Web Folio Builder can be found on the “Folios & Web Pages” link located in the static bar below the WGU logo.

1. Create a professional mission statement (suggested length of 1 paragraph) that includes the following:
? representation of your career goals, your aspirations, and how you want to move forward with your career
? overview of where you would like to focus your time and energies within the profession
a. Reflect on how your professional mission statement will help guide you throughout your nursing career.
2. Complete a professional summary (suggested length of 3–4 pages) that includes the following:
a. Explain how the specific artifacts or completed work or both in your portfolio represent you as a learner and a healthcare professional.
b. Discuss how the specific artifacts in your portfolio represent your professional strengths.
c. Discuss challenges you encountered during the progression of your program.
i. Explain how you overcame these challenges.
d. Explain how your coursework helped you meet each of the nine nursing program outcomes.

Note: Refer to the attachment below titled “Nursing Conceptual Model.”

e. Analyze how you fulfilled the following roles during your program:
• scientist
• detective
• manager of the healing environment
f. Discuss how you have grown professionally since the beginning of your program.

B. Complete the following within the section “Quality and Safety”:
1. Reflect (suggested length of 1 page) on your professional definition of quality and safety developed in Professional Roles and Values, including any necessary changes to your definition.
a. Discuss how the program assisted you in developing your professional definition.
b. Identify the artifacts in your portfolio that support your definition.

Note: The artifacts should be attached within the portfolio.

i. Explain how these artifacts support your definition from part B1.
2. Discuss the importance of the Institute for Healthcare Improvement (IHI) certificate for your future role as a professional nurse.

C. Complete the following within the section “Evidence-Based Practice”:
1. Reflect (suggested length of 1 page) on your professional definition of evidence-based practice developed in Professional Roles and Values, including any necessary changes to your definition.
a. Discuss how the program assisted you in developing your professional definition.
b. Identify the artifacts in your portfolio that support your definition.

Note: The artifacts should be attached within the portfolio.

i. Explain how these artifacts support your definition from part C1.
2. Reflect (suggested length of 1 page) on your understanding of evidence-based practice and applied nursing research by doing the following:
a. Discuss how you are able to evaluate current primary research and apply the concepts to your nursing practice, considering the following:
• relevancy and believability of data
• differences between quality improvement and research (places and uses of each)
• differences between primary and secondary research and resources and the implications of each in clinical practice
b. Explain how your experience in the program helped you achieve excellence in evidence-based practice.

D. Complete the following within the section “Applied Leadership”:
1. Reflect (suggested length of 1 page) on your professional definition of applied leadership you developed in Professional Roles and Values, including any necessary changes to your definition.
a. Discuss how the program assisted you in developing your professional definition.
b. Identify the artifacts in your portfolio that support your definition.

Note: The artifacts should be attached within the portfolio.

i. Explain how these artifacts support the definition from part D1.
2. Summarize (suggested length of 1 paragraph to 1 page) your Learning Leadership Experience task by doing the following:
a. Discuss the importance of professional collaboration for effective nursing leadership.

E. Complete the following within the section “Community Health”:
1. Reflect (suggested length of 1 page) on your professional definition of community and health you developed in Professional Roles and Values, including any necessary changes to your definition.
a. Discuss how the program assisted you in developing your professional definition.
b. Identify the artifacts in your portfolio that support your definition.

Note: The artifacts should be attached within the portfolio.

i. Explain how these artifacts support the definition from part E1.
2. Summarize (suggested length of 1 page) your Community Health task by doing the following:
a. Discuss what you learned during your Community Health Nursing task.
b. Discuss what you learned led to your community diagnosis.
c. Discuss how your initial focus and diagnosis evolved after working with your population.
3. Discuss the importance of the American Museum of Natural History (AMNH) certificate for your future role as a professional nurse.

F. Provide an appendix to your portfolio by doing the following:
1. Include all the documents, prior assignments, and additional items that are examples of your best work to support your mastery of all sections given in parts B, C, D, and E.
2. Include the following materials:
• the attached “Nursing Conceptual Model”
• a link to the current IHI Course Catalog
3. Provide an updated professional résumé.

Note: If you have a LinkedIn account, you can take a screenshot and include a copy with the rest of your documents.

4. Provide professional references, using one of the following:
• a professional reference questionnaire
• a full letter of recommendation
• a list of four professional references
5. Include a copy of your IHI certificate of completion.
6. Include a copy of your AMNH certificate of completion.

Sexually transmitted infections and the elderly

/in /by

Sexually transmitted infections and the elderly

Paper guidelines

Written Assignment
Select one of the following maternal-child health issues. Provide a complete and thorough explanation to the following questions.
An introductory and conclusion paragraphs are required.

Option 4: Sexually Transmitted Infections and the Elderly
Abstract
Introduction
Prompt One-Provide an overview of this issue, identifying the statistical data.
Prompt Two-What are the care issues/challenges associated with elderly women who are diagnosed with sexually transmitted infections.
Prompt Three-Develop a prevention teaching plan for the elderly population.
Prompt Four- Discuss the impact that sex enhancement drugs have on this issue.
Prompt Five-As a future nurse (include three roles of the nurse), how would you plan to address the issue?
Conclusion
Appendix
Handout

Coppin State University

Directions for the paper/writing assignment:
1. You want to prepare this assignment in APA 6th edition format, must have at least five sources-two-three recent articles and at least two internet sources. You cannot use WebMD, HealthyMinds, emedicinehealth or Wikipedia. You need to use a quality internet source that has an identified author or Nationally/Internationally recognized organization.
2. Must have an introduction and conclusion
3. Use the questions for this assignment as subheadings in APA format. The question prompts serve as the body of the paper.
4. Paper should not exceed five (5) page excluding cover and reference page
5. Paper needs to be submitted by the posted due date. Need two (2) hardcopies and one TurnItIn attachment. The paper will not be graded if it is not submitted using TurnItIn and providing the hard copies.
6. If you quote, it must be limited to no more than 80 quoted words. Direct quotes are allowed, but must be limited to the 80 quoted words. You are required to use quotation notes. Ideally, the wording of the majority of the paper should be paraphrased. The document must be considered at least 70 percent original thought. Failure to achieve this standard will result in a grade of zero.
7. Do not submit the rubric with the assignment.
Grading Criteria Possible Points 100 Your
Score
1. Title Page 5
2. Abstract 5
3. Introduction 5
4. Prompt 1 10
5.Prompt 2 10
6.Prompt 3 10
7.Prompt 4 10
8. Prompt 5-Summarize and describe the impact to your future nursing practice using the roles of the nurse. 15

8. Prompt 5-Summarize and describe the impact to your future nursing practice using the roles of the nurse. 15
9. Designated Conclusion section 5
10. Reference Page-At least five sources properly referenced on reference page. 5
11. Appendix-Appropriate Handout/Literature-Client Focused 5
12. Integration of all sources throughout the paper 5
13. Adherence to APA guidelines-running head, headers, subheadings, margins, font, etc. Refer to APA manual 5
14.Grammar 5
Total 100

The role of a nurse

Please use three roles of the nurse communicator, counselor, and coordinator to do prompt five paragraph. Please follow the rubric well, call me with any question

COPPIN STATE UNIVERSITY
HELENE FULD SCHOOL OF NURSING

Course Syllabus Appendix
NURS 320 Maternal Child & Women’s Health Nursing
Spring 2015

Submitted to Curriculum January 2012, Approved by Faculty Organization January 2012
Submitted to Curriculum November 24, 2008
Approved by Faculty Organization January 2009

Coppin State University
Helene Fuld School of Nursing
Maternal Child Appendix
Spring 2015

Written Assignment
Select one of the following maternal-child health issues. Provide a complete and thorough explanation to the following questions.
An introductory and conclusion paragraphs are required.

Option 1: Cervical Cancer
Abstract
Introduction
Prompt One-Provide a brief overview of cervical cancer.
Prompt Two-What are the nursing care considerations associated with prevention and treatment of cervical cancer?
Prompt Three-Develop a teaching plan that will focus on prevention of cervical cancer.
Prompt Four-Discuss the impact of cervical cancer treatment and health care cost.
Prompt Five-As a future nurse (must include three roles of the nurse), how would you plan to address this issue?
Conclusion
Appendix
Handout
Option 2: Domestic Violence
Abstract
Introduction
Prompt One-Provide an overview of domestic violence as it relates to pregnancy.
Prompt Two-Nursing care considerations related to domestic violence assessment.
Prompt Three-Discuss the impact of battering to the individual client, newborn and the family.
Prompt Four-What are the physical and mental assessment findings that the nurse may observe in a client who has been recently battered or battered in the past?
Prompt Five-As a future nurse (must include three roles of the nurse), how would you plan to address this issue?
Conclusion
Appendix
Handout

Option 3: Ethical Issues
Abstract
Introduction
Prompt One-Provide an overview of an ethical issue such as: sustaining the mother’s life, antepartum care of the client who is 21 weeks gestation, genetic selection, Gardasil to vaccinate or not to vaccinate, contraception and/or teenage pregnancy
Prompt Two-Provide a personal perspective supporting or not supporting the ethical issue.
Prompt Three-Provide a societal perspective regarding the ethical issue.
Prompt Four-Nursing care considerations for the client including specific community organizations or community supports are available related to the ethical issue?
Prompt Five-As a future nurse (include three roles of the nurse), how would you plan to address this issue?
Conclusion
Appendix
Handout

Option 4: Sexually Transmitted Infections and the Elderly
Abstract
Introduction
Prompt One-Provide an overview of this issue, identifying the statistical data.
Prompt Two-What are the care issues/challenges associated with elderly women who are diagnosed with sexually transmitted infections.
Prompt Three-Develop a prevention teaching plan for the elderly population.
Prompt Four- Discuss the impact that sex enhancement drugs have on this issue.
Prompt Five-As a future nurse (include three roles of the nurse), how would you plan to address the issue?
Conclusion
Appendix
Handout

Option 5: Women and Heart Disease
Abstract
Introduction
Prompt One-Provide an overview of women’s health as it relates to myocardial infarction.
Prompt Two- Discuss the implications for the high mortality rate related to myocardial infarction among women.
Prompt Three-Identify nurse education related to heart disease prevention.
Prompt Four-Discuss the impact that Obama Care will have on the healthcare of women, specifically preventative healthcare.
Prompt Five-As a future nurse (must include the three roles of the nurse), how would you plan to address this issue?
Conclusion
Appendix
Handout
Coppin State University
Helene Fuld School of Nursing
Assignment Grading Rubric

Directions for the paper/writing assignment:
1. You want to prepare this assignment in APA 6th edition format, must have at least five sources-two-three recent articles and at least two internet sources. You cannot use WebMD, HealthyMinds, emedicinehealth or Wikipedia. You need to use a quality internet source that has an identified author or Nationally/Internationally recognized organization.
2. Must have an introduction and conclusion
3. Use the questions for this assignment as subheadings in APA format. The question prompts serve as the body of the paper.
4. Paper should not exceed five (5) page excluding cover and reference page
5. Paper needs to be submitted by the posted due date. Need two (2) hardcopies and one TurnItIn attachment. The paper will not be graded if it is not submitted using TurnItIn and providing the hard copies.
6. If you quote, it must be limited to no more than 80 quoted words. Direct quotes are allowed, but must be limited to the 80 quoted words. You are required to use quotation notes. Ideally, the wording of the majority of the paper should be paraphrased. The document must be considered at least 70 percent original thought. Failure to achieve this standard will result in a grade of zero.
7. Do not submit the rubric with the assignment.
Grading Criteria Possible Points 100 Your
Score
1. Title Page 5
2. Abstract 5
3. Introduction 5
4. Prompt 1 10
5.Prompt 2 10
6.Prompt 3 10
7.Prompt 4 10
8. Prompt 5-Summarize and describe the impact to your future nursing practice using the roles of the nurse. 15
9. Designated Conclusion section 5
10. Reference Page-At least five sources properly referenced on reference page. 5
11. Appendix-Appropriate Handout/Literature-Client Focused 5
12. Integration of all sources throughout the paper 5
13. Adherence to APA guidelines-running head, headers, subheadings, margins, font, etc. Refer to APA manual 5
14.Grammar 5
Total 100

Clinical Logs
Each student is expected keep a Log and bring the Log when they are scheduled for their Clinical Evaluation.

Section 1-Resume
Section 2-Self Reflection-Weekly
Section 3-Skills Checklist
Section 4- Antepartum, Intrapartum, Postpartum and Newborn Prep Sheets
Section 5-Care Plans
Section 6-Research (Submit two articles or Evidence-based Guideline and one paragraph reflection)

Medication Worksheet-Independent Assignment-Students are required to be familiar with the medications as a part of clinical preparation. These medications will be tested as a part of examinations as appropriate as well as on the quiz.

Trade Name of Medication Generic Name Use Route Side Effects Nursing Implications
Albuterol
Aldomet
Ampicillin
Apresoline
Bethanechol Urecholine
Bicitra
Brethine Terbutaline
Caffeine
Celestone Betamethasone
Cervidil
Cleocin Clindamycin
Colace
Demerol
Dilaudid Hydromorphone
Duramorph
EMLA
E-mycin
Fentanyl
Flu Vaccine
Gardisil
Gentamycin
HBIG
Hemabate Carboprost
Hepatitis Vaccine
Indocin Indomethacin
Insulin
Labatelol
Lidocaine
Lortab
Magnesium Sulfate
Marcaine
Methadone
Methergine Ergometrine Contraindicated with history of HTN, Heart Disease, Retained Placenta, Pre-Eclampsia or Eclampsia
Misoprostol (Cytotec) E1 Analog Prostaglandin
Motrin
Mylicon Simethicone
Narcan Naloxone
Nubain Nalbuphine
Percocet
Phenergan Promethazine
Pitocin Oxytocin No contraindication when administered postpartum
Prepidil
Procardia
RhoGam
Seconal
Stadol Butorphanol
Survanta
Syntometrine Ergometrine and Oxytocin
T-Dap
Tetanus
Tylenol
Vancomycin
Vistaril/Atarax Hydroxyzine
Vitamin K
Yutopar Ritodrine
Zofran

Should obese people pay more for medical treatment

/in /by

Obesity is an incredibly expensive disease, both for the patients and the hospitals. Aside from being a disease which is associated with many further complications and problems, which themselves lead to an increased cost, this disease also requires costly medication and specialised equipment for diagnosis and treatment. This results in a condition which has proven extremely costly to nearly all parties involved. It has been reported that £47 million was spent purely on anti-obesity drugs in the fiscal year of ’06 to ‘07.1 This figure, coupled with the fact that the prevalence of adult obesity in the U.K. is above 20 per cent and set to rise10, signifies the incredible cost associated with this disease and, in turn, highlights the growing problem of obesity on a social and economic scale. It’s a problem that can’t be ignored, and throughout the course of this paper I will attempt to weigh and evaluate both sides of the argument; Should obese people pay more for medical treatment?, in order to find a resolution.

First, before jumping in to the crux of the question, it is imperative to establish the importance of the NHS as well as its core principles, in order to allow a fully in-depth analysis of the question at hand. The NHS, which is the primary healthcare provider in Great Britain, was set up in 1948 with one of its key principles being; “the health service will be available to all and financed entirely from taxation, which means that people pay into it according to their means.”2 It is important to stress the word all in the sentence. This word refers to the nation as a whole, regardless of their medical condition. The importance of the NHS clearly can’t be stated enough, a nationwide health service which aims to treat all without directly taking money from the patients, is vital to maintaining the infrastructure of the country. It would seem then that the very nature of this question would oppose the core principles established in the set-up of the NHS, however in the recent light of the current economic situation and even proposed budget cuts3, the question raised could one day become a reality.

It is important to first define and explain obesity ahead of tackling the ethical dilemma which is the title of this paper. One definition would simply be “too much body fat on an individual”, while this is somewhat accurate, it is also incredibly basic and not at all scientific. The BMI (body mass index) measurement is one of the most straightforward and useful techniques to establish the condition of obesity. The BMI is calculated by correlating a relationship between the height and weight of an individual, it is used by many organisations around the world such as WHO and NHS. The formula for calculating the BMI is:

The results gained from the BMI can be classified in table 1 in order to specify the particular weight class of an individual.

Classification

BMI (kg/m2)

Principal cut-off points

Additional cut-off points

Underweight

<18.50

<18.50

Severe thinness

<16.00

<16.00

Moderate thinness

16.00 – 16.99

16.00 – 16.99

Mild thinness

17.00 – 18.49

17.00 – 18.49

Normal range

18.50 – 24.99

18.50 – 22.99

23.00 – 24.99

Overweight

≥25.00

≥25.00

Pre-obese

25.00 – 29.99

25.00 – 27.49

27.50 – 29.99

Obese

≥30.00

≥30.00

Obese class I

30.00 – 34.99

30.00 – 32.49

32.50 – 34.99

Obese class II

35.00 – 39.99

35.00 – 37.49

37.50 – 39.99

Obese class III

≥40.00

≥40.00

Table 1. adapted from WHO

While the use of the body mass index to calculate a person’s weight class is used worldwide it has a fair number of shortcomings and flaws. For instance, this table of classification for BMI is not gender specific, so it is applied the same for both males and females equally, as well as this, it also doesn’t account for weight distribution in individuals nor is it possible to consider bone or muscle mass, both of which are heavier than fat. These problems will hold more significance later in this essay while discussing how obesity should be defined.

Obesity is caused by a variety of different factors. These include genetic susceptibility, socio-environmental factors, malfunctioning appetite regulation or may also be a cause of other diseases, such as Cushing’s syndrome.7 While it was previously thought that obesity was caused by a lack of willpower or a lifestyle choice, more recent studies have discovered that obesity is a chronic disease, involving a number of different biochemical and metabolic processes compared to individuals who aren’t obese.8

As stated previously, obesity is linked to many more serious health conditions and illnesses. Examples of these include diabetes mellitus, increased cholesterol, coronary heart disease and hypertension amongst many others.7 It is important to discuss the seriousness of these resulting conditions in order to fully comprehend the fatality of obesity. Diabetes mellitus (otherwise known as type II diabetes) is a serious condition which occurs when the body either does not produce enough insulin or the cells do not properly react to the insulin produced. This condition is said to affect approximately 2 million people across England and Wales, supposedly with a further 750, 000 unaware that they have this condition.4 Type II diabetes can also lead to kidney disease, nerve damage or even strokes. Coronary heart disease is another serious condition which can be caused because of obesity, which affects almost 300, 000 people a year in the U.K.11

There are multiple actions that can be taken in an attempt to treat or cure obesity. These include dietary therapy in order to regulate the number of calories taken in by an individual, and to maintain that over a long-term period. Other methods which may be used in conjunction with this may be increased exercise, to burn off calories, weight loss surgery, such as gastric band surgery or possibly drug therapy, which is often used as a last resort. It should be noted that not one of these methods are able to fully treat obesity alone, instead they must be used in unison depending on the severity of the disease and also the individuals diagnosed with them.

It apparent that obesity is an incredibly complicated disease in terms of the causes, secondary factors and treatments, all of which contribute towards a confusion regarding the nature of obesity in the minds of the public as well as upping the cost due it’s many treatment techniques, none of which can be considered 100 per cent effective. This encompasses all of the aspects of the disease, which is often described as an epidemic, as it’s a growing concern, and the economic burden attached is sure to evoke strong opinions regarding the question of this paper.

Now that the importance of the health care system has been established and the medical significance of obesity has been recognised, the essay question itself can be discussed. The initial views on this topic are polarising, with some instantly believing that the obese should pay more for the disease that they’ve inflicted upon themselves, believing that it is unfair that the rest of the nation should pay the cost. Others believe that they shouldn’t pay the financial cost, stating that the NHS was set up to help all, despite whether or not their condition is self caused. The argument can even be pushed further, extrapolating that smokers, drinkers and even athletes would also have to pay for the medical costs for their diseases or injuries, because, by that same logic, these conditions are also self inflicted. Although there are certainly some truths to be had in these two contrasting opinions, the two sides of the argument will be investigated and examined on the grounds of ethicality, societal and fairness in an attempt to bring about some form of a resolve on this controversial topic.

One of the primary factors for the argument for obese people having to finance the treatment of their medical condition is that the disease they are burdened with is self inflicted, which is to say that they literally brought it on themselves, so should therefore have to deal with the consequences. While there is some validity in this argument, it isn’t quite as black and white as it may initially sound, with many further complexities set to arise. Those that oppose this argument, are likely to call discrimination, as this ideology that separates a certain type of people from the rest and forces them pay more, which is highly unjust. Also, by this same reasoning, and in the issue of fairness, other patients with self inflicted disease should also have to pay more for conditions and illnesses which they have brought upon themselves. Such conditions would include lung cancer for smokers, liver disease for those who drink as well as injuries to sports players and athletes, as these are all, to some degree, self inflicted.

A counter point to this counter point would be that smokers and drinkers already pay more through an increased tax for the drugs (i.e. cigarettes and alcohol) which lead to the individual diseases, so an alternative, or possibly in addition, to forcing obesity patients to have to pay for medical treatments would be to raise the tax on foods with an increased calorie count. This may also be used to deter away from choosing these unhealthy foods as well as generate income from those who cost the NHS so much money in its treatment for obesity. However, this would result that members in the public that fall in to the “normal” weight range would also have to pay the increased tax for these same foods, if they choose to occasionally indulge. This, at first glance, seems like a fair compromise, as smokers who don’t cost the NHS with treatment for smoking related disease still have to pay the tax on cigarettes, however, the idea comes full circle that people who aren’t obese are still having to pay lifestyles of the obese, indirect as it may be, which is one of the main points evoking the question at hand.

There is evidence to suggest that those who are obese are also more likely to be in lower paid jobs, and as such, have less expendable income. This may be because those with lower income are more likely to live in poorer areas and where healthier, more nutritious foods aren’t as readily available or outside of their budget. This may also be due to a discrimination present against people who are obese and overweight. Employers may be more likely to hire those who aren’t overweight as they see their ability to resist overeating or staying in shape as a good quality in what Acs, Lyles and Stanton (2007) describe as a “willingness to delay gratification.” Whatever the reason may be for the correlation between being overweight and having lower income, the fact remains that the lack of capital possessed by the obese population would prove to be incredibly troublesome if obese people were to finance their medical treatment in this manner. The case for increasing the tax of unhealthy foods may be less applicable as it may push both healthy foods and unhealthy foods out of reach for poorer and obese population financially. To overcome this, healthier foods have to be made cheaper and more widespread, which may again be difficult given the nature to produce healthier and organic foods are likely to cost more. Even so, it would seem any loss made would surely help the NHS spend less on obesity, which, in the 2007, was estimated at £4.2 billion.6

The basis for this particular argument is on essentially boils down to the thought that “obese people are obese solely because of their own doings”, which many people believe to be an accurate portrayal of reality. However, this statement by no means holds true to the complete population of obese people. There is a genetic link associated with obesity, with the inheritable risk of obesity thought to be approximately 30%.7 Many genes have been found that code for weight control hormones, and a defect in these genes may be passed on the offspring, thereby increasing the chance of obesity in that child.5 This would bring about many more questions and dilemmas concerning the topic at hand. For instance, what if the cause for obesity was mainly genetic as opposed to being environmental? Should the patient still pay more even though, by definition, this type of obesity isn’t necessarily “self-inflicted”? Some may answer this question by stating that those with genetic factors shouldn’t pay, however, what if both social and biological factors play an equal role in the cause of an individuals’ obesity? Or, further expanding on the idea that those found to have the genetic link shouldn’t pay, how would the “obesity genes” be examined in the patient? Genetic testing may be carried out, but performing these tests on the entire to obese population in order to determine who should pay these costs would itself be costly, therefore being counter-productive where one of the primary aims of the question raised is to cut back on money being spent.

There are also further complications regarding this wide held belief that obesity is self-inflicted. Are cases where individuals are driven to high calorie, comfort foods because of bullying or depression, be considered self-inflicted? Also, who should pay the cost for cases of childhood obesity? While some may point the fingers at the parents, one would have to ask if that is at all fair. For instance, parents aren’t sentenced for the crimes that their children commit. Evidence exists which associates an addiction to eating (as well as other addictions) with mental illnesses.9 Should these cases also have to pay for medical treatment themselves? By this same merit should schizophrenics and patients with other mental conditions have to finance their treatment?

There are a host of other problems and issues which are presented if this question is to be seriously considered. The question of affordability and practicality surely arises when applying the theoretical question to a real-world scenario. If obese patients were to pay directly for their medication, surgery or weight-loss programs then how much should be charged? It would surely have to be a fairly significant amount as the cost of obesity itself is already at an extremely costly figure.6 Having to pay for medical treatment may create a divide between patients who can and can’t afford the costs, possibly adding another level of discrimination. And what if patients are unable to meet the expense of these bills? Should they be denied treatment? Anything beyond entertaining this idea would bring about huge moral dilemma’s, as the hospitals would essentially be playing God, deciding who lives and dies, based purely on their financial background.

Also, the practicality of such a situation is likely to bring up further complications, with one question being; how should it be charged? The NHS wasn’t set up to accept payments in this particular manner, so how could this be accomplished? Would the patients need to pay before their medication or surgery? If so, and the patient does not pay, it will again bring up the concept of denying treatment to patients. There is also the possibility that patients would pay post-surgery. But if they refuse to pay or can’t afford it, then some form of policing body would need to be enforced to ensure these payments are made. While this will cost more money, again a problem given the nature of the question is to decrease the money spent, it also sends out an image of the NHS reminiscent of some sort of mobster loan shark.

Another issue when considering this subject is the concept of defining obesity. Earlier I have stated the use of the BMI system to define obesity the world over, as well as outlining its fundamental flaws. A concern with defining obesity with the use of the BMI scale is that the differences between being classified as overweight or obese may literally be a few inches in height or a few kilograms in weight. This may very well create scenarios where a person may be a few inches shorter than another who is the same weight having to pay more for treatment. This could possibly be countered by measuring obesity by more methods than simply BMI alone, which is currently in place to diagnose obesity by the NHS. Other methodologies may also have to be in place in order to diagnose or differentiate between different classes of obesity. These could possibly include calculating the waist-to-hip ratio (WHR), Waist circumference (WCR) and Skinfold thickness.7 together these allows for a more accurate representation of a patients’ physical status, allowing to charge for medical treatment accordingly, if that path were to be taken.

It is clear that any attempt to find a solution to this question brings up series of arguments and counter points which negate and nullify each other, and instead of establishing a concrete plan of action, it would seem that the wisest and safest bet would be to sit on the fence. My personal opinion on the matter would be to increase the tax of unhealthy foods and make healthier foods readily available and at an affordable price as well as pushing for a more active lifestyle, something akin to the change4life scheme recently set up by the government. Though this isn’t without flaws, it certainly seems to reach a form of middle ground in term of ethics and equality. One of the main aims of the NHS was to treat all patients who pay tax, so forcing a section of people to pay more, regardless of whether or not the condition is self inflicted, opposes its key ideologies as well as being highly discriminatory. My proposed plan of action is certainly more subdued and the benefits of which would only be realised after a longer period of time, however, it strikes a fair balance between staying true to the NHS philosophy, equality for all an attempt to treat obesity and healthy lifestyle.

The report should be similar in overall style to the topic discussed in Nelson’s

Issue II (Human Organ Transplantation) above. Another example for style could

be a Scientific American article (e.g. How breast milk protects newborn

(December, 1995) by J. Newman, pp58-61).

The essay should cover the basic science, including recent developments and

ongoing research, but should focus on examination of the ethical, social and legal

issues related to the topic.

1.”More than a million anti-obesity prescriptions were issued in England in the last financial year at a cost of £47million. It means about 88,000 people could be on a course of treatment.”

http://www.thisislondon.co.uk/news/article-23406735-pills-not-the-answer-to-obesity-says-top-doctor.do

2. http://www.nhs.uk/NHSEngland/thenhs/nhshistory/Pages/NHShistory1948.aspx

3. http://www.nhs.uk/NHSEngland/thenhs/nhshistory/Pages/NHShistory1948.aspx

http://news.bbc.co.uk/1/hi/health/8012588.stm

4. http://www.nhs.uk/conditions/diabetes-type2/Pages/Introduction.aspx

5. Bouchard 1994

6. http://www.healthcarerepublic.com/news/934442/Cost-obesity-NHS-England-rise-62-billion/

Acs : 9781845425005 , obesity, business and public policy.

7. Tomlinson

8. brock

9. truth mental illness: 9780757301070

10. http://www.who.int/infobase/report.aspx?rid=118&iso=GBR&Def_Code=cd.0701&Survey_Year_End=2005&genGraphButton=Generate+Graph

11. http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Introduction.aspx?url=Pages/What-is-it.aspx

red: expand

blue: unsure

Different theories represent different worldviews, which are different ways of conceiving of knowledge

/in /by

Different theories represent different worldviews, which are different ways of conceiving of knowledge.

There are different theories in nursing and each theory highlights its position. As it stated by Blais and Hayes (2011), “Different theories represent different worldviews, which are different ways of conceiving of knowledge” (p. 97). Here are some contrasts and conceptual approaches of Jean Watson and Patricia Benner theories.
Nurses can gain their knowledge through experience without theory studying aspect. Job experience is foundation for becoming an expert. “Benner’s work focuses on developing understanding of perceptual acuity, clinical judgment, skilled know-how, ethical comportment, and ongoing experimental learning” (Alligood, 2010, p.141). There is novice to expert steps to go through. Benner believes that “skilled pattern recognition can be taught and will lead to advancement through the stages” (Altmann, 2007, p.115). Benner’s mainly concentrates on nurses not on the patient.
Over the past years nursing as a science has grown more towards human caring in the medical field. It means that modern nursing should be more humans bound. Human caring is a “normative ethical theory” or in other words a theory about what makes human actions “morally right or wrong” as points out Nel Noddings a renowned American ethicist, feminist, educationalist, and philosopher (Crowley, 1994, p. 75). Theorist Jean Watson continued and developed this idea and declares that “caring in nursing practice” is one of the “basic ethic and psychology’s concepts” as well (Watson, 2012, p. 42). The major concepts of Watson’s theory are love and caring, respect for person needs and wishes, as well as dignity, professionalism and problem solving. These theories represent different concepts and have the rights to take place.

Altmann, T. (2007). An evaluation of the seminal work of Patricia Benner: theory or philosophy. Contemporary Nurse: A Journal For The Australian Nursing Profession, 25(1-2), 115. doi:10.5172/conu.2007.25.1-2.114
Alligood, M. R. (2010). Nursing Theory (4th ed.). Retrieved from The University of Phoenix eBook Collection database.
Blais, K. K. & Hayes, J. S. (2011). Professional nursing practice: Concepts and perspectives (6th
ed.). Upper Saddle River, NJ: Pearson/Prentice-Hall.
Crowley, M. (1994). The relevance of Noddings’ ethics of care to the moral education of nurses. Journal Of Nursing Education, 33(2), 74-80.
Watson, J. (2012). Human Caring Science: A Theory of Nursing (2nd ed.). Retrieved from The University of Phoenix eBook Collection database.

_____________________________________________________________________________
_____________________________________________________________________________

4. (Answer post, 100 words, citation and references required)

(Someone’s post) (AT)
Re: Week 4: What contributions has nursing research made to nursing practice and health care?

Nursing research utilizes its findings into practice, which helps to apply new methods and medical treatments to patients, and, as a result increase patient care effectiveness. The main of the nursing research is to enhance patient’s satisfaction and health. Lately we are using term evidence-based research. As it stated by Blais and Hayes (2011) “It brings together theory, clinical decision-making and judgment, and knowledge of the research process; incorporating them into the evaluation of research and scientific evidence” (p. 183). It is important to have diligent sources of research, which would give an “Opportunities for providing high-quality care with accountability to clients and families are presented when practice decisions are based on scientific evidence and data” as it mentioned by Blais and Hayes (2011, p. 184). Nursing research helps to identify an issue and “Represents a systematic search for the knowledge needed to provide high-quality care” as it stated by Blais and Hayes (2011, p. 184). Research-based practice is extremely important when it comes to an appropriate care and patients feedback. Nurses and clinicians are directly involved in research process. As it stated by Blais and Hayes (2011) “Nurses in clinical practice identify the problems in need of investigation and collaborate with nurse-researchers, who design studies to address the problems identified and collect and analyze the data” (p. 186).

Blais, K. K. & Hayes, J. S. (2011). Professional nursing practice: Concepts and perspectives (6th ed.). Upper Saddle River, NJ: Pearson/Prentice-Hall.
__________________________________________________________________________________________________________________________________________________________

5. (Answer post, 100 words, citation and references required)

(Someone’s post)
Explain the relationship between nursing theory and professional nursing practice.
__________________________________________________________________________________________________________________________________________________________

6. (Answer post, 100 words, citation and references required)

(Someone’s post)
Describe the relationship between nursing research and evidence-based practice.

Individual Assignment Nursing Theory Grid.

/in /by

Individual Assignment Nursing Theory Grid.

NUR 403 Week 4 Individual Assignment Nursing Theory Grid
Resource: Nursing Theorists Grid on the Materials page of the student website

Complete the Nursing Theorists Grid for the theorist selected in Week Three.

Write in each grid cell at least 100 words of information that includes:

·The selected theorist

·The selected theorist’s theory

·The theorist’s historical background

·An overview of selected theorist’s philosophy

·An analysis of the major concepts as related to person, health, nursing, and environment

·How the theory applies to nursing practice, education, and research

·Citations from a minimum of four peer-reviewed references

Include a separate reference page formatted according to APA guidelines

Upper Extremity Pathophysiology Of Hemiplegia Health And Social Care Essay

/in /by

Stroke is the sudden loss of neurological function caused by an interruption of blood flow to the brain. Motor deficits are characterized by paralysis (hemiplegia), typically on the side of body opposite the side of the lesion. Interruption of blood flow for only a few minutes sets in motion a series of pathological events. (O’Sullivan, 2007).

There are several risk factors that decrease incidence of hemiplegia and those are regular exercise, lifestyle management, stress reduction techniques and diet.

The measurement of spasticity

The measurement of spasticity is part of the neurological examination of patients with disorders of the central nervous system. The Modified Modified Ashworth Scale (MMAS) was developed for the characterization of muscle spasticity. A study done by Naghdi S et al, (2008) determines the interrater reliability of the MMAS in the assessment of wrist flexor muscle spasticity in adult patients after upper motor neuron lesions resulted in hemiplegia.  In conclusion, the MMAS has very good interrater reliability for the assessment of wrist flexor muscle spasticity.

Ansari N in 2009 found that neurologically affected subjects may be affected by spasticity but Modified Ashworth Scale (MMAS) is a clinical tool used to measure spasticity and it has given reliable measurements between examiners when used on patients post-stroke with elbow flexor spasticity.

Spasticity is velocity and acceleration dependent, and it is therefore important to execute physiotherapeutic exercises at a relatively low and constant velocity. This can be more accurately managed by a robot than by a person when such exercises are administered continuously for more than 15-20 min. A controlled clinical by Fagekas G (2006) is under way to assess the effectiveness of the REHAROB movement therapy. According to the experiences of the first clinical investigation, the programming interface and the mechanical interface device between the patient and the robots had been improved.

Complications associated with spasticity in upper extremity-

Acute stroke patients with poor upper limb motor functions are more prone to soft-tissue injury of the shoulder during rehabilitation. Study done by Pong (2009) determines the association between the motor functions of the upper extremity and these injuries, which play an important role in hemiplegic shoulder pain and may impede rehabilitation andf to examine the hemiplegic shoulders for soft-tissue injury by musculoskeletal sonography.

Stokes L (2010) mentions that goals related to passive tasks were more often achieved than those reflecting active function. Qualitative analysis of goals nevertheless demonstrated change over a wide area of patient experience. Goal-attainment scaling provided a responsive measure for evaluating focal intervention for upper limb spasticity, identifying outcomes of importance to the individual/carers, not otherwise identifiable using standardized measures.

Current trends in spasticity management

A single case report was done with a female participant who was suffering from stroke since 2 years. According to Denham SP to neutralize spasticity botulinum toxin A (BTA) injections were given in the left upper extremity to neutralize spasticity and also other treatment approaches like occupational therapy, neurodevelopmental and biomechanical and activity based home program were added for her improvements.

According to Hurvitz EA,Conti GE, Brown SH, botulinum toxin reduced tone and increased ROM of the spastic upper extremity, the time course and degree of motor improvement appears to depend on the complexity of the task. So further studies might focus on adjunct therapy, task-specific training, in addition to botulinum toxin treatments to facilitate functional improvement of the spastic upper extremity.

Ozer K, Chesher SP, Scheker LR, saying that statistically significant differences were found in all three measures for only those treated with combined NMES and dynamic bracing. However, this significant effect lasted for only 2 months after discontinuation of the treatment. We conclude that the combined use of NMES and bracing is more effective than either alone but requires continuous application.

MRI scans were taken at rest and after upper arm exercise. Also opposition to passive movement was measured subjectively. Opposition and MRI to passive movement possibly will be useful in the evaluation of spasticity. For the progress and assessment of antispasticity treatments this might be clinically relevant. (Ploutz-Snyder L et. al., 2006)

Transcranial magnetic stimulation matched with maximum effort to make a target movement has shown to improve hand motor function in patients with chronic stroke. Some chronic patients with stroke who were unable to completely extend the affected fingers were examined in the study. (Izumi S et. el, 2008)

Study done by Zhao J (2009) to evaluate the effect of acupuncture treatment on the spastic states of stroke patients found out that control of spasticity is often a significant problem in the management of patients with stroke. These results suggested that acupuncturing surface projection zone of decussation of pyramid was effective in reducing spastically increased muscle tone and motor neuron excitability in stroke and could improve spastic states of stroke patients by providing a safe and economical method for treating stroke patients.

Botulinum toxin (BTX) treatment can relieve focal arm spasticity after stroke, presumably through dynamic changes at multiple levels of the motor system, including the cerebral cortex. However, the neuroanatomical correlate of BTX spasticity relief is not known and should be reflected in changes of cortical activation during motor tasks assessed using repeated functional magnetic resonance imaging (fMRI). This small study suggests that structures outside the classical motor system, such as the posterior cingulate/precuneus region, may be associated with the relief of post stroke arm spasticity.

Evidence based practice of different treatment strategies

A systematic review of the literature including electronic databases, primary reports, abstracts and conference proceedings followed by a literature-based evaluation was done. Till now no single valid and reliable outcome measure available to capture the full range of true function in affected upper limb. Validated tools are particularly required for passive and lower level function. Patient’s level of function and goals will be dependent on clinical evaluation.

Occupational Therapy management of hemiplegic upper extremity

Occupational therapy services were provided to a participant after botulinum toxin injections improvements 2 years. Injections are given to neutralize spasticity in the upper extremity after a stroke and the participant received occupational therapy for 12 weeks, using neurodevelopmental and biomechanical approaches and an activity-based home program. Two years after the injections, the MAS score ranged between 1 and 1+. Initially, the participant demonstrated functional limitations in areas of splint application, dressing, toileting, and bathing. Following BTA injections and occupational therapy, the participant demonstrated increased independence in all deficit areas. For this participant, BTA, combined with functional, activity-based occupational therapy interventions, was associated with neurological change and greater functional use of the spastic limb.

According to authors Sun S; Hsu C; Hwang C; Hsu P, Wang J, Yang C, constraint-induced movement therapy (CIMT) is a promising intervention for retraining upper-extremity function after a stroke. The purpose of this case report is to describe the use of a combination of botulinum toxin type A (BtxA) and a modified CIMT program for a patient with severe spasticity who was unable to use his right upper extremity

After stroke resistive exercise can improve strength. Also it will not increase spasticity. But its effects on muscle co-contraction and activation are not clear. Also on affected and non affected arms when forward reaching task was given and resisted with loads there were motor control deficits. Affected arm gave response higher that of control arm means normal arm of same individual. Although smaller increases in muscle activation and co-contraction levels that varied with load type were observed in the nonparetic arm. Few advance intervention studies are needed to determine whether loads are preferable for poststroke resistive exercise programs.

Psychosocial aspects associated with spasticity management

In USA stroke is a leading cause of long-term disability but it is difficult to understand that what its effects on quality of life are. The findings in this study are dependable with prior research demonstrating the importance of social factors to quality of life following stroke. Examiners in this study found out that measures of stroke-related quality of life should include assessment of social function and social support.

This article outlines a nonsurgical approach that includes neuromuscular electrical stimulation and dynamic bracing for the management of spastic deformity in cerebral palsy. Neuromuscular electrical stimulation is used commonly for lower extremity spasticity. Its clinical application in upper extremity spasticity, together with dynamic bracing, is a new entity providing predictable and quick short-term results with significant improvement in quality of life.

Myth discussion | History homework help

/in /by

Hello classmates and Dr C, here is my main post for the Week 1 Discussion

The function of myth is:

· (For this section discuss the ‘why’ of myths?  Why do cultures have them (all cultures do)?  What purpose does myth have?  Do they teach important cultural lessons to a people?  Do they help identify a ‘specialness’ to a culture?  Do they help explain phenomena that a culture cannot explain?  Are myths useful in bonding a group together?  Feel free to discuss any or all of these concepts in your answer)

·

Two examples of Neolithic myths are:

· ( Remember, I am looking for Neolithic myths here, so not the Greeks or Romans (they are not Neolithic cultures).  Give me some examples here, explain what the myth is.  Here are a few from the chapter that you might want to discuss)

o The myth of the San people of Zimbabwe (page 18).  Remember to always write these in your own words. Do not simple copy and paste from the  text or any other source

o The creation myth of the Maidu tribe of California (page 19)

o The emergence tale of the Pueblo (page 21)

o The creation story of ancient Japan (page 22)

· Choose any two of these and describe the myth in some detail.

·

Are myths inherently fictional or not?

· (Tell me in this section whether you believe myths are just made up, or if you think they started with some true event and then over time became these legendary stories)

·

An example of a modern myth is:

·  Please go online and search “your state Myths’  For Instance “Utah Myths” or “Texas Myths”…….Pick one and describe it… Please go a little deeper than broken mirrors, the Easter Bunny, Santa Clause or fairy tales.

Thanks

(Your first name.or name you want to be called)