Holistic Report on Older Adult and Alcohol Abuse as a Co-exsisting Problems

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1.0 Introduction

Kaumatua (older adult) identifies as the demographics age of 65 years and older (Santrock, 2014).  Currently, there are around 600,000 adults aged 65 years and older living in New Zealand. In the next ten years, there will be close to one million (Hodges, 2014a). New Zealand has the second highest portion of seniors that consume alcohol being 83 percent. Alcohol addiction was once construed as a youth to an adult problem. However, research integrates that up to 40 percent of older adults of 65 and older are being categorised as hazardous drinkers that could potentially cause hazardous consequence (Hodges, 2014b). It is estimated that 800 people in New Zealand will die each year from alcohol-related causes (Conner et al, 2013).  Mental illness affects 582,000 adults in New Zealand and are diagnosed with a common mental health disorder at some stage of their lives. Anxiety and depression disorder are the seconded leading cause of health decline in the older adult in New Zealanders and is predicted to become a major concern by 2020 (Mental Health Foundation of New Zealand, 2014).

The most common mental and neurological disorders in this age group is dementia, depression, and anxiety.  People who abuse alcohol are more likely to suffer from major depression or alcohol induced dementia (Ministry of Health, 2017a). Overall, alcohol is the fundamental substance abused in the older adults and often coincides with mental health disorders and is frequently overlooked or misdiagnosed, or there is an unwillingness to diagnose individuals because they are seen as old (Bogunovic, 2012). Older adult’s problem drinking in New Zealand tend to be classified as either, early onset or late onset drinkers (Health Promotion Agency, 2017b).

This report will discuss the holistic nature of a co-existing mental health problem, using Te Wheke, the Maori health model.  The report will analyse the effects of alcohol use in the Kaumatua (older adult) and identify effective strategies with interventions that can be installed to mediate the consequences of individuals and their Whanau/Family, Iwi and communities within New Zealand.

2.0 Definition of Co-existing problems

Mental health and substance abuse often coincide. The relationship of alcohol abuse is somewhat complicated as problem drinking can cause mental health conditions and, conversely, a mental health condition may cause problematic drinking. The two factors lead to substance and mental health problems occurring. Alcohol is strongly associated with social phobias, anxiety, depression, and dementia in the older adult in New Zealand. Alcohol addiction has a vast impact on one’s physical being.  Alcohol abuse can contribute to health problems such as cancers, cardiovascular disease diabetes and self-harm due to falls. One of the biggest risked with alcohol in the older adult is mixing their prescribed medications and alcohol (Alcohol Rehab, 2018).

3.0    Critically examine the holistic nature of co-existing problems using the Te Wheke Framework

The Maori health model designed by Dr. Rangimarie Turuki Rose Pere. The octopus and its eight tentacles represent the link between the holistic nature of the individual and whanau health, each tentacle focuses on a pacific health dimension (Ministry of Health, 2017b).

3.1   Hinengaro – The mind

Conditions such as depression, anxiety, suicide and substance misuse, delirium, dementia, and schizophrenia all fall in the contexed of mental health disorders in the older adult, but do not occur due to aging. Depression is one of the most commonly studied mental illnesses of the elderly. Depression in the elderly is believed to be associated with vascular brain changes. People with depression experience low mood and a loss of interest or pleasure, feeling extreme sadness or guilt and low self-worth, sleep disturbance and low appetite, low energy, and poor cognition. Diagnosing depression in the elderly population can be compounded by the difficulty of differentiating it clinically from dementia as dementia both present with impaired cognition fatigue, sleep disturbance and as mentioned above (Evans, Nizette, & O Brien, 2013).

3.2     Mauri – Life force in people and objects

Older adults that experience mental illness, feel that it is a private issue and are hesitant in sharing their experiences with others as they will burden their family with their depression and anxiety problems. The older adult often ignores symptoms for a long time and only seek medical help when they reach crisis point. When they are unable to concentrate and withdraw from social or whanau, they can become lethargic and no longer enjoy aspects of life they once did (Health Promotion Agency, 2018a).

3.3 Taha Whanau – Social

The reasons older adults’ social dimension is affected is related to pre-existing problems such as drinking alcohol and their bodies reduced ability to metabolise alcohol due to the normal aging process, poor sleep quality and reduced nutritional intake. Life events such as death of friends or loved ones, retirement, poverty, adverse reaction to polypharmacy, loneliness, chronic illness, disease or the feeling helpless or worthless, losing independence through illness or loss of mobility and that they are burdens to their families all contribute to social breakdown (Health Promotion Agency, 2018b).

3.4 Taha Tinana – Physical Wellbeing

Physical health is entwined closely with mental health. The mind and body are one. People with mental health disorder, subsequently this can impact their physical health and vice versa. When an older adult suffers from depression, they have a higher risk of cardiovascular disease, osteoporosis, diabetes, stroke, and Alzheimer’s disease and if they have any of the above condition, they at higher risk of developing depression. Older adults also experience a decline in their physical capabilities reduced mobility chronic pain/illness and can have many comorbidities that can potentially affect the mental health and intern affect their ability to maintain their physical wellbeing. (WHO, 2019). Furthermore, a contributing factor is substance abuse. Alcohol consumption in excess has a negative effect on short- and long-term health, one of which affects to the brain that can lead to Alzheimer’s disease or alcohol-related brain damage, dementia (ARBD). This is defined as long term memory and thinking decline due to damaged nerve cells shrinking of brain tissue and is also related to the deficiency of thiamine this affect the way your body stores nutrients (Alzheimer’s Society, 2019).

3.4   Whanaungatanga – Extended Family

Elderly people that are more socially connected with family and friends or involved in their community are happier, and are physically healthier and live longer with fewer mental health problems than people that are disconnected or isolated. Most elderly have spent many years bring up family’s, socialising and working and have found stability. However, elderly people are vulnerable to loneliness and social isolation this can be detrimental to the physical and psychological health.  This can occur due to retirement, bereavement, family, and friends moving away or losing physical capabilities to mobilise, or due not being unable to drive (Mental Health Foundation, 2019).

3.5    Wairuatanga – Spirituality

Many aged adults find spirituality and religion an important part of their identity and a strong predictor of quality of life, some ethnicities believe that mental illness is placed upon them, due to sins that they committed in their lifetime (Victoria State Government, 2018)

3.6    Whatumanawa – Emotional

Aging can bring many different emotional challenges. Loneliness is a normal phycological process that elderly people may experience and has been linked to early motility. Depression can present as server sadness, disconnection, and emotional torment. Being depressed can leave an individual feeling worthless, hopeless, many age adults see themselves as a burden to the family (National Institute of Health, 2015).

4.0   Effects of Alcohol on Individual

Hazardous and harmful alcohol consumption affects more men than women in New Zealand. Older adults are less tolerant to the effects of alcohol as the body ages, alcohol is not metabolised by the body effectively as the body muscle mass reduces also intracellular fluid and adipose tissue. This means alcohol will have a faster effect on the brain and nervous system.  Alcohol is a nervous system depressant and a psychoactive drug that enters the stomach and absorbed by the bloodstream and then metabolised in the liver by an enzyme called alcohol dehydrogenase (Health Promotion Agency, 2018). Alcohol contains ethanol or ethyl these are carcinogen that will affect every aspect of the body it will even provide a false sense of security to those that suffer from anxiety or depression, loneliness and can lead to individuals developing a dependency or addiction. If alcohol is used frequently it can cause depression as it lowers the level of serotonin being released. Alcohol also increases the risk of falls and injury, and developing cancer of the throat, oesophageal, intestines, liver and breast (CDC, 2018). It also affects eyes, nutrition, bones and muscle, coordination, cognitive function, brain tissue, nervous system and cardiovascular system (Lewis, 2016).

4.1 Alcohol and Family

When individuals have an alcohol addiction it can have a marked effect on other family members. It is not easy to live with a person with addiction as they are often full of conflict and torn between their addiction and not wanting the harm that follows. They often blame others when things go wrong and can become aggressive especially if there is hostility towards one another. Spouses and family often feel hurt and ashamed, fearful, and have a sense of failure that they are unable to make changes or their help is not received gratefully. Research shows that families affected by alcoholism are likely to have low levels of emotional bonding and excessiveness and independence. Furthermore, the older adult can become more socially isolated and experience financial hardship and are more susceptible to mental illness (American addiction centre, 2019).

4.3    Alcohol and Community

Fourteen percent of New Zealand’s population is predicted to meet the criteria for substance use disorder at some point in their life. Approximately, 23,000 people receive treatment in the publicly funded health system each year for alcohol or drug addictions in New Zealand. Between 18 -35 percent of New Zealand injury-based emergency department presentation are related to alcohol and this raises in the weekend 60 -70 percent. Alcohol misuse resulting in harm can be considerable costing between 1.5 – 2.4 billion in New Zealand. Over 100 drinking and driving offensives and arrest for intoxication and disorderly behaver, although the number of elderly people is low, it is still prevalent. Older adults who drink alcohol are at a greater risk of traffic accidents and falls. Alcohol also has an adverse effect on many commonly prescribed medications Approximately 45 percent of fire fatalities each year involve alcohol (Health Promotion Agency, 2017). New Zealand offer services for mental health and addictions that can be accessed via individuals or referrals to alcohol drug line, alcoholic anonymous or Arc Counselling services.

4.4    Alcohol – Iwi

In New Zealand, it is not uncommon to have alcohol at family gatherings as it is a part of New Zealand’s culture. Many New Zealander associate alcohol with having a good time socialising. It is also consumed in times of sorrow. In 2017 to 2018, 476 million litres of alcohol were consumed (Stats New Zealand, 2017).  Alcohol in the older adult is a growing concern for New Zealand and as stated above it is associated with violence, injury, and poor health outcomes physically and mentally. Eighty percent of Maori in New Zealand drank alcohol in the past year.  Forty-eight percent of Maori males and thirty-six percent female had a potentially hazardous drinking pattern (Health Promotion agency, 2018). The figure reveals the consumption of alcohol within Maori culture is still a concern. Kaumatua and whanau are held in high regard in the Maori culture, Iwi will hold huis and implement support services for their people that suffers from addiction (Drug Foundation, 2015).

5.0    Supportive Health Strategies

A strategy is a document that outlines the vision for the future and how it will be implemented to assisted people of New Zealand by improving or maintaining their health (Ministry of Health, 2019).

5.1    Healthy Aging Strategy

Healthy aging strategy. (2016) This strategy is closely aligned with the wider New Zealand health strategy and also has strong links with the positive aging strategy. The five New Zealand Health strategy’s that are implemented in the healthy aging strategy’s actions. Are, people-powered, closer to home, value and high performance, one team, and a smart system. The priority of the strategy is to improve the quality they live their life with a strong focus on prevention, wellness, and support for independence, and incorporating family/Whanau and community.  It gives priority to equity and support to the most vulnerable including final stages of life. It encourages communication with all services in the health profession.

The strategy recognises people age in different ways and that our population is diverse and the way older adults’ access and interact with services especially individuals affected with long term illnesses, complex needs and elderly population groups that experience poorer outcomes in New Zealand’s health system. It also looks at the need to meet the health needs and support of our increasing the ethnically diverse population. The strategy wants to ensure that people that work with older adults have adequate training and that services are available to the elderly population such as oral health, early detection of mental health, elderly with CEP have access to community mental health service with a reduced stigma attached (Healthy Aging Strategy, 2016).

The intervention is the implementation of the twenty-seven action, over the next ten years, this will provide a plan and will assist in the responsibility for improving living and the health of the older adult, as it will assist health professionals and services to implement adequate care that is suitable for our aging population (Healthy Aging Strategy, 2016).

5.2    Te Ariari o te oranga Framework

The framework, Te Ariari o te oranga. The Assessment and Management of people with Co-existing Mental Health and Substance abuse problems, (2010). The framework provides knowledge and skills to health care professionals working with CEP clients and enables health care workers to effectively respond to the client’s needs and their family’s/whanau. This also provides clinical guidance to services and health professionals. It allows relationships to build between services and staff as communication between services is proven to be fundamental to the success of the treatment CEP. There are seven key principles to the framework, wellbeing, cultural considerations, engagement, motivation, assessments of management and integrating care. The framework has five phases of treatment, Pre-treatment, early treatment, middle treatment, late treatment, and autonomous treatment. The principles can be implemented by health care professionals’ practice at each phase of care for the client. The framework has a holistic approach that incorporates Whanau, as it is recognised that whanau is the foundation of the Maori society and is the principal source of strong support, security, and identity (Todd, 2010). Te Ariari o te Oranga addresses the challenge with engaging with clients with CEP. The intervention is to establish engagement with the client and aims to reduce gaps and barriers between services. The intervention established was to aid health professional to implement the seven principles was Te Whare o Tiki, co-existing problems knowledge and skills framework, this enabled health professionals to know the level of knowledge and skill they will require when working with clients that suffer from CEP and their Whanau and assessment tools for them to assess their level of knowledge (Matua Raki & Te Pou, 2013).

5.3    Internal Strategy to Minimise Alcohol-Related Harm

Internal Strategy to Minimise Alcohol-Related Harm, (2016). This strategy is an adapted, updated version of Alcohol Harm reduction strategy of 2012.  The strategy was developed with the aim to make Auckland a safer and healthier city with reduced risk of alcohol-related harm within their community. It discusses the Auckland council wide-ranging role in actively minimising alcohol-related harm that illustrates a long term vision and desired outcomes and discusses consistencies of the minimalization of alcohol and alcohol-related harm, the strategies implements licensing and compliance, policy and bylaws  and will use New Zealand’s statistics to gauge the success of the strategy by assessing emergency admissions due to alcohol, reduction of alcohol-related motor vehicle accidence.

The vision is to work in a coordinated approach with governmental legislation and departments such as New Zealand police, health, and education as well as non- government agencies and the alcohol sector of the Auckland Council. With regularly monitor and inspections of licensed premises for compliance of sale and supply of alcohol that adheres to the Alcohol Act 2012. This will aid in the reduction of hazardous alcohol consumption and potentially reduce community alcohol-related harm (Auckland Council, 2017).

6.0   Evaluation of strategy’s

6.1   Evaluation of Healthy aging strategy

The writer believes this strategy actions will vastly improve the older adult population health with early detection of CEP and other care needs and that services are being made more available to the elderly of New Zealand. The writer believes that it is up to health care professionals to install these actions for the older adult and to recognise that the older adults have different needs at different times.  By implementing partnership, participation and protection while working in the health industry and ensuring professional obligations are met, will ensure the success of the strategy. The strategy was aimed at the older adult growing population but was not specifically aimed at reducing alcohol or mental health but had valuable areas of improving long term conditions that will, in turn, reduce adverse effects of long-term illness. The writer believes will successfully improve and prevent mental health problems.

6.2    Evaluation of Te Ariari o te oranga

The writer believes the intervention is a valuable tool to health care professionals, as it provides knowledge and a self-assessment for their existing knowledge on CEP. This will benefit them and the individuals with CEP and their Whanau. It will identify if there is a need for improvement.  As a section of the framework disclosed there are limitations in health care professional knowledge when it comes to working with people with CEP. Although the framework did not identify a pacific age group and focused on the general public a section did identify Maori and their kaumatua and other cultures. The writer believes that the early intervention and engagement is an important part of working with people with CEP and then you can establish motivational interviewing once the individual is engaged.

6.3    Evaluation of Internal Strategy to Minimise Alcohol-Related Harm.

This strategy was not specifically aimed at older adult with CEP but focuses on reducing hazardous drinking in Auckland’s CBD and surrounding communities. The aim is to reduce the harm caused by excessive unsafe drinking. The writer believes that this will reduce the number of vehicle accidents, crime and falls that are associated with hazardous drinking for all age groups and will benefit the elderly. Another positive is the strategy is working alongside New Zealand police and other community associations. With the focus to improve high alcohol risk populations by using education and promoting low-risk drinking advice to the public and provide more alcohol-free advents for communities. The writer believes this may improve New Zealand drinking culture.

6.0 Conclusion

To conclude, this report has provided some statistics in relation to depression and alcohol misuse. Then goes on to discuss the connection between co-existing and mental health problems and the affect the substance alcohol in the older adult. The report discusses the holistic effects of mental health using the Te Wheke model, the report also discusses the effects of alcohol to an individual, the family, community, and Iwi. The report identified three health care strategies and discussed how they could benefit and assist the individual older adult and their family and the wider community to improve their health outcomes mentally and physically.

References

 

Laparoscopic Cholecystectomy

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Laparoscopic Cholecystectomy

The aim of this Task is to identify and examine the role of the Registered Nurse (RN Rice) in the case study below. You are to identify all the key events that occurred throughout the patient’s admission. Particular emphasis in your report is to be placed on the legal and professional nursing practice roles and responsibilities.
Mr Rory Symes is a 64 year-old man who underwent a laparoscopic cholecystectomy in a large metropolitan hospital on the morning of 21 May 2015. Mr Symes was transferred to the Extended Day Only Unit (EDOU) at 1430 hours following the procedure. Mr Symes was to stay in the EDOU overnight with discharge planned for the following morning (22 May 2015).
A Medical Officer (MO) assessed Mr Symes at 1630 hours on 21 May due the patient reporting abdominal pain and distension. Mr Symes’ distended abdomen and pain levels were documented in the patient’s medical record by the MO and a phone call was made to report this information to the surgeon who performed the procedure. Analgesia was prescribed (10mg morphine subcutaneously) at 1715 hours to be given PRN 6 hourly in response to the patient’s reports of pain. Ms Celia Rice was the RN working on the 12-bed EDOU with another RN on 21 May. RN Rice had been registered as a nurse for five years. As per hospital policy, RN Rice and the other RN were the only two staff members rostered to the unit on night-shift that commenced at 2245 hours. The EDOU was at capacity on the night of 21 May. Two of the other male patients admitted to the unit were distressed; one was continuously vomiting post-appendectomy and the other was experiencing urinary retention following a Transurethral Resection of the Prostate (TURP).
There was also a female patient admitted to the unit who was very upset at being placed in a room with male patients due to her religious beliefs. This patient, who had very limited English language skills, was continually wailing and expressing anger over the fact that hospital management had not resolved this issue as promised to the patient and her husband on the afternoon shift. At 0210 hours on 22 May 2015, RN Rice documented the following in Mr Symes’ health record: ‘Temp 38.9, P 126, Resp Rate 16 and BP 110/72 (approx)’
These were the only observations documented during the night- shift. There was no evidence of analgesia administration documented on Mr Symes’ medication chart by the time day-shift staff commenced work. The day-shift RN for 22 May did report that RN Rice had verbally stated that she had been “extremely busy” all shift and had not finished her “notes” by the time handover occurred. At 0630 hours on 22 May 2015, Mr Symes’ temperature was recorded by the day-shift RN as being 39 degrees, heart rate 140bpm and blood pressure 80/46mmHg. He was experiencing acute abdominal rebound tenderness and reported that his pain levels had rapidly increased throughout the early morning. Mr Symes was ultimately returned to theatre where a perforated bowel was identified and successfully repaired.
You are to set out your Task in report format. The report is to include an introduction and conclusion. Headings are to be used to break up your main points of discussion (put each ‘issue’ that you identity in the case study as your heading).
Your interpretation and examination of the key issues that occurred for the patient Mr Symes throughout his admission are to form part of your argument. Your argument is to be supported by references to contemporary, scholarly literature obtained through the library databases or official websites. You are to include reference to specific governing nursing codes, policies and documents in your report.

Nursing care plan

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Nursing care plan

Develop a teaching plan for prevention of accidents and injuries in either children or the elderly. Include the main elements of your presentation to a group of parents or elderly or their caregivers. This is a PowerPoint presentation of between 8-10 slides. Preventing Accidents and Injuries For this Application Assignment, develop a teaching plan for prevention of accidents and injuries in either children or the elderly. Include the main elements of your presentation to a group of parents or elderly or their caregivers. This is a PowerPoint presentation of between 810 slides. Use a minimum of three references from the professional nursing literature in the assigned course readings and other references in the Walden Library. If they are relevant, you may use one or two professional Web sites in addition to the literature references. Overview 20 points After your title slide, include a brief overview of the purpose of your presentation. This should be at least 1 slide. Statistics of the selected accident or injury 30 points Describe the significance of your selected accident or injury. Include data about its rate of occurrence and references. This should be at least 1 slide. Prevention strategies / Teaching plan 80 points Outline your teaching plan. This should include the main elements of your presentation to a group of parents or elderly or their caregivers and be based on best practices. This should be approximately 45 slides.Summary 20 points End the presentation with a one-paragraph summary of the main points of the teaching plan/presentation. Format/Style Proofread the paper as described in the tips for success in this course and correct any typos, grammar, spelling, punctuation, syntax, or APA format errors before submitting your paper in the Dropbox. Up to 40 points can be deducted from the grade for this assignment for these types of errors, or for not using at least the minimum number of required references.Total points for assignment = 150 points.

Heart failure

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  1. Mr Wright’s admission states that he has heart failure (congestive cardiac failure). Clearly define heart failure. What organs and which body systems are affected by this disorder?

Heart failure is medical condition where cardiac output of the heart is reduced (Huether, McCance, Brashers & Rote 2012, p.623), and as a result, insufficient blood, or in other words, oxygen and nutrients can be pumped to meet the body’s needs. This also causes increased diastolic filling pressure of the left ventricle and increased pulmonary capillaries pressures. The cardiac tissues may respond by stretching to hold more blood or by becoming stiff and thickened. This temporarily helps keep the blood moving, but over time, the heart muscle walls eventually weaken and become contract less efficiently (Better Health Channel 2013). Heart failure, when happens to the left side of the heart, is commonly called congestive cardiac failure.

As the heart supplies blood to allow functioning of body tissues, all body systems would be affected by heart failure. In particular, the normal functions of the cardiovascular system, respiratory system and urinary system in the body would be impacted greatly, hence vital body organs such as the heart, lungs and kidneys would not be able to function optimally.


  1. Give a brief overview of the normal function of the body systems affected by this disorder.

Cardiovascular system

  • Delivers oxygen, nutrients and hormones to body tissues via the blood
  • Carries away body waste such as carbon dioxide, urea and bilirubin
  • Sustain a reasonably high blood pressure to allow blood perfusion to body tissues in the extremities and to maintain organ function, such as filtration in the glomerulus.

(Marieb 2012, p.392)

Respiratory system

  • Facilitate the movement of air into the lungs while filtering, humidifying and warming it
  • Allow oxygen and carbon dioxide exchange in the alveoli

(Marieb 2012, p. 436)

Urinary system

  • Kidneys maintain the purity and consistencies of the body internal fluid by filtration of blood
  • Regulating the blood’s volume, pressure by secreting enzymes and pH by ensuring acid-base balance
  • Allow excretion of wastes and excessive ions while retaining sufficient solutes, nutrients and water.
  • Produce erythropoietin to stimulate red blood cell production in the bone marrow
  • Kidney cells also convert vitamin D to its active form
  • Urinary bladder provide temporary storage reservoirs for urine

(Marieb 2012, p.534)

Digestive system

  • A passageway for food to enter the body from the mouth
  • Breaks down ingested food into particles that are small enough to be absorbed into the body to provide nutrients and building blocks for body cells
  • Hydrochloric acid (HCl) secreted in the stomach provides nonspecific protection against bacteria
  • Control absorption of water to maintain normal blood volume

(Marieb 2012, p.506)

Lymphatic system

  • Returns leaked plasma to the blood vessels
  • Immune cells in the lymph ensure cleansing of bacteria and foreign particles

(Marieb 2012, p.398)

Endocrine system

  • Regulate homeostasis by releasing body hormones that are crucial for growth and development, metabolism and reproduction

(Marieb 2012, p.308)

Nervous system

  • Conducts electrical signals to other body parts to maintain body control
  • Regulate sensation, coordination, emotional response, mobility and hormones stimulation

(Marieb 2012, p. 226)


  1. Define the signs and symptoms of heart failure, and explain why these signs and symptoms occur.
  • Swollen ankles or legs (oedema) (American Heart Association 2014)
  • As blood flow out of the heart slows, blood returning to the heart accumulates in the veins, causing fluid build-up and increased pressure in the capillaries. This in turn forces fluid to leak out of the vessels and accumulate in the tissues, hence causing oedema. The kidneys are also less able to secrete sodium and water, worsening fluid retention in the tissues.

  • Angina

    • As cardiac output decreases, blood perfusion to the tissues supplied by the coronary arteries reduce as well, hence less oxygen is delivered to the cardiac tissues, which causes angina symptoms.
  • Weight gain (Healthline 2012)
  • Fluid build-up in the body tissues would increase body weight, hence it is important for patients with heart failure to weight themselves often.
  • Shortness of breath during rest, exercise, or while lying flat (American Heart Association 2014)
  • Blood “backs up” in the pulmonary vein as blood is not pumped out of the heart efficiently. This increases pressure in the capillaries, causing fluids to leak out into the lungs, resulting in shortness of breath.
  • Fatigue/tiredness (American Heart Association 2014)
  • Fatigue occurs as body tissues do not receive sufficient oxygen and nutrients, hence energy production is reduced. The body also diverts blood away from less vital organs, for example muscles in the limbs, which causes weakness.

  • Loss of appetite/nausea (American Heart Association 2014)

    • Inadequate blood supply to the digestive system, resulting in reduced production of digestive enzymes, reduced absorption and muscle contraction.
  • Persistent cough that can cause blood-tinged sputum or wheezing (American Heart Association 2014)
  • Fluid builds up in the lungs causing shortness of breath, which causes reflex coughing in the body in attempt to obtain more air.
  • Confusion or impaired thinking (American Heart Association 2014)
  • Changing levels of electrolytes in the blood such as sodium can cause confusion.
  • Rapid or irregular heart rate (American Heart Association 2014)
  • The heart beats faster in order to maintain normal cardiac output, in the long term, this would lead to arrhythmia.

  • Rapid breathing (Healthline 2012)

    • The body compensates for shortness of breath by increasing respiratory rate

  • Cyanosis (Healthline 2012)

    • Cyanosis is a condition where the skin turns blue/purple due to lack of oxygen. This often occurs in body extremities as blood supply to these areas decrease as a result of heart failure.

  • Fainting (Healthline 2012)

    • Insufficient blood supply to the brain cells as a result of heart failure will result in fainting

  • Nocturia (MedicineNet onhealth 2014)

    • When patients lie down, fluids accumulated in the extremities returns to the heart easier, consequently increase blood perfusion to the kidneys, which in turn result in increased filtration and excretion.

  • Swollen abdomen/ abdominal pain

    • Fluid accumulation in the abdominal area and possible liver enlargement can impact on sensory nerves causing abdominal pain

  • Disturbed sleep pattern/sleep apnoea (MedicineNet onhealth 2014)

    • Nocturia, shortness of breath and coughing can contribute to disturbed sleeping patterns

  • Liver enlargement

    • Reduced blood return to the heart also results in accumulation of blood in the hepatic vein and liver, affecting the hepatocytes and contributing to liver enlargement

  • Palpitations

    • The heart beats faster in order to maintain normal cardiac output, especially when the body’s oxygen demand increases, resulting in palpitations.

  • Pale, clammy skin

    • Blood perfusion to the skin is reduced, hence cells in the skin layers do not grow and function optimally

  • Heart grows larger (UCSF Medical Centre)

    • In order to compensate for the reduced cardiac output, the cardiac cells grow in size so stronger contractions can take place, causing the heart to grow larger. The heart chambers also enlarge and stretch so they can hold a larger volume of blood.
  • Blood vessels narrow (UCSF Medical Centre)
  • Reduced blood return to the heart results in less blood flow through the veins, which causes decreased blood pressure in these vessels. To compensate for this, veins start becoming narrower to maintain the pressure.
  • Blood flow is diverted (UCSF Medical Centre)
  • When the blood supply is no longer able to meet all of the body’s needs, it is diverted away from less crucial areas such as the limbs, and instead channelled to the vital organs including the heart and brain. In turn, physical activity becomes more difficult as heart failure progresses.

  • Constipation

    • Reduced blood supply to the smooth muscles in the intestines reduce contraction and overall motility resulting in constipation

  1. List the information taken on his admission that demonstrates these signs and symptoms.
  • Cyanosis – blue/purple discolouration of skin indicates inadequate oxygen supply to the extremities
  • Dyspnoea – shortness of breath indicates fluid accumulation in lungs
  • Low oxygen saturation level – fluid accumulation impairs gas exchange in the lungs
  • Hypotensive – reduced cardiac output causes low blood pressure
  • High pulse rate – tachycardia occurs to compensate for reduced cardiac output
  • Increased respiratory rate – to compensate for reduced oxygen levels in the tissues
  • Ulcer – Reduced blood supply to lower limbs contribute to impaired wound healing
  • Loss of appetite – Reduced blood flow to digestive system
  • Constipation – Reduced blood supply to smooth muscles in GI tract
  • Confusion – Imbalance in body electrolytes e.g. sodium and potassium

  1. Do you think his diabetes is related to his leg ulcer and amputated left toe? Explain.

Yes, I think that his diabetes is related to his leg ulcer and amputated left toe as poorly controlled diabetes causes peripheral neuropathy (nerve damage) (National Diabetes Information Clearinghouse NDIC 2013) and peripheral vascular disease (impaired circulation causing cell ischemia).

Over time, high blood sugar levels in the blood causes nerve damage in the body, which may be asymptomatic initially. These damaged nerves cannot transmit messages to the brain effectively, hence causing loss of feeling particularly in the body extremities.

On the other hand, adequate blood supply is vital to facilitate wound healing and to resolve underlying infections. In poorly controlled diabetes, blood flow is impaired, thus tissues do not receive sufficient nutrients to repair themselves. There is also an increased risk of infection (due to inadequate white blood cells to fight off bacteria/foreign matter), which can turn into an ulcer if not taken care of. The tissues can also become necrotic after prolong period of inadequate blood supply and amputation may be required.

This is likely to have happened to Mr Wright, being unaware of a wound that he had due to sensory loss, the wound gradually worsen as blood flow was impaired. The wound slowly progresses to an ulcer, and eventually had to be amputated.


  1. One of the medications he is taking is Lasix. What is the action of Lasix? Which body systems are affected by it? Explain why you think Mr. Wright is ordered Lasix. (Your answer need only be brief.)

Lasix is the trade name of frusemide, which is a loop diuretic. It inhibits the reabsorption of sodium and chloride ions in the ascending limb of the loop of Henle, which accounts for retention of approximately 20% of filtered sodium in the kidney. (Australian Medicines Handbook 2012) As water follows sodium and chloride ions, reducing reabsorption of these ions also reduces water retention. Therefore, the main systems that are affected by frusemide is the cardiovascular system and the urinary system. In Mr Wright’s situation, congestive cardiac failure results in fluid retention in the lungs and legs. Frusemide has been to assist the body in getting rid of excessive fluids through the excretion in the urine. This would improve his oedema symptoms as well as shortness of breath.


  1. List three conditions in Mr. Wright’s relevant medical history that are commonly associated with ageing.
  • Type 2 Diabetes – pancreatic islet slowly deteriorate causing reduced insulin production, cell receptors might also be less sensitive to insulin, hence increasing blood glucose level
  • Arthritis – as the body ages, cartilage in the joints gradually wear out causing pain during movement
  • Glaucoma – increased pressure in the eyes due to inefficient clearing of aqueous humour

  1. Using Mr. Wright’s admission history and assessment, list the factors that may impact on his safety whilst in hospital and when he returns home.
  • Mr Wright claim that he has very blurry vision after using his drops. As he might not be able to see clearly, he is more likely to fall if there are obstacles in his home.
  • Mr Wright’s history of asthma and low oxygen saturation means that he can have asthma attack at any time especially during exertion or after long distance of walk. The feeling of out of air and panic can increase the risk of falling.
  • Mr Wright’s blood pressure is lower than normal, which can contribute to orthostatic hypotension and dizziness, further increasing his falling risk.
  • Mr Wright has an ulcer on his lower left leg, which is prone to further infection if not taken care of properly. Infection causes pain, redness, swelling and dead tissue which can affect his stability while moving.
  • Mr Wright has Type 2 diabetes which means he has to constantly monitor his blood glucose level. It can be quite dangerous if he becomes hypoglycemic, as he may experience dizziness or even fainting.
  • Mr Wright is orientated but slipping into confusion. This puts him in greater danger during his daily activities. Confusion can also lead to medication misadventure, which can have disastrous impact.
  • Mr Wright is currently on multiple medications. The common adverse effects of medications are nausea and dizziness, which therefore increase his falling risk.
  • The fact that Mr Wright has to walk with walking aid suggests that he is not steady on his feet, thus he is more prone to fall.
  • Mr Wright is experiencing chronic pain due to his arthritis on his left hip. The pain that he is undergoing can increase the risk of fall as well, especially when he gets out from the bed, when the affected site can be stiff and painful.

  1. What other health professionals will be involved in his care and what services can they provide for Mr. Wright.
  1. Podiatrist
  • Deal with the prevention, diagnosis and management of foot problems
  • Carry out regular checks to determine patient’s feet health
  • Provide necessary foot care for Mr Wright due to his diabetes (i.e manicure and pedicure)
  1. Dietician
  • Provide expert nutrition and dietary advice by translating scientific information into practical advice in diets.
  • Work out a suitable diet plan for Mr Wright to manage his condition while ensuring sufficient nutrition.
  1. Cardiologist
  • Develop a management plan to suit his heart condition and diabetes
  • Monitoring for any symptoms that suggest worsening of his condition
  1. Nurses
  • Assist in managing Mr Wright’s condition during his stay in the hospital, develop a care plan to assist in the recovery of functions and prevent deterioration of his condition
  • Help in managing Mr Wright’s asthma condition, regular spirometry check up to monitor his lung function
  • Educate Mr Wright about lifestyle changes in order to maintain good health.
  • Access Mr Wright’s ulcer and provide proper wound care such as choice of wound dressing to control the amount of exudate and promote wound healing
  1. Occupational therapist
  • Helping Mr Wright to regain or enhance his daily life after discharge
  • Assessing and modifying Mr Wright’s home and community to improve his functional independence as well as to reduce falling risks
  • Educating Mr Wright in the use of home health equipment to assist function
  1. Physiotherapist
  • Access Mr Wright’s movement and assisting him to overcome movement disorders
  • Assisting in management of his chronic pain
  1. Pharmacist
  • Manage his medications and provision of Webster-pak and medical advice
  1. Social worker
  • Provide everyday care that is needed by Mr Wright after discharge, for example bathing, meals, shopping, transportation and social support
  1. Ophthalmologist
  • Management and monitoring of his glaucoma
  1. Dentist
  • Provide dental care to Mr Wright, make sure that all his teeth and gums are healthy. This is because the teeth share the same artery as the heart, infection in the teeth can spread to the heart.

  1. List the nursing documentation you would expect to be used in the care of Mr Wright.
  • Fluid balance chart
  • Bladder chart
  • Bowel chart
  • Diabetic management chart
  • History assessment
  • Neurovascular observation chart
  • Pain assessment
  • Nursing wound assessment and dressing regime
  • Weight chart
  • Medication chart
  • Falls risk assessment tool
  • Patient admission form
  • Progress notes
  • Pressure area observation/care plan
  • Individual care plan
  • Observations graphic chart


References

  1. Huether, SE, McCance, KL., Brashers, VL. & Rote, NS 2012, Understanding pathology, 5

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    edn, Elsevier Mosby, Missouri.
  2. Better Health Channel 2013, Congestive heart failure (CHF), viewed 5

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    September 2014,

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http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Congestive_heart_failure_(CHF)

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  1. Marieb , EN 2012, Essentials of Human Anatomy and Physiology, 10

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    edn, Pearson Education, San Francisco.

  2. MedicineNet onhealth 2014, Congestive Heart Failure, viewed 5

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    September 2014, <

    http://www.onhealth.com/congestive_heart_failure/page3.htm#what_are_the_symptoms_of_congestive_heart_failure

    >.

  3. Healthline 2012, Congestive Health Failure (CHF), viewed 6

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    September 2014, <

    http://www.healthline.com/health/congestive-heart-failure#Overview1

    >.

  4. UCSF Medical Centre, Heart Failure Signs and Symptoms, viewed 3 September 2014, <

    http://www.ucsfhealth.org/conditions/heart_failure/signs_and_symptoms.html>

    .

  5. National Diabetes Information Clearinghouse (NDIC) 2013, Diabetic Neuropathies: The Nerve Damage of Diabetes, viewed 6

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    September 2014, <

    http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/

    >.

  6. Australian Medicines Handbook 2012, Australian Medicines handbook Pty Ltd, Adelaide, pp.233-235.

Analyze and critique a quantitative nursing research article from a nursing research journal published within the past 3 to 5 years.

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Analyze and critique a quantitative nursing research article from a nursing research journal published within the past 3 to 5 years.

Analyze and critique a quantitative nursing research article from a nursing research journal published within the past 3 to 5 years. Include 3 scholarly references—the article, the text, and one outside source. Use the University of Phoenix Material: Guidelines for Quantitative Nursing Research Critique to complete the following steps:
1. State the purpose of the study and identify the problem. Demonstrate that more aggressive measures improve the efficacy of analgesic interventions in patients with difficult pain conditions.
Breakthrough pain in patients with chronic cancer and their three categories:
1- Spontaneous pain with no evident precipitating event.
2- Incident pain, with a precipitating cause or event.
3- End-of-dose failure.
2. Analyze the literature review. The articles relevancy is that the use of IV morphine has advantages in specific clinical situations and should be part of daily physicians practice for patients with cancer pain.
No study has assessed the cost-effectiveness of IV morphine.
Majority of reference used were current, between 2000 and 2008, with cero resources from the last five years and eighteen resources from the last ten years.
Morphine iv would not require many days or weeks to reach an effective dose in patients with relevant needs, decreasing suffering for patients with high levels of pain intensity.
Decreasing in the cost of hospital stay, (discharge after dose titration with IV morphine was 4•6 days), and allowing bed availability for other patients.4

3. Analyze the study framework or theoretical perspective. The theoretical framework was implicit within the article, the framework was based on scientific theory: Total drug availability and predictable effects, short onset for opioid titration and breakthrough pain, flexible modalities: boluses, continuous infusion, patient-controlled analgesia, less initial metabolite formation, unlimited volumes, best for patients with oral tract precluded or poor gastrointestinal absorption.
The framework identify, described, and compared the different between patients treated with oral and iv pain medications:
1- Opioid titration (satisfactory pain relief, rapid titration and parenteral routes, and Conversion between IV and oral route).
2- Risk of respiratory depression with parenteral opioids.
3- Potential Interactions of IV medications (Morphine).
4. Identify, describe, and critique for appropriateness any research objectives, questions, or hypothesis. Research process was described in detail, and references were used from Medline, Current Contents, PubMed, and relevant articles using the search terms “intravenous and/or parenteral morphine” and “cancer pain”. Abstracts and reports from meetings were included only when they related directly to previously published work (between January, 1988, and June, 2009), to conclude that the findings were credible and appropriate methods were used, and that the use of IV morphine has advantages in specific clinical setting and should be part of the physicians practice while treating patients with cancer pain.
5. Identify, describe, and critique—conceptually and operationally—the major study variables. During palliative care interventions in patients with difficult pain, is important the outcomes of additional aggressive measures to improve the efficacy of analgesic interventions in patients with difficult pain, IV morphine is a preferred intervention, from a pharmacokinetics point of view, and for achieving rapid pain control. This review provided an overview of the use of IV morphine for management of cancer pain in a secondary-care setting.
Independent Variables of the study: Opioid administration, Effect of their therapeutic use, Interactions.
Dependent Variables of the study: Breakthrough pain, Opioid titration, Satisfactory pain relief, rapid titration and parenteral routes, and Conversion between IV and oral route, Comparison with the subcutaneous route.
6. Identified and critique attributes and demographics variables.
7. Describe and critique the research design.
8. Describe and critique the sample and setting.
9. Describe and critique the measurement instrument used in the study.
10. Describe and critique the procedures for data collection
11. Describe and critique the statistical analysis.
12. Describe and critique the researcher’s interpretation.

Essence Of Professional Practice Nursing Essay

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In this essay I am going to discuss about the scenario I have chosen, this scenario is scenario 1 which is Karens story. I will talk about why professionalism, emotional intelligence and communication is important throughout the nursing profession and how it is important to interact with the patient, to make them feel Happy on their hospital experience and also to make sure they receive the best care they can.

The points that stuck out to me of Karens story where that some of the nurses referred to Karen as the ‘bariatric women in bed 9 when Karen knows what the medical term means, this will make Karen have a low self-esteem. This is not professional behaviour, and people should be treated like individuals and to be respected by nurses. Another is when Karen knows and listens to the nurses say ‘phew when they have finished doing her care/ and the final point I have spotted in her story which stood out to me that Karen knows that she is overweight and she knows this is because of her mental issues and complication physical issues.

The feelings I thought when I read through scenario 1, I was shocked at how unprofessional the nurses were being, also there lack of respect and compassion. There was a lack of compassion shown, this was shown as the comments they made about Karen and when they were stood with her after doing Karens care. They didnt show a concern for the sufferings of other people.

I was sad at the fact Karen knew what was said about her and she understood the medical terms, she knows that she is overweight due to the fact of medical conditions, the nurses should of seen Karen as a person and not just the ‘bariatric women in bed 9.

Communication

I have chosen three aspects to discuss about in communication. The first one I have chosen to discuss is when the nurse went to change Karens position in her bed, when Karen heard a couple of sighs and even a nurse say ‘Phew. I believe that the nurse didnt show any empathy, I believe this to be the main communication issue. “Nurses demonstrate empathy when there is a ‘desire to understand the client (patient) as fully as possible and to communicate this understanding” (EGAN 2002, p97). This is because she/he didnt take into consideration of Karens feelings at that time because of been physically overweight Karen could of felt like a burden, and this would of made her feel bad in the first place. The nurse didnt also offer Karen a supportive role which Karen could of needed to make herself feel more happy with the nurses care because she would of felt more compassion from the nurses because they took the time to see what she needed and how she would need it.

The second issue I thought was a problem for communication when Karen heard the nurses talking about the ‘Bariatric women in bed 9. The main problem with calling Karen the ‘Bariatric women was that she wasnt getting treated as an individual by the nurses she was just getting treated like any other patient that is in the hospital. She isnt treated with dignity; they should have asked her what she wanted to be called for example if she wanted to be called Karen, or by her surname. It will be causing a problem with not treating her like an individual because it is showing that there is not enough time and this could lead to bad practice. “All staff should behave towards patients in a way that promotes dignity during each and every interaction”.

The Third issue I thought was an issue, was that Karen knows she is overweight because of her physical and mental problems, but she doesnt remind the nurses of this is why she is overweight she just lets them treat her with no dignity. “You must treat people as individuals and respect their dignity” (NMC Code of conduct). The nurses could also check her notes and let her have the compassion she needs. I also think the theory of interpersonal competence could have been used with the nurses and Karen. The first step is translating then getting to know you, then establishing trust, and going the extra mile. This could have helped with communication issues, and made the nurses more understandable.

Professionalism

“Professional identity has traditionally focused on the traits or characteristics that professionals were expected to demonstrate”.

I have chosen the same three that I chose to discuss about in communication, but to discuss them about professionalism. The first one I am going to talk about is when the nurses sighed and said ‘phew. The nurses who made the comment were not being professional because they treated Karen as a thing and not a person. It may have been a big job for the nurses to do, and they may have been struggling but they shouldnt under any circumstances make Karen feel like she is a problem, its a big lack of respect for Karen, the nurses havent thought about her. They also are not meant to discriminate anyone and treat everyone the same, which is not what theyre doing with Karen.

The second issue was calling Karen the ‘bariatric women this was not professional because she was stereotyped, and it could have been discussed why she was like how she was. It does not show professionalism because nurses have to be accountable for what they say and what they do, and this is an issue that would need to be reported because nurses should be showing patients/families with respect and dignity which the nurse did not do. The nurses should be taking the time to get to know Karen, which would be going the extra mile.

The third issue which I thought was bad professionalism is that Karen understood that she was overweight because of her physical and mental problems, which have led her to be the women she is now. I believe if there was better professionalism shown to Karen at the time, then they would have understood and then there wouldnt have had to be any other issues, such as calling her the bariatric women and saying phew.

Emotional intelligence

I have chosen the same three things to discuss as I have done for professionalism and communication. I am going to discuss the three topics as a whole for emotional intelligence; this is because everything I am going to discuss will be relevant. The three topics are when the nurses said ‘phew when moving Karen in her bed, ‘the bariatric women in bed 9 and also the fact Karen understands her physical and mental problems and that is a cause of her overweightness. The nurses havent also taken into consideration of how she feels when they have said these things about her, how it will affect her health and her self-esteem.

I believe the nurses didnt take the time to find out what the patient does, who she is, what her family is like, the nurses didnt take the time to just sit and talk to Karen, it could help in future for her care, and it could of also made her hospital experience better, which then in future she wouldnt feel self-conscious and a burden on other people, she would feel like that they are there to care and not be judgemental.

I think the most important things to remember which have been discussed are to treat your patients and patients in future as individuals and not just people who are there. The second thing to remember is to find the time to sit and get to know the individuals and not just the patient, this will help the nurse and also help the patient feel more comfortable and it will also lead to better care.

These will be the most important things that I will also make sure I do out on practice, to resolve the issues that patients have. I will make sure I have time to sit with my patients to get to know them and I will treat them as individuals and not just objects by getting to know about their situation.

I have achieved what I have set out to do in the introduction because I discussed about emotional intelligence, professionalism and communication, to do with patient and nurse approach. I need to improve some communication skills, I need to improve my nonverbal communication for example, eye contact, this is an important skill for good communication, and I find this quite hard to do. I believe I will be able to improve this quickly with just communicating with patients out on practice, and it will help me to turn eye contact into a positive aspect.

Return to giant pool of money – econ 120

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Return to Giant Pool of Money – Econ 120

By now you all know that the housing crisis has been implicated as one of the major contributors in the Great Recession.   But what exactly was the housing crisis?  This assignment consists of listening to an hour-long radio program that addresses that question.

1.  Listen to Return to the Giant Pool of Money  (This American Life, Episode 390 – in case you have to navigate to it yourself).

2.  In one to two pages, single spaced, font and margins similar to this size, summarize the show.  In your summary, correctly use three key terms from your textbook.  Underline the terms and indicate which chapter and page (or section) they are from.  You will lose credit if you go over two pages.

3.  Use key terms from three different chapters (they are in the margins and are in boldface type) and none of them can be from Chapters 9 or 10.   Don’t discuss the terms, just underline and reference them.  Do not use events (like Great Recession); use terms.

4.  Write your summary in three parts:  Prologue, Act 1, and Act 2.  Give equal coverage to both Acts 1 and 2.

5.  Break each Act into multiple paragraphs.  It can be very hard to read otherwise as the grading screen is small.   Also put a blank line in between paragraphs.

6.  Write a couple of non-normative sentences about what interested you.

7.  Note which file formats Safe Assign accepts (shown on the Blackboard Assignment page).  If you submit this in an unreadable file I will ask you to email it, but you won’t always get credit as the time stamp may be lost.

8.  When choosing your terms, carefully read the definition in the textbook.  Sometimes students don’t realize that terms like “invest”, or “production” don’t apply to monetary instruments as used in this course or textbook.

9.  Once again:  avoid all normative content in this summary.  I want to know what happened and what people did – not what you think should have happened or how they should have behaved.

Important Hint:  The show uses the term “greed”, but it’s a normative term as it denotes a value judgment on behavior.  Those value judgments aren’t a part of positive economics; rather economics focuses on behavioral analysis.  So be sure not to use the term greed or other normative terms or statements or you will not get full credit (and if it’s significantly normative you won’t get any credit).  It’s fine to discuss things in terms of costs and benefits as long as you have a source for your interpretation of the costs or benefits.

Operations Management – Case Analysis: Southwestern University (C)

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Southwestern University: (C)*

The popularity of Southwestern University’s football program under its new coach Phil Flamm surged in each of the 5 years since his arrival at the Stephenville, Texas, college. (See Southwestern University: (A) in Chapter 3 and (B) in Chapter 4.) With a football stadium close to maxing out at 54,000 seats and a vocal coach pushing for a new stadium, SWU president Joel Wisner faced some difficult decisions. After a phenomenal upset victory over its archrival, the University of Texas, at the homecoming game in the fall, Dr. Wisner was not as happy as one would think. Instead of ecstatic alumni, students, and faculty, all Wisner heard were complaints. “The lines at the concession stands were too long”; “Parking was harder to find and farther away than in the old days” (that is, before the team won regularly); “Seats weren’t comfortable”; “Traffic was backed up halfway to Dallas”; and on and on. “A college president just can’t win,” muttered Wisner to himself.

At his staff meeting the following Monday, Wisner turned to his VP of administration, Leslie Gardner. “I wish you would take care of these football complaints, Leslie,” he said. “See what the real problems are and let me know how you’ve resolved them.” Gardner wasn’t surprised at the request. “I’ve already got a handle on it, Joel,” she replied. “We’ve been randomly surveying 50 fans per game for the past year to see what’s on their minds. It’s all part of my campuswide TQM effort. Let me tally things up and I’ll get back to you in a week.”

When she returned to her office, Gardner pulled out the file her assistant had compiled (see Table 6.6). “There’s a lot of information here,” she thought.

TABLE 6.6 Fan Satisfaction Survey Results (N=250)(N=250)

     

Overall Grade

 

A

B

C

D

F

 

Game Day

A. Parking

90

105

45

5

5

  

B. Traffic

50

85

48

52

15

  

C. Seating

45

30

115

35

25

  

D. Entertainment

160

35

26

10

19

  

E. Printed Program

66

34

98

22

30

 

Tickets

A. Pricing

105

104

16

15

10

  

B. Season Ticket Plans

75

80

54

41

0

 

Concessions

A. Prices

16

116

58

58

2

  

B. Selection of Foods

155

60

24

11

0

  

C. Speed of Service

35

45

46

48

76

 

Respondents

 

Alumnus

113

 

Student

83

 

Faculty/Staff

16

 

None of the above

38

    

Open-Ended Comments on Survey Cards:

 

Parking a mess

Add a skybox

Get better cheerleaders

Double the parking attendants

Everything is okay

Too crowded

Seats too narrow

Great food

Phil F. for President!

I smelled drugs being smoked

Stadium is ancient

Seats are like rocks

Not enough cops for traffic

Game starts too late

Hire more traffic cops

Need new band

Great!

More hot dog stands

Seats are all metal

Need skyboxes

Seats stink

Go SWU!

Lines are awful

Seats are uncomfortable

I will pay more for better view

Get a new stadium

Student dress code needed

I want cushioned seats

Not enough police

Students too rowdy

Parking terrible

Toilets weren’t clean

Not enough handicap spots in lot

Well done, SWU

Put in bigger seats

Friendly ushers

Need better seats

Expand parking lots

Hate the bleacher seats

Hot dogs cold

$3 for a coffee? No way!

Get some skyboxes

Love the new uniforms

Took an hour to park

Coach is terrific

More water fountains

Better seats

Seats not comfy

Bigger parking lot

I’m too old for bench seats

Cold coffee served at game

My company will buy a skybox—build it!

Programs overpriced

Want softer seats

Beat those Longhorns!

I’ll pay for a skybox

Seats too small

Band was terrific

Love Phil Flamm

Everything is great

Build new stadium

Move games to Dallas

No complaints

Dirty bathroom

              

*This integrated case study runs throughout the text. Other issues facing Southwestern’s football stadium include: (A) Managing the renovation project (Chapter 3); (B) Forecasting game attendance (Chapter 4); (D) Break-even analysis of food services (Supplement 7 Web site); (E) Locating the new stadium (Chapter 8 Web site); (F) Inventory planning of football programs (Chapter 12 Web site); and (G) Scheduling of campus security officers/staff for game days (Chapter 13 Web site).

Discussion Questions

  1. Using at least two different quality      tools, analyze the data and present your conclusions.
  2. How could the survey have been more      useful?
  3. What is the next step?

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Essay On The Social Determinants Of Mental Health

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Suicides in Canada: At-Risk Populations and Nursing Implications

Mental health is an issue that affects one in five Canadians (“Mental Health Promotion in Ontario: A Call to Action.” 2018). An article was posted by The Star’s Peter Goffin (2017) which described how a famous rapper, Logic, spread awareness about this important issue. He wrote a song and used America’s suicide hotline phone number as the title. This raised discussion in Canada since we did not have a national, well-marketed, recognizable phone number for citizens in crisis (Goffin, 2017). Since then, the Canadian government has worked with Rogers to create one central line which will link existing hotlines across the country. This paper will discuss specific Canadian populations that are most at risk of impaired mental health due to the Social Determinants of Health (SDOH) impacting their lives. In addition, some nursing implications will be included to better understand Canadian mental health and preventing suicides.


SDOH: Early Life

Childhood experiences shape individuals more than most people understand. This determinant of health has lasting effects on a child’s biological, psychological, and social abilities even as adults (Mikkonen, J., & Raphael, D., 2010). The Canadian Facts states that the longer children live in adverse conditions the more likely they are to have developmental issues leading to cognitive deficits (2010). This source also states 15% of Canadian children are living in poverty, as defined as their parents earning less than 50% of median family income. A study in Utah evaluated over a thousand women’s self-reported abuse during their childhood and their dependence on government assistance as well as their current mental health (Cambron C., Gringeri C., Vogel-Ferguson M., 2014). This report found childhood abuse linked to many negative outcomes such as lowered academic, behavioural, and mental health. Adults exposed to violence in their early life are more dependent of government assistance due to lowered education and less successful employment outcomes. Abused adults are more likely to become obese and need further healthcare treatments and possibly medications. Lastly, antisocial and criminal behavior is more likely for an individual who has experienced childhood violence. In light of this data, early childhood development is integral to improving mental health across the nation. In addition, another report done by Larkin, H., & MacFarland, N. S. (2012) states that one in four adults is experiencing mental health disorders, a great number of those were affected by adverse childhood experiences. This report also explains that these same mental health and substance abuse problems have a strong correlation to increased suicides.


Nursing Implication: Building Healthy Public Policy

Improving early life development can be addressed with both a downstream and an upstream approach (Morse, 2018). A downstream approach is focused on treating the effects of a health issue. Talk therapy is an ideal example of this approach in cases of trauma or any other mental health concern. Nurses should be aware of the negative effects of childhood trauma in order to better recognize those affected and provide more specific resources or support groups. Nurses working in a low-income community should be especially knowledgeable as it was previously mentioned that affected adults tend to achieve lower paying jobs (Cambron et al., 2014). If these resources prove unsuccessful a suicide hotline would also be included in the downstream approach. On the other hand, the upstream approach focuses on prevention of the concerning health issue. For instance, finding ways to reduce childhood abuse and discrimination and in turn improve overall mental health would exercise this approach as described in the Canadian Mental Health Associations’ website (2018). One way in which children could spend time in a safe environment is through adequate daycare services. The Ottawa Charter’s health promotion strategy Building Healthy Public Policy would be an effective approach to accomplish this (The World Health Organization, 1986). A report written by Amber Moodie-Dyer in Missouri states that proper childcare improves childhood development and in turn, prepares youth for a successful education (2011). While her report discusses American states and by-laws the idea of childcare being un-affordable for low-income families remains universal. She explores the safety of children in unlicensed care and explains the likelihood of single mothers leaving their children with live in partners or friends (Moodie-Dyer, A., 2011). Using Canadian data nurses can create policies to implement better childcare in their cities by writing reports to Government decision makers. The government should be aware that early life development is a healthcare issue that has detrimental effects that will only end up spending healthcare dollars in years to come. Issues such as mental health disorders are a huge cost that can be avoided by investing into Canadian youth.


SDOH: Social Exclusion

Minority groups in Canada who are marginalized and limited in their access to social, cultural, and economic resources are said to be socially excluded according to York University’s list of Social Determinants of Health (SDOH) (Mikkonen, J., & Raphael, D., 2010). Social Exclusion encapsulate Aboriginal Status, Gender, Race, and Disability which are also included in York University’s list of SDOH. Individuals in any of these populations are more likely to be unemployed or earn lower wedges, have less access to healthcare and social services, and are far less likely to be given opportunities to further their education. For Aboriginal peoples in Canada, this exclusion is due to the brutal social, political, and colonial history (Cameron, Carmargo Plazas, Salas, Bourque Bearskin & Hungler, 2014). This includes the Indian Act of 1876, with a series of amendments which served as gateway to assimilation, The 60’s Scoop, in which over 11 000 children were removed from their homes and placed in child welfare system, and the Residential School system which displaced children from their homes and stripped them of their culture and language (Indigenous Culture Card London and Middlesex, 2016). In a study done in Alberta, inequities in accessing health care by Aboriginals was explored. Two Indigenous persons who had been to the Emergency Department recently were interviewed about their stay. Both expressed feeling less than other patients, having difficulty understanding the language and their own care, and feeling alone and judged (Cameron et al. 2014). With regards to Gender as a SDOH, women face more adverse social and professional conditions. Socially there is an expectation on raising children and professionally women are paid 80% of a man’s pay in the same position (Mikkonen, J., & Raphael, D. 2010). Canadians who are a part of the visible minority commonly face racism, lack of respect, and de-humanization. Similarly, individuals with a disability are part of a visible minority, they too face the same hardships as citizens of colour (Mikkonen, J., & Raphael, D. 2010). All of these SDOH create unsafe experiences and situations that negatively affect an individual’s health, as well as bringing a feeling of powerlessness. With regards to Canada’s new suicide hotline, these individuals are not likely to reach out and access this helpful resource in times of crisis.


Nursing Implication: Reorienting Health Services

Reorienting Health Services is the act of thinking outside the box, and outside the healthcare sector. This strategy revolves around the community and is sensitive to the needs being expressed by that specific population (Morse, 2018). In order to help Aboriginal individuals being affected by social exclusion it is important for nurses to advocate for their patient (World Health Organization, 1986). There is often a language barrier that requires nursing action to ensure their patient understands their own care plan. This often includes providing resources to patients. With regards to patients dealing with mental health disorders, resources may include expanding circle of care include a social worker or translator. As well as emergency or crisis actions such as a helpline. A report done by Lynne Pearce (2014) explains the nurses perspective on the other end of a helpline. A nurse states that operators have strong communication skills and are experts in the field of which they work. When discussing use of a helpline with patients experiencing social exclusion it should be important to explain the positive relationship individuals build with the operator. Helplines are free of judgment and many people benefit from an anonymous conversation.


SDOH: Education

Education may not seem as important to an individual’s health as proper food or housing for example, but it is a crucial determinant of health. Education creates a snowball effect which positively impacts people’s lives. Level of income, employment security, and working conditions are all improved when someone is educated (Mikkonen, J., & Raphael, D. 2010). When discussing mental health concerns education can be improved through resources. Whether an upstream or downstream approach is taken, if an individual or population is knowledgeable in finding help for themselves their overall health will be improved. Knowledge is power that can allow an individual to become an expert in their own care. Nurses and other healthcare professionals must also take on the role of being an educator in the sense that they have more information available to them than their patients might. For example, if a patient was experiencing mental health issues it is crucial that they are aware of local services that could help them. The one service all Canadians should be aware of and educated about is the suicide hotline, it works by locating a call and redirecting it to a local operator (Goffin, 2017).


Nursing Implication: Developing Personal Skills

In order to give the best care, it is integral that nurses use the Ottawa Charter’s strategy, developing personal skills (World Health Organization, 1986). This strategy supports personal development by providing education so that individuals have control over their health and are aware of opportunities available to them (Morse, 2018). In addition to aiding patients understand their conditions, this strategy is important for healthcare providers as well. There is always room for improvement and training programs should always be available and taken advantage of. The results of various training programs can have a large impact of nurse and patient relationships as displayed in a study done by Martha Scheckel and Kimberly Nelson (2014). The study focused on caring for suicidal persons. First the study explained that reading about a patient’s mental health status and previous behaviours contributed to fears before meeting with the patient. Charting describes a previous nurse’s perception of the patient and their actions, while it is necessary for that information to be documented, the context of which that occurred may be much different. As the nurses in the study began approaching clients with an open mind and the idea of wanting to understand the patients point of view they were able to extinguish fears and provide better care (Scheckel, M. M., & Nelson, K. A. 2014). Throughout this training nurse also learned that although suicide is an uncomfortable topic, many patients opened up easily about their troubles.


Summary

Nursing Implications are one of the most successful ways to positively impact a community. While suicide remains a prominent issue facing many Canadians, awareness is constantly being spread. Resources such as a suicide crisis hotline and other forms of therapy are readily available to citizens that simply need to be aware of these opportunities. Nurses across the country use many strategies to help individuals impacted by social determinants of their health.


References

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Role Of Public Health Practitioner

/in /by

The writer seeks to critically analyse the role of the public health practitioner in general, taking into consideration the current socio-political context, the knowledge and skills needed for the role, challenges that exists in fulfilling the public health role and the approaches. In the second part of this work, the writer has chosen an initiative and will critically appraise how well the identified initiative meets the criteria for good public health. Public health skills and competencies will be identified and discussed in this initiative including health promotion theories and approaches. See Appendix-1.

The public Practitioner role, knowledge and skills

The writer has found it appropriate to start by defining public health though there are many definitions. The Public Health Resources Unit (2008) state that the purpose of public health is to: “Improve health and population wellbeing; disease prevention and minimise its consequences; prolong valued life and health inequalities reduction (PHRU, 2008).

PHRU states that all these can be achieved through: taking a population perspective; mobilising the organised efforts of society and acting as an public health advocate; enabling people and communities to increase their own health and wellbeing; acting on the social, economic, environmental and biological determinants of health and wellbeing; protecting from and minimising the impact of the health risks to the population and ensuring that preventive, treatment and care services are of high quality evidence-based and of best value” (PHRU, 2008).

Public health as defined by Webster and French in (Tones & Tilford, 2001) comprise of three aspects which are population-level health promotion; the epidemiological analysis and health professional trained in medicine. Naidoo and Willis (2000 p. 181) looks at public health being characterised by several factors and embraces three domains; the health promotion of the whole population, health protection-a concern for the prevention of illness and disease and health service improvement-a recognition of the many factors that contribute to health

The public health practitioners have autonomy on specified areas and continually own work area and support others to understand it and practitioners are likely to work in multi-agency and multi-disciplinary environment, whereas general practitioners work as a part of a larger team led by someone working at a higher level (PHRU, 2008). An approach to public health is described by the Faculty of Public (2000) with emphasis on the collective responsibility for improvement in health and prevention of disease; recognizes the key role of the state, linked to a concern for the underlying socio-economic and wider determinants of health as well as disease. This approach is multi-disciplinary, incorporating quantitative as well as qualitative methods; emphasizes partnerships with all those who contribute to the health of the population (FPH, 2000).

Sir Donald Acheson, (1988) defines public health as “the science and art of preventing disease, prolonging life and promoting, protecting and improving health through the organised efforts of society”. He also describes the role as planning and evaluation of services as well as undertaking the surveillance of disease and co-ordinating the control of communicable diseases and public practitioner provide epidemiological advice on priority setting. Naidoo and Willis (1998) states that this will include public health practitioner skills for example communication, planning, networking, management and the use of research based evidence.

A public health practitioner is identified by Naidoo and Willis (2001) and Donaldson and Donaldson (2006) as a trained person with a role to make people and the environment healthier, to carry out researches, to advocate and work collaboratively with the community on identified projects. The public practitioner is required to implement health initiative by the government that are aimed at improving health inequalities in society. Naidoo and Willis (2008) also points out that there are three principles that underpins the health practitioner for example empowerment, participation, equity and collaborative working which concurs with World Health Organisation (WHO, 1986). Reducing health inequalities is a priority and all health professionals have a role to play in the targeting of individuals whose health status is below average, or who may not access current health services for a variety of reasons.

The 10 year NHS Plan (DOH, 2000) set a new statutory objective for NHS to allocate resources to contribute to a reduction in health status. Public health practitioners work to increase individual knowledge concerning the body function and ways of preventing illness, raising competence using health care system and awareness about political and environmental factors that influence health. Community capacity can be built by increasing their abilities to participate in promoting their health.

The government White Paper, Saving Lives (DOH, 1999) on public health strategy for England first response to Acheson Report set a national agenda for action to reduce health inequalities for example it gave a commitment to action on living standards and tackling poverty, child poverty in particular, pre-school education, employment as a poverty way out, transport, urban regeneration, crime reduction and housing improvement for disadvantaged areas, as well as preventative activities through a strengthened public health workforce (Hogstedt et al, 2008).

The government’s strategy in “Our Healthier Nation” in Department of Health 1999a is to ensure that the public health labour force was knowledgeable and skilled, well staffed and resourcefully supplied to deal with major task of delivering health strategies. Health professionals with their knowledge and skills are expected to play a part in meeting the aims set in the “White Paper” (DOH, 1999). Public health practitioner skills includes acting as leaders knowledgeable and quipped to manage strategic change and working in partnership with other agencies, focus on health promotion for community development, familiarising with public concepts and use evidence in guiding work were appropriate.

Socio-Political Context

Donaldson and Donaldson (2006) states that in the UK in 1980’s there were serious failures in the standards of care which was provided in public health. Communities before were seen as passive recipients of service and service users were not valued according to McKnight (1998) in (Gorin and Arnold, 1998). Naidoo and Willis (1998 p. 9) states that modern public health acknowledges the importance of living conditions to promote health, action on health inequalities, physical and social regeneration of neighbourhoods, development of healthy public policy on food, transport and the workplace.

Public health system lacked sufficient hospital beds, staff, buildings and equipment (Tones and Tilford, 2006). According to Naidoo and Willis (2001) the public health movement emerged with the noble idea of educating the public for good health. Under the Public Health Legislation of 1848 public health workers were appointed to regularly publicize health advice on safeguards against contamination. It was noted that there was a rise of the sanitary reform in which the local government focusing on environmental issues.

The National Health Service and Community Care Act (1990) was introduced which was a significant piece of public health legislation which brought changes in the way health services was delivered, which includes massive closure of health care institutions and people were cared for in the community (Donaldson and Donaldson, 2006). Naidoo and Willis (2006) notes the publication of “Health of the Nation” (1992) strategy which targeted five key areas which includes coronary heart disease, cancer, mental health, sexual health and accidents. However Donaldson and Donaldson (2006) pointed out that “Personal Hygiene” era noted that the main causes of death and disability shifted from infections to chronic illnesses, such as heart diseases, stroke, cancers, respiratory illness and accidents where lifestyles play a causative role.

Another role of the public health practitioner is to promote and protect individuals and the wider population’s health and wellbeing by preventing the spread of infectious diseases and protection against chemical radiation or other hazards. Lifestyle changes such as stop smoking, better nutrition and more physical activities can improve health and reduce the burden of diseases like obesity, coronary heart disease and cancer. Naidoo and Wills (2001), state that the intervention of the public health practitioner was health education with an emphasis on individual behaviour. The Public Health Act of 1994 focused on housing, sanitation, safe water and food.

Ewles and Simnet (2001) states that public health was introduced by the New Labour Party in 1997 matching with same principles as World Health Organisation adopting similar policies to the Jakarta (1997) declaration with emphasis on infrastructure and investment, with empowering the service user to make informed choices.

The Minister of Public Health was then introduced in 1997 (Donaldson and Donaldson, 2006) which led to the creation of Health Development Agency in (1998) with the aim of maintaining and publicizing evidence based for health improvement and advising on standards for public health and health promotion carrying out campaigns in addition to the formation of public health observatories which were linked with universities in order to monitor health and highlight areas of action and evaluating progress by local agencies with the aim to improve health and reduce inequality.

Naidoo and Willis (2000, p. 139) also states that the New Labour government created a Minister for Public Health in 1997 with a responsibility to co-ordinate health policy across different sectors and highlight the impact of different policies. New reforms were also introduced in ‘The New NHS-Modern, Dependable’ (DoH, 1997) with intention to replace the internal market with integrated care led by primary care groups of General Practitioners and community nurses whose responsibilities are commissioning and providing health care services for their local population. The New Public Health was introduced focusing on heath promotion and education using the “bottom-up” approach and focusing on public health rather than acute services.

Tones and Tilford (2001) cites the Acheson enquiry which raised concerns regarding critical inequalities in health that in society the worst off are more ill and die earlier resulting to Green Paper (2003) with aims to reduce health inequalities. Three areas were prioritised by the report in relation to health inequalities, assessment of all relevant policies, for example the health of families with children and further reduction of income inequalities and poverty.

The Department of Health (2003) Tackling Health Inequalities’ 3 year programme was set up to tackle health inequalities. It had four topics to support families to break the cycle of poverty, engaging communities and individuals to ensure relevance, responsiveness and sustainability as well as preventing illness and providing effective treatment and care culminating in addressing the underlying determinants of health.

Tones and Tilford (2001) furthermore notes the reformation of the NHS by the Labour government to create a health service fit for the needs of 21st century Britain which is better, faster, more convenient service for patients that is fair and free to everyone.

A variety of measures were introduced to improve quality of life in run down areas with a range of strategies to work towards quality homes for all. The New Labour implemented a policy of providing good housing in collaboration with the private sector in order to protect and meet the needs of the most vulnerable people (Naidoo and Willis (2001).

Challenges that exists

Challenges that exist in the public health sector are the current economic situation faced by the government which can cause difficulty in securing funding. The other challenge is failure in understanding or valuing the work of public health professional which can undermine their effectiveness and generate a defensive culture and negatively affects their moral; a lack of defined standards for public health practice and; a lack of clear accountability for health improvement.

The shortage of some technical skills for example needs assessment, analysis and interpretation of information, critical appraisal and implementation skills; limited number of eligible applicants; sub-optimal working arrangements with local authorities manifesting in lack of consistency of local community plans and health plans. The other challenges are inadequacy of health as opposed to health service information systems and surveillance system for communicable and non-communicable disease. The other challenge is the difficulty in accessing public health evidence of promptly in a useable form; duplication of activity, in marshalling epidemiological information and evidence of effectiveness of health programmes.

Lastly limited partnership between academic and public health service departments; limited pooling of resources and expertise between Health Boards and the NHS and other agencies and a lack of milestones by which to measure success (Review of the Public Health Function in Scotland, 2000).

Part 2: Health initiative (Sure Start)

The writer has chosen to focus on Sure Start which is a government programme aimed at delivering the best start in life for every child by bringing together early education, childcare, health and family support. The following are responsible for delivering Sure Start within Department for Children, Schools and Families: The Early Years, Extended Schools and Special Needs Group.

Britain had the highest teenage pregnancy rate in Europe in the mid-1990s which led to the need of health promotion (UNICEF, 2001). In UK the Child Act, 2004 provides the legal underpinning children’s services set out by the government in the Green Paper in 2003, Every Child Matters as a Government’s approach to the well being of children and young people aimed at giving all children the support they need to be healthy, stay safe, enjoy and achieve, make a positive contribution and achieve economic well being which concurs with Ottawa Charter.

The Children’s Plan (2007) was then published with a ten year strategy with aims to improve educational outcomes for children, improve children’s health, reduce offending rates among young people and eradicate children poverty by 2020 (DCFS, 2007). Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health (Ottawa Charter, 1986). For that reason the government therefore planned to deliver the best start for every child in bringing together early education, childcare, health and family support through Sure Start (Asthana and Halliday, 2006).

Sure start is a public health approach that takes a population perspective, tackling causes of ill health and this is done by teaching mothers on breast feeding avoids “lifestyles” focus and its marginalisation of socio-economic and environmental influences on health which is in line with Saving Lives: Our Healthier Nation (1999).

The Department for Education and Skills (2000) set up Sure Start’s core aims, targets and initiatives in their guidance document at the beginning of the programme (DES, 2000, pp. 1-2) were to improve health by accessing appropriate healthcare; enable informed choices about continuing a pregnancy or not; support teenage parents in caring for their children.

Ewles (2006) support the idea that there is evidence to support the use of behaviour modification in conjunction with changes in caring for the vulnerable children and levels of activities involved in pre and post birth which concurs with the government’s programme responding to Acheson report (1998) in Tackling Health Inequalities. This is seen by Beattie (1991) as objective reality of empowerment based on actual situation on community level.

By promoting and protecting the health of pregnant and parenting teen mothers and their children Sure Start seem to be inline with Bradshaw’s taxonomy (1972) of health and social needs. Teenage parenthood is identified by Sure Start as both a cause and a consequence of social exclusion (Social Exclusion Unit, 1999) and this can be a normative need. Social Exclusion Unit (1999) also predicted the problems that involve a greater than average risk of being poor, unemployed and isolated. This is in accordance to the Acheson report (1998) which focuses on health inequalities and defines public health as the “art and science of the prevention of disease and the promotion of health through the organised efforts of society.

According to McLeod (2001) teenage mothers when compared to other mothers they have been seen as more likely to experience poverty and social deprivation and even in adult life, although these likelihoods might be a meaning of their deprived status relatively than of becoming a parent early per se (Ermisch and Pevalin, 2003). According to Bradshaw taxonomy this could be identified as a comparative need which concerns problems which emerge by comparison with others who are not in need. Furthermore he state that one of the most common uses of this approach is the comparison of social problems in different areas in order to determine which areas are most deprived.

According to Social Exclusion Unit (1999) the government policy objective is to promote continuous learning among young people through Sure Start focusing on prevention of conceptions and secondly focussing on supporting teenage mothers primarily by measures to strongly encourage them to complete their education and keep in touch with the jobs market. This concurs with Naidoo and Willis (2001) who views public health as working together with others on shared programmes on the other hand to ensure that health promotion activities were achieved. Sure Start use collaboration, education and participatory approaches.

Furthermore Dugan (1996) encourages public health practitioners to use participatory approach as a process that has rewarding effects and increases local talent and capacity, provides flexibility and systematic process for people.

Micklewright (2002) assets that seven out of thirteen indicators in the second annual statement on poverty and social exclusion connecting to children and young people are measures of education and gaining skills. Educational approach enables health promoters to work with the community as partners giving guidance and not taking control but listening and taking their perspective on board.

Educational approach expressed by Naidoo and Willis (2001) enriches the community with knowledge, information and developing skills that will enable them to make informed choices with regards to their health behaviour. Whereas community development aims at empowering people to work together to influence the social, economic, political and environmental issues that influence them (Naidoo and Willis, 2000). World Health Organization believed that people needed to hold some degree of control over their living and working conditions in order to develop lifestyles conducive to health (WHO, 1986). Ottawa Charter defines health promotion as the process of enabling people to increase control over, and improve their health (WHO, 1986).

In conclusion public health practitioners’ role is to influence and identify those factors that promote the health of the population and contributes to reducing health inequalities, and able to influence teams and organizations and valuing professional development. For health practitioners to work effectively, good and effective communication skills are required that enables them to use appropriate verbal and non verbal communication skills to deliver relevant information to various people. It is essential that studies are conducted that primarily focus on the whole range of public health roles within health practice with particular emphasis given to examine the effects of these roles on public health professionals, and the education and training that will be necessary for these roles.