Values Practice Issues Within Mental Health Nursing Practice

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Using the values identified in the attached book (empathy and importance of self expression) review prepare a 2000 word discussion and analysis of values practice issues within mental health nursing practice.

Introduction

This essay aims to explore some issues around values and practice in mental health nursing. The essay builds upon a previous piece of work undertaken as a formative assignment, a review of a book read by the author, which raised some key points which may be important in mental health nursing practice. The process of uncovering these issues, in response to reviewing and reading a work of fiction, was one which led to a connection of ideas, from what the book presented, and from the author’s personal experience, life experience, and clinical experience and learning to date.

The identified issues are to do with compassion, empathy and the importance of self-expression. These are all issues which the author believes are very much taken for granted in everyday life, but which become very significant for users of mental health services, and for mental health service providers, because they affect many areas of the person, their experience, and the therapeutic relationship. This essay will explore these issues in the light of some of the published theory and debate on these topics, and the author’s own point of view and experiences.

Discussion

It would seem that within mental health nursing, the relationship between the mental health nurse and the client is very important, but this relationship is based on certain values which must underpin nursing care (Eagger et al, 2005), and certain needs or requirements that the client might feel in relation to the nurse. Nurses working within a framework of values is no new thing, and values (and ethics) have always underpinned medicine and healthcare (Eagger et al, 2005). According to Svedberg et al (2003), “Mental health is created by the interwoven process of one’s relationship to oneself and to others”, which would suggest that the relationships the client forms with anyone involved in supporting mental health are doubly important.

The client may find self-expression important for themselves, but also they will require compassion from the mental health nurse. The nurse, in turn, may be challenged by the client’s self-expression, and may find it hard to feel compassion or to empathise with the client at times.

One of the challenges of providing compassionate care and even for the mental health nurse to experience compassion is the supposed relationship which some authors have found between perceived suffering and caregiver compassion. Schulz et al (2007) suggest that there are links between perceived suffering and the level of caregiver compassion. If this is the case, then it could be argued that some mental health nurses who do not feel or display compassion are doing so because on some level they do not perceive or believe the client to be truly suffering, or to be worthy of compassion. This would raise an ethical issue, because all the patient’s needs should be met, no matter what the ‘personal’ response to the client. However, this could be a lack of perception on the part of the mental health nurse.

Akerjordet and Severinsson (2004) discuss the issue of emotional intelligence in nursing, a concept which affects the nurse-patient relationship, particularly within mental health nursing. Salovey and Mayer (1990) define emotional intelligence as “the ability to monitor one’s own and others’ feelings and emotions, to discriminate among them and to use this information to guide one’s thinking and actions” (p 185

).

In their qualitative study, Akerjordet and Severinsson (2004) found four dominant themes about emotional intelligence in mental health nursing

“

relationship with the patient; the substance of supervision; motivation; and responsibility.” This would suggest that emotional intelligence on the part of the nurse is important within mental health nursing. Akerjordet and Severinsson (2004) suggest that emotional intelligence “stimulates the search for a deeper understanding of a professional mental health nursing identity” and that “emotional learning and maturation processes are central to professional competence

,

that is

,

personal growth and development.” (p 164). Therefore, the mental health nurse would need to develop the emotional intelligence to understand why they are finding it hard to feel compassion for the client, and to take action to remedy this, and to act in a sensitive and supportive way towards the client, even if they do not truly feel compassionate towards them.

Shattell et al (2007) carried out research on the therapeutic relationship within mental health services, and found that clients expressed experiences of the therapeutic relationship under the following themes: ‘relate to me’, ‘know me as a person’, and ‘get to the solution’. “A therapeutic relationship for persons with mental illness requires in-depth personal knowledge, which is acquired only with time, understanding, and skill. Knowing the whole person, rather than knowing the person only as a service recipient.” (Shattell et al, 2007 p 274). This would suggest that the mental health nurse should be motivated to develop an empathy with the client through this knowledge, and should actively engage in seeking out ways to know and to understand the client. This may relate back to the issue of emotional intelligence, because the mental health nurse needs to know themselves very well, and to understand themselves and their professional persona (Akerjordet and Severinsson, 2004) before they can then go on to get to know and understand, and empathise with, the client.

Hamilton and Roper (2007) discuss the concept of insight, looking at its theoretical underpinnings, and the fact that it is problematic in mental health nursing because it can be difficult to have insight into patient’s experiences of mental illness. Insight is seen as part of the process of getting to know and understand the client, and from this, developing a knowledge of their mental illness, including diagnosing their particular mental illness (Hamilton and Roper, 2007). However, developing this insight is made difficult by problems such as the perceived difference in power between caregiver and client, and the expectations of ‘patient behaviours’ (Hamilton and Roper, 2007). This would suggest that the mental health nurse needs to see each patient as an individual, as unique, and to take the time to truly get to know the person and their experience of mental illness. Definitions of mental illness, and labels, can make this harder, for the nurse, and for the client as well, who fears being reduced to his or her disease rather than being seen as a person who is ill (Hamilton and Roper, 2007; Shattell et al, 2007).

Research by Shatell et al (2006) emphasises this point. In their study, clients raised a number of issues around being understood by mental health caregivers, and it was this concept of being understood which seemed most important in developing an effective therapeutic relationship. Some of these concepts include: feeling important; establishing connections, and being on the same level (Shatell et al, 2006). Research by Svedberg et al (2003) found similar results, and in their study “the patients described how the feeling of mutuality in the relationship with the nurse was important for the promotion of health processes. Mutuality was achieved by doing things together and by having a dialogue with each other.” (p 451). This author feels that these ideals can be properly achieved by mental health nurses who take time to get to know the client and who develop empathy with the client through focusing attention on them. The patients wanted to feel understood in Shatell et al’s (2006) study.

“ Feeling important was a major consequence of being understood. Being understood made patients feel like human beings rather than being treated like a number or being treated like in a factory. Participants wanted to be treated like human beings, not as sick, mentally ill persons; like persons, not a set of diagnoses “ (Shatell et al, 2006 p 237).

This could be viewed as a consequence of the compassion and self-awareness of the nurse as a professional, and of their ability to see the client as an individual, to not be prejudiced by anything about them, especially not their illness. This is very important. This author believes that compassion and empathy develop through getting to know the client properly, and that these all enhance the therapeutic relationship. Shatell et al (2006) also suggest that clients feel important when they know the nurse has been thinking of them at times other than face to face contact, and this is something to think of for practice, particularly in relation to the conversations that nurses have with patients. It is also important that mental health nurses develop proper listening skills, which would also allow them to develop compassionate understanding, and support the client in expressing themselves (Freshwater, 2006).

Encouraging self-expression is an important part of nurses getting to know their patients, it would seem, but self-expression is not easy for many people. People with mental illness are often negotiating a range of different sense of what constitutes their ‘self’ (Meehan and Machlachlan, 2008). “ For example, a professional woman becomes a mother and wife or ‘homemaker’ when she leaves the office for home. In changing from one self to another type, her multiple self voices renegotiate their hierarchy and positions and create a coherent self story consistent with the role of mother and wife.” (Meehan and Machlachlan, 2008). These negotiations can be problematic for the person with mental illness, and this just provides one example of how complex understanding the self can be, which makes self-expression similarly challenging. Yet it would be worthwhile to develop activities and actions which would sup port this.

It may be that there are ways that mental health nurses can encourage or support self-expression and the development of caregiver understanding of the client. For example, Raingruber (2004) discusses the use of poetry in child and adolescent mental health, as a means of self-expression, arguing that poetry has the power to allow clients to develop self awareness and to express their feelings. Raingruber (2004) suggests that “The complexity, power, and beauty of language within poetry allow the expression of intense human experiences” (p 14). While there are drawbacks and limitations to the therapeutic use of poetry, it might be that this offers one kind of opportunity for self-expression, on the part of the client, and empathy, on the part of the mental health nurse. “ When an appropriate moment arises, poetry should be used to help clinicians, nursing students, and clients become more aware of and open to possibilities.” (Raingruber, 2004 p 16). However, this author believes that the mental health nurse would need some skills in this area, or to be someone who is perhaps comfortable with using or writing poetry themselves, if they were to use it to any great extent with clients.

Feen-Calligan et al (2008) make similar assertions about using visual art in supporting mental health users who are substance misusers. Feen Calligan et al (2008) found that “As the women learned to verbalize their feelings and reflect on their situations through interpretative interactions with visual art, they gained insight into their feelings and issues they faced in their recovery from chemical dependency.” (p 287). This research seems to show that using visual art and image processing allowed the women to fully express their feelings in ways they had not been able to before (Feen-Calligan et al, 2008). Again, some kind of knowledge or skill on the part of the nurse would be necessary. Both of these examples are of arts-related activities, and relate strongly back to the formative assessment and book review. It might be that there is great scope within mental health nursing to encourage self-knowledge, self-expression and mutuality through the use of creative arts and fiction. Certainly this would provide a way for nurses to relate to clients more readily, to be on their level, and to talk in terms and metaphors that they are familiar with.

Conclusion

It would seem that underpinning mental health nursing are a number of core values which need to be more explicit in the discourses around the profession and in the practices of those within it. Svedberg et al (2003) state:

“The most important goal of nursing care is to promote the subjective experience of health. The health promoting efforts of mental health care nurses must be aimed at creating encounters where the patient will be confirmed both existentially and as an individual worthy of dignity.” (p 448).

The core values of mental health nursing should orientate towards this kind of confirmation of worth on the part of the healthcare provider for the client.

Eagger et al (2005) state:

“Organisations, too, would benefit from a clear, values-based statement that staff at all levels can identify with. Institutions encouraging a culture of care can contribute significantly towards creating a healing environment for staff as well as patients.” ( p 28).

This would be particularly relevant for mental health nursing and mental health services, and might signify and important area for future practice development. Undertaking this exploration has shown to the author the need for self-awareness and emotional intelligence on the part of mental health nurses, as a prerequisite for developing true compassion and empathy. Fostering self-expression amongst mental health services users, providing opportunities for this, and supporting them by paying attention and understanding them, is also important. While some experiences so far might suggest that in certain contexts and situations, this might be difficult to achieve, it should be the goal that we all strive for, and these are core values which should underpin all of our practice.

References 214727

Akerjordet, K. and Severinsson, E. (2004) Emotional intelligence in mental health nurses talking about

practice International Journal of Mental Health Nursing

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Benner, P. 2000. The wisdom of our practice: thoughts on the art and intangibility of caring practice. American Journal of Nursing. 100(10):99-105

Busfield, J. 2000

Rethinking the Sociology of Mental Health


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Castledine, G. 2005. Recognizing care and compassion in nursing. British Journal of Nursing. 14(18):1001

Eagger, S., Desser, A. and Brown, C. (2005) Learning values in healthcare?

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Feen-Calligan, H., Washington, O. and Moxley, D.P. (2008) Use of artwork as a visual processing modality in group treatment of chemically dependent minority women.

The Arts in Psychotherapy

25 287-295.

Freshwater, D. (2006) The art of listening in the therapeutic relationship.

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Hamilton, B. and Roper, C. (2006) Troubling ‘insight’: power and possibilities in mental health care.

Journal of Psychiatric and Mental Health Nursing

13 416-422.

Meehan, T. and MacLachlan, M. (2008) Self construction in schizophrenia: a discourse analysis.

Psychology and Psychotherapy: Theory Research and Practice

81 131-142.

Pilgrim, A. Rogers, D. 2005

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edition. OUP, Buckingham

Salovey, P. & Mayer, J.D. (1990) “Emotional intelligence”

Imagination, Cognition, and Personality,

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Schulz, R., Hebert, R.S. and Dew, M.A. (2007) Patient Suffering and Caregiver Compassion: New Opportunities for Research, Practice, and Policy. Gerontologist, v47 n1 p4-13 2007

Raingruber, B. (2004) Using poetry to discover and share significant meanings in child and adolescent mental health nursing.

Journal of Child and Adolescent Psychiatric Nursing

17 (1) 13-20.

Shattell, M., Starr, S. and Thomas, S.P. (2007) ‘Take my hand, help me out’: Mental health service recipients’ experience of the therapeutic relationship.

International Journal of Mental Health Nursing

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Shattell, M., McAllister,S., Hogan, B. and Thomas, S.P. (2006) “She took the time to make sure she understood.” Mental Health Patients’ Experiences of Being Understood.

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Svedberg, P., Jormfeldt, H. and Arvidsson, B. (2003) Patient’s conceptions of how health processes are promoted in mental health nursing. A qualitative study.

Journal of Psychiatric and Mental Health Nursing

10 448-456.

Evidence is necessary to improve our nursing practice. Using the CINAHL database in the Chamberlain Library- search for and locate a scholarly professional nursing journal article that meets these cri

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Evidence is necessary to improve our nursing practice. Using the CINAHL database in the Chamberlain Library, search for and locate a scholarly professional nursing journal article that meets these criteria:

  • Full-text
  • English language
  • Peer-reviewed
  • NOT an Evidence-Based Care Sheet or CINAHL Guide
  • Published in the past five years
  • Contains evidence to support a nursing practice in your practice area

Summarize this article in one paragraph. Explain why you selected this article. Provide an APA reference for this article.

EXAMPLE

in the article, Perinatal Substance Exposure and Long-Term Outcomes in Children: A Literature Review, the authors discuss substance abuse in pregnancy and the long-term effects it has on the babies who are exposed. The article goes on to define Neonatal Abstinence Syndrome (NAS) as a “[..]group of symptoms manifested at birth by infants upon discontinuation of the drug to which they were exposed in utero” (Joseph, Brady, Hudson, & Moran, 2020, P.164). The article explains the different symptoms and how the treatment is based on a scoring system. The authors go into great detail over how drug abuse during pregnancy can cause a delay in the child’s language, sensory, motor, and cognitive development. Children exposed to substances in utero showed to have a slower anthropometric growth pattern and were at a higher risk for engaging in risky behaviors, such as drug abuse themselves (Joseph, Brady, Hudson, & Moran, 2020). The article provides many references, facts, and statistics supporting these claims. The article concludes with a discussion on the importance of giving effective interprofessional education to these at risks patients to prevent negative outcomes from occurring. I chose this article because I currently work in OB and see many pregnant patients come in with substance-abuse problems. I have worked with many newborns who have NAS and have had to treat them with morphine due to the severe side effects of withdrawal. I have witnessed newborns withdrawing from multiple substances at a time, and have used the scoring system mentioned in the article. It is a very sad situation and I have always been curious as to how these newborns do as they grow. Reference: Joseph, R., Brady, E., Hudson, M. E., & Moran, M. M. (2020). Perinatal Substance Exposure and Long-Term Outcomes in Children: A Literature Review. 46(1), 163-143. Retrieved September 26, 2020. n the article, Perinatal Substance Exposure and Long-Term Outcomes in Children: A Literature Review, the authors discuss substance abuse in pregnancy and the long-term effects it has on the babies who are exposed. The article goes on to define Neonatal Abstinence Syndrome (NAS) as a “[..]group of symptoms manifested at birth by infants upon discontinuation of the drug to which they were exposed in utero” (Joseph, Brady, Hudson, & Moran, 2020, P.164). The article explains the different symptoms and how the treatment is based on a scoring system. The authors go into great detail over how drug abuse during pregnancy can cause a delay in the child’s language, sensory, motor, and cognitive development. Children exposed to substances in utero showed to have a slower anthropometric growth pattern and were at a higher risk for engaging in risky behaviors, such as drug abuse themselves (Joseph, Brady, Hudson, & Moran, 2020). The article provides many references, facts, and statistics supporting these claims. The article concludes with a discussion on the importance of giving effective interprofessional education to these at risks patients to prevent negative outcomes from occurring. I chose this article because I currently work in OB and see many pregnant patients come in with substance-abuse problems. I have worked with many newborns who have NAS and have had to treat them with morphine due to the severe side effects of withdrawal. I have witnessed newborns withdrawing from multiple substances at a time, and have used the scoring system mentioned in the article. It is a very sad situation and I have always been curious as to how these newborns do as they grow. Reference: Joseph, R., Brady, E., Hudson, M. E., & Moran, M. M. (2020). Perinatal Substance Exposure and Long-Term Outcomes in Children: A Literature Review. 46(1), 163-143. Retrieved September 26, 2020. In the article, Perinatal Substance Exposure and Long-Term Outcomes in Children: A Literature Review, the authors discuss substance abuse in pregnancy and the long-term effects it has on the babies who are exposed. The article goes on to define Neonatal Abstinence Syndrome (NAS) as a “[..]group of symptoms manifested at birth by infants upon discontinuation of the drug to which they were exposed in utero” (Joseph, Brady, Hudson, & Moran, 2020, P.164). The article explains the different symptoms and how the treatment is based on a scoring system. The authors go into great detail over how drug abuse during pregnancy can cause a delay in the child’s language, sensory, motor, and cognitive development. Children exposed to substances in utero showed to have a slower anthropometric growth pattern and were at a higher risk for engaging in risky behaviors, such as drug abuse themselves (Joseph, Brady, Hudson, & Moran, 2020). The article provides many references, facts, and statistics supporting these claims. The article concludes with a discussion on the importance of giving effective interprofessional education to these at risks patients to prevent negative outcomes from occurring. I chose this article because I currently work in OB and see many pregnant patients come in with substance-abuse problems. I have worked with many newborns who have NAS and have had to treat them with morphine due to the severe side effects of withdrawal. I have witnessed newborns withdrawing from multiple substances at a time, and have used the scoring system mentioned in the article. It is a very sad situation and I have always been curious as to how these newborns do as they grow. Reference: Joseph, R., Brady, E., Hudson, M. E., & Moran, M. M. (2020). Perinatal Substance Exposure and Long-Term Outcomes in Children: A Literature Review. 46(1), 163-143. Retrieved September 26, 2020.

Socw week 2 discussion 1 – diagnostic labels as powerful | SOCW 6090 – Psychopathology and Diagnosis for Social Work Practice | Walden University

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Discussion: Diagnostic Labels as Powerful Communications

A diagnosis is powerful in the effect it can have on a person’s life and treatment protocol. When working with a client, a social worker must make important decisions—not only about the diagnostic label itself but about whom to tell and when. In this Discussion, you evaluate the use and communication of a diagnosis in a case study.

To prepare: Focus on the complex but precise definition of a mental disorder in the DSM-5 and the concept of dimensionality both there and in the Paris (2015) and Lasalvia (2015) readings. Also note that the definition of a mental disorder includes a set of caveats and recommendations to help find the boundary between normal distress and a mental disorder.

Then consider the following case:

Ms. Evans, age 27, was awaiting honorable discharge from her service in Iraq with the U.S. Navy when her colleagues noticed that she looked increasingly fearful and was talking about hearing voices telling her that the world was going to be destroyed in 2020. With Ms. Evans’s permission, the evaluating [social worker] interviewed one of her closest colleagues, who indicated that Ms. Evans has not been taking good care of herself for several months. Ms. Evans said she was depressed.

The [social worker] also learned that Ms. Evans’s performance of her military job duties had declined during this time and that her commanding officer had recommended to Ms. Evans that she be evaluated by a psychiatrist approximately 2 weeks earlier, for possible depression.

On interview, Ms. Evans endorsed believing the world was going to end soon and indicated that several times she has heard an audible voice that repeats this information. She has a maternal uncle with schizophrenia, and her mother has a diagnosis of bipolar I disorder. Ms. Evans’s toxicology screen is positive for tetrahydrocannabinol (THC). The evaluating [social worker] informs Ms. Evans that she is making a tentative diagnosis of schizophrenia.

Source: Roberts, L. W., & Trockel, M. (2015). Case example: Importance of refining a diagnostic hypothesis. In L. W. Roberts & A. K. Louie (Eds.), Study guide to DSM-5 (pp. 6–7). Arlington, VA: American Psychiatric Publishing.

Study Guide to DSM-5(r), by Roberts, M.; Louie, A.; Weiss, L. Copyright 2015 by American Psychiatric Association. Reprinted by permission of American Psychiatric Association via the Copyright Clearance Center.

Provide a Discussion Post of at least 400-word response stating the following Topics, Content, and Headings.

Discuss how a social worker should approach the diagnosis.

In your analysis, consider the following questions:

· Identify the symptoms or “red flags” in the case study that may be evaluated for a possible mental health disorder.

· Should the social worker have shared this suspected diagnosis based on the limited assessment with Ms. Evans at this time?

· Explain the potential impact of this diagnosis immediately and over time if the “tentative” diagnosis is a misdiagnosis.

· When may it be appropriate to use a provisional diagnosis?

· When would you diagnosis as other specified and unspecified disorders?

Must have at least 4 references from the above-mentioned materials. Absolutely reference Paris (2015), Lasalvia (2015, and American Psychiatric Association (2013) DSM-5

. Which of the following is an example of discretionary fiscal policy? (Points : 3) an increase in unemployment insurance payments during a recession an increase in income tax receipts with rising income during an expansion the tax cuts passed by Congress in 2001 to combat the recession a decrease in food stamps issued during an expansion or boomQuestion 2.2.

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. Which of the following is an example of discretionary fiscal policy? (Points : 3) an increase in unemployment insurance payments during a recession an increase in income tax receipts with rising income during an expansion the tax cuts passed by Congress in 2001 to combat the recession a decrease in food stamps issued during an expansion or boomQuestion 2.2.

The majority of dollars spent by government prior to the Great Depression was spending at the ________ level. In the post World War II period, two-thirds to three quarters of all dollars spent by government in the United States are spent at the ________ level (Points : 3) federal; state and local state and local; federal state and local; state local; stateQuestion 3.3. The fastest growing category of government expenditure is (Points : 3) grants to state and local governments. defense spending. transfer payments. government purchases.4.Year Potential Real GDP Real GDP Price Level2013 $14.0 trillion $14.0 trillion 1502014 14.5 trillion 14.8 trillion 154Consider the hypothetical information in the table above for potential real GDP, real GDP and the price level in 2013 and in 2014 if the Congress and the president do not use fiscal policy. If the Congress and the president want to keep real GDP at its potential level in 2014, they should(Points : 3) buy Treasury securities. conduct expansionary fiscal policy. decrease government purchases. decrease the discount rate.5. A permanent tax cut would likely ________ consumption spending ________ than would a tax rebate like the one issued in 2008. (Points : 3) increase; more increase; less decrease; more decrease; less6. if government spending and the price level increase, then (Points : 3) the interest rate increases, consumption declines, and investment spending declines. the interest rate decreases, consumption declines, and investment spending declines. the interest rate increases, consumption increases, and investment spending increases. the interest rate decreases, consumption increases, and investment spending increases.7. During recessions, government expenditure automatically (Points : 3) falls because of programs such as unemployment insurance and Medicaid. rises because of programs such as unemployment insurance and Medicaid. falls because of the progressive income tax system. rises because of the progressive income tax system.8. According to the short-run Phillips curve, the unemployment rate and the inflation rate are (Points : 3) unrelated. positively related. negatively related. unaffected by monetary policy.9. What is the natural rate of unemployment? (Points : 3) the unemployment rate that exists when the economy is at potential GDP the unemployment rate that exists when the economy is at a trough in a business cycle an unemployment rate of 0% any unemployment rate that is above the inflation rate10. What impact does monetary policy have on the long-run Phillips curve? (Points : 3) Monetary policy can only shift the long-run Phillips curve to the left. Monetary policy shifts the long-run Phillips curve to the right or left, depending on whether monetary policy is expansionary or contractionary. Monetary policy can only shift the long-run Phillips curve to the right. Monetary policy has no impact on the long-run Phillips curve.11. In the long run, the Federal Reserve can control which of the following? (Points : 3) the inflation rate the unemployment rate the growth rate of real GDP in the economy the natural rate of unemployment12. Contractionary monetary policy will result in (Points : 3) higher interest rates. increased rates of inflation. an upward shift in the short-run Phillips curve. a leftward shift in the long-run Phillips curve.13. If the Federal Reserve announces that its target for the federal funds rate is rising from 4 percent to 4.25 percent, how do you expect workers and firms to react? (Points : 3) As long as the Fed’s announcement is credible, workers and firms will increase their consumption and investment spending, which will increase aggregate demand and inflation.

Assignment 1: certification plan begin to develop a plan to pass the

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Compare your home state’s laws(texas) in regards to Advanced Practice Nursing Practice to an alternate state with a less or more restrictive practice environment.

To prepare:

•Consider the differences in certification exams options for your specialty (FNP)

•Reflect on how to approach relocating licensure from one state to another  Write a 3 page paper which summarizes the following:

•Identify the certification exam you selected and explain why(There is two certification exam AANP FNP and ANCC FNP. The one I am planning to take is the AANP exam).

•Outline your plan for passing the appropriate National Certification Exam(AANP)

•Describe the NP Practice environment for your home state(texas) highlighting restrictions or limitations for practice

•Describe 3 strengths identified from the FHEA Exit Exam

•Describe 3 areas of weakness identified by the FHEA Exit Exam and develop a study plan for addressing these areas of weakness

APA format, 4 references within the last 5 years

How would you go about finding and identifying cosmogenous sediment?

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How would you go about finding and identifying cosmogenous sediment?

What are sediments? How are sediments formed?
What are sources of sediments? Make a list and give a brief description in your own words.
Examine the diagram above. Where do terrigenous sediments accumulate? Why do they accumulate here?
What happens to the size of sediment as you get farther away from the shoreline? Explain what is happening.
What are turbidites?
What is grading bedding?
How do turbidites produce grading bedding?
You are to collect a handful of the oldest biogenous sediment in the Atlantic Ocean. Where would you get it from? Explain why you selected these locations. (Hint: The mid-ocean ridge is a divergent boundary, which of which direction the plates would be moving.)
How might cores be obtained from below the seafloor? What types of technology might be necessary to accomplish this scientific task?
How would you go about finding and identifying cosmogenous sediment?
[Optional: Extra Credit] What was the name and latitude and longitude of the island you were stranded on at the beginning of the course? Would you expect there to be more biogenous sediment or abyssal clays on the ocean floor? Why?

Aging and Womens Sexuality

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  • Liqi Liu

The World Health Organization regards sexual health as a state of physical, mental, emotional and social well-being related to sexuality (Woloski-Wruble et al., 2010). It is not limited to the absence of disease, infirmity dysfunction or the mere presence of sexual intercourse activity. These factors are a reflection of a successful aging model that incorporates physical well being reflected by a low susceptibility to disease. It also includes social and emotional well-being associated with active engagement with life and mental well being exhibited by a high capacity for physical and cognitive function.

Sexuality is an essential component of health at all developmental ages and an important aspect of life satisfaction (Kalra, Subramanyam, & Pinto, 2011). The factors that influence the sexuality of women in their middle and old age are socio-cultural, feminine, medical, political, economic factors (Birkhauser, 2009) and international factors. Other influencing factors include social representations of sexuality, physiological conditions, and relationship factors (Ringa, Diter, Laborde, & Bajos, 2013).

Cultural practices play a critical role in determining sexuality (Shea, 2011). In China, some clinical educators view sexual activities in middle and old age a taboo. Other health professionals view women’s feudal attitudes as the main obstacle to sexual liberation. The change in women’s social status due to higher education, participation in the labor force and increased use of contraception has intensified sexual activity. These activities within the social environment largely affect the women’s responses to their aging process. Other contributing factors include improvement of living standards and life expectancy (Ringa, Diter, Laborde, & Bajos, 2013).

Health is another key factor affecting sexuality in middle and aged women (Birkhauser, 2009). Cardiovascular disease in postmenopausal women affects their physical, social and general well being. This leads to deterioration of quality of life and adds on the negative effects of menopause (Birkhauser, 2009). Access to health is determined by the financial ability of the women and enabling political framework.

Contrary to popular belief, the menopausal status is not a risk factor in sexual dysfunction. In some instances, it led to low sexual desire. Several studies have shown that women past the age of 50 are still sexually active (Ringa, Diter, Laborde, & Bajos, 2013). This essay aims to evaluate the various factors that affect sexuality in older women.


Background

The world’s aging population is increasing, as the current life expectancy is increasing. The life expectancy of women in Israel estimated at 82 years (Woloski-Wruble et al., 2010)

.

About a third of women’s life is lived after cessation of menstruation. China constitutes the world’s largest middle-aged and elderly population. Approximately one-fifth of the world’s elderly population and a quarter of the middle-aged population live in China. In 2010, 381.6 million people were between the ages of 40 and 59 while an estimate of 170.9 people was above 60 years of age (Shea, 2011).

Demographic studies project a rapid increase in these proportions over the next several decades. By 2050, it is expected that 35.4% of the population in China will be above 60 years of age (Shea, 2011)

.

As such, understanding the needs, desires and capabilities of this group is of paramount importance.

As of now, very few studies have focused on sexuality in the elderly and the existing literature contains contradictory information. For instance, some studies indicate that hormonal determinants have no effect on the sexual drive while others show a correlation between hormonal changes and sexual activity. Hence, further studies would greatly help in ascertaining assertions that sexual life is an important determinant of satisfaction in life (Shea, 2011).


Cultural Factors

Certain cultural norms are the cause of negative attitudes towards sexuality in older people. In some Western cultures, men are considered ready for sexual activity at a younger age than women (Woloski-Wruble et al., 2010). They also claim that women become asexual with age. However, women have in the recent time challenged this view and regarded sex as extremely important (Woloski-Wruble et al., 2010). Research has focused on the sexual dysfunction that is likely to occur after menopausal transition rather than the normal spectrum of normal activities due to the changes arising from hormonal changes. However, it is worth to note that menopause does not necessarily result in sexopause.

The belief that sexual activity decreased with age was held since sexuality was limited to intercourse. In recent years, sexuality has been broadened to mean any sexual arousing activity (Woloski-Wruble et al., 2010). Using this broader definition, studies have shown that women remain sexually active even in old age. An intimate relationship is one factor influencing sexuality in older women. Being able to address their expectations would enhance life satisfaction.

The Chinese culture is marked by three traditions; Confucianism, Buddhism and Daoism (Shea, 2011). The Confucian tradition advocated for sex for a married couple and only for the purpose of reproduction. Otherwise, it regarded other sexual activities as unrespectful and undignified. Buddhist taught that in order to enjoy perfect peace, one had to give up worldly pleasures and desires. As such, sexual activity beyond the purpose of reproduction was viewed as distracting one from their improvement. Daoist on the other hand regard sex as harmful and self-defeating as it makes men lose their semen (Shea, 2011).

A study conducted in China showed that a third of the studied population was of the opinion that sex later in life was unhealthy or abnormal. It also showed a correlation between the women’s attitude and the sexual activity. The women who viewed sex as normal were more likely to engage in sexual activities. Further, the women with positive attitudes led healthy relationships with their spouses. The study also suggested that the household composition such as the number of family members and number of generations contributed to the sexual activity later in life (Shea, 2011).


Social Factors

Women from different regions view menopause differently(Birkhauser, 2009). In the Muslim culture, menstruation is regarded as impurity. Hence, menopausal women gain a higher social status. It is therefore regarded as a happy event that calls for a celebration. In some cases, this is not the case, and hormonal therapy is considered in order to improve patient outcomes. Hormonal therapy provides symptomatic relief and restores sexual activity (Birkhauser, 2009).

Hormonal therapy should also be recommended for women with cardiovascular events unless there are associated risks. Some cultures do not allow bleeding and hence alternative medicine is sought to relieve the symptoms while allowing only the desired amenorrhea.The effect of the natural products has not been sufficiently studied (Birkhauser, 2009).


Medical Factors

The state of health influences the level of sexual activity (Birkhauser, 2009). Women who are of an advanced in age and are in poor state of health are less likely to engage in sexual activities. During the management of somatic diseases, clinicians often neglect the implications for sexual life and hence go undiagnosed (Maciel & Lagana, 2014). These problems may cause the patient to be socially withdrawn and result in depression. Cardiovascular diseases are one major cause of reduced activity. Women who suffered from myocardial infarction do not lead a sexually active life (Kalra, Subramanyam, & Pinto, 2011).

Besides cardiac problems, elderly women may suffer from physical disabilities that affect the motor function (DeLamater & Moorman, 2007). This group of patients experience pain and discomfort in sexual activities and are likely to withdraw. In addition, patients may suffer low libido and unwillingness to engage in foreplay (Woloski-Wruble et al., 2010).


Feminine Factors

Hormonal changes that occur during the onset of menopause result in vagina dryness and, as a result, affect sexual satisfaction (Lindau, Schumm, & Laumann, 2008). However, several studies in this area found no correlation between menopausal state and sexual activity (Ringa, Diter, Laborde, & Bajos, 2013). Perimenopausal women have increased levels of masturbation suggesting that hormonal changes do not hinder penetrative intercourse. However, some studies have reported that menopausal changes have a negative effect on the sexual life. These inconsistencies could be due to different characteristics of samples used in the different studies(Ringa, Diter, Laborde, & Bajos, 2013).


Political Factors

Older women have few sources of funds to pay for insurance premiums and taxes(WHO, 2007). Inadequate finances may result in delays to seek medical attention following illness. The developing disease compromises the state of health and affects sexual activities. Hence women living regions in which the health policies promote accessibility to health services regardless of the ability to pay enjoy relative health and hence healthy sexual health. It is the duty of each country to develop the best mix of policies in healthcare, income and social services in order to safeguard the well-being and health of older women (WHO, 2007).


Economic Factors

Poverty is a key player in compromising the health of aging women. Worldwide, women have lower participation in the labor force and are often underpaid as compared to men of equal qualifications. Older women receive employment in low-paying and part-time jobs. Insufficient funds limit the ability of old women to access the most basic needs such as healthcare, shelter and food. It is estimated that 70% of the women in the world live below the poverty line of less than US $ 1 a day (WHO, 2007). A large number of these are found in the developing countries. These income inequities compromise the well-being of the elderly women and, as a result, their sexual health is affected.


Conclusion

A satisfactory sexual life is an essential component of good quality of life. However, Sexual activity changes with age and may affect the quality of life. The factors that influence these changes include state of health, socio-cultural values political and economic factors. Different regions practice different traditions that may affect how women in their menopausal age view sexual activities. Some practices limit sexual activity for reproduction purposes while in some cultures sexuality is liberal.

One of the major health factors is cardiovascular events. Myocardial infarction leads to depression and anxiety. These factors affect sexual satisfaction and hence decrease sexual activity. While managing these conditions, it is essential that the healthcare providers engage the patients on sexual health. The level of economic empowerment determines the accessibility of social services such as health. Since older women have fewer financial resources, the right policy mix should be adopted to enhance accessibility to health services and other amenities.


Recommendations

It is of utmost importance to give sexuality issues in the older population priority same as the other vital needs. Therefore, health professionals should formulate interventions aimed at improving sexual health in menopausal women (Taylor & Gosney, 2011). A participatory approach would lead to meaningful interventions, as it would allow the professionals to understand the perception of the different women to sexual satisfaction. It would also ensure that the designed interventions help the women in arriving at successful aging (Shea, 2011).

An analysis shows that the present literature is based on speculation rather than facts. Healthcare professionals should carry out participatory research involving women of different ethnic groups, age, and languages. Development of evidence-based knowledge would aid in understanding the different aspects that constitute sexual satisfaction among older women. It would also help in designing of group-specific interventions aimed at improving the quality of life (Woloski-Wruble et al., 2010).


Reference

Birkhauser, M. (2009). Quality of Life and Sexuality Issues in Aging Women.

Climacteric

, 52-57.

DeLamater, J., & Moorman, S. (2007). Sexual Behaviour in Later Life.

Journal of Aging and Health

, doi.10.1177.

Kalra, G., Subramanyam, A., & Pinto, C. (2011). Sexuality: Desire, Activity and Intimacy in the Elderly.

Indian Journal of Psychiatry

, 300-306.

Lindau, S., Schumm, P., & Laumann, E. (2008). A Study of Sexuality and Health among Older Adults in the United States.

New England Journal of Medicine

, 762-774.

Maciel, M., & Lagana, L. (2014). Older Women’s Sexual Desire Problems: Biophysichosocial Factors Impacting them and Barriers to Their Clinical Assessment.

Journal of Biomedical Research

, doi. org/ 10.1155.

Ringa, V., Diter, K., Laborde, C., & Bajos, N. (2013). Women’s Sexuality: From Aging to Social Representations.

Journal of Sexual Medicine

, 2399-2408.

Shea, J. (2011). Older Women, Marital Relationships, and Sexuality in China.

Ageing International

, 361-377.

Taylor, A., & Gosney, M. (2011). Sexuality in Older Age: Essential Considerations for Healthcare Professionals.

Journal of Age and Ageing

, 1-6.

WHO. (2007).

Women, Ageing, and Health: A Framework for Action.

Geneva.

Colorectal Cancer Screening – Importance and Strategies

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The transformation of the United States healthcare system aims to advance and enhance the quality of healthcare delivery and patients’ health (Krist). Preventive care is a significant aspect of the transformation of healthcare. Cancer remains a top source of the number of deaths in the United States, although colorectal cancer (CRC) is a preventable disease. The prevention requires consistent utilization of screening methods as recommended (Spruce). Vast amount of research has continued to prove that CRC screening greatly reduces the occurrence of and death from CRC. There are a number of interventions for healthcare providers to use that help raise the rates that patients will adhere to screening, but ultimately health-promoting and preventive actions are a shared responsibility between both patient and healthcare provider. In order for the intended goal of raising CRC screening rates to occur, providers must not forget that patients need to be satisfied with their care, and that caring for and about the patient needs to be forefront (Spruce). This paper will discuss utilization of colorectal cancer screening and strategies to increase screening adherence with a theoretical basis from the metaparadigm of nursing, Watson’s Theory of Human Caring, and Reigel’s Theory of Self-Care, and discuss aspects of colorectal cancer screening in relation complexity science.


Phenomenon of Interest

CRC screening interventions have targeted different subjects in attempts to raise screening rates including patients, healthcare systems, and healthcare providers (Garcia). Primary care providers should be targeted for implementation of interventions because they are in a unique position at the forefront to impact CRC screening rates. A majority of adult patients have primary care providers that they receive care from regularly, and primary care providers can use these many opportunities to recommend screening to all appropriate patients (Spruce). A recommendation of CRC screening from a healthcare provider is significantly influential in determining if a patient will comply with cancer screening. The process of CRC screening is extensive and involves developing a connection and rapport with the patient, educating the patient and opening discussions about the multiple screening options available to them, and supporting the patient’s decision (Spruce). Several patient-identified barriers to CRC screening exist such as anxiety, embarrassment, fear, and perception of pain, danger, or discomfort. The patient-provider relationship can help to dispel most barriers to screening with proper communication and education (Garcia). Ensuring that patients have options to choose from and encouraging participation in their own health care decisions has proven to raise CRC screening rates (Spruce).


Metaparadigm of Nursing

Fawcett (1984) identified the metaparadigm of nursing as the most global perspective of nursing that involves four central concepts of nursing as person, environment, health, and nursing. Person is defined as the one who receives nursing care, which often refers to the patient, but can refer to more than one person, including sociocultural factors such as family, friends, and community (Fawcett, 1984, 1996). The next part of the metaparadigm of nurse theory construction is health. Fawcett (1984) defines this as the patient’s degree of wellness or illness. Patients’ health refers to a large variety of aspects of the person’s wellbeing such as genetic factors, and also includes less obvious factors such as the patients’ intellectual, emotional, and spiritual wellness (Lusk). In regards to CRC screening, this aspect of the paradigm involves the use of preventive care to maintain a healthy state. Unfortunately, the underuse of preventive care is an issue leading to patients that are most in need of preventive care only going to a provider for sick visits, not for prevention (Krist, 2011). Patients that are seen in these visits perceive themselves to be possible in an ill state, reporting signs and symptoms of gastroenterology issues, often leading to providers to initiate CRC screening based off of symptoms (Garcia). Patients reporting to a provider at a healthcare facility is an example of the patient interacting with their environment, which is another aspect of the metaparadigm. The environment aspect of the metaparadigm refers to all internal and external surroundings, circumstances, and influences affecting the person, including the setting in which nursing occurs (Fawcett, 1984, 1996). Nursing is the fourth concept of the metaparadigm and is defined as nursing interventions done on behalf of or with the patient and the results by which positive changes in health status are affected. Nurse practitioners are in a critical position to reshape primary care to where it is focused on becoming patient-centered. Reformatting concepts of healthcare practice and introducing more patient-centered models of primary care delivery will allow for patients to receive the screening tests they need based on provider recommendation and individual patient choice (Spruce). Providing patient-centered care allows healthcare providers to respect and care about patient differences, morals, preferences, and needs while advocating disease prevention and promoting wellness (Lusk).


Grand Nursing Theory: Watson’s Theory of Human Caring

Nurse practitioners care for patients from numerous upbringings, cultures, and healthcare challenges. Primary prevention of disease and health promotion are great concepts for health practice, but nurse practitioners have been encouraged to keep nursing theory and research as a basis for their practice. The integration of Watson’s Theory of Human Caring into advanced practice provides an all-inclusive, humanistic view of the person which allows the practitioner to look at all aspects of the patient in need of care (Hagedorn).

Watson (1990) states that caring is recognized as the central base to the nursing profession. According to Watson (1988), caring consists of ten Caritas – factors of care – that all create a structure for nursing science. The ten Caritas factors are: “humanistic-altruistic system of values, faith-hope, sensitivity to one’s self and to others, helping-trust relationship, expressing positive and negative feelings, creative problem solving, caring process, transpersonal teaching-learning, supportive, protective, and (or) corrective mental, physical, societal, and spiritual environment, human needs assistance and existential phenomenological-spiritual forces” (Watson, 1988). The first three factors shape the foundation for the science of caring, and the remaining factors stem from that foundation. Caritas Caring is defined as relationships with open communication that create a caring-healing environment (Watson & Foster, 2003). These relationships should be integrated with the guiding values of nursing that include upholding humanity, dignity, and fullness of self. The integration of and advancement of human caring as an initiative in nursing practice is a significant subject (Watson & Foster, 2003).

Watson’s Theory of Human Caring has several aspects that can be used for implications of practice with CRC screening. Colorectal cancer mortality and morbidity is a significant issue. Interventions as large as community-wide educational CRC screening programs embraces the Caritas through the transpersonal teaching and learning carative factor (Garcia). Interventions that are not as grand, such as individual provider and patient relationships to discuss CRC screening are just as powerful, if not more. Watson (1988) stresses the significance of having an equal partnership between nurse and patient rather than a relationship of imbalanced power. Shared decision making is applied and functional in the patient-provider relationship in the discussion of CRC screening strategies, in which the provider implements a caring attitude and respects the patient’s ultimate goals (Underhill). By sharing knowledge with the patient, the patient is able to assist in the decisions regarding their own care, and is the leader of their own plan (Lusk). Patients gain autonomy with shared decision making, and this leads to patients finding sense and purpose in their own existence. This leads to an increase in their ability to have inner control and to problem-solve (Watson, 1988). The mistake that providers made in the past is presenting a single CRC screening option as the patient’s only choice as this is not the essence of truly caring for the patient (Spruce). Using Watson’s Theory of Caring, the focus should not be to only complete the task of getting the patient to adhere to a screening method, but on all aspects of the patient. This can include offering culturally sensitive interventions to increase knowledge of CRC to help improve screening uptake (Underhill). Providers should present appropriate evidence-based knowledge to the patient that is in their best interest. Most often, the evidence is in favor of a particular screening intervention. The patient should be allowed to make a decision, and this decision will be based on evaluation of the evidence presented but will also involve considering their principals and belief system. The helping-trust relationship between the nurse and the patient supports the patient’s decision, even if the decision is not in line with the provider’s suggestion and evidence (Lusk). The patient as a whole should be taken into consideration with CRC interventions to better ensure that the foundation of caring is forefront, and studies show that strategies that are patient-centered improve CRC screening behaviors (Underhill).


Middle Range Theory: Reigel’s Theory of Self-Care and Chronic Illness

Reigel, Jaarsma and Stromberg (2013) define self-care as a process of preserving a healthy state with practices that promote health and handle illness. Self-care can be implemented in a state of health and an ill state. Reigel et al. (2013) explains that when a person is sick but stable, they can still maintain health without necessarily having to transition into a different type of care that focuses on the illness. This is seen in cases when patients report to the healthcare provider with signs and symptoms that may be related to colon cancer, the perceived state of illness, and want to take actions such as CRC screening to try and regain the state of wellness or manage their state. Intended outcomes of selfcare include sustaining a healthy state, stabilization of illness, well-being, and quality of life (Reigel, Jaarsma & Stromberg, 2013). The three key concepts that help define self-care explained by Reigel et al. (2013) are self-maintenance, self-monitoring, self-management. Self-care maintenance is defined as actions done to improve well-being, maintain health, or to keep the stability of physical and emotional aspects of the patient. Self-care maintenance tends to be behaviors that reflect the recommendations of providers (Reigel et al, 2013). The behaviors of self-maintenance may be performed by patients after strong encouragement by others such as health care professionals or family members or the patient may choose to perform behaviors on their own to meet personal goals. Recommendations of CRC screening are sometimes initiated by a patient’s providers and family. Provider recommendation of CRC screening is critical to predicting the use of screening methods (O’Farrell). Nurses at all levels of practice regularly provide recommendations for preventive care to patients, and they are in optimal positions to do so because of increased contact with patients. This allows for enhanced CRC screening counseling, providing information that will increase knowledge regarding CRC screening guidelines (Bardach). Self-care maintenance is strongly enhanced when a patient reflects on the usefulness of the self-care behavior, is observant in performance of the behavior, and continues to evaluate the benefits and the effectiveness of the activities (Reigel). The purpose of education of CRC screening is for the patient to have knowledge of the benefits of screening and for the patient to continue with this avenue of self-care by adhering to continued screening as recommended by national guidelines (Bardach). Adherence is a critical part of self-care maintenance. Health care providers collaborate with patients to discuss integrating into their daily life as many of the evidence based health-promotion behaviors as the patient can accept (Reigel). Adherence to CRC screening has been shown to be increased when providers utilized patient-centered care. These findings demonstrate the vitality of communication and a quality patient-provider in regard to screening behavior and have strong implications for clinical practice (Underhill).

The second aspect of self-care as stated by Reigel et al. (2013) is self-care monitoring. Self-care monitoring is defined as a process of routine surveillance and observation of one’s body. Consistent and orderly monitoring creates the best outcomes (Reigel). Reigel et al. (2013) explains that monitoring one’s self, understanding the importance of it, and reporting abnormalities can allow for appropriate healthcare interventions to take place before a situation becomes detrimental. This facilitates the provider’s ability to give the best care (Reigel). This concept is critical to one aspect of the purpose of routine CRC screening. Signs and symptoms that could be indicative of colon cancer signify a need for CRC screening, and this communication with the provider can facilitate the proper screening method to be implemented to potentially catch a situation before the devastating illness has developed (Bardach).

The third concept of self-care is self-care management. This is defined as involving an assessment of any changes in signs and symptoms – physical or emotional – to decide if an intervention is needed (Reigel). Reigel (2013) explains that decision making is one of the underlying concepts of self-care. Reigel () states that confusion, mistaken beliefs, and insufficient knowledge can all come into play and distort decision making, leading to inadequate self-care. This further indicates the importance of the relationship between patients and the providers (Reigel). Interventions that aim to educate and reduce barriers such as confusion are the most effective interventions targeting the patient for increasing participation rates in CRC screening (Garcia). Reigel () suggests that self-care is not always done by the patient alone. Most patients acknowledge the value of contributions from their environment or community and make use of the welcomed input-a process Reigel et al. (2013) describes as shared care.

Reigel et al. (2013) states that motivation is one of the outcomes of self-car. Patients can be motivated to perform self-care, and describes motivation as the power that influences people to achieve their objectives. The motivation can be intrinsic – driven by an internal desire – or extrinsic, referring to changing a behavior because it leads to a specific result that is anticipated (Reigel). Many patients have the extrinsic motivation to proceed with colorectal cancer screening with the hope that the outcome will be either remaining free from CRC or catching a potentially deadly disease early enough for the best prognosis (Atassi).


Complexity Science

Complexity science views systems as complex, having many parts that interact and are unpredictable, but can be adaptable. A complex adaptive system is a significant model of complexity science. Complex systems must be able to adapt, or else it will not survive (Florczak). Most systems involve layers of varied subsystems – microsystems – that intermingle with each other (Florczak). A complex system can adapt its behavior overtime, and its parts respond to their environment by using adopted rule sets that motivate its behaviors (Plesk). This theory is used to explain an organization’s office systems improvements to implement clinical guidelines of CRC screening. Evidence has shown that CRC screening is on the rise due to adjustments and improvements in screening strategies (Atassi). Because the screening rates are still not where national guidelines are targeting, further adaptations and improvements are implemented to increase adherence to screening, such as including patients in the decision making, and using information technology for more accurate screening rate surveillance (Triantafillidis). This model is delivered by monitoring performance reports from EMR data, using special alerts embedded in the EMR that remind providers to initiate CRC screening as well as patient reminders, ensuring providers are culturally competent and implementing the concept of patient autonomy in decision making (Triantafillidis). According to the complexity science theory, providers in healthcare facilities that have a goal of increasing colon cancer screening will act accordingly with efforts to recommend CRC screening to patients.

Healthcare systems are moving toward adopting practices that focus of preventive care. Colorectal cancer is a disease that is preventable disease that remains a source of the most number of deaths in the United States. The prevention of colorectal cancer, as well as any preventable cancer, requires consistent use of recommended screening methods. Using simple strategies and adapting primary care practice to more patient-centered care will make a difference in the incidence and mortality from CRC. A holistic view of patients should be taken into consideration with CRC interventions to help ensure that caring remains a staple in healthcare. Nurse practitioners have a unique position that would allow for transforming primary care to where it is focused on becoming patient-centered.


References

Watson, J. (1988). Nursing, human science and human care. New York: National League for Nursing.

Describe academic strengths and challenges, work experience, and career objectives

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Describe academic strengths and challenges, work experience, and career objectives

 

Essay (500 words maximum):

Autobiography describing academic strengths and challenges, work experience, and career objectives; Reasons for applying for scholarship: Your proposed field of study and future career plans; Name of University and why you choose the School.

My work experience :Registered Nurse since 2001 work in Med Surge Unit Waltham Deaconess Hospital State Massachusetts for 2 years then moved to Florida work in mental Health. Career: Nursing objectives: I recognize and understand the need for change. Name of University I am attending now is South Univ. Why I choose South : established in 1899 formed well known practitioners.

Identify issue (HIV/ Aids in men who have sex with men)

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Identify issue (HIV/ Aids in men who have sex with men)

 

Community Psychology: HIV/ AIDS

The following is the requirement for the paper that’s already been written:

“Identify issue (HIV/ Aids in men who have sex with men)