Health Impact of Dual Diagnosis

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A process in which simultaneous conditions are identified and diagnosed which can include eating disorders and alcoholism, schizophrenia and illicit drugs is referred to as a ‘dual diagnosis’ or also known as ‘dual disorder’. It is a diagnosis that refers to someone who has both a mental illness as well as a substance abuse problem. It suggests that two disorders are occurring at the same time, however there can be more than two disorders relating to either the substance abuse or mental illness. When diagnosed, the medical practitioner views one of more symptoms of one disorder that are established which is independent on the other disorder, but not just a number of symptoms that come from the same disorder. However multiple disorders re-occurring at the same time can also be classified as a dual diagnosis. In comparison to the individuals who have a mental health disorder and a substance abuse problem, the rates are considerably higher than the general public. Dual diagnosis patients experience more severe and chronic medical, social and emotional problems. It often leads to worsening of the psychiatric disorder which in return leads to the addiction relapse (American Psychiatric Association,

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition).

A high consumption of alcohol or drugs leading to leading to dependency is commonly referred to as alcoholism or substance abuse. These are chronic disorders with highly mental and physical consequences to the individual suffering from the known disorder. Substance abuse is characterized by a physical dependence upon the illicit drug, such as cocaine to prevent symptoms of withdrawal due to increased tolerance to the drug. Known as a co-occurring disorder, it usually develops alongside other illnesses/disorders such as an eating disorder. Eating disorders and cocaine addiction frequently occur in most cases. A major problem that exists between eating disorders and cocaine use is that the addiction for the drug is a stronger force than the complications that the individual may face due to the mental illness, however severe it may be. In the case of eating disorders, individuals cannot properly comprehend the fact that the drugs is in fact making the symptoms of their eating disorder much worse, which is why the need for alcohol has increased and will continue to increase and the tolerance level will not go down leading to worsened condition of their mental illness as well as their substance abuse problem.

Addiction to an illicit substance is a disease that affects brain function and behaviour. In a research conducted in Australia, nearly 50% of individuals with an eating disorder also have a substance abuse or alcohol problem which is a rate nearly 5 times greater than what is seen in the general population (Substance use and Eating disorders, National Eating disorders, Amy Baker Dennis & Bethany Helfman).

Substance abuse and eating disorders such as anorexia nervosa or bulimia nervosa are interconnected, one affecting the other with death rates higher from both the medical complications that the individual may face in the time as well as high risks of suicide. This particular dual disorder can cause cardiovascular disease, cancer, stroke, hepatitis B and C, as well as lung disease and cognitive changes and irregularities within the body and brain shown to be quite evident. In the past 20 years, the number of individuals with eating disorders combined with cocaine addiction has almost doubled, but only 10% of those have received any kind of treatment. Out of those who are treated, only 35% are at a special eating disorder facility and almost 80% of the individuals who get treatment aren’t in therapy long enough to achieve a full recovery. It has been highlighted that teenagers in the age of 13 start or try illicit substances (Integrated Treatment of Substance Abuse & Mental Illness)

Substance abuse are mostly influenced by genetics, biological, environmental and psychological factors

As a health practitioner who is treating individuals who are have present symptoms of a mental illness and a substance abuse problem, it is the duty of the health/medical practitioner to find an integrated program that supports the medical as well as physical and psychosocial treatments that will be the most effective in the recovery of both a substance addiction and the eating disorder Substance use and Eating disorders, National Eating disorders, Amy Baker Dennis & Bethany Helfman).

In addition also being aware of the connections between eating disorders and cocaine addiction can be quite advantageous in the treatment plans. In the event of educating the public, small seminar or sessions can be held for the public in order to gain some information about the disorders

Drugs, whether it’s overusing and becoming dependent on prescription medication or illicit drugs, both almost always worsens the underlying mental illness. Abuse of drugs results in a worse prognosis for a person with a mental illness who are actively using are less likely to follow with their treatment plans and often miss appointments with their medical health practitioner leading to adverse outcomes. The treatment of these co-occurring disorders are complicated and depending upon the individual and type of treatment given and received. Many people who are undergoing treatment go through the process of stopping their drug and alcohol abuse. This can include inpatient detoxification which can involve being admitted in hospital or a detoxification facility, with the addition of medications to minimize serious complications of substance withdrawal.

Research has indicated that individuals undergoing psychiatric treatment is more effective if they are not actively using substances such as drugs and patients who have safely been removed the use of drugs from their lives. It is very hard to treat these co-occurring disorders, however not impossible. The interventions that are used to treat a dual diagnosis disorders are more effective when the individual is sober and more able to actively participate in treatment. Some interventions can include inpatient rehabilitation centers or supportive housing. Some patients choose to return home to their family and friends for support and encouragement to continue their efforts as well as further encouragement. Some individuals find therapy to be a very helpful part to stay sober and away from drugs such as cognitive behavioural therapy as well as self help groups such as Alcoholic Anonymous, Narcotics Anonymous or Smart Recovery (Substance use and Eating disorders, National Eating disorders, Amy Baker Dennis & Bethany Helfman).

Dual diagnosis services involve developing the capability of hospital and community based alcohol and drug, mental health treatment and support services to improve health outcomes of individuals with a dual diagnoses.

In addition to providing hospital and community based services, it also provides primary, secondary as well as tertiary consultations with health practitioners who give you the best support and treatment available, both young and adult. Furthermore, providing education and training on dual diagnosis which is critical with patients who have a mental illness and a substance abuse problem (Eastern Health- Dual Diagnosis, 2014).

In conclusion, to be able to make the general public understand that even if their loved one is going through a similar situation, these conditions or disorders are treatable but seeking professional help is crucial. Understanding the connection between these two disorders can aid in the individuals need to seek professional help and treatment. By being aware of the resources and medical facilities and specialists that around you can further help you into making your decision. In order to recover and lead a normal and healthy life, one always has to make a step forward out of their comfort zone and take on the world, one step at a time.

REFERENCES


http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Dual_diagnosis


http://www.dualdiagnosis.org/eating-disorders/


http://www.psychologytoday.com/conditions/co-occurring-disorders


http://psychcentral.com/blog/archives/2013/10/02/living-with-co-occurring-mental-substance-abuse-disorders/


http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/By_Illness/Dual_Diagnosis_Substance_Abuse_and_Mental_Illness.htm

Dual Diagnosis Treatment – A Unique Approach. Proven Results


http://www.nationaleatingdisorders.org/substance-abuse-and-eating-disorders


http://www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis/alcohol-substance-abuse/relationship


http://www.easternhealth.org.au/services/mentalhealth/adult/dualdiagnosis.aspx

Present national data and trends based on the fbis uniform crime

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For this assignment, you can choose to either create a PowerPoint presentation or write a report depicting your analysis of historical crime data for a specific category of crime or criminal issue. Focus your research on one component of the criminal justice system (i.e., law enforcement, courts, or corrections). The data and charts you develop may be used in your Final Paper. For this assignment, you will

If you choose to create a PowerPoint presentation, your PowerPoint presentation must be a minimum of 10 slides long and must graphically display the statistical data developed for three comparable cities, counties, or states. Your presentation must incorporate national statistics for comparison. Your assessment may be in bullet or paragraph format and must be provided in the notes section of the presentation. Make sure you standardize your data (usually 1:1000; 1:10,000; or 1: 100,000) and incorporate the scale in a key for each chart.

You may wish to include visual enhancements in your presentation. These may include appropriate images, a consistent font, appropriate animations, and transitions from content piece to content piece and slide to slide. (Images should be cited in APA Style

People Living With Hiv Health And Social Care Essay

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HIV/AIDS is one of the most challenges to human life and dignity. It affects all levels of the society and has a massive impact on global economic and social development, (Rowden, 2009). Studies have been conducted on its impact on human life and how it could be controlled. This review was conducted by visiting a number of websites of different publishers and organisations for published articles on HIV/AIDS and stigma. Literature covering a period of 8 years from 2002-2010 was extracted from Assia, PubMed, Sage, British Medical Journal, Cochrane and Absco-host. However due to the topic in question, literature from most recent articles would have been preferred. The term HIV/AIDS stigma was used to capture a wide range of articles covering all areas of the globe. Abstracts from twenty studies were reviewed for the study, objectives, methodology and key findings. Twelve studies covering different locations of the world were chosen. Relevant documents and reports from other organisations such as UNAIDS, WHO and the World Bank were also reviewed. Both qualitative and quantitative data was used to present the information.

Due to the challenges presented by HIV/AIDS to global public health, Baum. (2008:241) calls for collective participation of all sectors in the fight against this deadly disease. Baum emphasises on the collective participation between the lay people and the health structures as key to success. This is further supported by Farmer, (1999), who does not condone the dominance of the biomedical perspective in health and healing. He believes that lay people have a significant role in the process of health improvements and emphasises on the importance of listening to, and understanding the lay peoples’ experiences of ill-health and how it is affected by their daily lives.

Goffman, (1963), and Parker and Aggleton, (2003),’s theories of stigma help us to understand how stigma is constructed and its influence in peoples’ lives. They view stigma and discrimination as functional systems which maintain boundaries between those in power and those without. Through such power, social inequalities are developed leading to creation of social norms. These formulate stigma by governing interactions between people and reinforce power structures that serve to isolate those that are regarded as outsiders, ( ). Both theories have been widely used in HIV related stigma to highlight how the prejudice, negative attitudes, abuse and maltreatment directed towards people living with HIV/AIDS have hindered the progress of prevention and treatment.

Findings from the studies highlight the significance of lay people for prevention and treatment of HIV/AIDS to be effective. In Tanzania, the study unveiled some discriminatory and stigmatised practices such as gossiping about patients’ HIV’s status, neglect, verbal abuse, testing and disclosing HIV’s status without consent, (Tanzania’s Stigma Indicators Field Test Group, 2005). Similarly in India, health workers were disclosing patients’ HIV status to their families without the patients’ consent, (Journal of Social Aspects of HIV/AIDS, 2007). Harassment, avoiding and isolation of HIV-positive patients and testing without counselling are common features of stigmatisation in most studies. Findings showed that stigma and discrimination in health care settings contribute a great deal in keeping people away from accessing HIV/AIDS treatment and care, therefore compromising their health and wellbeing. Patients felt greatly affected by the health workers feeling uncomfortable with them and treating them in an inferior manner. Some health workers wore protective clothing even if there was no physical contact during interactions. This affected peoples’ willingness to access the services despite it being vital to their health. The fear of being identified as infected with HIV was one of the reasons why some people prolonged testing for HIV even though they had the symptoms and only accessed services when their illness was at an advanced stage, (Bond, Aggleton, 2002, Human Resources of Health, 2007, Kinsler et al, 2007, Varga, Sherman, Jones, 2006, Kalichman, Simbayi, 2003). In Zambia, HIV-positive health workers were hiding their HIV status from their colleagues in fear of being stigmatised, (Dieleman et al, 2007). Experienced and perceived stigma and discrimination revealed by the studies have severe influence on people living with HIV/AIDS’ access to health services.

While most of the literature on HIV/AIDS and stigma and access to health services is negative, research also highlights increasing evidence of the value of supportive and de-stigmatising HIV services in some parts of the globe. Brazil has been viewed favourably by people living with HIV/AIDS. The lay people reported supportive inclusive structural systems that create healthy environments for all. The success story of Brazil’s effective HIV/AIDS and stigma prevention and control is attributed to active participation of different groups in the society and the Brazilian government, (Caltado, 2008). Another success of collective efforts of the lay people and the health structures has been noted in South Africa where most people believe in traditional healing. Aids Activism in South has made a positive significance in HIV/AIDS preventing and treatment by translating and mediating the biomedical approach within local ideological frameworks which are easily understood and acted on by the locals, (Colvin, Robins, 2010).

From the research findings it is clear that collaboration between the lay people and the biomedical approach to healing is essential for successful control of HIV/AIDS and stigma. There is no cure for AIDS but Anti-retrovirals (ARVs) can prolong life by keeping the level of HIV in the body at low levels therefore delaying the process between HIV and AIDS, (Robin, 2009). While ARVs are now readily available in most countries, concerns are mostly centred on the rising numbers of newly infected people. According to the World Bank, 60 million people are living with HIV/AIDS worldwide. Access to treatment has increased dramatically but for every 100 people on treatment, 250 become newly infected, (www.worldbank.org/EOL81VLA20 ). For this reason, pressure in now rising on the effectiveness of only relying on the biomedical approach as a concept of health and healing HIV/AIDS. Diseases such as HIV/AIDS need to be tackled using both the biomedical approach and the lay perspective for prevention and treatment to be effective.

The shortfall of the biomedical approach to treatment lies on its focus that is restricted to the physical illness of an individual’s body and the scientific understanding of disease therefore making the approach heavily based on pharmacology. While pharmacology is beneficial in the treatment and prevention of HIV/AIDS, it benefits the pharmaceutical industry which has also been critiqued as hindering the progress on controlling HIV/AIDS. Pharmacology further promotes the privilege of the biomedical model which may be inappropriate to the communities and create feelings of helplessness and vulnerability. This may contribute to the undermining of alternative approaches to treatment and prevention, (Global Health Watch, 2008, Rowden, 2009, Farmer, 1999). Such interventions are not successful in nations who believe in indigenous forms of healing, for example the dependency on traditional healing in Africa.

The lay approaches to healing are effective because they are embedded within local social and cultural structures, but as with HIV/AIDS care, this cannot be confirmed as true. Unlike in the biomedical approach, indigenous approaches seek to heal the whole person by linking the illness with the person’s social and economic background. In South Africa, despite people heavily relying on traditional healing approaches, the HIV prevalence continued to rise. Significance towards effective control of the epidemic has been noted with the increase in accessibility of ARV’s, (Colvin, 2009). In the UNAIDS report on global AIDS epidemic 2010, in 7 countries, five of them in Eastern Europe and Central Asia, HIV incidences increased by more than 25% between 2001 and 2009. Sub Saharan Africa, although still remaining the most highly affected by the epidemic, figures either stabilised or showed signs of decline owing to positive behaviour due to increased services that are embedded in local culture. The report affirms that stigma and discrimination, lack of access to services and bad laws can make the epidemic worse, (www.unaids.org/globalreport/Global_report.htm). The attribute to increased incidences in Europe and Central Asia could be on the countries’ reliability only on the biomedical model of healing.

Baum, (2008) asserts that community level mobilisation where there is partnership between the lay people and structures is the effective way of combating HIV/AIDS and stigma. Active participation of lay people will not only promote individual level responses to dealing with the stigma, access to care and preventing of HIV/AIDS but could also go a long way in improving global public health, (Parker and Aggleton, 2003). Improving health care services and making them accessible to people living with HIV/AIDS without fear of being stigmatised, educating health care professionals about the impact of stigma on patients and policies that encourage inclusion of people living with HIV/AIDS in decisions that affect their lives are some of the key factors of effectively tackling the epidemic, (Farmer, 1990:90).

Advocacy is another way lay people engaged to improve the relationship between health structures and people living HIV/AIDS. The Greater Involvement of People Living with HIV/AIDS, (GIPA), formally adopted as a principle at an AIDS Summit in 1994 emphasises the need for involvement of people living with HIV/AIDS at all levels in the fight against the disease. According to UNAIDS, people living with HIV/AIDS understand their situation better therefore their voices could be heard well if their needs were presented by people in the same situation, (www.unaids.org). In the Zambia study, with supportive structures, the professionals living with HIV/AIDS are in a better position to advocate for people accessing services. Baum, (2008:550) claims that advocacy involving public health practitioners is an effective way of influencing structural barriers in public health.

Both the biomedical and lay perspective approaches to health, healing and prevention of HIV/AIDS and stigma have both benefits and limitations. There is therefore the need for holistic approaches that collaborates both models for HIV/AIDS and stigma interventions to be effective. HIV/AIDS has claimed a lot of lives and continues to claim more; through collective action of the societies and the national structures the epidemic could be controlled.

Value of Reflective Practice for Skills Development

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Reflective practice has been defined as “Involving self, a process that is undertaken in response to a positive or negative event that may be initiate consciously or subconsciously, that requires to provide an answer” (Chapman, Dempsey et al. 2009). It has also been defined as “Paying critical attention to the practical values and theories which inform every day actions, by examining practice reflectively and reflexively, this leads to developmental insight” (Clouston, Westcott 2005). Reflective practice is a process to which a person dissects their internal reactions to certain situations, and how they dealt with the cause and effect. It is only through this reflection that an individual can comprehensively understand and learn from their previous decision making mechanisms. Reflective practice gives the opportunity for a health professional to look back at their clinical skills used in given situations, and assess how these skills could be amended to better their professional practice. It is a method of learning from experiences, using experiences to analyze why problems occurred, and then to find a solution to these problems (Taylor 2010).

Reflection has been defined by Dewey (1933) as “active persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusion to which it tends” cited by (Mann, Gordon et al. 2009). Boud (1978) reinforces Dewey’s assessment of reflection, however, he aligns himself with an overtly emotional assessment of personal experience. Boud defines reflection as “a generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to a new understanding and appreciation” cited by (Mann, Gordon et al. 2009).

There is a gap between academia and good professional practice. Although a student may have a very good understanding of theory, this does not necessarily teach them about good professional practice (Baird 2008). Knowledge is something that is to be challenged and reinforced. Gaining knowledge through clinical experience and reflection is key to being a reflective practitioner (Clouston, Westcott 2005). This can be obtained at university level within Radiography through clinical placement, positioning classes and a personal development system (PDS) (Baird 2008). These classes give the student an opportunity to challenge, discuss, but more importantly reflect on the theory which they have learned. It is through problem solving that a student can reach below the purely scientific understanding of processes and procedures, and can delve into the deeper, and one could argue, the more complexities of clinical practice. Through these teaching methods a student can learn that the theory of practice is not always going to work in given situations, and through reflection they can amend their knowledge to give the result of better clinical skills and professional practice (Baird 2008). It would be nieve to assume that every patient, every ailment, should reprieve a standard set method of treatment. The PDS is an online resource which provides a student with a key initial starting block to which they can build a more successful, productive, and ultimately professional methodology to explore key skill and developmental needs (Rowland 2006).

A study of students found that reflective exercises proved successful, and that they thought it could be a valuable part of their professional careers within the health service. Students realised that reflective practice can help to deal with any similar issues arising (Cronin, Connolly 2007). Another study found that student nurses gained confidence in decision making through journal writing also stating that they believed more, that writing could be used to learn (Epp 2008). Both studies show that reflective practice is a beneficial tool that can be used to enhance professional practice. However the first study is seemingly over crediting the usefulness of reflective practice on a ‘one size fits all’ basis. Students must not become fully dependant on the benefits which reflective practice may bring, and must leave room for ingenuity, and adapt these procedures to specific circumstances. The second study reinforces the benefits which reflective practice can bring to a student’s confidence in their own professional expertise.

The introduction of key performance indicators (KPI) into healthcare departments increased awareness among staff and gave an obligation to staff to fulfil certain tasks (Abujudeh, Kaewlai et al. 2010). Through KPI’s in individual can highlight areas of strengths and weaknesses, however more importantly can develop a systematic and detailed plan to improve their continual personal development. There are methods incorporated into KPI’S to encourage reflective practice, Continual Professional Development (CPD) and life long learning (LLL) (Chapman, Dempsey et al. 2009). Within radiography these two strategies are used to develop reflective practice. LLL was implemented with the intention for individuals to continually re-educate themselves on advances within their field of work. CPD is a resource which is discussed in detail with, the relevant line manager. If CPD is used properly reflective thinking is encouraged in the practitioner (Chapman, Dempsey et al. 2009). This reinforces the relationship which exists between CPD and the development of reflective practice. The society of radiographers has invested in an exclusive CPD tool which gives advice to members on how to reflect and learn. The CPD plan outlines that reflective practice can be carried out in a number of ways. Firstly by writing a reflective journal about personal experiences in the workplace or secondly in an educational environment through health professionals attending courses, to learn better ways of becoming a good reflective practitioner (Kelly 2005). It is only through implementation of all of these methods that a continual and productive mode of reflective practice can be achieved through the CPD plan. Writing a reflective journal helps a health professional keep a record of their practice, remind themselves of good and bad practice, why it happened and how they overcame or will overcome the problem (Clouston, Westcott 2005). A study found when a group of radiation therapists gathered to write journals together that their motivation, confidence, professional knowledge, critical thinking and professional practice all increased ensuring the CPD of staff (Milinkovic, Field et al. 2008).

It is vital for reflective practice to be a success, all individuals within an organisation must be wholly committed to the belief that reflective practice is a worthwhile and productive tool. Things which hinder reflective practice occur in workplaces where there is no emphasis put on it by line management.. The pressures placed on professionals in the clinical environment mean that the health professional may feel that time spent on reflective practice may seem wasted (Mann, Gordon et al. 2009). It is a well known fact that as the health professional spends more time in the profession, it is found that less of their time is spent reflecting. It has been said that barriers to reflective practice include lack of time and space, negative preconceptions, organisational culture, fear, the risk of routine and not fully understanding reflection (Clouston, Westcott 2005). A study found that the use of a facilitator within a healthcare team to guide people and help promote reflective practice was very beneficial to the team. The time spent on reflection was said to have enhanced critical thinking, professionalism, making decisions and being able to challenge things they were not in full agreement with (Mann, Gordon et al. 2009). The use of a reflective practice facilitator provides a systematic and constant reminder to practitioners of the importance and benefits which this tool can give in work life. The facilitator provides an outlet for relevant and knowledgeable advice in what a practitioner may perceive as being a difficult circumstance. This study suggests that reflective practice has a positive impact on clinical skills and professional practice. Another study found that within the format of a meeting environment consisting of health professionals, reflective practice was influenced by five factors. The first factor which influenced reflective practice was that too much structure in a meeting lowered the ability to reflect. Secondly the level of interest a professional has in reflection, the more interested being better reflectors. Meetings in which people have certain roles and consist of tasks do not provide ideal for reflection. A pressurised environment where a professional is obliged to complete tasks, was shown to prevent reflective capabilities also (Heel, Sparrow et al. 2006). It would be nieve and absurd to remove structure from this mode of reflection, as the KPI targets reinforce good reflection methods. .

Reflective practice has been proven to be an important tool in developing clinical skills and professional development. All studies had a similar agreement that reflective practice is good but the method of reflecting varied. Reflective practice has to be carried out from student to professional level. Reflection was said to increase confidence, decision making, motivation and professionalism (Clouston, Westcott 2005). There were no studies found that measured the effectiveness of reflective practice, perhaps this is an area where more research is needed. Another area that no research was located on was bad experiences of reflective practice. Further study into these areas could give more insight into how beneficial reflection is.

Compare and contrast the ANA or ICN Code of ethics for Nurses Practice Act.

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Compare and contrast the ANA or ICN Code of ethics for Nurses Practice Act.

Compare and contrast the ANA or ICN Code of ethics for Nurses Practice Act.Compare and contrast the ANA or ICN Code of ethics for Nurses Practice Act. How does each one guide the nursing practice.Provide examples to get your point across.1 page short.

Endodontic Surgery (Apicoectomy)

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In this modern times patient increasingly wish to preserve their natural dentition and often reluctant to get there teeth extracted . Endodontic surgery (apicoectomy) is the treatment performed on the root apices of an infected tooth, and its resection and removal of pathological tissues around the apices followed by placement of a filling (retrofilling) to seal the root end. Endodontic surgery offers patient a second chance or the final chance to save there tooth. Success of Root end surgery had a poor prognosis and success rate in the past but due to recent advances Endontics due to the surgical operating microscope and new tecniques the rate is much higher than before success

Its indications are as follows


1 RCT treated tooth that has severe periapical inflammation despite of a satisfactory RCT


2 Tooth with persistant periapical inflammation and inadequate RCT and has the following problems

a Severely curved root canals where access is an issue to reach the apex

b Completely calcified root canals

C Presence of post and cores in root

d Breakage of small instrument or filling material where it is not retrievable and an infection is still present in the apical region.


Teeth with periapical inflammation where completion of endodontic therapy due to

1 Foreign body present in the periapical tissues

2 Perforation of the inferior wall of the pulp chamber

3 Perforation of the root

4 Fracture of the apical third of the root

5 Dental anomalies (Dense in Dente )

6 Access for periradicular curettage

A non healing endodontic lesion is recognized by persistent pain and/or swelling, possibly with radiographic changes indicating increasing periapical bone loss. Non healing endodontically treated teeth that do not appear to be healing are not automatic indications for extraction and replacement with an implant. Persistent nonhealing cases can be saved by endodontic microsurgery with a predictably favorable prognosis

Nonsurgical endodontic treatment has a high rate of clinical success despite the anatomic and pathologic challenges of the procedure. Success in case of tooth without periapical extension of pathosis is more than 90%. On the other hand, studies show that infected root canals with an extension of pathosis into the periapical space have a reduced healing capacity . previously the conventional endosurgery has very low success rate . it was recorded as low as 37.4 % but now with recent advancement in endodontic surgery the success rate has improved significantly. According to a study conducted by shimon Friedman and Chaim Mor ( success of endodontic therapy -healing and functionality) in patients were endodontic surgery is performed the chances of healing after retreatment is between 74 to 86 %and their chance of being functional overtime is 91 to 97 % .Another study ( modern endodontic surgery concept and practice by syngcuk Kim and Samuel Kratchman)said that the traditonal apical surgerybased on clinical symptoms and radiographic findings ranges from 44% to 90%.it has even higher success rate with the endodontic microsurgery. . According to another study (outcome of surgical endodontic treatment performed by a modern technique – A meta anlysis conducted by Igor Tsesis , Surgical endodontic treatment have a success rate of 91 .4 % when followed up in a year time .

According toa study named Outcome of endodontic micro re- surgery by Minju song and team …. When an endodontic surgery fails we need to identify the problem and find the reason for failure. To solve the problem further treatment like retreatment with surgery and, extraction are the viable options. Some studies in the past have documented poor success rate if we have to redo a failed surgery again. But this study said that with the new microscope and microsurgical devices the success rate can be as high as 92.9 %. Most of the reason for failure is poor technique,poor seal at the apical region and not using biocompatible materials like MTA and super PBA in the past. In another recent study it was found that, at least in America, endodontic surgery was the least expensive intervention for failed RCT when compared to endodontic re-treatment and crown, extraction and fixed partial denture, or extraction and implant (Kim & Solomon, 2011).

When primary `endodontic treatment fails retreatment should be done and when retreated and if there is severe inflammation in the periapical tissues then endo surgery can be an option using advance techniqies and good operationg skill can add to the success of endo surgery.


1 Microscope

The microscope will provide good visualization, identification and treatment of infected canals, isthmuses and variant anatomy not reachable with traditional instrumentation techniques. Microscope can reach to more different locations and narrow spaces, by providing a clear field of vision. Good visualization also prevents damage to anatomical structures. Microscopic techniques significantly decrease complications and expand the case applicability for performing this procedure on teeth adjacent to these structures. With increased magnification and illumination, differentiating the root surface from the surrounding bone is also enhanced .A main cause of nonsurgical endodontic failure results from the inability to clean and sterilize the apical canal space, which is a complex anatomical entity.


2 ultrasonic tips

That allow accurate preparation along the long axis of the root canal with clear visualization of the preparation . This technique will allow us to do root-end fillings in the proper position to seal the root canal to sufficient filling depth and thickness to effectively seal the canal, dentinal tubules and accessory canals. Ideal ultrasonic tip length is 3mm long. A minimum of 3mm preparation depth is needed to prevent leakage.


3 Surgical advances

A smaller osteotomy will reduce bone removal (approximately 3-4mm) in diameter reduced

bone and permits quicker uneventful postoperative healing postoperative healing. By removing less bone in the coronal direction, buccal bone can be preserved and subsequent periodontal sequelae that may lead to the loss of the tooth are prevented.

  1. Root-tip resection of 3mm is needed to eliminate lateral canals and apical ramification- A study shows that the resection of 3mm of apex eliminates 98 percent of apical ramifications and 93 percent of lateral canals.
  2. Root section bevel angle is reduced to 0 -10 degrees
  3. Clear examination of the resected root surfaces for fracture and anoatomical variations
  4. Root-end fillings with MTA (Mineral Trioxide Aggregate- It has excellent biocompatibility, osteo- and cemento-inductive capabilities, effective antibacterial and sealing properties, and faster radiographic healing in comparison to SuperEBA and IRM. MTA will not cause soft tissue discoloration that can otherwise result from root-end filling materials like amalgam

Magnification Eyes or Loupes (1-4x) Microscope (4-24x)

Illumination Dental light Bright focused light

Armamentarium Macro-instruments Micro-instruments

Osteotomy Size Large (7-10mm diameter) Small (3-3mm diameter)

Bevel Angle Acute (45-60 degree) Shallow (0-10 degree)

Root-end Preparation Non-axial Axial to long axis of tooth

Depth of Root-end prep 1mm non-axial 3mm axial

Inspection resected root surface None Always

Root-end filling material Amalgam MTA

Success rate over 1 year Less than 50% Over 90%


Summary

There are many factors to consider when choosing to perform microsurgery on a tooth versus performing other treatment options such as nonsurgical retreatment or tooth extraction. Fortunately for the patient, the ability to perform endodontic microsurgery is an effective and highly successful procedure that produces minimal discomfort, alleviates periradicular pathosis, maintains restorations and provides for function and aesthetics as shown in Figure 6.33,34

Effects of Drug Abuse on Adolescents

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Drug Abuse: A Calamitous future of teenagers

Introduction

Every year, at a quickening rate, social progressions determined by engineering impacts us individually as well as our family, group, city, country, and the world. What does this need to do with Drug use and/or misuse? Exactly as gadgets persistently develop, drug use takes after comparable way of development. Individuals in the public arena use drugs to adapt to the pressure exuding from the social change, other get dependent by sitting in drug abusing society, number of them get impact by media, and the vast majority of them get compulsion by modeling their guardians (Hanson, Venturelli & Fleckenstein, .2012).

Ideally the age in which medical science emphasize on taking a healthy diet for proper nourishment of blood and bones, teenagers get indulge voluntarily or involuntarily in drug abusing habits. Besides its harsh effect on individual’s psychological and physiological health, it is the matter of the whole nation like our developing country Pakistan in which teenagers are expected to be extraordinary responsible for the well being and upcoming back bone of the nation. Drug use has been distinguished as a significant open wellbeing issue in Pakistan. As indicated by a review in 2005, there are around 3.5 million drug abusers, and the numbers are rapidly increasing at a yearly rate of 7%. From one of the overview of drug abusers among distinctive age group, 22.4 % of youngsters were included in drug abuse (Ali et al,. (2011). The drug abuser may expect or see the significance of Drug use as the accomplishment of pleasurable sentiments, expanded social associations (diminished restraint), physical progressions or evasion of withdrawal manifestations in somebody who is reliant on drug and modification of their mental condition to a more attractive state (idealism).

Body:

As far as open wellbeing, teenagers substance utilization issue has broad social and financial implications. The various unfriendly results connected with high school drinking and substance utilization issue incorporate deadly and nonfatal wounds from drug and alcohol related vehicle accidents, crimes, suicides, dangerous sexual practices, savagery, and psychiatric issue. The most common drugs which are used by teenagers in Pakistan are, Cocaine, alcohol, smoking, cannabis, barbiturates, heroin and ecstasy (Ali et al., 2011). According to National Institute on Drug Abuse (2013), Some of the effects which drugs cause on physiological and mental health are Increased tactile recognition; euphoria, consideration, judgment, coordination and equalization, expanded heart rate, expanded ravenousness schizophreniform issue, impeded transient memory, bronchitis, magnified tachycardia and impact on circulatory system, intensified hindrance of cognitive, psychomotor, and driving execution, Irritability, Chronic cough, odd bad dreams, and tension, Euphoria, dry mouth, warm flushing of skin, substantial feeling in furthest points, interchange attentive and sleepy states, sickness, tingling, discouraged breath, lung and upper aviation route carcinoma is undetermined. A 17 year old male patient was admitted in ward under treatment of lungs tumor, upon taking history, he revealed that he was a chronic smoker and using cannabis since 12 years of age, on further investigation on drug addiction he declared the reason of addiction was his father who was a chain smoker as well as a chronic alcoholic abuser. Moreover his acquaintances were also involved in smoking and alcohol consummating behaviors. The family and companion gathering have been recognized as two of the most essential components in understanding immature substance use. Parental impacts have likewise been discovered to be noteworthy indicators of teenager tobacco, alcohol, and drug use, counting the way of parental supervision and observing (David. 2005). Most of the time parents get so busy in their official and house chores that they could not be able to give proper attention and care to their children which can bring a wide gap between parent child relation and the child ultimately get prone to vulnerable society. Most of the teenagers indulge in drug abusing behaviors due to feeling of inferiority. For improvement in self esteem some low self esteemed teenagers starts using drugs, which describes that depressive symptomology initiates drugs use (Eva et al., 1987). Teenagers are getting victim of drug abuse globally. According to Hanson, Venturelli & Fleckenstein, (2012) the current illegal drug use in United states were: 9.8% in the West, 8.2% in the Northeast, 7.1% in the South and 7.6% in the Midwest. Seeing smoking in movies can just increase the risks three times more that an immature will have a go at smoking. In an investigation of New England youths, the individuals who saw the most measure of smoking in motion pictures were 2.7 times more prone to have a go at smoking contrasted with the individuals who saw the slightest measure of smoking. (Dalton et al., 2003).

Recommendations:

Teenage is a time period where a preschooler enters into social world and physiologically and psychologically changes occurs. As we understand that family structure is a significant predictor of adolescent substance use, even after controlling for family process variables and other factors. Some of the points of considerations are that when a child enters into pubertal stage they must be approached differently than elder adults considering their understanding and mental level. Individual teaching to friends and family, nursing campaigns for awareness of consequences of drugs, community level workshops, use of social media like news, radio, television an internet and organizing different teenage related health Programs should be take into account. Moreover, for treatment of adolescents in hospital settings and in community, we as a nurse must also need to be cautious about ethnicity, gender, stage of readiness to change, cultural background and disability status. Programs should be shape in a way that involves the teenager’s family due to its conceivable part in the roots of the issue and its significance as an agent of progress in the teenager’s environment. Negative effect of social media, poor attention of parents, and drug abusing society are the fundamental issues for spoiling teenagers and ruining their personal future as well as demoralizing the character of the nation globally. We all should bring hands together to vanish the burning issues from the society to live a healthy life.


References

Center for Substance Abuse Treatment. (1999). Treatment of adolescents with substance use disorders.

Ali, H., Bushra, R., & Aslam, N. (2011). Profile of drug users in Karachi city, Pakistan.

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Wakefield, M., Flay, B., Nichter, M., & Giovino, G. (2003). Role of the media in influencing trajectories of youth smoking.

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Hanson,G.R., Venturelli,P.J., & Fleckenstein,A.E. (2012).DRUGS AND SOCIETY(11thed.). Burlington, U.S: Jones & Bartlett.

Dalton,M.A., Sargent,J.D., Beach,M.L., Titus-Ernstoff,L., Gibson,J.J., Ahrens,M.B., . . . Heatherton,T.F. (2003). Effect of viewing smoking in movies on adolescent smoking initiation: a cohort study.Lancet,362(9380). doi:10.1016/S0140-6736(03)13970-0

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The Nclex Rn Is The Final Test Nursing Essay

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When a graduate nurse fails the NCLEX-RN exam, there may be significant adverse effects for stakeholders. Ethical responsibility of graduating student who meets the qualifications and academic rigor of the nursing program but cannot pass the NCLEX-RN exam needs to be addressed by educators. Approximately 15,000 students failed to pass the NCLEX-RN exam annually. Closure of nursing programs may result if students consistently fail to maintain the national benchmark standards set by the NCSBN. Graduates failing the NCLEX-RN affect three major stakeholders: graduate nurses, health care organizations, and the nursing program (Roa et al., 2010).

Nursing programs have implemented specific strategies for student success on the NCLEX-RN exam. Strategies for success include strict admission requirements, identifying at-risk students, developing and enforcing specific progression policies, developing course-related interventions, endorsing review courses, providing individual and academic support, and requiring interventions for at-risk students (Herrman & Johnson, 2009).

Faculty at a nursing program in the Southeastern region of the United States wanted to determine if the Computer HESI exit exam was equivalent to paper-and-pencil exit exam, the Mosby Assess Paper and Pencil Test (MAT). They administered two exit exams to their students, the Health Education Systems Incorporated (HESI) Exit Exam and the MAT. The HESI exit exam was given first and the MAT was given 4 months later. The MAT was completed for graduation and the HESI for evaluation. The HESI scores was r = 0.723,

p < .001. The schools’ passing score for the Mosby test was 60%. Of the 60 students, 12 failed to achieve this score and were required to retake the test before graduation. The chi-square analysis showed four of the students who passed the Mosby Test the second time and six students who passed the MAT on the first attempt failed the NCLEX-RN. In addition, students who made a score of 84 or higher on the HESI Exit Exam passed the NCLEX-RN the first time. Faculties voted to adopt the HESI exit exam due to the positive results of the study (Frith, Sewell, & Clark, 2008).

Educators at the University of Delaware developed a residency curriculum including a senior- year involvement. The curricula consisted of two seminars during the final year of school. The first seminar was conducted on key information related to professional clinical development. Culturally component caregiving, complementary and alternative health care practices, legal and ethical issues in practice, and career planning and preparation were also included (Herrman & Johnson 2009). The second seminar, scheduled the semester prior to graduation, consisted of reinforcement study skills and preparation for the NCLEX-RN. This course provides consecutive clinical building of NCLEX-RN specific content through the semester (Herrman & Johnson, 2009).

Faculties at Wichita State University (WSU) were unable to meet their set goal for passing the NCLEX-RN exam. Upon inquiry, they realized that the students did not appear overly anxious about taking the exam and usually waited until after graduation to start preparing for it. Due to their not meeting the national average, the faculty agreed that a program utilizing standardized practice test to increase preparation for NCLEX-RN and give feedback regarding their performance needed to be established. The faculty instituted a program of standardized computer testing. Test scores along with course grades were used to identify at-risk students to give them additional assistance (Jacobs & Koehn, 2006).

Educators reviewed various program and decided on the program established by ATI. Two tests were chosen by the school: the test of Essential Academic Skills (TEAS) and the Comprehensive Predictor test. Faculty tested the students near the end of the semester with students required to make the 60th percentile or remediation is necessary. Students not completing remediation by the end of the semester will receive an incomplete and cannot move forward to the next course until completed. The first class to graduate following the implementation of the ATI standardized computer testing, showed an improvement on NCLEX-RN pass rate. The ATI program validated a solid consumer-oriented program that was helpful to WSU nursing school (Jacobs & Koehn, 2006).

Bondmass, Moonie, and Kowalski (2008) conducted a study concerning a change in the

NCLEX-RN success rates following the addition of standardized exams throughout the program curriculum. They also compared the exam scores between graduates who passed the NCLEX-RN, and those who did not. The 187 students consisting of four classes were enrolled in the study. Twenty-three students (12.3%) did not graduate from the program. One-hundred and sixty-one students completed the program and graduated. The retention rate for the students was 87.7%. Of the 161 students, data was available for 147 students. One hundred and twenty-nine (87.8%) students passed the NCLEX-RN exam on the first attempt and 18 (12.2%) graduates did not pass.

Results showed a 8.5% change (p < 0.000) in the NCLEX-RN pass rate from their previous 5-year mean pass rate, and significant differences in standardized test scores for those who passed the NCLEX-RN compared to those who did not pass (p <0.0). Researchers concluded that the selected standardized exam scores significantly identified graduates likely to pass the NCLEX-RN exam (Bondmass et al., 2008)

National Council of State Boards of Nursing

Founded in 1978, the (NCSBN) is a not-for-profit organization created in order to guard the safety of the public. NCSBN protects the public by ensuring that licensed nurses provide safe and competent nursing care. NCSBN establishes regulatory excellence for public health to ensure that nurses entering the workforce have the necessary knowledge and skills to practice. To accomplish their goals, the NCSBN develops a licensure examination that is consistent with current nursing practice. NCLEX-RN test questions are based on Blooms’ taxonomy for the cognitive domain (NCSBN, 2012; Anderson & Krathwohl, 2001).

NCSBN is the collective voice of nursing regulation in the U.S. and its territories with work that involves:

Developing the NCLEX-RN, NCLEX-PN, NNAAP and MACE examinations.

Monitoring trends in public policy, nursing practice and education.

Promoting uniformity in relationship to the regulation of nursing practice.

Disseminating data related to the licensure of nurses.

Conducting research on nursing practice issues.

Serving as a forum for information exchange for members.

Providing opportunities for collaboration among its members and other nursing and health care organizations.

Maintaining the Nurses’ database, by coordinating national publicly available

nurse licensure information (NCSBN, 2012).

Computerized NCLEX-RN test includes multiple choices, exhibit items, fill-in-the- blank calculations, drag and drop, charts and graphs, and hot spot items. The NCSBN developed a position statement in July 2009 regarding the impending nursing shortage.

NCSBN posits that standards should be based on the highest degree

of available evidence for nursing practice, education, and regulation, and

that these standards should be upheld in order to secure, safe care and

quality education for students (NCSBNC, 2009).

This statement was developed based on chronological events that occurred in reaction to previous shortage employing deregulation of educational standards including decreased qualified faculty. The NCSBN reviews the NCLEX-RN exam every 3 years for possible increase in intensity of questions to reflect the complications of patient care encountered by health care organizations. The NCLEX- RN exam was updated in April 2010 because of the national practice analysis survey on current practice of entry-level nurses and because of employers demanding higher levels of competence from new graduate nurses (Roa, et al., 2010).

Assessment Technology Institute

According to Davenport (2008), various strategies associated with passing the NCLEX-RN exam. One such strategy, the Assessment Technology Institute (ATI) offers programs that are influential in improving faculty, student and program outcomes such as the predictor test. The ATI RN Comprehensive Predictor test provides students and faculties with a numeric report of the probability of passing the NCLEX-RN at the student present level of preparedness. Secondly, the predictor is a guide for remediation based on the content missed. Students are given a list of topics missed in the individual and group score report. An all-encompassing validation process involving statistical comparison of student performance on the RN Comprehensive Predictor and the concrete NCLEX-RN first attempt pass/fail status.

Students are required to purchase the ATI comprehensive package that gives them access to all required test throughout the program. Included in the program are computerized critical thinking entrances and exit exams, a learning style inventory, content-specific exams, and comprehensive predictor test, which are based on the NCLEX-RN test blueprint. Students complete nonproctored and proctored exams during each semester. The ATI comprehensive package assists educators in augmenting curriculum, upgrading courses, and faculty development (Davenport, 2008).

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Dunham (2011) conducted a study on standardized testing to predict first-time success from two prelicensing programs. The sample size (N=589) students, completed the nursing program between 2003 and 2009. Demographic data, GPA, and ATI RN scores were analyzed. The results of the study showed that the ATI RN Comprehensive predictor was associated with first-time pass success. Students at-risk of failing the NCLEX-RN exam could be identified prior to testing and remediated to increase their probability of passing.

Health Education Systems Incorporated

HESI is a standardized exam used by schools of nursing in evaluating student’s competency achievement of curricular outcomes. HESI provides various exams including the HESI Admission Assessment (entrance exam), specialty exams that can assess detailed clinical content, custom exam which assess faculty-specific content; and the HESI Exit Exam, a comprehensive exit assessment evaluate students’ knowledge base and their ability to apply nursing concepts. For this research purpose, the HESI Exit Exam will be reviewed (Morrison, Adamson, Nibert, & Hsia, 2008).

The HESI Exist Exam is a comprehensive 150-item test administered prior to completion of the nursing for evaluation of students’ readiness for the NCLEX-RN. Identification of students’ weaknesses, strengths, and the need for remediation prior to taking the exam is determined. Test items are based on a critical-thinking model that necessitates applying clinical reasoning to select the correct answers (Nibert, Young, & Adamson 2008).

The HESI Predictability Model, a proprietary mathematical model, calculates scores of this exam. The reliability of the exam is determined by conducting an item analysis on each exam for a composite report of the combined data. Validity is determined by an evaluation of content validity, construct validity, and criterion-related validity (Morrison, et al., 2008).

Critical Thinking

Critical thinking is an integral part of accountability and quality care within the nursing profession. Critical thinking continues to be an essential part of nursing and must be a central factor of course content. Shirrell (2008) conducted a study to determine if critical thinking is a predictor of NCLEX success. Results showed that critical thinking alone is not a good predictor of NCLEX-RN success. Including critical thinking, in the curriculum is essential for enhancement of the students’ higher level of thinking. Critical thinking skills are an expectation of all nurses for accurate interpretation of patient issues and appropriate management of their care. Patients’ lives depend on nurses making quick decisions and taking appropriate action.


Brookfield

(2010) describes critical thinking as developing an awareness of the assumption that an individual and others think and act. Critical thinking is what students see and how they will take care of problems to make the patient healthier. It essential for students to know CT is the distinction between keeping patients’ safe and putting them in harm’s way.

Alfaro-LeFevre (2009) created a 4 circle critical thinking (CT) model that

Educators’ can use in helping students to understand critical thinking.

CTA-JPEG

Figure 1

Alfaro-LeFevre, R. (2009). Critical Thinking and Clinical Judgment: A Practical Approach to

Outcome-Focused Thinking (4th ed). St Louis, Missouri. Beginning at the top and continuing clockwise, this model helps students understand the need for a commitment to developing critical thinking characteristics such as persistence and fair-mindedness. Second, students should be responsible for their learning by seeking out learning experiences that will get them academic and pragmatic knowledge needed to critically think. Third, students need to develop interpersonal skills for example, conflict management, teamwork, and being an advocate for their patients. Fourth, students should practicing related technical skills for example using computers, starting intravenous therapy, completing sterile procedures (Alfaro-LeFevre, 2009). Educators using the nursing process can help their students improving their critical thinking skills, pass the NCLEX-RN exam and be safe, effective nurses.

NCLEX-RN Test Plan

The licensing authorities within the state, commonwealth and territorial boards of nursing regulate entry into the practice of nursing. Development of the NCLEX-RN Test Plan is accomplished by collecting data on the current practices of entry-level nurses for the purpose of by conducting a practice analysis. Licensed RNs were asked about the occurrence and significance of performing 155 activities concerning current nursing practice. An analysis of the activities is completed in relation to the frequency of performance, impact on maintaining client safety and client care settings where the activities are performed. Result of the analysis serves as a guide for improvement of standards for entry-level nursing practice. The succeeding stage involves development of the NCLEX-RN Test Plan, which guides the selection of content and performances to be tested (2010 NCLEX-RN Detailed Test Plan, NCSBN, 2010).

The NCLEX-RN Test Plan serves as a template for development of the examination. The NCLEX® examination assesses the knowledge, skills and abilities that are essential for the nurse. The organization of the NCLEX-RN examination is based on nursing actions and competencies crucial for meeting the needs of patients. The test plan is reviewed and approved by the NCLEX Examination Committee. Resources used in this process include the recent practice analysis of RNs, expert opinions of the NCLEX-RN Examination Committee, and NCSBN’s member boards to certify that the test plan is reliable with state nurse practice acts. Upon approval of the NCLEX-RN Examination Committee, the test plan is presented to the Delegate Assembly for review and approval (2010 NCLEX-RN Detailed Test Plan, NCSBN, 2010).

In December 2009, the NCSBN Board of Directors made a decision to raise the NCLEX-RN from -0.21 to -0.16 logits. In combination with the 2010 NCLEX-RN Test Plan, the new standards was applied April 1, 2010. The Computerized Adaptive Testing (CAT) is used to administer the examination. CAT is a technique for administering exams that combines computer technology with contemporary measurement concept to increase the competence of the exam process (2010 NCLEX-RN Detailed Test Plan, NCSBN, 2010).

Test Plan Structure The framework of the test plan is based on client needs, defining nursing actions and competencies which focus on clients in all situations. The structure of the NCLEX-RN Test Plan has four major client needs categories with two of the four categories divided into subcategories. The four categories of the 2010 NCLEX-RN Test Plan and subcategories are:

Safe and Effective Care Environment

Management of Care

Safety and Infection Control

Health Promotion and Maintenance

Psychosocial Integrity

Physiological Integrity

Basic Care and Comfort

Pharmacological and Parenteral Therapies

Reduction of Risk Potential

Physiological Adaptation (2010 NCLEX-RN Detailed Test Plan, NCSBN, 2007).

Integrated Processes The following processes are fundamental to the practice of nursing and are integrated throughout the Client Needs categories and subcategories:

Nursing Process – a scientific, clinical reasoning approach to client care that includes assessment, analysis, planning, implementation and evaluation.

Caring – interaction of the nurse and client in an atmosphere of mutual respect and trust. In this collaborative environment, the nurse provides encouragement, hope, support and compassion to help achieve desired outcomes.

Communication and Documentation – verbal and nonverbal interactions between the nurse and the client, the client’s significant others and the other members of the health care team. Events and activities associated with client care are validated in written and/or electronic records that reflect standards of practice and accountability in the provision of care.

Teaching/Learning – facilitation of the acquisition of knowledge, skills and attitudes promoting a change in behavior (2010 NCLEX-RN Detailed Test Plan, NCSBN, 2007).

Distribution of Content Based on the results of the Report of Findings from the 2008 RN Practice Analysis: Linking the NCLEX-RN® Examination to Practice, Percentage of test questions allocated to each client needs category and subcategory of the NCLEX-RN Test Plan (NCSBN, 2009). Percentage of Items from Each Client Needs Category/Subcategory are:

Safe and Effective Care Environment

Management of Care 16-22%

Safety and Infection Control 8-14% Heath Promotion and Maintenance 6-12% Psychosocial Integrity 6-12% Physiological Integrity

Basic Care and Comfort 6-12%

Pharmacological and Parenteral Therapies 13-19%

Reduction of Risk Potential 10-16%

Physiological Adaptation 11-17% (2010 NCLEX-RN Detailed Test Plan, NCSBN, 2010).

The detailed test plan serves as a guide for students and faculty to assist in preparation for the examination. Additionally, the test plan directs item writers in the improvement of test questions and simplifies the classification of examination items. NCSBN creates two versions of the detailed test plan; 1) Item Writer/Item Reviewer/Nurse Educator version and 2) Applicant version. The Item Writer/Item Reviewer/Nurse Educator version has a more exhaustive and wide-ranging listing of content for each client needs category and subcategory. Following each category are sample questions, which are explicit to the client needs category reviewed in that section. The educator version of the test plan has an item writing guide with sample scenarios for hands-on experience in writing NCLEX style test questions. The student version of the detailed test plan does not have an item-writing guide (NCLEX-RN Detailed Test Plan, NCSBN, 2010).

Implications

Results of this study may have implications for nursing programs and show a need for further research. Academic variables might prove useful in the early identification of students at risk for failing the NCLEX exam. Results from this study may also influence nursing programs by assisting nursing faculty in identifying at-risk students who may need remediation to increase their chances of being successful in the nursing program. In addition, results from this study may be important because predictor variables may point to factors that may lead to a successful first attempt at the NCLEX-RN. The majority of the nursing graduates who take the NCLEX-RN examination are associate’s degree graduates, and success on the exam influences the number of

nurses entering the field each year (NCSBN, 2009).

Summary

Nursing programs need to identify causes for attrition and implement strategies to retain students and improve recruitment of students with increased probability of successfully finishing nursing school (NLNAC, 2008). The American Association of Colleges of Nursing (AACN, 2005) is in agreement with the recommendations from the NLNAC. Causes of the nursing shortage are multi-faceted. Literature review shows there is a downward trend in the number of nursing graduates who are successful with the NCLEX-RN exam for first time test takers. There is a critical need for registered nurses who can function as competent professionals. Nursing programs need to develop strategies that will help decrease their attrition rate in order for nursing graduates to be successful with the NCLEX-RN exam on the first attempt.

The scope of the national nursing shortage goes well beyond the healthcare agencies. Nursing programs are conscientiously working to increase the number of qualified graduate nurses to address the nursing shortage. Increase in graduates is only one consideration to increasing enrollment. Along with increasing enrollment, nursing programs must maintain quality programs. Nursing educators need to improve students’ likelihood of passing the NCLEX-RN through nursing programs’ structure curriculum, developing assessment testing, and utilizing program predictors to identify students at risk for failure on NCLEX-RN. The quality of a good nursing program is dependent on their graduates being successful with the NCLEX- RN exam on the first attempt.

Section 2: The Methodology

Introduction

With the growing shortage of nurses and increased number of students failing the NCLEX-RN, critical evaluation of predictors of success for first time test takers is essential for improvement of NCLEX-RN scores. Determining predictors of success will assist nursing programs in determining at-risk students for remediation to give them the greatest probability for NCLEX-RN success. The purpose of this quantitative study is to determine if there is a positive correlation between predictor test and NCLEX-RN success for first-time test takers. This study will examine predictors of success of an Associate Degree of Nursing program from 2010 to 2011. The research will address the following questions: Is there a correlation between GPA pre-nursing GPA, final GPA, and NCLEX-RN success? Is there a correlation between age, gender, and NCLEX-RN success? Is there a correlation between ATI scores and NCLEX-RN success?

To answer these questions, predictors of NCLEX-RN will identify four cohorts of students graduating in Spring 2010, Summer 2010, Spring 2011, and Summer 2011. NCLEX-RN results and ATI predictor results will be obtained from archival student data with permission of the college. The population will be students who completed a five-semester ADN nursing program. Data will be reviewed to determine:

Students who passed the NCLEX-RN on the first attempt and made the required score on the ATI test.

Students who passed the NCLEX-RN on the first attempt and did not make the required score on the ATI test.

Students who failed the NCLEX-RN and did not make the required score on the ATI test.

Students’ GPA before beginning the nursing program.

Students’ GPA at completion of the nursing program.

The dependent variable is the passing NCLEX-RN. The independent variables include students’ GPA pre-nursing and GPA at completion of the nursing program, age, gender, and the ATI predictor scores given at the end of the nursing program. These academic and nonacademic variables have been used in previous studies and are associated with a positive and significant predictor of NCLEX success (Gilmore, 2008; Frith et al, 2008; Truman, 2012; Wolkowitz, 2009).

Quantitative research (Lodico, Spaulding, & Voegtle, 2010) is conducted to determine the relationships between variables. There are two types of correlational designs, explanatory and prediction. An explanatory design, which will be used for this study, is a correlational design that examines whether changes in one variable will effect changes in one or more variables (Creswell, 2012). The following characteristics need to be present to use an explanatory design: correlation of two or more variables by the researcher, data are collected at one point in time, all participants are analyzed as a single group, obtains at least two scores for each individual in the group, employs correlational statistical testing in data analysis, and infers a conclusions from the statistical data. All characteristics apply to this study (Creswell, 2012).

Sample and Data Collection

The sample will consist of students who completed the program and sat for the NCLEX-RN exam spring 2010 (N = 54), summer 2010 (N = 44), spring 2011 (N = 49), summer 2011(N=41). Descriptive statistics will be used to describe and summarize the sample and examine relationships between each variable. Descriptive statistics will also be used to assess differences in the graduates who did not pass the NCLEX-RN exam and those who successfully passed the exam.

This study will be conducted in a technical college, located in the southeastern area of South Carolina. Students’ NCLEX pass rates, ATI predictor scores, academic and nonacademic predictors will be collected from archival student data. Data will be entered via Statistical Package for the Social Sciences (SPSS) version 18.0. Academic and nonacademic predictors will be correlated with the numbers of students who were successful on their first attempt with NCLEX-RN exam. Additionally, a correlation of the ATI predictor exam scores used by the college as subsequent NCLEX-RN success will be completed.

Data Analysis

The use of descriptive statistics to summarize the findings is essential aspect of research for clarity (Lodico et al, 2010). Descriptive statistics (mean, mode and standard deviation) will also be used to identify the continuous sample. The level of significance will be set at p<.05. Pearson Product Moment Correlation Coefficients (Green & Salkind, 2011) will determine a relationship between the independent and dependent variables. The Pearson product-moment correlation coefficient measures the strength of association that exists between two variables measured on at least an interval scale designated by the symbol r. The value of the correlation coefficient varies between +1 and -1. There is a near flawless degree of association between two variables if the value of the correlation coefficient is near ± 1. Pearson product-moment correlation coefficient has two assumptions. The first assumption is that the variables are approximately normally distributed. The second (Green & Salkind, 2011) assumption is the cases represent a random sample from the population and the scores on variables for one case are independent of scores on the variables for other data. Pearson product-moment correlation coefficient can be used in a inferential test. Assumptions for conducting an inferential test of correlation depend on the theory of a provisional distribution. The second number (Green & Salkind, 2011) in each cell of the matrix is the level of statistical significance (p-value) associated with the inferential test of the correlation value.

Pearson’s r is very vulnerable to outliers in the data so you need to test for outliers. Outliers can be detected by plotting the two variables against each other on a graph and visually inspecting the graph for errors. The outlier can be removed or manipulated as long as it can justified why it was done. If there is no justification for removing the outlier, a Spearman’s Rank Order Correlation can be done (Green & Salkind, 2011).

Ethical Considerations

Informed consent is not needed from students. The research will be limited to existing academic records maintained by the college of nursing program. No names will be used in this study. Data will be coded into the SPSS to protect students’ records. Students’ grades and ATI results are stored the nursing department and permission to view these records will need to be granted by the dean of nursing and the vice president of academic affairs. The researcher will also need approval from Institutional Research Board (IRB) before assessing any student records for the purpose of the study

Conclusion

Data from this project study will provide information that will assist in improving student success with NCLEX-RN on their first attempt. This quantitative study will assist the college in developing plans for early intervention and counseling for students who are at risk of failing the NCLEX-RN. Students will also benefit from consistent counseling by faculty and remediation for low scores on standardized test. Schools of nursing will also benefit from students improving

What are some specific goals and methods that you may incorporate into group counseling that might be shaped by your culture?

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What are some specific goals and methods that you may incorporate into group counseling that might be shaped by your culture?

 

Psychology

What are some specific goals and methods that you may incorporate into group counseling that might be shaped by your culture? Describe how you could accommodate group members’ diverse cultural backgrounds, values, and styles as they relate to these goals and methods.

Explain the differences between types of diabetes including type 1, type 2, gestational, and juvenile diabetes

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Explain the differences between types of diabetes including type 1, type 2, gestational, and juvenile diabetes

Diabetes and Drug Treatments
Diabetes is an endocrine system disorder that affects millions of children and adults (ADA, 2011). If left untreated, diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations. In this Assignment, you compare types of diabetes including drug treatments for type 1, type 2, gestational, and juvenile diabetes.

To prepare:
Review this week’s media presentation on the endocrine system and diabetes, as well as Chapter 45 of the Arcangelo and Peterson text and the Peterson et al. article in the Learning Resources.
Reflect on differences between types of diabetes including type 1, type 2, gestational, and juvenile diabetes.
Select one type of diabetes.
Consider one type of drug used to treat the type of diabetes you selected including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
Think about the short-term and long-term impact of the diabetes you selected on patients including effects of drug treatments.
BY DAY 6