Older People In Palliative Care Nursing Essay

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Worldwide, populations are experiencing an increase in life expectancy with associated serious chronic illnesses towards the end of life (World Health Organisation (WHO), 2011). In the UK, 457,000 people require palliative care services annually; however there are significant shortcomings in providing care to all those in need.

In a recent survey, by the Palliative Care Funding Review (2011), it was estimated that 92,000 people are not being reached by palliative care services. After decades of declining death rates, we now face the dual demographic challenges of increasing life expectancy and an increase in chronic illnesses towards the end stage of life. One outcome of this would be a corresponding increase in the number of patients with more complex healthcare requirements.

Palliative care advocates a holistic, problem-based approach for patients facing end of life in order to improve quality of life and symptom control (WHO, 2009). Studies have shown that, in addition to receiving the best possible treatment, patients want to be approached as individuals and have autonomy regarding decisions affecting their care (Gomes and Higginson, 2008).

This essay aims to discuss how an ageing population will influence the delivery of physiotherapy to the older person in palliative care. It will address the current necessary factors required to meet the needs of the older person whilst also evaluating the barriers preventing access to physiotherapy services in palliative care. The role of the physiotherapist will be evaluated with reference to appropriate and current health care policies.

In order to discuss meeting the needs of the older person, it is essential to establish a definition of the ‘older person’. As defined by WHO (2012) (1) ‘most developed world countries have accepted the chronological age of 65 years as a definition of ‘elderly’ or ‘older person”. Whilst it has generally been agreed by the United Nations (UN) that 60+ years is thought of as the cut-off point when referring to an ‘older person’ (WHO, 2011).

Over the last 25 years, the number of people aged 65 and over in the UK has increased by 18%, from 8.4 million to 9.9 million, and it continues to steadily increase (Office for National Statistics, 2010). Changing demographics mean that on average, people worldwide are living 30 years longer than they did a hundred years ago with life expectancy continuing to increase by approximately 4 months every year (United Nations, 2008). WHO (2011) estimates indicate that by 2050, more than one quarter of the population will be aged 65 years and older.

Whilst changing demographics indicate an inevitable increase in the population of the older person, patterns of disease are also changing, with more people dying from multiple debilitating conditions such as cardiovascular disease, neurological conditions, and diabetes. It could be argued that advances in medical knowledge and technology have allowed many patients to live longer, however a paradox of this success is that many will struggle in managing such a wide range of diseases, symptoms, and disabilities towards the end of life (Wu and Quill, 2011). Inevitably the combined pressures of increasing life expectancy and greater numbers of people living with multiple conditions at the end of life means that pressure will be put on palliative health and social care capacity in order to adapt (NCPC, 2010).

Palliative care is defined by The World Health Organisation (WHO) as:

‘…an approach that improves quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention, assessment and treatment of pain and other physical, psychosocial and spiritual problems.’

(WHO, 2002)

Physiotherapists are vital members of specialist palliative care teams, with a critical role to play in the management of the older person in palliative care (CSP, 2004). Physiotherapists work to restore physical function, reduce pain and disability and increase mobility ultimately improving the life of patients, regardless of life expectancy (Medscape, 2011).

The Association of Chartered Physiotherapists in Oncology and Palliative Care (ACPOPC), guidelines for Good Practice (1993) described the role of the physiotherapist in palliative care as being:

“. . To improve the patients’ quality of life by helping to achieve maximum potential of functional ability and independence.”

A fundamental core value of palliative care is to allow the older person to feel empowered as they face the end of their life. Wikman and Faitholm (2006) describe an empowered patient as a patient who works with the multidisciplinary team to formulate goals and make treatment decisions. Physiotherapists within palliative care are fundamental team members to provide patients with autonomy and sense of empowerment. A fundamental component of physiotherapy is to establish achievable goals with patients and work in partnership with both the patient and relatives to achieve these goals. Within palliative care, realistic joint goal setting provides the patient with control over their treatment when they are experiencing a loss of independence (Robinson, 2000).

As recognised by Baldwin and Woodhouse (2011), rehabilitation and palliative care may appear to be at the opposite ends of the spectrum however the World Health Organisations’ definition of palliative care (WHO, 2002) advocates offering support to improve quality of life and maximize functional ability until death. The appropriate physiotherapeutic intervention can allow functional ability and mobility levels to be maximized, thus improving quality of life, this in return promotes independence for the older person.

There are various well documented studies which demonstrate that exercise can improve reduced mobility prevalent among the elderly. From the outcome of a study where a high intensity strength training program was initiated for 100 nursing home residents, William (1999) concluded that because of their low functional status and high incidence of chronic disease, there is no segment of the population that can benefit more from exercise than the elderly. Although a relatively small sample size, this is just one of many studies with a similar outcome.

However, regardless of the evidence demonstrating the benefits of physiotherapy intervention to the older person, the National Institute of Health and Clinical Excellence (NICE) guidelines (2004) found that some patients are still unable to receive access to rehabilitation services. It is suggested that this is due to the patients’ needs not being recognized by healthcare members and a lack of allied health professionals who are adequately trained in the care of patients under palliative care (NICE, 2004).

Despite the important role physiotherapists can contribute and provide to the older person in palliative care, there are current barriers preventing the ageing population from accessing such services. With the current ageing population estimated to increase it is essential these barriers are overcome with measures set in place so that the demands and needs of such changing demographics can be met.

To date, the needs of the older person in palliative care has not been a research priority. Current research predominantly focuses on recommendations on the needs of the older person facing end of life as opposed to formal evaluations of the effectiveness of palliative care (WHO, 2004; WHO, 2011).

Until recently palliative care has been largely focused towards patients with a cancer diagnosis, with a large majority of palliative care research focusing upon palliative care specifically for the cancer diagnosis (Baldwin and Woodhouse 2011). However it is estimated by the National Council for Palliative Care that 300,000 people die each year from progressive non-malignant disease (Royal College of Physicians, 2007). For example, the Coronary Heart Disease Collaborative (2004) concedes that ‘heart failure produces greater suffering and is associated with a worse prognosis than many cancers’ (Baldwin and Woodhouse 2011). Whilst a study by Byrne et al (2009) concludes that there is a scarcity of evidence identifying the palliative care needs of patients with neurological conditions.

Considering that the number of older people having prolonged long-term medical conditions towards the end of life is forecast to increase, the inclusion of non-cancer related diseases within palliative care is essential (Gott and Ingleton, 2011). In correlation with recommendations from WHO (2011) guidelines, in order to meet the care needs of the older person, the dimensions of palliative care need to be expanded to encompass a broader range of conditions. This will require understanding from healthcare staff at all levels.

It is recognised worldwide that physiotherapy in palliative care is a specialty with physiotherapists required to have several years experience before they become involved in palliative care (CSP, 2004; WHO, 2011).

Specialist palliative care is defined by the NCPC as a multidisciplinary approach, providing a variety of specialist services to patients facing end of life, either as a result of the ageing process or terminal illness. There is compelling evidence to demonstrate that compared to conventional care, specialist teams improve satisfaction and identify dealing more with patient and family needs, whilst they can also reduce the overall cost of care by reducing the time patients spend in acute hospital settings (House of Commons Health Committee, 2004)

Specialist palliative care teams encompasses hospice care, including services such as inpatient services, day care and community care as well as a range of advice, education, support and care (NICE, 2011). Given that a common problem presented by the older person is a functional decline in mobility, a major barrier preventing the older person from accessing palliative care services are difficulties leaving the home. Worryingly, physical inactivity has been demonstrated to correlate to an increase in premature deaths of patients under palliative care services, therefore it is essential that provisions are put in place for patients unable to access palliative care services (Pate et al, (1995); Bryan et al, (2007).

One option is the proviso of palliative care physiotherapy in the community setting. There is an advantage for the older person to receive physiotherapy in their home setting as not only does it provide familiarity but it grants patient centred holistic care. It has also been found that the older person, specifically with dementia, (have been shown to) demonstrates greater progress and benefits when treated in a familiar setting such as the home setting rather than the clinical setting (Brissette, 2004). However studies by Kumar and Jim (2011), found that the scope of physiotherapy practice is influenced by the ratio of qualified physiotherapists to the population. Therefore in order to meet the needs of the older person under changing demographics, the scope of physiotherapy services within palliative care need to be evaluated to ensure that physiotherapists are readily available to treat the older person in both the clinical and home settings.

Although more physiotherapists will be required in order to meet the demands of the older person, the CSP (2004) highlights that in current clinical practice there is already a shortfall of physiotherapists working within palliative care. It is further emphasized that a predominant problem in accessing physiotherapy services as part of palliative care is a lack of experienced physiotherapists available (CSP, 2004). A short fall of physiotherapists within palliative care teams will reduce the effectiveness of care packages provided.

Further detracting from the effectiveness of specialist care packages provided to the older person in palliative care is the underutilization of physiotherapists into specialist palliative care teams (CSP, 2004). It is the ability to call upon a broad range of health professionals in specialist palliative care teams that provides care responsive to the older patient’s individual needs. Therefore, in order for physiotherapists to be able to meet these demands it is essential that the role of the physiotherapist within palliative care is clearly defined. Although NICE (2004) guidelines set aims relevant to the physiotherapeutic profession, whilst the updated NICE (2011) guidelines clearly state that physiotherapists are able to provide specialist skills, there is still a lack of specific mention of physiotherapists and the role they can contribute. Proposals, such as NICE guidelines on Palliative Care (2011) and recommendations by WHO (2011) emphasis the importance of a multidisciplinary approach to palliative care but the mention of specialist palliative care teams is restricted to doctors, nurses and careers. So although guidelines recommend rehabilitation to be available to all patients, the role and effectiveness of the physiotherapist is not highlighted.

The NHS Cancer Plan (2000) outlines palliative care guidelines to ensure patients receive the right healthcare services and support, as well as receiving the best, most holistic treatment. However in contradiction to this it was found by Montagnini, Lodhi and Born (2003) that in the palliative care setting, rehabilitation interventions are often overlooked and underutilized, despite patients demonstrating high levels of functional disability.

This has raised concerns, as by excluding the attributes of specialist physiotherapists from specialist palliative care teams this will be detrimental to patient care (CSP, 2004). More research is therefore required to identify the value and effectiveness of physiotherapy intervention for the older person under palliative care. Furthermore, it is essential that palliative care core guidelines are not just limited to medical teams and that physiotherapists are also recognised and identified as core members of the care teams. This will allow for the development and production of a recognised clinical career structure for physiotherapists working in palliative care and thus keep up with the changing demographics of ageing populations.

Discussions of ageing and palliative care assume that ageism is an important factor limiting access to palliative care for the older person. The TLC model of Palliative Care, Jerant et al., (2004) argues that palliative care is viewed as a terminal event rather than a longitudinal process. He argues that this can result in unnecessary distress to the elderly patient suffering from chronic, slowly progressive illnesses (Jerant et al., 2004). The TLC model further goes on to recognise that palliative care of the older person is essential to relieve the physical and emotional complications that often accompany chronic long term end of life diseases and the illnesses associated with ageing (Jerant et al., 2004). Therefore, regardless of whether death is imminent, palliative care should be a major focus throughout the ageing process, with physiotherapy services being readily available to improve symptom control (Jerant et al., 2004). With the older person facing more long term, chronic debilitating illnesses alongside the physical effects of ageing, it can be predicted that it will be crucial for physiotherapy services to be utilized over a prolonged period of time, regardless of their age.

In order for physiotherapists to keep up with the changing demographics of ageing populations, more research is required to identify the value of physiotherapy intervention for patients in palliative care and to identify the stage of ageing process that it’s necessary for the older person to receive intervention. It’s essential that the value of the physiotherapist and role is identified, established and incorporated into clinical guidelines in order to be able to provide the older person with patient centered holistic care. Whilst it is also essential that palliative care services focus on meeting the needs of the older person in the home setting as well as the clinical setting, through community services.

Furthermore, it can be predicted that a shortage of physiotherapists will detract from the ability to provide patient centered care therefore services need to be evaluated to ensure a sufficient number of staff within specialist palliative care teams.

Social Factors Influencing Individual Health and Well-being: Work and Employment

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Explain what key determining social factors are currently influencing an individual health and wellbeing, drawing on statistical data, focusing on “work and unemployment

 

 


Table of Content




Page

  1. Introduction …………………………………………………………………………………………………………………….…………………………. 3
  2. Some arguments on influence of social determinants on individual health and some preventive

measures put in place to address the Issue ………………………………………………………………………………………………..  3

  1. Conclusion ………………………………………………………………………………………………………………………….………………………  5
  2. References …………………………………………………………………………………………………………………………….……………………  6


Table of Figure


  1. Figure 1.

    The 2011 Workplace Employment Relations Study: First Findings (3

    rd

    edition),

Department for Business Innovation &Skills ……….…………………………………………….……………………….  4

  1. Introduction

Michael Marmot (2013) inferred that the environment we were born and grew in plays a major role on individual health. He furthermore stated that youth not in Employment,  Education or Training is a call for concern and on the other hand, ONS reported that the highest unemployment rate in the UK were in the North East and Yorkshire and the Humber at approximately 5.0% compare the West Midlands which was at 4.9%. the region with the lowest unemployment rate was South West 2.9% and East England 3.2%. Being healthy means different thing to different people that is what make its definition challenging to say and it brings us to the definition that health is socially constructed. Being in employment supposed to give us peace of mind however social inequality is greatly impacting on our health.


2. Some arguments on influence of social determinants on individual health and some preventive measures put in place to address the Issue.

The social determinants of health is the context in which individual is born, grew, age, work. The social determinant of health are mainly tied to health inequalities (WHO, 2018). The meaning of HEALTH can be differently interpreted by each and one of us. According to Aggleton (1990), “health is something than can be bought or sold or given “. Lee and McCormick (2004) inferred that by increasing health surely end up in quality of life being raised up, in other word health is defined as quality of life. Unemployed person will not be able to afford a good quality of life due to a lack of finance. PHE (2011) is there to make the public aware of the wider determinant of health and if possible reduce the negative impact social determinant of health is causing to individual in particular work and unemployment.

According to the social model of health, health is widely determined by the social class, political, environmental, economic, cultural without forgetting to mention the  biological (Earle, 2007a); which suggests that ill health is caused by the factors that influenced the outer physical body. The wider determinants of health are structurally engendered by poverty, social interaction, inequality, behaviour. The conception of health is viewed as being  socially formed. In line with what social model of health suggested, the working environment pause a threat to one’s healthy state.

We need to begin to have some understanding on why condition like poverty impacts on our health  to remedy the problem. According to Fryer (1992), poverty should be place in the centre of the question. Poverty is one factor that socially determine individual health. According to McLoone(1996), the majority in number of suicide rates found in Scotland between 1981 and 1993 focussed on deprived young people whose suicide rates estimated to be twice compared to those young people in affluent areas; it was equally found in Britain an increase in suicide rate between young men which was related to social deprivation, living alone, unemployment. WHO (World Health Organisation) suggested that “extreme poverty is the most serious cause of disease, with 70% of deaths in developing countries attributable to five causes that can easily and cheaply combated”. Poverty is the centre of social determinant of health because poor people will not be able to afford a day to day basic materials to sustain themselves which lead to health inequality issue and raising up the mortality rate.

According to Michael Marmot, before trying to reduce health inequalities we need to focus tackling social inequality, our social position determine our health equality which means people with low social class face health inequality issue. Health inequality makes a  significant contribution in individual life expectancy. In line with the “public health timebomb”, sir Marmot suggested that by reducing the inequality in health will have a positive impact on individual health. ONS reported that 1.38 million people in the UK are willing to go

into employment. Furthermore 8.74 million people aged 16-64 are NEET. 21.2% of the population were economically inactive. In addition, there has been an increase in the average weekly earning by 3.2% excluding bonus and 3.0% include bonus compare to the early years.

Work can be benefit health but also it can negatively impact on health. In accordance with the health and safety (2012), stress, anxiety and depression – muscle skeletal conditions were linked to employment suggests that employment can be associated with ill health. Nevertheless, NICE (2012) states that workplaces can be make healthier place by physical activity programme demonstrate to minimise staff sickness levels.

Shorter working hours were sound to increase job satisfaction and decrease levels of stress (European review, 2012), but within the UK an average working hours were the longest in Europe (i bid). The scope of using initiative was linked to job satisfaction (workplace employment relations study, 2011) compare to level of pay in both 2004 and 2011.


Figure 1



Source



:


The 2011 Workplace Employment Relations Study: First Findings (3



rd



edition), Department for Business Innovation &Skills

UK recession (2007) environment lead to increase in unemployment which is linked to the increase in the number of suicide rate (Barr. B et al, 2012).

During the recession years (2008), there was an increase in the number of unemployment which was lead to an increase in the number of suicides in men by 7% and  in women by 8%, which is linking to what Marmot inferred that, the environment in which one lives has an impact on his/her health.

According to Rodgers (1991), the MRC’s (1946) cohort study showed a decrease in the correlation among unemployment and psychological signs in both men and women thereafter the regulation of the financial difficulties. As stated by Stewart (2001) unemployment raised the mortality rate. Furthermore, unemployment impacts on men’s mental health and on top of that men’s family responsibility plays a huge role on the jobless mental health state.

In accordance with the health and safety statistic (2012), 22.1 million working days were lost in 2010/2011 linked to work related ill health.

As reported by the Office for National Statistic, the principal purpose of sickness was minor illnesses however the majority of the number of days that was lost was due to musculoskeletal l issues.

By preventing health issue further in a workplace, some actions need to be in place. For instance according to NICE (2012),  by making sure that workplace is healthy will reduce sickness absence, boost the local economy, improve employee morale, improve staff retention and have fewer injuries and work accidents.

In order to tackle unemployment health issues, some policy were put in place; Charities for the relief of unemployment  aimed to help relief the load of unemployment individual face by asking their trustees or promoters to take part in some activities which can contribute in the aim of the organisation. Activities suck as  giving advice and training to unemployed person regarding employment, self-employment, establishing co-operative enterprise, helping in Cv writing, giving unemployed practical support in assisting with travel fare, accommodation and childcare facilities; supplying capital grant or equipment to engage in new business.

UKCES (2011) was aimed to go over evidence on quality and quantity of low paid work; examine the evidence on the function of pre-employment training in assisting people move from benefit into low paid work; suggest future policy enhancement that might develop sustainability and progression; to review the kind of training that are furthermost successful in assisting people to go into employment; to analyse the data on the part of upskilling in pull people out of low pay-no pay chain into a stable job with progress and was link to the Marmot review.

  1. Conclusion

 

We need to work harder to tackle the issue at hand which is the influence social determinants of health particularly work and unemployment has on individual life. As Marmot stated youth unemployment is public health timebound, our youth are the future so if no action is taken properly into account, then no future is guarranti. Our local authorities need to look deep into the prevention and insuring that we have  not only work but healthy workplace as well. According to ONS, 1.38 % of the population are jobseekers and 21.1% of the population were economically inactive. The biggest influence as we have seen in male suicide rate in the UK. Barr et al (2010). As supported by Michael Marmot, the environment in which one was born or grew in impacts on his/her health, in that context we cannot attribute health responsibility rather social responsibility since social factors influence on individual health. By putting prevention into place such as “healthy lives, healthy people” which aim is to tackle health inequalities in the population and to increase people life expectancy by helping them live longer, healthier. A charity was set in place to help employee that is suffering from musculoskeletal and mental illness by creating a suitable work spaces to them. (PHE, 2017) One needs to consider the social role which bring me to the conclusion that health is socially constructed.


References

 

 

 

Comparison of Nursing Stress in Public and Private Hospitals

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Introduction

The profession of nursing is considered one of the most stressful professions in the world. Nursing is by nature a stressful occupation. Continuous and long-term stress can result in physical, psychological, and behavioral problems in nurses. Therefore these professionals have been researched time and again. To cope with these problems several coping styles are deployed by the nurse which help them deal with the everyday stressors of their life. It has been found via research that using certain unhealthy coping styles may result in a number of mental health problems (Srinivasan & Samuel, 2014).

Nursing is the kind of job in which professionals have to deal with immense workload which can result in a lot of health problems, both physical and psychological. . not only that, the patients that come to hospitals themselves accompany a host of problems with them such as the stress of being ill, being frightful and apprehensive about their future and often they are very bitter and sometimes even indignant. Nurses have to deal with all of this and have to maintain a sense of composure at the same time. Sometimes the nurses have to perform the role of doctors and deal with the attendants and patients which mean they have to take the insults that were meant for the doctors and wasn’t initially a part of their job requirement. Some patients and attendants can even be physically abusive at times; this can result in even more stress for the nurses. It is often seen that at times the patients are way too demanding and expect more than what their job entails, when those expectations are not met the patients can be aggressive and they tend to show their aggression in a both verbal and physical way. These stressors expose nurses to a host of problems, depression, anxiety and insomnia being a few of them (Srinivasan & Samuel, 2014).

There is an extreme scarcity of nurses in both the government and private hospitals in Pakistan which makes them a valuable asset, one that must not be taken for granted. This scarcity in the number of nurses is mainly due to the discrepancy between their workload and their pay scales which make them leave their homeland and migrate to countries that give them roper compensation for their work. The work-life issues threatening retention of nurses is of serious concern for health administrators. This shortage of nursing professionals in Pakistan was researched by the Joint Learning Initiative Report in 2004 and the World Health Report in 2006 and found Pakistan to be among those 57 nations that have the most significant lack of human resource (

Hamid

,

Malik

,

Kamran

&

Ramzan

, 2013).

There is no shortage of nursing schools and colleges in the country, there are roughly 109 nursing institutions and 44000 nurses on record in Pakistan but the lack of nurses are still a grave problem. There are insufficient nurses in comparison to the people that need medical attention. A country that has limited nursing professionals will have dire effects on its health care systems despite having sound technological facilities. This dearth in the amount of nursing staff is not just a matter for developing countries like Pakistan but also for the countries in the developed world. There are a host of reasons behind this deficiency in the amount of nursing staff, some of them being poor working conditions, low pay and poor job satisfaction. Among the factors that have contributed to the immense shortage of nurses in Pakistan are the increase in workload, lack of any admiration or reward such as monetary incentives and inflexible nursing management (

Hamid

,

Malik

,

Kamran

&

Ramzan

, 2013).

Therefore, there is a dire need to research this major work force of Pakistan that has been neglected and often taken for granted. This study was planned to examine occupational stressors that the nurses face, coping strategies they deploy to deal with those stressors, and mental health problems they have as a result of those stressors.

The aims of the research were to find out the differences among stressors of private and government hospital nurses. The objectives of this study were to find out the differences in the coping styles in nurses of government and private hospitals. The other objective was to find out whether faulty coping styles lead to mental health problems.


Literature Review

Sahraian, Davidi, Bazrafshan & Javadpour conducted a study in 2013 to find out the different kinds of occupational stressors faced by nurses across several wards, nurses working in surgical, internal and psychiatric wards were interviewed in teaching hospitals of Iran. In this cross-sectional study, 180 nurses were selected who worked in surgical, internal and psychiatric wards of 4 teaching hospitals. The results of the study indicated that nurses of surgical and internal wards showed significantly higher level of occupational as compared to the nurses working in psychiatric wards. It was ascertained through the results obtained that job stressors of nurses differ across different wards in the hospitals.

There are several sources of stress, the environment in which one works being one of the biggest stressors. The significance of management of occupational stress is acknowledged, it effects the production of work, and it is also found to be linked with the worker’s physical and mental health. This particular research sought to assess the basis and effects of work-related stress on the capability, output, and competence of nurses. Several factors of the job have been linked to stress for e.g., excess of work, feelings of powerlessness, lack of clarity about their role as a nurse and disagreements at work. Stagnancy in the expansion of career, fear of joblessness, feelings of being underestimated and ambiguity in the chances of growth and promotion are some of the other stressors that were observed. This research revealed that stress negatively effects work effectiveness, de-motivates the performance, and instills the feelings of detachment towards the organization and its workers (Moustaka & Constantinidis, 2010).

Nursing is an extremely stressful job by nature and nurses use several coping strategies to deal with the stressors of their job. The aim of this study was to examine the major sources and consequences of job stress and coping mechanism amongst nurses in public health services. The research was both qualitative and quantitative in nature. It was concluded through this research that the nature of the work itself was the biggest stressor for nurses. The work itself included the setting of the work place, the monotony of work and the over burden of work. Some other stressors that were identified were the insensitive and unprofessional nature of the superiors, lack of acknowledgement and work place clashes. It was also found out that increased social support of friends, family and colleagues worked as a positive coping strategy against the effects of the occupational stressors. The participants relied on a number of other coping mechanisms to battle with the effects of the job (Beh & Loo, 2012).


Significance of the study

This research can highlight the occupational stressors of nurses, the mental health problems they get as a consequence of not being able to cope with those work related stressors. This will show a different side of these professionals that people often fail to see and take their services for granted.


Rationale of the study

As mentioned above there hasn’t been any research done on this population and even though this job is among the toughest jobs in the world, it’s not given much regard in our part of the world. This study will not only highlight the stressors that nurses face but will also serve as a stepping stone for further researches.


Research Questions

  • What is the difference between the stressors of nurses of private and government hospitals?
  • What is the difference in the coping styles of nurses of private and government hospitals?
  • What is the difference in the mental health problems of nurses of private and government hospitals?
  • Working in which ward is the most stressful for the nurses of both government and private hospitals?
  • Which shift is the cause of most stress for the nurses of both government and private hospitals?
  • Do faulty coping styles lead to mental health problems?


Hypotheses

  • It is hypothesized that there will be no significant difference between the job stressors of private and government hospitals.
  • It is hypothesized that there will be no significant difference between the coping styles of private and government hospitals

    .
  • It is hypothesized that there will be no significant difference between the mental health problems of private and government hospitals.
  • It is hypothesized that positive coping behaviors would be associated negatively with mental health problems in nurses, and negative coping behaviors would be associated positively with mental health problems in nurses.
  • It is hypothesized that higher the level of job stressors, higher the degree of mental health problems in nurses.


Method


Research Design

A cross-sectional research design will be used for this study. It will be a comparative study as it aims to find difference between job stressors, coping styles and mental health problems of nurses of private and government hospitals. Therefore a Correlational study design will be used. This design tests for statistical relationship between two variables which are nurses of private and government hospitals.


Setting

Data will be collected from nurses of private and government hospitals.


Phase I. Exploring the Phenomenology

During the first phase the phenomenon of occupational stressors of the nurses will be explored. A total number of 50 nurses will be interviewed, 25 from government hospitals and 25 from private hospitals. Before beginning the interviews permission from the head nurse or the department of the nurses will be taken. The nurses will then be interviewed individually and will be asked about the stressors they face on a daily basis. Open ended questions will be asked so as to elicit more comprehensive and detailed responses from the nurses.


Phase II. Pilot Study

The second phase is the trial phase which will determine the feasibility of the research and will also determine the reliability and responsiveness of the items of the scale that is developed.


Main Study

In order to test the hypotheses the main study will be conducted.


Participants

This study will be conducted in government and private hospitals. The participants in this study will be a sample of 300 nurses, 150 from private hospitals and 150 from government hospitals.


Measures

  1. Demographic data includes age, marital status, qualification, family system, no. of children, years of experience and the kind of institution.
  2. Scales: occupational stress scale, cope scale and general health questionnaire.

The occupational stress scale is an indigenous scale which was developed according to the norms of our culture. The cope scale was also an indigenous scale which was adapted to find out the different coping styles of nurses in Pakistan. GHQ-12 was used to assess the mental health problems of the nurses, it is a psychometric tool often used to evaluate psychological distress, depression and anxiety.


Procedure

In order to collect data, the department of clinical Psychology University of Management and Technology Lahore will issue a letter which will explain the purpose of the research and data collection from different institutions. This letter will be presented to the nurses’ department at different government and private hospitals in order to obtain permission to collect data. Later the participants’ consent will be taken and the aim of the research will be explained to the participants. Ethical considerations will be considered and after the completion of data collection, results will be analyzed.


Analysis of Results

Once the data is collected, it will be analyzed by using SPSS 16.00 software program in order to test the hypotheses.

Streptococcal Pharyngitis: History- Pathology and Treatments

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Streptococcal Pharyngitis


A: Causative Agent

Streptococcal pharyngitis is the inflammation of the pharynx and presentation of white pus spots on the throat caused by the bacterium streptococcus pyogenes. Streptococcus pyogenes is a gram-positive cocci shaped bacterium that arranges in chains. Gram-positive cocci contain a thick peptidoglycan wall that encloses the inner plasma membrane and sits between the membrane and capsule. Unlike gram-negative bacteria, gram-positive bacteria do not contain more than one cell membrane. Streptococcus pyogenes are facultative anaerobes, which allows the bacteria to grow in anaerobic conditions. Facultative anaerobes are able to use oxygen when present to grow rapidly, which explains how S. pyogenes grows so effectively in the throat where oxygen is readily available.


B: History

The organism Streptococci was first founded in 1874 by Theodor Billroth. He discovered this organism through cases of wound infections and erysipelas. Louis Pasteur was the first to introduce this organism into history in 1879 through his discovery of isolating the microorganisms from the uterus and blood of women with puerperal fever. Friedrich Rosenbach received credit for naming the organism Streptococcus Pyogenes in 1884. One of the treatments called Penicillin was not established to be an effective treatment until 1940. In 1928 Alexander Fleming was the first person to be credited with the discovery of Penicillin through his founding of Penicillium fungus. However, Penicillin was not actually isolated to where it could be used as an effective treatment for diseases until 1939 by Howard Florey and Ernst Chain. Throughout decades this treatment continues to be the best option to treat streptococcal pharyngitis. With newer advances in technology led to more knowledge of the disease and the best treatment options to cure this disease.



C: Epidemiology


Streptococcal pharyngitis is prevalent worldwide. Although, there are more cases of strep throat found in low income regions. There are thousands of people worldwide who are currently infected with strep throat. Colder temperatures can tend to influence the outbreak of the disease. This is why strep throat is a very common disease to be infected with during this time of year. Based on the CDC there are 11,000 to 13,000 cases of streptococcal pharyngitis that arise every year in the United States alone (Centers for Disease Control and Prevention 2018). Each year 20-30% of strep throat cases are found in children and 5-15% of cases are found in adults (Centers for Disease Control and Prevention 2018). There are more than 18 million cases of streptococcal pharyngitis found worldwide each year (World Health Organization 2009). According to the CDC the mortality rate for strep throat is approximately 1,100 to 1,600 people die each year in the U.S. (Centers for Disease Control and Prevention 2018). Globally the mortality rate is approximately 500,000 people die each year (World Health Organization 2009).

This disease is transmitted through direct contact with an infected person’s saliva or nasal fluids. These fluids are transmitted through airborne droplets by the infected person sneezing or coughing. It can also be transmitted by an infected person touching an item that will be touched by several people such as a doorknob. A person will then be able to pick up the disease by touching the doorknob and transmitting it to either there mouth, nose, or eyes. Strep throat tends to spread more rapidly in crowded areas such as schools, dorms, daycare centers, military training facilities, and workplaces. Humans are the main reservoir of the disease. Asymptomatic Group A Streptococcus carriers are another reservoir of this disease. Children are most commonly infected with the disease.


D. Pathology

Streptococcus pyogenes can affect multiple systems, although in the case of pharyngitis S. pyogenes invades the epithelial cells of the pharynx and tonsils causing inflammation. Due to the body fighting off the infection, the tonsils and surrounding lymph nodes become swollen and white pus spots appear on the tonsils, back of the throat, and tongue. The accumulation of pus in the throat can cause a foul-smell to patients’ breath signaling there is an infection.

S. Pyogenes contains many virulence factors to aid in their invasion including: M proteins, exotoxins, hydrolytic enzymes, and a capsule around the cell wall. M proteins embedded in the cell wall aid the pathogen in adhering to host cells upon entry. Along with the M proteins, a hyaluronic capsule surrounds the microbe which also aids in adherence and prevents phagocytosis from the immune system. The capsule appears sticky causing incoming macrophages be unable to properly engulf the bacteria. The major cause of damage occurs from enzymes and exotoxins released from the pathogen. Streptococcus pyogenes releases an exotoxin that degrades surrounding tissue and causes an excess release of cytokines from surrounding T cells. This excess of cytokines, or a superantigen, causes an increase in inflammation around the infected area. Hydrolytic enzymes are another mechanism that S. pyogenes uses to damage host cells. These enzymes include C5a peptidase, streptolysin, and streptokinase. C5a peptidase is an enzyme that blocks the immune system’s complement cascade by cleaving C5 rendering it useless. Streptolysins O & S cause surrounding host cells and red blood cells to lyse and kill phagocytes. Lastly, the enzyme streptokinase is used to lyse blood clots which aid in the spread of bacteria to other tissue in the host.

When a host is infected with streptococcus pyogenes, the host will not exhibit symptoms for 2-5 days while the pathogen incubates. After 2 or so days, the rapid onset of a sore throat, swollen lymph nodes, fever, and malaise will set in. Vomiting in young children is common, although not as common in adults. When showing signs of the infection, the patient should consult a doctor to start treatment and take proper precautions to prevent transmission to others. If the infection is treated, symptoms will resolve within 7-10 days. Although if left untreated, S. pyogenes can cause two major immune-mediated sequelae.

A sequelae is a condition that presents after a previous disease has subsided. Streptococcal pharyngitis, if untreated, can lead to acute rheumatic fever and scarlet fever. Acute rheumatic fever appears within 2-4 weeks after the initial sore throat and is caused by a cross-reaction between the pathogen’s M proteins and the host’s heart muscle. This immunological cross-reaction causes the host to exhibit a fever, painful joints, and unregulated body movements. S. pyogenes’ other sequelae is scarlet fever. Scarlet fever occurs when streptococcus pyogenes has been infected with a phage. When a phage infects S. pyogenes, it begins to produce a erythrogenic toxin that causes a sandpaper-like rash to develop on the cheeks and chest along with a high fever.


E. Response and Treatment


The immune system takes action when fighting off strep throat. Inflammation of the throat and fever are key factors. CD4 T cells are directed against the M proteins of the streptococcus pyogenes bacteria. The body’s T cells secrete cytokines to guide that class switch recombination. Th17 cells protect against the GAS bacteria. IgG1 and IgG3 are responsible for the body’s humoral response and are developed over time, therefore adults are much less susceptible to this infection than children. Once exposed to the GAS bacteria, the body produces antibodies which have a protective capacity against infection. The B memory cells developed within the body help to fight of future infection of the same strain of bacteria. Vaccine development is currently focusing on antibody development more than the T cell immunity to encompass more the one strain.

Treatment of the disease will shorten the duration of symptoms, reduce the chance of transmission between people in close contact, and prevent further complications. Clinicians should treat patients who test positive for streptococcus pyogenes (Strep Group A) through a throat culture test or rapid diagnostic throat test, in order to reduce the risk of serious sequelae. Penicillin is the first choice of treatment for the bacteria, however cephalexin and vancomycin can be used if the patient is allergic to the penicillin family. Both of these antibiotics are taken for a span of 10 days to completely eradicate the bacteria. The body could potentially fight off the infection without treatment, however antibiotic treatment is important to prevent possible life-threatening sequelae.

In order to prevent the spread of the infection, proper hygiene and respiratory etiquette should be practiced. Washing hands after coughing or sneezing and before handling food will help stop the spread of bacteria.  Respiratory etiquette means covering your nose or mouth when coughing or sneezing and not coming into close-contact with sick individuals. Normally, after twenty-four hours of antibiotic therapy, the individual is no longer at risk of transmitting the bacteria. They should stay at home for one entire day after starting the medication and until their fever is gone to further limit other’s exposure to possible illness.


Infectious Disease Fact Sheet


Group Members: Kourtney Mathis, Savannah Ross, Hannah Stewart

Name of Disease

Streptococcal Pharyngitis


Name of Causative Agent

Streptococcus Pyogenes


Type of Microbe

Bacterium


If Bacterial

:

Gram-reaction

Gram-positive

Cell Shape/Arrangement

cocci, chains


Epidemiology

Geographic Prevalence

Worldwide

Average Rates of Infection

11,000 to 13,000 cases each year in the U.S., 18 million cases worldwide, 20 – 30% in children, 5 – 15% in adults

Reservoir(s)

Humans (primarily children), (asymptomatic) Group A Streptococcus carriers

Mode(s) of Transmission

Respiratory droplets

Direct contact

Nasal or saliva droplets from an infected person


Pathology

Major Virulence Factors

Exotoxins (superantigens), M proteins, capsule, streptolysins O/S, streptokinase, hyaluronidase, C5a peptidase

Major tissues/organs affected

Epithelial cells in pharynx, tonsils

Major Signs/Symptoms

Pain, redness/inflammation of throat/lymph nodes, fever, vomiting in children

Sequelae?

Acute Rheumatic Fever

Scarlet Fever

Latency?

2-5 days


Main Treatment Methods

Pharmacological Treatments

Penicillin, Vancomycin, Cephalexin

Typical Length of Treatment

7-10 days

Prophylactic Measures

Avoid direct contact with sick individuals

Proper hygiene/hand washing and respiratory etiquette

Works Cited

Relationship between Introversion and Depression

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The World Health Organization (WHO) reports that depression is the leading cause of disability worldwide. As a psychological disorder, depression affects more than 350 million people all over the world. Studies reveal that some people are more prone to depression, including those with introverted personalities.



Characterizing an Introvert

Introverted people are energized by the inner workings of their minds. They thrive on their own thoughts and ideas. Although they can be social and talkative in the company of close friends, introverts are generally quiet, especially in the presence of strangers or when they are in large groups. Introverts are observant and learn from what they see. It takes longer for them to make decisions because they are trying to process all the information within themselves.

Unlike extroverts, who tend to be invigorated by other people, an introvert’s energy is generally drained by socializing; thus, their preference to spend time alone in order to recharge. This natural interest in solitude is one of the most common traits of introverted individuals. Often, it is seen as part of the

behavior that makes them prone to depression

.

An introvert characteristically avoids social interaction and prefers to spend time alone or in the company of a few people. This, however, is not a negative trait indicative of antisocial behavior. Simply put, it is a personality trait typified by introspection. Many times, introversion is considered the same as shyness, but the two are not necessarily associated; a shy person may be either introverted or extroverted.



The Health Risks of Introversion

Being an introvert often leads to a better understanding of the world. Unfortunately, introversion is not without its negative points. Award-winning mental health journalist and author John McManamy wrote that

introverted behavior may lead to isolation and depression

. As an introvert diagnosed with bipolar disorder, McManamy knows the topic very well.

The tendency of introverts to isolate themselves makes them more susceptible to emotional health issues. Introverts often feel that people perceive them as odd or weird, and inability to speak up about their physical health problems may lead to a poor state of health or failure to get access to the best standard of care. Research indicates that introverted people have weaker immune systems than their extroverted counterparts.



The Relationship between Introversion and Depression

It is normal for anyone to have either an extroverted or introverted personality. Extroverted individuals may have lots of friends and be more action-oriented, while introverts prefer solitude and contemplation. This is not a sign of a personality disorder. However, studies confirm that introverts are at higher risk for depression.

A study in the

Journal of Psychiatric Research

found that the population of those with depression is 74 percent introverts. Another study suggested that introverts have lower psychological well-being and are more likely to engage in self-harming behavior. The same conclusions were published in an article in

Current Psychiatry Reports

, citing Dr. Janowsky’s scientific research on the persistence of depressive symptoms due to increased introversion.

As a matter of fact, the American Psychiatric Association added introverted personality disorder  to their

Diagnostic and Statistical Manual

(DSM) more than 30 years ago. For decades, the World Health Organization has also been including introverted personality in its manual, the

International Statistical Classification of Diseases and Related Health Problems

(ICD-9 CM).



Overcoming Depression as an Introvert

The studies associating introversion with depression do not mean that other personality types cannot develop the condition. Depression is a condition that you should not be ashamed of. You cannot be blamed for being depressed, just as you would not blame people for having other medical issues.

If you are an introvert, there is nothing wrong with you. Your penchant for isolation may, however, trigger a depressive condition. It’s true that depression is manageable, but your introverted tendencies can make it difficult to reach out for help because you prefer to stay in your head. Keep in mind that you cannot just will yourself out of depression. It is not something that disappears on its own. Depression requires treatment. You don’t need to suffer in silence.

If you believe

that your introverted behavior has become a gateway to depression

, you can rise above the gloom. Recognize your need for professional care and seek out the right-fit therapist independently contracted with

Carolina Counseling Services in Pinehurst, NC

. Counseling can help you adjust better when your

introverted personality is prone to depression

. Call now to request an appointment.

Mental Health of Children with HIV

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Chapter 1


  1. Introduction

Women are more at risk of acquiring HIV infection than men in sub-Saharan Africa mainly due to Gender inequality, this relatively increases the risk of children acquiring HIV through mother-to-child-transmission [1]. According to available statistics about 30% of babies born in sub-Saharan Africa to HIV positive mothers will themselves be infected with the virus either through childbirth or through breast-feeding [2].

From recent data there are about 3.2 million children living with HIV, 91% of these children living with HIV are found in sub-Saharan Africa [2]. The WHO recommendations stipulates that children below the age of 5 diagnosed with HIV should be placed on ART regardless of what their CD4 count is, 28% of these children living with HIV worldwide, requiring antiretroviral treatment (ART) currently have access to these drugs [2].

Since the onset of the epidemic, most of the children with perinatally acquired HIV in low and middle income countries do not live past infancy [3, 4]. However, results from recent research shows that life expectancy has improved and 36% of these infants live up to 16 years of age [5]. Likewise, strategies employed to screen pregnant mothers and test infants and children at risk for HIV infection, as well as the advances in ART, has improved the quality of life and ensure HIV positive children live longer [6, 7].

However, these children will have to face the challenges of living with a chronic illness, requiring tremendous social support for long, to enable proper development both mentally and physically. For example, recent studies indicate that living with a life-threatening and stigmatizing illness is also difficult and creates great psychological distress for children with HIV [8]. Children living with HIV are often confronted with fears/thoughts about their own death, most of them are stigmatized and discriminated against [8]. Consistent evidence also shows cognitive difficulties for HIV positive children [9].


1.2. Background and Context

Mental disorder is progressively becoming an important global health concern and the leading cause of disability globally. Depression an ordinary mental disorder, currently afflicts about 350 million people, both adults and children worldwide [10]. An increasing number of mental disorders are ranked among the leading causes of disability in the World Health Organization (WHO) Global Burden of Disease 2004 [11].

War, poverty, deprivation, marginalization and deracination are among the key social determinants of mental health identified as prevalent in sub-Saharan Africa (SSA) [12-15]. This in turn increases the prevalence of depression in this region, though the number are under-reported. Despite the clear indication that mental health is a huge public health concern in SSA, it has consistently been neglected, due to the preponderance of communicable diseases, malnutrition and other perinatal disorders.

Adults living with a chronic illness like HIV, are prone to psychosocial and psychological stressors so are children living with HIV. They are faced with anxiety associated with living with a chronic illness and the possibilities of death from the infection. High on the list for psychosocial stressor, is the issue of discrimination and stigmatization, as well as struggles with other challenges like malnutrition, poverty and diminished social support [15]. Evidence from studies have shown that children suffering from chronic diseases are more prone to developing mental disorders than their peers that are healthy. In one study [16] involving children with epilepsy, it was suggested that healthy children were less likely to suffer from mental disorder than those with epileptic conditions that had increased risks. Another study [17] showed minders of children with sickle cell disease reported more emotional and behavioural abnormalities among these set of children.

Studies from other region of the world have shown that there is a relationship between HIV and mental illness. It has been shown [18] that early abnormalities in children’s neurological development is attributable to HIV infection and no other factors like environmental and biological risks. The association between HIV and neurological impairment is well researched in children. Learning difficulties, attention deficit disorder [19, 20], behavioural abnormalities [21-23] and cognitive discrepancies [24, 25] are all associated with HIV infection in children. The Pediatric Acquired Immunodeficiency Syndrome Clinical Trials Group (PACTG) in their study reported increased risks for psychiatric hospitalization for children living with HIV compared to other children without the infection [26]. It was also suggested that children with perinatally acquired HIV infection may be susceptible to certain mental disorder due to the effects of HIV infection on neurological development. They also stated that there is a likelihood of increased mental illness among these children as they progress in life.

Result from a study conducted by Mellins et al.[27] that examined psychiatric indicators in children between the ages of 9-16 years with perinatal HIV infection, showed that 11% of the children had oppositional defiant disorder and 13% diagnosed with conduct disorder.

Moreover, other studies have shown that perinatal HIV infected children are at greater risk of experiencing abnormalities in brain development [28], these abnormalities include delayed motor and cognitive development [29] and in some cases short-term amnesia and mental retardation as a result of the infection [30, 31]. A study [32] of Ugandan HIV positive babies followed over a period of one year, showed that 30% of the babies on ART exhibited impaired motor functions while about 26% of the babies displayed impaired cognitive functions, this is in contrast with 5-6% of HIV negative babies that exhibited the same conditions.

Papola et al. [33] in their study, collected retrospective data on 90 school children living with HIV, in order to examine their developmental and needs. From their findings 44% of the children’s range of intelligence were below average or average, while 56% had language impairment. A similar finding were replicated by Bachanas et al. [32], result from the study showed that HIV-infected children had lower WISC-III scores and abysmal academic performance. They also exhibited significant psychological functioning deficiency.


1.3. Research Project and significance

With increasing access to ART, the number of children born with perinatal HIV infection getting to adolescence and adulthood has increased tremendously. These children in most cases share stressors experienced by other children living with other chronic illness, like long term medical hospitalization and treatment, and agonizing life experiences. Notwithstanding the burgeoning evidence and psychosocial consequences of living with a chronic disease, there are still dearth of studies that have investigated the mental health concerns of children living with HIV in SSA.

Most research elsewhere focuses on the effect of ART treatment and prevention of HIV. Though, there is an increasing cognizance of the likelihood of increased risk of mental health disorders for people living with HIV in the long run, owing to biomedical changes occasioned by ART and environmental risks.

Based on the glowing evidence from research on correlation between substance abuse, risky sexual behaviours and mental health disorders, it is then pertinent to understand the association between mental health and children living with prenatally acquired HIV infection in sub-Saharan Africa, especially because of its unique environment and the high prevalence of the social determinants of mental illness in the region. This is necessary to inform mental health treatment and prevention programmes.


1.4. Study aim

To review and provide a synthesis of research on the mental health and psychological functioning/outcomes of children who are perinatally-infected with HIV, corresponding risk and protective elements, treatment modes and areas of vital need for future research and interventions.


1.5. Organization of the Thesis

This thesis is organized as follows.

Chapter 1 deals with the scope and objectives of the thesis, it gives a brief background of children living with perinatal HIV infection and the current trend, the mental health issues associated with living with HIV/AIDS.

Chapter 2 deals with the methodology, the literature search and identification of studies, inclusion and exclusion criteria, data extraction, quality assessment and procedures used in the analysis.

Chapter 3 presents the study findings.

Chapter 4 presents the general discussions of the study findings, including limitations of studies included. And also the limitations of a systematic review study, strength and weakness.

Chapter 5 gives the concludes and summarizes the study, giving possible intervention to address the emerging mental health concerns for children living with HIV/AIDS, as well as recommendations and identified areas of future research.


Chapter 2


  1. Literature search

A systematic literature review was conducted using the theme “children living with HIV/AIDS in sub-Saharan Africa and mental health”. The study included studies up until July 2014. The research focuses on papers dealing with children living with HIV/AIDS and the effects on their mental health. The aim is to harness these research papers on the above-mentioned theme, and discuss the subject, present a summary, and highlight areas of future research needs. This informed by the body of evidence suggesting that in the long run, perinatal infected HIV children are liable to mental health issues, arising from factors such as environment, genetics, biomedical and familial [30-33].

Nonetheless, in the course of these research there are dearth of studies using the mental health as outcome and perinatal HIV infection as exposure in SSA. Hence, terms relevant to the review theme were discovered and used in finding the required papers. Studies on children living with HIV and mental health outside sub-Saharan Africa were not included in this review. It is not clear as explained in some studies, whether the mental health condition experienced by HIV positive children is neurologically or psychological. This might be a limitation of this review.

A comprehensive search of online database for published articles on mental health and psychological functioning of children who are perinatally-infected with HIV was conducted. The electronic databases includes: PubMed, EBSCOhost and Science Direct, MEDLINE, Psychinfo, PubMed, JSTOR and Google Scholar. In addition to the online databases, unpublished articles, theses and internal reports will also identified by citation snowballing from the initial journal articles. Data was collected between January 2014 and July 2014 from the databases. The search terms used, identified through MeSH include: mental health, psychiatric/psychological, emotional and behavioural problems, perinatal HIV infection, paediatric HIV and adolescence.


  1. Inclusion and Exclusion criteria

The initial search returned one hundred and eleven studies relevant to children in sub-Saharan African living with HIV and mental health concerns, restrictions were applied in terms of age, geography and study methodology. Only studies that included children between the ages of 1- 15 years were included. Studies conducted outside sub-Saharan African countries were not included. Both quantitative and qualitative studies were included if the primary research was on HIV infection as exposure studied, the researchers had a control group or standardized psychological instrument, mental health disorder/symptoms was the key outcome studied. Only English language articles were included. Out of the 111 studies selected only 10 that were relevant to the review was selected.

As the main aim of this review was to focus on well-grounded findings the mental health and psychological functioning/outcomes of children who are perinatally-infected with HIV, only papers that included both subject were selected. Exclusion of studies outside the geographical area of interest were only performed at a later stage, to ensure that relevant studies that did not stipulate their geographical emphasis in their keywords were not excluded.



















Figure 1. Inclusion and exclusion used in systematic review.


  1. Data Extraction

Children were classified as infected or uninfected based on their seropositive or negative status. The final synthesized materials were evaluated based on the research methodology employed, age range, and the outcomes from the study. To assist in the analysis Microsoft Excel was used. A content analysis was performed. As the studies used in the systematic review is small, a meta-analysis could not performed.

Role Of The Registered Nurse

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Registered Nurses (RNs) provide many different services to health care consumers in a variety of settings. Some things nurses do on a daily basis offer a unique contribution to health care, whereas others can be done by other health team members. Professional nursing offers a specialized service to society. Professional nurses use a broad approach when considering holistic health need of the people they serve. Because of the broad nature of the discipline, nurses assume multiple roles while meeting health care needs of clients.

For this reason, this paper would be discussing the role of the registered nurse in health care delivery. We would also discuss the professional standard and expectations for registered nurse. The quality assurance and confidentiality issues would then be discussed. In addition, this paper would explore the responsibility of the employers in hiring new health care staff. This would then include the employers’ expectation regarding competencies. Finally, a conclusion would be provided in order to highlight important details discussed in the paper.

Different Roles of the Registered Nurse

Primary Caregiver

As a caregiver, the nurse practices nursing as a science. The nurse provides intervention to meet physical, psychosocial, spiritual, and environmental needs of patients and families using the nursing process and critical thinking skills. The nurse as a caregiver is skilled and empathetic, knowledgeable and caring. RNs provide direct, hands on care to patients in all health care agencies and settings. They also take an active role in illness prevention and health promotion and maintenance (Chitty, 2005; Australian Nursing and Midwifery Council, 2006; Masters, 2009).

Nurse Leader/Coordinator

The Nurse Coordinator role is unique. It is a vital part of the multidisciplinary care team for patients and contributes to improved patient outcomes. The core functions of the Nurse Coordinator role centre around the patients’ physical and psychosocial assessment, care coordination, education and support, from coordinating the patients diagnostic work-up tests to assisting them to navigate the hospital system, and referring them to allied health professionals. The Coordinator is an important resource for the patient and family and acts as a focal point of contact throughout their time in the hospital (ANMC, 2006; Hood & Leddy, 2006).

Incorporated in this advanced practice role, the Nurse Coordinator is responsible for maintaining clinical competencies and participating in those activities that contribute to the ongoing development of self and other health care professionals. The Nurse Coordinator contributes to the educational needs of clinical nurses and participates in both informal and formal education programs at a national and international level (ANMC, 2006; Hood & Leddy, 2006).

Patient Advocate

The purpose of this role is to respect patient decisions and boost patient autonomy. Patient advocacy includes a therapeutic nurse-patient relationship to secure self-determination, protections of patients’ right and acting as an intermediary between patients and their significant others and healthcare providers (Blais et al., cited in Masters, 2009). A patient advocate is mainly concerned with empowering the patient through the nurse-patient relationship. The nurse represents the interests of the patient who has needs that are unmet and are likely to remain unmet without the nurse’s special intervention. The professional nurse speaks for the patients interest as if the patient’s interests were the nurses own (Chitty, 2005; ANMC, 2006; MacDonald, 2006: Masters, 2009).

Nurse Educator

Nurse educators teach patients and families, the community, other health care team members, students and businesses. In hospital settings as patient and family educators, nurses provide information about illnesses and teach about medications, treatments and rehabilitation needs. They also help patients understand how to deal with the life changes necessitated by chronic illnesses and teach how to adapt care to the home setting when that is required (Chitty, 2005; ANMC, 2006).

Nurse as Collaborator

Collaboration is important in professional nursing practice as a way to improve patient outcomes. Multidisciplinary teams require collaborative practice, and nurses play a key role as both team members and team leaders. To fulfill a collaborative role, nurses need to assume accountability and increased authority in practice areas. Collaboration requires that nurses understand and appreciate what other health professionals have to offer. They must also be able to interpret to others the nursing needs of patients. Collaboration with patients and families is also essential. Involving patients and their families in the plan of care from the beginning is the best way to ensure their cooperation, enthusiasm and willingness to work toward the best patient outcome (Chitty, 2005; ANMC, 2006).

Nurse Practitioner

A nurse practitioner is a registered nurse educated and authorized to function autonomously and collaboratively in an advanced and extended clinical role. The nurse practitioner role includes assessment and management of clients using nursing knowledge and skills and may include but is not limited to, the direct referral of patients to other health care professionals, prescribing medications and ordering diagnostic investigations. The nurse practitioner role is grounded in the nursing profession’s values, knowledge, theories and practice and provides innovative and flexible health care delivery that complements other health care providers. The scope of practice of the nurse practitioner is determined by the context in which the nurse practitioner is authorized to practice. (ANMC, 2006; Carryer, Gardner, G., Dunn, & Gardner, A., 2007).

Professional Standards and Expectations for Registered Nurses

Standards within a professional practice are known as statements of an authoritative nature through which the profession to which they relate to provide a unique description of the responsibilities of all practitioners within that profession (Campbell & Mackay, 2001). Further, the standards and expectations are in place to ensure that all practitioners are also accountable for the work and duties they perform. When it comes to nursing, this is done in order to create boundaries and to provide a level of care that is equitable for all patients. Further, the priorities and values of nurses must be common to each nurse within the profession, and the standards and expectations outlines this as such (Campbell & Mackay, 2001; Pearson, Fitzgerald, Wash, & Borbasi, 2002; American Association of Critical-Care Nurses, 2003; ANMC, 2006, 2008; Schiemann, 2007; Furaker, 2008).

While standards will vary in specifics across nursing specializations, and across countries, there is a general mindset as to what is expected of nurses in terms of expectations and standards. They are intended to provide daily guidance to nurses as they practice. Accountability, ethics, competence, knowledge, and the practical application of knowledge are key elements that are common to all nursing standards and expectations (Campbell & Mackay, 2001; Pearson, et al., 2002; AACN, 2003; ANMC, 2006, 2008; Schiemann, 2007; Furaker, 2008 ).

Nurses are required to be held accountable for every action that they take on a daily basis. This requires constant documentation of every element of their daily

job

, and following a chain of command within their select position. They are also required to maintain ethical standards within their practice, and to follow all ethical guidelines as set forth by their governing body of nursing. Furthermore, nurses are expected to have a set amount of knowledge before they enter the field of practitioner work, and with that knowledge set come an expectation of competence and practical application. Nurses are expected to be competent in their knowledge base such that they know and understand what they are supposed to in the medical field, and also, are supposed to know how to apply that knowledge in a practical manner (Campbell & Mackay, 2001; Pearson, et al., 2002; AACN, 2003; ANMC, 2006, 2008).

Quality Assurance

Quality Assurance is another issue that is common across all standards and expectations for nurses. Through this, quality assurance standards ensure that nurses are practicing with quality efforts which in itself promote their competence and practical applications. This will require continuous education on the part of the individual nurse, as quality assurance standards across many medical centers, cities, and countries are in a constant state of evolution. It is the responsibility of the

nurse practitioner

to understand their quality assurance expectations at all times (Ellis & Hartley, 2004; Hood & Leddy, 2006).

Confidentiality

Confidentiality is another element of most standards and expectations for nurses. This is a requirement that nurses do not have an option to practice or not. Legislation and privacy concerns are in effect all across the globe, and nurses have the expectation that they will maintain confidential and private information for their patients within the patient doctor realm. Patients use medical services under the understanding that their information and medical records are not being seen by the wrong person, or found in the wrong hands, and because nurses have the most contact between patient and doctor, these are standards of paramount significance to the

nursing profession

(Deshefy-Longhi, Dixon, Olsen, & Grey, 2004, Ellis & Hartley, 2004; Chitty, 2005; ANMC, 2006, 2008; Masters, 2009).

Employers’ Responsibility in Hiring New Health Care Staff

The employer of an organization has an inherent duty to employ competent staff. This is not only cost-effective on the part of the employer but also guarantee in some ways that the products and services provided by the organization are competently given to the end-users. In the context of health care employees, such as the RNs there is an accreditation scheme to ensure the capacity of the RNs to carry out his/her job. In this manner, the employer’s responsibility to screen the professional capacity of the RN is significantly simplified. Seeking only the certification of the newly hired RN will guarantee that he/she has satisfied the minimum requirements of training, licensure, and communication proficiency to carry out his/her role as health professional. Having the employer check the credentials of the newly hired RN as well as his/her certification with authorities will allow the employer to measure the RN capability to perform his/her jobs in the organization (Ellis & Hartley, 2004; Hart, Olson Fredrickson, & McGovern, 2006).

Employers’ Expectations Regarding Competencies

Registered nurses should appraise their strengths, weaknesses and preferences. The RNs must ensure that there is a good match between their abilities and employers’ expectations. Ellis and Hartley (as cited in Chitty, 2005) suggest that RNs examine themselves in seven areas in which employers have expectations.

  1. Theoretical knowledge should be adequate to provide basic patient care and to make clinical judgments. Employers expect RN to be able to recognize the early signs and symptoms of patient problems, such as an allergic reaction to a blood transfusion, and take the appropriate nursing action, that is, discontinue the transfusion. They are expected to know potential problems related to various patients conditions. (p. 212)
  2. The ability to use the nursing process systematically as a means of planning care is important. Employers evaluate nurses’ understanding of the phases of the process: assessment, analysis, nursing diagnosis/outcome identification, planning, intervention and evaluation. They expect nurses to ensure that all elements of a nursing care plan are used in delivering nursing care and that there is documentation in the patient’s record to that effect. (p. 213)
  3. Self-awareness is critically important. Employers ask prospective employees to identify their own strengths and weaknesses. They need to know that new nurses are willing to ask for help and recognize their limitations. New graduates who are unable or unwilling to request for help pose a risk to patients-a risk that employers are unwilling to accept. (p. 213)
  4. Documentation ability is an increasingly important skill that employers value. Employers expect RN to recognize what patient data should be charted and to know that all nursing care should be entered in patient records. (p. 213)
  5. Work ethic is another area in which employers are vitally interested. Work ethic means that prospective RN employees understand what is expected of them and are committed to providing it. Employers expect new graduates to recognize that the most desirable positions and work hours do not usually go to entry-level workers in any field. In the nursing profession, a nurse cannot leave work until patient care responsibilities have been turned over to a qualified replacement; therefore, being late to work or “calling in sick “ when not genuinely incapacitated are luxuries professional nurses cannot afford. (p. 213)
  6. Skill proficiency of new graduates varies widely, and employers are aware of this. Most large facilities now provide fairly lengthy orientation periods, during which each nurse’s skills are appraised and opportunities are provided to practice new procedures. In general, smaller and rural facilities have less formalized orientation programs, and earlier independent functioning is expected. (p. 213)
  7. Speed of functioning is another area in which new nurses vary widely. By the end of a well-planned orientation period, the new graduate should be able to manage the average patient load without too much difficulty. Time management is a skill that is closely related to speed of functioning. The ability to organize and prioritize nursing care for a group of patients is the key to good time management. (p. 214)

Conclusion

Through time nurses have advanced their roles into various spheres of practice, and this progression seems set to continue as healthcare continues to evolve. Whatever the reason, central to role extension should be the delivery of safe care to all patients, with the support of the multi- disciplinary team to ensure good standards of patient care. Nurses should ensure that each activity performed when advancing a role should complement the current job, one which they are competent in. Nurses should guard themselves against litigation and carefully consider what they really want to do, as each practitioner is accountable for their actions and should be aware of the legal implications of practice within the process of advancing professional practice.

Reference

American Association of Critical-Care Nurses. (2003). Safeguarding the Patient and the Profession: The Value of Critical Care Nurse Certification. Retrieved May 5, 2010 from

http://0-web.ebscohost.com.library.vu.edu.au/ehost/pdfviewer/pdfviewer?vid=4&hid=11&sid=a5993293-dc81-4e26-93ec-1fec6430d3b1%40sessionmgr4

Australian Nursing and Midwifery Council. (2008). Code of Professional Conduct for Nurses in Australia. Retrieved May 5, 2010 from

http://www.anmc.org.au/userfiles/file/New%20Code%20of%20Professional%20Conduct%20for%20Nurses%20August%202008(1).pdf

Australian Nursing and Midwifery Council. (2006). National Competency Standards for the Registered Nurse. Retrieved May 5, 2010 from

http://www.anmc.org.au/userfiles/file/RN%20Competency%20Standards%20August%202008%20(new%20format).pdf

Campbell, B., & Mackay, G. (2001). Continuing Competence: An Ontario Nursing Regulatory Program That Supports Nurses and Employers. Nursing Administration Quarterly, 25(2), 22-30 Retrieved from

http://0-web.ebscohost.com.library.vu.edu.au/ehost/pdfviewer/pdfviewer?vid=4&hid=11&sid=42ae05a5-ab95-46df-976e-9c3eaa7b6092%40sessionmgr12

Carryer, J., Gardner, G., Dunn, S., & Gardner, A. (2007). The core role of the nurse practitioner: practice, professionalism and clinical leadership. Journal of Clinical Nursing, 1818-1825. doi: 10.1111/j.1365-2702.2006.01823.x

Chitty, K. K. (2005). Professional Nursing: Concepts & Challenges(4th ed.). St Louis, Missouri: Elsevier Saunders

Deshefy-Longhi, T., Dixon, J. K., Olsen, D., & Grey, M. (2004). Privacy and Confidentiality Issues in Primary Care: Views of Advanced Practice Nurses and their Patients. Nursing Ethic, 11(4), 378-394. doi: 10.1191/0969733004ne710oa

Ellis, J., R, & Hartley, C., L. (2004). Nursing in Today’s World: Trends Issues & Management (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins

Furaker, C. (2008). Registered Nurses’ views on their professional role. Journal of Nursing Management, 16, 933-941. doi:10.1111/j.1365-2834.2008.0872.x

Hart, P. A., Olson, D. K., Fredrickson, A. L., & McGovern, P. (2006). Competencies Most Valued by employers-Implications for Master’s-Prepared Occupational Health Nurses. Business and Leadership, 54, (7), 327-335. Retrieved from

http://0-web.ebscohost.com.library.vu.edu.au/ehost/pdfviewer/pdfviewer?vid=7&hid=11&sid=42ae05a5-ab95-46df-976e-9c3eaa7b6092%40sessionmgr12

Hood, L. J., & Leddy, S. K., (2006). Leddy & Pepper’s: Conceptual Bases of Professional Nursing(6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins

MacDonald, H. (2006). Relational ethics and advocacy in nursing: literature review. Journal of Advance Nursing, 57(2), 119-126. doi. 10.1111/j.1365-2648.2006.04063.x

Masters, K. (2009). Role Development in Professional Nursing Practice (6th ed.).

Sudbury MA: Jones And Bartlett Publishers

Pearcey, P. (2008). Nursing Roles: Shifting roles in nursing – does role extension require role abdication? Journal of Clinical Nursing, 17, 1320-1326. doi: 10.1111/j.1365-2702.2007.02135.x

Pearson, A., Fitzgerald, M., Walsh, K., & Borbasi, S. (2002). Continuing competence and the regulation of nursing practice. Journal of Nursing Management, 10, 357-364. Retrived from http://0-web.ebscohost.com.library.vu.edu.au/ehost/pdfviewer/pdfviewer?vid=4&hid=10&sid=1e5abd6f-0fce-4667-af73-c2cfe7c90ba5%40sessionmgr11

Schiemann, D. (2007). Expert Standards in Nursing as an Instrument for

Evidence-based Nursing Practice. Journal of Nursing Care Quality,22(2), 172- 179. Retrived from http://0-web.ebscohost.com.library.vu.edu.au/ehost/pdfviewer/pdfviewer?vid=7&hid=10&sid=1e5abd6f-0fce-4667-af73-c2cfe7c90ba5%40sessionmgr11

Create a 700- to 1,050-word timeline paper of the historical development of nursing science, starting with Florence Nightingale and continuing to the present.

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Create a 700- to 1,050-word timeline paper of the historical development of nursing science, starting with Florence Nightingale and continuing to the present.

Historical Development of Nursing Timeline

• Create a 700- to 1,050-word timeline paper of the historical development of nursing science, starting with Florence Nightingale and continuing to the present.

o Explain the historical development of nursing science by citing specific years, theories, theorists, and events in the history of nursing.

o Explain the relationship between nursing science and the profession.

o Include the influences on nursing science of other disciplines, such as philosophy, religion, education, anthropology, the social sciences, and psychology.

Review of Literature on Schizophrenia

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Introduction

Schizophrenia is a prolonged and severe mental disorder that affects the cognitive abilities of a person. This disorder mostly appears in the late adolescent stage or the onset of early adulthood. Its symptoms are hallucinations, delusions and mental difficulties associated with the brain. Besides, schizophrenia has negative symptoms such as lack of inspiration. The other symptoms of schizophrenia are emotional and cognitive. The emotional symptoms of this disorder include aggressiveness while the cognitive symptoms include lack of concentration and poor memory. It impacts the behavioral activities of the individuals. This mental impairment affects the thinking and the emotions of the affected person. There are four types of schizophrenia that is catatonic, paranoid and undifferentiated schizophrenia. This disorder is caused by several factors such as genetic inheritance (Cooke & Matarasso, 2005, 245). The second factor that may contribute to this disorder is the equilibrium of chemicals such as dopamine in the brain. Also, environmental factors such as stressful experiences may trigger schizophrenia.

Literature search

Schizophrenia disorder can be treated through the administration of medicines such as risperidone and Seroquel to the patients. The disease is known to affect almost one percent of the population. The disorder has a severe impact not only on the patients but also on the other individuals. The expenses for management and control of the illness are very high in society. Cognitive impairment is the basic symptoms of schizophrenia. The cognitive impairment has to do with the mental capabilities of an individual which ranges from memory, lack of attention and poor reasoning ability. G.H.M. Pijnenborg, The British Psychological Society. The main reason for this essay is to search and show an account of the way the author gathered literature for review articles.  Nursing and allied health databases such as ‘CINAHL’ for this literature search was used.  The article was over two thousand after the search, it was now reduced to 500 after the screening, it now been reduced to 5, due to the author focused only the location in the United Kingdom, using the English as the only language. The author selected the main point in the topic, that is, ‘Effect of Schizophrenia on daily life’. The impact on individual and family. This keyword were reduced to search for the relevant articles, the search dates of the articles was from January 2010 to 2019 in order to show current articles. The speed of processing data among people with schizophrenia is very low. Besides, patients with schizophrenia have poor memory long term memory. The psychosocial life of these patients is also very poor. They are not interactive and they like staying alone, they isolate themselves from the other people due to emotional withdrawal (Lysaker et al., 2011, 58) The patients with the social cognitive disorder may possess poor communication due to lack of interaction skills. The poor communication stems from the aggressiveness of the schizophrenia patients. Moreover, schizophrenic patients face a lot of discrimination from the other individual thus they develop low self-esteem and aggression.

The patients with schizophrenia have a high mortality rate as compared to the other population. The main cause of death among schizophrenic patients is suicide, heart disease, and cancer. The antipsychotic treatment administered does not fully treat cardiovascular diseases but it minimizes the rates of death among patients with cardiovascular diseases. Almost a third of the death in patients with schizophrenia we as a result of unnatural causes. The psychotic disorders increase the mortality rate of individuals. Schizophrenia disorder can be addressed effectively through the administration of antipsychotics. The disorder can be rectified when it is discovered at an early stage. The use of medicine and psychosocial treatment. The patients may also be given cognitive behavior therapy to enable them to shape the reasoning, emotions, and behavior of an individual with a schizophrenic illness. This therapy consists of practical self-help programs. The cognitive behavior therapy combines two forms of therapy which include behavioral and cognitive therapy. The use of these forms of therapy enables patients to gain good thoughts and habits.

References

Bikson, M. (2014).  ‘Understanding tDCS effects in schizophrenia: a systematic review of clinical data and an integrated computation modeling analysis’. Expert review of medical devices, 11(4), 383-394.

Brady, N., McCain, G. (November 29, 2004) “Living with Schizophrenia: A Family Perspective” OJIN: The Online Journal of Issues in Nursing. Vol. 10 No. 1.

P Cronin, F Ryan, M Coughlan – British journal of nursing, 2008 Undertaking a literature review step- by -step.

Annotated Bibliography

Brunoni, A. R., Shiozawa, P., Truong, D., Javitt, D. C., Elkis, H., Fregni, F., & Bikson, M. (2014). Understanding tDCS effects in schizophrenia: a systematic review of clinical data and an integrated computation modeling analysis. Expert review of medical devices, 11(4), 383-394.


Source: Journal article


Content: Research report

The schizophrenia is the most prevalent disorder with a prevalence of about 0.5 to 1.5 and a chronic cause all over the lives. The symptoms of schizophrenia can be classified as impairment in sociability, abulia and emotional blunting. Patients with schizophrenia have cognitive dysfunction thus these patients have less functionality in carrying out the daily tasks (Brunoni et al., 2014, 385). The patient also has a poor quality of life and comorbidities which include depressive symptoms, substance-related disorders. These patients are also at a higher risk of facing cardiovascular illness and suicidal risks.

Koolaee, K. A., & Falsafinejad, R. M. (2014). Effects of communal living Skills on improving Activities of daily living of male patients with schizophrenia. Journal of Schizophrenia Research, 1(4).

Schizophrenia is an example of a disability disorder caused by psychiatric illness. The parent suffering from this illness have abnormal behaviors and many health impairments. The patient with schizophrenia disease have difficulties in interacting with the other members in the society. Moreover, these patients are disadvantaged in that they can’t take care of themselves. They are also depreciated by vocational skills. These patients due to their mental disorders face a hard time socializing with other people (Koolaee & Falsafinejad, 2014, 46). However, these patients can be helped by being administered with antipsychotic medicine. The patient with this mental illness often faces tremendous challenges since they are isolated from the rest of society. The community can devise a mechanism to help patients with schizophrenia to live better lives.

Moritz, S., Veckenstedt, R., Andreou, C., Bohn, F., Hottenrott, B., Leighton, L., & Schneider, B. C. (2014). Sustained and “sleeper” effects of group metacognitive training for schizophrenia: a randomized clinical trial. Jama Psychiatry, 71(10), 1103-1111’


Source: Journal article


Content: Research report

Many of the patients who have schizophrenia illness have neurocognitive disorders. They are also very quick to make the final judgment of everything. The cognitive aspects are associated with the pathogenesis of the impairment. They are also known to alter the functional results of the patients. The schizophrenia is followed by neuropsychological disadvantages which are distributed over many cognitive functions. The patient who has a mental disorder have incredible problems in their cognitive perception (Moritz et al., 2014, 112). Social cognitive disorder is the main element that foretells the less functional result in the disorder.

Sato, S., Iwata, K., Furukawa, S. I., Matsuda, Y., Hatsuse, N., & Ikebuchi, E. (2014). The effects of the combination of cognitive training and supported employment on improving clinical and working outcomes for people with schizophrenia in Japan. Clinical practice and epidemiology in mental health: CP & EMH, 10, 18.


Source: Journal article


Content: Research report

Schizophrenia is a mental disability that is strong contributed due to ethnic factors. However, the studies have not shown whether patients from different ethnicity have different brain disabilities. Patients with schizophrenia have poor abilities in performing neurocognitive tasks. The neurocognitive test battery showed that the patients who had the disorder low processing speed. They also took a very long time to switch the tasks and to focus on one task. The verbal communication of these patients is easily distinguishable from the rest of the individuals. Patients with mental disorders have increased paranoia and a lot of cognitive disabilities. These people suffering from schizophrenia have are very aggressive and they possess a blaming attitude toward the others. The diagnosis of schizophrenia is linked with demonstrable changes in the structure of the brain and transformation in dopamine neurotransmission (Sato et al., 2014, 28). The change in dopamine neurotransmission results in delusions and hallucinations.

Pijnenborg, G. H. M., Withaar, F. K., Brouwer, W. H., Timmerman, M. E., Van den Bosch, R. J., & Evans, J. J. (2010). The efficacy of SMS text messages to compensate for the effects of cognitive impairments in schizophrenia. British Journal of Clinical Psychology, 49(2), 259-274.


Source: Journal article


Content: Research report

Patients with cognitive diseases have a cognitive disability which affects their mental abilities. However pharmacological measures have been put in to place to restore this patient to normal functioning. Although, despite the measures that have been put in to place to rectify the cognitive impairment. Other alternative methods are used to help the patients recover from schizophrenia (Pijnenborg et al., 2010, 270).

Reflective Account of Nursing

My reflective account will feature the patients with schizophrenia. This reflective report will focus on the patient called Judy, whom I met with during my placement visit. This is a fictitious name to maintain confidentiality. The model proposed by Driscoll (2000) is used for this reflective report. Driscoll cycle contains three questions such as ‘what?’, ‘so what’ and ‘Now what’ (Burnard, 2000).

What/who?

Fifty patients diagnosed with schizophrenia with minimum time, regarding to an individual’s mental and social sphere. RK Solanki, (2008)  On my placement, I met Judy who was diagnosed with schizophrenia 10 years ago. Her symptoms started when she was 28 years old with occasional depressive episodes and hallucinations. She does not have any friend and she spend most of her time in her room. She speaks occasionally but incoherently. She tends to avoid keeping eye contact when she talks. She does not participate in any activity and seems uninterested most of the time. She does not observe personal hygiene and significantly lacks orientation to space and time. Her daughter visits her occasionally at her home. She was admitted into the psychiatric ward during the clinical placement because her aggressive behavior was out of control. Judy was encouraged by the mental health nurse to improve on her social interaction by getting involved in community activities.

So what?

It will consider effective methods of controlling and preventing mental illnesses. Many of the patients with mental illnesses were found to have different levels of depression. Thus my argument is whether all depressed patients have mental illnesses. Many hospitals have focused so much on eliminating mental illness without clearly providing means through which they can maintain good mental health. The researchers should aim at finding the root cause of illnesses in the laboratories. The public ought to be educated on how to maintain healthy minds and bodies. Less attention should be given to mental illness but more attention needs to be given to mental health. Mental illness is a result of poor mental health. Parents who are very aggressive due to stress and depression usually bore children who have mental disorders due to the transmission of genes. The discussion that should be emphasized is concerning the emotional and mental health (Jones & Jones, 2016, 36) I had a chance to visit a hospital and examine the patients who had mental health challenges. I was involved in the clinical practice where I had to take a physical examination with a mental health nurse, for five days. The patients with schizophrenia are given medication through the administration of medicine. This patient was treated psychologically by providing love and care.

Now what?

This recovery model in patient centered care has been around for over decade (Hummelvoll, Karlsson and Borg, (2015). Examining whether the schizophrenic patient is perceiving any voice is the first step in assessing whether the patient has hallucinations.  Participating and socializing with the patient with the mental disorders may help the patients to express their problem and the physicians can help the patients to recover (Cooke & Matarasso., 2005, 246) Helping the patients who are mentally affected by socializing with them can help to create the sense of worthiness in the patients thus the patients can increase their socialization skills. Speaking with the patients and listening to their views can enable them to develop listening and concentration skills. The concentration of the patients with schizophrenic disorder can be increased by drawing the pictures on a board and illustrating the pictures to them. This will enable them to focus on one thing on consistent bases. The cognitive activity of these patients can be increased by constantly motivating patients with a mental disorder. Judy was the first person diagnosed with schizophrenia I have ever came across. After the assessment and the diagnose by the mental health nurse and the consultant, I was able to understand better as a student nurse.

Conclusion

Overall, schizophrenia has debilitating effects on the cognitive abilities of the patients affected. This illness affects all the levels of cognitive functioning of the individuals. Its lowers the concentration ability of an individual thus the person cannot focus on a single task at a time. The illness also affects the memory of the patients who possess it thus the victim of this illness has a difficult moment remembering the past events. The illness negatively affects the ability of a person to interact with others. The patients suffering from this illness can experience emotional withdrawal and they are very aggressive. The patients with schizophrenia can be assisted through medication and psychosocial treatment.

Reference List

  • Cooke, M. and Matarasso, B., 2005. Promoting reflection in mental health nursing practice: A case illustration using problem‐based learning. International Journal of Mental Health Nursing, 14(4), pp.243-248.
  • Gall, S.H., Atkinson, J., Elliott, L. and Johansen, R., 2003. Supporting carers of people diagnosed with schizophrenia: evaluating change in nursing practice following training. Journal of advanced nursing, 41(3), pp.295-305.
  • Jones, A. and Jones, M., 2016. CONTINUING PROFESSIONAL DEVELOPMENT. Reviewing depot injection efficacy in the treatment of schizophrenia. Nursing Standard, 30(33)…
  • Lysaker, P.H., Buck, K.D., Carcione, A., Procacci, M., Salvatore, G., Nicolò, G. and Dimaggio, G., 2011. Addressing metacognitive capacity for self-reflection in the psychotherapy for schizophrenia: a conceptual model of the key tasks and processes. Psychology and Psychotherapy: Theory, Research, and Practice, 84(1), pp.58-69.
  • Hummelvoll, Karlsson and Borg, (2015). ‘Revovery of person centeredness in mental services.’

A manufacturer of fat-free granola bars is considering targeting school-age children by positioning its product as a healthy, nutritious snack food. How can an understanding of the three forms of cultural learning be used in developing an effective strategy to target the intended market?

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A manufacturer of fat-free granola bars is considering targeting school-age children by positioning its product as a healthy, nutritious snack food. How can an understanding of the three forms of cultural learning be used in developing an effective strategy to target the intended market?

A manufacturer of fat-free granola bars is considering targeting school-age children by positioning its product as a healthy, nutritious snack food. How can an understanding of the three forms of cultural learning be used in developing an effective strategy to target the intended market?