Cardiovascular Disease in African American Women

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According to Braun et al (2016), cardiovascular disease is considered to be one of the largest contributors with the increase of mortality and morbidity rates in African American women.  According to a 2015 study report, African Americans ages 20 and older, were 46.0% of African American men and 48.3% of African American women had cardiovascular disease (American Heart Association, Inc, 2015).  Cardiovascular disease is a heart condition which involved the narrowing or blocked blood vessels that can lead to myocardial infarction, angina, or stroke. Other examples of cardiovascular diseases include atherosclerosis, coronary artery disease, peripheral artery disease, carotid artery disease, and arrythmias. Cardiovascular disease could be caused by some risk factors which are smoking, unhealthy diet, hypertensions, obesity/lack of physical activity, poor hygiene, increased stress levels, and high cholesterol. Why are African American women at risk compared to other racial groups?

Dietary Patterns/Food Preferences

Another factor that can lead to cardiovascular disease would be having an unhealthy diet.  The author’s purpose of this study is identifying any dietary patterns and food options of African women who are in college, which may be a risk factor for cardiovascular disease. It is important to organize African American women’s dietary patterns and food options at an early age.  According to Brown et al (2010), the events of cardiovascular disease usually begin in young adulthood.  The author’s main focus of this study is to provide dietary education in regards for cardiovascular health in college students.

It is known that college students frequently lack the consumption of fruits and vegetables.  Some strategies that can reduce the burden of cardiovascular disease would be to maintain a healthy weight, consume foods that contain low saturated fat and consume for fruits and vegetables.  Nutritional guidelines can help decrease the risk of mortality in African American women whereas unhealthy eating patterns will increase the risk of carotid arteriosclerosis (Brown et al 2010).  Research shows that the death rates in cardiovascular disease in African American women are 69% higher than White women.  The author’s indicated that there is a minimum of research of dietary patterns and food options of African American women attending college/universities.

The American Heart Association set up nutritional guidelines in the American Heart Association Eating Plan for Healthy Americans (Brown et al 2010).  These guidelines indicate that you are able to eat five or more servings of fruits and vegetables a day, eat six or more servings of grains and whole grains and eat fish twice week.  Individuals should be able to limit the high-calorie food intake, pick foods that have healthy fats and oils (e.g. olive oil, canola etc.), and avoid foods that have saturate fats/cholesterol.  Brown et al (2010) indicated that individuals who follow nutritional dietary guidelines, this can lead up cardiovascular disease risks reduced to 14% within individuals.  Research shows that about 76% of the participants at an urban university usually eat the same foods every day.

Research indicates that about 90% of college students do not eat breakfast and about 74% of college students maintain diets although they are not nutritional (Brown et al 2010). There has been research that discusses about the consequences of racial differences in regards to dietary patterns. The amount of total fat intake is similar among African American, Hispanic, and White women (Brown et al 2010).  Research shows that African Americans are more likely to consume fat from meats than from dairy products.  This means that White women are able to consume less cholesterol and more potassium than African American women.

Furthermore, African American college women are less likely to read food labels, including whole grains, raw vegetables, and fruits in their diet.  African American foods are influenced by culture and food meanings which can increase a risk of cardiovascular disease.  For example, soul food would be a perfect example of African American culture since it originated in the South consisting of cornbread, fried chicken, collard greens, macaroni and cheese and etc.  This study contained 100 African American college women who were ages 18-40 years old and were enrolled in a historically Black college/university.  The participants were required to complete GFPQ II (Geiselman Food Preference Questionnaire II) and PBRC (Pennington Biomedical Research Center FFQ (Food Frequency Questionnaire).

The GFPQ II is used to determine the fat preference score based on the participants responses.  The PBRC is used to determine how much the participants consumption of foods per day, week, month, and year. Research shows that close to 70% of the participants have stated that they have a family history of health problems.  Of those health problems, 39% have reported type II diabetes as the top family health problem and 18% reported having a family history of coronary heart disease (Brown et al 2010).  The results indicated that approximately 65% of the participants would prefer high fat foods and 87% of the participants consume more than 30% of their daily intake from fat.

The authors suggest that dietary education should be taught to individuals who have a family history of cardiovascular disease or at risk.  Choosing healthy food options can deteriorate the individual’s risk of cardiovascular disease.  The authors proclaim that there should be some interventions held in regards to dietary patterns and food options among African American college women.  Nutritious snacks in vending machines, healthier drinks that contain low sugar and calorie intent, and providing books that discuss about nutrition for incoming freshman are some innovations that can be proposed on college campuses (Brown et al 2010). The author’s concluded that one of the factors for on campus eating behavior would be the food from the cafeterias.  They stated that historically black colleges/universities can provide helpful nutritional plans that can also serve a model for the administrators, faculty, and students in order to increase eating behaviors on-campus.

Physical Activity, Hypertension, & Hypercholesterolemia

The aim of the authors for this study was to determine that hypertension and hypercholesterolemia was major risk factors when it comes to high morbidity and mortality rates in midlife African American women. It was known in 2012 that the prevalence of cardiovascular disease in African American women was 48.3%, compared to 36.1% of White women.  The death rate for African American women was 99.7 per hundred thousand and for White women, it was 80.1 per hundred thousand.  African American women have a history of stroke that is twice as high than White women (Braun et al 2016).  The authors implemented The Women’s Lifestyle Physical Activity Program for African American women for the importance of physical activity.

Physical activity is important in terms of deteriorating the burden of cardiovascular disease because it can prevent myocardial infarctions, strokes, and stress. Physical activity can help you manage your blood pressure, cholesterol levels, and it can help maintain your weight.  The purpose of this study is to be able describe the risk factors of cardiovascular disease which are hypertension, hypercholesterolemia, smoking, diabetes, and obesity (Braun et al 2016).  The authors main focus is to spread awareness, treatment, and ways to control hypertension and hypercholesterolemia.  The sample of the study contained African American women who were ages 40-65 years old who did not have an exercise routine for the past 6 months.

They collected data urban-dwelling, midlife African American women participants, who were not exercising regularly two or more timed a week in the past six months (Braun et al 2016). The authors categorized the participants based on age, marital status, number children who are under the age of 18, education, employment and family income.  In the study, the participants were asked a few health questions in regards to whether they are prescribed medication for hypertension and hypercholesterolemia.  There were additional questions in regards any other cardiovascular disease risk factors (e.g. smoking and presence of diabetes).  Some question examples would “Have you smoked in the past year?”, “Are you diagnosed with diabetes?” (Braun et al 2016).

The results indicated that the participants who were eligible for the Women’s Lifestyle Physical Activity Program, there about 32.6% of participants who were located in < 25th percentile based on the Aerobic fitness step test.  This indicates that of the 297 women who were eligible for the program, about 58.2% had hypertension, 38.3% had hypercholesteremia, and 10.1% were current smokers. Approximately 14% of the participants were diagnosed with diabetes and majority of them had obesity which indicates they are at a high risk for cardiovascular disease (Braun et al 2016).   This means that about 94.9% of African American women had more than one cardiovascular disease risk factors, 69.1% had more than two, and about 31.7% had more than 3 cardiovascular disease risk factors.  The authors indicated that their data in regards to hypertension was similar to the National Health and Nutrition Examination Survey findings.

NHANES indicated that about 88.5% of African American women with hypertension were aware they had high blood pressure and only 82.3% of them were getting treatment with medication (Braun et al 2016).  In both of the studies, most of the women who had hypertension were aware of their condition and was getting treatment.  The authors have concluded that African American women who have a high prevalence of uncontrollable hypertension and treatment of hypercholesterolemia, were at high risk for stroke and cardiovascular disease.  With all the results from this study, it was concluded that African American women was at risk for a stroke and premature cardiovascular disease due to lack of support from the healthcare providers.

Social Conditions & Socioeconomic Status

One factor that can cause African American women to be diagnosed with cardiovascular disease would be due to living conditions in the neighborhood and socioeconomic status.  Barber et al (2016) aim for this study is to examine the impacts of neighborhood conditions that resulting in cardiovascular disease risk in African Americans.  They collected data from 4,096 of African Americans combined from the Jackson Heart Study.  Jackson Heart Study is considered to be the largest cohort study of cardiovascular disease among African Americans in order to examine the association between the neighborhood economic/social environment and cardiovascular disease incidence.  The author’s hypothesized that the increased levels of neighborhood disadvantage, violence, and lower levels of social cohesion is the main cause with increased risks of cardiovascular disease.

There were approximately 2,652 African American women and 1,444 African American men between the ages of 21-93 years old that resided in Jackson, Mississippi.  The author’s organized the data within neighborhood level conditions in three categories which are social cohesion, violence, and physical disorder.  These categories have been considered to be one the reasons for cardiovascular disease risk factors and disease onset. They categorized their data with based off of demographic characteristics (e.g. age, gender, family income, education) for analysis (Barber et al 2016).  They examined whether the participants had physical activity involved, the amount of food consumed and calories per day, the number of cigarettes used per day, and the amount of alcohol consumed from the portions of beer, wine, and liquor.  The authors also measured participants whether their body mass index was greater than or equal to 30.

The participants were required to answer a survey in regards to hypertension with the Seventh Report of the Joint National Committee (Barber et al 2016).  The Jackson Heart Study research staff had collected high-density and low-density lipoprotein cholesterol and triglycerides from participant during a clinic examination. According the Barber et al (2016), there were a total of 232 cardiovascular disease events that had occurred during a follow-up time of 8.4 years.  The authors indicated data with different tables with scores of recorded due to the cardiovascular risk in the participants. One table in this study had showed that some of the participants who had developed cardiovascular disease were older, had less family income and education, and had worse risk profiles (Barber et al 2016).

Majority of these participants had resided in disadvantaged neighborhoods and neighborhoods who had higher levels of violence and disorders.  Second table displayed that age-adjusted cardiovascular disease incidence rates were lower than recent reported estimates for African Americans and it would increase as neighborhood conditions have gotten worse for men and women.  Due to their results, they discovered that among African American women, there was a 25% increased risk of cardiovascular disease diagnoses due to a neighborhood disadvantage. For social environment in the neighborhood, there was increase in neighborhood violence and disorder which associates with an increase of cardiovascular disease risk among African American women.  However, this case is different for African American men since there is a decreased risk of cardiovascular disease due to higher levels of neighborhood violence and disorder.

This concludes that African America women living in neighborhood with poor social conditions, had an increased risk of cardiovascular disease.  The authors concluded that the worse neighborhood economic and social outcomes can contribute to an increased risk of cardiovascular disease among African American women. Furthermore, neighborhoods that contain higher rates of poverty and unemployment, they experience higher rates of criminal activities.  The main purpose of this study is to focus on the physical properties within the neighborhoods (e.g. access to healthy foods, higher security etc.).  There also should be some neighborhood policies that address the economic and social conditions within neighborhoods to help deteriorate the rate of cardiovascular risk among African Americans.


Improving Heart Health

The author’s main purpose was to examined the effectiveness of civic engagement as an intervention plan in order to address the cardiovascular disease in African American women. Approximately about 82% of African American women ages 20 years old or older are overweight. In this quasi-experimental study, the civic engagement was examined by assembling a sample of 28 African American women between the ages of 30-70 years old. Effectiveness data was characterized by dietary intake, amounts of physical activity, cardio-respiratory fitness, and blood pressure.  The results indicated that Research shows that the prevalence of diet and related diseases like cardiovascular disease, obesity, hypertension, are higher in African American women compared to racial groups.  There was a significant finished time on the cardiorespiratory fitness exam and the systolic blood pressure.   The author’s concluded that the study results suggested that the effectiveness of using civic engagement plan would address any behavioral changes that is acceptable for African American women.


References

  • Barber et al. (2016).  Neighborhood Disadvantage, Poor Social Conditions, and Cardiovascular Disease Incidence Among African American Adults in the Jackson Heart Study.

    AJPH Research.

    December 2016, Vol 106, No. 12. pp. 2219-2226.
  • Braun et al. (2016). Cardiovascular Risk in Midlife African American Women Participating in a Lifestyle Physical Activity Program.  HHS Public Access:

    J Cardiovascular Nursing.

    31(4): 304-312. doi:10.1097/JCN.0000000000000266
  • Brown et al. (2010). Cardiovascular Risk in African American Women Attending Historically Black Colleges and Universities: The Role of Dietary Patterns and Food Preferences.

    Journal of Health Care for the Poor and Underserved: Project Muse

    Volume 21, Number 4, November 2010, pp.1184-1193 (Article). Published by Johns Hopkins University Press
  • Heart Disease (1998-2018).

    Mayo Clinic

    .

    https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118
  • Statistical Fact Sheet, 2015 Update. African Americans & Cardiovascular Disease.

    American Heart Association Inc,

    2015.

Pathophysiology Disease Body

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Ulcerative colitis.

Pathophysiology is the study of disturbance of normal mechanical, physical and biochemical functions either caused by a disease or resulting from a disease or abnormal syndrome or condition that may qualify to be called a disease. It’s defined when something disrupts the normal physiology and it enters in to realm. Pathophysiology looks at the detailed malfunctioning that causes diseases. Pathophysiology deals with the how the body reacts incase of a pathogen in the digestive system. Pathophysiology of Ulcerative colitis is the most common inflammatory bowel disease affecting most people in the world and mostly in Australia. The inflammatory process of ulcerative colitis begins at the rectum area of the anal canal and progresses proximally to other body parts within the digestive system. After analyzing my patient, i found out some symptoms in him which are in ulcerative colitis. They included ; Frequent visit to the toilet with 7-8 visits during the night, diarrhea and the diarrhea progressed to have blood stains, loss of weight by 10 kg, loose of appetite, he was weak because of dehydration he experienced ache in the legs and this resulted to fatigue. These are the common symptoms in ulcerative colitis and this patient happened to have the symptoms after i diagnosed him. In most people the disease is confined to the rectum and sigmoid colon. Although ulcerative is untreatable, it has long-term debilitating manifestations which disrupt lifestyle.

Some of the common signs and symptoms of this disease fall under two categories that is internal manifestation and external manifestation. Some examples of the internal manifestation include; include; inflammation at the base of the crypt of lieberkun in the large intestine which is connected with the inflammation on the thick lining wall of the rectum it also happen to other parts of the digesting track. It is also characterized by remissions and exacerbations involving the inflammation of the rectum and colon. Blood stained stool with mucus also is another symptom for ulcerative colitis. Abdominal pain, tiredness and weight loss, mouth ulcers, malaise and malnutrition, frequent diarrhea with small passage of blood and purulent mucus, some people experience fever in the body some patients may start vomiting or have nausea other patients may experience pain in the anus while passing stool. Chronic inflammation leads to a trophy, narrowing and shortening of the colon, with loss of its normal haustra. Pseudo polyps, tongue like projections of bowel mucosa into of the bowel regenerates. The disease is also severe in the rectum and sigmoid colon. Loss of the absorptive mucosal surface and rapid colonic transit and this causes large volumes of watery diarrhea, anemia. Many of the external manifestation may be missed as the sign of Ulcerative colitis examples of external manifestation include; joint pain oral lesions, arthritis, osteoporosis and skin manifestation e.g. Erythemanodusum. Some other external manifestation may be in the eyes and liver. Other signs are anorexia, fatigue and weakness in the body. Some people may have frequent visit to the toilets which can equate to 6 to 10 visits per day with bloody stool. All these symptoms differ with normal health because when one is healthy he or she does not visit the toilet frequently, diarrhea, has blood stool, vomit or has fatigue and weakness in the body. When the gastrointestinal is normal, digestive system is also good and the colon and rectum function properly. Chronic inflammatory is caused by abnormal gastrointestinal. Gastrointestinal process is important because it strengthens the mucosal lining of the rectum this results to better absorption of vital nutrients and thickening of the colon wall.

After various medications failed, some of the visible effects of the current medication (cyclospororine) are; mild increase in transaminases, thrombocytopenia, and pancytopenia. This suggests that the therapy with VGC is effective against CMV in organ transplant. Also the current medication had fatigue problems the body was involved in a lot of metabolic processes and got exhausted because of that medication. This has led to general energy loss in the body as a whole. Although has negative impact to energy that is not reflected to weight has weight remained constant. The patient was not allergic to the medication and neither of his body parts responded negatively to the medication. Diarrhea has not stopped so the patient still administers predisone drug because it helps in reducing diarrhea. To avoid some of those effects the patient is supposed to medication that is suitable to his body. The medication i can recommend to the patient is the current drug because although it has so effects but it is helping the patient greatly. is an immunosuppressant for the treatment of the disease. Cyclosporine acts as an inhibiting lymphocyte which is important for propagation of inflammation. Apart from other immunosuppressive agent, this medication does not suppress the activity of other hamatopoetic cells

References

Trauma Radiography And Procedure

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Trauma radiography can be an exciting and challenging environment for the radiographer. However the performing trauma procedure can be intimidating and stressful. The difference depends on how prepared the radiographer is to handle the situation. To reduce the stress associated with trauma radiography, the radiographer must be properly prepared for multitude of responsibilities encountered in the emergency room (ER).

Trauma is defined as a sudden, unexpected, dramatic, forceful, or violent event. Trauma ranks as the leading cause of death. The term trauma center signifies a specific level of a emergency medical care as defined by the American College of Surgeons Commission on Trauma.

Specialized equipment in trauma.

Time is a critical element in the care of a trauma patient. To minimize the time required to acquire diagnostic x-ray images, many emergency rooms have dedicated radiographic equipment located in the department or immediately adjacent to the department. Specialized trauma radiographic systems are available and are designed to provide greater greater flexibility in x-ray tube IR maneuverability. These specialized systems help to minimize the movement of the injured patient while performing imaging procedure.

Mobile radiography is widely utilized in the emergency room. Many patients will have injuries that prohibit transfer to a radiographic table, or their condition may be too critical to interrupt treatment. Trauma radiographers must be competent in performing mobile radiography on almost any part of the body and be able to utilize accessory devices like a grids, air-gap technique. Its needed to produce quality mobile images.

Positioning aids are necessity in trauma radiography. Sponges, sandbags, and the creative use of tape are often the trauma radiographer’s most useful tools. Most trauma patients are unable to hold the required positions as a result of pain or impaired consciousness. Other patients cannot moved into the proper position because to do so would exacerbate their injury.

Exposure factors in trauma

Patient motion is always a consideration in trauma radiography. The shortest possible exposures time that can be set should be used in every procedure., except when a breathing technique is desired. Unconscious patients are not able to suspend respiration for the exposure. Conscious patients are often in extreme pain and unable to cooperate for the procedure.

Radiographic exposure factors compensation may be required when a making exposures through immobilization devices, like a spine board or backboard. Most trauma patient arrive at the hospital with some type of immobilization devices. Pathologic changes should also be considered when setting technical factors. For instance, internal bleeding in the abdominal cavity would absorb a greater amount of radiation than a bowel obstruction.

Types on trauma injuries.

The some types of trauma injuries is head injuries, spinal injuries, chest injuries, extremity fractures, wounds, burns and also postsurgical complications wound dehiscence.

The head injuries is the patients who have to received a blow to the head may have sustained serious injury, even when there are external signs of trauma. Damage may occur with or without a skull fracture. If have bleeding or swelling occurs inside the skull, a rise in intracranial pressure(ICP) may cause seizures, loss of consciousness, or respiratory arrest. incidentally, similar symptoms may also occurs in patients with increased ICP due to brain tumors.

The patients with spinal injuries, every trauma patient should be considered to have a potential spinal injury and should be evaluated by the ED physician before being moved. even slight movement of a spinal fracture may cause pressure on the spinal cord, resulting in paralysis or death. for this reasons, exposures should be made without moving the patient whenever possible. when a change of position is required, as for a lateral lumbar radiograph, use a “log rolling” approach, which keeps the body in one plane. this two-person procedure avoids twisting or bending the spine. patients with possible cervical spine fractures are immobilized with cervical collars and other radiolucent devices.

About the patient with the chest injuries is the motor vehicle accidents and falls are two of the most common causes of chest injuries seen in the imaging department. Deaths due to crushing or penetrating wounds of the thorax comprise a significant number of the trauma deaths each year. Fractures ribs are painful and can be life threatening if along or blood vessel in punctured.

Extremity fractures is a trauma involving the long bones of the body may classified in two categories, first is compound fractures, in which the splintered ends of bone are forced through the skin, and then the second is closed fractures. Compound fractures are usually partially reduced and dressing applied before radiographic examination. Some common types of fractures are greenstick, spiral, overriding, comminuted, transverse, compression, depressed(skull), and avulsion. Fractures may also be classified according to the nature of the injury. there are many ways of temporarily immobilizing extremity fractures. the two legs may be fastened together for stability during transportation, or a stiff object, such as a board or rolled-up magazine, may serve as a splint. When want to position the patients with fractured extremity that is not supported by a splint, maintain gentle traction while supporting and moving the arm or leg.

The wounds in the type or trauma is patients with open wounds have usually been treated before you see them in radiology suite. Bleeding has been controlled, and dressings have been applied. the radiographer primary responsibility regarding open wounds is to maintain the dressings and the report promptly any significant amount of fresh bleeding. This is usually considered to be the amount of bright red blood sufficient to soak through a fresh dressing. if a laceration or incision opens, causing severe hemorrhaging, apply direct pressure to the side of bleeding while summoning immediate assistance.

While burns in type of trauma is, burn patients may also have traumatic injuries such as fractures. Burns are frequently associated with respiratory complications. Inhalation of hot gases may result in pleural effusion or the development of pneumonia, which must be monitored radiographically. Burns may be categorized by cause of injury, percentage of body surface involved, and depth of tissue destruction. The depth of burns is classified as first, second or third degree. When a burn patient needs a radiograph, coordinate your examination with the nursing staff to ensure that the patient has had pain medication about 30 minute before the procedure.

Postsurgical complications(wound dehiscence) is the patient who had a major surgery may require radiographic examination. Wound dehiscence occurs when a suture line parts and the underlying tissues or organs protrude through the opening. While this rare, it may happen, particularly in obese patients who had extensive abdominal surgery. It is possible for evisceration its means loss of organs from a body cavity, it to result when extensive suture lines spread apart or split.

Positioning of the patient trauma

The primary challenge of the trauma radiographer is to obtain a high quality, diagnostic image on the first attempt when the patient is unable to move into the desired position. To minimize risk of exacerbating the patients condition, the x-ray tube and IR should be positioned, rather than the patient or the part. For examples, position the stretcher adjacent to the vertical Bucky or upright table as often as the patients condition allows. To increases the efficiency, while minimizing patient movement, is to take all of the AP projections of the requested examinations, moving superiorly to inferiorly. Then perform all of the lateral projections of the requested examinations, moving inferiorly to superiorly. This method moves the x-ray tube in the most expeditious manner.

Radiographers Role as Part of the Trauma Team

The role of the radiographer within the emergency rooms ultimately depends on the department protocol and staffing, as well as the extent of emergency care provided at the facility. Regardless of the size of the facility, the primary responsibilities of a radiographer in an emergency situation include the following , the first is perform quality diagnostic imaging procedures as requested. Then to practice ethical radiation protection , and also provide competent care. It is impossible to rank these responsibilities because they occurs simultaneously, and all are vital to quality care in the emergency rooms.

Diagnostic imaging procedures

producing a high quality, diagnostic image is one of the more obvious roles of any radiographer. A radiographer in the trauma environment has the added responsibility to perform that task efficiently. Efficiency and productivity are commo0n and practical goals for the radiology department. In the emergency room, efficiency is often crucial to saving the patients life. Diagnostic imaging in the emergency room is paramount to an accurate, timely and often life saving diagnosis.

Radiation protection.

One of the most essential duties and ethical responsibilities of the trauma radiographer is radiation protection of the patient, the members of the trauma team, and self. In highly critical care situations, members of the trauma team cannot leave the patient while imaging procedure are being performed. The trauma radiographer must ensure the others team members are protected from unnecessary radiation exposures. Common practices should minimally included the following close the collimation to the anatomy of interest to reduce scatter, gonadal shielding for the patients of child bearing age, lead aprons for all personnel that remain in the room, during the procedure, exposure factors that minimize patient dose and scattered radiation and also announcement of impending exposure to allow unnecessary personnel to exit the room.

Patient Care

As with all imaging procedures, trauma procedures required a patient history. the patient may provide this, if he or she is conscious, or the attending physician may inform you of the injury and the patients status. if the patient is conscious, explain what you are doing in detain in terms the patient can understand. listen to the patient rate and manner of speech, which may provide insight into his or her mental or emotional status. Make eye contact with the patient to provide comfort and reassurance. Keep in mind that a trip to the emergency room is an emotionally stressful event, regardless of the severity of the injuries illness.

Radiographers are often responsible for the total care of the trauma patient while performing diagnostic imaging procedures. Therefore it is critical that radiographers constantly assess the patient condition, recognize any signs of decline or distress, and report any change in the status of the patient condition to the attending physician. The trauma radiographer must be well versed in taking vital signs and knowing normal ranges, competent in cardiopulmonary resuscitation (CPR), administration of oxygen, and dealing with all types of medical emergencies. the radiographer must be prepared to perform these procedures when covered by a standing physicians order or as departmental policy allows. Additionally, the radiographer should be familiar with the location and contests of the adult and pediatric crash carts, and understand hoe to use the suctioning devices.

Patient Preparation

It is important to remember that the patient has endured an emotionally disturbing and distressing event in addition to the physical injuries he or she may have sustained. If the patient conscious, speak calmly and look directly in the patient eyes while explaining that procedures that have been ordered. Do not assume that the patient cannot hear you even if he or she cannot or will not respond.

Check the patient thoroughly for items that might cause an artifact on the images. Explain what are you removing from the patient and why. Be sure to place all removed personal effects, especially valuables, in the proper container uses by the facility example like a plastic bags, or in the designated secure area. every facility has a procedure regarding proper storage of a patients personal belongings. Be sure to know the procedure and follow it carefully.

Immobilization Device

A wide variety of immobilization devices are uses to stabilize injured patients. Standard protocol is to perform radiographic images without removing immobilization devices. Once injuries have been diagnosed or rules out, the attending physician gives the order for immobilization to be removed, changed, or continued. Many procedures necessitate the use of some sort of immobilization to prevent in voluntary and voluntary motion. Prudent use of such is discussed in many patient care textbooks. The key issue in the use of immobilization in trauma is not to exacerbate the patient injury nor increase his or her discomfort.

Image Evaluation

Ideally, trauma radiographs should be of optimum quality to ensure prompt and accurate diagnosis of the patients injuries. Evaluate images for proper positioning and technique as indicated in the routine projections. Allowance can be made when true right angle projections (AP/PA and also lateral) must be altered as a result of patient condition.

Reflect on the curriculum or program that your team is developing for your Course Project. In addition, reflect on the learning needs and diverse learning styles of your students/staff/patients.

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Reflect on the curriculum or program that your team is developing for your Course Project. In addition, reflect on the learning needs and diverse learning styles of your students/staff/patients.

Theorists have always been interested in how people learn. They have created and refined learning theories and provided authentic examples of human motivation and learning preferences. Much research has also been conducted on how educators teach others. Literature suggests that even when educators did not believe that they were using a theory, they were in fact using one or more to drive their instruction. Though nurse educators may naturally incorporate theories into their instruction, great care should be taken to consciously incorporate theories into the design and presentation of the curriculum. Doing so will not only benefit diverse learners but also aid in the curriculum development process.
In this Discussion, you explore how learning theories offer distinct strategies, approaches, and considerations.

Questions to be addressed:
1. Review the learning theories presented in this week’s Learning Resources. How can each theory, or combination of theories, guide the curriculum development process? A brief description of how learning theories guide curriculum development.
2. Identify your Course Project setting (Arizona State University) and provide a brief description of your team’s proposed curriculum or program (Doctor of Nursing Science (DNSc) programs).
3. Reflect on the curriculum or program that your team is developing for your Course Project. In addition, reflect on the learning needs and diverse learning styles of your students/staff/patients.
4. Select one learning theory that you could apply to your team’s curriculum or program. Consider how this learning theory could guide your team’s curriculum development process.
5. Explain how your selected theory applies to your team’s curriculum/program by sharing at least two authentic examples.
6. Access the “VARK: A Guide to Learning Styles” website, also found in this week’s Learning Resources (http://www.vark-learn.com/english/page.asp?p=questionnaire).Complete the learning styles assessment and review your scores and learning preferences. These results will assist you in your response post.

Capstone Project Milestone #2:

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Capstone Project Milestone #2:

Design for Change Proposal Guidelines
PURPOSE
You are to create a Design for Changeproposal inclusive of your PICO and evidence appraisal information from your Capstone Project Milestone #1. Your plan is to convince your management team of a nursing problem you have uncovered and you feel is significant enough to change the way something is currently practiced. In the event you are not currently working as a nurse, please use a hypothetical clinical situation you experienced in nursing school, or nursing education issue you identified in your nursing program.
COURSE OUTCOMES
This assignment enables the student to meet the following course outcomes.
CO1:Applies the theories and principles of nursing and related disciplines to individuals, families, aggregates, and communities from entry to the healthcare system through long-term planning. (PO #1)
CO2:Proposes leadership and collaboration strategies for use with consumers and other healthcare providers in managing care and/or delegating responsibilities for health promotion, illness prevention, health restoration and maintenance, and rehabilitative activities. (PO #2)
DUE DATE
Milestone #2 consists of the proposal for your Design for Change Capstone Project. Submit this Milestone to the Dropbox by the end of Week 4.
POINTS
Milestone #2 is worth 225 points.
DIRECTIONS
1. Create a proposal for your Design for Change Capstone Project. Open the template in Doc Sharing. You will include the information from Milestone #1, your PICO question, and evidence appraisal, as you compose this proposal. Your plan is to convince your management team of a nursing problem you have uncovered and you feel is significant enough to change the way something is currently practiced.
2. The format for this proposal will be a paper following the Publication manual of APA 6th edition.
3. The paper is to be four- to six-pages excluding the Title page and Reference page.
4. As you organize your information and evidence, include the following topics.
a. Introduction:Write an introduction but do not use “Introduction” as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association (2010, p. 63). Introduce the reader to the plan with evidence-based problem identification and solution.
b. Change Plan:Write an overview using the John Hopkins Nursing EBP Model and Guidelines (2012)
i. Practice Question
ii. Evidence
iii. Translation
c. Summary
5. Citations and Referencesmust be included to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format.In-text citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, “How do I know this?” and then cite the source. Scholarly sources are expected, which means using peer-reviewed journals and credible websites.
6. Tables and Figures may be added as appropriate to the project. They should be embedded within the body of the paper (see your APA manual for how to format and cite). Creating tables and figures offers visual aids to the reader and enhances understanding of your literature review and design for change.
GRADING CRITERIA: DESIGN FOR CHANGE CAPSTONE PROJECT
Category Points % Description
Introduction 25 11% Introduction to the plan is nursing focused, with evidence-based problem identification and potential solutions clearly identified.
Change Plan; Practice Question (Steps 1–5) 50 22% Activities to achieve the first steps of change are fully described in detail and are based on the first five steps of the John Hopkins EBP Process; Practice Question.
Change Plan; Evidence (Steps 6–10) 50 22% Activities to achieve steps six through tenof the John Hopkins EBP Process are fully described in detail; Evidence.
Change Plan; Translation
(Steps 11–18) 50 22% Activities to achieve the final steps of change are fully described in detail and are based on steps11 through 18of the John Hopkins EBP Process; Practice Question.
Summary 25 11% Clear, solid summary summarizing the key points and steps of the change plan is included; ways to maintain the change plan are described.
APA Format 25 11% Minimal errors.
Total 225 points 100%

GRADING RUBRIC: CAPSTONE PROJECT MILESTONE #2
Assignment Criteria Outstanding or Highest Level of Performance
A (92–100%) Very Good or High Level of Performance
B (84–91%) Competent or Satisfactory Level of Performance
C (76–83%) Poor, Failing or Unsatisfactory Level of Performance
F (0–75%) Total
Introduction
25 points Introduction to the plan is nursing focused, with evidence-based problem identification and potential solutions clearly identified.
23–25 points Introduction to the plan is nursing focused, with evidence to support the problem and potential solution identified but convincing areas are missing.
21–22 points Introduction to the plan is provided; however, evidence to support the problem and potential solution is not convincing.
19–20 points Introduction lacks evidence to support need for change and/or potential solution is not realistic.
0–18 points /25
Change Plan Practice Question
(Steps 1–5)
50 points Activities to achieve the first five steps of change are fully described in detail and are based on the first section of the John Hopkins EBP Process:
*Practice question is identified.
*Scope of the problem discussed (including supportive statistics).
*Stakeholders identified.
*Team is identified.
46–50 points Activities to achieve the first five steps of change are fully described, not in detail but are based on the first section of the John Hopkins EBP Process:
*Practice question is identified.
*Scope of the problem discussed (including supportive statistics).
*Stakeholders identified.
*Team is identified.
42–45 points Activities to achieve the first five steps of change are vague. The first section of the John Hopkins EBP Processis not clearly identified.
*Practice question is identified.
*Scope of the problem does not contain statistics to support the problem.
*Stakeholders are identified but not appropriate or missing key members.
*Team members are identified but not appropriate or missing key members.
38–41 points Activities to address and support change are not specifically addressed. Portions of the first five steps are missing or absent.
0–37 points /50
Change Plan Evidence
(Steps 6–10)
50 points Activities to achieve steps six through tenof change are fully described in detail and are based on the first section of the John Hopkins EBP Process: Evidence is identified.
*At least four reliable sources are used, three of which are peer-reviewed.
*Summary of evidence is thorough and detailed.
*Strength of evidence is discussed.
*Recommendation for change is based on evidence and is thorough.
46–50 points Activities to achieve steps six through ten of change are vague and are based on the first section of the John Hopkins EBP Process: Evidence is identified.
*At least four reliable sources are used, three of which are peer-reviewed.
*Summary of evidence is vague.
*Strength of evidence is discussed.
*Recommendation for change is based on evidence but connection is vague.
42–45 points Activities to achieve steps six through ten of change are vague and are based on the first section of the John Hopkins EBP Process: Evidence is identified.
*At least four reliable sources are used but less than three are peer-reviewed. *Summary of evidence is vague.
*Strength of evidence is not discussed.
*Recommendation for change is present but not weak connection to the evidence.
38–41 points Activities to achieve steps six through ten of change may be missing or absent.
*Less than fourreliable sources are used.
*Summary of evidence is not present or missing important elements.
*Strength of evidence is missing.
*Recommendation for change lacks support from evidence.
0–37 points /50
Change Plan Translation
(Steps 11–18)
50 points Activities to achieve the last steps of change are fully described in detail and are based on the last steps of the John Hopkins EBP Process:
Translation. *Action plan is well-developed with specific timeline in place to include all elements of the plan.
*Measurable outcomes and way to report results are discussed in detail.
*Plan for implementation is thoroughly discussed.
*Ways to communicate findings (internally and externally) are discussed.
46–50 points Activities to achieve the last steps of change are described and are based on the last steps of the John Hopkins EBP Process:
Translation.
*Action plan is developed with specific timeline in but some elements of the timeline are missing.
*Outcomes are present but not measurable. Ways to report results are discussed in detail.
*Plan for implementation is discussed.
*Communication of findings is present but does not address both internal and external ways.
42–45 points Activities to achieve the last steps of change are vague.
*Action plan is developed but timeline is missing.
*Outcomes are vague and not measurable. Ways to report results are discussed but not in detail.
*Plan for implementation is vague.
*Communication of findings is missing.
38–41 points Activities to achieve the last steps of change are vague or missing.
*Action plan is not well-developed or missing.
*Outcomes are vague or not present.Ways to report results are discussed but not in detail.
*Plan for implementation is not present.
*Communication of findings is missing.
0–37 points /50
Summary
25 points Clear, solid summary of the key points and the change plan are included; ways to maintain the change plan are described.
23–25 points A clear summary of the key points and part of the change plan are provided; ways to maintain the change plan are mentioned, but not in detail.
21–22 points A summary is present but is vague; parts of the change plan are highlighted; ways to maintain the change plan are not clear.
19–20 points A summary is difficult to determine or absent. Key points of the change plan are not recapped or are absent.
0–18 points /25
APA formatting, scholarly writing
25 points APA format sixth edition: third person, grammar, sentence structure, punctuation, and spelling; sources correctly cited and referenced; title page, headers, and page numbers. No errors to one error.
23–25 points Two to three errors.
21–22 points Four to five errors.
19–20 points Multiple errors
0–18 points /25
Total Points /225

Reference:

Dearholt, S. L., & Dang, D. (2012).Johns Hopkins Nursing Evidence Based Practice: Model and Guidelines (2nd ed.).Indianapolis, IN: Sigma Theta Tau International.

Examine the role that the International Monetary Fund and World Bank play in transfers and the conditions they set to effect this funding.

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Examine the role that the International Monetary Fund and World Bank play in transfers and the conditions they set to effect this funding.

Determine how human capital is used and what effect gender disparity has on these decisions.

· Determine what role health plays in developing economies.

· Examine the role that the International Monetary Fund and World Bank play in transfers and the conditions they set to effect this funding.

· Use technology and information resources to research issues in sociology of developing countries.

· Write clearly and concisely about sociology of developing countries using proper writing mechanics.

Discussion: Family Homeostasis

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ORDER NOW FOR AN ORIGINAL PLAGIARISM-FREE PAPER:  Discussion: Family Homeostasis

Discussion: Family Homeostasis

QUESTION 6: Chapter 6, Individual and Family Homeostasis, Stress, and Adaptation

Mary Turner stepped on a nail 5 days ago and sustained a puncture about 1 inch deep. She immediately cleaned the area with soap and water and hydrogen peroxide, and applied triple antibiotic ointment to the site. Today she comes to the clinic with complaints of increased pain and swelling in her foot. On assessment, the nurse notes that the puncture site is red and edematous, and has a moderate amount of yellowish drainage. (Learning Objective 9)

a. Describe the sequence of events that caused the local inflammation seen in Mary’s foot.

b. What is the role of histamine and kinins in the inflammatory process?

c. Which of the five cardinal signs of inflammation does Mary exhibit?

d. Because Mary’s injury occurred 5 days ago, the nurse should assess for what systemic effects?

QUESTION 7:

Chapter 7, Overview of Transcultural Nursing

The nurse manager of an ambulatory care clinic has noted an increased number of visits by patients from different countries and cultures, including patients from Mexico and other Latin American countries. Concerned about meeting the needs of this culturally diverse population, the nurse manager convenes a staff meeting to discuss this change in patient demographics, and to query the staff about any learning needs they have related to the care of these patients. (Learning Objective 3)

a. What strategy to avoid stereotyping clients from other cultures should the nurse include in this meeting?

b. Identify culturally sensitive issues to be discussed in the staff meeting.

c. One technician on the staff complains that some patients never make eye contact, and this makes it difficult for him to complete his work. How should the nurse respond?

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Frankenstein By Mary Shelley Letters 1-4- Chapters 1-10 Quiz

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1. Read Frankenstein by Mary Shelley  Letters 1-4, Chapters 1-10 

2. Take the quiz In the PDF answer all question in complete sentences and show textual evidence 

“NO PLAGIARISM”

A STUDENT NURSE HAS A 1-DY OBSERVATIONAL EXPERIENCE IN THE CCU. AS PART OF THE PREPARATION FOR THE EXPERIENCE, THE STUDENT NEEDS TO KNOW ABOUT ANTIARRHYTHMIC AGENTS INCLUDING LIDOCAINE, PROPRANOLOL, AND DILTIAZEM. ( LEARNING OBJECTIVES 2,3,4, AND 5 ).

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A STUDENT NURSE HAS A 1-DY OBSERVATIONAL EXPERIENCE IN THE CCU. AS PART OF THE PREPARATION FOR THE EXPERIENCE, THE STUDENT NEEDS TO KNOW ABOUT ANTIARRHYTHMIC AGENTS INCLUDING LIDOCAINE, PROPRANOLOL, AND DILTIAZEM. ( LEARNING OBJECTIVES 2,3,4, AND 5 ).

CASE STUDY #45 A student nurse has a 1-dy observational experience in the CCU. As part of the preparation for the experience, the student needs to know about antiarrhythmic agents including lidocaine, propranolol, and diltiazem. ( learning objectives 2,3,4, and 5 ).

(A). What are the therapeutic actions for lidocaine and propranolol?

(B) What are indications and pharmacokinetics for diltiazem?

(C). What are the lifespan considerations for the older adult for the use of antiarrhythmic agents?

(D). What are the key nursing implementation considerations for patients receiving anti-arrhythmic agents?

CASE STUDY#48. A nursing student is reviewing notes on drugs that affect blood coagulation The drugs that affect blood coagulation involve a complex process that involves vasoconstriction, platelet clumping or aggregation, and a cascade of clotting factors produced in the liver that eventually react to break down fibrogen into insoluble fibrin threads. The nursing student prepares a medication card for anticoagulants and drugs used to control bleeding.( learning objectives 2,4,and 5).

(A). What are the therapeutic actions and most common adverse reactions for aspirin, heparin, and urokinase?

(B). What are the indications and pharmacokinetics for antihemophilic factor and aminocaproic acid?

(C). What are the key nursing implementation considerations for patients receiving antihemophilic agents?

CASE STUDY#51. A nursing student is preparing medication cards on diuretics for a clinical experience on a medical floor. The student has been assigned to two patients; a young adult and an older adult. The student has to do teaching with a client on Furosemide (Lasix). The faculty members has requested that the student nurse do 5- minute preconference presentation on the various types of diuretics.( learning objective 2,3, and 5).

(A). What are the key therapeutic actions, indications, and most common adverse effects of diuretics?

(B). What are the key therapeutic actions and indications for the five types of diuretics?

(C). What are the most important teaching points for a patient receiving furosemide (Lasix)?

(D). What is the use of diuretic agents across the lifespan?

CASE STUDY#57. A nursing student is preparing a presentation for an in – service to the staff nurses on the unit where the clinical rotation is done. The in -service is being presented on medications for gastrointestinal orders, which are among the most common complaints seen in clinical practice. ( learning objectives 1,2,3 and 5).

(A). What are the current theories about the pathophysiologic process responsible for peptic ulcer disease ?

(B). What are the therapeutic actions for drugs used to decrease acid content (H2 receptor antagonists, antacids, proton pump inhibitors, and prostaglandins?)

(C). What does acid rebound occur?

(D). What are the therapeutic actions of sucralfate and misoprostol?

(E). What are the considerations for older adults when using drugs that affect GI secretions?

(F).What are the important teaching points to include for a patient receiving ranitidine?

Example Essay on Transition to Professional Practice

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Teamwork is one of the most important concepts in nursing. The purpose of teamwork is to ensure that clients receive the best possible care. For the new graduate or re-entry nurse there is many aspects to teamwork, these can be both positive and negative. You are required to critically analyse the literature to:

Discuss your responsibility and accountability as a new member of this team

Demonstrate an understanding of the interpersonal relationship skills that new graduates need to be part of this team

Define conflict resolution with specific reference to the new graduate or re-entry nurse

Discuss how new graduates manage conflict resolution situation in the workplace

Discuss conflict resolution principles with regard to bullying and harassment in the workplace

Introduction

Transition from being a student of nursing studying in a university to a new graduate nurse working in a hospital setting will never be an easy toll that every novice RNs (Registered Nurses) must face individually. New RNs will face challenges far more different and complex than those they have tackled inside the classroom and it is important that they are well equipped with the right knowledge once they enter their professional careers in the workplace. Building teamwork amongst each member of the team as well as developing an effective communication and conflict resolution skill will be an essential factor that new nurses should generally work on to ensure that clients get the best care possible.

Discussion

Discuss your responsibility and accountability as a new member of this team

As the newest member, it is my responsibility to fit in and establish a productive and positive working relationship with my colleagues (ANMC 2005, 10.1, p.7). Following the five-phase model based on organizational development and group process theory known as the Team Spirit Model, it is one way of opening up and starting team interaction (Griffiths & Crookes 2005). Introduction of one’s self to the rest of the team as an initial step is important, as well as sharing each others’ point of view and outlook on how they could work harmoniously amongst each other is an essential element of building trust within the team. The second phase is to have a shared vision and mission by being open about the assumptions they have of their own work and of the other members work leading the team to the third phase of the model which is doing the work assigned to each member of the team. The team at this stage usually becomes successful only if they were able to achieve the second phase of the model. The fourth stage is usually overlooked by the team, but celebration of recognition achieved by members and sharing of success stories is important in strengthening closeness among them. The last phase of the model is to ensure that an effective communication is always present between each member, ‘seek first to understand, then to be understood’ is a guiding principle that applies to effective communication (Griffiths & Crookes 2005). As a new graduate nurse, it is my responsibility to work collaboratively with the health care team by becoming an active participant in providing complete and proper nursing care by establishing a positive and productive working relationship with colleagues, and recognizing and understanding the separate interdependent roles and functions of each health care team members (ANMC 2005, 10.1, p.7; Griffiths & Crookes 2005, p.185). RNs should remember that they are accountable for every action and decision they make even if they are already part of the team and it is the RNs utmost responsibility to clarify unclear questions, decisions and directions which they do not understand. RNs should collaboratively work on the nursing care plan in consultation with the interdisciplinary health care team and explain to them the role that nurses play within the team (ANMC 2005, 10-10.1, p.7). According to QNC (2006, p.1), building a collaborative relationship needs a solid foundation and these include clarifying the roles of people with whom we wish to participate in collaboration, developing supportive environments and open communication. A successful patient management within the team will be based on individual accountability and responsibility while working collaboratively with the rest of the members in delivering quality care. It is important that the nurse first establish if they share any responsibility for the care being carried out by others so that they could be properly supervised and ensure that the care provided is within the scope of nursing practice (QNC 2005, p.5).

Demonstrate an understanding of the interpersonal relationship skills that new graduates need to be part of this team

Becoming the newest member of the health care team is not easy. Newly or re-entering RNs may encounter difficulties when it comes to establishing and or understanding interpersonal relationship skills. Interpersonal skills are basically the skills we need to get along with others in which effective communication becomes the foundation of interpersonal relationships (Hauck & Hussey 1997). In order to have a successful interpersonal relationship with other members of the team, the RN needs to improve different sets of skills like developing trust, empathy and respect for the individual/group, effective listening and communication, and by effectively initiating, maintaining and concluding interpersonal interactions (ANMC 2005, 9, p.7). One good example is when a high-risk patient arrives under our management, while working with the team, one should be able to practice and implement an effective therapeutic approach to successfully provide care. Collaborating and effectively communicating on how to organize the nursing care plan is important to facilitate continuity in the provision of a comprehensive nursing care to arrive at the agreed health outcome (ANMC 2005, 10.3, p.8). As the newest member, it is important to gain their confidence and trust by efficiently and competently doing what is assigned to me. If ever guidance is needed on my part, it is my responsibility to request for supervision in order to uphold that everything is for the best interest of the patient and to ensure that standards of practice are always met. New graduate nurses need to understand the importance of building good interpersonal relationship skills for them to jive effectively with their team. One example of good interpersonal skill is when a member of the team like an EN (Enrolled Nurse) came to ask a RN on how elevating the client’s leg, which is full of varicosities, with pillows helps in the minimizing leg congestion. The RN then focuses his attention to the EN to actively listen, and having good interpersonal skills, instead of telling the EN to just read on anatomy and physiology of the human body, the RN would explain that elevating the leg at a level above the heart would facilitate venous return by gravity because patient’s with varicosities have abnormalities in venous valves which causes the blood to backflow resulting in venous congestion and leaking-out of fluids to the surrounding tissues with the affected part appearing edematous, usually noticeable on the most dependent part of the body like of the lower extremities. With good applied interpersonal skills, the RN would definitely gain the trust and confidence of other members which would help build a harmonious relationship and a therapeutic-collaborative approach benefiting the team and most importantly, their patients.

Define conflict resolution with specific reference to the new graduate or re-entry nurse and discuss how new graduates manage conflict resolution situation in the workplace

RNs deal with different types of people, be it another professional health care worker or a client needing care. In reality, RNs are exposed to possible conflict scenarios more than any other health professionals. Conflict is a communication problem between two or more people which tends to ‘arise when there is a perceived difference in opinion or when one party believes that another is preventing them from reaching their goal’ (ADF Mental Health Strategy, nd.). According to Sivamalai (2008, p.9), ‘the failure to manage conflict effectively is one of the most common causes that prevent nurses from developing to their fullest potential. When conflict remains unresolved, trust and commitment do not exist’.

New RNs should follow the basic principles of conflict resolution when dealing with conflicts in the workplace. Having a nurse manager as a mediator would be the best, most direct way of negotiation between conflicting parties (Managing Conflict in the Workplace n.d.). The RN, if acting as the mediator, should initially bring both parties together and then lay down ground rules, e.g. they should not interrupt each other because each party will get a chance to state their opinion. The mediator should identify the problems with each party having the chance to outline the incident/issues from their point of view, prioritizing according to urgency. The RN must then find a way so that both parties would be able to understand each others’ feelings and point of view or to agree or disagree on cases of irresolvable issues. A resolution for each issue should be sought looking for ways to prevent recurrence in the future. The involved parties will be given a written transcript of the meeting and have each one sign a commitment to future awareness of the problem/issues. Review of the situation should take place to determine if the issues were resolved or if there is further need for another mediation procedure (State of Queensland (Integrated Resource Manual) 2007a).

Discuss conflict resolution principles with regard to bullying and harassment in the workplace

Bullying, harassment and discrimination includes a wide range of unwelcomed and unsolicited behaviors that are largely defined by the offended person and can be defined as ‘the repeated less favorable treatment of a person in the workplace which may be considered unreasonable and inappropriate workplace practice’ (ANF 2007; NSW 2005). Workplace harassment does not include any actions coming from the management if it is reasonably done and in scope of the employment practice such as corrective actions done by the management in response to the nurse’s poor working performance, and an isolated incident of an unreasonable behavior can’t be considered as bullying because of being a one-off incident, but typically should not be ignored or tolerated to prevent the situation from escalating (State of Queensland 2008, pp. 2 & 5; State of Queensland (Integrated Resource Manual) 2007b, p.2). Bullying tends to be a continuous behavior pattern aimed at causing someone else harm (CARM n.d.). According to Perry (2004), the prevalence of workplace harassment usually occurs downwards, employees being bullied by more senior staff which is often behind closed doors and tolerated by a culture of silence; laterally, between a nurse and a co-nurse and upwards, a nurse harassing his or her nurse manager. RNs have a role to play in eliminating harassment and bullying in the workplace by refusing to join in with these types of actions and are encouraged to report any incidents of such behavior so that a process of resolution can be made (State of Western Australia 2008, p.2).

According to ANMC (2008a, p.5), dismissiveness, indifference, manipulativeness and bullying are intrinsically disrespectful and ethically unacceptable so that nurses who harass or bully someone would violate provisions of this Code. Employers have the obligation to ensure the health and safety of their employees, therefore, employers obligation extend to minimizing or eliminating exposure to the risk of workplace harassment (Queensland Workplace Health and Safety Act 1995, s.28). As for employed RNs, they should ensure and be responsible enough to comply with the instructions given for workplace health and safety by their employer (Queensland Workplace Health and Safety Act 1995, s.36).

Every RN has the duty and responsibility to report any suspicious act of harassment or bullying, inability to report these health and safety issues would put the RN in violation of the Code of Professional Conduct for Nurses conduct statement 4 which states that ‘nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment and of their colleagues’ (ANMC 2008b, p. 4). The problem is that the victim often lacks the self-confidence to report and file a complaint to appropriate authorities for fear that they may have contributed to the act and fear of being dismissed from work if they lodged a complaint (Kieseker & Marchant 1999). Examples of bullying that could make a RN feel powerless and anxious about coming to work include: verbally abusing and humiliating a nurse by the employer/supervisor/medical officer when others are present, constant ridicule and being put down, spreading malicious gossips/rumors with an intent to cause the person harm and deliberately sabotaging a person’s work like withholding or supplying incorrect information, not passing on messages and getting a person into trouble (State of Queensland 2008). The RN should act early if harassment or bullying is suspected so as not to allow the behavior to escalate. RNs and other health care professionals should not discriminate, harass, bully or mistreat patients, clients, other employees or members of the public by treating all with courtesy, honesty and by respecting the dignity, rights and views of others, including different values, belief, cultures and religions (State of Queensland 2006).

The basic principles of conflict resolution aims to achieve resolution by commitment to an agreed action through a combined effort of problem solving, carefully analyzing the facts, looking at the situation in their perspective, dealing with aggression, emotion and stress appropriately separating them from facts, keeping hold of one’s agenda and focusing on the desired outcomes, learning to disagree as to minimize the risk of escalating the dispute is important, being aware of your actions and what you try to convey to the parties involved, and having someone to mediate between parties is important specially if one of the involved is a superior (ADF Mental Health Strategy, n.d.).

The RN must deal with the incident locally at first using the direct approach, not yet necessary at this stage to put everything in writing, by talking to a supervisor or any relevant authority regarding the issues of harassment that needs to be addressed. If the RNs immediate supervisor has failed to resolve the issue, it could be referred to the more senior manager which could offer the RN mediation, facilitation or other informal process. If all informal ways of handling harassment complaints have failed, the RN could then lodge a written complaint which would then be presented to the people you have complained against to give them a fair chance to respond, and a decision can be made about appropriate ways to resolve the grievance. After all has been done, but still cannot be resolved locally, it would be referred to the Workplace Investigating Unit (WIU) which would initially make an assessment of the complaint and may decide to still try and continue with informal methods or start an investigation. During the workplace visit, review of documentation and survey or interview staff members will be conducted by the inspector who will then identify if there is a risk of injury from workplace harassment through review of controls implemented at the workplace (State of Queensland (Department of Employment and Industrial Relations) 2007). The WIU would be the one to manage the investigative process by appointing an investigator and outlining the terms of reference of the investigation, and following the principles of natural justice, furnishing those involved of the copy of the decision made after due process has been followed (State of Queensland, n.d.).

Conclusion

In summary, it’s not easy for novice RNs to immediately accustom one’s self to a new environment and jive with a new set of heath care professionals. RNs need to develop very good interpersonal skills to be able to work efficiently and it is a must that a healthy professional relationship amongst each member be always present before, during and after each provision of care so that the patient’s best interest would always be upheld. It is the RNs responsibility to see to it that he or she would fit well with the team so that everyone could do their job efficiently. Support mechanisms need to be tailored accordingly to each new graduate nurse in an effort to meet their needs and that hospitals need to develop and implement realistic and practical ways to eradicate bullying in the workplace (Evans, Boxer and Sanber n.d.).

RNs must remember that they have an important role to play in eliminating harassment and bullying in the workplace, this is achieved by not joining and tolerating these kinds of behaviours and supporting the person to say ‘no’ to these behaviours (The University of New Castle Australia 2008). RNs need to be aware of the different guidelines and hospital policies when it comes to bullying and harassment so that incidents such as these would be tackled even before it escalates into a crisis situation. Resolution of conflict requires clear procedures for communication and decision making, commitment to team building, and consideration of factors such as number of team members and their personalities (Griffiths & Crookes 2005).

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