Impact of Asthma and Impact Reduction Strategies in Australia

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Asthma



Introduction:

Asthma is an inflammatory disease of the lung.  Asthma causes are still unknown, but researchers have labelled asthma as genetic (hereditary) and can be caused by environmental factors (Asthmaaustralia.org.au, 2019). The swelling process can happen throughout the whole airway from the nose to the lung. As the airway becomes inflamed, it becomes tighter, therefore allowing less air to pass through to the lung tissue. This can cause the asthma suffers to wheeze, cough and chest tightness, therefore results in struggling to breathe (Asthmaaustralia.org.au, 2019). People who have asthma have very sensitive airways, which can lead to the airways in the lungs to react and the patient could have an asthma attack (also known as a ‘flare up’) (Asthmaaustralia.org.au, 2019). These symptoms can provoke an asthma attack. When experiencing an asthma attack, the muscles in and around the airway found in the lungs start to tighten up and the symptoms begin to worsen.  According to (Asthmaaustralia.org.au, 2019) “Asthma cannot be cured, but it can be controlled using the right medication provided from a doctor.” Since 11% of Australian has the inflammatory disease known as asthma (2.5 million people), this case study will examine the problems of asthma in Australia and effectively recommend how to reduce its impact on Australia’s population.


Background:

Asthma is a serious problem in Australia, in fact it’s the most common chronic disease in children (WHO Asthma, 2019). The most recent data (Asthma snapshot, 2019) suggests that 1 in 9 people in Australia have reported having asthma in 2015, with 1 in 5 people over the age of 15 having an action plan to control their asthma. There is an awareness week about asthma called ‘Asthma week’. Asthma week is held from the first to the seventh of September spreading awareness of the dangers to help people control the condition (Asthma Week, 2018). The week also discusses hospitalisation as “South Australian children have the highest hospitalisation rate in Australia with a total of 361 children per 100,000 population admitted to hospital in SA, which is much higher than the Australian average (309)” (Asthma in SA, 2019).

Asthma reportedly is valued at $1.2 billion a year in healthcare costs which can lead to up to $28 billion a year in total ($11,740 per person) (Asthma statistics, 2019).

Asthma in Australia has been a detrimental health issue over the last 35 years, there has also been six large reoccurring thunderstorm asthma events, which have happened in November (this coincide with the peak grass pollen season) (Thunderstorm asthma, 2017). Thunderstorm asthma occurs when there are high amounts of pollen in the air (Spring/Summer), the main problem with thunderstorm asthma, is that it can affect anyone (even if you haven’t experienced asthma like symptoms in the past). During the thunderstorm outbreak in Melbourne (2016), there were cases of 9-10 people who died and more than 8,500 people in hospitals and medical centres who needed desperate help (Thunderstorm asthma victim, 2019).

Asthma severity can vary from mild to irregular intervals, which can cause problems for the individual. These problems can range from minimal to persistent wheezing and shortness of breath. The disease can have a severe impact on the way people view their lifestyle (people have said the asthma has caused an impact on their quality of life). This disease can also be life threatening for those who depend on medication (Thunderstorm asthma, 2017). When the thunderstorm occurred, it could take just 15 to 30 minutes to send someone in need from wheezing to respiratory failure (Davey, 2019). Mick Stephenson who is an emergency operation general manager for the Victorian ambulance department stated, “In the 15 minutes from 7:00pm when we would expect about 30 triple-0 calls for ambulance there were 200 calls — that’s a call every 4.5 seconds” (Thunderstorm asthma emergency, 2019) Mr Stephenson said that this event was extraordinary and unpredictable. According to the (Asthma snapshot, 2019) Hospitalisations can increase during the later stages of winter and heavily increase during the months in spring and summer. Therefore, there needs to be an action where people who struggle with hay fever need to complete asthma tests from a doctor. This allows for an action plan to be in place, so people who have a high risk of having an asthma attack in these events are prepared.

According to (Asthmaasutralia.org.au, 2019) thunderstorm asthma is so deadly due to the grass pollen grains that get swept up into the clouds as the thunderstorm is forming. As moisture is absorbed into the clouds, a substantial quantity of small particles of allergen are set free from the clouds (a pollen grain is able to breaker up into 700 smaller particles). These allergen particles are released down by the strong winds of the storm to ‘ground level’, which can be breathed deeply into the lung (as these particles are so small), causing asthma triggers (Thunderstorm asthma, 2017). In some people who have allergy issues, this will cause the lungs to become inflamed/aggravated. Irritation can cause swelling, which leads to the small airways in the lung narrowing and extra mucus builds up. This makes it difficult to breathe and can cause the person with the condition to have triggers such as wheezing, chest tightness and coughing (Thunderstorm asthma, 2017). These asthma symptoms may become severe very quickly, this can be dangerous so there needs to be awareness about this epidemic.


Detriments (Social, Behavioural and Biomedical):


Social:


The social determinants of health can be defined as “the conditions in which people are born, grow, live, work and age”. (Social Determinants of Health, 2008). The rates of genetically gaining asthma is affected by where the child lives, as well as their parents. Asthma severity can be determined by where you live, for example asthma can vary by remoteness and socioeconomic areas. Men aren’t affected by this factor according to (Asthma snapshot, 2019). During 2014-15 (Asthma snapshot, 2019) discovered the frequency of asthma was significantly higher for women in remote regions (15%) than urban areas (11%). The frequency of the inflammatory disease for Indigenous Australian’s were almost double compared to the rest of Australia (Asthma snapshot, 2019). A study was conducted in 2012-13 where (Asthma snapshot, 2019) found that, 18% of Indigenous Australian’s suffered with the inflammatory disease, also women had a rate of 20% which is differentiated by the males of 15%.

According to (Asthma snapshot, 2019) people who suffered with asthma stated that they viewed their lifestyle as poor. Asthma affects a person’s wellbeing and can impact their mental health; this can be due to their asthma being controlled poorly. (Asthma snapshot, 2019) discovered that in 2014-15 people with the disease were prone to report their health as poor or fair, rather than excellent. Asthma causes a ‘poorer quality of life’ if not controlled well due to needing a medication to relive themselves struggling to breathe. In 2012, asthma was not controlled well by adolescents In Australia; in fact, 2,868 teenagers controlled their condition poorly. It is stated that more than 50% of the teenagers were prescribed to use some sort of reliever (Asthma snapshot, 2019).



Behavioural:

The main behavioural risk for obtaining the condition of asthma leads to current or past lifestyle choices. These risk factors can increase the development of the chance of getting the condition or develop more health problems later on in their lifetime. The risk of strengthen the rate of getting asthma can be due to smoking. The (Risk factors Asthma, 2019) discovered that the victims of this disease were found to have smoked in their past life, 35.8% of ex-smokers had contracted asthma in comparison to 30.8% who had never smoked (these results were gained from people who were 18 and above). (Risk factors Asthma, 2019) also found that “parental smoking during pregnancy or infancy is linked to asthma symptoms in children, and smoking by a parent or child/adolescent is linked to asthma symptoms in adolescence”.


Biomedical:

Additional risks for asthma can include inactivity and weight. The National Health Survey (NHS), found that in 2014-15 people with asthma tend to have limited amounts of exercise and/or overweight, compared to people without the condition (Risk factors Asthma, 2019). Inactivity is also an important factor with health outcomes. Asthma links with obesity, people with asthma are 35.6% more likely to become obese (Risk factors associated with asthma – Australian Institute of Health and Welfare, 2019). Studies have found that exercise can decrease chronic respiratory diseases (Risk factors Asthma, 2019). The NHS found in 2014-15, 61.7% people who reported being physical inactive compared to 53.6% without. It was found that 38.3% of those adults were sufficiently active (Risk factors Asthma, 2019).



Goal:


Due to the high rate of Australians aged over 16 years who do not follow an asthma action plan to control their condition, it is vital for more awareness to be spread to reduce this rate. The recommended goal for an asthma program should be to increase the knowledge around thunderstorm asthma and to decrease the percentage of people who do not follow a management plan. Asthma is the largest chronic disease taking up to 10.8% of the population who have this disease. This goal would help people with high allergy issues to be aware of the dangers in the spring to summer season when there is a risk of thunderstorm asthma. The goal would also be extremely effective as this will help people gain an understanding of how dangerous asthma can be. This goal will link with the ideas of asthma week, this is helpful but not discussed enough. If asthma was talked about in schools (due to asthma being common in children and adolescences) children would be more aware and put an action in place for an extended interval of time, to avoid the dangers of asthma.


Conclusion:


Asthma is a major problem is Australia and especially South Australia, due to its extremely high hospitalisation rate in the state. Asthma can be prevented if the child or adult follows their action management plan to keep their triggers under control. It is evident that humankind who reside in rural regions of Australia are more likely to contract the inflammatory disease, due to their exposer of environmental factors. Therefore, asthma management plans should be in place for everyone who has the condition therefore decreasing the high rate of asthma, leading to an improvement in chronic health in Australia.


Bibliography:


Effect of Stigma on Chronically Ill Individuals

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Stigma is “a mark of disgrace associated with a particular circumstance, quality, or person” (Oxford Living Dictionaries). Stigma is most often a negative stereotype that causes individuals to feel isolated for having a certain attribute. In particular, the stigma projected onto those with chronic illnesses has created a world in which medical, industrial, commercial, and social stigmas feed off each other. Those living with chronic illnesses face an increased amount of discrimination due to a lack of knowledge and misunderstanding about their conditions. The general population’s treatment of “disabled” individuals stemming from discrimination affects patients’ rate of recovery. These stigmatizations have led chronically ill individuals to deal with exclusion from activities they are fully capable of doing and isolation from the world around them.

The stigma associated with chronic illnesses corresponds to a lower quality of life for people living with these conditions due to a lack of social support, an increase in self-stigma, and problems within the healthcare system.

The stigma associated with chronic illnesses has resulted in a lack of social support from society. Society’s lack of social support forms from an unacceptance and fear of being around an individual who is ill. For a majority of the population this fear is, “a natural tendency to pull away from people who are sick, whether [they] do so consciously or subconsciously” because people do not want to become sick (Pg.266 s1). Although patients suffering from chronic illnesses are typically not contagious; the general population’s innate fear of sickness leads to social exclusion for these patients. Not only do people have a fear of sickness, people have a fear of the unknown. Without an explanation for the cause of an illness or disease it becomes easier to just stay away from those living with these conditions. Since, “many chronic illnesses are “invisible”, and often misunderstood, people often make assumptions that are hurtful” (S2). The societal views of chronic illnesses and negative assumptions begin to directly impact the way friends and coworkers interact with these patients. A lot of friends and coworkers will treat patients completely different after finding out they have a chronic illness. People close to these individuals make choices to exclude individuals from social events assuming they are unable to participate or go-out and do certain things. Patients in return choose to take a step back from their social life. It is unfortunate how an, “Illness temporarily disrupts the social support network of the patient and family.”, because these are the times people need support the most (pg.63 s6). Oftentimes patients experience a lack of support in time within their household. Despite the initial response some loved ones began to get upset and angry since they cannot do anything to cure or fix someone they care about. Due to the stigmatization society places on chronically ill patients’, “Family members are also harmed by stigma and may be blamed for causing or contributing to the illness” (pg. 10 s11). When family members begin to feel overworked and judged by society, they then put the blame on the patient. Without support and acceptance from society, friends, and family a sense of self-blame is consistently being reinforced. This debasing environment chronically ill individuals live in begins to greatly impact their quality of life.

Society’s stigmatization and negative stereotyping towards chronically ill individuals leads to an increase in self-stigma. The negative stereotypes that these individuals are weak, lazy, or melodramatic has created a world in which discriminatory actions have become the norm. With this discrimination, patients face discreditation daily and treated as if they are not “normal”. For many patients they begin to, “agree with and internalize social stereotypes” as a coping mechanism (S2). Patients dwell on what they used to be able to do when they were able to prior to the diagnosis of a chronic illness; instead, patients should be focusing on getting better. Many individuals start believing that they are not contributing to society and that they are abnormal or overly sensitive. It is common for chronically ill patients Overtime this feeling of worthlessness and shame has been correlated with patients experiencing psychological distress. Some patients, “irrationally conclude that they have brought the disease upon themselves by being faulty or wicked in some way” (pg.14 s6). This mindset patients go into can lead to social isolation and further social exclusion. As the internalized stigma grows it becomes an even bigger concern when society’s negativity affects people’s recovery rate. Eventually, “the effects of stigma and its resultant social withdrawal may have a greater impact on an individual than the illness” itself (pg.10 s11). Therefore, in order to reduce their experience with stigmatization patients will do everything they can to blend in with society. While out with friends, individuals decide to hide their illness and pretend they are self-sufficient. Many chronically ill individuals will even refrain from telling their family and significant others about their illness. It has become easier for these individuals to create a barrier around themselves than to deal with the world’s social exclusion.

Through this barrier chronically ill individuals place around themselves, their reluctancy to accessing health care and receiving proper treatment leads to a decreased quality of life. During their time of living with a chronic illness, most patients have experienced social stigma whether it was from others’ labeling, discrimination, or stereotyping. After experiencing stigma within their work, friend, and family environments individuals assume society will always discredit their illnesses. Specifically, patients, “who perceive that they have experienced stigma in healthcare settings may be less likely to access care because they do not want to face additional negative treatment” (s3). This anticipated stigma of prejudicial treatment within the healthcare system is a huge contributor to why patients who need serious medical intervention still refrain from getting treatment. The more often medical staff stigmatizes patients the less likely they are to disclose all their symptoms or concerns related to their chronic illness. Although even when patients share their diagnosis and concerns, healthcare providers lack of knowledge and understanding about many chronic illnesses can cause patients to receive improper treatment. The minimal amount of research regarding these illnesses restricts the relativity and amount of information accessible to medical staff. In turn, “stigma can negatively affect medical decision making, and the provision supportive care can become significant source of stress and can increase suffering” (pg.3 s10). for chronically ill individuals. Healthcare providers will usually not take the time to search for answers because of their disbelief of patient’s illnesses. Doctors sometimes make patients internalized and anticipated stigma worse through there dismissive and skeptical attitudes. Rather than medical professionals encouraging patients to access healthcare, patients report, “receiving poor care, being denied care, and being blamed for their illness” (s3). In addition to medical professionals denying patients care, the insurance companies show even more discrimination. The cost of treatment or even medical testing without insurance is too much for most individuals. Patients who look for insurance have, “difficulty finding medical insurance that will cover someone with an established medical diagnosis” (S4). Insurance companies typically believe chronically ill individuals are over-treated, overly medicated, and require too much care. Patients encounter countless issues in the healthcare system especially with insurance companies and doctors which only further renders patients’ chances of improving.

The prolonged lack of social support, self-stigmatization, and problems within the healthcare system due to the stigma associated with chronic illnesses corresponds to a lower quality of life for these individuals. With chronic illnesses accounting for some of the most manageable health conditions, they also have the highest mortality rate in the U.S. Managing these chronic illnesses requires assistance from society and medical professionals. However, the misunderstanding and lack of knowledge about chronic illnesses has resulted in stigma negatively affecting the recovery rate for individuals. Within these individual’s personal life’s, they face social exclusion since they are viewed as “weak” and “melodramatic”. Society’s reinforcement of stigmatization leads individuals to believe the negative stereotypes society has given them. As chronically ill individuals internalize and apply these stigmas to themselves, they choose to isolate themselves from society. This isolation causes individuals to rarely access healthcare for treatment. The healthcare system only further attributes to these individuals’ self-stigma and social isolation by denying them care and blaming them for becoming ill. Chronically ill individuals are usually then left to manage their illnesses alone because of the way society treats them.

Digital Notecards

Source 1:

Beckjord, Ellen B., et al. “Cancer Stigma and Silence Around the World: Final Report

”.

Edited by Duchover, Yvonne,

Live Strong Cancer Institutes

, 2015, www.livestrong.org/sites/default/files/what-we-do/reports/LSGlobalResearchReport.pdf Accessed 10 Nov., 2018.

Notes:

“For the study, LIVESTRONG collected multiple sources of data—including an analysis of media coverage, public opinion surveys, and semi-structured interviews—from countries around the world to better understand how cancer is portrayed and perceived”. pg.1

“Communication is critical to decreasing cancer-related stigma, raising cancer awareness, and disseminating cancer education”. pg. 1

“there is a strong stigma associated with cancer or if people do not know what healthy behaviors to adopt, they may not engage in practices that reduce their cancer risk. Individuals may delay identification of the disease if fear of stigma creates a barrier to getting cancer-related symptoms checked by a doctor”. pg.3

“at population level, governments and health systems are less likely to devote resources to reduce their cancer burden if individuals affected by the disease are reluctant to express their needs and concerns or to advocate for themselves or others”. pg.3

“the world, cancer continues to carry a significant amount of stigma; however, there are opportunities to capitalize upon shifting perceptions and positive change”. Pg.1

“This perception often leads to discrimination against the stigmatized person, which in turn results in a loss of status, rejection, or isolation (Ling & Phelan, 2006)”. pg.3

“stigma can negatively affect medical decision making, and the provision supportive care can become significant source of stress and can increase suffering”. pg.3

“Despite these favorable perceptions, evidence shows that cancer-related stigmas exist and more awareness and education are needed”. pg.4

“Stigma also may stem from inaccurate perceptions of or myths about cancer”. pg.6

Source 2:

LeMaistre, JoAnn. After the Diagnosis : From Crisis to Personal Renewal for Patients with Chronic Illness. Berkeley, CA, Ulysses Press, 1995. Print.

Notes:

This book discusses how being diagnosed with a chronic illness can make an individual feel completely alone and overwhelmed. It explains how to handle those feelings through six stages and eventually learn to live life in a stage of “renewal”. The book sends a message to those dealing with chronic illnesses as well as their family, friends, and doctors.

“A gloomy perspective of resignation, self-denial, and helplessness, sometimes unwittingly fostered by our cultural beliefs”. pg.5 …emotional impact it has on patient

“This attitude of blame accounts for some of the worst psychological abuse of patients by their health practitioners and caretakers”. pg.5

“There is no more effective way to isolate yourself than to continually appear self-sufficient, denying any need for help or comfort from others”. pg.6

“If you are willing to ask for help and you have a wide support network, you’ll have an easier time than if you’re isolated”. pg.8

“Get tired and burned out when it becomes clear that “get well soon” has no relevance to chronic illness”. pg.11

“Many people irrationally conclude that they have brought the disease upon themselves by being faulty or wicked in some way”. pg.14

“Often families are unable to help because they themselves are angry at the patient”. pg.14

“Illness temporarily disrupts the social support network of the patient and family”. pg.63

“The critical issue is that there be a good match between physical ability and expectations of activity”. pg.434

“She was deeply hurt by friends who could not make time for her in their lives-not even for a phone call”. pg.63

“New understanding brings new resilience; it does not make the losses go away”. pg.17

Source 3:

Earnshaw, Valerie A., and Diane M. Quinn. “The Impact of Stigma in Healthcare on People Living with Chronic Illnesses”.

Journal of Health Psychology

, vol. 17, no. 2, 2011, pp. 157–168.

Sage Publications

, doi:10.1177/1359105311414952. Accessed 8 Nov., 2018.

Notes:

“particularly harmful within healthcare settings to the extent that they act as barriers to the regular healthcare access that can be critical to controlling chronic illness symptoms”. pg.157

“People living with chronic illnesses report feeling shame, guilt, and diminished self-worth (Person et al., 2009); embarrassed and odd (Kilinc and Campbell, 2009); responsibility for their illness (Mak et al., 2007); and even dirty and diseased (Conrad et al., 2006)”. pg.158

“Previous research with a variety of concealable stigmatized identities, including illnesses, has found that greater anticipated stigma is related to increased psychological distress (Quinn and Chaudoir, 2009).” pg.158

“stigma impacted more than the physical health of people living with chronic illnesses – it impacted upon their overall sense of satisfaction with life”. pg.164

“harmful effect of stigma in healthcare settings on the quality of life of people living with chronic illnesses”. pg.166

“Participants who anticipated greater stigma from healthcare workers, in turn, accessed healthcare less and experienced a decreased quality of life”. pg. 157

“Internalized, experienced, and anticipated stigma within healthcare settings likely act as barriers to care access” pg.159

“This decreased healthcare access may, in turn, undermine the overall well-being of people living with chronic illnesses”. pg. 157

Source 4:

Cashel, Allie.

Suffering the Silence: Chronic Lyme Disease in an Age of Denial.

North Atlantic Books, 2015.

Pinellas Public Library Cooperative.

Notes:

“Viewed Objectively, it’s a natural tendency to pull away from people who are sick, whether we do so consciously or subconsciously”. Pg.266

“Reason for that omission concerned the fact that, out in the “real” world, we didn’t want people to know we had Lyme disease, in case we’d be shunned by society or even dropped from our insurance” pg.266

“Societal opinions about Lyme negatively affect patient experiences every day, with industrial, medical, commercial, and social perceptions of illness constantly feeding off of each other”. pg.267

“Sontag’s theories on the societal views of illness also contributed to my confusion, to my lack of feeling integrated”. pg.289

Source 5:

“What Is Stigma?”

STIGMA Standing Together Against Fear, Blame and Shame

, International Conference on Stigma, 2018,

www.whocanyoutell.org/what-is-stigma/

. Accessed 10 Nov., 2018.

Notes:


“

Stigma is a degrading and debasing attitude of the society that discredits a person or a group because of an attribute”.

“Stigma destroys a person’s dignity; marginalizes affected individuals; violates basic human rights; markedly diminishes the chances of a stigmatized person of achieving full potential; and seriously hampers pursuit of happiness and contentment”.

“When stigma is associated with a medical condition or disability it prevents individuals from seeking evaluation and treatment, disclosing the diagnosis to the people most likely to provide support and in following treatment guidelines”.

“Stigma prevents individuals from getting tested for HIV, seeking medical care, disclosing diagnosis and in adhering to treatment and follow up. Fear of social abandonment and losing intimate partners prevents many with HIV from sharing the diagnosis with their loved ones and sexual partners”.

Bibliographies

  • Beckjord, Ellen B., et al. “Cancer Stigma and Silence Around the World: Final Report.” Edited by Duchover, Yvonne, Live Strong Cancer Institutes, 2015, www.livestrong.org/sites/default/files/what-we-do/reports/LSGlobalResearchReport.pdf Accessed 10 Nov., 2018.
  • Borchard, Therese J. Beyond Blue : Surviving Depression & Anxiety and Making the Most of Bad Genes. New York, Center Street, 2010. Print.
  • Cashel, Allie. Suffering the Silence: Chronic Lyme Disease in an Age of Denial. North Atlantic Books, 2015. Pinellas Public Library Cooperative.
  • CDC. “Mental Health and Chronic Disease Fact Sheet.”

    Preventing Chronic Disease,

    vol. 10, no. 2, October 2012,

    www.cdc.gov/workplacehealthpromotion/tools-resources/pdfs/issue-brief-no-2-mental-health-and-chronic-disease.pdf

    . Accessed 10 Nov., 2018.
  • Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. Prev Chronic Dis [serial online] 2005; 2(1).

    http://www.cdc.gov/pcd/issues/2005/jan/04_0066.htm

    . Accessed 29 Nov., 2018.
  • Earnshaw, Valerie A., and Diane M. Quinn. “The Impact of Stigma in Healthcare on People Living with Chronic Illnesses.”

    Journal of Health Psychology

    , vol. 17, no. 2, 2011, pp. 157–168.

    Sage Publications

    , doi:10.1177/1359105311414952. Accessed 8 Nov., 2018.
  • Edwards, Laurie. In the Kingdom of the Sick: A Social History of Chronic Illness in America. New York, Walker & Co, 2013. Print.
  • Esposito, Jennifer, and Eve Adamson. Jennifer’s Way: My Journey with Celiac Disease — what doctors don’t tell you and how you can learn to live again. Boston, Da Capo Press, 2014. Print.
  • Good Days. “Living with the Stigma of Chronic Disease.” Effective Compassion, 10 June 2014, www.mygooddays.org/blog/living-with-the-stigma-of-chronic-disease. Accessed 10 Nov. 2018.
  • LeMaistre, JoAnn. After the Diagnosis : From Crisis to Personal Renewal for Patients with Chronic Illness. Berkeley, CA, Ulysses Press, 1995. Print.
  • Saliba, Therese. “Stigma in Healthcare Source & Effects.”, Mental Health Care Services, 2017. deputyprimeminister.gov.mt/en/phc/Documents/stigma_in_health_care.pdf. Accessed 10 Nov., 2018.
  • “Stigma .” English Oxford Living Dictionaries, Oxford University Press, 2018, en.oxforddictionaries.com/definition/stigma. Accessed 10 Nov., 2018.
  • Vickers, Sue. “The Stigma of Chronic Illness.”

    Fibrodaze,

    30 March 2015. www.fibrodaze.com/stigma-chronic-illness/. Accessed 5 Nov., 2018.
  • “What Is Stigma?” STIGMA Standing Together Against Fear, Blame and Shame, International Conference on Stigma, 2018,

    www.whocanyoutell.org/what-is-stigma/

    . Accessed 10 Nov., 2018.

What are some of the questions you would ask each representative about his or her company’s specific plan that will help you make a decision?

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What are some of the questions you would ask each representative about his or her company’s specific plan that will help you make a decision?

Paper , Order, or Assignment Requirements

To support your work, use your course and text readings and also use outside sources. As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Complete your participation for this assignment by Wednesday, June 22, 2016.
MCOs
You are a new physician setting up your own practice in a new town. You are researching the different MCOs offered in your area and are considering becoming a physician for one of these networks. You have also invited the sales representatives of several health plans to speak with you about the benefits of choosing their plans.
Based on the above scenario, answer the following questions:
• What effects would joining a MCO have on your clinic regarding staffing, patient volume, and financial stability?
• What policies and procedures should be used by the MCOs to reduce costs for their clientele?
• Discuss the ethical issues or concerns about MCOs providing a lower quality of care compared to traditional fee-for-service (FFS) organizations?
• What are some of the questions you would ask each representative about his or her company’s specific plan that will help you make a decision?
• Do you believe that the evolution of MCOs and consumer driven health plans (CDHPs) has affected the healthcare environment today by integrating the financing and delivery of healthcare services? If yes, how?
• How have the roles and relationships between physicians and patients changed by each of these types of plans?

Although medical technology brings numerous benefits, what have been some of the main challenges posed by the growing use of medical technology in the United States?

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Although medical technology brings numerous benefits, what have been some of the main challenges posed by the growing use of medical technology in the United States?

Prompt: Although medical technology brings numerous benefits, what have been some of the main challenges posed by the growing use of medical technology in the United States? Next, how do American cultural beliefs and values influence the use of medical te
create a thread in response to the provided prompt for each forum. Each thread must be at least 600 words and demonstrate course-related knowledge. In addition to the thread. Each thread must include at least 2 peer-reviewed source citations, must ne in current APA format. Each thread will also require integration of at least 1 biblical principle.

Economic theories and models in health care | NUR 621

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1. Economic Theories and Models in Health Care

Complete the “NUR-621 Economic Theories and Models in Health Care” worksheet. This assignment explores the efficiency and components of current health care models.

Your responses should be based on evidence. Include references to your textbook and one scholarly article.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

2. Health Care Reimbursement Training Plan

Scenario: You are an administrator at a health care facility providing a training session for new employees.

Create a training plan using the “NUR-621 Health Care Reimbursement Training Plan” template provided that describes how Medicare, Medicaid, and private insurance reimburse health care organizations for their services.

Include two to three references, including your textbook.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Peaceful End of Life Theory

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Peaceful End of Life Theory

: Peaceful End of Life Theory Peaceful end of life theory was developed by nursing theorists Moore Shirley and Cornelia Ruland. They argued that, though death is inevitable, human kind should try to ease the pain that is associated with death of the loved one by approaching a method that will help to ease the pain and fear associated with death among family, patient and nurse during the dying process of the patient. They advocated for peaceful transition of human kind. The theory was developed to assert that nurses, patient, family members are integral to the conception of peaceful end of life. The theory advocated for emotional support, freedom from suffering, and treating with respect and empathy among patients with terminal illness. This theory was developed based on standard care which was created by some expert nurses with an aim of managing substantive care among the patient with terminal illness. For many decades this theory plays a significant role in promoting progressive outcomes during the dying process between the patients and their familiesCITATION Jul10 l 1033 (George, 2010).

Public Health Core Functions Health And Social Care Essay

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In 1988, the Institute of Medicine made a report (IOM, 1988) on “The Future of Public Health” which basically changed the way public health was planned in the USA. The committee that was set up recommended in that report that health agencies for the state levels should intensify their managerial capabilities in three essential functional areas which are assessment, policy development and assurance. The rise in attention to managerial competence has gone with the rise in interest in tracking, quantifying and improving the assessment of health impact of government agencies in the USA, (Wang, 2002) in other countries that are developed (Kemm, 2000) and all over the world (Sim, and Mackie, 2003). In the United States of America, the effort got to a serious level when the “Healthy people 2000” was published and is growing continuously. Considerable progress has been achieved in relating specific goals for the improvement of the health of the population like the rate of screening cancer and immunization to specific managerial activities like the development of human resources through programs like the Turning Point Performance Management Collaborative (Public Health Foundation, 2002). On the other hand, these programs don’t deal with some holistic questions on public health (Kemm, 2000) like is it obligatory to be competent in all three functions, or is being proficient in one or two enough to attain improvement in health status that is above-average?

The Institute of Medicine conducts two national programs for children. This is geared towards the improvement of the building blocks of the children. The programs are School Breakfast Program (SBP) and the National School Lunch Program (NSLP). These programs play important parts in assisting the health and nutrition of school students in the United States by offering low-cost or free lunches that are balanced nutritionally each school day. In 2008, the School Breakfast Program (SBP) gave breakfast to 10.5 million children while over 30.5 million children received lunch from the National School Lunch Program (NSLP). At present, to get compensation from federal, school meals must meet the 1995 established regulations for standards of nutrition and requirements for meal. In the years, developments have been made in dietary guidance since those guidelines were set up.

The way in which requirements for meal are monitored and implemented will ascertain whether students take part in SBP and NSLP and eat the food that is given to them. Vital strategies of implementation to promote modification and increase the participation of student in the program include involving the school as an entity, involving parents, students, and the public; educating the students on nutrition; and providing practical assistance. The involvement of industry will be relevant to the process of implementation which includes introducing attractive foods that are low in saturated fat and sodium and those that have a higher ratio of whole grain to refined grain. Additionally, current methods for monitoring will guide the efforts of implementation. The support recommended from the services of food and nutrition include;

Practical support for continuously developing and improving menus, placing orders for suitable foods and controlling the cost of these foods while upholding their quality.

New methods for supervising the quality of meals in the school that lay emphasis on meeting important regulations for diet.

Activities of public health have considerably improved the quality and length of life all over the world (Centre for Disease Control and Prevention, 1999). In certain, the decreased incidence and occurrence of infectious disease has been a major achievement of public health. On the other hand, the progress of the future will be more problematic to achieve and assessing the public agencies’ health impact will be more difficult. As stated by Jocelyn Elders, the former surgeon General of the United States, ‘public health is poorly understood-perhaps because when it is effective, nothing happens'(Elders, 1995). As there are a variation in the interventions and health impacts, the ability to identify the activities of a health agency that is directly contributing its quota to the progress is hard to ascertain and is always dependent on debate (Coyne and Hilsenrath, 2002). A set of three important functions as stated above has been developed by the Federal Government’s Institute of Medicine in the USA.

Not many studies have made attempt to measure the condition of public health practice in the USA as it is linked to the recommendation of the Institute of Medicine (IOM, 1988) regarding all three important functions. Out of eight studies that were initially conducted, four laid emphasis on department of local health (Handler and Turnock, 1996; Scutchfield et al., 1997) and the other four took an approach on state level (Halverson et al., 1996). Scott et al., 1990 were the first team to carry out a complete census based on the important functions of public health indicated by the Institute of Medicine. Seven years later, Scutchfield et al., (1997) repeated the survey done by Scott et al., (1990) and found that the number of agencies involved in assurance and assessment activities was in general, unchanged. On the other hand, the percentage of health agencies in the state level that are enthusiastically involved in policy development dropped from 72% to 49% within the same period. For policy development as it relates to particular issues, such as genetics and the prevention of disease (Piper et al., 2001), states displayed even decreased levels of activity. This means that in just about half of the states, the functions of a formal policy development were absent even on the basis of self-report. In the research on management, approaches bases on configuration are used to look at the relationship between performance, structure of the organization and decision making, and the strategic planning capabilities of organizations. Additionally, a positive connection between financial performance and systems configuration of strategic planning has been confirmed to exist objectively (Veliyath and Shortell, 1993). On the other hand, no researches to date have made attempt to distinguish configurations on non-monetary measures of success such as the outcomes of healthcare.

The extremely essential feature of any configuration is defining the planned purpose of the organizations that are analyzed. From the perspective of public health, it is essential to assess the effects of the important functions on the measures of population health status. Consequently, analytically linking the planning models of agency to the assessment of public health impact is a natural addition of the methodology of configuration.

The department of health and human services in the US has recognized 10 leading health pointers and suggested that they should be used as measures of outcome because they “help everyone understand the importance of health promotion and disease prevention… developing strategies and action plans to address one or more of these indicators can have a profound effect on increasing the quality of life and eliminating health disparities” (US Department of Health and Human Services, 2000). The principal health indicators are

Physical activity

Obesity

Use of tobacco

Abuse of substance

Sexual behavior

Mental health

Violence and injury

Quality of the environment

Immunization and

Access to health care

Other researchers and organizations (Sutocky et al., 2000) have set up a directory of the health status of community using similar measures for example, since 1989, the group called the UnitedHealth has formed yearly reports that ranks the general state of health in all 50 states. The report gives a detailed view of the health trends of the population across the US. The marks are made to pull attention to vital measures that affects the health of the public. Additionally, arranging the items into a single variable permits an all inclusive comparison of general health progress with the important functions. Consequently, pinpointing relationships between the configuration of important functions and the improvement of the health of the population is a relevant addition to both research in public health and management.

Background

In recent years the use of Health Impact Assessment has been on the rise in the USA, energized by an increasing awareness among professionals of transportation, public health and planning that transportation planning and land use can have a considerable impact on the health of the public. Health Impact Assessment is an instrument to help decision makers and other planners better identify the health outcome of the decisions they make. Health Impact Assessment is described as “a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population” (European Centre for Health Policy, 1999). HIA have been broadly used in Europe and other places (Kemm, 2004), and procedures are the same in the United States and Europe. Furthermore, local examples are needed to increase the suitability of politics, to increase consciousness of their use round the country, to serve as examples for further Health Impact Assessment, to be used as models in United States based training course for Health Impact Assessment and to keep record that Health Impact Assessment applies in the settings of the U.S.

Lesser resources may be needed to organize new HIAs if researchers can pull the reviews of literature and methods from related Health Impact Assessments formally done in the United States, taking note of the variations in domestic environment and specifications of project and policy. For instance, the analysis of health impact based on U.S. of additional income from a living salary order (Bhatia and Katz, 2001; Cole et al., 2005) may be important as part of the effect of health analysis that is attributed to employment created by a new business development in the United States’ data on network between income and health from Europe will be not so applicable for such an analysis because of clashing economic, social and political conditions.

An expert team in 2004 critically looked into the possibility for increased use of HIAs in the United States and made suggestions on the next steps that could improve the use of HIAs (Dannenberg, 2006). These steps includes carrying out experimental HIA projects, creating a database of Health Impact Assessment completed, beefing up the capacity to train people to carry out HIAs, developing motivation to increase the demands for Health Impact Assessments by those who make decisions and developing practical methods for predictions (Dannenberg, 2006)

Obesity Epidemics Related to Racial/Ethnic Differences

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Obesity Epidemics Related to Racial/Ethnic Differences



Kheesha Abreu

Obesity is becoming a serious health issue in the United States. Overweight is defined as having a body mass index between 25 and 29.9; obesity is defined as having a body mass index of 30 or more. The number of overweight and obese people is increasing every year. Statistics show “that the number of overweight and obese individuals globally has increased from 857 million in 1980 to 2.1 billion in 2013”. If this obesity epidemic continues to rise then current and future generations will have a shorter life expectancy. The current number of deaths associated with obesity in the United States alone is between 112,000 and 300,000. Obesity is now considered as one of the most crucial health problems in the United States. Obesity rates differ between racial and ethnic minority groups and are influenced by environmental factors.

For the most part, non-Hispanic Blacks reside in the South more than any other race and it has been shown that the South states have the largest occurrence of obesity, followed by the Midwest, then the West, and lastly the Northeast. New Hampshire is the lowest obesity ranking state for non-Hispanic Blacks but five other U.S. states had a population of forty percent or more obese individuals: Alabama, Maine, Mississippi, Ohio, and Oregon. A study revealed that in 2011, non-Hispanic Black women were eighty percent more probable to be obese than non-Hispanic White women. Also, in 2010, non-Hispanic Black adults were seventy percent less likely to engage in physical activity compared to non-Hispanic White adults. The stereotype is that in the South you eat a lot of fried chicken, mash potatoes and gravy, corn bread, biscuits, etc. these types of foods plus a sedentary lifestyle can be a factor to the high levels of obesity.

When focusing on Hispanics, the highest occurrence of obesity was in the Midwest, followed by the South, then the West, and then the Northeast. Maryland was the lowest ranking state for Hispanics and Tennessee was the highest ranking state in terms of obesity. In 2011, Hispanic adults were thirty percent less likely than non-Hispanic White adults to engage in any kind of physical activity. Plus, Hispanics eat a lot of unhealthy foods, such as white and/or yellow rice, fried plantains, fried salami, fried cheese, tamales, etc. These foods have a high calorie count and low levels of healthy nutrients. Another reason why Hispanics are higher on the obesity scale may be because Hispanics like to be curvy and voluptuous; so they do not see their body image as bad or unhealthy. In 2010, Abbey Berenson and her colleagues went to public health clinics in Texas where they surveyed 1,076 Hispanic women about their weight. “The researchers found about twenty five percent of the overweight Hispanic women perceived their weight as “normal,” while only fifteen percent of non-Latino white women did” (Rodriguez, 2013).

When looking at non-Hispanic Whites, the greatest occurrence of obesity was in the Midwest, followed by the South, then the Northeast, and then the West. Virginia was the lowest obesity level state but five of the other states had a population which was twenty percent or less obese than the rest of the nation: California, Colorado, Connecticut, Hawaii, and New Mexico. Non-Hispanic Whites tend to be less overweight than non-Hispanic Blacks and Hispanics but are presumed to be sixty percent more likely to be obese than non-Hispanic Asians.

Furthermore, non-Hispanic Asians are the opposite of non-Hispanic Blacks and Hispanics. It is actually somewhat uncommon for non-Hispanic Asians to be considered obese; less than eleven percent of Asian adults are in the heavyweight category. In reality, about one in every ten Vietnamese and Korean adults are underweight. When looking at obesity, compared to the overall Asian population, Filipino adults are considered seventy percent more probable to be obese. The communities they live in probably have more supermarkets with healthy foods, such as whole foods. They may be advertising reduced sugar or no sugar products. Also, people may simply exercise more often, or there is less use of motor transportation.

Environmental factors contribute to the epidemic of obesity. Racial and ethnic groups have different lifestyle behaviors that affect weight gain. For example, non-Hispanic Blacks and Hispanics choose to be sedentary instead of exercising during their down time, while non-Hispanic White adults choose to be more physically active. There are also differences between ideal body weights among different racial groups. For example, non-Hispanic Black women and Hispanics tend to have a larger body shape than non-Hispanic White women. Even with a smaller body, non-Hispanic White women are dissatisfied more with their weight than non-Hispanic Black women. Also, non-Hispanic Black men have said they prefer bigger women. And lastly, there are socio-economic inequalities, like having a safe place to exercise and having healthy foods available. There is evidence to show that neighborhoods with a large minority population, especially where there is low income, have fewer grocery stores where the healthy foods are affordable. There actually tends to be a lot more liquor stores and convenience stores. There is also proof to back up the impression that minority and low income groups live in communities that lack fitness centers, parks or playgrounds and where they do not go walking or running out of fear for personal safety.

In addition, people who live in a town with a high population of non-Hispanic Blacks or Hispanics have had a significantly higher body mass index and have a greater chance of being overweight or obese. On the other hand, individuals who live in a community with a high population of non-Hispanic Asians have on average a lower body mass index and were less likely to be overweight or obese. When examining body mass index and obesity, these results obviously illustrate the importance of the race/ethnicity of an individual and community composition.

Overall, obesity is a multifactorial disease that is influenced by the race/ethnicity of the individual and the environment. Just like previous studies have shown, Kirby and colleagues’ obesity study illustrated that non-Hispanic Blacks had the highest obesity level, followed by Hispanics, then non-Hispanic Whites, and lastly non-Hispanic Asians. Also, the United States, in general, promotes bad eating habits that lead to obesity.


References

Davaasambuu, S. (2014).

Obesity among American adolescents: Effects of racial, socioeconomic, neighborhood, and immigration status.

ProQuest Information & Learning).

74

(11-), No Pagination Specified.

Kirby, J. B., Liang, L., Chen, H., & Wang, Y. (2012). Race, place, and obesity: The complex relationships among community racial/ethnic composition, individual race/ethnicity, and obesity in the United States.

American Journal of Public Health, 102

(8), 1572-1578.

L Pan, MD, DA Galuska, PhD, B Sherry, PhD, AS Hunter, JD, GE Rutledge, MPH, WH Dietz, MD, PhD, LS Balluz, ScD. (2009). Differences in Prevalence of Obesity among Black, White, and Hispanic Adults –United States, 2006–2008.

Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.


MMWR, 58

(27); 740-744

Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011–2012. NCHS data brief, no 131. Hyattsville, MD:

National Center for Health Statistics

. 2013.

Paddock, Catharine PhD. (2009, July 20). More Obese Blacks than Hispanics and Whites in the US. Retrieved from

http://www.medicalnewstoday.com/articles/158077.php

Wei, L., & Wu, B. (2014). Racial and ethnic differences in obesity and overweight as predictors of the onset of functional impairment.

Journal of the American Geriatrics Society, 62

(1), 61-70. doi:10.1111/jgs.12605

Apply principles of nursing theory to the public health system by analyzing determinants of health and the public health intervention wheel.

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Apply principles of nursing theory to the public health system by analyzing determinants of health and the public health intervention wheel.

Intervention and Evaluation

Purpose

The purpose of this PowerPoint presentation is to provide an opportunity to develop a community health nursing intervention and evaluation tool for your identified community health problem (described in Milestone 2: Assessment and Diagnosis) and identify the components of the nursing process as they apply to a community or population.

Course Outcomes

This assignment enables the student to meet the following course outcomes.

 

CO1: Apply principles of nursing theory to the public health system by analyzing determinants of health and the public health intervention wheel. (PO 1)

CO3: Plan prevention and population-focused interventions for vulnerable populations using professional clinical judgment and evidence-based practice. (PO 4, 8)

CO4: Evaluate the delivery of care for individuals, families, aggregates, and communities based on theories and principles of nursing and related disciplines. (PO 1)

Due Date

Submit your assignment to the appropriate basket in the Dropbox by 11:59 p.m. MT Sunday of Week 6.

Points: 250 points

Scenario

You are a community public health nurse (C/PHN) working in your setting of choice. You have analyzed the data collected from your windshield survey and assessment and diagnosis assignments (the first two milestones) and identified one community health nursing problem. You have decided on one nursing intervention and need your organization’s approval for funding of this intervention. Your leadership team has agreed to listen to your proposal.

Directions

  • Watch the Milestone 3 tutorial by clicking this link. This tutorial is also available on Course Project page under Course Home as well as Week 6 Assignments page.
  • Choose a community health nurse setting. Some examples of settings are school nurse, parish nurse, home health nurse, nurse working in the health department (be specific to what area in the health department, e.g., WIC, STD clinic, health promotion, maternal-child health, etc.)
  • Introduction: Introduce the identified problem, the purpose of the presentation, and reiterate at least one or two important findings that demonstrate this problem in your community (average of 1–2 slides)
  • Proposed Intervention: Propose one community health nursing intervention that would address one or more of the major factors that contribute to the problem (average of 3–4 slides).
    • Describe your specific nursing intervention relating it to the public health intervention wheel (Nies & McEwen, 2015, p. 14, Figure 1-3)
    • Who is your target population?
    • Where is this intervention taking place?
    • Will it take place one time or multiple times?
    • How will you reach out to your target population?
      • How will you get your target population involved?
    • What is the CH nurse’s role in this intervention?
    • Will you collaborate with anyone (e.g., physician’s office, church, local resources, etc.)
    • Is anyone else involved besides yourself (C/PHN)?
      • If yes, are they paid or volunteers?
    • What level(s) of prevention is your intervention addressing (primary, secondary, or tertiary prevention)?
  • Intervention Justification: Justify why the problem and your nursing intervention should be a priority.
    • Based on what you have found in the scholarly literature, discuss why these interventions are expected to be effective.
    • Include summarized information from at least two professional scholarly sources from peer reviewed journals related to your intervention (average of 2–3 slides).
  • Proposed Evaluation Methods: Your presentation must include at least one proposed quantitative or qualitative evaluation method that you would use to determine whether your intervention is effective. Outcome measurement is a crucial piece when implementing interventions (average of 2–3 slides)
    • Describe at least one quantitative or qualitative method you would use to evaluate whether your intervention was effective. (There is a helpful tool found in Doc Sharing to assist you with understanding qualitative and quantitative methods of evaluation).
    • Describe the desired outcomes you would track that would show whether your intervention was working.
    • Include a discussion about the long-term and short-term impact on your community if the intervention is successful.
  • Summary: The summary should reiterate the main points of the presentation and conclude with what you are asking to be accomplished; for example, “Based on ABC, it is imperative our community has XYZ. Thank you for your consideration.”
  • In addition to the slides described above, your presentation should include a title slide with your name included and a reference slide. Remember, you are presenting to your leadership team, so the slides should include the most important elements for them to know in short bullet pointed phrases. You may add additional comments in the notes section to clarify information for your instructor.

Guidelines

  • Application: Use Microsoft PowerPoint 2010 (or later).
  • Length: The PowerPoint slide show is expected to be no more than 20 slides in length (not including the title slide and reference list slide).
  • Submission: Submit your files via the basket in the Dropbox: Milestone 3 Intervention and Evaluation by 11:59 p.m. Sunday of Week 6.
  • Save the assignment with your last name in the file title: example: “Smith Intervention and Evaluation.”
  • Late Submission: See the course policy on late submissions.
  • Tutorial: If needed, Microsoft Office has many templates and tutorials to help you get started.

Best Practices in Preparing PowerPoint

The following are best practices in preparing this project.

  • Be creative but realistic with your intervention and evaluation tool.
  • Incorporate graphics, clip art, or photographs to increase interest.
  • Slides should be easy to read with short bullet points and large font.
  • Review directions thoroughly.
  • Cite all sources within the slides with (author, year) as well as on the reference page.
  • Proofread prior to final submission.
  • Spell check for spelling and grammar errors prior to final submission.
  • Abide by the CCN academic integrity policy.

Grading Rubric: Caring for Populations: Intervention and Evaluation (250 points)

 Criteria A(92–100%)Outstanding or highest level of performance B(84–91%)Very good or high level of performance C(76–83%)Competent or satisfactory level of performance F(0–75%)Poor or failing or unsatisfactory level of performance Pts
Problem identification20 points Presentation includes at least one slide that introduces the problem and significant findings in the community.(18–20 points) Problem is introduced but lacks support with findings.(17 points) Supportive findings discussed but problem identification not clear.(16 points) Problem is not introduced and does not include community findings.(0–15 points) /20
Proposed intervention85 points One community health nursing intervention is proposed that would address one or more of the major direct or indirect factors that contribute to the problem. Intervention includes specifics:*Intervention described and related to Public Health Intervention Wheel*Community setting outlined.

*Intervention location described.

*Timing of intervention (length and number of sessions) included.

*Outreach and engagement methods described.

*CHN role in intervention outlined.

*Collaborating with other disciplines or community leaders discussed (e.g., physician’s office, church, local resources).

*Level(s) of prevention addressed (primary, secondary, and/or tertiary).

(78–85 points)

 One intervention is proposed but is missing one or two specific details from column one.(71–77 points) Intervention is missing more than two specific details from column one.(65–70 points) Intervention is not proposed or does not address any details in column one.(0–64 points) /85
Intervention justification and application of evidence-based literature30 points Includes at least one slide that discusses why this intervention should be a priority based on two scholarly findings. Two or more quality references from peer reviewed articles and their findings are summarized to show that the evidence supports your intervention.(28–30 points) Includes slide stating why the intervention should be a priority. Two references cited but references may be not be a scholarly article or is not directly relevant to your rationale.(25–27 points) Intervention justification inadequate or fewer than two scholarly references cited.(23–24 points) Lacks slide on intervention justification. No references cited.(0–22 points) /30
Evaluation70 points Presentation includes at least one proposed quantitative or qualitative evaluation method and desired outcomes. Long-term and short-term impact on your community if the intervention is “successful” discussed.(64–70 points) At least one evaluation method adequately described but lacks discussion on long- and short-term impact on community.(59–63 points) Long and short term impact on community discussed, but evaluation method unclear.(53–58 points) Presentation lacks clear evaluation method and future impact.(0–52 points) /70
Summary20 points Includes at least one summary slide that reiterates the problem and purpose of the presentation.(19–20 points) Summary does not clearly reiterate the problem or purpose.(17–18 points) Lacks reiteration of problem and purpose.(15–16 points) Summary slide not present.(0–14 points) /20
Overall presentation10 points Presentation is presented in a clear and logical manner. PowerPoint is appealing to the eye and includes creativity. Bullet points with short phrases used instead of paragraphs. Font is easy to read.(9–10 points) Presentation is clear and organized but lacks creativity or slides are too busy.(8 points) Presentation is somewhat disorganized and lacks creativity.(7 points) Presentation is disorganized and difficult to understand.(0–6 points) /10
Mechanics15 points Excellent mechanics with no more than two errors of the following:– complete title slide– correct grammar, spelling

– all sources cited in the text of slide

– all references listed on the reference slide and in APA format (hanging indent not needed for PowerPoint).

(14–15 points)

 Three mechanical errors of elements listed in column one.(13 points) Four mechanical errors of elements listed in column one.(12 points) More than five mechanical errors of elements listed in column one.(0–11 points) /15
Total points: /250

Chamberlain College of Nursing NR443 Community Health Nursing NR443 Qualitative and Quantitative Evaluation Methods 9/27/12 mm 1 QUALITATIVE AND QUANTITATIVE EVALUATION METHODS For the final assignment in NR 443: Community Health Nursing, you will need to utilize a qualitative or quantitative evaluation method to evaluate your proposed intervention. Qualitative evaluation techniques generally are subjective data and can include methods such as: • observation methods • interviews • focus groups • other non-statistical data Example: If your proposed intervention is relatedto childhood obesity, you may want to interview the children pre and post intervention to see if their attitude about food and health has changed. This would be a qualitative evaluation method. Example: For the same intervention, you want to have a focus group with pre and post intervention with parents to see if their children’s attitudes about food have changed. This would be a qualitative evaluation method. Quantitative evaluation techniques generally are objective data and can include methods such as: • surveys/questionnaires • pre/posttests • physiologic data • statistical analysis Example: Your proposed intervention is the same as the example above, but instead of an interview, you would like to measure the children’s weight pre and post your intervention. This would be a quantitative evaluation method. Example: Another example of a quantitative evaluation method would be having a pre and posttest on healthy foods and importance of exercise. You would compare the pre intervention test results with the post to measure if your intervention was effective.

Mobile Radiography Procedure Reflection

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Introduction:

I will be reflecting upon my experience of a mobile radiography procedure using the ‘John’s Model of Reflection’. This framework allows the person to identify what they want to achieve using a series of five questions before entering the clinical environment and from the outcomes that meet or did not meet certain standards; an evaluation can be completed to reflect upon the clinical performance as a practitioner, and how to improve where we may not be succeeding. I will reflect upon my day spent within mobile radiography within intensive care unit. I will refer to John’s model as it involves the roles of others within an experience to understand the experience within a context (Jaspar, 2013).



Description of the Experience:

The day I spent on mobile radiography procedures was within departments such as the special baby care unit, recovery wards, and intensive care unit (ICU).  The experience I will reflect upon is the mobile request within ICU. The request was for a male requiring a chest x-ray querying an infection. However, the male was sedated, heavily monitored and extremely obese. The mattresses have got pockets which enables easier positioning of a detector bag that can be passed behind the patient with minimally moving the patient.

However, as the man was sedated and obese it made positioning him to ensure an optimal image very challenging. He was leaning to one side; pillows and foam pads were used to help straighten the man – this was to ensure the image was not lordotic, it was straight, and the full chest was visualised. It was left to the radiographer and I to position this man as best as we could; no other member of staff offered or replied to our request for help. The staff within ICU only intervened when we asked about the monitoring equipment. The chest x-ray required as much of the equipment out of field of view so equipment which wouldn’t compromise the patient was moved. The deep sedation and weight of the male meant efficiency was required to obtain an image as the ancillary equipment used couldn’t withstand the male for any length of time.



Reflection:

During this procedure I was trying to achieve effective communication with the radiographer for correct preparation of equipment, positioning of the patient was done correctly and no compromise to the patients monitoring or condition. This was my first time within ICU as a student, so I wanted to ensure I was conducting myself correctly; the patient’s best interests and the appropriate protocols were being met. The communication between the radiographer and I ensured patient safety and established a trust, together we both had the same intentions of this examination and both sought the same outcome.

My growing confidence came sooner than anticipated; this was due to the need to quicken my way of working and adapting to a new environment. But most importantly the lack of help from the ICU team.  It made me aware of how working in this environment independently is challenging. I intervened by prepping the x-ray equipment and communicating what equipment could be safely moved before the examination began. The radiographer soon seen how I adapted to working within this environment and together we started collaborating on how we would conduct this procedure with the limited support we had.

Inter-professional work is a process which is being implemented for team work within different health care professionals to provide excellent communication to ensure a quality health service is provided (Munro & Henwood, 2013). However, the lack of support from the ICU team made the examination more challenging. The weight and the unconsciousness of the male created great difficulty for only two people. The patient’s conditions within ICU is time critical; if efficiency and accuracy is not conducted it could compromise a patient’s life. Within ICU sophisticated equipment is used to monitor, maintain, and support a patient’s bodily functions until they recover; ventilators to help with breathing, IV lines for nutrition, fluids and medicine, and drains to remove any fluid or blood build up from the body (NHS, 2016) – any movement or disruption will result in the patient’s condition being compromised.

As there was no response to my appeal for help from the ICU team it led to the patient being in a more compromised position and led to additional images being taken due to insufficient quality which resulted in the patient receiving a higher radiation dose. In the NHS, due to the lack of good inter-professional working and communication it has resulted in approximately 70-80% of errors within healthcare by human factors (Xyrichis & Ream, 2008).

My first time within ICU was overwhelming – the different types of sounding equipment monitoring the severely ill patients, and the care members instant response if an alarm sounded if a measurement was not within an acceptable range – can be frightening (Valentino, 2015). However, the circumstances and absence of multi-disciplinary help made me feel determined to help in any way I could and provide a high standard of care to this critically ill patient.

Afterwards, I had a feeling of guilt – as the patient was sedated, this was the first time as student I was unable to communicate or interact with the patient. They were not necessarily consenting to the examination and undergoing radiation unknowingly. I had always been taught to communicate with patients to gain verbal consent to the examination, to understand the risks associated with radiation exposure (Whitley, 2017) However, despite the risks associated the patient should understand the benefits and the nature of the examination.

The feeling of anger started to arise within me – the non-existing help from the ICU team meant the patient’s condition was at risk of deteriorating or suddenly changing. Munro and Henwood (2013) established the lack of good inter-professional working resulted in poorer health outcomes, higher death rates and medical errors. Thus, there was a discrepancy with the patient’s welfare during the examination.



Influencing factors:

Within myself; I knew I wanted to ensure the best outcome for the patient. The time critical nature of ICU made me very aware I had to act quickly and ensure optimal patient safety. Since this was my first time within this department, I wanted to ensure I was making the correct impression; I adapted and worked despite the challenges that occurred. My decision making was influenced by creating a prior plan of communicating how technique was to be adapted and how the equipment and patient was to be positioned or moved to not impede image quality or compromise the patient.

The state of the patient and how the radiographer was solely conducting the procedure influenced my decision making to intervene. The limited support from the ICU team influenced my decision of intervening and assisting the radiographer. Good communication and effective listening between the radiographer and I ensured the common goal of best patient care was achieved (Ehrlich, 2013).

The condition of the patient influenced my decision making – heavy sedation and the obesity created a greater risk of deterioration. Adverse reaction to sedation can vary but the most common include hypotension, amnesia, post-traumatic stress disorder and reduction in gut motility (Woodrow, 2019). This knowledge allowed for the requests from the radiographer to be completed efficiently and effectively – ensuring optimum patient safety and image quality.



Could I Dealt with it better:

Before the procedure the radiographer and I could have had a conversation with the ICU team; explaining what needed to be achieved and how it would be conducted. It should have been discussed what type of help was required. It could be queried if the examination was justified; was it necessary for the image or could it be postponed till the patient was more stable. Whitley (2017) outlined that justification is a key aspect to ensure it is completed only when required for a medical diagnosis and treatment and whether the benefits outweigh the risks associated; this includes considering the medical history of the patient, the radiation protection and the request.

Prior discussion could have improved how the examination was conducted however the time critical nature of ICU means efficiency is high priority. The role of the radiographer and I was to ensure time was spent ensuring the optimal image quality and there was no compromise to the patient’s condition. The poor acknowledgement of help from the ICU team could have led to the radiographer refusing to complete the examination as it was deemed the safety of the patient could be compromised.

If the examination had not been completed when it was requested, it could have delayed the diagnosis and treatment for the patient. This could then have led to the patient in a more compromised and life-threatening situation.



Learning:

This experience made me feel anxious about returning to ICU. Whilst I should have benefitted from the time spent within ICU; it made me uneasy about returning because of the shortfall of communication between inter-professional teams. Despite both teams having identical intentions of achieving best patient care; the discrepancy could have resulted in poorer health outcome. However, despite the challenges it made me feel determined to guarantee patient wellbeing and safety throughout my learning. Whilst adapting my technique safely to suit the patient to ensure image quality is still optimum.

For future practice I will communicate with those involved in the procedure how it must be conducted and communicate what is needed from everyone involved. Furthermore, information should be shared amongst professional bodies to ensure everyone involved is aware of what intentions are to be achieved. Thus, ensuring the patient and the staff involved have optimum safety.

I will continue to achieve optimal patient wellbeing despite of challenges and being within a new environment. Regardless of the fact I had never been within this environment and the shortfall of multi-disciplinary help, optimum delivery of care and image quality is the priority no matter what the department and this will continue throughout my career.

The actions I took were for the benefit of both the patient and the radiographer. The radiographer was unable to position and perform the examination solely – the non-existing help from the ICU prompted myself to intervene when the radiographer requested my help to move the patient and equipment. The welfare of the patient was also my priority and I believed the way I had supported the way I did ensured no compromise to the patient’s condition. This experience has allowed me to quicken my adaption to a new environment for future practice – despite the new surroundings the patient’s welfare is always the priority.




Conclusion:

To conclude using John’s Model of Reflection I reflected upon my mobile radiography procedure within ICU. This experience of poor communication and the shortfall of inter-professional collaboration enabled me to appreciate the need for a strong multi-disciplinary team and effective communication to ensure the best delivery of patient care.

For future practice, I will ensure effective communication is established for the purpose of patient safety and correct delivery of care. Good inter-professional working collaborates expertise knowledge to provide an optimal service. Effective communication between disciplinaries ensures progress is established through the quality patient safety and care service. The qualities required for successful communication is trust and respect of other disciplinaries – everyone relies on the other to ensure the wellbeing of the patient is guaranteed. Everyone involved must be equally as determined to achieve the common goal and to co-operate when issues arise. I will continue throughout my time as a student onto when I qualify to perform and improve upon this goal; establishing a good communication between inter-professionals ensures a trust of intentions to achieve the common goal. Thus, everyone involved should be appropriately informed to guarantee an efficient and accurate diagnosis for the patient. I will plan my intentions before conducting an examination; establishing the challenges, communicating with those involved and assess requirements needed to overcome and achieve the goal.




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