Socio-economic Influences on Health

/in /by



Scenario

You are employed by the Public Health England as an assistant to the regional Public health officer in UK. Your manager has asked you to produce a report on why the life expectancy of individuals in the Midlands is lower than the London. Your report should cover AC 1.1, 1.2 and 1.3 (

Evidence type-Report)


AC 1.1

Explain the effects of socio-economic influences on health. Your report should highlight the reasons for the difference in life expectancy for the two regions

M1

.

The term ‘socio-economic’ has been developed from the sociology and economic disciplines which, respectively, explore and examine people which comprise society and the economy which encapsulates finance. Together, social and economic factors, their interaction is examined to identify its impact and/influence on outcomes such as health. Socio-economic factors include income/low or no income, employment/unemployment, the environment, access to information, and citizenship status.

The availability of jobs, and the type of jobs, is, in the main, the factor which impacts on life expectancy. Income is derived from employment, whether self or external, and with income housing can either be purchased or rented, food can be bought and citizenship issues can be resolved; albeit across a range such as the quality of food and housing stock. However, it is quite often the case that without income acquiring food, clothing and shelter is problematic. Over many years the main industries, which allowed families to manage their lives, have been either reduced or eliminated across the UK, and more so in some areas than in others. In the Midlands many of the textile industries no longer exist, as too the car manufacturing industries, and training in new technologies, available in other areas of the UK such as London, has either not been made available or is available in specific areas as opposed to all areas. Hence, without investment in other technologies by both the private and public sector jobs in areas such as the Midlands are limited; educated Midland’s people whose voice may have been heard in demanding better civic services, such as in regular weekly bin collection, are no longer heard as many migrate to London for employment, and/or better employment opportunities.

High socio-economic factors almost guarantees good health in that the quality of food is most likely to be nutritious and with ‘ready’ access to health information, whether in text or through networking such as having a neighbour who is a doctor or a medical researcher, high socio-economic individuals will manage and monitor their health with regular visit to alternative practitioners and gyms as they practise a preventative health lifestyle to avoid negative socio-economic health conditions. Obviously, some health conditions cannot be prevented if they are hereditary but, conditions linked to obesity for example, are more likely to be avoided with the assistance of a physical fitness trainer for example. In so doing, obesity is avoided and linked lifestyle conditions such as Type 2 diabetes and hypertension can either be avoided or delayed. This may not be the case with those living with low incomes, either owing to poorly paid employment positions or unemployment. Such people would not be able to afford a personal trainer who may also assist them in constructing a menu conducive to a healthy lifestyle; notably not all vegetables are of the same nutritious quality so even if low income families are eating healthily they may not be eating quality health food when compared with those with a high income (Fowajuh, 2007; Joseph Rowntree Foundation, 2011). Based on available employment opportunities, it would be ‘safe’ to claim that high income individuals/families are more likely to be found in London than in the Midlands, with the observation that life expectancy being greater in London than in the Midlands.

Along with the quality of food purchased, and opportunities to purchase help to support a healthy physical regime, is the issue of housing. Low income individuals may have to content themselves with having ‘a roof over their heads’, irrespective of damp which brings on mould, poor heating and a generally ‘unpleasant’ environment. Conditions, as stated in previous sentence, impacts on respiratory health, and if a child grows up in such conditions, these conditions can either exacerbate asthma or increase the chances of developing it, with long-term effects into adulthood and quite limiting life expectancy. A child from a high income family may have asthma but the chances of his or her home environment aggravating the condition is quite minimal, if at all. In addition, those with high disposable incomes are more likely to live in hospital trust areas which are well resourced and well-funded, and if not they are more likely to ‘make a fuss’ to try and force a change or have the ‘know how’ to demand a second opinion or go to the private sector; Low income individuals are unlikely to do the same and most certainly will not have the finance ‘to go private’

Quite, unfortunately, socio-economic factors, which are greatly affected by income leave certain regions in the UK at the mercy of those ‘dispensing’ healthcare, whether it is adequate and fit for purpose or not, hence the discrepancy in life expectancy in regions such as London and the Midlands. In essence, the central socio-economic factor, ‘Money buys goods and services that improve health. The money families have, the better the goods and services they can buy. [and] For various reasons, people on low incomes are more likely to adopt unhealthy behaviours – smoking and drinking, for example – while those on higher incomes are more able to afford healthier lifestyles’ (Joseph Rowntree Foundation, 2014).


AC 1.2 Assess the relevance of government sources in reporting on inequalities in health in England

There are many various government sources reporting on the levels of health experienced by public service users across England. These sources include Health Survey for England (HSFE), Acheson Report ‘Independent Inquiry in Inequalities in Health’ (1998), Census Data and Health and Lifestyle Surveys (HALS). These sources, with the exception of the Census Data, provide a ‘snapshot’ of health of public health service users in England. The information acquired from these different sources assist the government in its decision making when allocating health related funding to the various regions in England, recognising that the variation in health needs, or to be precise health inequalities, within one particular region may be as great, or greater than, the variation in needs between regions.

In a blog, on the Guardian website in 2010, the following statement partly explains the relevance of government sources in reporting on inequalities in health in England in that ‘It has been said that each stop on the District line to east London cuts life expectancy by a year’ (Guardian, 2010). The District line runs through some of the most expensive areas in London through to some of the most deprived. Drawing on statistics produced by the Office of National Statistics (ONS), this same blog highlighted the following: the average life expectancy age of a man in London is 78.6; however along the District Line, from west to east, the following boroughs showed variants around this average age, as follows:

  • Ealing 78.9
  • Hammersmith & Fulham 78.1
  • Kensington & Chelsea 84.4
  • Westminster 83.4
  • Tower Hamlets 76.0
  • Newham 76.2
  • Barking and Dagenham 76.5

(Guardian, 2010).

In an NHS study on life expectancy it was observed that ‘Money may not buy you happiness, but it is linked to good health’ (NHS, 2015). Notably, this report considered the ‘North-South’ divide in England, but this observation is very much applicable to the findings included in the Guardian blog above. Either side of the two richest boroughs in England, Kensington & Chelsea and Westminster, the link between money and health, in London, is clear. At the west end of the District line male life expectancy differs from the London average by tenths of a percentage point; Ealing being six tenths of a percentage point higher, while Hammersmith and Fulham is five tenths of a percentage point lower. Overall family income levels are not as high in these two boroughs when compared with Kensington & Chelsea and Westminster, however, family income levels are higher than those in Tower Hamlets, Newham and Barking & Dagenham which have all been classed, at various times, as deprived boroughs (Hill, 2015).

Although, the examples of life expectancy above are for men in London, the point should not be missed that money, or to be precise the lack of money, does play a part in health inequalities. Thus, it is undoubtedly necessary for the government to be fully conversant with the varying conditions of wealth, which impact health outcomes, across England. In this way, funding and resources should be deployed to areas experiencing inequalities in health, and in so doing health inequalities should be address for the benefit of the population most in need of public funded health care.


AC 1.3 Discuss reasons for barriers to accessing healthcare.

There are many reasons why there are barriers to accessing healthcare. These reasons include a lack of education, information, funding for staff and facilities and mobility, plus limited or no access to GPs and other health professionals.

In detail, there is a somewhat convoluted cycle of ‘lack’ which may results in those with the most health needs not receiving the necessary medical attention. A lack of education may prevent a potential public service user from accessing and/or receiving the relevant information even if it is available, which may assist them in making an informed decision as to which health professional could be seen first. In England, now, a pharmacist could be the first point of call, avoiding possible long waits to see a GP. Therefore, ‘simple and treatable’ conditions could get worst while awaiting a GP appointment.

Without the appropriate information a public service user may not know that a certain question should be asked; it is difficult to ask a question if one is ignorant of the fact that a question should be asked. Lack of information, along with restricted numbers in staffing contributes to ignorance in health related conditions, since the staff which could possibly mitigate the outcomes, arising from no written information by sharing that information in discussion, may have been cut owing to limited and/or reduced funding. Funding, or the lack of it, reduces staffing levels and the appropriate facilities to address public health issues. Funding also impacts on GP availability if a health trust decides to cut funding per patient to a GP; in this way GPs may be reluctant to accept new patients, or reduce surgery cover which may impact on the services provided by other health professionals linked to a surgery. Without a nearby and accessible surgery, those service users with mobility issues may find it a struggle to attend the ‘nearest’ surgery which requires a journey involving two or more changes using public transport.

Whatever the reason, or combination of reasons, for being unable to access healthcare, most negative outcomes are probably quite preventable, and as such more costly to the public health providers when corrective action must be taken.


REFERENCES

Fowajuh, G. (2007) ‘West Midlands Key Health Data 2007/08 – Chapter Ten: Inequalities in Life Expectancies in the West Midlands’ Available online at

http://medweb4.bham.ac.uk/websites/key_health_data/2007/ch_10.htm

accessed on 27/02/17

Hill, D. (2015) ‘London’s Poorest Boroughs Once Again Prepare to Make the Biggest Cuts’ Available online at

https://www.theguardian.com/uk-news/davehillblog/2015/feb/23/londons-poorest-boroughs-once-again-prepare-to-make-the-biggest-cuts

accessed 27/02/2017

Joseph Rowntree Foundation (2011) ‘Does Income Inequality Cause Health and Social Problems? Available online at

https://www.jrf.org.uk/report/does-income-inequality-cause-health-and-social-problems

accessed on 27/02/17

Joseph Rowntree Foundation (2014) ‘How does Money Influence Health?’ Available online at

https://www.jrf.org.uk/report/how-does-money-influence-health

accessed on 27/02/17

NHS (2015) ‘Study Finds North-South Divide in UK Life Expectancy’ Available online at

http://www.nhs.uk/news/2015/09September/Pages/Study-finds-North-South-divide-in-UK-life-expectancy.aspx

accessed on 27/02/17

Public Health Reflection on Care

/in /by


Title: Reflect upon an incident which occurred during your clinical placement as a student Public Health Nurse. The chosen incident is one where you met an elderly client with a leg ulcer who was not complying with the treatment prescribed from hospital.

This essay is a reflective consideration of a case that had been encountered in clinical practice. For the purposes of illustrative discussion, I shall use the Gibbs model of reflection as a guide. (Gibbs, G 1988)


Description:

describe in c.400 words the experience. Client fell at home and fractured lower ankle. He neglected this and developed ulcer. He attended GP and completed 2 courses of antibiotics: referred to leg ulcer clinic in local hospital; diagnosis was ulcer with mixed arterial / venous disease.

The client concerned will be anonymised and referred to as Mr.S in accordance with the NMC guidelines (NMC 2004). Mr.S is a 68 yr old man who lives alone having been widowed for 12 years. He is normally self caring but has been getting progressively more frail as time goes by. He fell at home and fractured his lower tibia. There was a suspicion that he has been drinking rather more than might be considered good for him and it is possible that this fall was after a bout of drinking. (Nicol M et al. 2004).

Being generally very stoical, he initially ignored this but was forced to seek medical advice when the pain got too great. The fracture was treated with a plaster cylinder after reduction of the fracture but he subsequently developed a leg ulcer from direct pressure and friction from the cylinder which eventually attained a size of about 10 – 15 cms across and, despite being referred to the leg ulcer clinic and having regular visits from the community nurse who applied Aquacell AG , it refused to heal. (Harding K G et al. 2002)

It was subsequently discovered that after the nurses had been to clean and dress the leg, Mr.S would take the dressings off and put iodine onto the wound which produced a marked allergic reaction. When challenged about this he said that he “didn’t hold with these newfangled ideas” and that he wanted to use a remedy that his grandmother had used with great success when she had developed a leg ulcer. Initially there was an impasse with the nurses wanting to use the dressings that had been prescribed by the hospital and Mr.S, although allowing them to be out on, would promptly disturb them and put the iodine directly onto the wound. The community nurses were asked to persist with the dressing regime and after a few weeks it became clear that the leg ulcer was making no progress at all. It was not healing, it was permanently infected and persistently sore with inflamed and macerated wound edges. (Donnelly A et al. 2000).

There was considerable discussion in the primary healthcare team relating to Mr.S’s right to autonomy (Seedhouse D 1998) and whether it was right or not to continue to commit large amounts of resources to a clinical situation that was not only not healing but was actually being actively undermined and made worse by the patient. (Thomas J E et al. 1990). To an extent, it is not ethical to insist on, or to impose a treatment which the patient is (by word or action) objecting to. It is difficult to justify a course of therapeutic action, which may have the strongest of evidence bases, if the patient does not want it. (Hunt T 1994)

The situation was compounded by the fact that Mr.S was not an easy patient to deal with as, since his wife died, he had become progressively more reclusive and he was clearly uneasy with other people coming into his house. The current course of treatment was clearly not successful and therefore a completely different approach needed to be tried.


Feelings:

how did client/you/others feel in this situation? How did you know this? The student was annoyed that the client was not complying with treatment and she knew the treatment he was applying was outdated and potentially harmful. Student is accountable to An Bord Altranais for their practice and must refer to evidence based practice. Student observed how the treatment applied by client had its place in the past and PHN made family aware that new dressings have silver content which has greatly improved results. Empowerment and advocacy were adopted.

I found my feelings ran through an evolution of emotions and that the initial set of feelings were of annoyance, frustration and irritation that Mr.S could not see that the healthcare professionals were trying to help him. I initially saw him as a rude and aggressive gentleman who clearly did not want “interference” from the nurses and was content to live in comparative squalor. His persistence of the use of the iodine seemed to me to be mainly due to sheer perversity rather than any rational reasoning. (Osterberg L et al. 2005)

I know that my original exchanges with him were very terse and aggressive, as I could not understand why he was persisting in using something which had no substantive evidence base and was clearly making the situation worse. My feelings changed to being less overtly annoyed as I came to realise that Mr.S was actually trying to use something that he had seen his grandmother use to heal her own leg ulcer and that there was a degree of reason beneath his obstinacy.

My mentor took a different view and explained that empowerment and education (Howe J et al. 2003) was the way to achieve success with Mr.S and I watched as she firstly gained his confidence and then explained the reasoning behind the new Aquacell AG, she also explained that the iodine, far from helping healing was, in his particular case, preventing the leg ulcer from healing and that his situation was quite different from the situation of his grandmother‘s ulcer. (Miller, A. 1995). After about three sessions, it was noted that Mr.S had stopped interfering with the dressings and that the iodine was no longer being applied. As a result, the wound started to heal. As soon as he saw this, Mr.S became much more content to allow the nurses to continue with their work and actually became almost welcoming. (Faden, R R et al. 1986). At this stage, I found that my feelings changed to actually liking Mr.S and looking forward to each meeting. I also developed a great deal of respect for my mentor and the other important realisation was a feeling of annoyance towards myself at my own initial inability to realise the motivation behind Mr.S’s actions. (Schon, D. 1997)


Evaluation

: what was good and bad about the situation? Mentor was able to develop relationship of trust with client.

The bad elements of the situation was that the concept of empowerment and education (Howe J et al. 2003), was not embraced earlier in the treatment programme and that each treatment application was simply met by the acceptance that Mr.S was interfering with the dressings. There was the additional possibility that Mr.S was drinking more than was good for him and this element of the situation was overlooked with the prime focus being on the leg ulcer rather than making a holistic assessment of the whole situation. Equally bad was my inexperience-based lack of insight into the situation.

On the good side, the fact that the mentor was able to “stand back” from the situation and make a dispassionate and empathetic assessment of the situation, construct an appropriate managements plan and then persuade Mr.S to comply with it to achieve a good clinical outcome, was a very positive step and a testament to the clinical experience of the mentor.


Analysis

: what sense can you make of the situation? what knowledge did or should have informed you? how does this connect with previous experiences? Reflection is necessary to enlighten a clinical situation. Element of compromise needed. Client centred approach required. Student PHN had experience of working as Community General Nurse. She found observing how the mentor dealt with the situation very enlightening. Discussion with client’s family was beneficial.

Analysis of the situation shows the potential gulf between the pursuit of evidence based medicine and the practical difficulties in actually applying it. It is all very well knowing that Aquacell AG releases ionic silver into the wound in a delayed and controlled release manner as the wound exudate is absorbed, thereby releasing more silver in the most contaminated wounds. ( Bowler P G, 2003).

The fact that the dressing formulation itself is thought to protect the periwound skin and thereby aid in granulation formation is of theoretical importance. In cases of leg ulceration, the fact that the dressing conforms easily to the surface of the wound helps with occlusion and thereby maintains a moist healing environment (Jude E B et al. 2007) is clearly a substantial contribution to the evidence base in this area. The fact that dressing exerts a demonstrable antimicrobial activity for up to 7 days reduces the need for frequent dressing changes and therefore frequent wound disturbance (Jude E B et al. 2007) is of practical and clinical importance, but none of these factors are of any use at all if the patient does not understand or is willing to comply with the clinical therapeutic regime.

In essence, this case illustrates the gulf between the knowledge that is assimilated in an isolated academic situation and the knowledge that is derived from experience in clinical situations. (Van Manen, M. 2007). It was my reflection on the situation that allowed me to appreciate the true value of my mentor’s experience and handling of the situation which was the critical factor in persuading Mr.S to understand both his predicament and the rationale behind the treatment that was being offered and this was the key to his eventual understanding and compliance. (Marinker M. 1997). It was clear that simply persisting with the situation was not going to achieve the desired effect and that a degree of compromise was needed. That compromise was achieved by viewing the situation from the patient’s viewpoint and then tailoring the clinical approach to an empathetic understanding of that perspective. In other words a client centred approach. (Platt, F W et al. 1999).

The point about Mr.S’s drinking was no longer overlooked and discussions with his extended family confirmed the clinical suspicion. Pressure was exerted by the family to reduce the opportunities for his drinking and they increased the degree of social interaction (reduced his social isolation) which also had a beneficial effect (Wilkerson, S. A et al. 1996)


Conclusion:

how do you now feel about this experience? what else could you have done? has this changed my ways of knowing?

I can say with confidence that reflection on this whole episode was a major learning experience for me. Not only did I witness and important lesson in patient management, but I was able to reflect on the evolution of my emotional approach to the situation. It showed me how my initial aggression and annoyance was not only completely misplaced, but that it was also completely counterproductive. As a conclusion, I have seen just how important it is to stand back from a difficult or deteriorating situation and make a completely dispassionate and holistic assessment of the patient and his clinical situation before trying to construct an appropriate management plan. A further conclusion must be that there is very little merit in simply knowing the evidence base surrounding a particular course of treatment if one lacks the experience or humanity to actually effectively put it into action. (Fawcett J 2005)


Action Plan:

if this arose again, what would you do differently?

As I have already mentioned in the conclusion, it is because this episode was a major learning experience for me that I can say with confidence that, if a similar situation arose again, I would deal with it in a completely different way to the way which I handled this episode. I would not initially approach Mr.S with a feeling of aggression and annoyance as it proved not only to be counterproductive but it was also a barrier to my standing back and reviewing the situation. If Mr.S was clearly not complying with the treatment I would ask myself (and the patient) what were the reasons why compliance was a problem. Having ascertained the reasons, I would then construct an appropriate treatment or management plan which directly addressed this reason and contained a mechanism for directly confronting it. Empowerment and education have been demonstrated to me as very powerful tools in the quest for patient compliance and concordance. I would actively use these concepts to try to maximise the effectiveness of the treatment and also to enhance the overall patient experience. (Hewison, A. 2004)


References

Bowler P G, 2003. Progression towards Healing: wound infection and the role of an advanced silver-containing dressing. Ostomy Wound Management 49 : (8) Suppl. 2 – 5

Donnelly A, Alistair M Emslie-Smith, Iain D Gardner, and Andrew D Morris (2000) ABC of arterial and venous disease : Vascular complications of diabetes BMJ, Apr 2000; 320 : 1062 – 1066.

Faden, R R, Beauchamp, T L. (1986) A History and Theory of Informed Consent Oxford University Press New York. 1986

Fawcett J (2005) Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories, 2nd Edition. Boston: Davis & Co 2005 ISBN : 0-8036 – 1194 – 3

Gibbs, G (1988) Learning by doing: A guide to Teaching and Learning methods. EMU Oxford Brookes University, Oxford. 1988

Harding K G, Morris H L, Patel G K. (2002) Healing chronic wounds. BMJ 2002; 324 : 160 – 163

Hewison, A. (2004) Management for Nurses and Health Professionals : Theory into practice. Blackwell Science: Oxford. 2004

Howe J, Anderson M (2003) Involving patients in medical education. BMJ, Aug 2003 ; 327 : 326 – 328.

Hunt T (1994) Ethical issues in Nursing. London : Routledge 1994

Jude E B, Apelqvist J, Spraul M, Martini J. (2007) Prospective randomised controlled study of Hydrofiber dressing containing ionic silver or calcium alginate dressings in non-ischaemic diabetic foot ulcers. Diabet Med. 2007; 24 : 280 – 288.

Marinker M.(1997) From compliance to concordance: achieving shared goals in medicine taking. BMJ 1997; 314 : 747 – 8.

Miller, A. (1995) The Relationship between Nursing Theory and Nursing Practice.

Journal of Advanced Nursing

10, 417 – 424.

Nicol M, Carol Bavin, Shelagh Bedford-Turner Patricia Cronin, Karen Rawlings-Anderson (2004) “Essential Nursing Skills” 2

nd

ed. Churchill Livingstone, Mosby 2004

NMC (2004) Nurse Midwifery Council: Code of professional conduct: Standards for conduct, performance and Ethics (2004) London : Chatto & Windus 2004

Osterberg L, Blaschke T (2005): Adherence to medication.

N Engl J Med

353 : 487 – 497, 2005

Platt, F W & Gordon G H (1999) Field Guide to the Difficult Patient Interview 1999 Lippincott Williams and Wilkins, pp 250 ISBN 0 7817 2044 3 London: Macmillian Press 1999

Schon, D. (1997)

Educating the Reflective Practitioner

. Jossey Bass, San Francisco. 1997

Seedhouse D (1998) Ethics; the heart of health care. London, John Wiley & Sons 1998

Thomas J E & Waulchow W J (1990) Well and Good : Case Studies in Biomedical ethics. Broadview Press 1990

Van Manen, M. (2007) Linking Ways of Knowing with Ways of being Practical.

Curriculum Inquiry

6 (3), 205 – 228.

Wilkerson, S. A., & Loveland-Cherry, C. J. (1996). Johnson’s behavioral system model. In J. J. Fitzpatrick & A.L. Whall (Eds.),

Conceptual


models of nursing: Analysis and application

(3

rd

ed., pp. 89-109). Stamford, CT : Appleton & Lange. 1996

For the Module 4 Case Assignment- you will consider the phases of negotiation in a blog entry. If youre unsure about what a blog entry involves or what makes a good one- try googling preparing a blo

/in /by

For the Module 4 Case Assignment, you will consider the phases of negotiation in a blog entry. If you’re unsure about what a blog entry involves or what makes a good one, try googling “preparing a blog entry” and you’ll find several websites that can guide you.

Before beginning, review the background readings, especiallyBauer, T., & Erdogan, B. (2012). Chapter 10.5: Negotiations. In An introduction to organizational behavior. Flat World Knowledge. Retrieved from https://saylordotorg.github.io/text_organizational-behavior-v1.1/s14-05-negotiations.html

Case Assignment

In your blog entry, consider a negotiation that you’ve been involved in or one for which you are preparing.

Start by summarizing the five phases of negotiation, being sure to mention some of the important elements of each.

Then discuss your own negotiating style.

Finally, set forth how you will approach the negotiation you’ve chosen to discuss in the five phases and according to your negotiating style.

Your blog entry should be the equivalent of a 4- to 5-page paper. Also, be sure to use in-text citations and a reference list. For administrative purposes, please add a title page so that your assignment can be readily identified.

Discuss about nursing shortage and nurse turn-over, nurse staffing ratios, unit closures and restructuring, use of contract employees

/in /by

Discuss about nursing shortage and nurse turn-over, nurse staffing ratios, unit closures and restructuring, use of contract employees

1.Select an issue from the following list: nursing shortage and nurse turn-over, nurse staffing ratios, unit closures and restructuring, use of contract employees (i.e., registry and travel nurses), continuous quality improvement and patient satisfaction, and magnet designation.
2.Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
3.Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style.
4.Use at least two references other than your text and those provided in the course.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

smilesmilePLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING TERM PAPERS TODAY AND GET AN AMAZING DISCOUNT

get-your-custom-paper

Emergency assessment and management of diabetic ketoacidosis

/in /by

Diabetic Ketoacidosis: Diabetic ketoacidosis (DKA) is developed due to deficiency in insulin which is moving all over the body. DKA is developed in the body due to depletion of water r and electrolytes from both the intra and extra cellular fluid compartments. Even if the patient is dehydrated, they use to maintain normal blood pressure and maintaining considerable urine output until extreme volume depletion and shock occurs in the body which create critical decrease in renal blood flow and glomerular filtration.

Assessment:

Once the diagnosis and examining the factors that have developed its cause has been confirmed, according to it a clinical evaluation should be developed. It is very important to determine what are the main causes of infection. Also it is very important to check the weigh of the patient. Assess clinical severity of dehydration. It is also important to assess the level of consciousness using Glasgow coma scale [GCS].

Management:

Laboratory blood glucose should be measured at diagnosis. An ECG monitor should be applied until the patient is stable. Consulate the Diabetes Team as soon as possible for a decision on continuing management. Transfer to subcutaneous (SC) insulin one the patient is able to eat and drink properly. Do not stop the IV insulin until SC insulin has been given. Patient with known diabetes should go back to their previous insulin regimen. If possible identify the precipitating cause of DKA. Always inform the Diabetes Team so that education can be given to reduce the risk of future episodes of DKA.

Hyperosmolar non – ketotic coma (HONK): Type 2 diabetes, usually in patients over 60 years. This condition is characterized by hyperglycemia and high plasma osmolality without significant keton-uria or acidosis (Pinies JA, Cairo G, Gaztambide S, et al.1994).

Assessment:

Same as Diabetic ketoacidosis (DKA) but look for precipitating medical condition, e.g. sepsis, myocardial infarction etc

Management:

Management of Hyperosmolar non – ketotic coma is same as DKA . Also the insulin infusion rate should be halved as paradoxically these patients can be quite insulin sensitive. Elderly patients are more likely to need a CVP line to optimize fluid replacement. Risk of thromboembolic disease is high – anticoagulant fully if no contraindications. Most patient can be managed with oral hypoglycemic agents or diet, but recovery of insulin may take time and insulin may be required for few weeks.

Hypoglycemia: Hypoglycemia is developed due to the mismatch between insulin dose, food consumed and any other recent activities undertaken like exercise. Because it can be accompanied by unpleasant, embarrassing, and potentially dangerous symptoms and because it causes significant anxiety and fear in the patient and their caregivers, it’s occurrence is a major limiting factor in attempts to achieve near normal BG levels (Clarke WL, Gonder-Frederick A, Snyder AL, Cox DJ 1998,Cryer PE 2002).

Assessment:

Each hypoglycaemic episode should be assessed carefully to determine its cause evaluating the insulin action profile (time of insulin administration, peak insulin action and intensity of insulin action). Check the recent food intake (timing and amount of carbohydrates eaten and peak BG effect on recent food. Also check recent physical activity (timing, duration and intensity). Also check and missed signs and symptoms of early hypoglycaemia.

Management:

Management of hypoglycemia involves immediately raising the blood sugar to normal, determining the cause, and taking measures to hopefully prevent future episodes. Initially Glucose 10-20 g is given by mouth either in liquid form or as granulated sugar (2 teaspoons) or sugar lumps (Smeeks FC, 2006). If hypoglycemia causes unconsciousness, or patient is unco-operative, 50 mL of glucose intravenous (IV) infusion 20% can be given. Alternatively, 25 mL of glucose intravenous infusion 50% may be given, but this higher concentration is viscous, making administration difficult; it is also more irritant.

Once the patient regains consciousness oral glucose should be administered as above.

References:

1. McDonnell CM, Pedreira CC, Vadamalayan B, Cameron FJ, Werther GA. Diabetic ketoacidosis, hyperosmolarity and hypernatremia: are high-carbohydrate drinks worsening initial presentation? Pediatr Diabetes 2005 Jun: 6(2): 90-4.

2. Rewers A, Klingensmith G, Davis C, Petitti DB, Pihoker C, Rodriguez B, et al. Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study. Pediatrics 2008 May: 121(5): e1258-66.

3. Pinies JA, Cairo G, Gaztambide S, et al. Course and prognosis of 132 patients with diabetic non ketotic hyperosmolar state. Diabete Metab 1994; 20: 43-48.

4. Kovatchev BP, Cox DJ, Kumar A, Gonder-Frederick L, Clarke WL. Algorithmic evaluation of metabolic control and risk of severe hypoglycemia in type 1 and type 2 diabetes using self-monitoring blood glucose data. Diabetes Technol Ther 2003: 5: 817-828.

5. Cryer PE. Hypoglycaemia: the limiting factor in the glycaemic management of type I and type II diabetes. Diabetologia 2002: 45: 937-948.

From your article I was able to understand the pathophysiology, prevention and the treatment of Macrovascular complications. Also I would like to add that Macrovascular can also be reduced by improved metabolic of diabetes. Controlling the blood sugar is essential but along with it, treatments of Dyslipidemia (e.g. familial hypercholesterolemia) play an important part to reduce the Macrovascular complications. Participating in healthy exercise and not smoking also makes big difference Diabetic complications can be classified broadly as Microvascular or Macrovascular disease. Microvascular complications include neuropathy (nerve damage), nephropathy (kidney disease) and vision disorders (eg retinopathy, glaucoma, cataract and corneal disease). Macrovascular complications include heart disease, stroke and peripheral vascular disease (which can lead to ulcers, gangrene and amputation). Other complications of diabetes include infections, metabolic difficulties, impotence, autonomic neuropathy and pregnancy problems. Also I would like to mention that Erectile dysfunction is one of the most common complications of diabetes mellitus. Many studies have found that Erectile dysfunction is closely associated with cardiovascular risk factors (Solomon H, Man JW, Jackson G, 2003) .The age of the patients has been related to the extent of ED. Erectile dysfunction is less frequent in the young population, although its incidence starts to rise from the fourth decade of life. In patients >60 years, prevalence of ED amounts to about 35% to 40% (Braun M, Wassmer G, Klotz T, et al.2000). Diabetic Retinopathy can be prevented by using laser surgery which is used to shrink abnormal blood vessels. Scatter Laser and focal later treatments are the type of laser surgery used to prevent Diabetic Retinopathy. Also it is important to keep blood pressure and cholesterol level under control.

References:

1. O’Connor P, Spann S, Woolf S: Care of adults with type 2 diabetes mellitus: a review of the evidence. J Fam Pract 47 (5 Suppl):S63-64, 1998.

2. UK Prospective Diabetes Study Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352:837-53, 1998

3. Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med. 2007;120(2):151-157

4. American Heart Association. Statistics Statistical Fact Sheet-Populations 2007 update: International Cardiovascular Disease. http://www.americanheart.org/downloadable/heart/1177593979236FS06INTL07.pdf. Accessed December 24, 2008.

5. http://battlingforhealth.com/2011/02/microvascular-complications-of-diabetes-retinopathy/#ixzz1J0hC11CK

Eliza, you have given a prefect picture of emotion and stress which Belinda is facing. Now a day’s diagnosis of breast cancer is a great shock. Today women fear breast cancer more than heart diseases, even though they have a better chance of surviving cancer than dying to stoke or heart failure (National institute of Health 2008).

As the women being to deal with diagnosis and treatment of breast cancer, their body automatically start reacting to emotions. Their physical response to overall stress may be fear (trouble sleeping, headaches or body aches), Anger (Change of blood pressure), Depression (fatigue, crying. Feeling moody), stress (pain, irritability, tension). Also once women accept her diagnosis, they may also face another emotional concern. The loss of breast or part of breast has a deep impact that goes beyond the physical fact. Moreover if aggressive treatment is required, it may also be long term impact on the health. The fear of recurrence. Loss of attractiveness, difficulty in sexual function and loss of fertility also plays important role to increase the stress.

Every woman who is facing this situation should understand that getting help for emotion is not the sign of weakness. There are certain ways to cope with this emotion. The best is communicate with family and friend, maintaining intimacy with your partner, visiting the counsellor or spiritual person, joining the support team are some of the sign which will make great difference to tackle emotions.  In term of health care practice, Report any symptoms or change to the healthcare team. Always maintain a log of health visit, test result etc. educating yourself about the cancer and the treatment and having regular exercise along with plan for crisis make a huge impact.

References:

1. Journal of the American Geriatric Society. Effect of depression on diagnosis, treatment, and survival of older women with breast cancer. Published January 2004.

2. Journal of Psychosocial Oncology. Examining the influence of coping with pain on depression, anxiety, and fatigue among women with breast cancer. Published 2005.

3. National Institute of Health. WomenHYPERLINK “http://www.nhlbi.nih.gov/health/hearttruth/press/fear_doubled.htm”‘HYPERLINK “http://www.nhlbi.nih.gov/health/hearttruth/press/fear_doubled.htm”s Fear of Heart Disease Has Almost Doubled in Three Years, But Breast Cancer Remains Most Feared Disease. Published 2008.

4. National Cancer Institute. Support for People with Cancer – Taking Time. Published 2005.

5. California Breast Cancer Research Program. Does Change in Emotional Expression Mediate Cancer Survival? Final Report Published 1999.

6. Boehmke, M., & Dickerson, S. (2006). The diagnosis of breast cancer: Transition from health to illness. Oncology Nursing Forum, 33(6), 1121-1127.

7. Ganz, P. A., Coscarelli, A., Fred, C., Kahn, B., Polinsky, M. L., & Petersen, L. (1996). Breast cancer survivors: Psychosocial concerns and quality of life. Breast Cancer Research and Treatment, 38(2), 183-199.

8. Winzelberg, A. J., Classen, C., Alpers, G. W., Roberts, H., Koopman, C., Adams, R. E., et al. (2003). Evaluation of an internet support group for women with primary breast cancer. Cancer, 97(5), 1164-1173.

9. Eysenbach, G. (2003). The impact of the internet on cancer outcomes. Cancer Journal of Clinicians, 53, 356-371.

10. Eysenbach, G., & Till, J. E. (2001). Ethical issues in qualitative research on internet communities. British Medical Journal, 323(10), 1103-1105.

Tracy, you have indeed developed a proper Morden care plan for Christine. Now a days Type 2 diabetes has become common and as well as major health concerns among indigenous people in Australia. Most of them try to avoid and get help from the Morden medicines. They still believe in their traditional beliefs and medicines developed by the elders in their communities. Less physical activities and traditional indigenous diets are the main factors which contribute towards obesity and development of type 2 diabetes among indigenous population. It is found that the main complications for diabetes among the indigenous Australian are renal disease, retinopathy, heart disease and infection, cerebrovascular disease and neuropathy (Australian Institute of Health and Welfare, 2002).

Due to infection and neuropathy factors, most of the indigenous Australian suffers from painful foot related infections (Australian Bureau of Statistics 2006). Most of the admission regarding foot complication requires amputation of toe and further risk.

Even though indigenous Australian tries to avoid Morden medications, there are various factors which can help them to improve their glycaemic control to minimise their micro vascular and macro vascular complications (Couzos S, O’Rourke S, Metcalf S, Murray R 2003). The most important change they can make is in regards to dietary control. It can be maintained by reducing the carbohydrate and mono – unsaturated fat and fibre.  Maintaining and developing physical activities and Exercise also improve glycaemic control. This is good for controlling hypertension and cholesterol level.

It is also very important that education and information should be provided to indigenous Australian who is suffering from diabetes regarding the intake of smoking and alcohol (National Health and Medical Research Council 1997) it is important to inform the diabetic smoker about the risk of smoking and should be encourage to stop. They should also limit the intake of alcohol and should be consumed in strict control manner.

Swot Analysis Of Health Care Organization Mayo Clinic Health Essay

/in /by

Mayo Clinic is the first and largest not-for-profit medical group practice, health care organization initially run as a temporary hospital by the practice of Dr. William and his two sons, William J. and Charles H. Mayo when a Tornado struck Rochester in 1883. Today however Mayo Clinic has thrived into a huge organization with three clinics and four hospitals in three states, employing more than 40,000 physicians, scientists, nurses and allied health workers. In addition, the Mayo Clinic owns and operates the Mayo Clinic Health System, which consists of more than 70 hospitals and clinics across Minnesota, Iowa, and Wisconsin. Mayo Clinic also runs   colleges of medicine, including Mayo School of Health Sciences, Mayo Medical School and the Mayo School of Graduate Medical Education. More than a million people get treated at Mayo Clinic from all 50 states and around 150 countries each year.

Through growth and change, Mayo Clinic remains committed to its guiding principle, as articulated by Dr. Will that the best interest of the patient is the only interest to be considered (Mayo Clinic, 2011). As of 2011 Mayo Clinic had total revenue of $8,476 million which reflects the business success of Mayo even in the time of economic downfall.

Mayo’s Mission Statement

As stated on its website Mayo Clinic’s (2012) mission statement is

“To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research.”

Their primary value states that “The needs of the patient come first” therefore we can say that Mayo Clinic is a patient focused organization.

Environmental Assessment

Mayo Clinic maybe considered as a true national brand of Health Care in America since it is well known. Focus of Mayo Clinic since it was established has been on providing highest quality of care to all patients. The organization steadily focuses on team work and group oriented approach, which is why instead of a marketing strategy its success has been built by work-of-mouth after all these years of quality patient care. This quality is what makes Mayo Clinic differ from other healthcare organizations that also tend to provide same kind of services.

Organizational Assessment

The Environment at Mayo Clinic values strong work ethics and excellence in skills. Expertise is highly recognized and employees tend to show commitment towards their organization. A scholarly environment for education and research is also provided which acts as an edge for the organization. Further physician governance is incorporated in organization’s environment which makes doctors the leaders and provides an egalitarian environment. Mayo Clinic tends to provide exceptional decorum, facilities and professionalism in their service structure. Mayo Clinic realizes that the world is on a rapid quest towards technological advancement. Further employees are the face of Mayo Clinic which is why the organization has taken initiatives like the Mayo Effect survey and using social media which lets employees and patients share their unique experiences at Mayo Clinic (Donlin, 2010).

Human Resource Assessment

Mayo Clinic has long followed the philosophy of its founders which states that since medical knowledge is so cast it is impossible for one man to excel in it. Therefore best interest of patient which is to get benefit from advance knowledge combination of various forces is vital. Due to which it is necessary to incorporate cooperative science including clinician, specialists, and laboratory workers to work in a group oriented approach focusing on the elucidation of problem at hand. Mayo has inhibited a culture of teamwork and collaboration since its founding a tradition which is conserved through scrupulous recruitment procedure (Ramlall, 2009). Mayo Clinic provides facilities like online shared clinical record for peer review, paging system and salary based compensation to its employees. Further the employees are free to practice multi disciplines and enhance their skills and knowledge in the research centers.

Political Assessment

Several acts were enacted in the presidency of President Obama like Patient Protections and Affordable Care Act. This act restricts insurance companies to drop people when they get sick, it allows young adults to stay on their parent’s health plans till the age of 26 and likewise. These policies tend to facilitate general public on their health care. Health Care Organizations are also directly affected by such policies since non-profit organizations depend on grants and funding from the government. Right now the health care bills are how ever being criticized for their not so positive role in improving the health care condition of Americans.

SWOT Analysis

Strengths

Research and Innovation

Mayo Clinic tends to give a lot of attention to Research and education activities. The teams at Mayo are involved in multidisciplinary a research which helps in rapid discoveries of new treatment and prevention techniques.

Focus on Quality

At Mayo Clinic quality is the in-depth outlook on the experience of a patient. Mayo tends to focus on excellence in knowledge and expertise, care, compassionate staff and technology. Measures of quality are mortality rate, surgical infections, and number of people who have been successfully diagnosed along with the integration of confidential medical record. Mayo Clinic also tends to measure quality in the time given to patient, treating with respect and dignity and making sure that the appointments are on time along with the availability of the doctors.

Integrated Medical Record System and Team Work

Mayo has incorporated a patient scheduling system which allows assigning patients to physicians and organizes the patient’s time at clinic. The system records important details like availability of the patient, laboratory tests, comments by doctors and any other diagnosis being given. Doctors can check patient’s previous history and this way multiple doctors work as a team through this system in treating a patient.

Weaknesses

Even though Mayo Clinic has high quality care system and a patient focused multidisciplinary force yet there is room for improvement like

The affiliated regional medical groups researched that the ambulatory care of Mayo Health System ranked below regional average of 12 as of 2008.

A variation in the intensity of care was found at the Dartmouth researchers found “surprising variation” in the end of life intensity of care among patients treated at different Mayo Foundation Hospitals which requires Mayo to show more consistency across hospitals.

As Mayo Clinic brings people from different cultures to work together if a diversity synergy is not created it may cause any conflict inside the organization

Opportunities

The translation of research into practice has always been an opportunity creator for Mayo Clinic. Since their research centers provides innovative systems approach to disseminate benefits of research discoveries in daily medical practice which generates room for new treatments and diagnosis.

Mayo Clinic tends to focus on in affiliations to expand its reach into new states and build a larger. In 2011 incorporated a Mayo Clinic Care Network which helps it to affiliate with other hospitals and broaden its scope (The Advisory Board Company, 2012).

Threats

Salary-based compensation system may increase the fixed cost of the hospital

Lack of highly qualified medical practitioners in America

Criticism on researches and innovation by competitors and other authority officials

Increasing number of physicians are likely to demand reimbursement for input, call and other activities in future

Recommended Strategies for the Future

According to Dr. Schwenk three interrelated forces are the pillars on which success of Mayo Clinic rests. First is Salary-based compensation plan for doctors along with multidisciplinary practices which tend to enhance patient care in a group oriented approach. Secondly the well-integrated technological infrastructure along with focus on research and innovation. Last but not the least a business model which states that best interest is focusing on the best interest of the patient and putting patient first.

However along with these strategies there are few additional strategies which Mayo Clinic might need to work on. First is expansion of heath care facility units as according to research due to aging population of the baby boomers in a few years there will be an increase in the number of people looking for quality treatment and Mayo Clinic right now is accommodating maximum number of patients.

Secondly Mayo Clinic needs to find new ways to raise funds for its research programs, since they are unable to continue most of their groundbreaking researches due to lack of funds. Like a research on delaying degeneration of the tissues in 2011 was denied funds since the funding organization’s reviewing committee did not find it up to the mark (Wade, 2011). This might discourage the innovative approach which Mayo Clinic is known for.

Furthermore Mayo Clinic needs to justify its investment policies since it was highly criticized for investing $180 million in building a proton beam treatment facility which critics claimed was even yet proved to be worth the amount (Emanuel & Pearson, 2012). Mayo Clinic should not pose such strategies which make people think that it is only trying to compete with its rivals like Massachusetts General Hospital.

Lastly quality control and improvement techniques like Lean Operations and Six Sigma are being incorporated in Health Care Sector. Mayo is also implementing them in their business model but the management might face resistance while changing the historic practices and bringing new practices in the hope of improving patient access, cost reduction and improved quality.

Motivational Interviewing for Smoking Cessation

/in /by

  • YEOH ENG SENG

Maria (titanium number: 47144) is a retired, 65-year-old lady who visited the clinic, for the replacement of her teeth in quadrant 4 (#33-36) after the removal of the old bridge and the abutments by a private dentist due to weakened abutments.

According to the patient, her last visit to the dentist was 2 weeks before her first appointment with me. It was for the removal of the residual root of 44 which served as one of the abutments for the previous bridge. Maria brushes her teeth twice a day, using a soft bristle toothbrush and fluoridated toothpaste. She also flosses and rinses her mouth with Listerine mouthwash twice a day.

The patient has underlying cardiac arrhythmia, chronic bronchitis, fracture on vertebrae T5 and T7, depression, fibrocystic breast, hypertension, sciatica leg, scoliosis, type 2 diabetes and osteoarthritis on her rotator cuffs as well as her knees. She is allergic to resedronate sodium.

Socially, Maria is a smoker and she smokes 15 cigarettes a day since she was 17 and she is not thinking of quitting. She drinks occasionally.

Upon oral examination, her oral hygiene is generally good with some mild plaque and calculus deposition. Her PSR score was 0 for all sextants, suggesting no active periodontal disease but generalized gingival recession was present. Her #24-27 as well as #34-36 was replaced by bridges. There were restorations on almost all of the dentitions with only 4 sound teeth. However, no active carious lesion was found.

Tobacco smoking can cause damage to almost every system of the human’s body, contributing to a variety of diseases thus increasing the mortality rate.

1

Moreover, studies have shown that smoking can affect oral health in diverse manners such as increasing occurrence of oral cancer, periodontitis as well as causing teeth discolouration.

2

Therefore, it is the responsibility of a dental practitioner to address this issue. In Maria’s case, the habit of smoking is rather alarming because it not only can affect the oral health but her general wellness. From her medical history, it has been shown that she is suffering from multiple diseases that can be modified by tobacco smoking. Most significantly, smoking is the major cause of chronic bronchitis and can further exacerbate the symptoms.

3

Hence, motivational interviewing was attempted to help Maria in quitting smoking.

I started the motivational interviewing session by exploring the stage of change Maria was at. According to Maria, she has thought of quitting but it was very difficult because smoking provide her a means to relieve anxiety and depression. She also expressed that she was not ready to quit. From here, it can be deduced the she is at pre-contemplation stage. Subsequently, I asked for her permission to discuss about this issue, emphasizing that the decision of quitting is up to her. She agreed and in return, I give affirmation by thanking for her willingness to talk about quitting.

To elicit the ‘change talk’, I started by further exploring the source of her barrier. She told me that her medical conditions and the need for surgery were making her depressed. From here, I presumed that her concern about health could be a good motivator. Then, I asked her the reason as to why she has thought of quitting. In response, she said that she wanted to be healthier and that she was aware of the disadvantages of smoking as her GP had always advised her to quit. Furthermore, smoking had also become a financial burden for her. At this point, I summarized that her goal was to improve her health. Hoping to develop a discrepancy between smoking and her goal, I asked her to think about the advantages of quitting smoking. She replied that by quitting smoking, she might be able to become healthier and save some money. When I asked her about her ability to make the change, she replied with ‘I really don’t know.’ As I was facing resistance, I tried to find an alternative question. When she was asked about what she would do to make the change, I got a similar reply ‘I am not sure.’ With her permission, I introduced her to the quit line. Finally, I concluded with reiteration of the discrepancy between smoking and her goal to become healthier.

A brief evaluative session was done before a restorative procedure when I updated her medical history. She told me that she just had a biopsy done, suspected with breast cancer and still using cigarette to relieve stress. Due to time pressure, the session stopped here.

Judging from Maria’s response during the conversation, it can be seen that although I have successfully encouraged her to think and talk about the issue, the intention of quitting is low. The response ‘I really don’t know’ and ‘I am not sure’ suggest that she is highly in doubt of her ability to quit. In addition, it is clear that cigarette as a stress reliever is a strong ambivalence that stops her from quitting.

I feel that the session was a good start for both Maria and I but there is still a lot of improvement needed. To illustrate, I lack the experience in giving appropriate affirmations. There were a few instances where my affirmations were rather awkward. Besides, I need to improve my skill in complex reflection. For instance, when she talked about the source of depression which was her health, I could have leaded her to a new thought whereby smoking cessation can improve health and hence, reducing the source of depression. I could have also asked Maria to compare the advantages and disadvantages of smoking. This might help her to recognize her goal and ambivalence better. As she has low confidence in quitting, there should be more discussion as to how help could make a difference.

4

In conclusion, motivational interviewing can be a good approach to induce behavioural change in patients however practice is needed to develop the skills and to execute it effectively.

References

  1. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’observations on male British doctors. BMJ 2004; 328:1519-1528.
  2. Sham AS, Cheung LK, Jin LJ, Corbet EF. The effects of tobacco use on oral health. Hong Kong Med J 2003; 9:271–277.
  3. Rebecca JT, Frank ES, Bernard R, Dimitrios T, Walter CW. Cigarette Smoking and Incidence of Chronic Bronchitis and Asthma in Women. Chest 1995; 108(6):1557-1561.
  4. David B. Rosegren. Building Motivational Interviewing Skills: A Practitioner Workbook. 1 edn. Washington: The Guilford Press, 2009.

The management of wound dressings whilst on placement

/in /by

This reflective piece will look at the management of wound dressings whilst on placement in the community. I will use the Gibbs model of reflection this will allow me to describe the event, explore my thoughts and feelings, make an evaluation on the event and then analysis different components which can be explored separately including different dressings and why they are used, finally I will conclude and action plan looking at if this happened again what I would do differently.

Whilst on placement in the community I visited a lady who had chronic leg ulcers on both legs and the district nursing team had been visiting this lady for a number of years. The lady had oedematous legs and poor mobility and sat in a recliner chair although the chair was never reclined. I had visited the lady previously on a number of occasions and had applied her dressings and documented what I had done and the dressings used in her district nursing records. On this occasion the lady requested that I didn’t put the K-lite dressing on and allows the other nurse do this, as previously when I had dressed her legs she stated the dressing had become loose.

I mapped the dressing so that the notes had an up to date record of the size of the wounds and washed and redressed the legs as per the plan of care. The plan of care stated to wash the legs apply aqualcel ag silver this is used for wounds that have a high level of exudates, then atruman was applied covered by mesorb, comfifast yellow then K-soft and then I passed over to the Registered Nurse (RN) to apply the final layer, whilst she applied the final layer I documented the notes that the leg had been mapped, washed and redressed as per the plan and noted that strikethrough was on the dressing prior to removal I also noted the patients level of pain at the time of the cleaning and mapping of the wounds and also after the legs had been redressed. I documented the patient’s records that the patient had been advised to elevate the legs when resting to aid healing.

When the patient advised me that she would prefer the RN to do the top layer I felt like my confidence had been knocked. The patient had never said this before and always stated not to wrap the dressings too tight as she found it very uncomfortable. I told her that I didn’t do them too tight as she always stated not to do so and apologised to her that they had fell down and in future would ensure that they weren’t too tight but would not fall down either. When I left the patients house with the RN she told me that this lady does this to all the new nurses that visit her and not to worry about it.

Pressure sores and leg ulcers are classed as chronic wounds and are defined as slow healing wounds with the likely hood of reoccurrence and the pain that a patient feels may be severe and ongoing (Dealey 1999). The dressing plays a major part in the reduction of pain and by choosing the wrong dressing this can cause discomfort when removing the dressing and the nurse needs to avoid this by using careful assessment prior to administering the dressing (Dealey 1999).

For a wound to heal the key is to have successful wound management, the nurse should use a wound assessment tool this will ensure that there is valid reliable and also consistent information documented. Wounds need to be regularly reassessed to ensure that evaluation is given on the treatment that the patient has received. When making a wound assessment this should include the location of the wound, the cause, etiology, tissue type the size and the exudates and finally the level of pain the patient is experiencing (Prescribing Nurse Bulletin). To achieve optimum healing the role of the nurse is to be able to select the most appropriate dressing for the wound, this is to be based on the most up to date evidence, and recent development of new dressings makes this a challenge for the nurse (Lansdown 2004).

The wound should be assessed for slough and necrosis, signs and symptoms of infection and wound malodour. The patients records need to be documented to state if the wound is healing, e.g. granulisation and epithelisation (White 2005).

The ideal wound dressing that will meet the treatment objective and promote the wound from further injury would be a moist wound healing dressing, that manages excess exudates and prevents the wound from maceration and further wound breakdown, ensure that it prevents the exit and entry of organisms, it will cause minimal trauma at the time of removal and is cost effective (Northern Health and Social Services Board NHSSB 2005). One important factor in wound dressings is to ensure that dressings get the maximum exposure to the wound bed. This can be achieved by a dressing that decreases the voids and spaces where bacteria can thrive (Jones etal 2005).

Aquacel Ag dressings contain Hydro fibre Technology and it gels on contact with the exudates and micro-contours to the wound bed this helps to eliminate voids or spaces where bacteria and fluid can collect it maximising exposure of the wound to antimicrobials. It is presented as a soft sterile, non-woven pad and is impregnated with ionic silver (Aquacel Ag 2006). This dressing can absorb a large amount of fluid and helps to prevent exudates leakage onto the periwound skin. The dressing can be left in place for up to 7 days however should strikethrough be evident on the dressing then the dressing needs to be changed (NHSSB 2005).

It has been recognised that silver is an effective antimicrobial agent (Thomas and McCubbin 2003). It has proved that it is effective against methicillin and vancomysin-resistant strains of bacteria (Lansdown 2002)

Atrauman dressings are made of a fine mesh of hydrophobic, polyester fibres and have mesh pores with a smooth surface this effectively counteracts adhesion to the wound by preventing new tissue from penetrating the dressing and allowing the exudates to pass through, this means that the dressing is easy to remove and causes minimum discomfort to the patient and also to the wound. The dressing is highly permeable to air and water vapour and has been found to be very well suited to the management of infected wounds (Hartmann 2010).

In recent years Honey has been found to benefit wound healing, clinically topical honey treatment has been found to possess antimicrobial properties, promote autolytic debridement, deodorise wounds and stimulate the growth of wound tissues to quicken healing, it also stimulates anti-inflammatory activity helping to reduce pain, oedema and exudates (White 2005). A fast rate of healing has been reported in wounds treated with honey (Ahmed 2003) it helps the developing of a clean granulating wound bed (Stephen-Hayes 2004)

It is clear that wound management is a complex area and the it is the nurses responsibility to ensure that they give the correct care to the patient and they use the dressings that are selected on their knowledge and understanding of what the dressing will achieve they need to be constantly aware of new products available to treat the wounds. By regular assessment of the wound they will be able to see if the dressing selected is helping to promote wound healing.

I am aware that if I wish to work in the community I would need a good knowledge of dressing that is used in wound management. I know that I am likely to meet patients who try to make me doubt my ability however this is something that I know I will over come as my confidence builds and I become more used to working in the community.

What does it mean to have a commitment to diversity and how would you develop and apply my commitment to diversity at the school

/in /by

What does it mean to have a commitment to diversity and how would you develop and apply my commitment to diversity at the school

 

Personal/Goal Statement

Order Description
Personal Statement describing my objectives in undertaking family nurse practitioner doctor of nursing practice program FNP DNP( main areas of clinical study and/ or health issues i wish to pursue, specific focuses within this area, short and long term goals,outcomes i wish in relation to my identified area of clinical study, facilitating my career goals i.e how the program will help in attaining my career goals and educational goals, e.t.c), my special interest, plans, strengths and weakness in my chosen field. Significant life experiences that have contributed to my development such as honors, activities, and accomplishments that make me a unique applicant, describe experience with evidence based practice.

Comment on my clinical practice experiences and how they have informed my choice of speciality . Describe how i will contribute e.g through education, research, and practice to enhance the health and quality of life for people of all cultures, economic levels, and geographic locations. Describe how you and the program is a good match ( why did i select the school)? Please address your specific interest in your chosen program.

The mission of the University is to transform healthcare and policy through knowledge and education of future leaders from diverse backgrounds. The vision is to be a preeminent leader in advancing global health and nursing. Please comment on how i can contribute to the mission and vision as a student and future alumnus.

Please comment on what i see major challenges that i will need to overcome (i.e financial constraints, family responsibilities, job) in pursuing the degree. what are my plans for addressing these challenges.

What does it mean to have a commitment to diversity and how would you develop and apply my commitment to diversity at the school

Mental Health Support for Youth Depression

/in /by

Introduction

Feeling sad, unhappy, or “down in the dumps” occasionally is not unusual, however when these feelings outweigh a youth’s happiness or excitement it is concerning. Depression is a common and severe disorder amongst adolescences. Depression has lasting effects on an individuals’ feelings, thoughts, self-worth, behaviors, social relationships, physical functioning, biological developments, work productivity, and life fulfillment. It is a common psychiatric disorder that often affects adolescences and has been ranked as the fourth leading cause of disability and early death worldwide. Depression not only affects emotions but is a serious condition which makes coping difficult and leaves a person feeling sad most of the time. Feelings of sadness and low self-worth are overwhelming and can last for weeks, months or even longer for individuals (Beyondblue, n.d.).

Incorporating mental health programs into the lives of youth is valuable to send a message to individuals that depression is treatable, people can help, and that things can improve. Children and adolescents spend a considerable amount of time at school, and it is necessary for schools to offer mental health programs that include prevention and intervention services targeted at youth suffering from depression (Stallard, 2013). This paper will discuss the causation of adolescent depression, physical manifestations, educational supports, and professional supports.

Causation

Everyone experiences depression differently and there is not an easy answer for why youth develop the condition, but there is a combination of reasons. It is a mental illness that significantly affects youth. Depression is more common amongst girls than boys but boys often find it hard to share their feelings (Beyondblue, n.d.). Some of the

common causes

of youth depression are the same as adults such as biological causes, stress, and trying life events. Other causes of youth depression include parenting, substance abuse, and low self-worth (Coleman, Walker, Lee, Friesen, & Squire, 2009). According to Mental Health America, depressed youth can have too much or too little of certain brain chemicals which also causes depression. Other sources of depression are having a family history of depression, side-effects from medications, and persistent negative thought patterns (Depression in Teens, 2016,).

It is normal for people to feel sad or discouraged at times because we all feel these emotions at some point due to various life events. Such life events like fighting with a friend, a breakup happening, getting a poor grade on an assignment or test, or the death of someone can all create feelings of sadness or disappointment. Non-depressed individuals experiencing these events and feelings manage to deal with the emotions and get past them with a little time and care. However, depressed people experience these events differently because the feelings last longer and affects not only the person’s mood but their thinking too (Lyness, 2016,).

Many things can change how we think, feel, and behave; however stressful life events can cause youth to

develop depression

. Symptoms might present with feelings of sadness, distress, and anxiety, however over time they become more intense and overwhelming. Prevalent causes of depression in youth are loss and grief, bullying, alcohol and drug use, low self-esteem and body image, discrimination, physical health problems, life events, family breakups, and loneliness. Stress is another common factor in an adolescent’s life and when young people are under stress, it can increase their likely hood of developing depression. At times problems can seem too big and overwhelming to solve, but the best thing adolescents can do is talk to someone. Youth who take steps and recognize how they feel are on their way to recovery (Andersen, & Teicher, 2008; Beyondblue, n.d.).

Physical Manifestations

One in five youth suffer from clinical depression, and more than 25% of adolescents will experience a major depressive disorder by age nineteen. Depression is also prevalent amongst 1% of the population under age twelve, but between age fifteen to eighteen is dominant amongst 17% to 25% of youth. Depression is not an easy diagnosis amongst youth because they have different signs compared to adults. Moodiness amongst youth is common, but when it lasts for more than two weeks help should be sought. Adolescents are likely to be irritable without visible signs of sadness. On the other hand, depressed youth will have low school performance, withdraw from friends and activities, feel hopeless, lack enthusiasm and energy, overreact to criticism, have low self-esteem, lack concentration, feel restless and on edge, have a change in eating and sleeping patterns, develop problems with authority, and exhibit suicidal thoughts or actions. Young people feeling depressed have increased feelings of irritability, sadness, stress, anger, restless, and over analyze what is on their mind. Other feelings youth might experience are guilt, worthlessness, frustration, unhappiness, indecisiveness, and disappointment (Depression in Teens, 2016).

Adolescents experience more emotional and behavioral problems than do non-depressed youth. Young people who are depressed can have co-occurring disorders such as anxiety, difficulties paying attention and hyperactivity, aggression, substance use, and Post Traumatic Stress Disorder (PTSD) symptoms. Youth who are experiencing depression not only have personal issues, but their social relationships are affected too. Depressed adolescents feel unsupported by friends and adults. Youth also show more signs of a lack of interest in activities they find enjoyable, feel extremely sleepy throughout the day, have a decreased ability to think and focus, feel deeply saddened, and suicidal. Suicide unfolds with age, therefore before the age of ten it is rare for children to have suicidal thoughts or actions, but increases between the age of ten and fourteen, and rises ten times higher in youth ages fifteen to nineteen (Andersen, & Teicher, 2008).

Educational Support Implications

Since depression is a common mental health diagnosis amongst youth, it is important to know depression screening is one possible method for managing depression. Then again, there are risk factors for screening youth. A few risk factors are testing is costly, it can cause harm to some people due to misdiagnoses and in proper treatment, and there could be false positive results if screening tools are not administered properly. Across the United States, screening programs have been implemented in some schools and medical settings. Screening is an early intervention to help detect signs and symptoms amongst youth who otherwise show none. Depression symptom questionnaires and small sets of questions are used for testing to identify individuals who may have current depression that has not been recognized (Thombs, Roseman, & Kloda, 2012).

Depression is not easy to determine amongst youth due to the different symptoms, on the other hand few children are identified and referred for treatment. Schools are natural and convenient setting for mental health prevention programs to be offered. Youth regularly spend a substantial majority of their time at school. Many adolescents who have depression have no contact with mental health services. Schools can provide universal programs to target all youth regardless of risk, or they can provide selective interventions which target selected groups with an increased risk. When providing a global approach schools can cover a larger population and mental health is less stigmatizing; however, the programs can result in smaller treatment effects. Programs can be appealing and have a significant impact on mental health if supported and implemented correctly (Stallard, 2013).

At school youth also need to be able to talk with a counselor or social worker about their feelings. They also need to be provided with adequate daily exercise, exposure to daylight, and healthier eating options. School personnel can teach relaxation skills to help increase sleep and decrease feelings of worry. Many adolescents find it beneficial to confide in and talk to a trusting adult. Educators can listen and show empathy, remind the youth that things can get better and that they are there for them, help them see things that are already good in their life, find enjoyable things to do, and give honest compliments and smiles. Youth need to be educated on how to manage sad feelings. In order to help youth gain positive coping skills, schools need to provide educational curriculum on eating healthy foods, getting the right amount of sleep, exercising, taking time to relax, and taking time to notice the good things in life (Lyness, 2016, August). Schools can be a common place for students to see a mental health professional; therefore, it is important for schools to have effective school-based programs to address mental health issues in the schools.

It is vital for schools to provide school personnel opportunities for training in recognizing youth depression. Classroom teachers have contact with students throughout the school day and are likely to see changes in students’ behaviors. Not only is it important to recognize depression in youth, but it is necessary to evaluate and treat depressed adolescents. School counselors, school nurses, school psychologist, and school social workers can help students experiencing depression, especially if youth are not receiving professional outside counseling. These school personnel are trained to recognize and plan for mental health issues in students and should be utilized to help students with depression. School mental health professionals can screen students for mental health, develop interventions and plans, provide prevention programs, and provide individual or group counseling. Although schools have resources, to be most helpful, schools should connect with resources outside of school (Beyondblue, n.d.; Stallard, 2013).

Professional Supports

Youth struggling with depression need immediate treatment because if left untreated it can lead to death. Some adolescents may refuse treatment; however significant adults in their life can seek professional help. Depressed youth should see a therapist to assist them in understanding why they feel the way they do and to learn how to use coping skills to handle stressful situations. There are individual counseling options available along with group and family counseling opportunities. When working with a mental health professional, youth may be presented with the possibility of medication to help feel better. Several factors contribute to youth depression, but prompt and appropriate treatment are critical in helping youth cope with depression. When working with a therapist young people can do psychotherapy, cognitive-behavioral therapy, interpersonal therapy, and medication (Depression in Teens, 2016).

With the right care and treatment, depression can get better and easier to manage. Individuals who are depressed should not wait to get help because things can only get worse. Youth who feel depressed should talk to a parent or an adult and get the right help. A medical doctor can provide a checkup and look for symptoms causing depression. Different medical conditions that might cause depression include hypothyroidism and mono. Another resource for youth is to utilize a therapist or counselor to talk about his/her emotional state. Speaking to a counselor or therapist allows individuals to understand emotions, put feelings into words, feel understood and supported, builds confidence, increases problem-solving skills, helps change negative thinking, increases self-worth, and increases experiencing positive emotions (Lyness, 2016).

Conclusion

Youth depression is growing at a fast rate. When young people are feeling down, they can try to make new healthy friendships, participate in sports, a job, other school activities, or hobbies, join an organization, and ask a trusted adult for help. However, sometimes these will not help an individual, and they become depressed (Depression in Teens, 2016, December 08). Even though schools provide mental health programs for youth at risk, many students with mental health diagnoses are being untreated. In schools, it is common for school counselors, school nurses, school psychologist, and school social workers to provide mental health services to students. Schools are a safe place for youth to become educated positive, healthy ways to cope with stressful life circumstances. Depression can go unrecognized because people do not realize they are depressed, it might be misunderstood as a bad mood, or some people with depression have co-occurring mental health issues. Without recognition of a change in mood, thoughts, and behaviors many depressed adolescents will turn to unhealthy coping mechanisms such as alcohol, tobacco, and drugs; therefore, depression education for all individuals is essential (Depression in Teens, 2016).

References

Andersen, S. L., & Teicher, M. H. (2008). Stress, sensitive periods and maturational events in adolescent depression.

Trends in Neurosciences,31

(4), 183-191. doi:10.1016/j.tins.2008.01.004

Beyondblue. (n.d.). Retrieved July
6, 2017, from

https://www.youthbeyondblue.com/understand what%27s-going-on/depression

Coleman, D., Walker, J., Lee, J., Friesen, B., & Squire, P. (2009). Childrens Beliefs About Causes of Childhood Depression and ADHD: A Study of Stigmatization.

Psychiatric Services,60

(7). doi:10.1176/appi.ps.60.7.950

Depression in Teens. (2016, December 08). Retrieved July 07, 2017, from

http://www.mentalhealthamerica.net/conditions/depression-teens

Lyness, D. (Ed.). (2016, August). Depression. Retrieved July 06, 2017, from

http://kidshealth.org/en/teens/depression.html#

Stallard, P. (2013). School-based interventions for depression and anxiety in children and adolescents.

Evidence Based Mental Health,16

(3), 60-61. doi:10.1136/eb-2013-101242

Thombs, B. D., Roseman, M., & Kloda, L. A. (2012). Depression screening and mental health outcomes in children and adolescents: a systematic review protocol.

Systematic Reviews,1

(1). doi:10.1186/2046-4053-1-58