Learning Difficulties: Causes

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Learning Difficulties


LO. 1 – Explain what is meant by “learning disabilities”, and outline their possible causes and manifestations.

The term and definition of learning disability has its controversies and ambiguousness and the term means different things to different people having various cultural and medical connotations. Individuals identified as having learning difficulties are recognized and understood by the communities in which they live, the personal services they need, and the kind of support they expect. Yet, generally Learning Disability can be defined as a cognitive disorder that adversely affects people’s ability to interpret visual and auditory information or to link different pieces of information from different parts of the brain to integrate them in a coherent manner. There is thus an apparent lack of integration and coordination of information (see Emerson et al., 2001). These limitations as revealed through learning disabilities can be manifested as specific difficulties with coordination, attention, spoken and written language, or even self-control. Difficulties in learning also affect schoolwork and can lead to impediments in learning to read and write.

According to the Department of Health, Learning Disability can be defined as


‘A significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), with, a reduced ability to cope independently (impaired social functioning) and which started before adulthood, with a lasting effect on development.’

(DOH, 2001 p14)

Specifically in Scotland the term learning disability is used to describe:


‘ those with a significant, lifelong condition that started before adulthood, that affects their development and which means they need help to understand information, learn skills and cope independently

.

‘

(Scottish Executive, 2000)

According to the British Institute of Learning Disabilities, (BILD), Learning Disability is just a label. BILD points out that the term learning disability is being increasingly replaced by the term learning difficulties and as given by the Warnock Committee ‘learning difficulties’ is a term used ‘to cover specific problems with learning in children that might arise as a result of a number of different factors, eg medical problems, emotional problems, language impairments etc’ (BILD, 2005).

There can be different types of learning disabilities that can be categorized into three broad groups:

Learning Disabilities related to developmental speech and language disorders.

Learning Disabilities associated with academic skills disorders

Learning Disabilities associated with coordination disorders, learning handicaps and problems in integration of information

For deciding that someone has learning disabilities, three diagnostic criteria are used:

  • Intellectual Ability
  • Legislative definitions of learning disability
  • Social competence.

Learning disability can also be classified into two main categories and the causes can be genetic or environmental.

Learning disability can occur due to several different types of causes. Impairments causing learning difficulties can occur before, after or during birth. Before birth reasons can be congenital and include Down syndrome, Turner syndrome, Hurler syndrome or Fragile X syndrome. Oxygen deprivation during birth and postnatal illnesses, brain injury or meningitis can lead to learning disabilities and impaired cognitive development. Environmental factors leading to learning disabilities can include infections, trauma, drugs or social deprivation and neglect (Watson, 2003). As we have already mentioned particular types of learning disabilities are associated with particular kinds of manifestations and specific learning characteristics.


LO.2 – Estimate the prevalence of learning disabilities and appreciate the impact that this may have on professional health care practice.

The incidence and prevalence of learning disability is difficult to determine as the only manifestations of learning disability that can be detected at birth are clear syndromes like Down syndrome and the majority of infants with learning disabilities go undetected till much later. Delays in children’s cognitive development help ascertain whether they have learning disabilities. Prevalence of a disease or a general condition is the estimation of the number of people affected as a proportion to the general population. If IQ is used as an indicator of learning disability, then many people with learning disabilities go unaccounted for. Administrative prevalence of any such condition refers to the number of people that are provided with some form of service from caring agencies.

The general consensus is that the overall prevalence of moderate and severe learning difficulties are 3-4 people per 1000 in the general population (DoH, 1992). The prevalence of severe to moderate disability has been recorded at 3.7 per 1000 population whereas the prevalence of mild learning disability seems to affect 20-30 per 1000 of the general population. Further it has been observed that among 3-4 persons in 1000 within UK suffering with learning disabilities nearly 30% report severe or profound learning problems. Within the group of individuals suffering from severe learning difficulties most also suffer from multiple physical and sensory impairments as also behavioral difficulties.

These individuals require lifelong support to maintain themselves and to achieve a level of lifestyle. Emerson et al (2001), have suggested that within UK there are some 230,000-350,000 persons with severe learning disabilities, and around 580,000-1,750,000 persons with mild learning disabilities. They also suggest in their study that there are differences in male and female prevalence rates and incidence of disabilities with males showing higher prevalence than females.

Enable et al. (2003) have suggested that the number of people with learning disabilities has increased by 1.2 % a year over the last 35 years and since 1965 the number of people with severe learning disabilities has increased by 50%.

There are many controversies on the validity and use of epidemiological data and on prevalence and incidence rates of learning disabilities. All children with learning disabilities are not reported and in most cases it is difficult to understand the symptoms of learning disability until at a much later stage. One of the major problems is the argument that collection of data on disabled individuals invariably leads to labeling and brings in concerns as to whether such discrimination is useful or necessary. However some scholars have argued that labeling helps in identifying the disabled individuals and ensures that special needs of such people are met through adequate care provisions. Incidence rates and prevalence data on learning disabilities are helpful in clinical practice as it provides an estimate of the nature and extent of support that healthcare services should be prepared to provide.


LO.3 – Describe how people with learning disabilities have been misunderstood in the past and how this may affect contemporary provision of health care for them.

Attitudes and beliefs about people with learning disabilities have changed rapidly in the last few decades and have consequently shaped healthcare provisions available to this group of people. Models of social inclusion and community care have replaced traditional models of institutional care and there is more emphatic appreciation of civil and human rights of individuals with learning disabilities. It has been argued that the rate of change in services to disabled individuals has been slow in Scotland as compared to other parts of Britain, but this has also helped enable accurate assessment and greater response to fulfilling needs of people with learning disabilities. Social care policies by the Department of Health, legislative definitions of learning difficulties along with human rights campaigning for such people and increased spread of awareness that learning disability is more of a convenient label, have altogether led to improved conditions and stronger commitments to provide a more person centered approach to care than before.

People with severe or moderate learning disabilities were regarded as mentally deficient or retarded and since the implementation of the Mental Deficiency Act in 1913, it was recommended and all mentally retarded be categorized according to the level of disability and by 1929 100, 000 mentally retarded individuals were institutionalized in the UK. Although in the early 19th century, institutional care for patients with learning disabilities aimed at modifying or changing mental defect, this was quickly replaced by a philosophy of control and coercion in custody. The initial institutionalized ‘colonies’ were changed to long term hospitals following the NHS 1946 Act. By the 1950s and 1960s the concept of custodial institutionalized care for learning disabilities was questioned and there was an eventual introduction of community care.

In 1971 the White Paper

‘Better Services for the Mentally Handicapped

‘ was introduced in Great Britain and the care philosophy was led by the concept of normalization rather than segregation. This was aimed to increase social participation and greater social roles of individuals with learning disabilities to integrate them in mainstream society. The contemporary provision of health care as set by the Department of Health or NHS gives emphasis to schedules of community care, social inclusion and social participation of individuals with learning disabilities and discourages institutionalization.


LO.4 – Define the concept of inclusion and identify barriers that serve to exclude people with learning disabilities from mainstream services.

Introducing the strategy for services supporting people with learning disabilities in England, the Department of Health (2001) has described social inclusion in the following words:

‘Being part of the mainstream is something most of us take for granted. We go to work, look after our families, visit our GP, use transport, go to the swimming pool or cinema. Inclusion means enabling people with learning disabilities to do those ordinary things, make use of mainstream services and be fully included in the local community.'(p24)

People with learning disabilities have long been marginalized and excluded from society not only regarding social issues but also indirectly on decisions about their own lives. The Human Rights Act 2000 has also stressed on the basic fundamental rights of such individuals and this has given them a voice and strength in society. Whether it is choice of career or access to health services, the individuals with learning disabilities now have many options, and varied preferences. According to Jenkins et al (2003), ‘an inclusive approach recognizes that formal and informal elements of the wider society need to change or adapt to enable excluded people to use opportunities and services.’ This explains the general approach in providing care to individuals with learning disabilities and the aim is to help them adapt and merge with the mainstream society with increased opportunities and special services.

Yet there are major barriers to providing such individuals with the advantages of normal provisions and services. Some of these barriers include the nature of the problems that can involve severe physical or mental impairment. Factors identified as impediments to social inclusion of learning disabled individuals can be the process of ‘labeling’ itself which discriminates socially healthy individuals from the disadvantaged ones. Although labeling has it won advantages, identifying individuals as disabled can lead to special exclusion and discrimination in areas of jobs, lifestyle or social participation.

Although the situation has drastically improved after recognition of human rights needs of the learning disabled, the disadvantaged people’s own low levels of motivation, heightened social anxiety, discomfort in social participation, feelings of inferiority and practical problems in not being able to perform normal physical activities are common barriers to a health social life for these individuals. The mindset of people towards disadvantaged individuals may be changing but needs to change even further. Several associated illnesses, physical, visual, language deficiencies, special health needs such as weight problems, requirements in special schools and education needs are also some of the barriers that impede the active participation of such individuals in mainstream society.


LO.5 – Identify the main additional health problems faced by people with learning disabilities, and the consequent challenges posed to mainstream health services.

Some of the associated health problems in people with learning disabilities are

  • Mental illness such as schizophrenia, anxiety and depression and also challenging behavior such as aggression and self-injury. Prevalence rates of mental health illnesses are greater among individuals with learning difficulties than among the general population. Learning-disabled persons are also categorized as mentally deficient or retarded as they may not be able to perform intelligence tests due to their learning problems. Thus such people may be categories as having severe intellectual difficulties resulting in subnormality or abnormality. Abnormal conditions are however more of psychopathic disorders found widely in these individuals.
  • Epilepsy shows higher prevalence rates in persons with learning disabilities than in the normal population. The British Epilepsy Association has estimated that there are nearly 200,000 people with learning disabilities severely affected by the learning disability disorder. (BILD, 2001)
  • Physical and Sensory disabilities are common in people with learning disabilities as visual and auditory impairments are common in such conditions. Hearing impairment is found in individuals with Down’s Syndrome and these additional disabilities are also associated with the fact that the persons with learning problems do not get support as far as using other devices are concerned.
  • Complex health needs are common among people with learning disabilities and issues such as weight problems, or lack of a balanced diet are barriers in the betterment of such individuals. Significant numbers of people with such conditions do not engage in required amounts of physical activities and there is also a general lack of awareness about the amount or nature of diet that should be taken for a sedentary life. This leads to further complications such as heart problems, kidney problems etc at a young age.
  • Chronic dental problems, poor oral health and unhealthy teeth and gums are some of the common problems. Such individuals have untreated tooth decay that is prolonged and causes damage, as well as a very poor sense of oral hygiene with irregular or minimal brushing and cleaning of the mouth etc. This aggravates other associated health problems.

Facing and consequently overcoming health problems are the major barriers and also the major challenges not only for individuals with learning disabilities but also for social workers, community healthcare professionals and the Department of Health as a whole.


The concept of social inclusion necessitates that these related health problems should be considered.


LO.6 – Discuss the importance of working in partnership with people with learning disabilities, using advanced communication skills, and the concept of capacity to give informed consent, along with the potential impact this may have on professional health care practice.

According to Dunbar, working in partnership with people with learning disabilities is an essential first step towards social inclusion of such individuals. He wrote,


people with learning disabilities or a mental illness should be treated in the same way as other people, not in side rooms. this lessens the chance of the person being out of sight, out of mind

(Dunbar, 2003).

This possibility of discrimination of such individuals have led to the recognition of the need for improved training, services and communication skills to effectively support and help these individuals. Health care professionals caring for persons with learning disabilities are required to have positive attitudes towards their patients. However within the healthcare setting negative attitudes and discriminatory practices are common and several studies have reported that such individuals are deprived of health care facilities and do not receive the care they should receive. In certain cases, inappropriate and derogatory language is also used to describe such patients and there have been reports of denied access to aids such as glasses or hearing equipment that can improve the quality of life for such individuals.

The NHS Executive (1998) has stated that nursing staff require special training opportunities to face and overcome their fears or prejudices towards people with learning disabilities in order that they may learn to treat them with respect and equally as they treat other normal patients. Nurses and other health professionals should always try to go beyond social obstacles and try to meet or associate with such individuals in normal social situations and recognize their needs and shed any notion of stereotypes.

The White Paper –

The same as you

(Scottish Executive, 2000) has placed great emphasis on the needs of individuals with learning disabilities and to treat them equally. These are:

  • being at the centre of decision making and have more control over their care;
  • being included, better understood and supported by the communities in which they live;
  • having information about their needs and the services available, so that they can take part, more fully, in decisions about them;
  • having the same opportunities as others to get a job, develop as individuals, spend time with family and friends, enjoy life and get the extra support they need to do this; and
  • being able to use local services wherever possible and special services if they need them. (Scottish Executive, 2000)

It is recommended that specialized training should be provided to nurses to help them explore strategies of care for learning disabled individuals. Assisting in enabling inclusion and stressing on a holistic improvement of health and lifestyle of the individuals are areas of focus in nursing for such people. However as individuals with learning disabilities usually show auditory or speech difficulties, communicating with them effectively is a major challenge for nursing professionals and requires special skills and training. Communication is essential as according to legislative policies informed consent of the individual as to what treatment he should be subjected to and what his decisions are, lie as the primary focus of treatment. This is both an ethical and legal requirement that individuals with learning disabilities should be made aware and be allowed to express their opinions on any treatment or health care procedures (Eldridge, 2003).


Conclusion

:

In this article we discussed 6 learning outcomes related to the health care needs, definitions, legislative policies, social implications and challenges of individuals with learning disabilities.


Bibliography

Human Rights Act (1998)

London: HMSO.

Mental Deficiency Act (1913)

London: HMSO.

Mental Health Act (1959)

London: HMSO.

Department of Health (2001)

Valuing people: a new strategy for learning disability for the 21st century. London: The Stationery Office.

Disability Discrimination Act (1995) London: HMSO.

Scottish Executive (2002)

Promoting health, supporting inclusion.

Edinburgh: Stationery Office.

National Health Service and Community Care Act (1990)

London: HMSO.

Department of Health (1999)

Once a day. London: NHS Executive.

DOH (1998)

Signposts for success in commissioning and providing health services for people with learning disabilities

.

London: NHS Executive.

DOH (1989)

Caring for people: community care in the next decade and beyond. Cm.849. London: HMSO.

DoH (1992)

Social care for adults with learning disabilities. (Mental Handicap (LAC (92)15). London. HMSO.

Dunbar, I. (2003)

Inquiry under the fatal accidents and sudden death inquiry (Scotland) Act1976 into the death of James Mauchland. Sheriffdom of Tayside, Central and Fife at Dundee, Scotland.

Emerson, E.; Hatton, C.; Felce, D. and Murphy, G. (2001)

Learning disabilities: the fundamental facts.

The Foundation for People with Learning Disabilities. London.

Jenkins, R.; Mansell, I. and Northway, R. (2003)

Specialist learning disability services in the UK. In: Gates, B.

Learning disabilities: towards inclusion.

Edinburgh: Churchill Livingstone. pp349-367.

World Health Organization (1993)

Describing developmental disability. Guidelines for a multiaxial scheme for mental retardation (learning disability),

10th revision, Geneva: WHO.

Gates, B. (2000)

‘Knowing: the importance of diagnosing learning disability.’

Journal of Learning Disabilities, 4(1) pp5-6.

Enable (7 Oct 2002) Adults with Incapacity Act (2000). Available at, http://www.enable.org.uk/ld/awi/

Also Adults with Incapacity (Scotland) Act (2000) London: HMSO.

Eldridge, P. (2003)

Ethics and research involving people with learning disabilities. In: Markwick, A. and Parrish, A. Learning disabilities: themes and perspectives. Edinburgh: Elsevier Science pp65-80.

Department of Health (2001) Valuing people: a new strategy for learning disability for the 21st century. London: The Stationery Office.

Hogenboom, M. (2001)

Living with genetic syndromes associated with intellectual disability.

London: Jessica Kingsley.

Scottish Executive (2000)

The same as you? A review of services for people with learning disabilities. Edinburgh: Scottish Executive.

Watson, D. (2003)

Causes and manifestations of learning disabilities. In: Gates, B. (ed) Learning disabilities: toward inclusion.

Edinburgh: Churchill Livingstone.


British Institute for Learning Disabilities

Links


Department of Health

http://www.doh.gov.uk


The Scottish Executive

http://www.scotland.gov.uk/


National Health Service

www.nhs.uk

WHAT IS DIKW AND HOW DO YOU USE IT IN YOUR PRACTICE?

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WHAT IS DIKW AND HOW DO YOU USE IT IN YOUR PRACTICE?

 

REQUESTING ONLY WRITER 18365 FOR THIS 2 PAGE APA FORMAT PAPER 2 SCHOLARLY NURSING REFERENCES ,, PLEASE GIVE MORE DETAIL FROM REFERENCES SINCE WE ARE ONLY USING TWO !!! SEE SELECT FILES FOR DIRECTIONS AND READING ,,, PAPER HAS TWO PARTS #1 HOW DOES THE CONCEPT OF WISDOM IN NURSING INFORMATICS COMPARE TO THE CONCEPT OF PROFESSIONAL NURSING JUDGEMENT? #2 WHAT IS DIKW AND HOW DO YOU USE IT IN YOUR PRACTICE? (MY PRACTICE , CURRENTLY ER DEPARTMENT NURSE AND FUTURE FAMILY NURSE PRACTITIONER) THE ARTICLE TOWARDS AN UNDERSTANDING OF WISDOM IN NURSING SHOULD BE USED FOR DIKW PLEASE GIVE DETAIL AND QUOTE IF HELPFUL.. MINIMUM 300 WORDS TOTAL PREFER TWO FULL PAGES OF CONCISE DETAIL ( PLEASE LET ME KNOW FINAL WORD COUNT)

Early Intervention in Youth Suicide Prevention and Community Engagement

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EARLY INTERVENTION IN YOUTH SUICIDE PREVENTION AND COMMUNITY ENGAGEMENT

Suicide has a devastating and far-reaching impact on families, friends and communities. The stigma, poor surveillance and the fact it’s considered a criminal offence in some countries means that many people are not able to get help. These facts and the lack of timely interventions make suicide a serious public health issue globally (WHO, 2014).

On 7

th

October 2013, World Health Organization (WHO), launched the ‘Mental Health Action Plan 2013-2020’, focusing on mental health, an issue that has been neglected for a long time.  A collective decision was taken by member countries to work towards the global target of reducing the suicide rate by 10% by 2020 all over the world.

Worldwide, suicide accounts for the second highest cause of death in 15-29 year-olds (WHO 2014). The mental health of youth and the alarming increase in their suicidal behaviour is a matter of great concern.  With suicide rates among teens nearly doubling in the last eight years fears have increased that we are raising a “suicidal generation” ( Shipman, 2019).This sharp increase in suicide in the late teens can be attributed to several factors. While self-harm, mental illness, alcohol,   drug misuse and, social isolation are some of the risk factors common to all age groups, others like family adversity, bullying, internet, social media, educational stress and relationship break- up are youth-specific (Rodway et al., 2016).

Traditionally mental healthcare has been focused on adults and community-based early interventions for youth have always been neglected. The associated stigma, decreased mental health knowledge, poor accessbility to suitable services and inadequate health system  has led to reluctance among people aged between 12 and 25 years in accessing mental health services when compared to people belonging to other age groups. (McGorry & Mei, 2018).

On 10

th

October 2018 World Mental Health Day, British Prime Minister appointed Jackie Doyle- Price as minister for suicide prevention, a step to improve mental health particularly suicide. Research conducted in 2018, by the Brent Centre for Young People revealed that teenage suicide due to hopelessness in London was four times the national average, with a marked increase of 76 % among post-teens (19-24)groups ( The Independent, 2018). The appointed minister would be working to improve these figures.

The WHO target can be achieved only with active participation from communities to prevent suicide especially in youth (WHO, 2014). Several countries have taken initiatives that has seen tremendous progress in early intervention services for youth mental health. Some of the successful initiatives are discussed below.

Australia was one of earlier countries to initiate suicide prevention strategies.  In Australia, a government funded, innovative and integrated youth mental health care model called Headspace was created to provide youth-friendly, stigma-free, non-judgmental early intervention services to 15-25 year old presenting with high levels of psychological distress. People belonging to marginalized group and those at risk of mental health issues also found the model to be beneficial (McGorry & Mei 2018).  Since the inception of Headspace there has been significant reduction in suicide ideation and  self- harm among youth,  a decrease in absenteeism from school and work place was also noted  (McGorry & Mei 2018).

The success of Headspace has prompted other countries like UK, Ireland, Canada, USA, Europe and Asia to adopt culturally suitable models.  Headstrong and the Jigsaw in Ireland and Youthspace, in Birmingham, UK are examples of two such models developed to cater to youth mental health in these countries.  These offer easy accessibility for effective community-based mental health care for individuals aged 12–25 years (McGorry & Mei 2018).

Preventing Suicide in England: A cross-government outcomes strategy to save lives developed in consultation with members of the National Suicide Prevention Strategy Advisory Group (NSPSAG) is a strategy developed by   Government to address suicide prevention in United Kingdom.  The key objectives of this strategy: “a reduction in the suicide rate in the general population in England; and better support of those bereaved or affected by suicide” (Mackley et al., 2018).

In January 2017 the Third Progress Report, entitled ‘Preventing suicide in England’ was published.  The aim of the report was to refocus on patients who are identified to be at higher risk of suicide, such as young and middle-aged men, and bring new focus on support for bereaved families also educating young people about mental health (Mackley et al., 2018).

#308conversations is an initiative launched by the Mental Health Commission of Canada for suicide prevention. In this programme each of Canada’s 308 Members of Parliament and community leaders have discussions within their community about suicide prevention. The success of this initiative prompted the World Health Organization to collaborate with the Mental Health Commission of Canada to adapt this approach for global use (WHO 2014).

In any healthcare system early intervention plays an important role.  For suicide prevention, early intervention techniques can be grouped into three main criteria namely individual or ‘indicated’, group or ‘selective’ and ‘universal’ interventions ((Catalogue.nla.gov.au, 2019).

Individual or ‘indicated” intervention which is the most commonly understood methods, treats individuals displaying suicide-related behaviors. It involves the concerned individual as well as the people around them like family, friends, colleagues, teachers etc. ((Catalogue.nla.gov.au, 2019)

Group or ‘selective’ intervention focuses on specific groups and communities at higher risk of suicide in the society, like LGBT, youth bereaved by suicide, or those with history of mental illness or previous attempt at suicide and those who have self-harmed and it operates at national and local levels ((Catalogue.nla.gov.au, 2019).

A ‘universal’ intervention targets the entire population or a particular segment of it, on the assumption that some individuals within the population may be at risk of suicide, but these risk factors will not be exhibited.  It increases the general awareness of suicide risks and it is commonly used to screen mental health issues in schools (Catalogue.nla.gov.au, 2019)

The aim of most intervention strategies conducted across clinical, educational, workplace, community, digital, and face-to-face settings is to reduce the risk factors and promote protective factors (Catalogue.nla.gov.au, 2019).

Robinson et al., (2018) in their meta-analysis have analyzed the complete spectrum of interventions across multiple settings like clinical, educational/workplace and community and their impact on suicide-related outcomes. They had reported that frequency of self-harm and suicidal ideation was reduced with brief contact interventions in clinical settings, and psycho-education combined with screening in school setting.

The drawback of the study was that it neither included low-middle income countries nor demographic populations which are at increased risk of suicide and also very few studies were conducted in workplace, universities and primary care. Furthermore, with suicide being relatively rare, it was difficult to obtain a statistically significant sample size which could demonstrate the impact of intervention on suicide related outcome (Robinson et al., 2018).

Significant difference has been observed in the patterns of suicide rates based on age, gender and time across countries (Roh et al., 2018).  A phenomenon known as ‘gender paradox’ was observed in the suicidal behavior of adolescents. The absolute number of completed suicide was found to be higher among male adolescents as compared to females, but suicidal ideation and attempts were more frequent among female adolescents (Roh et al., 2018). In certain countries like China and India, higher suicide rates were seen in female youth as compared to male, and in the west suicide rates for females aged 14 or younger were found to be higher.

In several European countries there was a remarkable decrease in suicide rates among the males,however, the rates were either stable or increased in the females (Roh et al., 2018).  Firearm restrictions and improvement in global health were cited to be the reason for this decrease. In contrast, increasing suicide rates for both genders were noticed in Korea and Japan, economic recession, inequality, and rapid changes in family structure were believed to be the reason (Roh et al., 2018).

Although intervention programs are important in treatment of mental health issues in youth, community involvement is also required to achieve the WHO target. Discussed below are some of the ways in which community engagement contributes to suicide prevention in youth.

Suicide prevention is something that cannot be achieved by single person, an organization or an institution on their own, it needs the whole community’s support. Communities’ gives individuals a sense of belonging, vulnerable individuals are provided with social support and follow-up care, they raise awareness and help fight stigma surrounding suicide and support individuals bereaved by suicide. Sometimes community members become “gatekeepers” to identify people who are high risk of suicidal behaviour or to identify emerging suicide clusters in their community (WHO, 2014).

In recent years community engagement techniques have been recognized as an innovative tool in tackling mental health issues especially in low income and minorities’ population, but very often these strategies don’t have clear guidelines for their successful implementation (Mendel et al., 2011).  It becomes difficult to know where or how to initiate action especially when dealing with a sensitive issue such as suicide prevention. Often, communities find they are not prepared adequately or are too overwhelmed to   successfully establish suicide prevention strategies.  Against this background the WHO toolkit provides  suggestions which are practical  and which  communities all over the  world can use regardless of  their  available  resources  or their  current  progress status with reference to suicide prevention efforts (WHO 2014).

Suicide prevention efforts are effective when community engagements use well planned strategies that help to understand various aspects of suicide. Clear goals need to be set and activities that are proven to be effective should be prioritized (Sprc.org, 2019). It’s important that community members voice their concerns and opinions about suicide prevention in their particular community. This process helps in identifying gaps, gather information about the available resources and ongoing activities in that community.(WHO, 2014).

Before starting it is important to know the extent of the community engagement, the population or region that is involved, available data and data limitations (WHO, 2014). It will be useful to have prior information regarding suicide incidence and suicide prevention prevalent in the particular community. Information regarding  numbers , means and access to means, the associated stigma, cultural or religious beliefs in that particular community,  ongoing  suicide prevention programmes and  particularly the manner in which the suicide issue is addressed by the community  will help in formulating effective suicide prevention strategies(WHO, 2014).

Involving people from the community in planning and carrying out engagements paves the way for successful suicide prevention strategy. A good way to start community engagement is to create a steering committee of around 10 like-minded people from different background equipped with diverse skills and ideas but whose concerns are similar and who are motivated to engage in suicide prevention (Mental Health Commission of Canada, 2015; Suicide Prevention Australia, 2014).

The formal and informal leaders in a community like police, politicians, religious leaders and other members like nurses, teachers, firefighters etc., who have the ability to act as gatekeepers have an important role to play in trying to achieve a common goal (WHO, 2014). Gatekeeper training is an essential activity in suicide prevention. It is important that these people called ‘Community Facilitators’ are educated about various aspects of suicide prevention and play an active role in identifying vulnerable persons who are at risk of suicide within the community (Coppens al, 2014,).  Uniting the community and bringing people together can help achieve this common goal of suicide prevention, as demonstrated by Inuit population in Canada (Kral et al., 2009).

Teamwork, open dialogue, and compromise are hallmarks of successful community engagement and it is essential to establish these at the beginning itself. Community engagement plays an important role in restricting access to means of suicide. Awareness programmes and community education are important especially in context where suicides are impulsive (WHO, 2016b).  For instance, in rural agricultural communities especially in low- and middle-income countries pesticide poisoning is very common means of committing suicide,because pesticides are easily accessible in such communities. Hence, in such communities , potential suicide prevention activities should target farmers and their families (WHO, 2014).

Suicide is shrouded in stigma and increasing dialogue about it will help reduce the stigma associated with it and is a practice frequently used in suicide prevention. This can be achieved through educational programmes conducted by a health care professional or support group member/ volunteer or a bereaved survivor or an individual who has experienced self-harm (WHO, 2014).  In some instances creativity  like art participation  can be used to address to raise awareness, reduce stigma to  help individual and communities heal following suicide by suicide survivors sharing their experience in public (Mohatt et al.,2013).

Suicide is a public health problem and the media has a major role to play in influencing opinion and attitudes of the public to a large extent. It is important that the media act responsibly while reporting cases in order to avoid imitation of suicidal acts by vulnerable persons. Inappropriate reporting on suicide in the media may lead to a contagious effect or “Werther effect””, on the other hand   responsible media reporting of suicide will   have a protective effect and leads to what is known as the “Papageno effect”. Responsible media coverage of suicide can correct misperceptions and myths that surround suicide.  Communities can productively use media outlets for conveying public health messages about suicide, suicide prevention, it can be used to encourage vulnerable people and those at increased risk for suicide to seek help, and provide information regarding support groups and services where help can be found when required (WHO, 2014).

School-based mental health awareness, interventions and training skills required to tackle some of adverse life situations such as stress,  suicide attempts and other mental health issues  have been shown to be effective in reducing incidence of suicide among adolescents (Wasserman et al., 2015). Including youth into suicide prevention programmers will be useful, as they will be able to identify the inherent risk factors that are youth centric in their community and this can provide invaluable help in the planning community engagement (WHO, 2014). The Australian funded organization Headspace is an example of hugely successful programme in which youth participation and engagement formed the pillar of the model (McGorry & Mei 2018).

It is common knowledge that crisis precipitates suicidal behavior. It is important that crisis support is available and easily accessible. Communities have an big role to play in such instances, as they can help by giving information about various helplines, support groups and other crisis intervention services that can be accessed. Another important area where communities can be involved is in lobbying for increasing the availability of support services/ helplines for suicide prevention. They can help to motivate and encourage persons in crisis to get help from support services available. Crisis support services and help-seeking are important activities in suicide prevention (WHO 2014).

To conclude suicide in teenagers remains a major public health concern globally. Although suicide prevention is feasible, preventing suicide is not an easy task. Several factors like biological, psychological, social, environmental and cultural are thought to responsible for precipitating suicide.  Recent studies have shown that suicide prevention involves a wide range of activities, from accurate and timely assessment of mental disorders and effective intervention techniques to environment control of risk factors like restricting the means.

National suicide prevention strategy is multi-sectoral and specific to each country as the cultural and social   identity of each country is different.  The success of any national suicide prevention strategy depends to a large extent on the contribution from community. Communities influence and shape policy and services by initiating activities that are comprehensive and combine multiple strategies that focus on key areas that are appropriate to their local context. Vulnerable people need to feel a sense of belonging and require help in coping with emotional and physical difficulties and this is provided by the community support system.

The use of specific and focused strategies that reflect the local needs , effective healthcare  and social support service by community groups – as discussed at length above – will make it possible to achieve the WHO global target of reducing the suicide rate  by 10% by 2020 worldwide.



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BIBILIOGRAPHY

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Analyze the trends, and thinking as a healthcare administrator, how do you capitalize on these trends to improve operation and bottom line performance? How can you mitigate the negative impact of the trends?

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Analyze the trends, and thinking as a healthcare administrator, how do you capitalize on these trends to improve operation and bottom line performance? How can you mitigate the negative impact of the trends?

 

Prepare and submit a paper responding to the following items:

Use the online library, Internet, required reading, and other resources to research and develop a more complete appreciation of the inpatient setting. References should be no more than 5 years old. Web sites are only acceptable when accessing a government site.

Based on your findings, write a graduate level scholarly paper that clearly addresses the following:

1.Identify and describe an inpatient setting (e.g., acute inpatient units, inpatient rehabilitation, skilled nursing, etc.) or an outpatient setting to include the services provided, key personnel within the department, and how this department supports or is supported by other departments.

2.Identify and describe at least one trend that will have an impact on the setting you selected. These can be trends related to supply and demand, political climate, regulatory, demographic changes, or patient care.

3.Evaluate the impact of these trends on the inpatient and outpatient settings. Regarding the inpatient and outpatient setting you have chosen, be factual and current. Comment also how this trend can be evaluated for success.

4.Analyze the trends, and thinking as a healthcare administrator, how do you capitalize on these trends to improve operation and bottom line performance? How can you mitigate the negative impact of the trends?

Assignment Expectations

Write a 4- to 6-page double-spaced paper (this does not include title and reference pages). It needs to be well written, based on information from scholarly research, and should demonstrate a thorough analysis of the topic.

Make a list of steps in problem solving, briefly explaining each one.

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Make a list of steps in problem solving, briefly explaining each one.

Consultants are usually employed to deal with problems. Special skills are needed to evaluate the conditions, to analyze a problem, and to develop and implement a plan for solving the problem. This week you will focus on use of problem-solving skills in the health care setting.

Consider this scenario:

Franco Valencia, of Healthcare Consultants Inc., was hired as a consultant by Dr. Rita Krakowski, director of Hope Medical Center. The center, which deals mostly with cancer and organ transplants was facing a problem with its medical personnel. Physicians seemed to be calling in sick more often than usual, coming early and leaving late. Time spent around the water cooler and in the break room was increasing while actual time spent in patient care was decreasing. The nursing staff had a turnover rate which far exceeded the national average.

Dr. Krakowski asked Mr. Valencia to help her solve the hospital’s problem of worker productivity.

Mr. Valencia developed a confidential questionnaire which, with the permission of Dr. Krakowski, was placed in the personal mailbox of each doctor and nurse on staff. In the questionnaire he introduced himself as a consultant to the hospital who was interested in making the hospital a more positive place to work in. He asked the personnel to briefly discuss three main concerns, conflicts, or frustrations. He also asked them to note how long they had been having these concerns and what if anything they had tried as individuals, as a group, or as an institution, to deal with these concerns. Personnel were asked to drop off their responses in a locked box in the HR department. They were free to respond anonymously if they wished.

In the meantime, Mr. Valencia asked Dr. Krakowski to trace the development of the problem as she knew it. Specifically, he asked for a time frame for problem, what circumstances may have coincided with the development of the difficulties, what solutions had she already tried. While discussing the matter further, Dr. Krakowski also mentioned that the rapid turnover of personnel and the reluctance of current personnel to become engaged with patient care was seriously impacting the quality of care patients received. Further, the reputation of the hospital was suffering and she was having trouble recruiting new staff.

The questionnaires from the personnel provided a new perspective on the problem. Both physicians and nurses reported that their main source of stress on the job was dealing with issues of mortality. The transplant operations called for a high level of expertise and doctors were often tense and curt when interacting with nurses in the operating rooms. On their part, some of the doctors expressed sadness, a sense of frustration about losing patients, even though they had done their best to save their lives. Both doctors and nurses expressed reluctance and concern about having to carry out “difficult conversations” with the families of patients, conversations related to decisions about using extraordinary measures to prolong life, and when to offer palliative care.

Based on a list of programs that he had to offer, Mr. Valencia chose a program and set a start date. He indicated who would be involved and sought help from Dr. Krakowski to set up a schedule that would fit with the staff’s in-service meeting times.

Using the information in your text, and in the additional resources, write a paper analyzing the problem-solving skills used in this scenario. One way to do this would be:

•Make a list of steps in problem solving, briefly explaining each one.

•Give examples from the scenario to illustrate each step.

•Be sure to note the particular sub-stages of the steps involved

•Note what steps may have been left out.

•Evaluate the problem solving attempt above, and add any suggestions for improvement.

Support your analysis with three additional scholarly web or print resources.

Length: 5-7 pages

Your paper should demonstrate thoughtful consideration of the ideas and concepts that are presented in the course and provide new thoughts and insights relating directly to this topic. Your response should reflect scholarly writing and current APA standards

Gate Control Theory Of Pain Health And Social Care Essay

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OA knee pain – prevalence, cost to NHS etc. Physio treatment of neck pain→ electro modalities, esp TENS

Pain is something that everyone suffers with at one time or another. Pain can be a huge burden on employers due to absenteeism (White et al, 2005). There are many methods used to relive pain with TENS being one method.

Having completed a review of current literature, it is clear that the application of tens has a significant effect on the pressure pain threshold of a subject, however no study to date has researched the effects the positioning of the TENS being applied has on the pressure pain threshold. Therefore this study has the aim of investigating whether the positioning of the electrodes at the nerve root level will affect the pressure pain threshold of the relevant dermatomal area giving rationale for the use of TENS as a pain reliving modality for injuries to the extremities.

Literature Review 4k

Literature Search

This research is investigating the effect of transcutaneous electrical nerve stimulation at a nerve root has on the pressure pain threshold at the periphery in relation to osteoarthritis of the knee. A review of the current literature was conducted using the following databases: PubMed, ScienceDirect, MetaLib (Cardiff University’s Electronic Resources) and Google Scholar for journals dated 1982-2012. The main key words used in the search included, “transcutaneous electrical nerve stimulation”, “pain”, “osteoarthritis”, “knee”, and “periphery”. Backchaining was also used to ensure all relevant literature was obtained.

Introduction

Osteoarthritis a very common joint disorder occurring in any joint but most commonly in the hip, knee, the joints of the hand and foot, and spine (Symmons et al. 2003). It mostly affects those aged 60 and over with approximately 40% of people over the age of 65 suffering symptoms associated with knee OA (Zhang et al., 2008) resulting in globally nearly 250 million people having osteoarthritis of the knee, 3.6% of the population (Vos et al. 2012). This resulted in osteoarthritis becoming the fourth leading cause of disability in the year 2000 (Symmons et al. 2003) and costing the NHS a total of 25 million pounds in 2008 (NICE 2008)

Arthritis knee

Osteoarthritis of the knee is a chronic degenerative disorder with a multifactorial aetiology (Felson, 2000). This includes general factors; such as age, sex and obesity, mechanical factors; such as alignment and trauma (cooper et al. 2000) and genetic factors (Reginato et al. 2002).

Osteoarthritis of the knee is characterised by both loss of articular cartilage and by central and marginal new bone formation (subchondral sclerosis, osteophytes) (Woolf and Pfleger, 2003). There is also often thickening of the capsule and low grade synovitis resulting in alterations in biomechanics of the joint. Osteoarthritis affects the whole joint with secondary changes including ligament laxity due to articular cartilage loss and muscle weakness around the joint due to disuse respectively (Felson 2000).

Osteoarthritis of the knee is associated with pain, joint stiffness and deformity, which in turn lead to limitations of daily activities for sufferers. Although there is currently no cure available, there are a number of treatment options open to sufferers to provide symptomatic relief, as well as joint function improvements. There are many non- pharmacological treatment options available such as education, rehabilitation exercises, manual therapies, acupuncture and electro-modalities such as TENS. There is also a wide range of pharmacological measures available, non-steroidal anti-inflammatory drugs, oral analgesia and topical treatments. Pharmacological treatments also include intra-articular modalities such as injections of corticosteroid and hyaluronic acid and tidal irrigation to reduce symptoms. In severe cases, where nonsurgical interventions have failed, more invasive approaches may be needed (Cooper et al 2000) including therapeutic arthroscopy and joint replacement.

Models of Pain

Pain something that the medical profession aims to alleviate in all patients suffering from it. In order to do this an understanding of the function of pain is needed as well as knowledge of the physiological processes the cause pain.

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage (Bonica 1979). It serves as a stimulus to motivate an individual to cease or withdraw form damaging or potential damaging situations, or to protect a damaged body part during the healing process (Winlow et al. 1984). There are three main models of pain, the cognitive-behavioral model of pain, the gate control theory of pain and the neuromatrix theory of pain.

Gate control theory of pain

The gate control theory suggests there is a neurological “gate” in the dorsal horn of the spinal cord (Melzack and Wall 1967). This gate either blocks pain signals or allows them to continue to the brain. This “gate” in the spinal cord differentiates between the types of fibers carrying pain signals. Pain signals travelling down the larger C nerve fibers are blocked whereas pain signals travelling done the smaller a-delta nerve fibers are allowed to pass through and therefore continue up to the brain where the pain can be perceived (cord (Melzack and Wall 1967). This gating mechanism is influenced by descending nerve impulses from the brain in response to ascending pain stimuli.

Cognitive behavioral theory of pain

The cognitive behavioural pain theory explores the perception of pain by relating it to more than just the physical and physiological attributes of the pain mechanism, and explores the predisposing and perpetuating factors as well as the psycho-social aspects involved in pain perception (Letham et al. 1983). This model explains why some individuals continue to experience pain after trauma has healed, or display a pain response disproportionate to the original condition.

The theory states that the perception of pain is influenced by predisposing factors such as personality, coping style and previous history of illness, as well as perpetuating factors such as behaviour, emotions, and physical symptoms (Letham et al. 1983). This explains why some individuals suffer with continued pain after the original injury has resolved and are driven by fear of further pain leading to increasingly restricted activities despite the original injury being resolved, exhibit a maladaptive avoidance response. While other will experience very little pain in situations that would otherwise be excruciating, for example soldiers in battle (Letham et al. 1983)

Neuromatrix theory of pain

The pain neuromatrix theory is a development of the gate control theory of pain.

A widespread distribution of neurons imprint a ‘neurosignature’ upon nerve impulse patterns that pass through the sensory matrix (Melzack 2001). This neurosignature creates the experience of self and gives subsets of patterns that give unique experiences such as pain. The perception of pain in the brain would be as the end result of an activation of the pain neuromatrix with a characteristic pattern relating to the pain signature (Melzack 2001). This is part of a multi system response to a perceived threat. However there are many other inputs that can trigger the pain neuromatrix in the brain including movement, touch, fear and visual stimuli (Melzack 2001). This is due to the fact that the widespread neurons which make up the neuromatrix for pain perception are involved in many other activities so the pattern for pain perception can be triggered by other groups of neuromatirx being active during other activities not purely the pain neuromatrix

Pain and pathways

There are four basic processes involved in nociception(processing of pain), Transduction, transmission, perception and modulation (McCaffery and Pasero, 1999).

Transduction begins when nociceptors (free nerve endings) of either the A-delta fibres or C fibres of the primary afferent neurones respond to noxious stimuli. A noxious stimulai occurs when tissue is damaged and inflation occurs. The nociceptors are found in the somatic structures (skin, muscles, and joints) as well as the visceral structures (organs such as gastro-intestinal tract or the liver). (Wood 2008)

Although both the C fibre and A-delta fibres are Primary afferent fibres they have different cell structures and are associated with different pain qualities (table 1).

Table 1: Characteristics and functions of C fibres and A-delta fibres (Farquhar-Smith 2007)

C fibres

A-delta fibres

Characteristics:

Small diameter

Unmyelinated

Slow conducting

Receptor type:

Polymodal: respond to more than one type of noxious stimuli:

Mechanical

Thermal

Chemical

Pain quality:

Diffuse

Dull

Burning

Aching

Referred to as ‘slow’ or ‘second’ pain

Characteristics:

Large diameter

Myelinated

Fast conducting

Receptor type:

High-threshold mechanoreceptors: respond to mechanical stimuli over a certain intensity.

Pain quality:

Well-localised

Sharp

Stinging

Pricking

Referred to as ‘fast’ or ‘first’ pain

There are three stages to the transmission of pain; first the impulse is transmitted from the site of transduction along the nociceptor fibres (first order neurons) to the dorsal horn, in the spinal cord, where both C fibre and A delta fibres terminate. In the dorsal horn they synapse with the second order neurons and which then cross the spinal cord via the anterior white commissure and ascend to the thalamus via the two main nociceptive ascending pathways. These are the spinoparabrachial pathway and the spinothalamic pathway. The thalamus then directs the nervous impulse to multiple areas of the cortex and higher brain for processing as there is not a discrete pain centre (Wood 2008).

The end result of the pain transmission is the perception of pain. This is where pain becomes a conscious and multidimensional experience with affective-motivational, sensory-discriminative, emotional and behavioural components. When painful stimuli are transmitted to the brain stem and thalamus, three main cortical areas are activated, the reticular system, the somatosensory cortex, and the limbic system, each one is responsible for a different response to the pain stimuli. (McCaffery and Pasero, 1999)

The reticular system is responsible for the autonomic and motor response to pain, for example, automatically withdrawing from a painful stimulus. It also plays a role in the affective-motivational response to pain, such as assessing an injury after pain has occurred.

The somatosensory cortex is involved with the interpretation and perception of sensations. It identifies the location, type and intensity of the pain sensation and relates this sensation to past experiences before triggering a response.

The limbic system is responsible for the behavioural and emotional response to pain as well as past experiences of pain.

The modulation of pain involves altering or inhibiting the transmission of pain impulses in the dorsal horn of the spinal cord. The complex pathways involved in the modulation of pain are called the descending modulatory pain pathways (Ossipov et al. 2010). These pathways can lead to either an excitatory response (an increase in the transmission of pain impulses) or an inhibitory response (a decrease in transmission of pain impulses). Descending inhibition produces an analgesic effect by causing the release of inhibitory neurotransmitters which partially or completely block the transmission of pain impulses in the spinal cord (Ossipov et al. 2010).

Endogenous pain modulation helps to explain the wide variations in the perception of pain in different people as individuals produce different amounts of inhibitory neurotransmitters. Endogenous opioids are found throughout the central nervous system (CNS) and prevent the release of some excitatory neurotransmitters, for example, substance P, therefore, inhibiting the transmission of pain impulses.

Physiotherapy and treatment of Pain

Transcutaneous electrical nerve stimulation (TENS) – papers on TENS and Pain (critical review of the literature)

Transcutaneous electrical nerve stimulation (TENS) is an electro therapy procedure the aim of which is pain relief. During treatment a low amplitude and frequency alternating electric current is passed between two electrodes placed on the body resulting in stimulation of the nervous system. Research will be reviewed examining the theory that TENS is an effective pain reliving modality. Previous studies by Chesterton et al (2002, 2003) Vance et al (2012) and Chen et al (2010) have all shown TENS to be an effective form of pain relief against blunt pressure pain with. All however have used different parameters for both the TENS settings and application sites.

All of the previous studies looked at found TENS to be an effective method of pain relief based on pressure pain threshold measurement. Both of Chesterton’s and Vance’s studies found a statistically significant increase in pressure pain threshold after a twenty minute application of TENS (p=0.005, p=0.01, and p=0.002 respectively). Chen also found a significant difference in post TENS of p=<0.001. However unlike the other studies which looked at the difference between the pre and post treatment pressure pain values Chen’s study looked at the number of subjects that achieved a set increase in pressure pain value (10N). This does not take into account the normal distribution of the group, meaning that this set increase may not actually be a significant difference in pressure pain threshold in all of the subjects tested.

Vance was the only study to look at other forms of pain measurement s outcome measures, as well as the use of a pressure pin threshold measure similar to the other studies a cutaneous mechanical pain threshold measure using Von Frey filaments and heat pain threshold measure were also used. Although using these additional outcome measures to assess the effectiveness of TEN as a pain reliving modality it was only the pressure pain threshold measure that yielded a significantly change. Therefore the results of the study can still only be extrapolated to the pressure pain reliving abilities of TENS and no other forms of pain.

Both Vance and Chen explored the differences between the frequencies TENS applied. Chen uses 3Hz for low frequency and 80Hz for high frequency. Vance does not specify the actual frequency used and only states high and low frequency Tens was used with the definition of High frequency TENS >50Hz and Low frequency TENS <10 Hz. This reduces the validity of Vance’s results as the study cannot be repeated and the exact parameters are not known.

In Chesterton’s 2002 also explored the differences between the frequencies of TENS applied using 4Hz as the low frequency and 110Hz as the high frequency. The results were similar to Chen with the high frequency TENS proving a more affective pain reliving modality of TENS.

All three studies have good internal reliability, the same experimenter was used for every measurement, and standardised testing procedures were used. The rate of application of the algometer was kept constant when measuring the pressure pain threshold and the same point was used on each subject for the measurement. Chen and Vance, however, relied sole on the skill and consistence of the experimenter to ensure the pressure pin threshold reading was taken in the same manner for every subject. Chesterton’s studies used a special mounting frame for the algometer to ensure that it was perpendicular to the skin and that the rate of application was constant. This improved the internal reliability of the study as each subject will have had the reading taken in exactly the same way.

Chesterton and Chen both use healthy volunteers as the subjects in their studies. Both studies have a good sample size with an equal distribution of males and females. Chen’ subjects have a small age range (mean ± SD, age 26.7 ± 2.9 years) which is not representative of the population. Chesterton’s sample has a much larger are range (mean ± SD, age 30± 7 years, range 18-57 years) which is a far closer representation of the general population and makes the extrapolation and application of the results more reliable. However both of these studies, due to only using healthy subjects, cannot be reliable extrapolated to apply to people who are not healthy. Therefore it cannot reliably be said that anyone suffering with a painful condition, be it degenerative, trauma, or surgical, will benefit from the application of high frequency TENS or that it will reduce their pain. It can only reliable be said that it will reduce the pain perceived in healthy individuals. This however is addressed by Vance, although using smaller sample size than Chesterton all of the subjects used in the study all had a diagnosis of medial compartment osteoarthritis of the knee. Unlike the other studies Vance did not have an equal split of male to female subjects (29 male 46 female), however by using a stratified randomisation process it was ensure that each experimental group had the same ratio of male to female subjects. Therefore unlike the other studies Vance’s results can be reliably extrapolated to apply to a population with a diagnosis of medial compartment osteoarthritis of the knee, and high frequency TENS can be reliably used as a pain reliving modality.

Random allocation of groups

Not all subjects tens naive

Blinding

All have good baseline comparability between groups.

Chen

Good base line A paired t-test on this data found no significant differences (mean + SD = -1.50 ± 5.65N, P = .143)

Chesterton 2002

Good basleine similar This was confirmed by a one-way analysis of variance (ANOVA) for pre-treatment mean MPT (P 0:19

Chesterton 2003

Good One-way analysis of variance (ANOVA) showed no significant differences in PPT, between the groups at baseline (p 0:142)

Vance

Bad not equal gender split 29 male 46 femle.

But good that same ration in each group.

Good There were no significant differences between groups in demographic characteristics, with the exception of body mass indexes (P.027).

Algomiter reliability

Aim(s)

Hypothesis (hypotheses)

Does High-TENS affect pressure pain threshold (PPT) at the periphery?

Null Hypothesis: There will be no difference in the pressure pain threshold between the control group and experimental group.

Methods

Design

This study was an experimental repeated measures clinical trial. The independent variable being assessed was transcutaneous electrical nerve stimulation. The dependent variable was Pressure pain threshold. The study included 20 people who had no previous history of knee pain and had not previously experienced TENS. Subjects attended two sessions with a 48 hour interval. In the first session subjects were given a placebo TENS and in the second a single high frequency TENS treatment. Outcome measurements were obtained before and during each treatment. Ethical approval for the study was granted by the University Ethics Committee (Cardiff University, 2012).

Participants

A convenience sample of 20 subjects from Cardiff University School of Healthcare was used. The inclusion criteria consisted of being a healthy subject. Subjects were screened for relevant contraindications and exclusion criteria including: pacemakers, heart disease or arrhythmias, undiagnosed pain, epilepsy, peripheral neuropathy (Fox and Sharp, 2007), history of trauma or surgery to the dominant leg in the last 6 months, medication, history of pregnancy or knowledge or use of TENS treatment (Chesterton et al., 2002). No subjects were excluded. The experimental procedure was explained to each subject who then signed a consent form witnessed by an independent person (Appendix 4). At the first session, subjects were assessed for bilateral recognition of sharp versus dull pressure at the L3 dermatome to rule out loss of sensation.

Ethics

Ethical approval was obtained from The School of Healthcare Studies Ethics committee Cardiff University and a single blind experiment using repeated measures was used. A risk assessment was carried out for the pilot and data collection assess risk to the subjects and the investigator using the standard risk assessment method of the cardiff university Physiotherapy department. The risk is quantified by the Risk Rating Number which is calculated by multiplying the probable frequency by the potential severity. For this research the probable frequency is unlikley scoring two and the potential severity is negligible scoring one (appendix 1). The Risk Rating number is two which requires no further action (Cardiff Univeirsity 2012).

Individuals with a history of knee pain were excluded, reducing the likelihood of physical injury to the subjects during the PPT measurement process. In the event of an injury subjects would be withdrawn from the study and appropriate medical advice would be sought. The privacy and dignity of the subjects during electrode placement was ensured by using screens, and gaining informed consent before exposing the skin on the back. The information sheet given to the subjects (Appendix 3) informed them of what the study involved, and that the results would be analysed as part of this research project. Subjects were informed they were free to withdraw from the study at any time. All data was confidential and anonymous. All data stored on a computer was and password protected and anonymous.

Pilot study

A pilot study was conducted on 3 subjects not included in the main study prior to data collection. This was to ensure that the method to be used was satisfactory and to allow researcher to familiarize themselves with the equipment. It also allowed the researcher to estimate the time required, allowing appropriate time slots to be set. Another reason for the pilot study to be carried out was to expose any unforeseen errors or limitations in the design protocol allowing modification as necessary (Jenkins et al, 1998). The pilot study highlighted variations in subject foot placement in sitting, in turn effecting the knee positioning needed for a PPT reading to be taken. It was therefore decided to give subjects the following verbal command on how to sit, “sit with your feet flat on the floor and your knees at ninety degrees”, to minimize variance in knee position. The rest of the method was deemed sufficient and no further changes were made.

Apparatus

The pressure pain threshold was assessed using a handheld pressure algometer (Algometer commander, Jtech medical, United States) with a flat circular metal tip measuring 1.1 cm in diameter. The force was displayed digital in increments of 0.1N and applied at a rate of at 5N/s (Chesterton et al 2002). The subjects were instructed to say “stop” when the sensation first became painful. A practice test was first performed on the non-dominant knee to familiarize subjects with the procedure. The use of a pressure algometer for measuring pressure pain threshold has excellent test-retest reliability (r.70-94) (Fischer, 1987), and is a valid measure for deep-tissue hyperalgesia as discussed by Staud et al. (2007)

Electrical stimulation was generated via a commercially available a dual channel, TENS unit (200 plus, TPN), the unit uses an asymmetrical, biphasic waveform. The pulse width was set at 50 microseconds and the frequency 150Hz, and the intensity was increased to the subjects’ verbal report of when the feeling became strong but still comfortable.

Procedure.

Before taking part in the study, all subjects were given an information sheet (appendix 3) explaining research study and what would be expected from them if they participate and completed a consent form (Appendix 4).

Subjects came in on two separate occasions 48 hours apart; once for the control trial (sham TENS) and once for the application of TENS. In the first session demographic data was obtained, which included age and gender.

A standard ‘sharp/blunt’ discrimination test was performed, using neurotip at each stimulation site, to ensure intact skin sensation. The skin was then cleaned using an alcohol wipe before the application of electrodes (Chesterton et al., 2003).

Two TENS electrodes were then placed over the L3 spinal level. Each electrode was placed over the L3 Spinal nerve root the location of which was found by palpating to the L3 spinal level (Rhoades et al. 2009). The first electrode was positioned 10mm to the left of the L3 spinal process with the second positioned 10mm to the right. The center of each the electrode was placed level with the inferior aspect of the L3 spinal process (figure 1). Experimenter 1 was responible soley for the electrode psoiting nd TENS application to ensure internal reliability. Figure 1

Subjects were seated in a comfortable upright position with feet flat on the floor. The position of the pressure pain reading was then marked bilaterally. This was done by measuring 30mm superior to the central aspect of the superior border of the patella in flexion (figure 2). Experimenter 2 was responsible solely for the positioning of the pressure pain reading and the algometer application to ensure internal reliability. Figure 2

A practice pressure pain measurement was then performed on the subject’s non dominant side with subjects instructed to say “stop” when the sensation first became painful. At this point the experimenter immediately retracted the algometer. (Chesterton et al. 2003) This process was then repeat three times at 30 second intervals on the dominant side to establish a base line figure (Vance et al 2012).

The Tens machine was then turned on and the intensity increased to the subjects’ verbal report of when the feeling became strong but still comfortable. For the sham TENS subjects were told that some forms of TENS were imperceptible and, they might not feel any sensation. The battery in the TENS unit was inserted the wrong way round. The unit was still visibly switched on and the intensity turned up, but no current was flowing (Chesterton et al 2003). A 30 minute timer was started as soon as the intensity was correctly adjusted.

When the 30 minute time period had elapsed three further pressure pain threshold readings were taken again at 30 second intervals on the dominant side to a post treatment figure. Once these reading were taken the TENS machine was turned off and the electrodes removed. Subjects were monitored for a further 30 min after the end of the stimulation period (Chesterton et al 2002).

Subjects returned for the second session 48 hours later.

Data Analysis

All data was entered into Windows Excel version 2010 Descriptive analysis was carried out using means, standard deviations this was presented as tables and graphs. The data was then entered into SPSS (Statistical Package for Social Sciences version 20.0). The data was interval ratio and the study investigated one group of subjects. A paired t-test was conducted to compare the percentage change in pressure pain threshold between the control and high TENS conditions. A statistical significance level of 95% (p<0.05) was used (Hicks, 2004). All raw SPSS outputs can be found in Appendix 5.

Results

The demographic data can be seen in Table 1. The following tables and graphs present both descriptive and statistical analysis of the pressure pain threshold data. All SPSS outputs can be seen in appendix 5 and raw algometer data can be seen in Appendix 6.

Table 1: Demographic Characteristics of Sample

N

minimum

maximum

mean

S.D

Age

20

19

23

19.95

1.09904

Key: N = Number of subjects

S.D = Standard Deviation

A small standard deviation is seen for the age of subjects in Table 1. The male to female ratio was 1:1 with 10 female subjects and 10 male subjects. All subjects met the inclusion and exclusion criteria, and all were able to complete the study.

Discussion

There are two primary and related theories for explaining the efficacy of TENS in chronic or acute pain relief. The gate theory (Wall, 1965 (Melzack R, Wall P. Pain mechanisms: a new theory. Science. 150(699):971-979,1965)) proposes that pain transmission relies on a ‘gate’ to the thalamus and cortex for nocireceptive information to be interpreted as pain. This theory postulates that inhibition of nocireceptors can be caused by rapid impulse activation of myelinated nerve fibers. The second related theory postulates that neurotransmitter exhaustion can be caused by rapid nerve activation outside of its refractory period, and that the temporary exhaustion of neurotransmitters would provide pain relief until such time as neurotransmitter synthesis had ‘refilled’ the synaptic junctions (Kaye, 2007(Transcutaneous Electrical Nerve Stimulation: WebMD eMedicine. http://www.emedicine.com/pmr/topic206.htm January 26, 2007)).

Limitations

Clinical Implications

Further research

Conclusion

Describe the ways that your relative can prevent the onset of osteoporosis.

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Describe the ways that your relative can prevent the onset of osteoporosis.

 

Osteoporosis is a bone disease marked by brittle and fragile bones. In this assignment, you will explore this disease in more detail using the scenario below.
Scenario:
During a recent visit with a female relative, the relative informs you that she has been diagnosed with osteopenia, a precursor to osteoporosis. In order to help your relative, you decide to research this disease further.
To complete this assignment, do the following:
Research this disease using the sources I have uploaded below.
In a minimum of 2 pages (not counting the references page), address the following:
Explain how osteoporosis develops and the potential causes.
Describe the ways that your relative can prevent the onset of osteoporosis.
Include a references page at the end of your document, formatted using the APA guidelines, that lists your research sources.
References for both uploads please make sure to cite correctly.
Boughton, B., & Davidson, T. (2015). Bone Density Test. In J. L. Longe (Ed.), The Gale Encyclopedia of Medicine (5th ed., Vol. 2, pp. 777-779). Farmington Hills, MI: Gale. Retrieved from http://go.galegroup.com.ezproxy.rasmussen.edu/ps/i…
Kaczkowski, C., & Frey, R. J. (2013). Osteoporosis. In B. Narins (Ed.), The Gale Encyclopedia of Nursing and Allied Health (3rd ed., Vol. 4, pp. 2456-2463). Detroit: Gale. Retrieved from http://go.galegroup.com.ezproxy.rasmussen.edu/ps/i…
This is property of essayprince.org. Welcome for all your Research paper needs and our professional tutors will help you from start to finish. Sign up NOW and fulfill your Research paper help needs

16-Healthcare informatics: Transition to Electronic Health Record.Research and discuss three challenges facing an organization, and review how the conversion to a full electronic health record could address the challenges identified.

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16-Healthcare informatics: Transition to Electronic Health Record.Research and discuss three challenges facing an organization, and review how the conversion to a full electronic health record could address the challenges identified.

Order Description
Research and discuss three challenges facing an organization, and review how the conversion to a full electronic health record could address the challenges identified.
THEN BRIEFLY: Evaluate the factors that drive an organization to adopt a strategy to create an electronic health care record.

NOTE:
Use APA format for any research or sources that are being used or quoted.
Sources must include this text by Gartee:
Gartee, R. (2011). Health information technology and management. Saddle River, NJ:

Would be ethical or lawful to lie to or withhold information from a patient?

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Would be ethical or lawful to lie to or withhold information from a patient?

Are there any circumstances where it would be ethical or lawful to lie to or withhold information from a patient?need MLA essay paper strictly answering the question above;

Are there any circumstances where it would be ethical or lawful to lie to or withhold information from a patient?

need MLA essay paper strictly answering the question above

The Importance of Continuing Professional Development in Dentistry

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Introduction

Continuing professional development (CPD), in reference to dentistry, is referred to as “the mechanism by which dental practitioners develop their skills and knowledge and maintain up-to-date practice” (Barnes et al., 2012). The main aims of CPD is to protect the public and patients, as well as supporting dental professionals in maintaining and improving their skills and knowledge. This in turn can help to enhance the quality of care given to patients and can help the dental professionals themselves in being confident in their knowledge and skill set (GDC, 2013). You are required by law to do 250 hours of CPD in a 5-year period. At least 75 of these hours needs to be verifiable i.e. it needs to meet the GDP’s definition of CPD and provide documentary evidence of this and have written information from the provider confirming that you have undertaken the CPD (GDC, 2013). Continuing professional development is important for career-long knowledge and understanding as the skills are required for one’s whole career. New technologies are continuously being brought out such as hand-held X-ray machines as opposed to wall mounts and new ways of carrying out particular procedures (such as carrying out a root canal) are being developed, and CPD can make dentists aware of these new technologies and aid in acquiring the knowledge in which to use the equipment and carry out the procedures. Therefore, making life for the dentist easier, as well as for the patient (Barnes et al., 2012).


How CPD is Assessed

There are several different ways in which to carry out CPD. For example, hands-on courses (the main choice, which includes seminars and lectures), reading journals or books, e-learning, distance learning etc. (Barnes et al., 2012). Dental professionals will be required to keep and maintain a personal development plan (PDP). In your PDP portfolio, activities undertaken must be categorised as so: A for communication, B for management, C for knowledge and D for skills (Royal College of Surgeons, 2019). Activities that fall into category A, which are undertaken in order to improve on or maintain the GDC required standard for effective communication with patients, others in the dental team and when dealing with general concerns and complaints from the patients as well as raising concerns if a patient or patients are at risk. Examples of CDP specific courses for this area could be lectures or seminars on communication skills, consent, complaints handling, raising concerns and safeguarding. Additionally, activities that fall into category B focus on effective management of one’s self and the others in the dental team, and development of leadership skills. Examples of courses to attend could be on effective practice management, business management, team working and leadership skills. Activities that fall under category C would be for the maintenance and development of skills and knowledge in the dental professionals’ specific field of practice. For example, clinical and technical areas of study, radiography, cross infection control, medical emergencies, emerging technologies and treatments. Moreover, category D activities for CPD can also focus on maintenance of behaviours and attitudes in relation to patients and putting their interests first. For example, courses can be taken specifically relating to ethical and legal issues, professional behaviours and equality and diversity training (GDC, 2018). The GDC may not directly evaluate individuals’ PDPs, but it will definitely require evidence of completion of the portfolio. According to Ucer et al.’s research (2014), there doesn’t seem to be a concrete way to assess the quality of CPD. Although, a common form of assessment can be a certificate or an award for the specific type of CPD performed. Additionally, continuing education (CE) points or transferrable credits for courses can be given that meet the standards of the GDC. Feedback from the course providers can also serve as quality control for the dental professional.


Examples of CPD Activities

Lectures

Conferences

Short training courses

Study clubs/ journal clubs

Mentoring activity (discussions/supervision by experienced colleagues in the workplace)

Peer review

Self-assessment

Clinical audit

Internet/journal reading

Problem based learning activity

e-learning

Distance learning


Figure 1.

Table adapted from Ucer et al. (2014), depicting the common types of CPD activities that could be carried out by a dental professional in order to maintain and improve on their dental skills.


Drawbacks

One drawback about CPD in dentistry is that the individual has the choice of what form of CPD to choose from. This can be counteractive as some activities will be chosen on the basis of convenience or interest as opposed to their learning needs. This has been shown to have an effect on the standard of CPD. For example, seminars were seen as the most useful way to carry out CPD as it has a practical element in which the acquired knowledge can be applied, compared with journal reading which doesn’t necessarily allow for active application of knowledge. This is reinforced by the fact that when CPD is undertaken over a long period, is interactive and includes on the job application, it is a lot more effective than more passive forms of CPD. Additionally, if practitioners only undertake one form of CPD, this can also be less beneficial than when multiple forms are carried out. For example, reading journal articles, attending seminars/lectures and carrying out problem-based learning are more effective than only reading journals or only attending seminars. It is not acceptable to only know what is up to date for best practice, the dental professional needs to be able to reflect on and engage in the process. Furthermore, it is crucial that the practitioners learning environment is conducive for the application of learning and that the workplace promotes learning. This is important as other practitioners surrounding in the workplace can encourage and share knowledge and/or be a mentor to those around them (Barnes et al., 2012).


Benefits

Despite some of the drawbacks, with appropriate implementation and management of the PDP portfolio, CPD has the opportunity to encourage dental professionals to develop their skills and understanding in their particular field of expertise. CPD is beneficial as it allows for the publics’ expectations of the dental professional to be met. It gives the public/ patients more confidence in the competency of their dentist and that the best possible treatment plan will be implemented as a result of their continuing professional development (Eaton et al., 2011). Another benefit of compulsory CPD in dentistry is that all individuals are required to complete 250 hours in a 5-year period (as stated previously). This is beneficial as it means that all individuals will have completed the same number of hours and it brings in some form of uniformity into the assessment of CPD. Although there are concerns about the imbalance in type of CPD activity undertaken, Barnes et al. (2012) found that 88% of practitioners chose to do a hands-on-course. This is positive as hands-on-courses are seen as the most favourable way to acquire knowledge for CPD.


Conclusion

In conclusion, CPD is a valuable means in which to maintain dental practitioners’ competency and skill set. Compulsory implementation of CPD in 2008 for dental professionals, is a favourable way in which to ensure that the individuals are keeping up to date with their knowledge and safeguarding the needs of the patients and the public. It is essential that these skills are maintained as it allows for new ways of carrying out procedures that are more beneficial to the patient to be done. Additionally, it allows for the dental practitioner to make sure that they remember how to carry out various procedures that they may have not conducted in a certain amount of time.


Bibliography