Issue of the Over-Prescription of Antibiotics

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TITLE:

“Over-prescription of antibiotics now threatens the future health of millions”. Analyse and discuss this statement with reference to specific examples, using a range of academic sources.


INTRODUCTION

This essay is about the over-prescription of antibiotics and the way it can affect the ‘future health of millions’. It intends to give background information on the discovery of antibiotics, the different groups of antibiotics. It also briefly describes their mechanism of action and what they are used for.  It analysis the different types of bacteria, the different routes of transmission and how bacteria can become resistant to antibiotics. It will also explain how they can become a threat to public health if they become resistant to current antibiotics, with examples of Multi-drug resistant bacteria. Lastly, this essay will give suggestions of ways to prevent from antibiotic resistance.

Antibiotic resistant is a very dangerous and life-threatening matter as it is likely to happen in individuals with low immunity such as young and the elderly individuals. One of the biggest worries is the failure to create new antibiotics for bacteria that are becoming resistant. This results in the bacteria being left untreated and therefore could lead to the death of the infected patient.


Antibiotics

Antibiotics are a type of drug frequently prescribed to treat bacterial infections.

Alexander Fleming discovered the first antibiotic in 1928, Fleming found a culture plate with staphylococci being grown within it, the growth present was contaminated with a mould of genus Penicillium. (American Chemical Society, 2018). He learnt that the bacterial growth in the region of the mould was stopped. As a result, he put the mould in pure culture and established that it produced an antibacterial substance, which he named Penicillin.

According to an online source, there are over 100 antibiotics but there are 7 main classes: Sulfonamides, Penicillin’s, Cephalosporin’s, Macrolides, this includes; erythromycin, Fluoroquinolones such as levofloxacin, Tetracyclines such as tetracycline and lastly, Aminoglycosides, including gentamicin. (Shiel Jr, MD and FACP, 2018). Every antibiotic is used to treat a specific infection. The antibiotic chosen by the doctor depends on factors such as allergies, which part of the body is infected and the type of bacteria it is infected by. This lowers the chances of antibiotic resistant as the right antibiotic would be prescribed. Penicillin was used to treat many different bacterial infections, however, due to overuse, penicillin resistance became a huge clinical problem.

Antibiotics work by targeting bacteria and stopping their growth, or by killing the bacteria. Each antibiotic works differently, but they all work by influencing things that bacterial cells have, which don’t exist on human cells. Penicillin and cephalosporin work by stopping the bacteria from creating a cell wall, which results in the membrane bursting due to pressure. Other antibiotics attack different parts of the bacteria, such as the DNA while it is being replicated. Levofloxacin breaks the DNA and stops it from being repaired, which means the bacteria cannot live or reproduce. Antibiotics do not work against viral infections such as the common cold and the flu, therefore using antibiotics for these illnesses, contributes to antibiotic resistance and side effects.

The image below summarises how different antibiotics work.

(Figure 1: an illustration showing the mechanism of action for different antibiotics. (Garima Kapoor, 2017).


Bacteria

A bacterium can be defined as a “member of a large group of unicellular microorganisms, which can cause disease” (Google Dictionary). There are different types of bacteria, however they can usually be categorised as being either Gram-positive or Gram-negative. The structure of the cell and the thickness of the cell wall defines whether it can be stained with Gram’s stain. Gram-positive bacteria have a simple cell wall structure. It contains peptidoglycan, acidic polymer, protein and polysaccharides (Rang et al. Pharmacology, 2016). Whereas Gram-negative is more complex. It contains enzymes, peptidoglycan, lipid bilayer, proteins and complex polysaccharides. This makes it difficult for some antibiotics to pierce the complex outer layer. The image below shows a side by side comparison of Gram-positive and Gram-negative.

(Figure 2: An illustration comparing the cell walls of Gram-positive bacteria to Gram-negative bacteria (Deena T Kochunni, 2018).

Infectious diseases can be transmitted through a variety of ways the following is just a few examples, such as from direct or indirect contact with an infected person. This can be through the droplets in the air from sneezing and coughing e.g. Meningitis, skin/mucous membrane e.g. Staphylococcus aureus infection, blood or bodily fluids through sexual contact e.g. Gonorrhoea and lastly, through contaminated food or water e.g. Salmonella. (Higuera and Pietrangelo, 2018).

The bacteria become resistant to antibiotics by changing. The resistance occurs by the bacteria surviving and multiplying in number, which causes more harm. The bacteria develop resistance by modifying their gene immediately or through a genetic exchange with other resistant bacteria in the body. This, therefore, results in resistance as the antibiotic that once worked on the bacteria, no longer works. A bacterium becomes a ‘superbug’ when its known to be resistant to one or more antibiotics.

There are numerous patients that go through regular treatments such as organ transplantation, cancer treatments, hip and knee replacements which are frequently prescribed antibiotics. This helps to prevent from infections throughout their treatments. However, the problem of antibiotic resistance is increasing, this results in more deaths from bacteria that are resistant to common antibiotics prescribed. This creates a big problem for routine surgical procedures as it makes it harder to prevent from bacterial infections and the procedures could become hazardous. A reliable source mentioned that “Sepsis is a common cause of death in the UK with over 44,000 deaths every year”. These deaths are due to untreatable antibiotic resistance infections and this high number is more than the deaths from lung cancer (35,000) and bowel cancer (16,000). (Antibiotic Research UK, 2018).


Examples of multi-drug resistant Bacteria

It is undeniable that antibiotic resistance is life-threatening in the same way as cancer and other dangerous diseases. World Health Organisation believes that antibiotic resistance is one of the biggest threats to human and animal health worldwide. WHO created a rank of bacteria names which need new antibiotics urgently. This list has the names of bacteria in order of priority depending on how much they threaten human life. The first bacteria on the list is, Acinetobacter baumannii. This superbug can cause different diseases such as meningitis and pneumonia, which are life-threatening if left untreated. Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae are all dangerous bacteria that have become resistant to many strong antibiotics such as Carbapenem. These bacteria can be very threatening, which is the reason they are number one on the list (Lawe Davies, 2017). Another superbug that is multidrug-resistant is Salmonella typhi. This bacterium is extremely transmittable and it causes infections such as typhoid fever, salmonellosis in the intestinal tract and many other acute diseases that could potentially lead to death. Its stated that, about 1% of those infected will die (Christine McCaughey, 2018). This strain of salmonella typhi has become extensively resistant to many antibiotics such as chloramphenicol, ampicillin and trimethoprim. (Rowe B, Ward LR and Threlfall EJ, 1997).

In addition, other examples of bacteria that have become resistant to almost all the easily accessible antibiotics are: Methicillin-resistant Staphylococcus, Multi-drug-resistant Mycobacterium tuberculosis, Vancomycin-resistant Enterococcus and Carbapenem-resistant Enterobacteriaceae. Bacteria such as MRSA and Neisseria gonorrhoea were both controlled by penicillin, and now they are almost always resistant to benzyl penicillin. (Betterhealth.vic.gov.au, 2018)


Prevention

There are ways to prevent antibiotic resistance, Firstly, doctors need to minimise the prescription of antibiotics especially in developing countries. Secondly, it is advised to finish the entire course of antibiotics prescribed by the doctor. This way the antibiotic can be fully effective and kill the bacteria instead of allowing it to develop resistance. Thirdly, being sanitary such as washing hands and contamination control procedures need to be practised, this way the risk of transmitting infection is reduced especially in places like hospitals and GP’s, where bacteria can easily be transmitted. Moreover, always make sure the food is cooked before its eaten and stay up to date with vaccination. (Betterhealth.vic.gov.au, 2018). Furthermore, another method to help with antibiotic resistant is to create new antibiotics to fight against the resistant bacteria, but in the recent years, only a few options have become available, with under fifty potential new antibiotics being tested. This is a very small number because most of the drugs are unsuccessful. (Patient Research Exchange, 2018).

 


CONCLUSION

In conclusion, I believe antibiotics have played a vital role in medicine and saving lives. However, in recent years there has been an increase in the unnecessary prescription of antibiotics. The NHS stated that a fifth of prescriptions provided throughout GP surgeries were to patients who do not need them. From this, a study was conducted which investigated the number of antibiotic prescriptions that were not required in GPs from 2013-15. They found “8.8% and 23.1% of all antibiotics prescribed to be known as inappropriate” (NHS.uk, 2018). This may be due to patients asking for antibiotics without considering the type of organism that caused their infection, which could result in the inappropriate prescription of antibiotics. If all bacteria become resistant, then a simple infection could become life-threatening and routine surgeries would become much more difficult and dangerous. I think more people need to be educated about the causes and the risks of antibiotic resistance. This could result in patients being more responsible with the use of antibiotics and in prevention from infections.

 


Word count: 1531

 


REFERENCES


Websites

  • American Chemical Society. (2018).

    Alexander Fleming Discovery and Development of Penicillin – Landmark – American Chemical Society

    . [online] Available at: https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/flemingpenicillin.html [Accessed 9 Dec. 2018].
  • Antibiotic Research UK. (2018).

    Antibiotic Research UK – The problem explained

    . [online] Available at: https://www.antibioticresearch.org.uk/about-antibiotic-resistance/ [Accessed 9 Dec. 2018].
  • Shiel Jr, W., MD and FACP (2018).

    Antibiotic Side Effects, Types & Drug Interactions

    . [online] eMedicineHealth. Available at: https://www.emedicinehealth.com/antibiotics/article_em.htm#what_drugs_interact_with_antibiotics [Accessed 9 Dec. 2018].
  • Antibiotic resistance and the challenges of conducting new antibiotic clinical trials – Patient Research Exchange. (2018).

    Antibiotic resistance and the challenges of conducting new antibiotic clinical trials – Patient Research Exchange

    . [online] Available at: https://www.patientresearchexchange.org/stories/detail/antibiotic-resistance-and-the-challenges-of-conducting-new-antibiotic-clini [Accessed 9 Dec. 2018].
  • Betterhealth.vic.gov.au. (2018).

    Antibiotic resistant bacteria

    . [online] Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/antibiotic-resistant-bacteria [Accessed 9 Dec. 2018].
  • Bennington-Castro (2018).

    What Is Acinetobacter Baumannii?

    . [online] EverydayHealth.com. Available at: https://www.everydayhealth.com/acinetobacter/guide/ [Accessed 9 Dec. 2018].
  • Christine McCaughey, L. (2018).

    Five of the scariest antibiotic-resistant bacteria of the past five years

    . [online] ABC News. Available at: https://www.abc.net.au/news/2018-09-03/scariest-antibiotic-resistant-bacteria-australia-contagion/10194230 [Accessed 9 Dec. 2018].
  • Lawe Davies, O. (2017).

    WHO publishes list of bacteria for which new antibiotics are urgently needed

    . [online] Who.int. Available at: https://www.who.int/news-room/detail/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed [Accessed 9 Dec. 2018].
  • Labtestsonline.org. (2018).

    Antibiotic Resistance in Bacteria | Lab Tests Online

    . [online] Available at: https://labtestsonline.org/articles/antibiotic-resistance-bacteria [Accessed 9 Dec. 2018].
  • Netdoctor. (2018).

    Medicines for bacterial infections (antibiotics)

    . [online] Available at: https://www.netdoctor.co.uk/medicines/infection/a25910/treatments-for-bacterial-infections-antibiotics/ [Accessed 9 Dec. 2018].
  • Deena T Kochunni, J. (2018).

    10 Differences between Cell wall of Gram positive and Gram negative Bacteria

    . [online] Majordifferences.com. Available at: https://www.majordifferences.com/2018/06/difference-between-cell-wall-of-gram.html#.XBF43xP7Rdg [Accessed 9 Dec. 2018].
  • nhs.uk. (2018).

    Up to 1 in 5 antibiotics may be prescribed inappropriately

    . [online] Available at: https://www.nhs.uk/news/medication/1-5-antibiotics-may-be-prescribed-inappropriately/ [Accessed 9 Dec. 2018].
  • Higuera, V. and Pietrangelo, A. (2018).

    Disease Transmission: Direct Contact vs. Indirect Contact

    . [online] Healthline. Available at: https://www.healthline.com/health/disease-transmission#indirect-contact [Accessed 9 Dec. 2018].

J

ournals

  • Rowe B, Ward LR and Threlfall EJ (1997).

    Multidrug-resistant Salmonella typhi: a worldwide epidemic. – PubMed – NCBI

    . [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8994789 [Accessed 9 Dec. 2018].
  • Ventola, C. (2018).

    The Antibiotic Resistance Crisis: Part 1: Causes and Threats

    . [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/ [Accessed 9 Dec. 2018].
  • Garima Kapoor. (2017). Action and resistance mechanisms of antibiotics: A guide for clinicians. [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672523/ [Accessed 9 Dec. 2018].


Book

  • Rang, H., Dale, M., Ritter, J., Flower, R. and Henderson, G. (2016).

    Rang and Dale’s pharmacology

    . [Amsterdam]: Elsevier, Churchill Livingstone.

 

 

 

 

Admission Essay to DNP Programme/Nursing School

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Admission Essay to DNP Programme/Nursing School

Topic: Admission Essay to DNP Programm/Nursing School

Order Description

Personal Statement:
? 3-4 pages, double spaced, addressing the following 5 components: Overview of professional experiences
Short and long term professional goals
Nursing practice interests
Motivation for pursuing a doctoral degree
Educational objectives you hope to pursue if admitted

Conduct an educational needs assessment and analysis of your place of employment

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Conduct an educational needs assessment and analysis of your place of employment

 

 

Conduct an educational needs assessment and analysis of your place of employment.
Write a 1,050- to 1,750-word paper describing the results of your assessment.
Include the following information in your assessment:
Type of institution
Type of nursing care or service provided
Volume of activity of the institution
Levels of nursing care staff employed
A summary of the results of the educational needs assessment and analysis, obtained by completing the following steps:
Select a small sample from your representative group.
Collect data through interviews, questionnaires, checklists, a review of the institutions documents, or direct observation.
Analyze the data.
Identification of the highest priority educational need
Identification of institutional forces in favor of and those against responding to educational needs, such as budgetary and staff constraints, staff receptiveness and buy in, and support from management
Identification, based upon the existing structure of the organization, of the next step within the institution to respond to the educational needs identified as highest priority
Format your paper consistent with APA guidelines.

Overview of the American Disabilities Act (ADA)

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  • Crystal Mullen


What did you learn this week that you did not know before or that you found interesting?


What outside resources did you use this week?


Your submission should be 1 page APA formatted paper, not including your title page.

I grew up in the 70s and 80s; a time when every building, every walkway and certainly every restroom was geared toward able bodied individuals. I heard stories of my mom having to help my wheelchair-bound great-grandmother out of her chair, into a ladies room stall and then back into her chair. Certain shops were outside my great-grandmother’s ability to frequent because the door to get in was too narrow for her wheelchair or the building had to be accessed by climbing steps. If these are a few of the obstacles my great-grandmother had to overcome, I can only imagine how people who are blind, deaf, or even small statured managed to live in a world that was designed for people with two good eyes, two good ears and five feet, five inches tall. This is why I’m thankful for the Americans with Disabilities Act.

The American Disabilities Act (ADA) is an all-encompassing civil statute with the magnitude of a constitutional amendment. It requires equal accessibility to interact with society and equal opportunity for gainful employment. This means that restaurants offer menus in Braille. It may also means an office adjusting a workspace for an employee in a wheelchair (The Center for an Accessible Society, 2014).

As alluded to, one of the main areas that are affected by the ADA is the workplace. Employers are not allowed to discriminate against applicants who are qualified but have disabilities. This means when an employer is interviewing a job hopeful, for hire, the employer is not allowed to directly question the applicant’s disability. Furthermore, the job hopeful be given the same consideration for the job at hand as his or her able-bodied counterpart. Finally, though certainly not exhaustively, employers are required to provide reasonable accommodations to their employees with disabilities. If necessary, employers will need to make accommodations that are considered reasonable for employees who become disabled temporarily by providing temporary reassignment of duties (Kesee, 2014).

One of my favorite shows is the TLC reality show “The Little Couple”, Dr. Jen Arnold, who’s 3’ 2” tall is a is a doctor who works in the Neo-Natal Intensive Unit (NICU) at a hospital in Houston. In order for the hospital to accommodate the doctor’s stature, there are step ladders strategically placed throughout the NICU as well as a motorized chair quickly transport her through the long corridors of the hospital (Wikipedia, 2014). Modifications like these are required in the workplace to accommodate anyone with disabilities and those requirements are the result of the Americans Disabilities Act.

Another area that is affected by the ADA involves public transportation. Under the ADA, all modes of public transportation needs to be accessible by passengers who are wheelchair-bound or otherwise disabled. This means buses and trains must provide designated seating areas for disabled individuals. Furthermore, transit facilities are required by law to allow the entry of service animals that assist passengers onboard their vehicles of transportation. Finally, airports, train stations and bus stations are required to provide assistance when needed or when asked. These are just a few areas of transportation that are affected by the ADA (Kesee, 2014).

Finally, but not exhaustively, a third area that is affected by the ADA involves access into public buildings. Public buildings must ensure that entryways as well as restrooms can be wheelchair accessible and that its accessibility to the public meets ADA requirements. Many of the public buildings are now equipped with doors that open and close automatically so that wheelchair-bound individuals are granted entry. Furthermore, public buildings with steps need to provide wheelchair ramps. Finally, though certainly not exhaustively, public restrooms are required to provide at least one stall with that has a wider entrance necessary for wheelchair entry. Public facilities like grocery store counters or gas stations however must provide some type of assistance for disabled individuals who require assistance (Kesee, 2014). These are just a few measures mandated by the ADA open the doors to those with disabilities.

Every wide sweeping measure has its pros and cons and the ADA is no exception. There are instances where the ADA is both well-meaning yet problematic for small businesses – particularly those that are in areas where are few or no disabilities to address. One example is that businesses are mandated by the ADA to provide public spaces and ensure that disabled patrons can accesses needed spaces. This includes continuous railings be found along the stairs and ramps, the ramps need to be constructed with low grade slopes, designated and widened parking spaces and restrooms with hand railing. While I believe these mandates by the ADA are well-intentioned, these changes and modifications to a company’s infrastructure can be costly. However, if a business chooses not to comply, they face fine that far outweigh the cost for implementing the changes. For example, the Morena Business Association incurred many lawsuits for violating ADA requirements in their San Diego, California location. Because they ignored ADA mandates from 1992 to 2007 the local business was forced to pay $1 billion in fines (Holzer, 2014).


Conclusion

Despite the financial challenges to small businesses, I believe the ADA has positively changed society and the workplace so that everyone – regardless of their abilities can participate in society and bring value to any workplace. Last summer I had the opportunity of working with someone who was partially hearing impaired. There was a time when she would never get a job due to her disability. However, thanks to technology, she could receive communication through emails and direct face-to-face communication; she was able to perform data-entry duties along with the rest of her team. I credit the ADA with these changes to society and the workplace and these changes have made our society and workplace a more welcoming environment for all. Furthermore, I’m so thankful to get on a bus and hear bus stops audibly announced for the visually impaired. Finally, though certainly not exhaustively, I wish my great-grandmother was alive today to see she can enter any restaurant and use any restroom all by herself and with her dignity intact. Therefore, despite its flaws the ADA has provided a great amount of good for those with disabilities and even those who have two good arms, legs, eyes and ears. It benefits everyone across the country.


References

Holzer, D. (2014).

ADA Compliance Issues.

Retrieved March 16, 2014, from eHow.com:

http://www.ehow.com/list_6611054_ada-compliance-issues.html#ixzz2SLge5VT1

Kesee, C. (2014).

American Disabilities Act.

Retrieved March 16, 2014, from eHow.com:

http://www.ehow.com/about_6626833_american-disabilities-act.html

The Center for an Accessible Society. (2014).

The Americans with Disabilities Act.

Retrieved March 2014, 2014, from The Center for an Accessible Society.

Wikipedia. (2014).

The Little Couple.

Retrieved March 16, 2014, from Wikipedia:

http://en.wikipedia.org/wiki/The_Little_Couple

Describe in detail the social-psychological principle you believe is relevant. Your job here is to demonstrate that you understand the principle or theory, and that you can describe it in your own words.

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Describe in detail the social-psychological principle you believe is relevant. Your job here is to demonstrate that you understand the principle or theory, and that you can describe it in your own words.

 

In addition to entertaining us, movies offer detailed portrayals of human social behavior. Your task in this assignment is to analyze — from a social-psychological perspective — the behaviors and events depicted in one of the films listed below. You are not being asked to critique the film in terms of its value as a work of art or as entertainment. Rather, you should think carefully about the human actions and events portrayed in the film. Then, to make sense of this material, apply what you’ve learned this semester regarding the factors that predict and explain human social behavior. This assignment is comprehensive: We urge you to bring any/all concepts encountered in this course that relate to the issues, interactions, and behaviors portrayed.

Your assignment is to choose one of the films listed below. Most should be available at any video rental store or at many locations online. View the film you choose at least once(two viewings may offer an advantage. Then, after reviewing your notes and text, identify at least3 different social-psychological principles that appear to be operating in the events or individuals depicted in the film (e.g., cognitive dissonance, schemas, self-fulfilling prophecies, groupthink, deindividuation, conformity, realistic conflict theory, modern racism, etc.). For each principle that you identify:

(a) briefly describe the relevant scene.This should take up no more than half a page as you may assume that your reader has seen the film.

(b) describe in detail the social-psychological principle you believe is relevant. Your job here is to demonstrate that you understand the principle or theory, and that you can describe it in your own words. An occasional quote from your text or another source is fine, but for the most part, you should be conveying your knowledge without the aid of others’ words. You don’t need to do library research for this – using your text or your lecture notes as resources is fine – but remember the rules about avoiding plagiarism. Again, we need you to show us that you have a good understanding of the concept/principle. It’s best if you are specific about the principles you discuss. For example, don’t just indicate that your scene illustrates helping, or conformity, or persuasion, or aggression. Instead, indicate what specific theory, or principle or aspect of helping/conformity/persuasion/aggression, etc. that your scene illustrates.

(c) elaborate on how the selected scene illustrates the principle you have identified. It’s also acceptable to write about how a scene fails to follow predictions derived from the social-psychological principle or theory. Where possible, make reference to how your scene maps onto specific research findings (for example, describe how the scene is similar to or different from relevant experiments you’ve read in your text). ) It’s very important that you do more than simply say something like “this scene illustrates conformity.” You must be specific on precisely how and in what form the scene illustrates conformity, or how it fails to support what you learned about conformity in the class.

Patient Care Plan Analysis: Suicide Attempt Case Study

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The purpose of this essay is to explore the effectiveness of the care delivered to Mike during clinical placement. In order to achieve this, the essay will demonstrate development of therapeutic relationships through the use of appropriate communication and interpersonal skills will be demonstrated in this essay the essay will look at the formulation and documentation plan of care of mike including his family or carers within a framework of informed consent. The essay will also evaluate and document the outcomes of nursing and other interventions. Finally, the essay will discuss the opportunities utilised and created to promote the health and well-being of patients, clients and groups. For confidentiality reasons, names and places used in this essay are changed in compliance with Nursing and Midwifery Council Code of Conduct (NMC, 2010).

Mike, a 54 year old widower was taking to the accident and emergency (A&E) department when found in a semi-conscious state after taking an overdose of his prescribed pain killers. Mike’s neighbours alerted the police when they realised his curtains had not been drawn and reported he had not been attending the local social club for a couple of weeks. Mike collapsed on his bed with an empty packet of tablets beside him and a suicide note addressed to his son Duke who lives in Greece. Mike appeared to have been neglecting himself, lost weight and there were signs he had made superficial cuts to his wrist. Mike was also suffering from chronic lung condition due to excessive smoking. Following an assessment Mike was diagnosed of depression and was detained under section 2 of the Mental Health Act (MHA) since he refused to be admitted voluntarily.

Hospital environment can be very stressful for clients when they first arrive at the ward. Nurses need to engage positively with clients to develop therapeutic relationship. Barker (2009) argues that, therapeutic relationship empower clients to learn, or cope more effectively with their environment. The nurse began a therapeutic relationship with Mike by initially introducing himself to Mike and addressed Mike by his preferred name. Mike was listened to without any immediate advice or diminishing his feelings. NMC (2010) recommends that, patients must be treated as individuals and respect their dignity. Mike had daily 1-1 nursing time with staff and through this Mike’s goals and wishes were identified which was incorporated into his care plan. DOH (2006) declares that, one to one session are therapeutic, they enable the patient to engage well with staff as empowering them to express their feelings and thoughts.

In other to deliver effective care to mike to promote his recovery, person-centred care plan was devised. NICE (2009) recommends that, treatment and care should take into account patients’ needs and preferences. It also suggests, people with depression should have the opportunity to make informed decisions about their care and treatment, in partnership with their practitioners. Since Mike had severe and complex mental and physical health needs, different health professionals’ i.e. psychiatrists, psychologists, GP, nurses, social workers, occupational Therapist and other community care providers were involved in his care. DOH (2004) ten essential shared capabilities recommends that professionals, patients, families, carers should work in partnership to provide quality care. Consent was sought from Mike if he wanted his son Duke to be involved in his care. Gaining consent is a legal aspect of mental health nursing and it shows that patients are treated with respect (Diamond, 2008). Mike and Duke were fully involved in every aspect of the plan of care for Mike. CPA (2008) recommends, patients, families; carers should be involved in making decision about their care plans. The author and other team members provided Mike with vital info to promote Mike’s choice and to enable Mike to make informed decisions. The MDT reviewed Mike’s mental and physical health regularly and any significant changes in Mike’s health were amended on his care plan to make sure Mike’s needs were still being met. Meeting service users other needs improves their quality of life and provides good well-being, No Health without Mental Health (2011)

Due to the nature of Mike’s illness and presentation, Mike was initially nursed within eyesight observation which was later reviewed to general observation (NICE, 2005). Mike also had lots of supports, reassurance and prompts to enable him attend to his personal care since he appeared unkempt. Mike losing his wife and the chronic lung condition may have impacted on his mood. Also it is possible that Mike had limited social support network and felt vulnerable, which can add to low mood. Therefore team’s occupational therapists regularly engaged Mike in therapeutic activities both on and off the ward to lift Mike’s mood up and also to promote his independence. New Horizons (2011) suggests, occupational activities are therapeutic and they help patients to engage with staff and other patients in the ward and builds self-worth and confidence towards discharge. Mike was also provided with bereavement support. NHS (2012) recommends bereavement support to carers, families and patients if they lose a dear one as it has impact on their mental health and well-being. Mike was made known of options of treatment available to him (NICE, 2009). Apart from being treated with antidepressant medication, Mike also had lots of inputs from the team psychologist to help promote Mike’s recovery. NICE (2009) recommends that, people with moderate or severe depression should be provided with a combination of antidepressant medication and a high-intensity psychological intervention i.e. cognitive behavioural therapy (CBT) or individual personal therapy (IPT). Papageorgiou, C. et al. (2011) affirms that, one of the most widely known types of psychological therapy for depression is CBT, which combines both cognitive and behavioural techniques into an integrated whole.

The MDT and the ward staff carried out initiatives that raised awareness and promoted healthier lifestyles choices and patients awareness of health, and also reduced the risk of experiencing illness. Wrycraft (2009) argues that, mental health promotion is an activity healthcare professionals carryout as part of their everyday practice in their roles and do not realise they are engaging in such activity. However at other times they actively seek information about health promotion activities. The nurse did provide Mike with information in the form of leaflets about his condition and range of information on smoking cessation and different methods involved. Staff facilitated these health promotions by strengthening the patients on the ward, they increased emotional resilience through communicating and negotiation with the patients to promote self-esteem, life and coping skills.

This plan of care should be reviewed by the MDT depending on the progress of Mike health.

Disease Prevention in Nursing

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According to The World Organization [WHO] (1946), “health is the state of complete physical, social, and mental welfare and merely the absence of disease”. WHO’s definition, however, does not reflect on the importance of spiritual health and wellbeing, and as evident in a research study by Olson (2015), spirituality whether practised through religion or secular means has a positive effect on patients toward managing and coping with health outcomes or recovery. Thus, the public health in New Zealand emphasises the need for holistic models of health such as Te Whare Tapa Whā model or Fonofale model for health promotion and disease prevention. Nurses are one of the largest regulated health workforces in Aotearoa New Zealand that embrace a holistic view of health (Clendon and Munns, 2018). Thus, nursing consists of maintaining individual and whanau’s health and wellbeing of all ages, ill or healthy and in all environmental and cultural setting. Nursing also includes but not limited to concepts such as the prevention of illness (WHO, 1984). Prevention of disease consists of three different levels of preventions and aims to maintain health and wellbeing by removing the causes and determinant of ill health, such as unhealthy nutrition, or environmental factors (Clendon and Munns, 2018). Therefore, the essay aims to address the role of nurses in maintaining individual and whanau health and explain how it fits with the prevention concept with supporting evidence using Mrs Siosiana K wellness check.

According to the Nursing Council New Zealand [NCNZ] (2018), nurse’s role is to assess health-related obligations and promote care, advice and support individuals to maintain their health. International Council of Nurses’ [ICN] (2012, p. 2) also states that nurses are to practice in “an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected”. Therefore, nursing consists of sustaining individual, whanau and community’s wellbeing, ill or healthy, at any age, in any emotional, physical, or social state and in all environmental and cultural setting, thus nurses integrate a holistic view of health into their practice (Clendon& Munns, 2018). A study by Olson (2015) also highlights the power of integrating client’s spiritual status and needs in the nursing practice, as it provides hope, sense of identity and purpose in their life, which become a powerful tool with the healing process. Moreover, a report by Auckland District Health Board [ADHB] (2016) highlights the importance of whanau, family, or friend’s involvement in the patient’s healthcare and is particularly significant to Maori and Pacifica patients. The ADHB (2010) report indicates that one in twenty patients (5%) and with twice as many Maori and Pacifica patients (11%) declared that allowing support is one of the significant factors toward their recovery, quality of care and treatment. Therefore, it is indeed fundamental to use a holistic approach in nursing to maintain a better understanding of the client’s health and wellbeing education level, to increase control of the factors of health, encourages self-care and thereby improves their health, and prevents the occurrence of a disorder or disease such as type II diabetes. For instance, as Mrs Siosiana K is Tongan, as a nurse, when assessing her, I would use a pacific holistic model such as the Fonofale model. The model was constructed as a Pacific Island model of health and wellbeing in New Zealand and bases on the resemblance of a fale/house. The roof represents Mrs Siosiana K strong cultural values as a Tongan; the foundation is her family support; and the Pou are the four dimensions of life: her strong spiritual faith as a Christian, along with her physical, emotional and social health such as education level, occupation or income level (Puloyu-Endemann, 2001). Using the Fonofale model will also provide a more profound understanding of my client’s knowledge and motivations that may aid her to a healthier life as well as an understanding of the lifestyle and living condition to determine Mrs K health status. However, the wellness check provided lacked inquiries about social, cultural, and spiritual beliefs, which as discussed are fundamental to gain a comprehensive understanding of the client.

Prevention concept consists of measures and strategies applied to prevent the occurrence of a disease and aims towards eliminating or reducing the impact of disease and disability (Clendon and Munns, 2018). WHO (1984) defines prevention concept as “the process of enabling people to increase control over the health and its detriments, and thereby improve their health”. According to Clendon and Munns (2018), public health in New Zealand classifies prevention in three groups: primary, secondary, and tertiary prevention. The focus of the primary level is to improve the health of an individual, whanau or community and have the client avoid or reduce high-risk determinants of ill health. For instance, according to George (2013), Pacific people have one of the most severe health indicators in NZ and experience a high number of preventable deaths mainly due to chronic non-communicable diseases (NCDs) such as diabetes and heart disease. Type II diabetes is more common among Pacific people and rates 2-3 times higher compared with the total NZ population (George, 2013). Survey also indicated that one of the leading causes of diabetes and heart-related disease among the Pacific people is obesity, with a rate of 90 percent in comparison with 60 percent of the total NZ population (Tapaleao, 2017). Some factors that affect their health, are low health literacy toward nutrients, or low physical activity and a lack of awareness of health care services available (Tapaleao, 2017). Therefore, primary prevention is preventing obesity, particularly in Pacific people, to gain quality health and wellbeing. Secondary prevention, on the other hand, relates to early diagnosis, and the goal is to persuade the client to have an early screening to reduce or prevent the progression of the disease. For example, according to George (2013), Pacific people are known to have little knowledge of primary health care services available, such as cervical and breast screening and also have low immunisation coverage rate. Thus, secondary prevention is to address this gap in knowledge to prevent the occurrence of disease such as cervical cancer. Lastly, tertiary prevention focuses on supporting the client in disease management and preventing further physical deterioration in order for the client to have the best quality of life possible, such as access to renal dialysis services as a result of renal failure due to diabetes (Hill, Ward, Grace and Gleadle, 2017).

Nurses play an essential role in disease prevention with the client, family, and community (Kemppainen, Tassavainen, and Turunen, 2012). According to Kemppainen et al. (2012), nurses educate clients on the benefits of a healthy lifestyle, such as eating healthy, exercising, obtaining an adequate amount of sleep, and ensure the client is participating in early detection diagnostic tests and screenings, thus preventing diseases. For instance, as a nurse, doing a wellness check such as Mrs Siosiana K’s check allows evaluation of Mrs K knowledge of health management and screening services available, such as breast screening and smear test, and confirms they done regularly. The wellness checks also provide a slight indication of Mrs K eating habits, sleeping patterns, and highlighted evidence that Mrs K is heading toward obesity with a BMI of 41.22. According to the wellness check, one factor of the weight gain could be due to sleep deprivation, as Mrs K stated a sleep of only 5 hours a night. A research study by Hanlon and Knutson (2013) states that sleep deficiency contributes to the increasing occurrence of overweight and obesity along with obesity related diseases such as type II diabetes and heart disease. Hanlon and Knutson’s (2013) findings prove that lack of sleep indeed weaken glucose metabolism and interferes with the central nervous system, leading to excessive food intake. Thus a further assessment of Mrs K sleep and rest patterns and the causes to her lack of sleep along with physical assessment is necessary in order to intervene based on the needs specific to Mrs K, such as planning activities and routines that may enhance the duration of sleep. The wellness check, however, failed to identify any other factors to Mrs K’s weight gain, such as whether it is lack of education toward healthy eating, her understanding toward risks of obesity or if it is stress or emotional related weight gain. Therefore, to prevent the occurrence of obesity related disease, it is vital in this case to gain more information about Mrs K using Fonfale holistic model as well as the wellness check, thus encourage self-care and thereby improve health.

In conclusion, the role of nursing range from simple to complex duties and includes but not limited to physical examination, prevention of disease and promotion of health for the individual along with the whanau, and community. Therefore, nursing act in the interest of the people of Aotearoa New Zealand, and work in partnership with individuals, whānau, and communities along with other health and social care providers in order to achieve optimal health outcomes. It was evident in the wellness check, some of the responsibility and quality of nurse’s role is disease prevention by interpreting information and factors that influence a client and develop a plan of care to treat an illness or simply improve quality of life, health and wellbeing. Moreover, the major need of using a holistic approach in nursing was apparent in order to maintain a more profound understanding of the client’s lifestyle and living condition, to best determine the health needs and thus provide the intervention required that is explicit for the client.


References:

  • Clendon, J., & Munns, A. (2018).

    Community Health and Wellness: Principles of primary health care.

    Victoria, Australia: Elsevier.
  • Hanlon, E. C., & Knutson, K. L. (2013). Sleep Deprivation and Metabolism.

    Sleep Deprivation and Disease, 119-129 => need to be sited as a chapter of a book, see life span
  • Kemppainen, V., & Tassavainen, K., & Turunen, H. (2012). Nurses’ roles in health promotion Practice: an integrative review.

    Health Promot Int, 28(

    4), 490-501. doi: 10.1093/heapro/das034.
  • Olson, J. K. (2015). Knowledge Required to use the Power of Spirituality in Healthcare.

    Acta Paulista de Enfermagem, 28(

    2), 3-5. Doi: 10.1590/1982-0194201500017.
  • World Health Organization.

  • https://openrepository.aut.ac.nz/handle/10292/11436

  • https://academic.oup.com/heapro/article/28/4/490/556908
  • https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2648.1995.tb03118.x
  • https://dailyhealthpost.com/sleep-deprivation-disease/
  • http://eds.a.ebscohost.com.ezproxy.aut.ac.nz/eds/pdfviewer/pdfviewer?vid=13&sid=79fd9835-ff9a-4225-bfc7-bf0ac0c7cab4%40sessionmgr4006

How is ethical behavior an integral part of being a nurse leader? How does one display the characteristics of a role model with this provision?

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How is ethical behavior an integral part of being a nurse leader? How does one display the characteristics of a role model with this provision?

T 11

How do you serve others in the profession of nursing? Explain how the way you serve others in the profession of nursing could become more closely aligned with the issue of serving as explained by the servant-leadership paradigm. How does the issue of serving differ from the secular view of power?

UNIT 12

Choose one provision from the ANA Code of Ethics. How is ethical behavior an integral part of being a nurse leader? How does one display the characteristics of a role model with this provision? Does a nurse leader have an ethical foundation to inject into business practice?

UNIT 13

Have you ever worked with a leader that made you feel that you were more important than they? How did this make you feel? What were the circumstances? What was the outcome? If you have never experienced this kind of treatment from a leader, imagine what it would be like. Based on your response, explain how the displays of humility by a leader exemplify servant leadership. Are displays of humility required to make someone else feel more important than you? Explain your answer.

UNIT 14

Analyze and integrate the impact of cultural competence and ethical decision making models on clinical reasoning, health policy and practice in regard to this more comprehensive understanding in the role of the NP.

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Analyze and integrate the impact of cultural competence and ethical decision making models on clinical reasoning, health policy and practice in regard to this more comprehensive understanding in the role of the NP.

Evaluating the necessity of a more comprehensive understanding of pathophysiology, pharmacology, and physical assessment skills for the role NP in contrast to the role of the RN. Analyze and integrate the impact of cultural competence and ethical decision making models on clinical reasoning, health policy and practice in regard to this more comprehensive understanding in the role of the NP.

A child is seen in a hospital-based pediatric clinic for active treatment 10% of first and second degree burns to the calf area on the left leg. 5% of third degree burns on her right hand.

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A child is seen in a hospital-based pediatric clinic for active treatment 10% of first and second degree burns to the calf area on the left leg. 5% of third degree burns on her right hand.

A child is seen in a hospital-based pediatric clinic for active treatment 10% of first and second degree burns to the calf area on the left leg. 5% of third degree burns on her right hand. What ICD-10
A child is seen in a hospital-based pediatric clinic for active treatment 10% of first and second degree burns to the calf area on the left leg. 5% of third degree burns on her right hand. What ICD-10-CM codes are reported?