The chain of infection

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Chain of infection

The CDC estimates that around 1.1 million adults and adolescents are living with HIV in the USA, including those not yet diagnosed, and including those who have already progressed to AIDS. There are many ways it could be transmitted. In this paper you will understand the impact of infectious diseases, the process of infection and how we as humans can reduce the spread of HIV and if medical asepsis plays a big enough role to stop the infection from spreading. Medical asepsis is techniques used to control and to reduce the spread of the pathogenic microorganisms for example, hand washing.

HIV is a group of viruses that infect and destroy cells of the immune system causing the marked reduction in their numbers that leads to a diagnosis of AIDS. It makes it harder for your body to fight infectious diseases. it can spread by sexual intercourse by the fluids, by an open wound, some people are born with it by the mother being infected, people who also inject them selves with needles for drugs/steroids and share is also a way to catch HIV. To protect yourself you are sexually active wear a condom, make sure it’s on correct that stops from any body fluids from being transmitted. Don’t share needles, if you’re getting a tattoo or body piercing make sure everything is clean and had not been used? Make sure you’re not infected and get tested.

There are many ways infections are spread. There all everyday objects we touch, for example floors, door knobs, dirty-laundry ect. They’re everywhere you could think of. Healthcare workers who deal with sick patients daily have a bigger risk of getting infected. Although you can’t see them there are bacteria, fungus, Virsus’s and so forth. They turn into infections when you have an open cut and don’t do anything to take care of it, Pathogens multiply and an infection is created. Many people don’t feel or look sick even if they are infected. They all spread from mostly not washing your hands correctly or even if your foods not cooked correctly.

Infections can happen when pathogens that are also known as microorganisms enter the body and cause you to get sick. First you must know how it spread in order to prevent it from spreading. The chain of infection is showing how the disease spread from one person to another; This is called the chain of infection. There are six links in the chain of infection. Link one is the infectious agent meaning the patient who has the virus/Bacteria and is causing it to spread. The Second link would be the reservoir, which means where the pathogens reproduce. The third link is portal of exit meaning how the pathogens spread/How they left the body. Could be by a simple handshake or a kiss on the cheek. The fourth link is mode of transmission meaning the way the bacteria was transferred from one person to another. The fifth link is portal of entry meaning an open wound or broken skin any opening allowing pathogens to multiply and make you sick/infected. Last is link six, which is the susceptible host meaning the person who has a lack of immunity would most likely catch the infection and worsen.

Infection control is realizing and decreasing the risks of infections spreading. The risk of catching HIV in health care hospitals and areas expanded in years for the staff and patients. When you work in the medical field and deal with patients, You must treat everyone as if they were infected because now in days you can’t tell who’s infected and who isn’t just by looking at someone. You should always keep in mind its a big responsibility working in the healthcare industry. its also good to always think clean and make sure to wash your hands correctly. Follow all instructions so you and your patient could be protected from catching anything.

HIV is something I never ever want to experience. it’s sad what people have to go through… at the risk of being human, having sex, being born HIV positive…. HIV to me is something no one should go threw but its part of life for some of us .life destroying. and something you can’t run away from. Although there are many ways to prevent from getting HIV people still just don’t get. I hope my paper helped you understand the role of how infections are created ect.

Evaluation of the New Zealand Disability Strategy

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Task 1


1.1

New Zealand Disability Strategy (2016-2026) will help the government agencies to solve any disability issues which will occur between the years 2016-2026.

(Ministry of Social Development, 2016)

This strategy has a vision which states that New Zealand has many disabled people and all of them have an equal opportunity in the society to reach their goals and aspirations and all of the people in New Zealand should work as a team to make this possible.

(Ministry of Social Development, 2016)


Objectives of the


New Zealand Disability Strategy


(2016-2026)

  1. Education

The provision of education should be in such a way that it supports the person both academically and in their social development. The ones who use a different mode of communication such as sign language, should have an opportunity to have them accessible to them and they should be able to progress in that. The education services that are provided for the disabled should be equal as the others and of high quality.

(Ministry of Social Development, 2016)

  1. Employment and Economic Security

There should not be any obstacles in their way when they are applying for jobs. They should be treated in a respectful manner by their colleagues who are non-disabled so that their work feels appreciated and relevant to them. (Ministry of Social Development, 2016)

  1. Health and Wellbeing

There should not be any obstacles in their way for accessing health services because of the impairments that they have. They should be well respected by the healthcare staff. Information about the health services should be available to them in ways which they can access it according to their disability. (Ministry of Social Development, 2016)

  1. Rights Protection and Justice

They should be treated in a fair way in the justice system. If they need support and services by the judicial system, they should be able to easily access it without any obstacles in their way. (Ministry of Social Development, 2016)

  1. Accessibility

Housing should be available to them according to their needs which will support them to participate in the community. Places should be easily accessible to them such as their workplace, schools, shops, public facilities.

Transportation should be available to them according to their needs. Different formats of communication should be available to them, such as sign languages and different languages such as Te Reo Maori which is the official language of the country. Their access to the community places such as banks, parks, malls should be free from obstacles so that they can interact with other non-disabled people.

(Ministry of Social Development, 2016)

  1. Attitudes

Their disabilities should be understood and they should be treated well and with respect by the society. They have the right to choose the way in which they want to be known as. They should be able to use their own languages to express their views on things and be heard by other people. Their views should not be declined by the society. (Ministry of Social Development, 2016)

  1. Choice and Control

Get to make their own choices about their lifestyle that how do they want to live. Their permission will be taken before doing things that will have an effect on them. They are capable of changing their decisions. Availability of resources should be informed to them so that they can make their choices rather than settling for less. If they are going to make risky decisions, support should be provided to them and they should be told about the consequences of their decision. (Ministry of Social Development, 2016)

  1. Leadership

They should be supported to be leaders in the role that they choose to be in. they can be leaders in so many things such as employment, which could be either in political ways or voluntary. Their skills and talents should be acknowledged by others. When there are discussions happening about disabled people, there should be a leader who is there to express the disabled people view on behalf of them in the discussions. (Ministry of Social Development, 2016)


1.2


Own Advocacy Practice

  1. Health and Wellbeing

They would be supported to access healthcare services at any time that they need to. They would be treated with respect by all the healthcare staff. Support would be provided to them if they have language barriers while accessing healthcare. A translator would be provided. They would receive support to access all the information about the services that they have access to. (Office for Disability Issues, 2016)

Most of the services for the disabled are funded by the Ministry of Health. Services that are funded are hearing and vision services and AutismSpectrum Disorder support. The disabled people would be educated about the services which are available to them. (Ministry of Health, 2019)

For the people who are in wheelchairs and who are not able to walk without support, they would be assisted by a carer to accompany them to the healthcare facilities to receive healthcare support that they need.

  1. Accessibility

Disabled people would be supported to have access to buildings and other public facilities. The New Zealand Standards Design for Access and Mobility – Buildings and Associated Facilities states the different ways in which public places and building can be accessed by the disabled. There are parking spaces for disabled, ramps, widened footpaths, taps and toilets are made accessible to them. (Standards New Zealand, 2001)

If the people are wheelchair bounded, they are supported to access buildings through the ramps. Workplaces are made accessible to them, wide spaces to get through and reachable desks are provided. People in wheelchairs and who can not walk properly are supported to access building through lifts rather than stairs. There are public toilets for the disabled which is more spacious and easier for them to get in and use. There are seats for the disabled in movie theatres. Carers can support the disabled to access these services. Disabled people can be educated about the services that they do not know about.

  1. Rights and Protection Justice

Disabled people have their own rights. They have the right to be treated equally, participate in social, economic and cultural activities, make their own decision on where they want to live and who they want to live with and they have the right to use their own language. Their rights are protected by the Human Rights Act. Support is provided to the disabled to participate in social and cultural activities. They are taken to the venues where the activities are supposed to take place. Support is provided to the person if they need to make a complaint if their being discriminated. There is a disability complaint guide on how to make a complaint. Firstly, they are supposed to warn the person to stop harassing them, if they do not listen then they are to take support from the police, Human Rights Commission or a lawyer. Support would be provided to the person to access the police services and to give warning to the person by whom he is harassed. (Human Rights Commission, 2019)

  1. Choice and Control

Support is provided to the disabled to make their own choices and to reach their goals. They have a control on their life and the things that they want to do. An example of choice and control is if a disabled person wants to stay with a particular person, he/she can. Support is provided to them for their freedom. Support is provided to them by their carers or other people in the community by giving them knowledge about the things that are good for them and the things which are not. Support is provided to them from the Individualized Funding. By this funding the disabled people can progress towards their goals and they can spend it on things which will be a source of support for them. (Ministry of Health, 2019)

  1. Employment and Economic Security

Support is provided to them to get equal work opportunities. Support is provided by the managers at their workplace if they are discriminated and action is taken. The workplace building is made accessible to them to come to work, such as lifts and ramps and widened paths. Their working area is spacious, for the ones in wheelchair specifically, this is to help them to move around easier. Support is provided at their workplace by hearing their opinions and views about things. Support is provided to the disabled workers to progress in their careers. The pay of the disabled people is the same as the non-disabled, this shows equality between both of them and there is no discrimination. (Office for Disability Issues, 2019)


Task 2


Health and Safety at work strategy in New Zealand

The strategy is to improve the health and safety of the workers. The level of injuries caused in the workers in New Zealand is higher than the international standards. Most of the workers have a higher risk of getting injured while working, some of the people are Maori’s, old workers and youths. The New Zealand Strategy shows that how they can be more capable of improving at their workplaces to decrease the harm that is caused to the workers. It shows that how workers can work in partnership and discuss that what improvements could be made.

(New Zealand Government, n.d.)


Healthcare safety in a healthcare setting in New Zealand

The people who are working in healthcare facilities are more prone to getting hurt and being exposed to chemicals and dangerous diseases. There are instructions on how healthcare workers can be safe at their workplace.

The management should work together to create a health and safety programme for the betterment of health. There should be a policy on health and safety that needs to be followed. It should state the responsibilities of the managers that who needs to do what and how are hazards and risks supposed to be identified and how can they be managed. There should be a health and safety coordinator who would work towards completing the health and safety goals. There should be proper interaction between the management and the staff. The policies should be up to date and it should include things about the visitors, healthcare staff and all the patients. Consultation takes place in the facility to make the health and safety practice at the workplace better. All the staff can interact and give their opinions on how to solve the risks that they have and can also identify any new problems that they have, it could be either major or minor. The senior management also gives their opinions and views. There is a plan with objectives and standards that need to be met with a specific time period in which it should be completed in. Audit and review are done on the standards that if it is sufficient or not. The study of the incident, accident and bad health data is done. This is basically done to see if there are any changes that need to be done. There is a system on how to identify hazards and control them. The system is the same throughout the entire facility so that there is no confusion between the workers. At first the hazards are identified and then an assessment is done and then the staff discusses on how they can control the hazards. Monitoring is done at the workplace to see if everything is safe and if the staff, patients or any other people at the facility are exposed to any type of risks and hazards. Emergency procedures are planned and all the staff is told what to do in case on an emergency. Occupational health and safety training is done. (Worksafe, 2017)


Australia

People who are considered at healthcare workers are doctors, nurses, caregivers and other staff who are there to support. Most of the injuries in healthcare facilities are causes by moving, lifting objects or patients or stretching their muscles and bodies too much which causes sprains or strains. an example is moving a person from a bed to a chair, this is known as a hazardous way of manual handling. Consultation is done by staff interacting and being involved in meetings and discussions on how to make things better and to create a better workplace. If there are any health and issues which the staff have to speak about then they can and it can be discussed by all the staff that how can that problem be solved. There is a process on how to manage the risks. The hazards are identified, it is assessed, there are ways found on how it could be controlled and it is applied. Workers are given training and the management given them a safe environment to work in. (Work safe Victoria, n.d.)


Health and safety in the UK

In order to manage the safety and health of the people at work, a risk management is taken place. The hazards and risks are identified and ways how to get rid of it is discussed. It is a law requirement that risk assessment has to be done. Risks are identified at the workplace by finding what the hazard is, think that who can be injured from the hazard and in what possible way, the risk is assessed, everything is noted down, assessment is studied again and if necessary, changes are made. (Health and Safety Executive, n.d.)

Carers help the people who need support and assistance for certain things. Safety of the workers at work can be managed when there is excellent management, well trained workers, and a setting where everyone feels like that their opinions and problems are heard. There should be a proper plan on how things should be done. If there are workers from other countries working in the facility, a few things need to be considered about them. The way that they speak and communicate, ability to read and write, the level of education that they have and their health status. If young workers who are under 18 are employed then the risks associated with it should be considered because of their less experience or no experience at all. All the incidents or accidents occurring at the workplace should be reported to RIDDOR which is the main law. The long form of it is reporting injuries, diseases and dangerous occurrences regulations 2013. If there are any deaths at the workplace, injuries or accidents it should be reported immediately and it should be received to the RIDDOR within 10-15 days depending on the issue. Good moving and handling methods should be used to avoid injuries being caused. This has a key law which is manual handling operations regulations 1992. Proper training should be given to the staff members about how things should be done around the facility and how equipment’s should be used. Bed rails should be fixed properly on the beds to avoid injuries to the residents. For the tripping and falling, the hazards associated with that should be considered such as liquid spills on the floor, uneven surfaces and powder or other slippery substances on the floor. The control and prevention of infections should be done by giving knowledge to the workers on how to avoid these issues. There should be hand washing rules, proper sanitization and use of gloves. Legionella is a deadly form of pneumonia which is common in people who are above the age of 45 who smoke and consume heavy amounts of alcohol. The risks increase with a higher age. This is spread through water sources. The temperature of the waters should be managed to avoid the bacteria and also at the same time the staff should take precautions to avoid getting scalds because of the water temperatures.   (Health and Safety Executive, 2014)


Comparison

New Zealand and Australia have the same healthcare facility health and safety standards. In both the countries the management is in charge to make the workplace a better one. Policies should be followed. Trainings are given to the staff. Consultation takes place in both. Hazards are identified in both the countries using the same procedure.

The health and safety of UK is different than Australia and New Zealand. A few of the things are the same such as trainings are provided and the management works together in order to create a better workforce. They have a different policy for workers who are from other countries working in the facilities, they need to consider their education level, communication skills and health status. Australia and New Zealand does not have any specific criteria that needs to be met for migrant workers. UK has main laws under which accidents, deaths and incidents are supposed to be reported within a time period. Australia and New Zealand do not have such things, they are only to be recorded and kept at the facility. UK has key legislations for nearly all the policies in the facility. An example is the manual handling operations regulations 1992 for manual handling. Legionella is common in the UK and measures to prevent it have to be taken whereas New Zealand and Australia do not have to take such measures.


References

NURS 699 Course Assignment Week 1 to 8

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Description

NUR 699 Course Assignment

NUR 699 Week 2 Assignment 1, Evidence-Based Practice Proposal – Section A: Organizational Culture and Readiness Assessment

NUR 699 Week 2 Assignment 2, Evidence-Based Practice Proposal – Section B: Problem Description

NUR 699 Week 3 Assignment, Evidence-Based Practice Proposal – Section C: Literature Support

NUR 699 Week 4 Assignment, Evidence-Based Practice Proposal – Section D: Solution Description

NUR 699 Week 5 Assignment 1, Evidence-Based Practice Proposal – Section E: Change Model

NUR 699 Week 5 Assignment 2, Evidence-Based Practice Proposal – Section F: Implementation Plan

NUR 699 Week 6 Assignment, Evidence-Based Practice Proposal: Section G: Evaluation of Process

NUR 699 Week 7 Assignment 1, Benchmark – Evidence-Based Practice Proposal Final Paper

NUR 699 Week 7 Assignment 2, Evidence-Based Practice Presentation

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

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Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.Ask a probing question, substantiated with additional background information, evidence, or research using an in-text citation in APA format.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Validate an idea with your own experience and additional research.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Explain the short-term and long-term impact of diabetes on patients including effects of drugs treatments.

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Explain the short-term and long-term impact of diabetes on patients including effects of drugs treatments.

Explain the differences between types of diabetes including type 1, type 2, gestational, and juvenile diabetes.
Describe one type of drug used to treat the type of diabetes you selected including proper preparation and administration of this drug. Include dietary considerations related to treatment.
Explain the short-term and long-term impact of diabetes on patients including effects of drugs treatments.

A quantitative research regarding the significance of hand hygiene in health care setting within the health care worker to decrease and control healthcare related infection.

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A quantitative research regarding the significance of hand hygiene in health care setting within the health care worker to decrease and control healthcare related infection.

A quantitative research regarding the significance of hand hygiene in health care setting within the health care worker to decrease and control healthcare related infection.

 

Introduction

The main aim of this research is to decrease and control healthcare related infection and to spread the awareness regarding significance of hand hygiene through different hand hygiene programs, detect barriers of non compliance and apply appropriate strategies (Landelle, Marimuthu & Harbarth, 2014). It is the responsibility of the health care worker to wash their hand before, after and between the procedures and follow the 5 movement of hand washing procedure (Allegranzi & Pittet, 2009). There are countless harmful opportunities microorganisms ready to transfer between patient and health care worker. Therefore improving hand hygiene is most essential methods to prevent from infection (Allegranzi & Pittet, 2009).

Almost 99,000 deaths and 1.7 million infections occur in each year in hospital due to not adhering infection control policies, which is transmitted form healthcare worker hand to the patients directly and indirectly (Button, Sreeramoju, Smith & Rivers, 2011). In 19th century Hand hygiene was introduced, when medical student did not wash hand and enter delivery suite from autopsy rooms, lead to increase in maternal mortality rate, due to puerperal fever (Stewardson, Allegranzi, sax, Kilpatrick & Pittet, 20011). Additionally another patient died in 1847 and his autopsy was examined and ravelled similar pathophysiology condition to the women died from puerperal fever. Therefore hand-washing policy was implement by Semmelweis, which revealed ten times drop in maternal mortality rate (Stewardson, et al., 2011).

Due to increase of infection in health care setting proven that patient is not being treated properly (Gould, et al., 2010). Patients are at risk in hospital of developing infections, maximum infections are spread through direct contact from the hand of health care worker to the patients (Gould, et al., 2010). Conventionally, hand washing has been proven the single effective way of decreasing infections (Gould, et al., 2010). Therefore Landelle, et al., (2014) observed, hand hygiene compliance among 560 healthcare worker, where 237 of the workers was nurses, 190 was physicians, and 133 were other healthcare workers. Yet hand hygiene compliance remains poor. Proper hand hygiene proves to decrease nosocomial infections, which lead to improve patient health condition, shorter hospital stay and reduce hospital budget (Gould, Moralejo, Drey & Chudleigh, 2010). Good Hand hygiene means washing hand with antimicrobial soap or disinfecting with antiseptic agent (Erasmus, Daha, Brug, Richardus, Behrendt, Vos, & van Beeck, 2010). Hand hygiene helps to keep patients safe, but not following infection control policy keeps patient health at risk (Erasmus, 2010). Additionally due to lack of time, sinks and work overload, demotivate health care worker to implement hand hygiene (Baily, 2013).

I choose this topic because, while I had a placement at hospital, I witnessed health care worker was not washing their hand before and between the procedure such as dressing, catheterization, personal care which lead patient to have infected wound, UTI’s, rashes, MRSA. To promote hand hygiene, poster were displayed in different ward concerning cross-contamination, nosocomial infection and important of hand hygiene. Alcohol based hand rub made available in individual bottle to carry in pocket. Yet they were using gloves instead of washing hand. Despite of different infection control education, hand hygiene compliance remains poor in hospital

In 1975, hand hygiene policies were applied in hospital before and after doing invasive procedures using antimicrobial soap (Scott, Duty & McCue, 2009). Furthermore, Alcohol based hand rub was introduced to disinfect hands, when there were overload of work or sinks were unavailable (Erasmus, 2010). Progressively, alcohol-based hand rub used instead of hand washing (Gould, et al., 2010). MRSA is also called hospital-acquired infection because it’s a most common infection transmitted through the hand of health care worker to the patient. Hence, it is important to follow infection policy such as washing hand, using alcohol based hand rub and using PPE to reduce, prevent and save patients life from hospital associated infection (Gould, et al., 2010).

Literature Review

A comprehensive approach was used to search related article for above research such as Ovid, Cinahl plus, Cochrane library, PubMed, Medline and Google scholar. The article range between the 5 years limit.

Stewardson et al., (2011) survey, Hand hygiene become an effective technique, applied by Semmelweis in 1818-1865, that revealed puerperal fever can be decrease, if doctor perform surgical hand wash before and after invasive procedure. The world health Organization (2009) also survey, hand hygiene is the first method to prevent from hospital related infection. However, not following hand hygiene policy million of patients are affected, putting their health at risk, longer hospital stay leading to depression, increase hospital budget (Allegranzi & Pittet, 2009). Conversely, adopting new approach such as using alcohol based hand rub is an effective technique to prevent from infection (Gould, et al., 2010). WHO (2009) explained, nearly 1. 5 million patients are suffering from healthcare associated infection therefore, adopting new method encourage health care worker to be compliance with hand hygiene, leading to prevent from infection. Gould et al., (2010) show, various pathogens are resistance, due to incorrect use of antimicrobials. WHO (2009) stated, about 8-10% of patient in hospital suffer from health care related infection, due to not adopting proper hand washing technique. Thus, following hand hygiene procedures is the best approach to prevent from illness or disease related to hospital infection (Gould & Drey, 2013).

Borges, Rocha, Nunes and Filho (2012) observed, Hand hygiene promotion at university of Geneva Hospital for 2 years using direct observation, regardless there were not increase in the rate of hand hygiene compliance. Hence the infection level remains elevated. Additionally Lary, Hardie, Randle and Clavert (2013) directed another campaign using direct observation on 1365 health care worker, patient and their visitors, where there was higher level of compliance showed in health care worker while patient and visitor were non compliance with hand hygiene. Altogether 105 samples took from hands and 92 from surfaces, MRSA observed 5% in hands and in surfaces (Lary, et. al., 2013).

Lebovic, Siddiqui and Muller (2013) survey, the rate of hand hygiene compliance for 2 years by direct observation with 3387 health care worker using alcohol based hand rub and antimicrobial soap. The result showed, most health care worker used alcohol based hand rub compare with soap. Chen, sheng, Wang, Chang, Lin, Tien, Hasu and Tsai (2011) also survey, the rate of hand hygiene compliance on alcohol based hand rub which showed, hand hygiene compliance in 2007 was 95.5%. As a result MRSA rate also decrease in ICU by 8.9%. Chen at el., (2011) stated, health care associated infection was 16000 before hand hygiene programme but gradually decreases and become 1400 after HH programme. Additionally HH programme cost $233,000 where as health care infection cost $5,522,408. Hence health hygiene programme is less expensive and more effective approach to reduce infection (Chen, at el., 2011).

Ataei et al., (2013) compare hand-washing compliance between public hospital and private hospital. Public hospital had less number of sink and limited resources to wash hand (Ataei, et al., 2013). The overall hand hygiene compliance result showed 1.4% in private hospital whereas 6.2% in pubic hospital. Despite of being better facility private hospital had low compliance rate (Ataei, et al., 2013). Therefore lack of hand washing resources and irritation of skin due to frequent hand washing could be the reason of being non-compliance with hand hygiene (Ataei, et al., 2013). Bailey (2013) showed, due to lack of time, sinks and work overload, demotivate health care worker to implement hand hygiene (Bailey, 2013).

Despite of many research, awareness and educate done to decrease infection, yet some patient are suffering from hospital associated infection due to their low immunity system (Ataei, et al., 2013).

Identify Gaps

Gould et al., (2010) stated, various study were not able to explore the obstacles of being non-compliance with hand hygiene between healthcare workers. Also did not explain the hand hygiene protocols properly and unable to found the reports regarding the effectiveness of hand hygiene between patients (Ataei, et al., 2013). Likewise, there was a lack of instruction of how to and how often alcohol hand rub should be use and the side effect of it (Gould et al., 2010). Moreover, there is no proof that microorganism in health care workers were the same that found in patients.

The research did not compare the compliance rate of hand hygiene in hospital between different shift worker, different health care worker and patients (Chen, 2011). Yet, it is important to know in which section hand hygiene is missing in order to prevent from further transmission and colonization of infection (Chen, 2011). Thus to increase hand hygiene compliance serious attention should commence methodologically research to study the effectiveness of completely planned hand hygiene and Implement those intervention (Gould et al., 2010).

Research aim and question

Since, it has been proven that effective hand hygiene lower the rate of hospital associated infection but the query is why health care worker is not being compliance with hand hygiene and what will encourage healthcare worker to be compliance with hand hygiene policies? Mathur (2011) state despite of all proof, Why Hand hygiene policies is not being following properly in health care settings? The aim of this research is to increase hand hygiene compliance through different intervention to limit the increase of infection and provide the infection free environment to the patient to save their life.

Significance

Hand hygiene is the single most effective method to control infection and least expensive way to decrease health care associated infection (Gould & Drey, 2013). If health care worker implement hand hygiene properly, it can drastically decrease infection alone. The above research shows implementation of hand hygiene approaches is feasible and supportable in most of the countries in order to reduce infection (Sax, et al., 2009). Additionally, this research is vital and will increase the knowledge regarding importance of hand hygiene in order to reduce infection (Sax, et al., 2009). Yet, furthermore research is required to know the reasons of being non-compliances recognize barriers and implement strategies to prevent patient form healthcare associated infection (Landelle, Marimuthu & Harbarth, 2014).

References

Allegranzi, B., & Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection, 73(4), 305-315. doi: 10.1016/j.jhin.2009.04.019

Ataei, B., Zahraei, S. M., Pezeshki, Z., Babak, A., Nokhodian, Z., Mobasherizadeh, S., & Hoseini, S. G. (2013). Baseline evaluation of hand hygiene compliance in three major hospitals, Isfahan, Iran. Journal of Hospital Infection, 85(1), 69-72. doi: 10.1016/j.jhin.2013.07.001

Button, T., Sreeramoju, P., Smith, E. A., Rivers, B., Snapp, M., & Couger, D. (2011). Effectiveness of Reinventing System-Wide Hand Hygiene Program Utilizing Revised Hand Hygiene Observation Tool, Education, Hand Hygiene Champions and Development of an Interactive Intranet Based Data Entry Tool.American Journal of Infection Control, 39(5), E164-E165. doi: 10.1016/j.ajic.2011.04.278

Bailey, C. (2013). The Effects of Executive Involvement, Goal Setting, Targeted Education and Caregiver Recognition on Hand Hygiene Performance. Hand,30(40.00), 50-00. Retrieved from https://proventix.com/wp-content/uploads/2013/06/Cullman-Regional-Medical-Center-APIC-2013.pdf

Chen, Y. C., Sheng, W. H., Wang, J. T., Chang, S. C., Lin, H. C., Tien, K. L., … & Tsai, K. S. (2011). Effectiveness and Limitations of Hand Hygiene Promotion on Decreasing Healthcare–Associated Infections. PloS one, 6(11), e27163. doi: 10.1371/journal.pone.0027163

Erasmus, V., Daha, T. J., Brug, H., Richardus, J. H., Behrendt, M. D., Vos, M. C., & van Beeck, E. F. (2010). Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infection Control and Hospital Epidemiology, 31(3), 283-294. doi: 10.1086/650451

Gould, D., & Drey, N. (2013). Types of interventions used to improve hand hygiene compliance and prevent healthcare associated infection. Journal of Infection Prevention, 1757177413482608. Doi: doi:10.1177/1757177413482608

Gould, D. J., Moralejo, D., Drey, N., & Chudleigh, J. H. (2010). Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev, 9. doi: 10.1002/14651858.CD005186.pub3.

Lary, D., Hardie, K., Randle, J., & Clavert, A. (2013). P120: Monitoring hand hygiene compliance and the distribution of MRSA in paediatric wards.Antimicrobial Resistance and Infection Control, 2(Suppl 1), P120. doi: 10.1186/2047-2994-2-S1-P120

Lebovic, G., Siddiqui, N., & Muller, M. P. (2013). Predictors of hand hygiene compliance in the era of alcohol-based hand rinse. Journal of Hospital Infection,83(4), 276-283. doi: 10.1016/j.jhin.2013.01.001

Landelle, C., Marimuthu, K., & Harbarth, S. (2014). CURRENT OPINION Infection control measures to decrease the burden of antimicrobial resistance in the critical care setting. Curr Opin Crit Care, 20, 000-000. doi: 10.1097/MCC.0000000000000126

Mathur, P. (2011). Hand hygiene: back to the basics of infection control. The Indian journal of medical research, 134(5), 611. doi: 10.4103/0971-5916.90985

Rocha, L. A., Nunes, M. J., & Gontijo Filho, P. P. (2012). Low compliance to handwashing program and high nosocomial infection in a brazilian hospital.Interdisciplinary perspectives on infectious diseases, 2012. doi: 10.1155/2012/579681

Stewardson, A., Allegranzi, B., Sax, H., Kilpatrick, C., & Pittet, D. (2011). Back to the future: rising to the Semmelweis challenge in hand hygiene. Future microbiology, 6(8), 855-876. doi: 10.2217/fmb.11.66

Scott, E., Duty, S., & McCue, K. (2009). A critical evaluation of methicillin-resistant< i> Staphylococcus aureus</i> and other bacteria of medical interest on commonly touched household surfaces in relation to household demographics. American journal of infection control, 37(6), 447-453. doi: 10.1016/j.ajic.2008.12.001

Sax, H., Allegranzi, B., Chraïti, M. N., Boyce, J., Larson, E., & Pittet, D. (2009). The World Health Organization hand hygiene observation method. American journal of infection control, 37(10), 827-834. doi: 10.1016/j.ajic.2009.07.003

Sroka, S., Gastmeier, P., & Meyer, E. (2010). Impact of alcohol hand-rub use on meticillin-resistant< i> Staphylococcus aureus</i>: an analysis of the literature. Journal of Hospital Infection, 74(3), 204-211. doi:10.1016/j.jhin.2009.08.023

The World Health Organization. (2009). Guidelines on Hand Hygiene in Heath Care: World Alliance for Patient Safety: First Global Patient Safety Challenge “Clean Care is Safer Care”, World Health Organization. Retrieved from https://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf

Health and Wellbeing in a Rapidly Urbanising Environment

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An Analysis of


Health and Wellbeing in a Rapidly Urbanising Environment


:


The Urban Hanoi

 


Abbreviations

COPD – Chronic Obstructive Pulmonary Disease

LMIC – Low-middle-income Country

NCDs – Non-communicable Diseases

O

3

–       Ground-level Ozone

TB –      Tuberculosis

WHO – World Health Organization

 

 


Urbanisation and the Global Perspective

Cities make up a crucial part of the societal fabric of countries(1). They provide opportunities for employment, education, cultural enhancement, hope for a better life, improved health outcomes, and contribute to national and regional economies worldwide(1). Over half of the world’s human population now reside in urban cities(21, 2), with that proportion predicted to continue rising(2). The percentage of the global population living in urban areas increased from 32% in 1955 to 38% in 1975 and 45% in 1995(1). From 1995 thru 2005, the urban population in low-middle-income countries(LMIC) grew by approximately 1.2million people per week (165,000 people per day)(3). By 2030, the World Health Organization(WHO) estimates that 60% of the world’s population will become city dwellers, with those projections increasing to about 70% by 2050(3). “The world is rapidly urbanizing with significant changes in our living standards, lifestyles, social behaviour and health,” says Dr Jacob Kumaresan, director of the WHO Centre for Health Development, Japan(3).


Rapid Urbanisation in South East Asia

South-East Asia is progressively urbanizing(4, 5). In 1950, 16% of its population lived in urban areas, which increased to 42% by 2010, an incline of about 250 million people, with the percentage of urban dwellers in the region anticipated to reach 50% by 2025(4, 5). The urban population growth rate within South-East Asia is approximately 2.2% per year, with the growth rate among the least urbanized countries in the region being much higher (Timor-Leste 5%; Lao 4.8%; Cambodia 3.2%)(5). By 2050, all countries in the region will have a majority of their population living in urban areas(5).

Urbanisation and economic development in general mutually reinforce one another, with the most urbanized countries being the most economically developed(4, 5). The same holds true in South-East Asia(4, 5). The most economically advanced countries in the region (Singapore, Malaysia and Brunei) report urbanisation levels over 65% with the least economically developed countries (Cambodia, Myanmar, Timor-Leste and Vietnam) reporting urbanisation levels less than 34%(5). The increase in urban inhabitants occurs in correlation with the region’s economic growth, with urban cities connecting to global markets and becoming major economic centres(5).

 


Urbanisation: The Vietnamese Context

Vietnam is presently facing one of the world’s most accelerated urban transitions(6). In the past three decades, Vietnam has emerged from one of the poorest countries in the world to the third fastest developing economy in South-East Asia and the fourth worldwide(7). Over the next decade, its cities and towns are anticipated to grow at a rate of 7% per year, increasing the nations urban population from one-third to one-half(6). The capital city Hanoi is one of the key sites for this urban transition(6). While the aspect of this transition has improved individual living standards, much of the changes also pose negative impacts on overall quality of life, particularly for poor and vulnerable populations like children and the elderly(7).

The Vietnamese government recognize that growth in Hanoi and cities alike is vital to the national shift from agriculture to manufacturing services, to increase the nation’s gross domestic product and improve the lifestyle and well-being of the country’s population(6). However, the rapid growth in populations and activities in and around cities places immense pressure on the local leaders to maintain the escalating demands for infrastructure, housing, social services, public facilities and environmental controls(6). So, while there is consensus on the benefits of urbanisation, concerns on the burdens resulting from the urban progression and the importance of anticipating and addressing them are also raised by foreign academics and decision-makers(6).


The process of Urbanisation in Vietnam

In Vietnam, the process of urbanisation can be divided into two categories, planned urbanisation (i.e. city centres) and spontaneous urbanisation (i.e. slums)(6). While urbanisation is very important for large cities like Hanoi and Ho Chi Minh, the central state has embarked on a large-scale urbanisation plan since 2000, to foster economic growth(6). This has led to the transformation of agricultural land into ‘urban’ land for industrial and housing development and the re-establishment of slum areas, displacing slum dwellers into public housing(6). Whether planned or spontaneous, urbanisation has vast consequences for the local communities (i.e. displaced farmers, slum dwellers or new migrants)(6). In all cases, communities are faced with various challenges; finding new livelihood (employment, housing, access to food), competing for scarce resources from rural to urban dwellings, adapting to changing environments, infrastructure development and regulatory frameworks(6).


Current Urban Development Trends in Hanoi

In the 1990s, Hanoi went through a transition, transforming from a city of walking and cycling to motorized transport(7). Concurrently, the city evolved from a place where people lived and worked in the same space, to a city where homes are separate from workplaces(7). Over time, the city’s skyline is swiftly shifting from a city of low buildings to one of high rises(7). The previous urban fabric with which residents identify with is vastly being replaced by a ‘modern city’, one unfamiliar to its citizens(7). Peri-urban spaces, better defined as spaces of transition are now a common sight in visualizing and understanding urbanisation in Vietnam and its socioeconomic and political transitions(6). These peri-urban spaces function as a bridge between the traditional rural environment that once dominated the economic and socio-cultural fabric of the country to the new megacity and global market that it aspires to be(6). So this raises the following questions, how are populations impacted by these rapid social, environmental, cultural and economic transformations affecting their everyday lives?

 

 


Health and Wellbeing in the Changing Urban Environment

Cities are an important determinant of the future sustainability of human health and wellbeing(2). According to the WHO, although “urban living continues to offer many opportunities, including potential access to better health care, today’s urban environments can concentrate health risks and introduce new hazards”(3). The health risks linked to urban milieu are diverse(2). Many cities now face various health threats like infectious diseases that stem from crowded populations in substandard housing conditions(2); severe and chronic diseases associated with industrial pollution(2); an increase in non-communicable diseases(NCDs) (COPD, diabetes, cancers) from unhealthy urban lifestyles (physical inactivity, unhealthy diet, tobacco and alcohol use)(21, 3); injuries from motorcycle and vehicle accidents; violence, crime(2); and environmental and climate change(2).


Urbanisation and NCDs

NCDs cause millions of deaths globally, with most casualties occurring in LMIC(8). With the rapid urbanisation in Vietnam, it suffers the double burden of current incidences of communicable diseases and an increase of NCDs(8). Between 1970 – 2013, Vietnamese ministry of health reported a decrease in the percentage of communicable diseases by 56% while NCDs increased by 64% in the same time period, concurrent with the urban development boom in Vietnam(8). With the incline of NCDs, it has put a strain on the healthcare system. A study testing urban commune health stations capacity to respond to NCDs in Hanoi, found them to be unequipped to respond to the rising prevalence of NCDs, due to the limited workforce, budget, little to no NCD services and treatments at the commune health stations(8). Urban commune health stations are the closest healthcare service to the communities in Vietnam but also the lowest level in the health system(8), making it difficult to adequately combat NCDs in urban Hanoi.


The Spread of Diseases: Rural to Urban Migration

Rapid urbanisation has substantial implications on population health. The rising movement of individuals from rural to urban regions alters the epidemiological disease profile of a country as new diseases form and old ones re-emerge(9). This has been the case of tuberculosis(TB), malaria and HIV/AIDS(3). Urbanisation has also led to changes in diet and exercise habits, increasing the prevalence of obesity, diabetes and cardiovascular disease(21, 3, 9). While many migrants tend to be young and in healthy conditions, when they arrive in cities, they are often subjected to poor and overcrowding conditions, increasing their incidence of diseases like typhoid fever, malaria and respiratory diseases(9). In recent years, TB has presented high infection rates in major cities, with 83% of TB infected individuals living in cities(3).

High rates of sexually transmitted diseases, including HIV/AIDS, are now prevalent in migrants(9). As they are highly mobile, they often spread the virus when they return back to the rural, village or countryside, where health services are inadequate to combat infections as they are in the cities(9). Much migrant health issue result from unfamiliarity with and lack of access to existing health services(9). In Vietnam, migrants workers health coverage in their rural hometowns do not function when they migrate to urban cities like Hanoi. As a result, the high medical costs in cities make them reluctant to go to the hospital and seek medical attention when needed(9).

Urbanisation has also impacted vulnerable populations in cities. Children are particularly susceptible to disease when they live in an environment that is overpopulated, in poor hygiene, with high noise pollution, and lack space for recreation and study(9). The strong and undesirable impacts of urbanisation also affect the elderly their independent mobility, access and utilisation of quiet spaces for socializing and leisure(7). These groups bear not only the unfavourable physical environment but also the stressors associated and from other factors like the violence, such an environment creates(9).

Crowded urban cities, combined with poor sanitary surroundings and insufficient waste disposal bred conditions for the spread of infections and becomes a risk factor for diarrheal and parasitic diseases(9). Given the outcome urbanisation can have on health, it is essential that health considerations play a vital role in urban planning and policy making, as the negative burdens are placed on the poor, migrants, and marginalised.


Air Pollution in Urban Hanoi

A common negative feature of congested urban areas is air pollution. Common air pollutants include particulate matter (PM10 and PM2.5), ground-level ozone (O

3

), and carbon monoxide (10, 11). The poor air quality is commonly attributed to solid particles, dust or allergens suspended in the air, industrial plants and refinery wastes, motor vehicle emission, wood burning and bushfires(10, 11). Due to the vast population in urban cities, air pollution has been known to result in cardiovascular and respiratory diseases (i.e. asthma, lung cancer)(10). When exposed to poor air conditions for a prolonged period, city dwellers can experience harmful health effects like loss of lung capacity, become more susceptible to various respiratory ailments, and a shortened life span(10).

The WHO reports that urban air pollution kills approximately 1.2 million people annually, mainly due to cardiovascular and respiratory diseases(3). In LMIC, motor vehicles, generators and household fuel combustions are major contributors to urban pollution(3). In Hanoi, there has been a correlation of high O

3

to hospital admission for respiratory diseases(12). Among all air pollutants, O

3

is the most prominent, exceeding the limits in many parts of the world, including South-East Asia(12). Acute exposure to high levels of O

3

can elicit chest pain, throat irritation, cough and wheezing, with regular exposure resulting in poor lung function and growth(12). The rapid urbanisation and economic expansion in Vietnam have been associated with high levels of O

3

in the country with the main contributor in Hanoi being vehicles, crop burning in suburban areas, fossil fuel power plants(12).

 


Accidents and Injuries

The rapid motorization of Hanoi has become dominated by motorcycles as the main source of transport(6, 7). It enables one to commute faster, do business, work and generate income(7).  Since its initial introduction to Vietnam, the motorbike has become a symbol of personal mobility, an asset and one of the most convenient means of transportation in a Hanoi, a city where its urban framework is dominated by narrow alleys(6). Motorbike ownership in Hanoi has reached high rates, with 80% of households owning a motorbike and 40% of households owning at least two motorbikes(6).

The encumbered and weak traffic network in Hanoi is bearing increasing infrastructural pressure(6). The road system and structure represent less than 7% of the land area, compared to 15% in most European cities and 11% in China’s large cities(6). As a result, the streets of Hanoi have become overcrowded and at rush hour traffic can come to a standstill(7). Over the last 10 years, travel speed and time in downtown Hanoi have worsened by traffic congestion and longer travel distances(6). The slow progression in road development, disorderly driving style, lenient traffic law enforcement and rising traffic congestion has resulted in an increase in transport cost, air and noise pollution and accidents(6). Road traffic injuries are the ninth leading cause of death globally, with most road traffic death occurring in low-middle-income countries(3). About 50% of casualties in road traffic accidents are among pedestrians, cyclist and motorbike users(3). In Vietnam, road traffic accident kills approximately 14,000 people (aged 15 – 29 years) per year, with motorcyclist accounting for over 50% of the fatalities(13).


Lack of Public Space

Hanoi is well-known as one of the most overcrowded cities in the world(6). In 2008, the human densities in the urban regions averaged 272 persons per hectare and reached up to 404 persons in the city centres, compared to 370 persons in Hong Kong, 86 in Paris and 62 in London(6). Such high human densities put pressure on the city to provide public spaces for people to engage, interact socially, exercise, escape the traffic, pollution and enjoy the environment and green space(6). Hanoi can hardly meet the demands of its residents for public space. Recreational areas especially are inadequate to serve the urban communities(6). Urban parks account for just 0.3% of the city’s land, representing just less than 1 m

2

per person(6). Present parks are unevenly distributed across the city and are inaccessible for youths and the elderly(6). About 50% of Hanoi’s citizens are not within walking distance to a park from their homes, while current public spaces offer few recreational options to users(6). Instead, urban public spaces in Hanoi, are mostly designed with lakes and flowerbeds which hardly meet the populations growing demand for spaces to socialize and for recreational activities(6).

The lack of formal spaces and easily accessible urban public parks have been compensated by informal adaptive use of sidewalks and street spaces in Hanoi for an array of activities including domestic, social, and recreational uses(6). However, the most regulated informal spaces in Hanoi is not a permanent solution and is not match to the safety and accessibility of public parks and recreation centres where citizens are free from traffic, air pollution, and can interact with the community(6).


Physical Inactivity and Diet

The removal of public spaces where people can exercise and the transition from active transportation (walking and cycling) to passive (motorbikes) had declined population physical activity impacting population health(7). Urban environments often incite physical inactivity and an unhealthy diet(3). Engaging in physical activity is discouraged by urban factors like over-crowding, heavy traffic, poor air quality, lack of safe recreational spaces(7). Moderate levels of physical activity are essential to public health as it reduces risk factors for chronic diseases and obesity by 50 per cent(7). A common phrase in Hanoi is “people here don’t like to walk”(7), however, a more appropriate phrase is the city is not designed or conducive for physical activity. While physical activity is essential for health and well-being, it is far easier in a supportive environment(3).

 

In addition to physical inactivity, poor diet is another way urbanisation impacts population health, a double burden many faces in urban dwellings(10). Urban cities like offer access to quick, easy and cheap food that often unhealthy containing large amounts of sodium and sugar(10). The constant consumption of low-quality fast food attributes to diabetes, hypertension, heart disease and obesity(7, 10). The lack of exercise and in combination with an unhealthy diet becomes detrimental to one’s health(10).


Combating Negative Health Outcomes of Urbanisation: The Interdisciplinary Approach

How can we develop a liveable and healthy city without the negative aspects of urbanisation? There is no one method or solution, however, the approach should address urban design and planning, supporting urban development with a public health perspective(7). Developing an urban environment that is low-stress, safe, low in traffic, injuries, and crimes, green, and encourages physical activity and social integration(7). Hence, an interdisciplinary approach is ideal. Although challenging as each discipline presents its own particular concept and ideologies, it is also essential for positive urban planning with health needs in mind, shifting development practices and involving dialogue with stakeholders and policy-makers(2). For instance, Hanoi is developing with various professionals who often work separately(7), however addressing its urbanisation challenges requires effective collaboration between researchers, architects, engineers, health professionals, urban managers, economists and policy-makers(2).

In an interdisciplinary team, specialists can work together, as it is vital to have voices from different sectors participating in the dialogue collectively(7). Also, engaging with the communities and ensuring the active inclusion of citizens during the urban planning process is important(7). This restores citizens pride and involvement in the development of their city and is a step in developing cities that supports its population’s well-being, health, happiness and quality of life(7). As a linear urban planning approach is no longer ideal under the complexity that is ‘urbanisation’(2).

It is proven that urban inhabitants can have good health and a sense of happiness and well-being when supported by an environment that encourages pro-activity, reducing the risk factors for diseases(7). From a public health perspective, action needs to be taken to reduce environmental stressors (i.e. air and noise pollution, traffic), creating more green spaces, built environment that inspire physical activity and healthier food diets, developing healthcare systems combat communicable diseases and the rise of NCDs and addressing poverty and inequality exacerbated by urbanisation. Above all, healthy urbanisation can be achieved by empowering populations to control their health and determinants through a positive urban environment and governance that fosters equal social opportunities for health for all(14).

References:

1. Moore M, Gould P, Keary BS. Global urbanization and impact on health. International journal of hygiene and environmental health. 2003;206(4-5):269-78.

2. Bai X, Nath I, Capon A, Hasan N, Jaron D. Health and wellbeing in the changing urban environment: complex challenges, scientific responses, and the way forward. Current Opinion in Environmental Sustainability. 2012;4(4):465-72.

3. Urbanization and health. Bulletin of the World Health Organization: World Health Organization; 2010.

4. Yap D, Yap ks. Urban Challenges in South-East Asia. 2013.

5. Urbanisation in Southeast Asian Countries. Singapore: Institute of Southeast Asian Studies; 2010.

6. Labbé D, INRS-Centre Urbanisation c, société. Facing the Urban Transition in Hanoi: Recent Urban Planning Issues and Initiatives: INRS-Urbanisation, culture et société; 2010.

7. Geertman S. Urban development trends in Hanoi & impact on ways of life, public health and happiness. Liveability from a Health Perspective. Vietnamese Urban Planning Journal. 2010.

8. Kien VD, Van Minh H, Giang KB, Ng N, Nguyen V, Tuan LT, et al. Views by health professionals on the responsiveness of commune health stations regarding non-communicable diseases in urban Hanoi, Vietnam: a qualitative study. BMC health services research. 2018;18(1):392.

9. Chelala C. Rapid urbanization affects public health. Chinadaily. 2011.

10. DePalatis C. The Effects of Urbanization on Humans Physical Health Medium2018 [Available from:

https://medium.com/the-healthy-city/the-effects-of-urbanization-on-humans-physical-health-e2cd73c91001

.

11. Common air pollutants and their health effects NSW Health: Health NSW Government; 2013 [Available from:

https://www.health.nsw.gov.au/environment/air/Pages/common-air-pollutants.aspx

.

12. Luong LMT, Phung D, Dang TN, Sly PD, Morawska L, Thai PK. Seasonal association between ambient ozone and hospital admission for respiratory diseases in Hanoi, Vietnam. PloS one. 2018;13(9):e0203751.

13. Kapur R. Vietnam’s Lethal Traffic: Traffic accidents kill thousands of Vietnamese each year.: The Diplomat; 2016 [Available from:

https://thediplomat.com/2016/05/vietnams-lethal-traffic/

.

14.  Healthy Urbanization: Regional Framework for Scaling Up and Expanding Healthy Cities in the Western Pacific 2011 – 2015. Geneva: World Health Organization; 2011.

Apply an ethical/legal framework to a nursing management situation.

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Apply an ethical/legal framework to a nursing management situation.

Time Management and Priority Setting

Learning Objectives

Module III concentrates on the following course outcomes—

1. Apply an ethical/legal framework to a nursing management situation.

Different ethical principles regarding management are discussed; laws and other legal processes related to employment, management and related human resources issues are explored.

2. Identify the human, fiscal and material resources necessary to efficiently achieve quality healthcare outcomes.

Decision-making and problems solving skills are presented as well as discussion of critical thinking. Resource management is discussed via patient safety, time management, and priority setting.

Reading Assignment

Sullivan: Chapters 8, 10, 13

Principles for Delegation ANA. https://www.indiananurses.org/education/principles_for_delegation.pdf (Links to an external site.)

Overview

The professional nurse uses ethical principles and legal frameworks to deliver patient care, both as a staff member and as a manager. Decision-making and problems solving are essential processes to nursing; the use of analytical tools can assist the nurse in delivering patient care and managing others. Federal laws direct the staffing of healthcare organizations. The manager needs to address maintaining adequate numbers of staff for the patient population, whether it is legal to float staff to other units within the hospital or organization and the use of agency nurses (temp staff). Federal law dictates that staffing ratios be made available to patients, families. California is one of the first states to legislate staffing ratios. Other states have followed. Additionally, the American Association addresses staffing ratios, and floating staff from one unit to another. There are guidelines that must be adhered to and each nurse needs to know the law in the respective state and that of the place of employment. Other legal issues that managers must face include employment laws regarding hiring and firing and issues related to discrimination.

Decision making is a purposeful goal driven process that involves choosing between or among options. Problem solving and critical thinking are related concepts. Problem solving is different than decision making and is focused on solving a more immediate problem. Decision making is based on decision making models which serve as frameworks and guides. There are decision making styles and relate to the one making the decision. The styles include autocratic, democratic or participative approach. Styles vary with the individual personality and are influenced by the environment and those within. Autocratic decision making may be used in emergent situations, however participative decision making is more appropriate when working with professionals in general on an ongoing basis. Group decision making has many advantages, like buy in from the group, as they came up with the idea. However, it is time consuming and work within the group may not be carried out equally.

Delegation involves giving responsibility for a task to another while at the same time retaining accountability. There are many guidelines or practice strategies outlined by the American Nurses Association that regulate delegation. First, a nurse must be familiar with the state law and nurse practice act of that state where employed. Some Nurse Practice Acts defines what is within the role of Registered Nurse and Licensed Professional Nurse (LPN). A Registered Nurse cannot legally delegate a task to an LPN that is outside the LPN’s scope of practice. See Principles of Delegation from the ANA cited in the hyperlink under readings. Accountability and responsibility are key concepts related to delegation. Distinction needs to be made between delegation and assignment making. As mentioned with delegation, responsibility is transferred but not accountability, with assigning, both are transferred. Care given by one RN to another is assigning both responsibility and accountability. Whereas, when an RN gives a task to an LNP or unlicensed care giver, accountability is retained (delegation). The RN is always responsible for assessing, diagnosing, planning and evaluation.

Time management has a number of personal and professional implications. Time management contributes to timely outcomes, fiscal responsibility and also to work-life balance. Many factors influence time management and each person needs to assess their own situations to determine factors that enhance or negatively affect time management. A key related concept is priority setting.

Assignment questions: Post answers in Forums Module III. See calendar for due dates.

1. What is the relationship among delegation, authority, responsibility, and accountability?

2. Discuss professional resources such as laws and professional nursing organizations in place for directing delegation.

3. After reviewing the ANA Principles of Delegation, discuss how delegation differs from assignment making.

4. Discuss factors from the reading and your experience that influence priority setting.

5. What issues have you encountered with delegation and how have you handled them?

6. What decision making model is used in your organization as a basis for decision making and is it effective? If not, what would be more effective

Choose a borrowed theory and apply its framework to an advanced nursing issue.

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Choose a borrowed theory and apply its framework to an advanced nursing issue.

Choose a borrowed theory and apply its framework to an advanced nursing issue (i.e., hostility in the workplace, instituting bedside reporting, and shared leadership). Choose a borrowed theory and apply its framework to an advanced nursing issue.

Case Study: Factors of Health and Healthcare

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This essay will focus on the factors to healthcare and health promotion based on Fiona, a character derived from a scenario in the university close. The author will examine how social, political, equality and diversity influence public health. An analysis of statistical and theoretical framework will be carried out. A comparison of the behaviour models Health Belief Model (HBM) and Trans theoretical Model (TTM) will be analysed to find which model is suitable for Fiona. The author will discuss the role of a nurse working in partnership with the multi-disciplinary team to provide Fiona’s well-being and as well reflect on what they have learnt from Fiona’s condition.

Fiona, a 54 years old lives alone due to recent sudden death of her husband (from a road traffic accident). She has one son who is 30 years and lives in Australia. She has had to return to work due to financial difficulties. Fiona has been a type two diabetic for three years and was recently seen by the GP because of uncontrolled blood sugars and symptoms of depression. Names have been changed for confidentiality according to Nursing and Midwifery Council (NMC), (2018).

There are two type of diabetes type 1 and type 2 which are both lifelong condition with different causes, this essay focuses on TD2 (Mohamed et al.,2018).Type two diabetes (T2D) is a  progressive condition which occurs when enough insulin for the body is not produced causing the blood sugars to become high (National Health Services (NHS), 2017a). The two major causes of T2D are overweight and obesity, and also a combination of genetic and environmental factors apply ( Public Health England (PHE), 2018; Sung et al.2012). Fiona’s pancreas is not producing enough insulin to maintain normal blood sugar levels. In the long term, T2D has risk factors which includes blindness, renal failure and amputation (NHS, 2017b).

Sources form PHE (2016) indicated that T2D has cost national health services (NHS) 10% of its budget amounting to 10 billion each year. According to World Health Organisation (WHO), (2018) an estimated figure of 108 million adults are living with diabetes globally and that figure has risen to 422 million within four years in 2014 because of the rise in T2D which has accounted for 90% of all diabetes cases in the UK. Currently there are 3.8 million people diagnosed with diabetes in the UK and 90% of those have T2D ( WHO, 2019 ; PHE, 2018).  The prevalence of diabetes in Luton is 7.6% in which Fiona lives and it is significantly higher than the average of England 6.3% (Luton Borough Council, 2016). T2D is a major cause of premature death claiming around 22 000 people each year in UK (PHE, 2018).

There are many public health promotions available for T2D and there is need to support  individuals to change their lifestyle and  eating habits (WHO, 2018). Ottawa Charter 1986 mentioned in WHO (2014), explained health promotion as “the process of enabling people to increase control over, and to improve their health, so that they have full capacity of physical, mental and social well-being”.

Educational programmes like Diabetes Education and Self-Management for Ongoing and Newly Diagnosed course (DESMOND) is a health promotion that provides Fiona with self-management education modules and care pathways for people withT2D (Diabetes UK, 2019). A research done by Torjesen, 2016 indicated that people who attend DESMOND programme benefit more on how to self-manage their diabetes.

Another programme which might help Fiona is Health Living for People with diabetes (HELP- Diabetes) which has shown improvement for glycaemic control. It is an online programme  offered during NHS routine appointments put in place of face to face programmes like DESMOND (Khunti et al, 2012). A research done by Arafat et al, (2016) shows that people feel that awareness of diabetes brings fear and hysterical while missing the point on how serious is type two diabetes and the risk factors associated with it. The campaign resulted in more people having their risk assessed at pharmacies and GP surgeries.

Public Health for England launched a national ‘Change for Life’ which encourages people to do more physical activities and eating healthy. This campaign might be useful for Fiona to stabilise her blood sugar levels when eating healthy. According to Ley, et al, (2014) found that eating wholegrain food, fruits, nuts, vegetables, white meat helps glycaemic control. PHE (2016) have the opportunity of supporting behaviour change of individuals’ well-being through NHS programmes and in collaboration with NHS England and NHS improvement. The challenges Fiona might get is financial difficulties to fund this life style however she can get personal independence payment (PIP) since she is over 16 and has not reached pensionable age (GOV.UK, 2019).

World Health Organization (WHO, 2019) defined health inequalities as the contrast of health determinants among a group of population because of geographical, social, psychological, physical  and other aspects. According to WHO, (2019) social determinants of health are “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness”. These circumstances are made by social, cultural, economic, environmental and political determinants (Marmot, 2010). These are daily activity and lifestyle of an individual  see Dalgren Whitehead model in appendix 1 in line with health inequalities.

The wider determinants of health which determine the health quality of Fiona are age, gender, individual life style behaviours, social and community networks.  Fiona’s age and gender puts her at high risk for T2D and depression. Higher risk of depression is found in women than men ( Mocan et al, 2016). Effective diabetes management help address Fiona’s depression symptoms as her mood is enhanced and able to comply with treatment routines ( Petrak et al, 2015). Yin, et al, 2016 suggested that T2D is more common in middle-aged woman and this implies to Fiona who is 56 years old. Fiona lives alone since she lost her husband and feels isolated with no support from family as her son lives in Australia. There is no evidence to suggest that she has other friends and relatives. This has an impact on her mental and physical wellbeing ( Utz, Caserta and Lund , 2011).

Important factor to consider is Fiona’s awareness of services available to her and how she can gain access. Dalstra et al, 2012 states that less than one in five patients know the services available in their community. Advertisement of the services through  posters or leaflets can be helpful as many service users tend to read posters and leaflets while waiting health care waiting areas ( Maskell, McDonald and Paudyal, 2018). Health care professions such as the GP or other specialists, can provide awareness of health services, such as support groups to Fiona.

There are barriers to health services which includes psychological, geographical, educational , employment, cultural and language issues (Dezetter et al, 2015). Financial difficulties act as a barrier for Fiona as she will need to have money to  attend appointments or travel to support groups. Distance and cost of transport to the GP is a barrier to access  health services. Fiona does not have the financial support of her husband  and travelling costs can affect her. Education is another barrier as health literacy is important to break the barrier. Fiona needs to know where and when to seek support when having a health issue. She also needs the confidence and skills to talk about her illness and treatment with health professionals. Employment is one of the social determinants of health, it can hinder your personal life and social life. Fiona could not afford to buy healthy food because of  income Fiona’s social life is affected as she will be having anxiety of not having  enough money hence not able to go out with friends  and the only family she has is her son who is in Australia, this affect her mental wellbeing. Fiona’s health may also be affected because of long waiting list, and the budget allocated to the hospital. Since Fiona has just returned to work, the fear of not getting time off is another barrier of her health service (Ross, et al, 2018).

Statistically, 70% of individuals with diabetes are from low and middle income countries and poor education, unemployment and low income contributes to the risk of diabetes which leads people to live in deprived areas (Sundmacher, et al, 2011). People who have poor education or not educated may get  a low paid job or unemployed  which results for them to live in deprived areas and being homeless (Dalstra et al, 2012). Therefore, they might have limited access to health services and  less chances of living longer compared to those who are educated and earning more money as they have more access to private health services, engage to healthier lifestyles and can live longer (Ford et al, 2016). Although Fiona has not been going to work in the past it was no longer the case as she has just returned to work and this may help her to bring back her old routine.

Treatment is based on lifestyle changes for Fiona such as weight loss, physical activities and diet. Fiona needs to attend regular medical examinations and screening such as eye checking which needs to be done yearly to reduce developing physical health problems. Therefore, getting an appointment maybe a challenge since there are long waiting list at NHS and getting time off can be difficult because she has just started a new job.

There are many types of behavioural theories and the author will analyse Health belief model (HBM) and trans-theoretical model (TTM). HBM focuses on identifying aspects influencing people in preventing health action in their condition. It is made up of four stages namely perceived susceptibility and severity, perceived benefits and barriers, cues to action and self-efficacy (Rosenstock, Strekher and becker, 1988). Perceived susceptibility is suitable for Fiona as she needs to change her diet to tackle blood sugars level from rising.

However, TTM or stages of change, which was developed by Prochaska and Diclemente in 1980  is the most applicable theory in promoting healthy behaviour on weight management as it comprises of six stages which are precontemplation, contemplation, preparation, action, maintenance and relapse (RCN, 2016 : Prochaska and Diclemente , 1984).  Research by Jalilian et al (2019) found that 48.1 of the patients were on the pre-contemplation stage. This means the patients have lack of knowledge regarding how weight loss have a benefit in controlling blood glucose, hence educational awareness can be the primary prevention. In addition, astudy by Holmen et al (2016) identified half of the patient on pre-action for physical change and 79% for dietary change. The barriers were cultural and lack of proper spaces for exercising. Fiona was on the maintenance stage of change  because she  was maintaining her blood glucose levels very well  but, she is now not coping maybe because there is no one to motivate her and hence the symptoms of depression. She is now on relapse stage which is the stage when a person has gone back into old or unhealthier lifestyle  and the best plan for the nurse is to begin the process again. In supporting Fiona to begin the process again the nurse has to make sure Fiona gets the information clearly and ask for her opinions as well.

If Fiona controls her blood glucose, the chances of developing further diseases and complications like renal failure and damaged eyes will be prevented and even the chances of  lower amputation  due to damaged nerves resulting in no sensation and foot ulcers will be reduced (NICE,2015). Fiona has symptoms of depression maybe because of loneliness since she lost her husband and does not have family near her. She is in a phase of grieving her husband and responding to the  loss of herhusband (Hamilton (2016). Fiona was more attached to her husband and seems he was the only family member she could rely on and losing him is painful and it is more challenging to accept as she cannot see the purpose of living.

The nurse can refer Fiona to the psychologist for counselling, support and also involve her family which means the nurse has to contact her son who is in Australia for support. According to (Schrempt, et al 2019) the link between loneliness and isolation contributes to depression, additionally Diabetes UK  states that people with T2D are prone to depression and anxiety because managing diabetes regularly can be  stressful. Roy and Lloyd, (2012) states that there is a link between T2D and depression. This is a challenge for Fiona and she needs someone to motivate and remind her to attend the appointments.

Person-centred approach with the help of interprofessional team  is needed to help Fiona to overcome these conditions. Person-centred evolving a plan with a person who is prepared to take action and eager to change. Fiona should give consent before any treatment or procedure (NHS, 2019). General Practitioner (G.P) and nurses are the first professions to see a patient.  Nurses play a vital role  and  responsibility when looking after patients with diabetes and prescribing medication (RCN, 2019).  Additionally, Matzious et al (2014) emphasised that one profession cannot treat a patient on their own nonetheless needs interprofessional to work together with and have a better care of the patient.

Community diabetes nurse’s role is helping Fiona to monitor blood sugars, help her to have a better understanding of the risk factors of not controlling blood sugars and any referrals needed.  A referral to the dietitian is essential to advise Fiona on the  healthy food choices  for a healthier balanced diet. Taplin, Anderson and Meller, (2018)  stated that patients seen by dietitian can manage to control their blood sugar well and they are taught about reducing carbohydrates in their meals.

This is upon the individual to make their own decision and the nurse should accept the individual’s decision in accordance to NMC (2015) code of conduct which states that nurses have to respect individual’s right for decision making to refuse or accept treatment. As Fiona has mental capacity the nurse must respect the decisions she makes however, if it was determined that she lacks capacity an assessment will be carried out under Mental Capacity Act, (2005) in order to treat Fiona in her best interest.

Reflecting on the above I have learnt that type two diabetes is an ongoing condition which needs commitment of self-management. Further I know the prevalence of diabetes globally and internationally and it is the main cause of premature death. To prevent it  there are social behavioural theories which can be introduced to the patient. In future I will consider all these when I qualify to support patients with type two diabetes.

In conclusion type two diabetes can lead to other risk factors such as amputation and kidney failure, and is the most cause of death in the United Kingdom. There are several health promotion campaigns for awareness and prevention  of T2D which patient should be engaged. Despite all the health intervention the numbers of people with diabetes are growing.  Health services can have impact on patients access to health like long waiting lists and hospital budget. Employment, low income and education hinders the patients access to health. It is important to include the patient in decision making of their health and respect their opinion.

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