Personal Perception of Advanced Practice Role

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Personal Perception of Advanced Practice Role

Definition of Advanced Practice Nursing in California

Advanced Practice Registered Nursing refers to the advanced specialization nursing further than the formal entry entry-level education requirements; As a result, Advanced Registered Practicing Nurses (APRNs) have advanced specialized skills and knowledge acquired through doctoral or master’s level education which equips them for advancement, expansion and specialization of nursing practice. The specialization of nursing practice entails concentrating on a single aspect of the entire nursing field (Jansen & Zwygart-Stauffacher, 2010). Expansion of nursing practice entails acquiring new skills and practice knowledge and the skills and knowledge required for the APRN to function autonomously within some specific areas of nursing practice that tend to overlap with the conventional boundaries of medical practice. As a result, APRNs may operate as independent practitioners. Advancement combines both expansion and specialization and is typified by an integration of practical, research-based, and theoretical knowledge that are part of the graduate nursing training. In California, Advanced Nursing Practice is established by the State law under the California Nurse Practice Act, and is aligned with recommendations established by the National Specialty Nursing Organizations’ Practice and American Nurses Association Standards of Practice. Advanced Practice Nursing is the inclusive term for a number of roles including nurse practitioner (NP), certified nurse mid wife (CNM), certified registered nurse anesthetist (CRNA) and clinical nurse specialist (CNS).

The role of the Advanced Practice Nurse, Family Nurse Practitioner

The responsibilities for APNs vary according to the specialization area and title. APNs often operate as a primary healthcare provider and are involved in patient examination, prescription of treatment, diagnostic testing and offering healthcare advice. In addition, APNs can administer a patient’s care without the need for supervision from a doctor. Specific roles and responsibilities are determined by the scope and definition of practice, which includes nurse practitioner, certified nurse mid wife, certified registered nurse anesthetist and clinical nurse specialist. Nursing practitioners work in community care, tertiary care, long term care and primary care. Nurse practitioners can write treatment prescriptions and play an active role in the management of a number of health problems through counseling, education, diagnosis and medical examination. The scope of nursing practice for nursing practitioners include disease prevention, health promotion and performance assessments. The Californian Business and Professional Code do not distinguish the scope of practice for an ARPN from the scope of RN (Jansen & Zwygart-Stauffacher, 2010).

Clinical Nurse Specialist offer service to patients in community care locales, home health care, ambulatory care and tertiary care. Clinical Nurse-Specialist take part in the management of complicated healthcare problems using avenues such as research, education, consultation and direct care. Certified Registered Nurse Anesthetists work in ambulatory care, surgical and operating rooms. CRNAs can provide treatment to any person who is undergoing a surgical operation. In addition, CRNAs also take part in pre-operative assessments, managing post-anesthesia recovery and treatment administration of anesthesia. The scope and standards of practice for CRNAs was established by the American Association of Nurse Anesthetists, and CNRAs are considered anesthesia professionals; thus, they should offer anesthesia-related care upon demand. Certified Nurse Midwife involves a wide-ranging management of women’s healthcare in various settings such as pregnancy, infancy care, family planning, gynecology, and postpartum period (Jansen & Zwygart-Stauffacher, 2010).

Carrier Goals As It Pertains To the Scope of Practice of a Nurse Practitioner

With regard to the scope of practice for nursing practitioners, the first career goal is to make substantial contributions in medical research. As a nurse practitioner, one must be updated on as regards medical studies and improvement of treatment options through modifying their nursing practice. The second career goal as regards a nursing practitioner is to be able to provide comprehensive care and aspire towards an independence practice.

Reference

Jansen, P., & Zwygart-Stauffacher. (2010). Advanced Nursing Practice: Core Concepts for Professional Role Development. New York: Springer.

Diabetes Mellitus Among Filipinos Philippines Health And Social Care Essay

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Most of us just heard about diabetes but how much do we know about it. The thing that we only know that many people does have diabetes mellitus, and most of them are Filipinos. There Mellitus are more than 300,000 Filipinos who suffer from Diabetes Mellitus. In the United States, there are about 16 million diabetics and about 1800 new cases are diagnosed each year. Type I Diabetes, used to be called Juvenile Diabetes, is insulin-dependent (the person’s pancreas does not produce insulin), meaning insulin injection is needed to treat the condition. It is medically known as IDDM (Insulin). Dependent Diabetes Mellitus, most commonly among persons younger than 30 years old associated obesity is not common. It accounts for 5 to 10% of all diabetics. Type II Diabetes is NIDDM (Non-Insulin Dependent Diabetes Melllitus), which can be treated by pills (sulfonyl ureas, antihyperglycemic drugs) rather than insulin, most commonly found Diabetes those who are older than 30, and associated obesity is frequent. It accounts for majority (90 to 95%) of diabetics. The third type is Gestational Diabetes.

Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body. Symptoms include frequent urination, lethargy, excessive thirst, and hunger. The treatment includes changes in diet, oral medications, and in some cases, daily injections of insulin.

The most common form of diabetes is Type II, It is sometimes called age-onset or adult-onset diabetes, and this form of diabetes occurs most often in people who are overweight and who do not exercise. Type II is considered a milder form of diabetes because of its slow onset (sometimes developing over the course of several years) and because it usually can be controlled with diet and oral medication. The consequences of uncontrolled and untreated Type II diabetes, however, are the just as serious as those for Type I. This form is also called noninsulin-dependent diabetes, a term that is somewhat misleading. Many people with Type II diabetes can control the condition with diet and oral medications, however, insulin injections are sometimes necessary if treatment with diet and oral medication is not working.

The causes of diabetes mellitus are unclear, however, there seem

to be both hereditary (genetic factors passed on in families) and

environmental factors involved. Research has shown that some people

who develop diabetes have common genetic markers. In Type I

diabetes, the immune system, the body’s defense system against

infection, is believed to be triggered by a virus or another

microorganism that destroys cells in the pancreas that produce insulin.

In Type II diabetes, age, obesity, and family history of diabetes play a

role.

In Type II diabetes, the pancreas may produce enough insulin,

however, cells have become resistant to the insulin produced and it

may not work as effectively. Symptoms of Type II diabetes can begin

so gradually that a person may not know that he or she has it. Early

signs are lethargy, extreme thirst, and frequent urination. Other

symptoms may include sudden weight loss, slow wound healing,

urinary tract infections, gum disease, or blurred vision. It is not

unusual for Type II diabetes to be detected while a patient is seeing a

doctor about another health concern that is actually being caused by

the yet undiagnosed diabetes. “Education is the Cornerstone of

Diabetic Therapy” said by World Health Organization.

We will try to see and enumerate in this study the dominance of Diabetes Mellitus Among Filipinos in the Philippines.

B. Statement of the Problem

The research aims to know the dominance of diabetes Mellitus and the different factors that affect a person specifically, the study sought to answer the following questions:

Specifically the study sought to answer the following:

How prevalent is the diabetes mellitus?

Which type of diabetes is most common among Filipinos?

Is diabetes hereditary?

What are the signs and symptoms of Diabetes Mellitus that occurs to all diabetic Filipinos?

What are the things that can be done to treat Diabetes?

C. Hypothesis

There is very huge number of diabetic people and they are continuing to grow even more larger as expected, due to the different factors related to the illness.

D. Significance of the Study

The study is important for several reasons.

Goverment officials of the Philippine Republic. The government officials will eventually know that one of the disease that kills a person is diabetes, and for them to give importance in giving a prioritize fund about it.

Nursing Students. The students will realize the importance of taking good care of their self, especially their eating habits which is the most common reason of having Diabetes.

Parents. The study will serve as guide to parents on how to manage the proper diet for their family knowing the study of diabetes Mellitus.

Future Researchers. The research paper will help them to more about it in a concrete way. So that, they will be able to conduct a more efficient research on this.

E. Scope and Delimitation

The study aims to determine the dominance of diabetes among Filipinos here in the Philippines. Furthermore, this research explored the statistics of Filipinos who have Diabetes Mellitus.

Diabetic Filipinos in Philippines are the only concerned population and it is limited to the study of Diabetes Mellitus.

F. Materials and Methods

G. Definition of Terms

In order to have a clear view of the problem in this study, some terms considered relevant to the study have been made defined.

Diabetes Mellitus. Often referred to simply as diabetes (Ancient Greek: διαβαίνειν “to pass through”), is a syndrome of disordered metabolism, usually due to a combination of hereditary and environmental causes, resulting in abnormally high blood sugar levels (hyperglycemia).

Diabetes type 1. Is usually diagnosed in children and young

adults, and was previously known as juvenile diabetes. In type 1

diabetes, the body does not produce insulin. Insulin is a hormone

that is needed to convert sugar (glucose), starches and other food

into energy needed for daily life.

Insulin. A polypeptide hormone secreted by the islets of

Langerhans and functioning in the regulation of the metabolism of

carbohydrates and fats, especially the conversion of glucose to

glycogen, which lowers the blood glucose level. Any of various

pharmaceutical preparations containing this hormone that are

derived from the pancreas of certain animals or produced through

genetic engineering and are used in the medical treatment and


management of diabetes mellitus

Sulfonylurea. Any of a group of hypoglycemic drugs, such as

tolbutamide, that act on the beta cells of the pancreas to increase

the secretion of insulin.

Anti-hyperglycemic Drug. A drug that helps to move out of

the system the presence of an abnormally high concentration of

glucose in the blood.

Gestational Diabetes. is a condition in which women without

previously diagnosed diabetes exhibit high blood glucose levels

during pregnancy.

Microorganism. An organism of microscopic or submicroscopic

size, especially a bacterium or protozoan.

Pancreas. Secretes hormones that affect the level of sugar in

the blood. These cells secrete: Glucagon-raises the level of

glucose (sugar) in the blood Insulin-stimulates cells to use

glucose Somatostatin-may regulate the secretion of glucagons

and insulin.

Hereditary. Transmitted or capable of being transmitted

genetically from parent to offspring: a hereditary disease. E.g.

Diabetes Mellitus.

Lethargy. abnormal drowsiness : the quality or state of being

lazy, sluggish, or indifferent.

Chapter 2

Related Literature

Many people are diagnose to have diabetes mellitus and there are also many people who didn’t know that they have diabetes. The extent of its disease In Filipinos is really big.

Prevalence of Diabetes Mellitus among Filipinos

Different statistic has been laid out by different people at

different time. Administration [1] Four point one (4.1%) of Filipinos

have diabetes mellitus. At the current estimate of the population,

this means 2.5 million Filipinos with diabetes, with perhaps an equal

number which remain undiagnosed. Administration [2] The health

care Indicator statistics of the Department of Health has found that

diabetes is the ninth leading cause of death in the Philippines,

affecting 1 out of 25 Filipinos. As estimated 3.36 Million Filipinos are

affected by the disease today. Leading cause of mortality by sex,

number, rate/100,000 population and percentage Philippines,

2003.Diabtes Mellitus, Male-6,823, Females-7,373, number,

rate-17.5% and a percentage of 3.6.This number is expected to rise

to about 8 million after 20 years.

Types of Diabetes most common among Filipinos

Gonzales [3] There are two main types of

diabetes mellitus: type 1 and type 2. There are

several other specific types, but they occur rarely. There is also a

type of diabetes, gestational diabetes mellitus that occurs during

pregnancy. In this type of diabetes, the abnormality in sugar

metabolism usually disappears after delivery although women who

develop this condition are at a higher risk (30-60 percent) of

developing diabetes later in life. Type 1 diabetes, which accounts

for about five to 10 percent of all cases of diabetes, is an

autoimmune disease. An autoimmune disease results when the

body s defense system (immune system) against infection and

other foreign substances turns awry and attacks the bodys own

cells.Type 2 diabetes the type that afflicts your partner is the

most common form of diabetes. It accounts for about 90-95

percent of all cases of diabetes mellitus. Initially, people diagnosed

with this type of diabetes produce enough insulin, but for unknown

reasons, the cells do not respond appropriately to it. Subsequently,

over a period of years, insulin production by the pancreas

decreases.

Diabetes a Hereditary

Gonzales [ 3] The risk of a person with a parent with type 2

diabetes of developing diabetes is about 15 percent if the parent

was diagnosed before age 50 (as in the case of your husband) and

seven to eight percent if the parent was diagnosed after age 50. If

both parents have type 2 diabetes, the probability is about 40

percent.

Signs And Symptoms of Diabetes Mellitus

Manzella [4] Signs and symptoms of Diabetes Mellitus:

Frequent trips to the bathroom, Unquenchable Thirst, Losing Weight

Without Trying, Weakness and Fatigue, Tingling or Numbness in Your

Hands, Legs or Feet, and Blurred vision, skin that is dry or itchy,

frequent infections or cuts and bruises that take a long time to heal

are also signs that something is amiss.

Things done that leads to a better health even you have Diabetes.

Administration [5] There is currently no cure for diabetes

Mellitus. Diet, exercise, and careful monitoring of blood glucose

levels are the keys to manage diabetes so that patients can live a

relatively normal life. Diabetes can be life-threatening if not properly

managed, so patients should not attempt to treat this condition

without medical supervision. Treatment of diabetes focuses on two

goals: keeping blood glucose within normal range and preventing the

development of long-term complications. Alternative treatments

cannot replace the need for insulin but they may enhance insulin’s

effectiveness and may lower blood glucose levels. In addition,

alternative medicines may help to treat complications of the disease

and improve quality of life.

References:

A. Book

Boulton, A. J. and Rayman, G. (2006). The Fact in Diabetes. West Sussex, England: John Wiley and Sons Limited. RD 563 B6 2006.

Unger, U. M. D. (2001). Diabetes Management in Primary Care. Philadelphia, USA: Lippincott Williams and Wilkins a Wolters Kluwer Business. RC 660 U5 2007.

Schwarts, S. L. (1989). Management of Diabetes Mellitus. Texas, USA: Essential Medical Information System, Inc. MS616 462 sch1m 1989.

Drum, D. and Zierenberg, T. (2006). The Type II Diabetes Sourcebook. New York, USA: The McGraw-Hill Companies, Inc. 616 462 D8447 2006.

Frost, G. and Moses, R. (2003). Nutritional Management of Diabetes Mellitus. West Sussex, England: John Wiley and Sons Limited. 616.4620654 F92n 2003.

Parriesh, D. and Machado, A. C. (2006). Healing Gourmet eat to beat Diabetes. New York, USA: Medical Meals, Inc. 616.4620654 d197H 2006.

B. Article

Pultante, Jr. “Diabetic Foot Care”, Manila Bulletin, (August 17, 2002). p.11-13.

Gonzales, Dr. Eduardo G. “Diabetes Mellitus”, Manila Bulletin, (August 23, 2005). p. C-4

Ramirez, Carlo Gerando. “Therapy Option for Type I Diabetes”, Manila Bulletin, (February 25, 2002). p. 1

Mercado, Charmaine. “How to Help a loved one with a medical condition”, Health Today, (December 2003). p. 50-51.

Tacio, Elena D. “Diabetes: Hidden Epidemic”, Philippine Panorama, (August 3, 2003). p.19

Sy, Gary S. “What is Diabetes Mellitus?”, Manila Bulletin, (August 21, 2002). p.11-12.

Mamanglu, Shianee. “Juvenile Diabetes cases rising in RP”, Manila Bulletin, (March 28, 2000). p.23.

Gonzales, Eduardo G. “A Primer on Diabetes Mellitus”, Manila Bulletin, (July 16, 2007). p. C-5.

Fox, Maggie. “New drug study raises worries”, Manila Bulletin, (May 23, 2007). p.11, B-12.

Sy, Gary s. “Understanding Diabetes and its Complications”, Manila Bulletin, (January 25, 2008). p.11, B-18.

Lopez, Estrellita. “Diabetes and Diet”, Life Today, (June 2001). p.15.

Tacio, Henrylite D. “Taking Diabetes More Seriously”, Manila Bulletin, (October 21, 2003). p.32-33.

Lansang, Segundo L. “Diabetes, A Brief History”, Life Today, (June 2001).

Calcimon, Nerissa V. “Nature of Diabetes”, Life Today, (June 2001).

Lopez, Estrellita. “Treatment of Diabetes”, Life Today, (June 2001).

Salazar, Tessa R. “2-M-1 Pill for Diabetes”, Philippine Daily Inquirer, (April 22, 2006). p. B-6.

Puyalte, Jose.”Now that you’re Diabetic”, Women’s Journal, (April 9, 2001). p.11.

Moseh, Terry L. “WHO: Diabetes, a health threat”, Manila Bulletin, (November 27, 2005). p.H-2.

Gomez, Ma. Congee S. “Beware: Diabetes the New Health Scare”, Women’s Journal, (August 24, 1996). p.40-41.

C. Electronic Media

Manriquez, D.J.: Diabetes Melltus.2008.

Diabetes Profile. February 22, 2009

Manzella, D. : Top Warning Signs of Diabetes December 15, 2008.

Diabetes Mellitus.

P., Erlich H.A ET. Al. The association of class 1 and II alleles with type I diabetes among Filipinos June 2002.

Diabetes rising among Filipinos. February 22, 2009. http://article.wn.com/view/2008/11/11/Diabetes_rising_among_Filipinos Philippine Inquirer ¶

Diabetes Mellitus Case Study. May 15, 2008. http://nursinocrib.com/diabetes_mellitus_case_study

Treatments for Diabetes Alternative. Medicine February 22, 2009http://www.shirleys_wellness_cafe.com/diabetes.htm.

Diabetes Mellitus. Februaty 22, 2009.

www.diabetes center.org.ph/?fid=education Februaty 22, 2009

Medi co limited | Accounting homework help

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Medico limited intends investing in a project during march 2021.  The project is expected to cost R2500 000 with a 5 year useful life, and no residual value.  The annual volume of production for the project is estimated at 150 000 units, which can be sold for cash at R12 per unit Depreciation is expected to be R500 000 per year.  Annual cash operating costs are as follows:

Variable costs                    R225 000

Fixed costs                          R 750 000

Calculate:

Net Present value

Accounting Rate of Return on average investment (answer expressed in two decimal places)

Internal Rate of Return if the net cash flows are R720 000 per year for 5 years

What are key sociological issues and how do they determine a person’s state of health?

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What are key sociological issues and how do they determine a person’s state of health?

Questions ( 300 words approximately for each answer)

 

 

  1. Why is a policy cycle an appropriate tool for developing a new policy? (your response must include referenced materials and do not use dot points).

 

  1. How is a health policy different to a government policy document? (your response must include referenced materials and do not use dot points).

 

  1. How does the ‘new public health’ differ from the old public health approach? (your response must include referenced materials and do not use dot points).

 

  1. What are key sociological issues and how do they determine a person’s state of health? (your response must include referenced materials and do not use dot points).

 

  1. What policy considerations should be included in a national obesity health campaign? (your response must include referenced materials and do not use dot points).

 

 

1.2. What is Policy?

Policy, in the broadest sense, is something that has encompassed a set of specific issues, views, goals and ideas together and formed a plan of action based on this (Fleming & Parker, 2012). The aim of a policy is to solve potential problems through avoiding, preventing and even minimising these (Fleming & Parker, 2012). As Palmer and Short (2010) point out – policy can be a general set of intentions and directions or a specific statement. Time is represented by past, present and future directions and intentions (Palmer & Short, 2010). Public policy relates to government actions, laws and directives for a society or community including funding structures, regulatory control even cultural structure and societal morés.

Health policy specifically, is explained by Palmer and Short as a term that:

….embraces courses of action that affect the set of institutions, organisations, services and funding arrangements that we have called the healthcare system. It includes actions or intended actions by public, private and voluntary organisations that have an impact on health (2010, p.23).

 

1.3. The Policy Cycle

The definition of the term “policy” provides a broad statement that refers to a number of concepts that can vary from well defined objectives and processes to statements about organisational direction (Althaus, Bridgman & Davis, 2013). This unit involves an exploration of policy documents and courses of action that shape organisations, the provision of services and funding arrangements in the Australian Health Care system. Therefore, ‘health policy’ includes the actions that determine how health care is organised, how its services are delivered and the funding mechanisms that enable the process of delivery (Mason, Leavitt & Chaffee, 2012). It encompasses the role that private, public and non-government organisations play within the health care system.

Policy can be regarded as a set of ideals and activities aimed at decreasing inequalities or inequities by allocating and redistributing available resources. This process occurs at a local, state, national and international level.

Policy making has to contend with competing demands- allocation of resources, determination of priorities and competing values. It is a political process and takes account of:

  • availability of funds and funding mechanism
  • demography and epidemiology
  • workforce availability
  • electoral cycle and the government of day
  • media and community expectations
  • legislation

 

Policy development is not a linear process that neatly and predictably follows a sequence of steps. It can be ambiguous and layered and not a single, uniform, transferable process. Policy development occurs as a series of processes that are continuous and vigorous and that always respond to an act or event. Policy development is however described within a policy cycle (Althaus et al. 2013).

As such, the policy cycle should not be read as a staged and ordered process but an active and iterative process. The policy cycle model does, however, outline the key components required to develop policy (Althaus et al. 2013).

The policy cycle forms a framework to consider presenting problems, the formulation of proposals for dealing with these problems and the endorsement and introduction of these as the government’s stated health policy.

Althaus et al (2013) offer an Australian policy cycle model (see figure 1) with the following stages:

  • issue identification;
  • policy analysis;
  • policy instruments;
  • consultation;
  • coordination;
  • decision;
  • implementation; and
  • evaluation.

 

1.4. Social Theory and Social Policy

Social policy is regarded as a set of ideals and activities aimed at decreasing social inequities and inequalities and by re-allocating and redistributing the available resources. This process occurs across all levels of government- local, state and national and also internationally through organisations such as The World Health Organisation https://www.who.int/en/)(.

The study of social theory draws on the body of knowledge contained in subjects such as, politics, economics, sociology, geography and philosophy. For example, political scientists argue over the privacy of the individual in health care provision, economists question the ability of Government to meet specific social needs, sociologists debate issues in regard to inequalities in health and other social needs on the basis of gender, age, class and race. Philosophers reflect on the under-pinning ideologies and the moral and political issues. Social policies in turn identify and promote issues in regard to human welfare including housing, employment, education, welfare benefits and health.

The last three decades have seen a global shift in the way governments determine social and health needs of their populations. Western Nation governments of all political persuasions have created a mood that stresses the need for individuals to take greater responsibility in the prevention of disease by practising healthy lifestyle choices. For example, “six of the 10 leading factors contributing to the global burden of disease are lifestyle related: unsafe sex, high blood pressure, tobacco use, alcohol use, high cholesterol and obesity (Resnik, 2007, p.444). This as well as the aging of the population, the proliferation of high technology, greater levels of consumer awareness and education on health issues, and greater fiscal consciousness have necessitated a rethinking of the provision of health care and social policy.

“Social Policy is a mechanism for the allocation of a society’s resources for the purpose of achieving outcomes that bring to fruition the society’s dominant values and the corresponding objectives and goals. In practice, this means specifically the goals and objectives, and the underpinning values, of the government of the day…” (Jamrozik, 2001, p. 37).

Social policy-making has therefore to deal with competing demands including the allocation of resources, and the determination of priorities and competing values.

“everyday life issues…. are the substance of social policy: the way a society is organised, who gets what benefits, and who is left to fend for themselves” (Dalton, Draper, Weeks, & Wiseman, 1996, p.4).

This places social policy squarely in the lap of economic policy. In doing so, moral decisions are constrained and influenced by the amount of public funds, lobby groups, private corporations charities and trade unions (Gold, Pulman & Colman, 2013). The political process of making and implementing social policy involves three important determinants:

  • availability of resources
  • competing values
  • determination of priorities

 

 

1.5. Social determinates of Health

Health arises from multiple actions within a person’s life such as work, home, school, the community and our leisure activities (Gunner, 2013). The World Health Organisation defines the social determinates of health as:

Access to and utilization of health care is vital to good and equitable health. The health-care system is itself a social determinant of health, influenced by and influencing the effect of other social determinants. Gender, education, occupation, income, ethnicity, and place of residence are all closely linked to people’s access to, experiences of, and benefits from health care. Leaders in health care have an important stewardship role across all branches of society to ensure that policies and actions in other sectors improve health equity. (Commonwealth on Social Determinants of Health 2008 p.8)

Key sociological issues which exert the greatest influence on health and health care such as poverty, gender, social class, ethnicity and race are explored in the reading by Baum (2008) and by Wilkinson and Marmot (2003) who were commissioned by the World Health Organization to compile a list of social determinants of health that were evidence-based and had a most significant impact on health.

1.6. Ethics and distributive justice in health resourcing

Ethical thinking requires an understanding that ethics is about ‘what should be done’ in the world rather than what is done (Staunton & Chiarella, 2013). It encompasses many schools of thought and amongst them are: deontological theories that propose that actions are of themselves (intrinsically) right or wrong; and teleological theories that hold that actions are either right or wrong based on their good or bad consequences (Staunton & Chiarella, 2013, pp. 32-33). Johnstone (2009, p. 57) explains that “deontology asserts that some acts are obligatory (duty-bound) irrespective of their consequences”. Examples that illustrate this ethical perspective include: people who feel duty-bound or obligated to always tell the truth irrespective of the outcome (good or bad); and people whose religious convictions lead to them to refuse life-giving medical interventions. Alternately in teleological (utilitarian), consequence-based theory actions or decisions are only considered to be good or bad in the context of the outcome. That is an action is good if it achieves the most favourable of outcomes, or “the greatest good for the greatest number of people” (Staunton & Chiarella, 2013, p. 33). Beauchamp & Childress (2013) discuss these and other ethical theories in the context of ethical dilemmas and challenges that impact on contemporary medical and nursing practice.

The need for ethical thinking when analysing policy is highlighted by Buse, Mays and Walt (2012) who draw attention to the fact that policy change and analysis is never-neutral but rather is politically driven and often serves political purposes. They argue that ethical issues arise from every aspect of policy change and analysis, even when intellectual and creative skills are sufficient to adequately understand and manage the complexity inherent in the policy process.

Whilst ethical theories can be applied in the broadest sense when making decisions about health policy there are four key ethical principles that are perhaps more readily used: respect for autonomy (the right to self-determination); beneficence (“above all, do good”); non-maleficence (“above all, do no harm”); and justice (fairness), (Beauchamp & Childress, 2013; Staunton & Chiarella, 2012). Rawls (as cited in Allingham, 2014) summarised the idea of justice as fairness, as follows:

“all social values – liberty and opportunity, income and wealth, and the social bases of self-respect – are to be distributed equally unless an unequal distribution of any, or all, of these values is to everyone’s advantage”: injustice “is simply inequalities that are not to the benefit of all” (Rawls, 1999, 24).

Clearly the key concept here is equality. Giving to all equally, however, does not a priori, lead to equal outcomes. Equality of outcomes is more likely to be a result of an equitable distribution of resources, that is, an unequal distribution based on need. Guy and McCandless (2012, p.55) refer to this equitable distribution as social justice and they explain, ”to be clear, “equity” and “equality” are terms that are often used interchangeably, and to a large extent, they have similar meanings. The difference is one of nuance: while equality can be converted into a mathematical measure in which equal parts are identical in size or number, equity is a more flexible measure allowing for equivalency while not demanding sameness”.

In the context of this unit social policy has a range of goals including social justice goals that concern themselves with what it means to have a socially just allocation or distribution of resources for health. This is distributive or allocative justice (Althus et al., 2013) is likely to address the health disparities that exist between groups of people because of the extent of their social advantage or disadvantage (Wilkinson & Marmot, 2003). In Australia there are other, competing policy agendas and goals, including; economic goals for economic growth and prosperity (Palmer & Short, 2010); education goals for excellent standards of education and adequate resourcing (Gonski, 2011). This creates conflict between a Government’s agenda to redistribute the country’s resources to achieve equity, versus the push for efficiency in services and their subservience to market forces. In this context a Government’s role is to make hard decisions that are ethical, politically relevant and economically sustainable (Althus et al., 2013). It is for us to decide whether these macro-decisions made by Governments are sustainable in an ethical sense.

 

There are many examples of how ethical theories and principles can impact on biomedical decision-making in the Australian health care system. Take for example the dilemmas presented by the decision to preserve and prolong life at all costs, sometimes well beyond the point at which it’s possible for a person to regain a reasonable state of health or the situation when there is an end-of life decision, opposed by family members, to cease life-sustaining artificial nutrition and hydration for a person who has ongoing post-coma unresponsiveness (Barraclough & Gardner, 2008, pp. 166-170). This presents an ethical dilemma where what is right, is neither black nor white. The associated debate uncovers issues that are problematic for clinicians given the ethical imperatives to respect autonomy, to do good, and above all to do no harm. The Australian legal system has provided direction that enables lawful decision-making about appropriate action in the situation whilst the policy process has been less instructive. Barraclough and Gardner (2008) argue the need for national ethical guidelines that support health professionals in their effort to be ethical in their decision-making in complex health care situations. Another example may include decisions related to discharging vulnerable people from hospital before they are medically, socially or psychologically ready to leave, restricting treatments because of cost and supply, withholding treatment because of the demographic profile of patients/clients and rationing staff levels, and mix, because of the need to contain budgets and/or make profits (Fiack, Knapp & Lee, 2012). The ethical concepts that are implicated in this example refer to all four ethical principles, as well as to distributive justice.

 

When considering distributive justice in the Australian and International health care contexts it is essential to not only refer to ethical theories and principles but to also take into account the equally relevant social determinants of health. Wilkinson and Marmot (2003, p.7) argue that:

“even in the most affluent countries people who are less well- off have substantially shorter life expectancies and more illnesses than the rich. Not only are these differences in health an important social injustice, they have also drawn attention to some of the most powerful determinants of health standards in modern societies. They have led to a growing understanding of the remarkable sensitivity of health to the social environment and to what have become known as the social determinants of health.

 

1.7. Legislation

A country’s culture and social systems are not the only factors that need to be considered when formulating policy. The law is also an integral part of policy development as many policies require legislation to make them effective. All policies have a legal context because governments and their departments are themselves subject to the rule of law. An example of this is that in Australia no policy may prejudice against religion. Commonwealth law prevents this occurring (see https://www.comlaw.gov.au/ for the complete and current collection of Australian legislation, bills, Acts etc). The constitutions of the Commonwealth, States and the Territories also describe the limits of governmental process. Thus whilst the making of policy is often heavily political, the power of politics in making policy is constrained by the constitution of the Commonwealth (Barraclough & Gardner, 2008).

The relationship between the law and policy is interesting. Both are adaptable and are sometimes required to change to allow the formulation of the other. A good example of how policy has shaped legislation is provided by the implementation of harm minimisation policies for drug use, specifically intravenous drug use. The provision of safe injecting rooms across the world has required the amendment of legislation to allow for the injection of illicit drugs in designated facilities without the fear of prosecution. Thus whilst the cultivation, trafficking, sale and possession of these drugs is illegal, the injection of them in medically supervised injecting rooms is not (see https://www.sydneymsic.com/ for details on the Sydney Medically Supervised Injection Centre).

Another powerful example of the relationship between legislation and policy can be seen in their respective roles in the formulation of human cloning and stem research policy. The Coalition of Australian Governments (COAG) met recently to determine a uniform approach to human cloning and stem research across all states and territories. Once agreement was reached, legislation was developed and then passed through parliament. This legislation was then used to inform policy making in Australia.

There are many emerging issues for public health law (Reynolds, 2011), and consideration needs to be  given to the possibility of changing public health regulations in areas such as: tobacco control; the obesity epidemic (https://www.obesityaustralia.org/); creating healthy environments; regulating alcohol; the limits of personal responsibility for health; and the role of law and policy in responding to new epidemics (for example SARS, and vCJD (mad cow disease) see https://apo.org.au/research/impending-influenza-pandemic-lessons-sars-hospital-practice) .

The required reading illustrates clearly that in some instances to enact health policy, legislation is required. It is clear that legislation has had a significant impact on healthy public policy and its implementation.

THE STRESS OF CARING

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THE STRESS OF CARING

Case 5
The Stress of Caring
Source: Robbins, S. P., & Judge, T. A. (2015). Organizational Behavior (16e), pp. 585-587g).

Organizational Behavior
Professor Ron Stone
Keller Graduate School

MGMT-591

Note: This case is provided as the basis for class discussion.
Case 5

The Stress of Caring
Learning Goals
One of the most consistent changes in the structure of work over the past few decades has been a shift from a manufacturing economy to a service economy. More workers are now engaged in jobs that include providing care and assistance, especially in education and medicine. This work is satisfying for some people, but it can also be highly stressful. In the following scenario, consider how a company in the nursing care industry is responding to the challenges of the new environment.
Major Topic Areas
• Stress
• Organizational change
• Emotions
• Leadership

The Scenario
Parkway Nursing Care is an organization facing a massive change. The company was founded in 1972 with just two nursing homes in Phoenix, Arizona. The company was very successful, and throughout the 1980s it continued to turn a consistent profit while slowly acquiring or building 30 more units. This low-profile approach changed forever in 1993 when venture capitalist Robert Quine decided to make a major investment in expanding Parkway in return for a portion of its profits over the coming years. The number of nursing homes exploded, and Parkway was operating 180 homes by the year 2000.
The company now has 220 facilities in the southwestern United States, with an average of 115 beds per facility and a total of nearly 30,000 employees. In addition to health care facilities, it also provides skilled in-home nursing care. Parkway is seen as one of the best care facilities in the region, and it has won numerous awards for its achievements in the field.
As members of the baby boom generation become senior citizens, the need for skilled care will only increase. Parkway wants to make sure it is in a good position to meet this growing need. This means the company must continue expanding rapidly.
The pressure for growth is one significant challenge, but it’s not the only one. The nursing home industry has come under increasing government scrutiny following investigations that turned up widespread patient abuse and billing fraud. Parkway has always had outstanding patient care, and no substantiated claim of abuse or neglect in any of its homes has ever been made, but the need for increased documentation will still affect the company. As the federal government tries to trim Medicare expenses, Parkway may face a reduction in funding.
The Problem
As growth has continued, Parkway has remained committed to providing dignity and health to all residents in its facilities. The board of directors wants to see renewed commitment to the firm’s mission and core values, not a diffusion of its culture. Its members are worried there might be problems to address. Interviews with employees suggest there’s plenty to worry about.
Shift leader Maxine Vernon has been with Parkway for 15 years. “Now that the government keeps a closer eye on our staffing levels, I’ve seen management do what it can to keep positions filled, and I don’t always agree with who is hired. Some of the basic job skills can be taught, sure, but how to care for our patients—a lot of these new kids just don’t pick up on that.”
“The problem isn’t with staff—it’s with Parkway’s focus on filling the beds,” says nurse’s aide Bobby Reed. “When I started here, Parkway’s reputation was still about the service. Now it’s about numbers. No one is intentionally negligent—there just are too many patients to see.”
A recent college graduate with a B.A. in psychology, Dalton Manetti is more stressed than he expected he would be. “These aren’t the sweet grannies you see in the movies. Our patients are demanding. They complain about everything, even about being called patients, probably because most of them think they shouldn’t be here in the first place. A lot of times, their gripes amount to nothing, but we have to log them in anyway.”
Carmen Frank has been with Parkway almost a year and is already considering finding a new job. “I knew there were going to be physical parts to this job, and I thought I’d be able to handle that. It’s not like I was looking for a desk job, you know? I go home after every shift with aches all over—my back, my arms, my legs. I’ve never had to take so much time off from a job because I hurt. And then when I come back, I feel like the rest of the staff thinks I’m weak.”
“I started working here right out of high school because it was the best-paid of the jobs I could get,” says Niecey Wilson. “I had no idea what I was getting myself into. Now I really like my job. Next year I’m going to start taking some night classes so I can move into another position. But some of the staff just thinks of this as any other job. They don’t see the patients as people, more like inventory. If they want to work with inventory, they should get a job in retail.”
Last month, the company’s human resources department pulled the following information from its records at the request of the board of directors. The numbers provide some quantitative support for the concerns voiced by staff.
Injuries to staff occur mostly because of back strain from lifting patients. Patient incidents reflect injuries due to slips, falls, medication errors, or other accidents. Certified absences are days off from work due to medically verified illnesses or injuries. Other absences are days missed that are not due to injuries or illnesses; these are excused absences (unexcused absences are grounds for immediate firing).

Year Patients Injuries Per Staff Member Incidents Per Patient Certified Absences Per Staff Other Absences Per Staff Turnover Rate
2000 21,200 3.32 4.98 4.55 3.14 0.31
2001 22,300 3.97 5.37 5.09 3.31 0.29
2002 22,600 4.87 5.92 4.71 3.47 0.28
2003 23,100 4.10 6.36 5.11 3.61 0.35
3004 23,300 4.21 6.87 5.66 4.03 0.31
2005 23,450 5.03 7.36 5.33 3.45 0.28
2006 23,600 5.84 7.88 5.28 4.24 0.36
2007 24,500 5.62 8.35 5.86 4.06 0.33
2008 24,100 7.12 8.84 5.63 3.89 0.35
2009 25,300 6.95 9.34 6.11 4.28 0.35

Using Organizational Development to Combat Stress and Improve Performance
The company wants to use such organizational development methods as appreciative inquiry (AI) to create change and re-energize its sense of mission. As the chapter on organizational change explains, AI procedures systematically collect employee input and then use this information to create a change message everyone can support. The human resources department conducted focus groups, asking employees to describe some of their concerns and suggestions for the future. The focus groups highlighted a number of suggestions, although they don’t all suggest movement in the same direction.
Many suggestions concerned schedule flexibility. One representative comment was this: “Most of the stress on this job comes because we can’t take time off when we need it. The LPNs [licensed practical nurses, who do much of the care] and orderlies can’t take time off when they need to, but a lot of them are single parents or primary caregivers for their own children. When they have to leave for childcare responsibilities, the work suffers and there’s no contingency plan to help smooth things over. Then everyone who is left has to work extra hard. The person who takes time off feels guilty, and there can be fights over taking time off. If we had some way of covering these emergency absences, we’d all be a lot happier, and I think the care would be a lot better.”
Other suggestions proposed a better method for communicating information across shifts. Most of the documentation for shift work is done in large spiral notebooks. When a new shift begins, staff members say they don’t have much time to check on what happened in the previous shift. Some younger caregivers would like to have a method that lets them document patient outcomes electronically because they type faster than they can write. The older caregivers are more committed to the paper-based process, in part because they think switching systems would require a lot of work. (Government regulations on health care reporting require that any documentation be made in a form that cannot be altered after the fact, to prevent covering up abuse, so specialized software systems must be used for electronic documentation.)
Finally, the nursing care staff believes its perspectives on patient care are seldom given an appropriate hearing. “We’re the ones who are with the patients most of the time, but when it comes to doing this the right way, our point of view gets lost. We really could save a lot of money by eliminating some of these unnecessary routines and programs, but it’s something management always just says it will consider.” Staff members seem to want some way to provide suggestions for improvement, but it isn’t clear what method they would prefer.

Your Assignment
Parkway has taken some initial steps toward a new direction, but clearly it has a lot of work left to do. You’ve been brought in as a change management consultant to help the company change its culture and respond to the stress that employees experience. Remember to create your report as if for the leadership of a major corporation. When you write your recommendations, make sure you touch on the following points:
1. What do the data on employee injuries, incidents, absences, and turnover suggest to you? Is there reason for concern about the company’s direction?

2. The company is going to be making some significant changes based on the AI process, and most change efforts are associated with resistance. What are the most common forms of resistance, and which would you expect to see at Parkway?

3. Given the board of directors’ desire to re-energize the workforce, what advice would you provide for creating a leadership strategy? What leader behaviors should nursing home directors and nurse supervisors demonstrate?

4. What are the major sources of job stress at Parkway? What does the research on employee stress suggest you should do to help minimize the experience of psychological strain for employees? Create a plan for how to reduce stress among employees.

The Stress of Caring

Introduction

Parkway Nursing Care Company is going through tough times at the moment. With the ever increasing need for better patient care services in the world, the organization has struggled with serving the increased number of people (Hayes et al., 2013). Consequently, the organization has also been struggling with change. Because there has been an increased interest by the government in the documentation and the quality of service being provided by these healthcare institutions. The level of performance has since increased and will continue increasing in spite of the work stress that the employees in such organizations like parkway nursing care experience.

The report below will focus on the type of changes that can be done to an organization to increase the quality of service and employee performance. The subject of the report is Parkway Nursing Care Company that has been in the healthcare industry for over a century. However, in the recent years there has been a lot of stress that has negatively affected the healthcare institution. Therefore, the report will focus on the specific causes of the adverse effects, understand them and suggest methods for conquering these influential aspects of the organization.

Findings

After carefully analyzing the situation at Parkway nursing care. It was realized that the most effective way to ensure that the organization continued to thrive was by changing the perspective by which work was being done at the organizational level. The employees, although not most of them, have no idea about what nursing care entails. Consequently, the patients in the care of the staff at the Institute are at sometimes treated as products of some kind and not human beings. Therefore, as we see there are a lot of changes that need to be put in place to neutralize the situation and ensure that the organization moves towards ensuring better care for their patients above all other things.

Most of the information collected was through interviews. Some of the interviews created a basis for the report. The foundation of the report was considered to be the included I=in the following points of discussion.

Firstly, the government has since structured a policy that would increase the documentation to avoid cases of inappropriate billing and cover-up of patient abuse. Consequently, the government has also requested that the documentation be done in such a way that it would be easy to correct and alter the information.

The issue has caused a lot of problems at the Parkway nursing care institute. One of the problems regards the use of an electronic software system that would make use of current technology to implement the documentation of patients. Moreover, the old nurses that are not so equipped with technology have some resistance to the adoption of the new system and would like to keep the old system of documentation in use. But, the younger nurses vouch for the new system considering that they can type faster than they can write. Thus, a lot of time is saved from the documentation process that can be used in more serious work.

Secondly, from the data provider about employee injuries and other aspects. Per staff, member absences have increased to a high of 4.28, and that is not good for any business. The absences that have gone unnoticed in the institution have caused a lot of stress to other staff members. For instance, licensed nurse does almost all of the work in the organization. Reason being most of them have the expertise regarding nursing and care. Therefore, when a licensed nurse takes time off. All the other staff members are forced to work extra hard, and this causes some stress on their performance. Eventually, the quality of service offered goes down. Employee job satisfaction decreases. More staff members ask for time off due to excess fatigue and the cycle continues. The situation above is dangerous for such an organization. The organization should try and find ways to neutralize the situation before it gets out of hand.

Thirdly, the appreciative inquiry that was used to depict what type of change the organization requires. The AI process went smoothly apart from some resistance to change from some staff members. One thing the organization needs to consider is that change will happen one time or another time, but eventually it will happen. Then it is crucial to consider the benefits of this change happening earlier than later in spite of all the resistance it is going to face. It is quite normal for change not to be accepted. However, from a management perspective, change is inevitable. Therefore, it most happens. But for the change to be of positive effect on the organization. There must be some ways put in place to counter the resistance that will be faced. To effectively manage the resistance, we have to understand the common types of resistance that might be witnessed in this situation. The most common type of resistance might be shown through reduced employee performance or morale. To counter this, it is prudent that the management considers creating a change message that would be a motivating factor that would put the staff in the organization in support of the proposed changes for the betterment of the organization.

Recommendations

The most crucial part of an organization is considered to be the leadership (Perrewé et al., 2013). In this case, job stress at Parkway has been there, and the management has considered doing some changes to solve the issue. However, if the leadership structure and behavior of the organization are not changed, the proposed changes will have no significant effect on the organization. Therefore, it is wise first to ensure that the leadership is up to today’s standards and will uphold the core values of the organization. Hence, the board of directors need to ensure that the leadership behavior in the organization is bent towards the betterment of the quality of service provided.

Another key aspect of the organization is the number of staffs. The staff seems to be less and overworked at some point. For instance, when one staff member gets tie off work. The result is the other staff members working very hard to counter the absence of one of them. Therefore, it is wise to employee new staff members with diverse skills to reduce work stress at the organization. Increasing the number of staffs will not only reduce the work ration per employee but also increase the individual attention or care given to the patient (Chung et al., 2011). Hence, in the long run, increasing the quality of services offered at Parkway nursing care.

Lastly, the organization needs to keep up with technology. In these modern times, technology has become the backbone of most businesses and eventually the global economy. It is considered a crucial aspect of the success of any business or organization. Therefore, the organization needs to adopt a software system that would solve the issue of documentation. The system must be modern, easy to use and have tight security to maintain the integrity of the documents.

Conclusion

Parkway nursing care has had a lot of years of experience in the healthcare industry. With the growing need for specialized healthcare, the organization needs to change to deal with the demand in an efficient and effective manner that ensure the quality of service. Hence, change has to be done swiftly and the transformation process successfully.

References

Chung, C. E. E. (2011). Job stress, mentoring, psychological empowerment, and job satisfaction among nursing faculty.

Hayes, B., Bonner, A., & Douglas, C. (2013). The levels of job satisfaction, stress and burnout in Australian and New Zealand haemodialysis nurses.

McVicar, A. (2015). Scoping the common antecedents of job stress and job satisfaction for nurses (2000–2013) using the job demands–resources model of stress. Journal of nursing management.

Perrewé, Pamela L. The Role of Emotion and Emotion Regulation in Job Stress and Well Being. Eds. Jonathon RB Halbesleben, and Christopher C. Rosen. Emerald Group Publishing Limited, 2013.

Essay on Memory and Traumatic Brain Injury

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Memory is an important aspect of our daily life. When memory is disrupted by a life-changing event such as traumatic brain injury (TBI), it can have residual effects. Memory impairment is common in individuals with TBI. Brookshire and McNeil (2014) stated TBI is a head injury resulting from complications that include brain lesions and concussions. Some of the symptoms that are seen in patients with memory loss secondary to TBI include forgetting important events, forgetting important details, and forgetting important occasions (Brookshire & McNeil, 2014). Patients with TBI show signs of impaired cognitive functioning and spoken communication, which includes (a) processing and sequencing information, (b) word retrieval, (c) expressing thoughts, and (d) developing clear narratives (Dinnes, Hux, Holmen, Martens, & Smith, 2018). Due to TBI being associated with speech and language deficits, treatment is an important aspect for recovery and teaching compensatory techniques.  The purpose of treatment for patients with TBI is to effectively train them to function independently and carry what was learned over into daily life routines by focusing on strengths and targeting weaknesses (American Speech-Language-Hearing Association [ASHA], n.d.). Goverover, Chiaravalloti, and DeLuca (2010) stated treatment should focus on improving acquisition of information in patients with TBI who have memory impairments. The purpose of this paper is to evaluate memory treatment through the research for patients with TBI.


Research Studies

Sumowski, Coyne, Cohen, and DeLuca (2014) conducted a within-subject design study to investigate the effects of retrieval practice for patients with severe TBI. The goals of the study were to evaluate if retrieval practice enhanced delayed recall after long- and short-term delays and to demonstrate if retrieval practice will improve memory in patients with severe TBI. Ten participants with severe TBI and patients with mild TBI and memory impairments ranging from 21 to 57 years old were evaluated based on memory strategies and divided across three learning conditions: retrieval practice, spaced restudy, and massed restudy (also known as cramming). During the retrieval practice study, the participants were asked by researchers to recall information that was presented to them previously. The participants in the massed restudy and spaced restudy groups were evaluated on cramming memory and distributed learning strategies. Each participant’s session included assessment of memory performances and delayed recall practice. Based on the study, the researchers found that retrieval practices were beneficial for patients with severe TBI who have memory impairments. The researchers concluded that retrieval practice was the most effective treatment for the participants with severe TBI and had better results than the spaced restudy strategy; however, participants with mild TBI found massed restudy a more beneficial method for memory strategies. Additional practice and training are needed to evaluate the impact of retrieval practice for patients with TBI (Sumowski et al., 2014).

Fish, Manly, Emslie, Evans and Wilson (2008) conducted a randomized control crossover study to examine the results of paging systems as a compensatory strategy for patients with acquired memory and planning disorders. The goal of this study was to examine if using the paging system as a compensatory strategy would maximize cognitive rehabilitation for patients with TBI. Participants who exhibited planning and memory impairments were chosen for this study. For this seven-week study, the participants were divided into two groups, and both groups had three phases. For group A, the treatment included baseline, introduction to pager, and return to baseline. For group B, the treatment included baseline and then the introduction of the pager. The participants did memory diaries and used the paging system as a compensatory strategy to help remember the errands or activity they needed to do during the day. Based on the study, the participants with TBI showed great benefits and demonstrated maintenance by using the paging system as a compensatory strategy. The researchers concluded the paging system had long-term improvements in most of the participants even after the discontinuation of the pager. Further studies about the use of a paging system need to be conducted; however, the researchers believe patients with memory impairment will benefit from short-term use of a paging system (Fish et al., 2008).

Coleman, Frymark, Franceschini, and Theodoros (2015) conducted a systematic literature review comparing telepractice treatment versus in-person treatment for patients with acquired brain injury. The goal of this research study was to examine whether the telepractice service delivery method was an impactful method for speech language pathologists (SLP) to use as a communication and cognitive intervention. Also, the researchers examined the impact of an in-person delivery model versus the telepractice delivery method for cognitive improvements in participants. The researchers evaluated 218 research articles between April and August 2013 from databases (PsycInfo, PubMed, and Rehabdata); however, 10 articles were chosen based on the inclusion criteria (Coleman et al., 2015). Based on the results, similar outcomes were found for both telepractice and in-person treatment methods, resulting in inconclusive findings. (Coleman et al., 2015).

Vik, Skeie, Vikane, and Specht (2018) examined the effects of music production on patients with mild TBI. The goal of this between group and longitudinal within-subject design was to examine how music plays a role in restoring cognitive impairments after a mild TBI. The researchers believed that music therapy helps with cognitive rehabilitation by recognizing familiar tones and melodies. Participants ranging from 19 to 42 years old with mild TBI were recruited for this study. The treatment consisted of three groups: group one consisted of patients with mild TBI that were receiving music therapy, group two was the control group with healthy participants receiving music therapy, and group three consisted of healthy participants that did not have music therapy. Groups one and two’s cognitive functioning were assessed pre and post music therapy. The researchers concluded music production therapy has a significant impact on cognitive functioning; there is causal relationship between the two (Vik et al., 2018).

Burgeois, Lunius, Turkstra, and Camp (2007) examined the impact of errorless training on patients with memory loss caused by TBI. The purpose of this experimental design study was to examine whether spaced retrieval approach helped patients with TBI maintain and generalize everyday memory strategies to enhance their quality of life. Also, the researchers questioned if therapy by phone would be an effective approach for treating patients with memory impairments secondary to TBI. Thirty-eight participants with chronic brain injury who exhibited memory impairments were recruited for the study and were assigned to a treatment and control group. The participants and their caregivers were asked to write down items they had difficulties remembering, which included forgetting appointments and planners, losing items, and forgetting to take medications. Each participant’s training session was 30 minutes for four to five days per week. The researchers began the session by asking the spaced retrieval training group prompt questions and asking the participants to respond. The participants were asked to answer the questions the same way for each question on each trial. If the participants gave the researchers a correct response after the initial prompt, the next prompt was given. During the session if the participants answered the questions incorrectly, the researcher modeled the correct response. The participants were asked to respond immediately to each prompt without struggling to retrieve the answer. The participants in the control group received the same therapy as the spaced retrieval group; however, the content for each session included memory strategy discussions with the researchers that helped each participant. The researchers concluded that errorless training that implemented spaced retrieval treatment had a positive impact on the treatment and control groups to help with memory impairments. However, there was not enough evidence that spaced retrieval training by phone would generalize and have a positive effect the participant’s quality of life. According to the researchers, continued research is needed to evaluate treatment strategies that will improve situations, behaviors, and environments of patients with acquired TBI (Burgeois et al., 2007).


Analysis of Research

Each one of the studies evaluated treatment strategies of memory for patients with TBI. The retrieval training approach helped the participants with severe TBI to restore their memory by using a recall training technique to regain cognitive processing. The researchers focused on teaching the partcipants how to retrieve information from memory and encouraged the participants to let the information come out of their mouth (Sumowski et al., 2014). The compensatory strategies treatment focused on altering the participant’s environment by including a paging system in their daily activities to help with cognitive communication impairments to remember important events, such as picking up their children from school, taking medication, and looking in their planner daily (Fish et al., 2008). Music therapy treatment focused on the role music plays in restoring cognitive function for patients with mild TBI (Vik et al., 2018). The errorless training was an approach that was used to help the participants eliminate errors. The treatment consisted of the researchers asking the participants to avoid guessing and to instantly correct errors before fading prompts (Burgeois et al., 2007).


Conclusion

Memory impairment due to TBI can affect an individual emotionally and socially. Memory impairment due to brain injury can persist for years despite treatment. As a result, clinicians have investigated through evidence-based practice the best approach to use to restore memory (Brookshire & McNeil, 2014). There are many different treatment approaches SLPs use to help with memory for mild to severe TBI, which include repetitive practice, errorless teaching, retrieval training, compensatory strategies, and the use of AAC devices. Treatments that are evidence based should focus on compensating or strengthening cognitive communication impairments (ASHA, n.d.). There is continuous study concerning treatment approaches for memory. Sumowski et al. (2014) stated research should focus on strategies that are challenging for patients with TBI who have memory impairments, to improve long-term knowledge. The researchers whose studies were reviewed in this paper examined the effects of different treatment strategies on cognitive plasticity and memory. Continued research is needed to consider what method is more beneficial for generalization of skills learned in therapy for patients with memory impairments in daily life.


References

  • American Speech-Language-Hearing Association. (2018). Traumatic brain injury.  Retrieved from https://www.asha.org/public/speech/disorders/traumatic-brain-injury/
  • Brookshire, R. H., & McNeil, M. R. (2014).

    Introduction to neurogenic communication disorders

    (8th ed.). St. Louis, MO: Mosby.
  • Bourgeois, M., Lenius, K., Turkstra, L., & Camp, C. (2007). The effects of cognitive teletherapy on reported everyday memory behaviours of persons with chronic traumatic brain injury.

    Brain Injury

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    (12), 1245-1257. doi:10.1080/02699050701727452
  • Coleman, J., Fryamrk, T., Franceschini, N., & Theodoros, D. (2015). Assessment and treatment of cognition and communication skills in adults with acquired brain injury: A systematic reveiw.

    American Journal of Speech-Language Pathology, 24,

    295-315. doi: 10.1044/2015_AJSLP-14-0028
  • Dinnes, C., Hux, K., Holmen, M., Martens, A., & Smith, M. (2018). Writing changes and perceptions after traumatic brain injury: “Oh, by the way, I can’t write”.

    American Journal of Speech-Language Pathology, 16

    ,1-16. doi.10.1044/2018_AJSLP-18-0025
  • Fish, J., Manly, T., Emslie, H., Evans, J., & Wilson, B. (2008). Compensatory strategies for acquired disorders of memory and planning: Differential effects of a paging system for patients with brain injury of traumatic versus cerebrovascular aetiology.

    Journal of Neurol Neurosurg Psychiatry

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    , 930-935. doi:10.1136/jnnp.2007.125203
  • Goverover, Y., Chiaravalloti, N., & DeLuca, J. (2010). Pilot study to examine the use of self-generation to improve learning and memory in people with traumatic brain injury.

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    , 540–546. doi:10.5014/ajot.2010.09020
  • Sumowski, J., Coyne, J., Cohen, A., & DeLuca, J. (2014). Retrieval practice improves memory in survivors of severe traumatic brain injury.

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  • Assessment and Treatment of Cognition
  • and Communication Skills in Adults With
  • Acquired Brain Injury via Telepractice:
  • A Systematic Review
  • Assessment and Treatment of Cognition
  • and Communication Skills in Adults With
  • Acquired Brain Injury via Telepractice:
  • A Systematic Review
  • Vik, B., Skeie, G., Vikane, E., & Specht, K. (2018). Effects of music production on cortical plasticity within cognitive rehabilitation of patients with mild traumatic brain injury.

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    (5), 634-643. doi:10.1080/02699052.2018.1431842

What are some of the political and social forces that shape the social determinants of health? What is the current state of the social determinants of health in Canada? What are some of the reasons for this current state and what can be done to improve the situation?

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What are some of the political and social forces that shape the social determinants of health? What is the current state of the social determinants of health in Canada? What are some of the reasons for this current state and what can be done to improve the situation?

 

Draft Version of Scholarly Discussion Paper (4 pages): Due at 2:30 p.m. on Monday, October 23, 2017, the date of Session/Week 6 (N.B.: Your submission must be uploaded onto Turnitin through our Moodle Course Website) The purpose of this two-stage assignment is to provide the individual student with an opportunity to prepare a discussion paper which provides an overview of a current key issue pertaining to one major health topic in Canada. Page 6 of 17 Students will have the opportunity to select a topic of interest and conduct a limited literature search of the professional health literature pertaining to the policy or management perspectives. You will also have the opportunity to revise your paper based on instructor feedback in order to improve your written literacy and analyses skills. Instructions: Choose one of the three issues below. If you have difficulty selecting a topic, approach the professor or your teaching assistant for assistance. 1) Health Policy: What are some of the political and social forces that shape the social determinants of health? What is the current state of the social determinants of health in Canada? What are some of the reasons for this current state and what can be done to improve the situation? 2) Health Management: What are the key features of Canada’s health care system? What are some of the problems that need to be addressed in Canada’s health care system? What are some of the proposed solutions being advanced? What are their strengths and weaknesses? 3) Health Informatics: What are the proposed benefits of instituting electronic health records? What evidence is there that doing so would improve health? What have been some of the barriers to instituting electronic health records in Canada? How can these be overcome? Conduct a literature search of professional journal articles and government and agency reports pertaining to the topic that you have chosen. Identify 5 to 6 relevant, current articles, and additional resources which discuss the topic in further detail. Prepare a draft of your paper by discussing each of the following: 1) Introduction to the issue (e.g. problem, dilemma, and concern); include a thesis statement. 2) Why it is an issue? What is the history (how the issue evolved) and how it captured your interest? Who does the issue involve (e.g., key stakeholders such as the public, government, and healthcare organizations)? 3) What are the implications for the public and policy makers? 4) Summary (your conclusions, new insights, and pulling the paper together). Format: Use subheadings to separate/organize different aspects of your paper which support your main thesis. Your draft paper will be 4 pages excluding cover page and references. Use 1-inch margins (2.54 cm), 12-point font in Times Roman, double spacing, and APA style referencing format

Portion of the Health Promotion Project Custom Paper

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Portion of the Health Promotion Project Custom Paper

The following is the template to be used for the Article Review (Part 2, Step 1) portion of the Health Promotion Project.

Primary/Secondary Research Study -OR- Integrative Review
1. A primary or secondary research study is one that reports on data and findings from ONLY ONE study. A primary study is based on the initial aims of the research. A secondary study is one that uses research data from a previous study to answer new study aims or purposes. Primary and secondary studies can be laboratory experiments, clinical trials, case-control studies, cohort studies, survey research, methodological studies, or evaluation research. Students DO NOT have to identify if it is a primary or secondary study.
2. An integrative study is one that summarizes or draws conclusions from MORE THAN ONE primary/secondary study. These studies are often called meta-analyses, systematic reviews, or research syntheses.
Please do not use other types of journal articles, including consensus statements, case studies, clinical protocols, editorials, and letters to the editor. If you are unsure about whether or not your article is acceptable, please email it to the course coordinator for confirmation.
PURPOSE: (12 points)
Three criteria: (1) background information; (2) study purpose; (3) population under study
In one paragraph, describe the purpose(s) or aim(s) of the study and the population under study. Also include a brief description of the relevant background information (author’s introduction section and/or review of literature).
FINDINGS: (12 points)
Three criteria: (1) major findings; (2) study limitations; (3) clinical implications
In one paragraph, describe the major findings of the study. Also include a description of the study limitations and the author’s stated clinical implications.
PRACTICE: (12 points)
Three criteria: (1) implementation; (2) benefit; (3) evaluation
In one paragraph, describe how a nurse might implement the findings into clinical practice and what benefit it may have for the population of concern. Also provide an explanation on how the nurse would evaluate the effectiveness of implementation.
The following is a sample paper
REFERENCE:
Health Assessment & Promotion
Health Promotion/Disease Prevention/Wellness Project Article Review Example
Fazeli , P. L., Marceaux, J. C., Vance, D. E., Slater, L., & Long, C. A. (2011). Predictors of cognition in adults with HIV: Implications for nursing practice and research. Journal of Neuroscience Nursing, 43(1), 36-50. doi:10.1097/JNN.0b013e3182029790
TYPE OF ARTICLE:
Primary/Secondary Research Study
PURPOSE:
People with HIV are living longer due to advances in antiretroviral treatment. However, due to the effects of HIV disease, HIV-positive individuals are experiencing declines in cognitive function at early ages than HIV-uninfected individuals. The purpose of the study was to determine possible predictors of cognitive performance in adults living with HIV. Ninety-eight adults, aged 24 to 67, participated in the study. Of the sample, 71% were men and 69% were African-American. Cognitive performance was measured in five areas: speed of processing, psychomotor ability, attention and working memory, reasoning, and executive function. General predictors that were examined included age, gender, socioeconomic status, reading ability, social networks, hardiness, mood disturbance, medical problems, psychoactive drug use. HIV-related predictors included HIV chronicity (years living with HIV), CD4 cell count, and HIV medication usage.
FINDINGS:
Among the sample of 98 HIV-positive adults, the most consistent predictors of poorer cognition among people living with HIV were older age (speed of processing, psychomotor ability, reasoning, and executive function), poor reading ability (speed of processing, attention and working memory, and executive function), depressed mood (speed of processing, psychomotor speed, and reasoning), low CD4 count (reasoning and executive functioning), and lack of HIV medication usage (psychomotor speed and reasoning). Limitations of the study included: (1) self-report of CD4 cell count and psychoactive drug use that may have resulted in self-reporting bias; (2) restricted age range of the sample; and (3) no inclusion of a medication adherence measure. According to the authors, nurses are the key to recognizing cognitive changes in patients with HIV due to their close proximity to patients. They can then act promptly to help stabilize and improve cognitive functioning through educating about medication adherence, promoting general health and well-being, and providing activities that promote new learning.
PRACTICE
Adults living with HIV may experience cognitive decline at earlier ages than adults that are not HIV infected. As such, it is imperative that nurses assess cognitive function and look for cognitive changes in patients living with HIV. In addition, the nurse can intervene in several ways that may help maintain and or improve cognitive function in adults living with HIV. First, as lack of HIV medication usage was related to lower cognitive function, the nurse can work with the patient to promote adherence to antiretroviral medication usage. Effectiveness of medication adherence can be determined through laboratory results, as effective medication usage will lead to increased CD4 cell count and lowered (to hopefully undetectable) viral load. The second is to promote general psychological well-being as depressed mood also affected cognitive function. This can be done through appropriate therapy referrals, support groups, and, if needed, pharmacotherapy for depression treatment. Computerized cognitive tests, such as those used in the study, can be used to assess cognition and changes in cognition due to implementation of such therapies.
The following is my topic that I need to get the research paper for;
I would like to base my research on the elderly population diagnosed with type 2 diabetes. I would like to research the impact of insulin with regards to glucagon in regulating and controlling blood sugar levels

A Systematic Review of Thyroid Cancer After the Chernobyl Accident

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ABSTRACT



Background:


Following the immediate fallout of the Chernobyl nuclear accident, many epidemiologic studies were conducted to ascertain the effects of ionizing radiation on cancer incidence and prevalence. The aim of this study was to understand the long-standing trends that can be attributed to the disaster through extended epidemiologic studies that assess thyroid cancer within highly irradiated populations.



Methods:


The analyses within this review encompass a variety of study designs and methodology with incidence being assessed through risk projection models and international cancer registries. Given the complexity of this incident, the analysis has been supplemented by appropriate case-control and cohort data to further understand the dose-response and radiobiological relationships between ionizing radiation and cancer.



Results:


The risk projection models indicate that Chernobyl may have been responsible for up to 16,000 cases of thyroid cancer due to exposure to

131

I and 1,000 thyroid cancer deaths. Additionally, some of the countries within the most highly contaminated countries show markedly higher thyroid cancer incidence rates than their more western counterparts.



Conclusions:


A review of the Chernobyl disaster indicates that the event is responsible for a noticeably increased incidence rate of thyroid cancer within highly contaminated areas due to the high

131

I thyroid dosages.


INTRODUCTION

On April 26, 1986, the Chernobyl power plant in Ukraine suffered a catastrophic reactor accident that shocked the world in its severity and scope. Massive amounts of radioactive material were jettisoned thousands of meters into the atmosphere, resulting in the release of several types of radionuclides, consisting of (1.2-18) x 10

18

Bq of short-lived

131

I and roughly 1.4 x 10

17

Bq of long lived

134

Cs and

137

Cs.

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Nuclear fallout quickly contaminated the surrounding communities and dispersed these harmful radionuclides across Europe. Dispersion was concentrated within Belarus, Ukraine, and what is today the western part of the Russian Federation, here, ingestion of food stuffs irradiated with radioactive iodine resulted in those populations (particularly children) receiving significant doses to the thyroid gland.

2

To this day, the area surrounding the facility is closed to the general public in an “exclusion zone” that encompasses some 30 square kilometers around the site. While many of the results of the disaster were clearly obvious to the public through horrific scenes of radiation poisoning and an irradiated habitat, the more insidious effects of radiation exposure have manifested themselves in increased cancer burden both within the immediate population as well as the greater population of Europe.

While much study has gone into the assessment and containment of the disaster, epidemiological pursuits have focused on the 3 most contaminated countries and confirmed a causal link between the observed risk of thyroid cancer and exposure to the radioactive isotope

131

I from the Chernobyl fallout amongst those who were adolescents or children when the accident occurred.

3-5

Other cancers, including leukemia, have been researched, but these studies have not been able to clearly demonstrate an association with radiation exposure. Additionally, there have been more recent studies that suggest a possible small increase in the incidence of premenopausal breast cancer in the most contaminated districts found within Belarus, the Russian Federation, and Ukraine.

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However, these findings and studies need further validation through more robust epidemiologic studies that include amongst other measures, careful individual dose reproduction in accordance with dose and exposure models.

The primary objective of this study is to assess and evaluate the burden of thyroid cancer incidence within the countries most impacted by the Chernobyl accident, as well Europe as a whole.


MATERIALS AND METHODS

There are a variety of approaches to understand and estimate the thyroid cancer burden in Europe due to the Chernobyl accident. This review utilizes multiple means of analysis, including: radiation dose reconstruction, risk projection models and studying updated incidence rates.



Data Sources

Incidence and mortality data were obtained through the International Agency for Research on Cancer (IARC) and further derived from the Global Cancer Observatory (GLOBOCAN). Information that was found within contributing sources and references was drawn from the United Nations Economic Commission for Europe (UNECE), United States Census Bureau, the Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), as well as other international databases and organizations.



Study Population and Cases

Analyses ranged in their scope and manner of quantification, with predictive risk models and ecological studies providing the majority of data. The distribution of thyroid cancer and radiation dosage were analyzed by age group, dose received, year of diagnosis, and country. Within European countries, there were two distinct groups that constituted the basis for establishing the severity of irradiated iodine, those three countries most contaminated by the disaster and the rest of Europe. Predictive risk modeling included analysis that focused on 40 countries. Due to available cancer time-trend data, incidence was limited to 9 countries with 3 of those countries containing multiple cancer registries. Except in more recent incidence data, populations were aggregated together to assess the overall cancer burden that effects the two main areas of interest.



Radiation Dosage

Dosage reconstruction for European countries was found through country-specific radiation monitoring databases and their subsequent estimates of exposure levels on individual populations. For Belarus, Ukraine, and the Russian Federation, detailed information was obtained through publications by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) and the UN Chernobyl Forum Report.

1,7

As detailed within Cardis,

2

data on

137

Cs deposition density and activity of

131

I and

137

Cs foodstuffs during the first year following the disaster were used to estimate the country and region specific estimates of whole-body contamination of the thyroid due to

131

I. Imprecise dosage values were considered the lowest in Belarus, Ukraine, and the Russian Federation, which have extensive and robust radiation monitoring systems in place.



Projection Risk Models

Projection risk models used within this summary analysis were based the risk models constructed by the US National Research Council’s Committee on the Biological Effects of Ionizing Radiation (BEIR VII).

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These models combine excess relative risk (ERR) and excess absolute risk (EAR) models, both of these risk measures were written as a linear function of dose, contingent on sex, age at exposure and attained age. The BEIR VII risk models for thyroid cancer were based upon published combined analyses of the data on atomic bomb survivors and medically exposed cohorts.

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Projection risk estimates relating to radiation exposure over time assumed that population demographics and cancer incidence would remain constant from 1986 to 2065. As presented in the BEIR VII, the risk estimates summarized within this review, the risk estimates are accompanied by substantial and subjective uncertainty intervals that quantify uncertainty sources: (1) sampling variability in risk model estimates from atomic bomb survivor data, (2) uncertainty in the correct value of dose and dose-rate effectiveness factor (DDREF), and (3) all solid cancers and leukemia, uncertainty in using Japanese atomic bomb survivors to estimate risks in populations with dissimilar baseline risks.

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Trends in Thyroid Cancer Incidence

Incidence data were assessed through an ecological survey of readily available cancer registries produced by IARC and its subsequent publications GLOBOCAN and CI5.

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Due to certain country-specific thyroid cancer rates being unavailable, Belarus was used as a proxy for high contamination dosage when compared to lower does found throughout Europe. Graphs, tables, and figures were compared by country-specific cancer, based upon sex, age group (when available), and time. Subsequent data were compared to radiation dosage maps and registries. Based upon these input factors, thyroid cancer attributed to radiation from the Chernobyl accident was assessed for an approximate lag time of approximately 5 years and onwards. Additionally, as found within the Cardis analysis,

2

the effect of dosage and thyroid cancer incidence was examined using Poisson regression to create a registry organization scheme that could be subdivided into various dosage groups.


RESULTS



Radiation Doses Attributed to Chernobyl

Figure 1.

2

Following the accident in 1986, radiation doses were highest in Belarus and Ukraine, with the average cumulative whole-body dose exceeding 0.5 mSv. At a 2005 follow-up measurement, the average cumulative country-specific whole-body doses were respectively, 2.8 mSv in Belarus, 5.1 mSv in heavily contaminated areas of the Russian Federation and 2.1 mSv in Ukraine.

2

The average cumulative dose through 2005 for highly irradiated areas in Belarus and Russian Federation was estimated to be roughly 20 times higher (approximately 10 mSv) when compared to Europe (0.5 mSv) as a whole. As seen in Figure X,

2

the spatial distribution of dosage to the thyroid gland from

131

I is shown for children younger than 5 years old and for adults at least 30 years old in 1986. Doses of

131

I were markedly higher than whole-body doses due to external and internal exposure to longer-living radionuclides. Amongst these higher thyroid doses, the highest average dosages were received in the Gomel region of Belarus, in the Bryansk region of the Russian Federation and in the Zhytomir Region of Ukraine.

2,7



Risk Projections

Table 1.

2

Predicted thyroid cancer cases and deaths between 1986 and 2065 (with the latter indicating values 80 years following the accident) are shown in Table 1. Country groups were determined upon average thyroid dose with the lowest group receiving <5 mSv and the highest group receiving ≥100 mSv. For thyroid cancer, the estimated attributable fractions (AFs) range for countries contaminated with

131

I, with the least contaminated ranging from 0.08%, to 12% in the most contaminated countries (average thyroid dose <5 mSv and an average thyroid of at least 100 mSv). Uncertainty intervals for the estimates are particularly wide, ranging from 3,400 to 72,000 additional thyroid cancer cases by 2065. Roughly half of the possible additional cases are expected to occur in areas with average dosages of at least 25 mSv, representing only 3% of the population under study. Amongst the massive number of predicted radiation-induced cases of thyroid cancer, 90% are expected to occur in those younger than 15 years of age when the Chernobyl accident transpired.



Cancer Incidence Trends


Figure 2.

11

Figure 3.

12

Incidence rates for thyroid cancer incidence across Europe are found within Figures 11 and 12. Figure 11 shows the female, Thyroid Age Standardized Incidence Rate amongst various European countries. Figure 12 shows the male, Thyroid Age Standardized Incidence Rate amongst various European countries. Data measurements fall within the age period of 1953 and 2012, with the majority of countries first reporting data in 1983. Although increasing trends can be observed amongst both genders and all countries, Belarus shows one of the most drastic increases with an overall incidence (0.49 to 3.25 for males, 1.72 to 14.78 for females). As seen in the comparison of the two groups, females show an approximate 4.5 times increase in thyroid cancer incidence compared to males.

Figure 4.

2

Figure 4 shows the trends of thyroid cancer by age at diagnosis and registry grouped by thyroid dose. Trends indicate that incidence increases in the 3 groups with the highest dose. The effects of geographic distribution can also be seen within the incidence of thyroid cancer as those European countries further west show decreased incidence in conjunction to decreased thyroid doses. The increase was greatest among children exposed age <15 and was most pronounced in the registries showing the highest dose. Analysis performed on all registries from 1981 to 2002 indicate statistically significant associations (p<0.05) between the average dose in each registry and the incidence of all cancers.

2

Further analyses of the linear contrasts between registries and groups indicated that although cancer incidence had been increasing in Europe since 1981, the slope actually decreased after 1991 for all cancers. Since 1991, only thyroid cancer has shown a consistent, statistical increase in the slope for cancer incidence.


DISCUSSION



Conclusions

This systematic review serves as an updated assessment for the burden and severity of thyroid cancer incidence as a result of increased ionizing radiation attributed to

131

I from the Chernobyl accident. The strength behind this analysis includes the assessment and synthesis of both old and updated data on radiation exposures, resulting in an evaluation of the unique pathology and spatial distribution of iodine-related radionuclides in Europe. The analysis includes predictions for the number of thyroid cancer cases due to radiation from the Chernobyl accident to the year 2065 using projected risk models based upon previous instances of populations exposed to radiation.

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Due to the susceptibility of children to high 131I thyroid doses, the radiation received has been proven through various epidemiological studies to have a demonstrated association between radiation dosage to the thyroid and thyroid cancer in the general population.

13,14



Limitations

As the primary intent of this review was to understand the general trends of thyroid cancer incidence in Europe and highly contaminated areas, more complex factors such as pathology and dosimetry were only briefly covered. Because the spread of radionuclides was relatively limited outside of Belarus, the Russian Federation and Ukraine, epidemiological studies have had very little power to ascertain an association between the Chernobyl accident and cancer risk. Given the resource intensive nature of the surveillance required to fully assess the cancer burden associated with low-level radiation exposure, there have not been systematic studies by international organizations within the past 15 years to ascertain the changes in cancer incidence more broadly. With the latency period being approximately 20 years for most of the cancers associated with radiation exposure, only now are the full effects of the Chernobyl accident beginning to manifest themselves.



Recommendations

Further analyses to better understand the overall cancer burden found within Europe as a result of the Chernobyl accident could explore cancers that are only now falling within the relatively long latency period seen between exposure and occurrence for the many categories of radiation-related cancers. Future studies might investigate the possible influences of other factors, such as screening bias, socioeconomic factors, as well as controlling for iodine deficiencies found throughout the most heavily irradiated areas.  Careful analytical studies that follow-up with the most exposed populations on specific outcomes, such as breast cancer incidence, will aid in updating future risk prediction models that will be used to evaluate the true burden of cancer from the Chernobyl disaster.


REFERENCES

  1. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Sources and effects of ionizing radiation- Volume II, Effects. New York: United Nations, 2000.
  2. Cardis, Elisabeth, Daniel Krewski, Mathieu Boniol, Vladimir Drozdovitch, Sarah C. Darby, Ethel S. Gilbert, Suminori Akiba, et al. “Estimates of the Cancer Burden in Europe from Radioactive Fallout from the Chernobyl Accident.” International Journal of Cancer 119, no. 6 (2006): 1224–1235.

    https://doi.org/10.1002/ijc.22037

    .
  3. Cardis E, Kesminiene A, Ivanov V, Malakhova I, Shibata Y, Khrouch V, Drozdovitch V, Maceika E, Zvonova I, Vlassov O, Bouville A, Goulko G, et al. Risk of thyroid cancer after exposure to 131I in childhood. J Natl Cancer Inst 2005;97:724-32.
  4. Davis S, Stepanenko v, Rivkind N, Kopecky KJ, Voilleque P, Shakhtarin V, Parshkov E, Kulikov S, Lushnikov E, Abrosimov A, Troshin V, Romanova G, et al. Risk of thyroid cancer in the Bryansk oblast of the Russian Federation after the Chernobyl power station accident. Radiat Res 2004; 162: 241-8.
  5. Jacob P, Bogdanova TI, Buglova E, Cherpurniy M, Demidchik Y, Gavrilin Y, Kenigsberg J, Meckbatch R, Schotola C, Shinkarev S, Tronko MD, Ulanovsky A, et al. Thyroid cancer risk in areas of Ukraine and Belarus affected by the Chernobyl accident. Radiat Res 2006;165:1-8.
  6. US National Research Council. Health risks from exposure to low levels of ionizing radiation. BEIR, VII Report, phase II. Washington, DC: National Academy of Science, 2005.
  7. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Sources and Effects of Ionizing Radiation. New York: United Nations, 2008.
  8. Pukkala E, Kesminiene A, Polyakov S, Ryzhov A, Drozdovitich V, Kovgan LN, Kyyronen P, Malakhova I, Gulak L, Cardis E. Breast Cancer in Belarus and Ukraine after the Chernobyl accident. Int J Cancer 2006; www3.interscience.wiley.com, doi: 10.1002/ijc.21885
  9. Ron E, Lubin JH, Shore RE, Mabuchi K, Modan B, Pottern LM, Schneider AB, Tucker MA, Boice JD, Jr. Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. Radiat Res 1995;141:259-77
  10. International Agency for Research on Cancer (IARC). CI5plus. 2019 https://gco.iarc.fr/
  11. International Agency for Research on Cancer (IARC). CI5plus. 2019.

    http://ci5.iarc.fr/CI5plus/old/Graph4p.asp?cancer%5B%5D=250&female=2&country%5B%5D=11200000&country%5B%5D=20300000&country%5B%5D=20800000&country%5B%5D=23300000&country%5B%5D=25000000&country%5B%5D=27600000&country%5B%5D=61600700&country%5B%5D=75600000&country%5B%5D=82605000&sYear=1950&eYear=2012&stat=3&age_from=1&age_to=18&orientation=1&window=1&grid=1&line=2&moving=1&scale=0&submit=%C2%A0%C2%A0%C2%A0Execute%C2%A0%C2%A0%C2%A0
  12. International Agency for Research on Cancer (IARC). CI5plus. 2019.

    http://ci5.iarc.fr/CI5plus/old/Graph4p.asp?cancer%5B%5D=250&male=1&country%5B%5D=11200000&country%5B%5D=20300000&country%5B%5D=20800000&country%5B%5D=23300000&country%5B%5D=25000000&country%5B%5D=27600000&country%5B%5D=61600700&country%5B%5D=75600000&country%5B%5D=82605000&sYear=1950&eYear=2012&stat=3&age_from=1&age_to=18&orientation=1&window=1&grid=1&line=2&moving=1&scale=0&submit=%C2%A0%C2%A0%C2%A0Execute%C2%A0%C2%A0%C2%A0
  13. UN Chernobyl Forum Expert Group Health (EGH). Health effects of the Chernobyl accident and special health care programmes. Geneva, Switzerland: World Health Organization, 2006.
  14. Cardis E, Howe G, Ron E, Bebeshko VG, Bogdanova T, Bouville A, Carr Z, Chumak V, Davis S, Demidchik Y, Drozdovitch V, Gentmer N, et al. Cancer consequences of the Chernobyl accident: 20 years after. J Radiol Prot 2006;26:(doi:10.1088/0952-4746/26/2/001).

IDENTIFY A COMMON, SIMPLE EVENT THAT FREQUENTLY OCCURS IN YOUR ORGANIZATION THAT YOU WOULD LIKE TO EVALUATE.

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IDENTIFY A COMMON, SIMPLE EVENT THAT FREQUENTLY OCCURS IN YOUR ORGANIZATION THAT YOU WOULD LIKE TO EVALUATE.

Workflow analysis aims to determine workflow patterns that maximize the effective use of resources and minimize activities that do not add value. There are a variety of tools that can be used to analyze the workflow of processes and clarify potential avenues for eliminating waste. Flowcharts are a basic and commonly used workflow analysis method that can help highlight areas in need of streamlining.

In this Assignment, you select a common event that occurs regularly in your organization and create a flowchart representing the workflow. You analyze the process you have diagrammed and propose changes for improvement.

To prepare:

Identify a common, simple event that frequently occurs in your organization that you would like to evaluate.
Consider how you would design a flowchart to represent the current workflow.
Consider what metrics you would use to determine the effectiveness of the current workflow and identify areas of waste.
To complete:

Write a 3- to 5-page paper which includes the following:

Create a simple flowchart of the activity you selected. (Review the Sample Workflow of Answering a Telephone in an Office document found in this week’s Learning Resources for an example.)
Next, in your paper:
o Explain the process you have diagrammed.

o For each step or decision point in the process, identify the following:

Who does this step? (It can be several people.)
What technology is used?
What policies and rules are involved in determining how, when, why, or where the step is executed?
What information is needed for the execution of this step?
o Describe the metric that is currently used to measure the soundness of the workflow. Is it effective?

o Describe any areas where improvements could occur and propose changes that could bring about these improvements in the workflow.

o Summarize why it is important to be aware of the flow of an activity.

Remember to include a cover page, introduction, and summary for your paper. APA format. Must include at least 3 course reading for references and 2 additional scholarly references

Course Readings

McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge(Laureate Education, Inc., custom ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 16, “Nursing Informatics: Improving Workflow and Meaningful Use”
This chapter reviews the reasons for conducting workflow analysis and design. The author explains specific workflow analysis and redesign techniques.

Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Medical Research Methodology,11(1), 43–61.

Retrieved from the Walden Library databases.

In this article, the authors describe an implementation of workflow engine technology to support clinical decision making. The article describes some of the pitfalls of implementation, along with successful and future elements. Koppel, R., & Kreda, D. A. (2010). Healthcare IT usability and suitability for clinical needs: Challenges of design, workflow, and contractual relations. Studies in Health Technology and Informatics, 157, 7–14.

Retrieved from the Walden Library databases.

This article points to many health information technology designs and workflow decisions that limit their value and usage. The authors also examine the structure of the conceptual relationships between HIT vendors and the clinical facilities that purchase HIT. U.S. Department of Health & Human Services. (n.d.b). Workflow assessment for health IT toolkit. Retrieved, June 18, 2012, fromhttp://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865

This article supplies a toolkit on the planning, design, implementation, and use of health information technology. The sections of the website provide a definition of workflow, examples of workflow tools, related anecdotes, and research. Document: Sample Workflow of Answering a Telephone in an Office (Word document)

Note: You will use this document to complete this week’s Assignment.