Hypertension And Blood Pressure

/in /by

Hypertension is a common and major cause of stroke and other cardiovascular disease. There are many causes of hypertension, including defined hormonal and genetic syndromes, renal disease and multifactorial racial and familial factors. It is one of the leading causes of morbidity and mortality in the world and will increase in worldwide importance as a public health problem by 2020 (Murray and Lopez 1997).

Blood pressure (BP) is defined as the amount of pressure exerted, when heart contract against the resistance on the arterial walls of the blood vessels. In a clinical term high BP is known as hypertension. Hypertension is defined as sustained diastolic BP greater than 90 mmHg or sustained systolic BP greater than 140 mmHg. The maximum arterial pressure during contraction of the left ventricle of the heart is called systolic BP and minimum arterial pressure during relaxation and dilation of the ventricle of the heart when the ventricles fill with blood is known as diastolic BP (Guyton and Hall 2006).

Hypertension is commonly divided into two categories of primary and secondary hypertension. In primary hypertension, often called essential hypertension is characterised by chronic elevation in blood pressure that occurs without the elevation of BP pressure results from some other disorder, such as kidney disease. Essential hypertension is a heterogeneous disorder, with different patients having different causal factors that lead to high BP. Essential hypertension needs to be separated into various syndromes because the causes of high BP in most patients presently classified as having essential hypertension can be recognized (Carretero and Oparil 2000). Approximately 95% of the hypertensive patients have essential hypertension. Although only about 5 to 10% of hypertension cases are thought to result from secondary causes, hypertension is so common that secondary hypertension probably will be encountered frequently by the primary care practitioner (Beevers and MacGregor 1995).

In normal mechanism when the arterial BP raises it stretches baroceptors, (that are located in the carotid sinuses, aortic arch and large artery of neck and thorax) which send a rapid impulse to the vasomotor centre that resulting vasodilatation of arterioles and veins which contribute in reducing BP (Guyton and Hall 2006). Most of the book suggested that there is a debate regarding the pathophysiology of hypertension. A number of predisposing factors which contributes to increase the BP are obesity, insulin resistance, high alcohol intake, high salt intake, aging and perhaps sedentary lifestyle, stress, low potassium intake and low calcium intake. Furthermore, many of these factors are additive, such as obesity and alcohol intake (Sever and Poulter 1989).

The pathophysiology of hypertension is categorised mainly into cardiac output and peripheral vascular resistant, renin- angiotensin system, autonomic nervous system and others factors. Normal BP is determined and maintained the balance between cardiac output and peripheral resistant. Considering the essential hypertension, peripheral resistant will rise in normal cardiac output because the peripheral resistant is depend upon the thickness of wall of the artery and capillaries and contraction of smooth muscles cells which is responsible for increasing intracellular calcium concentration (Kaplan 1998). In renin-angiotensin mechanism endocrine system plays important role in maintain blood pressure; especially the juxtaglomerular cells of the kidney secrete renin in order to response glomerular hypo-perfusion. And also renin is released by the stimulation of the sympathetic nervous system which is later convert to angiotensin I then again it converts to angiotensin II in the lungs by the effect of angiotensin- converting enzyme (ACE). Angiotensin II is a potent vasoconstrictor and also it released aldosterone from the zona glomerulosa of the adrenal gland which is responsible for sodium and water retention. In this way, renin-angiotensin system increases the BP (Beevers et al 2001). Similarly, in autonomic nervous system sympathetic nervous system play a role in pathophysiology of hypertension and key to maintaining the normal BP as it constricts and dilates arteriolar. Autonomic nervous system considers as an important in short term changes in BP in response to stress and physical exercise. This system works together with renin-angiotensin system including circulating sodium volume. Although adrenaline and nor-adrenaline doesn’t play an important role in causes of hypertension, the drugs used for the treatment of hypertension block the sympathetic nervous system which had played proper therapeutic role (Beevers et al 2001). Others pathophysiology includes many vasoactive substance which are responsible for maintaining normal BP. They are enothelin bradikinin, endothelial derived relaxant factor; atrial natriuretic peptide and hypercoagulability of blood are all responsible in some way to maintain the BP (Lip G YH 2003).

The seventh report of the Joint National Committee (JNC-VII) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines some important goals for the evaluation of the patient with elevated BP which are detection and confirmation of hypertension; detection of target organ disease (e.g. renal damage, congestive heart failure); identification of other risk factors for cardiovascular disorders (e.g. diabetes mellitus, hyperlipidemia) and detection of secondary causes of hypertension (Chobanian et al 2003).

Most hypertensive patients remain asymptomatic until complications arise. Potential complications include stroke, myocardial infarction, heart failure, aortic aneurysm and dissection, renal damage and retinopathy (Zamani et al 2007).The drug selection for the pharmacologic treatment of hypertension would depend on the individual degree of elevation of BP and contradictions. Treatment of non-pharmacologic hypertension includes life-style, weight reduction, exercise, sodium, potassium, stop smoking and alcohol, relaxation therapy and dietary improvements, followed by pharmacology therapy.

Commonly used antihypertensive drugs include thiazide diuretics, β-blockers, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, direct vasodilators and α-receptor antagonists which are shown in the following table.

Diuretics have been used for decades to treat hypertension and recommended as first-line therapy by JNC-VII guidelines after antihypertensive and lipid-lowering treatment to prevent heart attack trail (ALLHAT) success. They reduce circulatory volume, cardiac output and mean arterial pressure and are most effective in patients with mild-to- moderate hypertension who have normal renal function. Thiazide diuretics (e.g. hydrochlorothiazide) and potassium sparing diuretics (e.g. spironolactone) promote Na+ and Cl- excretion in the nephrone. Loop diuretics (e.g. furosemide) are generally too potent and their actions too short-lived, however, they are useful in lowering blood pressure in patients with renal insufficiency, who often does not respond to other diuretics. Diuretics may result in adverse metabolic side effects, including elevation of creatinine; glucose, cholesterol, triglyceride levels, hypokalemia, hyperuricemia and decreased sexual function are potential side effects. The best BP lowering response is seen from low doses of Thiazide diuretics (Kaplan 1998).

Β-blocker such as propranolol are believed to lower BP through several mechanisms, including reducing cardiac output through a decrease heart rate and a mild decrease in contractility and decreasing the secretion of renin, which lead to a decrease in total peripheral resistant. Adverse effects of b-blockers include bronchospam, fatigue, impotence, and hyperglycemia and alter lipid metabolism (Zamani et al 2007).

Centrally acting α2-adrenergic agonists such as methyldopa and clonidine reduce sympathetic outflow to the heart, blood vessels and kidneys. Methyldopa is safe to use during pregnancy. Side effect includes dry mouth, sedation, drowsiness is common; and in 20% of patients methyldopa causes a positive antiglobulin test, rarely haemolytic anaemia and clonidine causes rebound hypertension if the drug is suddenly withdrawn (Neal M J 2009). Systemic a1-antagonists such as prazosin, terazosin and doxazosin cause a decrease in total peripheral resistance through relaxation of vascular smooth muscle.

Calcium channel blockers (CCB) reduce the influx of Ca++ responsible for cardiac and smooth muscle contraction, thus reducing cardiac contractility and total peripheral resistant. Thus long-acting members of this group are frequently used to treat hypertension. There are two classes of CCB dihyropyridines and non- dihyropyridines. The main side effect of CCB is ankle oedema, but this can sometimes be offset by combining with β-blockers (Lip G YH 2003).

Direct vasodilators such as Hydralazine and minoxidil lower BP by directly relaxing vascular smooth muscle of precapillary resistance vessels. However, this action can result in a reflex increase heart rate, so that combined β-blocker therapy is frequently necessary (Neal M J 2009).

ACE inhibitors works by blocking the renin-angiotensin system thereby inhibiting the conversion of angiotensin I to angiotensin II. ACE inhibitors may be most useful for treating patients with heart failure, as well as hypertensive patients who have diabetes. Using ACE inhibitors can lead to increased levels of bradikinin, which has the side effect of cough and the rare, but severe, complication of angioedema. Recent study demonstrated that captopril was as effective as traditional thaizides and β-blockers in preventing adverse outcomes in hypertension (Lip G YH 2003).

Angiotensin II antagonists act on the renin-angiotensin system and they block the action of angiotensin II at its peripheral receptors. They are well tolerated and very rarely cause any significant side-effects (Zamani et al 2007).

Another helpful principle of antihypertensive drug therapy concerns the use of multiple drugs. The effects of one drug, acting at one physiologic control point, can be defeated by natural compensatory mechanism (e.g. diuretic decrease oedema occurring secondary to treatment with a CCB). By using two drugs with different mechanisms of action, it is more likely that BP and its complication are controlled and with the low dose range of combined drugs also help to reduce the side-effects as well (Frank 2008) . The following two-drug combinations have been found to be effective and well tolerated which are diuretic and β-blocker; diuretic and ACE inhibitor or angiotensin receptor antagonist; CCB (dihydropyridine) and β-blocker; CCB and ACE inhibitor or angiotensin receptor antagonist; CCB and b-diuretic; α-blocker and β-blocker and other combinations (e.g. with central agents, including α2-adrenoreceptor agonists and imidazoline- I2 receptor modulators, or between ACE inhibitors and angiotensin receptor antagonists) can be used (ESH and ESC 2003). If necessary, three or four drugs may be required in many cases for the treatment. The use of a single drug will lower the BP satisfactorily in up to 80% of patients with hypertension but combining two types of drugs will lower BP about 90%. If the diastolic pressure is above 130 mmHg then the hypertensive emergency is occurred. Although it is desirable to reduce the diastolic pressure below 120 mmHg within 24 hours in accelerated hypertension, it is usually unnecessary to reduce it more rapidly and indeed it may be dangerous to do so. This is because the mechanisms that maintain cerebral blood flow at a constant level independent of peripheral BP are impaired in hypertension. However, it is important to reduce the BP quickly by giving the intravenous drugs but caution should be taken to avoid cerebrovascular pressure inducing cerebral ischemia (Grahame-Smith and Aronson 2002).

In conclusion, hypertension emerges as an extremely important clinical problem because of its prevalence and potentially devastating consequences. The major classes of antihypertensive drugs: diuretics, β-blockers, CCB, ACE inhibitors and angiotensin receptor antagonists, are suitable for the initiation and maintenance of antihypertensive therapy which helps in reduction of cardiovascular morbidity and mortality.

Self Reflection on Communication in Nursing

/in /by


AMITA KHOWAJA


Introduction

Reflection is an organized and a planned way to think positively and make better decisions. Reflection allow person to learn from their mistakes and past experiences. This is more applicable to form the fundamentals of healing and therapeutic process in health care field. According to Parker (2006) Reflection in health care profession will enhances effective care and therapeutic process. In line with this thought I shall reflect on the change noticed in my communication style after analyzing the situation occurred few days back.

After the incident happened which I have discussed in my self-awareness piece of writing there are number of lessons I learned from the experience which includes inappropriate communication style. Initially I was following the passive style then turned into aggressive style which I feel worsen the problem rather than solving it. I identify that my poor communication style had created stress and bad feelings within relationship with my roommate so, I decided to follow the assertive communication style to solve the conflict going on between me and my roommate.

Assertive communication is a skill to express positive and negative thoughts and feelings in an open, calm and straight forward way. It recognizes our rights at the same time respecting the rights of others. It is a sense of taking responsibility for ourselves and our actions without judging or accusing other people.

I choose this style because I want to express to my roommate what I want, what I was thinking, my wishes, desires and feeling to make her understand that we both matter. Moreover, I want to learn to say no to request from others without having guilt feelings. In this way, mutually satisfying solutions will be drawn to avoid any future conflict and good relationship will be maintained between me and my roommate.

Before starting the conversation with my roommate, I had made my mind to be clear with some of the aspects of assertive communication such as when practicing assertive communication my body language should convey the message of openness and receptiveness. I must maintain upright, relaxed posture with clear voice tone and maintain good eye contact with her. I must show willingness to hear her point of view and accept feedback from her rather than denying and counter attacking her.

By keeping in mind all the skills, I went to her and start my conversation


“I am really worried about the conflict which had occurred between you and me. So, I want to ask you when is a good time for us to talk about things that has been bothering me.”


Response

: “we can discuss it right now.”


“I feel frustrated and overwhelmed when you are not sharing with me the household responsibilities so, I want to discuss about the following points with you like sharing the responsibilities of monthly payments of internet, house rent, hydro, house cleanliness, cooking food and doing grocery etc. From the following tasks, I would appreciate if you could take the responsibility of doing monthly payments”



(using I statements).


Response:

“Before shifting over here I was living with my parents so they are taking care of all the house hold responsibilities of monthly payments and my mother cooking food for me”

“

Let me see if I understand you are saying that sometime if I ask you to make monthly house payments or ask you to cook food is not the suitable job for you?”



(Paraphrasing and active listening)


Response: “

yes, I am not aware about the proper procedure of making the payments as well as I do not have expertise in cooking”.


“


The steak which you had prepared was good in taste but it need little bit more cooking from inside so that the blood will not ooze.”



(Encouraging)



.


Response: “

I spent all afternoon preparing that meal and that’s the last time I cook for you.”


The best solution to this is that as I have more experience in cooking so I will look after the cooking. For monthly payments, could you please

tell

me more about how enough information you have about the payment process so that I will help you out for further steps?”



(Open ended question, encouraging).

Few more examples that depict my assertive communication are:


“I hate it when you do not listen to me when I was discussing with you about the grocery items that need to purchase”.


Response: “

You want to say that I was pretending to be alert while thinking about somewhat else. You are just saying based upon your pre-assumptions about me.”


“I think I hear and understand what you are saying



,




(encouraging)



but I am in disagreement

.

I feel frustrated and annoyed when I have to get back with you about the conversation which we had already did related to grocery items. Moreover, I would appreciate it if I don’t have to remind you over and over to wash your left-over dishes and empty trash from your room”.


Response:

“I will be careful about my dishes next time. When I hear rude words about me I feel very upset and they hurt my feelings”.

“

I need to be careful about using alienating messages”.



(Accepting criticism)

When I reflect upon the above conversation I can say that I had use effective interpersonal communication skills for example:


Right time and right place

: I choosing the private place (our house) with proper time (when she is available) to do open dialogue for discussing the important issues and to respond with clarity.


Organize ideas in mind:

when communicating with her I have some key points in mind to stick like about different house hold responsibilities to make my conversation clear, focus and directive. By using the ‘I’ statement for expressing my feelings I was making my roommate aware of the problematic situation without making any accusations. My purpose was to become crystal clear in informing her about the problems and for initiating actions.


Clear body language:

I was using soft, gentle and aware facial expressions during the conversation and try to avoid negative facial expressions, such as frowns or raised eyebrows.


Be attentive when listening:

By actively listening to her I could reflect on the content of the conversation, her feelings as well as trying to understand the nature of problem from her perspective. This can help me to recognize and correct mistaken views. I gave her opportunity to talk about her feelings without interruption and when she has finished talking I reflect back upon what I have heard.


Paraphrasing:

Once I had absorbed what she has said, I use clarification skills of paraphrasing to make sure that I had understood accurately and let her know that I have heard her point and understand her side. Furthermore, by asking open ended questions I was allowing her to share her knowledge.


Accepting criticism

: Accepting criticism always provide a room to improve, feel better about self and help to be the better person. I accept criticism with empathy and owning my personal contribution in a conflict to set good example and to shows the maturity.

I was able to practice interpersonal communication skills with my roommate and it make a huge difference in establishing healthy relationship with my roommate. It enables me to swap my old behavior patterns towards a more positive approach of life. It helps in diffusing the situation and draw a mutual agreement between both the parties (me and my roommate) hence, better decision making and problem-solving would be done. Furthermore, my stress will be managed better as I have learned to set boundaries earlier.

By adopting an assertive communication style my communication become greatly enhances with others and produce positive outcomes. My interpersonal relationships become strong. I am now able to reduce my feeling of anxiety, stress and helplessness and gain a better sense of control. In addition, I learn to treat people more respectfully to retrain self-respect thus my self-esteem will be enhanced.

Being a health care assistant assertive communication style help me in building effective team relationships with other health professionals. I will be more likely to provide patient with appropriate care hence, improving their quality of care. In addition, my appropriately delivering assertive stand to a possibly harmful situation will help in preventing medical errors and empower me become a better patient advocate. The use of assertive behavior constitute feeling of respect for both parties (me and my patient) and thus my confidence and self-esteem will be enhanced. Proper team communication will increase my moral as a worker and prevent me from high levels of stress, burnout and poor job satisfaction, overall my quality of life will be improved.

Effective interpersonal communication is necessary to negotiate the challenges of everyday living, whether in your personal or professional life. Because human beings are complex and each individual brings his or her own set of internal variables to every situation, the possibilities of interactional outcomes of any given communication can be exponential.

Although much has been written regarding workplace violence (e.g., bullying), practical strategies for addressing the mechanics of effective interpersonal communication are lacking. In order to address this, we need frank, open conversations regarding how our personal internal variables affect our interpretation of the world as we see it. This article has hopefully provided an opening dialogue in that direction with pragmatic discussion of common areas of concern. These recommendations are often ones that we, as nurses, offer to patients every day. Taking the time to consider them as they may apply in our professional and personal lives may go a long way to encourage healthy communication, and thus healthy nurses!

Communication problems often arise because we don’t say how we feel, what we think or what we want. People often avoid communicating because they are embarrassed or concerned about upsetting the other person. Sometimes we just assume that others should know what we think. The problem is that when you don’t say what you need to say, it increases the likelihood of feeling angry, resentful and frustrated. This leads to tension in relationships and, sometimes, to angry outbursts.


https://crana.org.au/uploads/pdfs/Other_48.pdf


https://justice.alberta.ca/programs_services/mediation/drn/Documents/AssertiveCommunicationPresentation.pdf


http://firstlanexperts.blogspot.ca/2013/10/interpersonal-communication-in.html

  • Improve interpersonal relationships
  • Reduce conflicts/anxiety
  • Enhance self esteem
  • Retrain self respect
  • Minimize stress
  • Treats others respectfully
  • Reduce feelings of helplessness/depression
  • Gives a sense of control



REFERENCES

  • Leonard, M., Graham, S.,Bonacum D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care, 13, 85-90
  • Parker, M. (2006). Aesthetic ways in day-to-day nursing. London: Sage Publications.
  • Wilk, J. M., Newmaster, R., Sorrentino, A.S., & Remmert, L. (2012). Mosby’s Canadian Textbook for the Support Worker (3

    rd

    ed.). Canada.

The 1999 landmark study titled “To Err Is Human: Building a Safer Health System” highlighted the unacceptably high incidence of U.S. medical errors and put forth recommendations to improve patient safety. Since its publication, the recommendations in “To Err Is Human’” have guided significant changes in nursing practice in the United States.

/in /by

The 1999 landmark study titled “To Err Is Human: Building a Safer Health System” highlighted the unacceptably high incidence of U.S. medical errors and put forth recommendations to improve patient safety. Since its publication, the recommendations in “To Err Is Human’” have guided significant changes in nursing practice in the United States.

 

 

The Effects of “To Err Is Human” in Nursing Practice

The 1999 landmark study titled “To Err Is Human: Building a Safer Health System” highlighted the unacceptably high incidence of U.S. medical errors and put forth recommendations to improve patient safety. Since its publication, the recommendations in “To Err Is Human’” have guided significant changes in nursing practice in the United States.

In this Discussion, you will review these recommendations and consider the role of health information technology in helping address concerns presented in the report.

To prepare:

•Review the summary of “To Err Is Human” presented in the Plawecki and Amrhein article found in this week’s Learning Resources.

•Consider the following statement:

”The most significant barrier to improving patient safety identified in “To Err Is Human”is a “lack of awareness of the extent to which errors occur daily in all health care settings and organizations (Wakefield, 2008).”

•Review “The Quality Chasm Series: Implications for Nursing” focusing on Table 3: “Simple Rules for the 21st Century Health Care System.” Consider your current organization or one with which you are familiar. Reflect on one of the rules where the “current rule” is still in operation in the organization and consider another instance in which the organization has effectively transitioned to the new rule.

Post on or before Day 3 your thoughts on how the development of information technology has helped address the concerns about patient safety raised in the “To Err Is Human” report. Summarize how informatics has assisted in improving health care safety in your organization and areas where growth is still needed.

Reference:

Wakefield, M. K. (2008). The Quality Chasm series: Implications for nursing. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (Vol. 1, pp. 47–66). Rockville, MD: U. S. Department of Health and Human Services. Retrieved from https://www.ahrq.gov/qual/nurseshdbk/docs/WakefieldM_QCSIN.pdf

Week 1 Learning Resources

Increase text size

Decrease text size

Print Page

This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.

Required Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Readings

•American Nurses Association. (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: Author.

•“Introduction”

This portion of the text introduces nursing informatics and outlines the functions of the scope and standards.

•McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (Laureate Education, Inc., custom ed.). Burlington, MA: Jones & Bartlett Learning. ◦Chapter 1, “Nursing Science and the Foundation of Knowledge”

This chapter defines nursing science and details its relation to nursing roles and nursing informatics. The chapter also serves as an introduction to the foundation of knowledge model used throughout the text.

◦Chapter 2, “Introduction to Information, Information Science, and Information Systems “

In this chapter, the authors highlight the importance of information systems. The authors specify the qualities that enable information systems to meet the needs of the health care industry.

◦Wakefield, M. K. (2008). The Quality Chasm series: Implications for nursing. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (Vol. 1, pp. 47–66). Rockville, MD: U. S. Department of Health and Human Services. ◾Pages 1–12

These 12 pages highlight the issues raised by the Quality Chasm Series and examine their long-term implications for nursing. The text reviews external drivers of safety and quality, design principles for safe systems, and guidelines for health care redesign.

•Cipriano, P. F., & Murphy, J. (2011). Nursing informatics. The future of nursing and health IT: The quality elixir. Nursing Economic$, 29(5), 282, 286–289.

Retrieved from the Walden Library databases.

In this article, the authors focus on how nurses can use health information technology to help transform health care using the recommendations included in the 2010 Institute of Medicine report “The Future of Nursing, Leading Change, Advancing Health.” The author also discusses the 2011 National Strategy for Quality Improvement in Health Care.

•Plawecki, L. H., & Amrhein, D. W. (2009). Clearing the err. Journal of Gerontological Nursing, 35(11), 26–29.

Retrieved from the Walden Library databases.

This article presents a summary of the Institute of Medicine report “To Err Is Human: Building a Safer Health System.” The authors provide an overview of what has been accomplished in the decade following the IOM report, focusing in particular on health information technology.

Media

•Laureate Education, Inc. (Executive Producer). (2012e). Introduction to nursing informatics. Baltimore, MD: Author.

Note: The approximate length of this media piece is 8 minutes.

In this video, Doris Fischer, Richard Rodriguez, Carina Perez, and Carmen Ferrell introduce the concept of nursing informatics. These individuals provide insight into how informatics is transforming the health care system by improving efficiency and quality of care.

Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript

Optional Resources

•Hilts, M. E. (2010). Up from the basement. Health Management Technology, 31(9), 14–15.

Retrieved from the Walden Library databases.

•Institute of Medicine. (1999). To err is human: Building a safer health system. Retrieved from https://iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

•Kohn, L. T., Corrigan, J. M., & Donaldson, M.S. (Eds.). (2000). To err is human: Building a safer health system. Washington, D. C.: Institute of Medicine. Retrieved from the National Academies Press website: https://download.nap.edu/catalog.php?record_id=9728

Community Health Assessment of a Virtual City

/in /by

This is a community health assessment of a virtual city called Sentinel City.  As the location of this city is unknown a direct comparison to other cities is impossible to perform.  The city was subdivided into four districts that vary in population, income, and quality of living.  There are countless community health concerns found throughout the city ranging from social in addition financial to environmental.  There is a multitude of service available throughout the city but have not been utilized to their full potential.


B.




Identification of Community: Assessment of Needs and Risks


  • Demographics / Population Economic Status

The total population of Sentinel city in 2017 was 663,862 with 80.6% whites, 10.4% Black, 2% Native American, 3.7% Asian, 0.2% Hawaiian/Pacific Islander, 3.1% two or more races.  Whichc is further broken down into 31.5% Hispanic or Latino and 52.7% non-Hispanic white.

The median household income was $49,091, with


18.9% of the populous living below poverty level

. The age breakdown is 7.4% under 5 years of age, 21.7% under age 18, 60.4% are over 18 and under 65 years old, 10.5% over age 65.  (Sentinel City:  Sentinel City, n.d.)

The Nightingale Square district has a population of 103, 974 which, primarily has a White population of (81.3%) followed by Hispanic (3.7%).  The average household income was $269,550. The Acer Tech Center had a population of 168,390 majority of the population is white at  (70.2%) and Latino (13.7%).  The average household income was $166,300.  The Casper Park District had the biggest population within the city at 352,643, which was largely white (63%) followed by Hispanic (24%).  The median household income was $80,134.  The Industrial Heights district had a population of 38,855.  The governing culture was Hispanic (46%) and the secondary was Black (13.1%).  The average household income was the lowest in the city at $24,672.

(Sentinel City:  Sentinel City, n.d.)


  • Neighborhood/Community Safety Inventory

Nightingale Square appeared well kept and clean with only a few exceptions.  There was garbage noted outside of Joe’s Grocery store with by a stray cat. The door to the Nightingale Square apartments was full of graffiti. At the edge of the district towards Acer Tech Center there was trash on the roadside.

Acer Tech Center was in the process of being refurbished but had some debris by the buildings.  A train could be heard running on a track overhead.  There were several policenoted through-out the streets of this area.

Caster Park District had an overgrown abandoned lot.  The lot may have been a homeless camp site as there were burning barrels, and piles of crates and debris.  A stray dog was wandering in the lot.  There was trash accumulated in the corners of buildings.  Containers were noted with flammable symbols at the construction site close to what appeared to be a sewage leak.

Industrial Heights had a fenced area with rusting barrels marked as hazardous material.  A factory smokestack could be seen with smoke comeing from it .  Debris was observed floating in the air.

Of the population 26% consme alcohol, 24% tobacco, 13% Marijuana, 8% Heroin, 6% cocaine, 6% CNS depressants, 3% club drugs and 1% methamphetamines.  Furthermore, to these 12% of all prescriptions filled within Sentinel City in the last year was for hydrocodone.

(Sentinel City:  Sentinel City, n.d.)

Of the crimes committed within Sentinel City 23% of arrests were for cannabis, 17% battery, 16% controlled substance, 9% criminal trespassing, 6% reckless conduct, and 6% public intoxication.  The response times of EMS are 7.46 minutes on average.

(Sentinel City:  Sentinel City, n.d.)

Observable gang violence within the Industrial Heights area was noteable.  A car was set on fire and a store front with smashed windows was barricaded off with crime scene tape.  Consitent with the data set within the last year there had been approximately 19 homicides, 35 simple assaults, 40 robberies and 95 aggravated assaults.

(Sentinel City:  Sentinel City, n.d.)


  • Windshield Survey

The Nightingale Square area was clean and well maintained.  The buildings are well constructed of brick and concrete.  There were trees along the streets with several open green spaces noted.   Several restauranst availale.  There was a gym, pharmacy, dental office, health system, tattoo parlor, convenience stores as well as a large gas station.  There was a large condominium.  Joe’s Grocery store was a large market that appeared to have plentiful supply of goods.  Billboards advertise recycling.  There was a large recreational center with people playing on courts.  People were excercising throughout the streets.  Groups of people were gathering across from Joe’s watching street performers. There were cars parked on the road side and bus stops noted.

Acer Tech Center was fairly clean with some debris seen on roadsides.  The buildings are conctructed of brick and concrete. People were observed using  bikes for transportation and walking.  A police officers were seen walking the streets.  There were several restaurants, a coffee shop, a barber’s shop, City Center Historical Hotel and a large farmer’s market providing fresh fruits and vegetables to the residents.  Dogs were observed both on and off leash.  A group of protestors were noted outside of City Hall.  A train could be heard on an overhead track.  People were using cars, bikes and walking. Green grass and shrubs were noted around the City Hall.  Trees could be seen along the streets.

Casper Park District was more rundown.  The buildings were older and made of brick.  Trash was seen in the corners of the buildings.  Trees were seen lining some streets.  There were signs for a business redevelopment project coming soon.  A coffee shop, a doughnut shop, bookstore, several small grocery stores and multiple check cashing stores were noted along with a sushi shop.  There was a small produce stand.  This section of the city included the Casper Senior Living Center and the ABC Daycare.  There was a large overgrown lot with graffiti, piled up crates, a stray dog and burning barrels. The lot had the feel of a homeless encampment.  Several strays roamed the area including dogs, cats and a feral rabbit.  Billboards advertise for flu vaccines, fighting addiction and not to text and drive. There appeared to be a sewage leak and behind it large containers with a flammable product within them. A motorcycle was noted among the pedestrians. Numerous construction workers were noted in this area.

The brick buildings of the Industrial Heights district appear run down.  There was a factory smokestack billowing smoke, a fenced area with hazardous material in rusting barrels, burning trash cans and debris falling like snow.  There was a large amount of graffiti.  A building with smashed windows was blockaded behind a fence and had crime scene tape on the door.  There was a busy soup kitchen behind the church.  A school with a nice playground was filled with children.  Trees were seen lining the street.  A burning car was possibly the result on gang violence.  There was check cashing stores and one convenience store.  There was an obvious lack of retail services in this area and no fresh food seen.  Billboards advertised to stop smoking and against teen pregnancy.  There were multiple concrete barricades at the boarders of this area.


  • Population Health Scavenger Hunt

Parks and Recreation:  Offers Swimming lessons, Nutritional Courses, Gardening Courses, Kids summer programs, City sports leagues, Adult Fitness Courses and After School Programs.  The budge for Parks and facilities has dropped significantly from year one but has increased in programs.  The most common complaint was park location (40%) followed by crime (15%), drugs (15%) and stray animals (15%), then homeless population (10%) and lastly cleanliness (5%).  The most common citations were for Trespassing after hours (31%), violent crimes (24%), Intoxication and drug use (16%), littering (11%), prostitution (9%).

(Sentinel City:  Sentinel City, n.d.)

Healthcare System-Elderly Services:  Seniors used the following services in the last year Transportation (6.5%), service animals (2.5%), Meals on Wheels (1.3%), 0.95 elder abuse prevention advocates (0.95%), community centers (2.9%), government entitlement assistance (7.6%), medical care advocates (8.3%).  Living options for seniors consist of Independent Senior Apartment units 1048, Senior Living Center Units 3472, Nursing Home Units 2874, Assisted Living Units 248, Skilled Nursing Care Beds 64, Long term care 36, Swing-Beds 24.

(Sentinel City:  Sentinel City, n.d.)

The incidents of services utilized were as follows. City Hall-Social Services: Adult and Child Protective Services provided Adoption assistance (425), Head start & early head start (110), Youth Independent Living services (90), Safe at home program (25), Child care provider accepting subsidized benefits (25).  Healthcare Assistance provided Medicare over 100,000, ACA under 40,000, Medicaid under 20,000 and a small percentage of charitable healthcare.  The Special Supplemental Nutrition Program for Women, Infants and Children (WIC): 70 infant/children, 11 Breastfeeding, 10 pregnant, 9 postpartum.  Supplemental Nutrition Assistance Program (SNAP): Recipients last year 24,359 Low income persons, 17,359 Disabled persons, 15,320 Persons in training programs, 9,953 Elderly, 60+ years.

(Sentinel City:  Sentinel City, n.d.)

Community Health Center:  Services provided include Contraceptive services, Pregnancy testing and counseling, Achieving pregnancy, basic infertility services, sexually transmitted disease services, Breast cancer screening, cervical cancer screening, other preventative health services.  The rate of teen pregnancy had dropped from well over 800 in year 3 to just over 400 last year.  There is no statistical data indicating the number of new cases of STDs diagnosed in the last year.  The data set indicated the percentage of new cases of STDs between the individuals age 15 to 25 and over 25.  The overall new cases seem to be largely in the over 25 population especially Hepatitis B and HIV.  The most prevalent STDs in ages 15-25 was Gonorrhea and Chlamydia.

(Sentinel City:  Sentinel City, n.d.)

Soup Kitchen: The Soup kitchen served between 40,000 to 50,000 meals per month.  The recipients included Homeless Adults (64%), Disabled Adults (7%), Elderly (6%), Healthy Adults (6%), Homeless children (3%), healthy children (2%).

(Sentinel City:  Sentinel City, n.d.)

Affordable Housing Project:  The average renters’ income by unit had dropped each of the last five years.  Last year average renter’s income occupying the 2 bedroom units was just over $30,000, 1 bedroom unit was under $30,000 and studio unit was under $20,000.  The majority of the occupied units are 2 bedrooms with only a small number of vacancies.   The studios were about three-fourths occupied, while only about half of the 1 bedroom units were full.  Crime in the city had gone down in recent years dropping from 3900 incidents three years ago to 2100 incidents, but remains higher in this area.  Of the 2100 reported crimes city-wide 420 were in the area of the low-income apartments and 14 were on property.  The most common tenant complaints were factory smoke (21%) followed by dogs barking (18%), Noise (17%), loitering (13%), high rent (10%) and police activity (6%).

(Sentinel City:  Sentinel City, n.d.)


B1.




Analysis of Collected Data

As 18.9% of the populous living below poverty level, there was a myriad of problems stemming from this.  A significant portion of the population in the Industrial Heights and Casper Park District were health uninsured, at 37.5% and 22.7% respectively.  Of students in higher education 67% have no student health services, 24% have limited student health services and only 9% have comprehensive student health services.  Although there were no data sets indicating obesity levels, health problems that obesity can contribute to are prevalent within Sentinel city.  Heart disease may be a problem as Sentinel City EMS had to treat ventricular fibrillation at a significantly higher rate to the comparison cities at over 140. The pharmacy also prescribed a significant percent of lisinopril, amlodipine, hydrochlorothiazide to treat high blood pressure.  There are 6 cardiology practice within the city. The second most common medication filled at the pharmacies is simvastatin, which indicates that high cholesterol is prevalent in the population.  Insulin and metformin were also in the top eleven prescribed medications, showing a prevalence of diabetes in the cities inhabitants.

(Sentinel City:  Sentinel City, n.d.)

In addition to the residents living near or below the poverty line there is an unknown number of homeless individuals living within Sentinel City.  The soup kitchen statistics indicated that 70% of the meals were administered to the homeless.  Thirty-five percent of the complaints about the city parks were in regards to the homeless population which had increased from only ten percent five years ago.

(Sentinel City:  Sentinel City, n.d.)

According to the data set, 27% of children receive free or reduced lunches. The source of calories consumed by children age two through nineteen was 7% from school, 14% from fast food, 5% from restaurants, 67% from home and 7% other.  Adults consume 68% at home, 13% fast food, 10% restaurants and 9% other.

There has been an increase in childhood vaccinations, 50% of all students having received vaccinations up from approximately 20% five years ago.

(Sentinel City:  Sentinel City, n.d.)

Although this was significant progress it falls well below the national average and the goal of 90% by Healthy People 2020.

(“Healthy People: Immunization and Infectious Diseases,” 2017)

On the windshield survey pollution was observed but air and water quality reports on Sentinel City were unavailable.  The most common complaint for residents of the low-income housing was factory smoke.  The most common medical issue among collage age students was respiratory complaints which may be result from the poor air quality.

Food safety was a problem in the city both in the grocery store and restaurants.  An alarming 90 cases of food-borne illness was reported from seafood and almost 60 from poultry at Joe’s Grocery in the last year. Restaurant food safety violations included cleaning and washing (6), food storage (5), heating/cooling food (3), and bugs/rodents (2).  Each of these violations were up one incident from the prior year.

(Sentinel City:  Sentinel City, n.d.)

There is a lack of pet responsibility.  Approximately 60% of owned pets are unregistered.   A mere ten percent of the animals entering shelters have been spayed or neutered.  Of the animals entering the shelter, 32% of the animals were reunited with their owners and 26% were adopted out.  The result was 2,040 animals being euthanized last year.

(Sentinel City:  Sentinel City, n.d.)

According to the ASPCA, of the 542,000 dogs and 100,000 cats that are brought in each year only about 26% of dogs and 5% of cats are returned to their owners. Which indicates a higher than average pet return rate inspite of the lack of pet registration.  (Shelter Intake and Surrender, n.d.)


C1. Community Diagnosis by:




Identification of Top Three Problems in Sentinel City Comparing the Top 3 Problems in Relation to Problems to Healthy People 2020

Sentinel City is faced with multiple challenges but a large cluster of problems fall under the Healthy People 2020 topics and objectives category of nutrition and weight status.  This topic covers both obesity and malnutrition as well as heart disease, hypertension, dyslipidemia and other weight effected medical problems.  This overlaps with the second objective topic of Heart disease and stroke. In addition to this problem Environmental Health concerning air and water quality was a significant problem in this city.

(“2020 Topics and Objectives,” n.d.)


C2.




Selected #1 Health Problem and Availability of Community Resources

Nutrition and weight status is the number one concern with in Sentinel City.  As 18.9% of cities inhabitance living below there is high likely hood of food insecurity. “Food Security is defined as the assured access at all times to enough food for an active, healthy life, as well as enough food that is safe, nutritious, and acquired in socially acceptable ways.”

(Edelstein, 2011, p. 71)

If this problem was properly addressed a number related problems could be controlled.  Poor nutrition is linked to obesity, hypertension, high cholesterol, heart disease, diabetes, stroke, gout and cancer.

(Ajmera, 2015)

It is assumed that this is a problem in the city as evidence by the large number of blood pressure medication prescribed as well as medications for high cholesterol and diabetes. In addition, the high incidence of ventricular fibrillation treated by EMS, indicate a higher than average occurrence of heart disease.  The Casper Park District had a lack of access to fresh foods as well as a low-income level.  The city has a large famers’ market in the Industrial Heights area, if a Farmers’ Market Nutrition Program (FMNP) could be established with in the Casper Park District it would allow access to healthy, local, fresh foods to a large at-risk population.  The City Hall Social Service could apply to the state for a grant for the FMNP to provided coupons to WIC participants and seniors.  The coupons allow the participant to buy foods from famers and farmers’ markets that have been authorized by the state.

(“Farmers’ Market Nutrition Program (FMNP),” n.d.)

The Project for Public Spaces (PPS) suggests that the interactions at a farmers’ market is a social experience that enhances a sense of community among the participants.

(“PPS,” n.d.)

The Parks and Recreation department already provides nutritional and fitness courses.  These programs need to be targeted to the at-risk population and marketed aggressively.  The nutritional programs should encourage the my plate method as an easy guideline for choosing the appropriate proportions of each food type.

(“Choose My Plate,” n.d.)

Further education on the DASH Diet would benefit those with or at risk of obesity, hypertension and diabetes.  The DASH Diet teaches healthy eating of foods in their natural and unprocessed forms.  It has been proven to lower blood pressure and help participants lose weight.

(“Dash for Health,” n.d.)

A weight loss as small as 5% will decrease obesity related risk factors such as heart disease.

(Sample, 2016)


C3.




Identification of Primary Prevention Topic

The primary prevention concern identified was Obesity/Nutrition.   In the top eleven medications prescribed with in the last year, eight of them can be related to obesity and nutrition.  Simvastatin for high cholesterol (>10%), Lisinopril for hypertension (10%), Levothyroxine for hypothyroid may be exacerbated by obesity (>8%), Amlodipine for hypertension (just under 8%) Omeprazole for acid reflux is also exacerbated by obesity (just under 8%), Metformin for diabetes

(approximately 5%),

hydrochlorothiazide for hypertension (approximately 5%), and insulin for diabetes 4%). The EMS responded to over 140 ventricular fibrillations within the last year.  The closest comparison city was less than 120.  The city supports the need for 6 cardiology practices and performs approximately 25,000 cardiac surgical procedures annually.  The average hours a day high school students participated in sport, exercise and recreation was an alarming 0%.

(Sentinel City:  Sentinel City, n.d.)

The inhabitant of this city need to establish a healthier life style.  There needs to be an increase in physical activity and an improvement in dietary habits.  They need add fresh fruits, fresh vegetables and minimally processed foods to their diet.  Fast foods and prepackaged foods that are high in sodium, fats and carbohydrates need to severally limited or avoided all together if possible.  The schools and aftercare facilities should ensure that the children are provided with a healthy balanced diet.  This will help to establish healthy lifestyle, give them energy to learn, play and grow.  The Soup Kitchen and other community resources that provide nutrition must also facilitate healthy eating practices.  Unfortunately, processed and prepackaged foods tend to be cheaper and quicker to prepare that fresh foods, but they offer less nutrient and are laden with unhealthy preservatives.  Classes within the school and the community should emphasize exercise and healthy nutritional choices.  If these changes can be made the overall health of the community will improve.


D.




Application of Learning from Simulation to Future Community Assessment Strategies

The Sentinel City simulation has allowed me to practice the skills I will need to perform a community health assessment in my own community.  It provided a safe environment to test out each step and easily return to follow up and areas I needed more information on.  This will ensure I have a better understanding of the information I will be looking for when I ride out in my own community and efficiently collect that data I require.


References

Discuss the impact of the Patient Protection and Affordable Care Act of 2010 on access to quality care and disparities in underserved populations in the US.

/in /by

Discuss the impact of the Patient Protection and Affordable Care Act of 2010 on access to quality care and disparities in underserved populations in the US.

Healthcare has always been in a constant state of flux, accelerating in the last two decades due to increasing costs, limited access to care and demands for quality. The paper is a scholarly discussion of forces that drive healthcare today, how health policies shape our healthcare system and the global healthcare environment, and your personal and professional experiences within the healthcare system.

The content of the paper should:
Provide an overview of the history of healthcare insurance in the US (refer to Chapter 3 in your textbook), using citations to support your discussion. The name of the book is: ( Shi, L. & Singh, D. (2017). Essentials of the U. S. healthcare system (4th ed.). Sudbury, MA: Jones
and Bartlett, ISBN# 978-1-284-10055-6)
Review and discuss current healthcare policy finances and insurance reimbursement in regard to Medicare, Medicaid, private insurance and exchanges.
Compare the U.S. healthcare system to at least one other country regarding costs, financing and/or outcomes. Use citations to support your discussion.
Discuss the impact of the Patient Protection and Affordable Care Act of 2010 (PPACA) on access to quality care and disparities in underserved populations in the US. Use citations to support your discussion.
Discuss the impact of the PPACA on current healthcare policies. Present one to two specific examples to explain the relationship of current healthcare policies to your personal and professional experiences. For this section, you may use “I” in your description of your experiences. Citations are not required for this section.

sepsis treatment/ nursing intervention.

/in /by

sepsis treatment/ nursing intervention.

This is nursing intervention of sepsis management it has to be written in table.
System Nursing intervention Rationales

Nursing intervention in sepsis management

Additive Manufacturing; Stereolithography in Dentistry

/in /by


Introduction:

Digital revolution because of computers has made the previously manual tasks much easier, faster and more reliable at a reduced cost. Such modifications are always welcomed in dentistry, especially from materials and manufacturing perspective. The digital revolution in the form of dental CAD–CAM took place many years ago, since than many modified systems have appeared on the market with great rapidity.

It is expected that another digital dental revolution will take over dentistry in the form of layered fabrication techniques, once they are able to produce high quality dental prostheses. This situation has also posed great challenge for the material scientists in the form of materials that are suitable for long term use in dentistry and oral environment. This can potentially take dental materials research in a totally different direction.


Additive manufacturing

:

Dentistry is the most suited field for additive manufacturing, as it is associated with rapid production of customized units made to fit the patient with high degree of precision and accuracy.

In principle

it creates a series of cross-sectional slices from a 3D computer file which are then printed one on top of the other to create the 3D object without any material being wasted.

Additive manufacturing technologies

includes many and Stereolithography (SLA) is one of them.


Stereolithography (SLA)

Stereolithography (SLA) is the most widely used rapid prototyping technology. The term “Stereolithography

”

was first introduced in 1986 by Charles W. Hull, who defined it as a method for making solid objects by successively printing thin layers of an ultraviolet curable material, one on top of the other.


Materials and Required time:

A number of materials that the industry uses have increased greatly and modern machines can utilize a broad array of photo curable polymers. Timing depends on the size and number of objects being created, the laser might take a minute or two for each layer (a typical run 6 to 12 h). One can now even print 50 to 80 dental crown units in 56 minutes with high quality mode.


Applications in dentistry:

Dental applications are very suitable for processing by means of SLA due to their complex geometries, low volume and strong individualization. Most common are models fabricated from intraoral or impression scans. However, popularity is gaining for orthodontics and removable prosthodontics.


1. Production of anatomical models

: SLA models are preferred because of higher strength, higher temperature resistance, lower moisture absorption, and lower shrinkage. They can be sterilized for surgical use, and literature has shown superior accuracy (Barker

et


al.,

1994, Choi

et al.,

2002, Cunningham

et al.,

2005). Table-1 summarizes basic characteristics of the three most common types of 3-D models used in the United States. SLA clinical models are used as an aid to diagnosis, preoperative planning and implant design and manufacturing. Surgeons use models to help plan surgeries but prosthetists and technologists also use models as an aid to the design and manufacturing of custom-fitting implants. These models are particularly very useful for restorative rehabilitation of oral cancer patients. Medical models are frequently used to help in the construction of Cranioplasty plates. The models are effective tools to facilitate patient education and as a teaching aid for students and junior colleagues.


2. Manufacture of crowns and bridges, resin models:

Its use is gradually being extended to include the manufacture of temporary crowns and bridges and resin working models for loss wax casting.


3. Production of removable partial denture frameworks

: The removable partial denture frameworks is made using rapid prototyping, SLA technique. It was developed by 3D Systems of Valencia, CA, USA in 1986.

4. Production of individually-customized digital aligner models for orthodontic use: Whole trays of individually-customized aligner models which serve as extremely accurate base-mold tools upon which the clear aligners are then thermoformed, can be produced by this additive technique.


5. Manufacturing of scaffolds for bioengineering and nerve guide conduits:

Scaffolds for bioengineering and nerve guide conduits for peripheral nerve regeneration are the newer applications of a similar process i.e. microstereolithography (µ SLA).


Future advancements:

With the improvements in the speed, reliability, and accuracy of the hardware, additive manufacturing will seriously compete with traditional manufacturing in creating end-use products. Many possible biomedical engineering applications might be available in the coming years.


Conclusion:

It will still be many years before the machines will be able to produce work of a quality that can be achieved by the best dental technologists in the world. For the dental materials scientist these technologies will throw up a whole new way of materials processing and with it the opportunity to use a whole new range of materials.


SLA models


SLA models


3 D printed models


Material

Acrylic

Epoxy

Starch


Physical properties

Translucent, strong

Translucent, strong

Opaque, brittle


Sterilization

Possible

Not recommended

Not possible

Table-1 Basic characteristics of 3 D models (Choi

et al

., 2002)


References and further reading:

Barker, T.M, Earwaker, W.J.S, Lisle D.A. (1994) Accuracy of stereolithographic models for human anatomy.

Australas Radiol,

38(106).

Berman, B. (2012) 3-D printing: The new industrial revolution.

Business horizons

,

55

(2), 155-162.

Cassetta, M., Giansanti, M., Di Mambro, A., Stefanelli, L. V. (2013) Accuracy of Positioning of Implants Inserted Using a Mucosa-Supported Stereolithographic Surgical Guide in the Edentulous Maxilla and Mandible.

The International journal of oral & maxillofacial implants

,

29

(5), 1071-1078.

Choi, J.Y., Choi, J.H., Kim N.K. (2002) Analysis of errors in medical rapid prototyping models.

Int J Oral Maxillofac Surg

, 31(23). doi: 10.1054/ijom.2000.0135.

Cunningham, L., Madsen, M., Peterson, G. (2005) Stereolithographic modeling technology applied to tumor resection.J Oral Maxillofac Surg, 63, 873–878.

Gauvin, R., Chen, Y. C., Lee, J. W., Soman, P., Zorlutuna, P., Nichol, J. W., Khademhosseini, A. (2012) Microfabrication of complex porous tissue engineering scaffolds using 3D projection stereolithography.

Biomaterials

,

33

(15), 3824-3834.

Mehra, P., Miner, J., D’Innocenzo, R., Nadershah, M. (2011) Use of 3-D stereolithographic models in oral and maxillofacial surgery.

Journal of maxillofacial and oral surgery

,

10

(1), 6-13.

Melchels, F. P., Feijen, J., Grijpma, D. W. (2010) A review on stereolithography and its applications in biomedical engineering.

Biomaterials

,

31

(24), 6121-6130.

Morris, L., Sokoya, M., Cunningham, L., Gal, T. J. (2013) Utility of stereolithographic models in osteocutaneous free flap reconstruction of the head and neck.

Craniomaxillofacial trauma & reconstruction

,

6

(2), 87.

Patel, M., Al-Momani, Z., Hodson, N., Nixon, P., Mitchell, D. (2013) Computerized tomography, stereolithography and dental implants in the rehabilitation of oral cancer patients.

Dental update

,

40

(7), 564-6.

Tasaki, S., Kirihara, S., Soumura, T. (2011, November) Fabrication of Ceramic Dental Crowns by using Stereolithography and Powder Sintering Process. In

Ceramic Engineering and Science Proceedings

(Vol. 32(8), 141-146). American Ceramic Society, Inc., 735 Ceramic Place Westerville OH 43081 United States.

Van Noort, R. (2012) The future of dental devices is digital.

Dental Materials

,

28

(1), 3-12.

explain what recent research has found/ said about topic, and b) in the context of this, describe at least a few specific studies that have addressed the topic.

/in /by

explain what recent research has found/ said about topic, and b) in the context of this, describe at least a few specific studies that have addressed the topic.

 

 

socioeconomic status and educational development/success

Write a 10 page research paper that summarizes the current research literature in said area of educational psychology (socioeconomic status and educational development/success).
Goal is to both a) explain what recent research has found/ said about topic, and b) in the context of this, describe at least a few specific studies that have addressed the topic.
Include bibliography/references section at the end of paper. In addition, need to make clear which study(s) are being discussed throughout paper using APA formatting.
Writer qualifications: American/ English with background in education or educational psychology.

References for paper.
1. Rowan-Kenyon, H. T. (2007). Predictors of Delayed College Enrollment and the Impact of Socioeconomic Status. Journal Of Higher Education, 78(2), 188-214.

2. Dugdale, A. E., & Siew Tin, C. (1977). Factors influencing school achievement of children from low socioeconomic groups in Malaysia.International Journal Of Psychology, 12(1), 39.

3. Shuqiang, Z. (2009). The Impact of Economic Disadvantage on Academic Achievement in Hawaii: A Multi-level Analysis. International Journal Of Learning, 16(7), 367.

4. Henry, K., Cavanagh, T., & Oetting, E. (2011). Perceived Parental Investment in School as a Mediator of the Relationship Between Socio-Economic Indicators and Educational Outcomes in Rural America. Journal Of Youth & Adolescence, 40(9), 1164-1177. doi:10.1007/s10964-010-9616-4
5. Crosnoe, R., & Cooper, C. E. (2010). Economically Disadvantaged Children’s Transitions into Elementary School: Linking Family Processes, School Contexts, and Educational Policy. American Educational Research Journal, 47(2), 258-291.

Identify the positive, effective qualities of the meeting in one list, and identify the qualities which were ineffective in a separate list.

/in /by

Identify the positive, effective qualities of the meeting in one list, and identify the qualities which were ineffective in a separate list.

In this assignment, you will study how a leader can conduct a variety of meetings effectively.

Complete the following tasks:

Part I

Based on your reading, understanding of the articles, and your experience in the meeting you attended, answer the following questions:

    • Where is the meeting being conducted, and what is its purpose? Is the meeting focused on communications or problem solving, or is it a meeting with no specific agenda?
    • Is the meeting a regularly scheduled event, such as a monthly scheduled meeting or a meeting to address a specific matter?
    • Does the meeting have a set communication designed with relevant information to advance the meeting? Please explain.
    • Was the meeting opened with an announcement or explanation of its purpose and importance?
    • What was the communication style of the meeting’s leader or facilitator?
    • What were the leader’s bases of power? Select from a number of conceptual paradigms and elaborate on your selection.
      • Authoritative
      • Knowledge and Expertise
      • Correction or Castigation
      • Reward or Incentive
      • Persuasion
      • Mentoring or Coaching
      • Relationships or Individual or group interactions
      • Direction or Vision
      • Charismatic or Personable
    • Did the members or attendees have an opportunity to express opinions? Were they asked for suggestions, ideas, and information?
    • Did you recognize any conflict, disrespect, or tension among the members or attendees? If so, was the source of the conflict evident?
    • Did you observe the participants’ body language (such as posturing, positioning, or gesturing) when different topics were introduced? Describe it.
    • What was the intended outcome of the meeting? Was it achieved? Why or why not? What were the pivotal moments of the meeting which contributed to its success or failure?

Part II

Complete the following tasks to provide an overall critique of the meeting you attended:

  • Identify the positive, effective qualities of the meeting in one list, and identify the qualities which were ineffective in a separate list.
  • Arrange each list from top to bottom, from most important to least important.
  • Take the top three ranked factors from each list and explain the affect they had on the meeting.

Helping Nursing Students to plan and understand their career

/in /by

Introduction

This paper provides critical information aimed to help Nursing Students to plan out their career and have a better understanding of Reflection Nursing in the health care industry. The paper is separated into two different parts. As a nurse, individuals are exposed to several number of employment positions during the working life. The paper consists of two specific areas related to the industry. The success of a nursing career depends on gaining experience, skills and competencies to climb the ladder with different roles at higher and higher levels (Turner, 2007). Therefore, the first part of the paper provides the reader with a Career Development plan along with an analysis of the main skills and attributes requires for a nurse to have in them. The second part of the paper focuses on

reflection in nursing

, discussing the aspects of this practice, including the importance of it, even though it is a criticized area in the health industry itself. This paper will focus on the technicalities behind starting off a Nursing Career and also, discuss aspects of the industry that involves constant reflections, critical thinking and analysis.

Part A

A Nursing Career Plan

According to Dan Thomas (1994), you must manage your career like a business. In order to pursue in nursing, a career plan is an essential tool for professional development, job satisfaction and illustrates commitment to your discipline. The career as a nurse is a rewarding career with plenty of room for advancement and development (Zehr, 2010). My long term goal to achieve is to be a nurse who leads an entire ward of a health institute. However, to get there, I need to have a strong foundation. Therefore, within the coming 3 years, through hard work and continuing education, I would like to become a registered nurse and start working in an established health institute.

The main attribute that attracted me towards this career is because being a nurse requires you to be intimately involved with another human being (Turner, 2007). I once read that “Nursing affords the opportunity to make a difference in the lives of others. You can earn good money, but you can also make a difference” (Hugg, 2005, cited in Turner 2007). This was the main aspect that drove me towards a nursing career in general. This career requires you to be involved in people’s most important life moments, such as birth, death or even surgery (Turner, 2007). Along with this, in the nursing career, there are always chances for more advancement and diverse ranges of specialty.

In order to reach my goal to be a nurse in a leadership role, there are few processes I have to go through. The first is to pursue my Bachelor’s Degree of Science in Nursing. As an undergraduate, I would be able to study and familiarize with areas such as medical technology, patient care procedures, math, anatomy and biology, along with any specialized areas I might consider in the future, such as surgical nursing, obstetrics nursing, etc (Jeffress, 2003). The completing of a nursing degree takes a minimum of 2 years.

While pursuing my nursing degree, I want to join an internship program at a hospital. This would be a chance for me to earn while learning. By joining an internship program, I will be able to demonstrate the understanding and competence in technical skills and procedures related to my specialty while being provided with an opportunity to apply sound clinical judgment and critical thinking throughout the process in the management of patient care (Lee Memorial, 2011). In short, I will be able to gain a knowledge base and skill set needed to transition to competence in clinical nursing practice.

After the completion of my 2 year degree program, the biggest step I need to take is to pass the national licensing test in order to earn my Registered Nurse Credentials. This test would be where my theoretical and practical skills will be tested in order to ensure that I have the required qualifications to become a Practical Nurse. Passing this test would set the path to the starting off of my nursing career.

Most new nurses begin their careers in emergency rooms, ambulatory care units, and general hospitals (Jeffress, 2003). Hence following the passing of the licensing exam, I would apply to work as an emergency room nurse, starting off my practical career. From here onwards, I would work my way up the ladder, to reach my long term goal, pursuing my continuing education along the way.

While this would by plan for the coming three years, I plan to stay active in my career development throughout my whole career in order to stay successful. This is because many nurses’ careers burnout or stagnates with time without considering long-term strategies (Turner, 2007).

Skills & Attributes needed for a Nursing Career

Nursing is a service profession (Turner, 2007) which requires me to have a combination of several skills. Nursing career is an integral part of the healthcare profession which calls for skill, hard work and devotion. While there are several skills required to be in a nurse, there are certain skills that takes priority which are:

Professionally Competent – knowledge based skills and ability to answer questions feasibly

Developed Interpersonal Skills – communication and observational skills

Emotional Skills – be able to deal with emotionally charged situations and ability to offer advice

Being professionally competent is defined as ‘the knowledge and skills of the nurse to make decisions and prioritize care, and includes competence in relation to physical or technical aspect of care’ (McCormack & McCance, 2010). As a nurse I need to be organized and be effective in multitasking. While taking care of patients, nurses interact a lot with them, sometimes more than the doctors themselves. So, in order to answer any question the patient or their family might have, I would need to have a deep knowledge and understanding of the conditions of the patients (NHS Careers, 2011). A strong background in Science is required to understand most aspect of this area since it helps me understand better what is wrong with the patients. Since nurses are responsible for recording patient’s information such as the medical history accurately, it is important for a nurse to be intuitive to ask the right questions without missing out any critical part. Along with working with patients, a nurse has to work with different kinds of machines and medications during work (College Crunch, 2009). In order to work with these tools harmoniously, a nurse requires being fluent in math. Being familiar with math includes being fluent with both the standard and metric system of measurement, specifically while dealing with medications (College Crunch, 2009). According to Calman (2006), patients describe competent nursing practice as a combination of technical care and nursing knowledge, but it is only when technical care is assumed that interpersonal attributes become the more important indicators of quality nursing care.

Another main kill that is required for nurses to have is a well developed set of interpersonal skills. As a nurse, I would have to work with doctors, patients and a team of other nurses communicating with them in a very fast paced environment (College Crunch, 2009). Poor interpersonal communication by a nurse can be profound and often increases the vulnerability experienced by patients. As a nurse, it’s crucial to be a good at listening as well as talking. With the patients, this is important to make them and their loved ones feel secure leaving their care in your hands and this skill proves important with doctors and your peer because without communicating with them, carrying out the task of patient care will be impossible. Nurses also have to be constantly alert to changes in patients’ conditions and the implications in terms of care (NSH Careers, 2011). They have to be able to spot anything out of the ordinary or basically anything that doesn’t seem right. These changes need to be communicated back to the doctors clearly and concisely in order to ensure the patient’s well being. With poor interpersonal skills, barriers might occur in this communication process which might include misunderstandings and even lack of information provided to certain parties involved in this communication process. In healthcare, these are errors that might lead to grave problems. Effective communication requires a combination of good verbal and non-verbal skills (McCormack & McCance, 2010). Therefore, as a nurse, I would have to be able to understand gestures and facial expressions of my patients, peers as well as doctors, especially during an emergency.

Emotional skills can be considered as the next main attribute a nurse is required to have. Empathy and compassion are foundation of nursing care (Turner, 2007). As a nurse, I would be able to see people at their worst days and also at their best. This involves me to have developed traits such as caring, understanding, being non-judgmental and have a strong ability to empathize with the patients from all the walks of life (College Crunch, 2009). At times of crises, a nurse is required to play a key part in helping patients and their loved ones come through these crises and manage distress within a very distressed environment. This requires very strong emotional stability in a person. Since I plan to start off my career from an emergency room, this skill set needs to be extra strong in me. This is because in the emergency room of a hospital, nurses have to deal with people who are very sick, disabled, or experiencing any number of physical, mental and emotional issues and even major accidents (College Crunch, 2009). In an environment as such, I would have to be emotionally strong enough to provide the patients with the help they require without letting the situation affect my judgment or quality of work. In order to gather emotional skills, I would have to learn take care of myself in order to be balanced enough to provide care to other since I will encounter difficult staff members, angry physicians, non-cooperating patients and disgruntled family members as well (Turner, 2007).

With these skills and many others put in consideration, I will be able to achieve my goal into becoming a successful registered nurse.

Part B

In the nursing practice, reflection is a process of reviewing an experience of practice in order to describe, analyze and evaluate and so inform leaning from practice (Bulman, 2004). Reflection is undoubtedly an important concept, which has succeeded in stimulating debate and investigation, and influencing nursing education around the world (Bulman, 2004). This process involves focusing on how the individuals interact with their colleagues and with the environment to obtain a clearer picture of their own behavior (Nursing Times, 2004). Reflective thinking highlights the intermingling of practitioner’s feelings and emotions, and acknowledges this interrelationship with actions as well as the importance of intellectual thinking thus providing a vehicle for legitimizing professional knowledge that develops from the realities of practice and challenges more traditional form of knowing (Bulman, 2004).

The process of reflection in nursing aims to develop professional actions that are aligned with personal beliefs and values. Current thinking in nursing advocates the need for nurses to be educated in ways that develop their autonomy, critical thinking, sensitivity to others and their open-mindedness (Reed & Ground, 1997). Nursing is a practice discipline and effective preparation of nursing requires that we are able to care competently for our clients and continue to develop our skills and knowledge over a professional lifetime. They are responsible for providing care to the best of their ability to patients and their families (Turner, 2007). In order to achieve this, it is vital for nurses to focus on their knowledge, skills and behavior to ensure that they are able to meet the demands made on them by this commitment. According to Fitzgerald (1994), nurses develop competence through a process of critical reflection on experience; they examine their work and the contribution their nursing and nursing generally makes socially. She also states that in turn, nurses also consider the effect social forces have upon themselves and their work. Through the process of reflection, nurses are able to gain a heightened awareness of the variety of factors that shape their practice resulting in informed practice (Bowden, 2003). Grasping the idea that reflection is a combination of thinking, emotion and commitment to action is not an easy one. (Bulman, 2004).

The process of achieving reflection in a field such as nursing can be seen as a challenge. These skills required to achieve reflection was stated by Atkins & Murphy (1993) as self-awareness, description, critical analysis, synthesis and evaluation. But while the competent nurse just beginning to utilize the reflective practice is unlikely to be able to use all of these, this stems in part from the limitations of the level of performance which may be efficient and complex but is based on deliberate planning (Benner, 1984). Reflective practice is part of the requirement for nurses constantly to update professional skills. As a nurse, professional competency is a vital attribute to ensure efficiency in their daily works. Using reflective practice, portfolio offers considerable opportunity for reflection on ongoing development. Annual reviews of their self and skills allow nurses to identify their own strengths and areas of opportunity for future development (Nurse Times, 2004). Reflection on personal attitudes, feelings and values as well as reflection on life and educational experience is a critical process in nursing education; it is a critical process in becoming a nurse (Lundy & Janes, 2009).

However, there are some cases where it has been identified that reflections of the nurses as taken-for-granted assumptions that rarely acknowledge that ‘doing’ as a nurse is more important than thinking or reflecting (Bowden, 2003). For reflection to be really meaningful, it must being with a shared overall aim to achieve effective learning and positive experience. Nurses face ethical dilemmas, and both professions are characterized by specific moral discourses and practiced. In nursing, it is importance to practice a professional identity and practice of personal behavior bound up with notions of ‘moral agency’: empathy, compassion, understanding. It is imperative that self-reflection be developed early in the educational experience and continued in nursing practice (Lundy & Janes, 2009). Reflective practice potentially provides a way to justify the importance of practice and recognizes the interrelationship between theoretical and practical knowledge, embracing the intermingling of thinking, emotion and action (Bulman, 2004). This appeals to nurses especially because it they are able to identify with this aspect of reflective thinking since it provides a justification for practice knowledge.

Peden MacAlpine (2005) discusses the importance of design, evaluation and outcomes of a reflective practice intervention that can be used to train critical care nurses on how to incorporate family intervention into their nursing practice. The befits and problems of reflective practice are many and most beneficial aspects include improvement of professionalism and better ability to tackle similar situation leading to professional development through experience in nursing (Oxbridge, 2011). Reflection practicing relates to a nurse’s experience and learning from the experience, helping them to change their attitude towards critical care especially in family and enhanced their communication and ability to build proper relationships with families bringing in a new way of understanding family stress or appreciating family values.

Reflection helps nurses face practical problems encountered related to role integration, professional autonomy, legal and consent issues, non-medical prescribing and role evaluation. Considering the benefits of changing nursing attitudes and developing professionalism through reflective practice, many researchers have emphasized the need to use reflective practice as a training method within nursing education (Oxbridge, 2011). Guidelines could be developed according to the theoretical framework of reflective practice and can give a new direction nursing education. Reflective thinking has become a popular word in nursing education worldwide, but its meaning and effective use remains debatable because of lack of clarity in its meaning (Mackintosh, 1998).

Donald Schön (1983) suggested that the capacity to reflect on action so as to engage in a process of continuous learning was one of the defining characteristics of professional practice. Nurses should consider the ways in which they interact and communicate with their colleagues. Communication as discussed in Part A of this paper is a vital attribute to a nurse in the face paced environment they work in. And using reflective practicing in order to harmoniously communicate with the peers help create a more efficient working environment along with developing their personal skills as well. They should aim to become self-aware, self-directing and in touch with their environment (Nursing Times, 2004) rather than depending on their peers to carry out certain works during their daily work. This allows the nurses to provide efficient service to the clients/patients more feasibly through reflective thinking. It allows the nurses to think out of the box rather than stick to traditional methods and moving forward in their career themselves. This goal can be achieved by making full use of the opportunities available to them via the feedback using the impact on patients, their families, colleagues and the organization as a whole (Nursing Times, 2004).

Hospitals over the millennium have developed relinquishing their role as the recognized hub of care delivery, while delivery of health care services at home, at work, at play, in schools and churches, online with the World Wide Web through the internet, and on the telephone continues to increase. In order to stay on course with these developments, nurses have been challenged to re-conceptualize their roles within the complex and changing medical contexts (Forde, McPhee, McCahon & Patrick, 2006).

Reflective Practicing can be used as a feasible tool against such as discriminatory practices. This tool can be used as a framework for professional development by analyzing the current, past and future actions of the individuals to avoid going against the strong ethical codes set for nurses. Evaluations along with alternatives to similar situations can be provided using reflective practice to ensure that problems do not arise in behavior of professionals (Oxbridge, 2011). While there are no set rules to developing a reflective framework, with experience an efficient framework can be developed incorporating not only reflections on actions but ethical, political and broader social issues that develop for a given experience (Bowden, 2003). This helps bring together a reflective solution that works for an organization in whole, ensuring more efficient processing of daily works within the organization.

Comments that reflective practice is regarded by many authors as particular importance to continuing professional excellence which has lead to an almost unquestioned element in professionalism; the room to excellence is through reflection (Forde, McPhee, McCahon & Patrick, 2006). Reflection in nursing leads to the individuals in developing their skills in leadership and provide stability to deal with difficulties and complexities within a stressing environment such as a hospital. As discussed above, there is enough educational research and theory that advocates the importance and effectiveness of learning through reflective practicing (Bulman, 2004). Through constant questioning, we see more clearly just who we really are, and what remarkable resources we have access to. We will also see more clearly, what is really facing us, and we will become more capable of accepting and responding to change (Ferguson, 2010).

Conclusion

In conclusion, the Nursing Career is clearly a career with chances for development and allows individuals to continue their education as they progress through their career. During their career, nurses needs to develop extensive skills during their daily basis and also use their intelligence to climb up the ladder in their career. With long-term planning and reflective practicing in hand, it is obvious that one could become very successful in the a career such as nursing.