Due to the current advice on coronavirus, group presentations scheduled for Friday 20th March have been cancelled.

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Due to the current advice on coronavirus, group presentations scheduled for Friday 20th March have been cancelled. However, you are still required to submit the group power presentations by the due date and time (23rd March, 2020 at 18:00). Each group member is expected to submit a copy of their group power point presentation.

In addition to the power point presentation, you are also requested to submit an Individual 500 words reflection on:

(1)  Your role within the group on the development and preparation of the materials for the presentation

(2)  How the presentation slides/materials uploaded have demonstrated achievement of the four module learning outcomes

The reflection is due on 27th March 2020 at 18:00. A separate submission link for the reflection has been created on Moodle under the assessment tab.

Learning Outcomes

There are four learning outcomes for the module and by the time you have completed it, it is envisaged that you will be able to:

1. Criticallyanalysehow national politics and policy making is influenced by globalisation and demographic change; and the impact these have on local decision-making about service delivery and resource allocation.
2. Critically review the leadership challenges in implementing policy changes at a local level, including marketing and communicating the changes internally and externally
3. Critically evaluate how the implementation of policy is sustained through governance and regulatory mechanisms in localorganisations
4. Examine and evaluate local responses to national and international policy drivers and critically discuss the tensions which can arise when policy is translated into practice.

Attached file of Presentation and related resources.

Pregnant is part of the lifetime event brings happiness and change value and perspective in our life (Modh, Lundgren, & Bergbom, 2011).

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Introduction

Pregnant is part of the lifetime event brings happiness and change value and perspective in our life (Modh, Lundgren, & Bergbom, 2011). However, some of the pregnancy either plan or unplan could bring negative life impact towards mother or foetus, for example like abnormal chromosome (Goh,2005).

Chromosome abnormality especially Down syndrome(DS) chances to be happen would increase in advance age pregnancy (Goff, et al., 2013).Investigation would recommend in their  12 weeks of pregnancy by using serum biomarker B-Human Chorionic Gonadotrophin( free B-Hcg), Protein A(PAPP-A) and Nuchal translucency(NT) for chromosomal abnormality(Shiefa, Amargandhi, Bhupendra, Moulali, & Kristine, 2013).

Abortion is an alternative option for those pregnant do not want to keep their child in such situation as above (Goff et al,2013). In Singapore, there are four authorize abortion. First, for those with financial difficulties. Second, any possible foetus substantial of mental or physical abnormality as such serious handicapped. Thirdly, pregnancy result from rape. Lastly, any pregnancy is endangering mother’s life (TODAYS,2020).

Prior to the procedure, eligibility should meet. As a result, citizen, legal working permit holder or whoever stay in Singapore at least 4 months allow to make decision on abortion. On exceptional cases, abortion decision fall on medical professional when there is a need for life saving (Singapore Legal Advice,2018).

In the role of counselling in abortion as Advance Practice Nurse (APN), we should provide enough information in helping patient to make their own decision. However, due to multi-races, cultural and believe we should be aware of the risk of ethical involved (British Medical Association, (2007). Ethics act as a moral by doing good among physician regardless of their believe. However, which can be a legal conduct once the decision or behaviour is out of the social acceptance (Patil et al,2014).

In order to avoid ethical dilemma, counselling in abortion is challenge. Thus following, will discuss the important information need to be advice in abortion counselling for couple who has DS foetus by using Beauchamp and Childress’s 4 principle model which include respect autonomy, beneficence, non-maleficence and justice (TAN,2005).

Respect patient Autonomy

Autonomy and informed consent are two important components involved in healthcare ethics. It’s consisted of bioethics model by providing enough information and time to allows decision making without coercion. In alternative model, mutual trust should build between physician-patient to helps the context of disclosure prenatal testing counselling (Nuffield Council Bioethics, 2017).

Building trust through effective communication is important by assessing the health literacy, belief and preference of parents on abortion before offering further investigation for those think that the act is unmoral (Than&Papp,2017). Women has the right to do self- determination on the decision making on abortion if she is competent. Whereas, a competent person is who can understand, retain and weigh the information provided. Meanwhile, she also able to communicate her decision clearly after she weigh against the risks and benefits given by physician (BMA2007).

The ethics of abortion be argued over the year, is it a right of a person by making such decision or is a wrongdoing action. Statement of pro-lifer and pro-choicer often presented as a war between religious or conservative (Tan,2005).

A person consider has the right to make decision if they have a full entity of moral to be called as personhood. In pro-lifer find the idea of embryo-foetus is person even from day one in the form of embryo. However, to be understanding as a person they should feel pain, communicating, reasoning, selection ability and self-concept. It might consider during quickening time while a woman feels the movement of a foetus (Austin,2019).

In DS, they don’t even gain their personhood until reach age of 4-5 yrs. which is hard to convince that they have the right on the decision make. It’s could be just worth to protect because it’s containing human DNA which potential person. However, the argument is continuing, because an embryo is giving chance nature in womb and in pro-lifer terminating in those potential people is wrong (Svenaeus,2018).

Contrarily, on the pro-choicer shown women has the right to make decision on abortion, because foetus is part of their body. There are not wrong in deciding what to do on his own bodies which meant belong to them and has right on the issues of reproductive. Ethical dilemma occurred between mother and foetus on the autonomy perspective (Straits Times,2018).

As a healthcare professional we shall respect a person autonomy of women or a foetus? However, we shouldn’t not and not expect to oppressive patient decision, but we can justify base on the time permitted by law, circumstance as well as state of the foetus(defects) to respect a personal decision (Svenaeus,2018)

Over the year, healthcare system evolving to accommodate the increasing elderly population as well as incidence of chronic diseases (ICIC,2017). In surging of population, ratio of nurse to patient in various setting would decrease.

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Self-reflective on community health care services need (Gibbs Model)

Fast evolving and specialities skill

Over the year, healthcare system evolving to accommodate the increasing elderly population as well as incidence of chronic diseases (ICIC,2017). In surging of population, ratio of nurse to patient in various setting would decrease. Community nurses helps in early identify, maintain and manage patient symptom in society to make the healthcare more accessible and affordable, especially in elderly (Channel News Asia,2019).

In current, there are multiple channel provide health information to public which include multimedia. Though, it’s helps increase the health literacy on public, but it could become another platform in providing unreliable information which accelerate and affecting elderly believe. This phenomenon change could become a challenge in providing education in community setting (Smith&Denali,2014).

Specialities affect in care delivery

In view combat with shortage in manpower and false information, community nurses need to be more experience and knowledgeable in various setting of care. However, in Singapore nurses training is more specialize and focus in an area (How, H. C., & Ming, F. K. ,2014).  Specialization could be narrow nurses learning, clinical skill as well as lower their confident level while out from there specialty area. Being confident in various practice and become public health information resource, community nurse should equip well with various experience in care. In order to achieve it, a rotation base working method could be proposed.

Evaluation Experience oncology specialisation setting

Throughout 10 yrs. working in oncology, even though practice in different hospital, inpatient and outpatient, and paediatric to adult setting, personal I felt an inadequacy myself in community services. Specialisation would be benefit on gaining the experience on an area and building strong relationship foundation on relevant team, but it can’t broader my understanding on care in other department to identify the problem in a bigger picture. Medical condition towards community might not confine to one but multiple, in each specialty almost all the patient has additional common diagnosis, but the care and management is out from my knowledge to be able to give advice. Such Inadequacy would refrain doing a good education in public as well as lack confident in different field of practice.

Suggestion of Job Rotation

‘Job Rotation’ being systematically rotate staff to different department to learn the different practice needs over a period of times. Rotation could expand staff knowledge and gaining recognition through the knowledge they are learning at the same time reduce the resistance to change and practice in other sector where to overcome the shortage issues.

Interpersonal relationship would better through the people encounter in different department. Closeness between team member who has opportunity work together will reduce the conflict and reaffirm the theoretical framework.

Through understanding each department practice which would build more resilience staffs even with lower ratio manpower but still able to delivery convincing service to public by all the different experience to gaining a trust.

Conclusion

‘Job Rotation’ could be help in future healthcare system dealing with shortage and combat with unreliable multi-channel health information. However, which might still need to have a proper plan by caring out the suggestion. There could have diverse feeling of anxiety, anger, sadness and insecurity in the initiation of job rotation. However, it would be benefited to expand staff knowledge and improve the flexibility integrate in the community needs. Improving in confident level through various experience and improve better connection among staff by increase understanding on different working processes. Once, more experience and confident in what we are doing, would help building patient relationship and gain trust to be a main resource person in community.