A 50-year-old male presents to the community clinic. He has just relocated to the area and has no primary provider. He is a long distance truck driver and requires a physical examination to maintain his continued employment.

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A 50-year-old male presents to the community clinic. He has just relocated to the area and has no primary provider. He is a long distance truck driver and requires a physical examination to maintain his continued employment.

Physical examination demonstrates a BMI of 33, blood pressure of 180/90 mm Hg, diminished femoral pulses and bilateral varicose veins with 1+ pitting edema in both ankles. He has a 30 year history of smoking two packs of cigarettes per day.

Initial Discussion Post:

What additional information is needed from the patient history and physical assessment to determine if this patient has arterial or venous insufficiency?
Compare and contrast evidence based nursing interventions for the patient diagnosed with arterial insufficiency and the patient diagnosed with venous insufficiency.
Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.

A 22-year-old female who adheres to a vegan diet has been diagnosed with iron-deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation?

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A 22-year-old female who adheres to a vegan diet has been diagnosed with iron-deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation?

A 22-year-old female who adheres to a vegan diet has been diagnosed with iron-deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation? (Points : 0.4)
Decreased mean corpuscular volume (MCV)
Decreased hemoglobin and hematocrit
Microcytic hypochromic red cells
Decreased erythropoietin levels
Question 2.2.A child has been diagnosed with thalassemia. Which of the following other health problems is the child at risk for? (Points : 0.4)
Hypocoagulation
Iron and ferritin deficiencies
Splenomegaly and hepatomegaly
Neutropenia
Question 3.3.A 24-year-old woman presents with fever and painful swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has: (Points : 0.4)
A mild parasitic infection
A severe bacterial infection
A mild viral infection
A severe fungal infection
Question 4.4.A couple who are expecting their first child have been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple have approached their nurse practitioner with this request and are seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can the nurse practitioner best respond to the couple’s inquiry? (Points : 0.4)
Stem cells can help correct autoimmune diseases and some congenital defects.
Stem cells can be used to regenerate damaged organs should the need ever arise.
Stem cells can be used as a source of reserve cells for the entire blood production system.
Stem cells can help treat some cancers and anemias but they must come from your child himself or herself.
Question 5.5.A 16-year-old female has been brought to her primary care nurse practitioner by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the nurse practitioner to rule out infectious mononucleosis? (Points : 0.4)
The girl has a temperature of 38.1C (100.6F) and has enlarged lymph noes.
Her liver and spleen are both enlarged.
Blood work reveals an increased white blood cell count.
Chest auscultation reveals crackles in her lower lung fields bilaterally.
Question 6.6.A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma? (Points : 0.4)
Her neoplasm originates in secondary lymphoid structures.
The lymph nodes involved are located in a large number of locations in the lymphatic system.
The presence of Reed-Sternberg cells has been confirmed.
The woman complains of recent debilitating fatigue.
Question 7.7.A nurse practitioner is explaining to a 40-year-old male patient the damage that Mycobacterium tuberculosis could do to lung tissue. Which of the following phenomena would underlie the nurse practitioner’s explanation? (Points : 0.4)
Tissue destruction results from neutrophil deactivation.
Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis.
Macrophages are unable to digest the bacteria resulting in immune granulomas.
Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.
Question 8.8.A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stools that has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely? (Points : 0.4)
The woman has depleted blood volume due to her ongoing blood loss.
She will have iron-deficiency anemia due to depletion of iron stores.
The patient will be at risk for cardiovascular collapse or shock.
She will have delayed reticulocyte release.
Question 9.9.A nurse practitioner student is familiarizing herself with the overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as being least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history? (Points : 0.4)
A 66-year-old obese male with left-sided hemiplegia secondary to a cerebrovascular accident
A 90-year-old female resident of a long-term care facility who has been experiencing transient ischemic attacks
A 30-year-old female with a diagnosis of left leg DVT and a pulmonary embolism
A 21-yer-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use
Question 10.10.A 60-year-old male patient with an acute viral infection is receiving interferon therapy. The nurse practitioner is teaching the family of the patient about the diverse actions of the treatment and the ways that it differs from other anti-infective therapies. Which of the following teaching points should the nurse practitioner exclude? (Points : 0.4)
Interferon can help your father’s unaffected cells adjacent to his infected cells produce antiviral proteins that limit the spread of the infection.
Interferon can help limit the replication of the virus that’s affecting your father.
Interferon helps your father’s body recognize infected cells more effectively.
Interferon can bolster your father’s immune system by stimulating natural killer cells that attack viruses.
Question 11.11.A nurse practitioner is providing prenatal care and education for a first-time expectant mother 22 weeks’ gestation who has a diagnosis of a sexually transmitted infection. Which of the following statements by the expectant mother demonstrates an adequate understanding of vertical disease transmission and congenital infections? (Points : 0.4)
Gonorrhea and chlamydia pose the greatest risks of transmission from mother to child.
I know that my baby will need observation for HIV signs and symptoms in the weeks following my delivery.
My baby could become infected either across the placenta or during the birth itself.
Prophylactic immunization will reduce my baby’s chance of being born with an illness.
Question 12.12.The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating? (Points : 0.4)
Impaired immune function
Acid-base imbalances
Impaired thermoregulation
Fluid imbalances
Question 13.13.A 30-year-old man has spent 5 hours on a cross-country flight seated next to a passenger who has been sneezing and coughing and the man has been inhaling viral particles periodically. Which of the following situations would most likely result in the stimulation of the man’s T lymphocytes and adaptive immune system? (Points : 0.4)
Presentation of a foreign antigen by a familiar immunoglobulin
Recognition of a foreign MHC molecule
Recognition of a foreign peptide bound to a self MHC molecule
Cytokine stimulation of a T lymphocyte with macrophage or dendritic cell mediation
Question 14.14.Which of the following phenomena would be least likely to result in activation of the complement system? (Points : 0.4)
Recognition of an antibody bound to the surface of a microbe
The binding of mannose residues on microbial glycoproteins
Activation of Toll-like receptors (TLRs) on complement proteins
Direct recognition of microbial proteins
Question 15.15.A tourist presented to a primary care health clinic complaining of malaise fever and headache. She has subsequently been diagnosed with Rocky Mountain spotted fever a pathology caused by Rickettsiaceae. Which of the followed statements best captures a characteristic trait of Rickettsiaceae? (Points : 0.4)
They are eukaryotic.
They have both RNA and DNA.
They have a distinct spiral-shaped morphology.
They are neither gram-negative nor gram-positive.
Question 16.16.A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? (Points : 0.4)
Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response.
Exposure to allergens in large regular quantities overwhelms the IgE antibodies that mediate the allergic response.
Repeated exposure stimulates adrenal production of epinephrine mitigating the allergic response.
Injections of allergens simulate production of IgG which blocks antigens from combining with IgE.
Question 17.17.A 71-year-old male patient with a history of myocardial infarction and peripheral vascular disease has been advised by his nurse practitioner to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the nurse practitioner’s suggestion? (Points : 0.4)
Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.
Aspirin helps to inhibit adenosine disphosphate (ADP) action and minimizes platelet plug formation.

Leadership and time management skills.

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Leadership is defined as the to make people understand to gain certain course, and also the leader must follow the same power of mind.

Leader ship is not an authority of an organization but it’s a strange strength personality which attracts the ordinary person.

Personal and professional skills for a successful Manager/Leader:-

Time Management

Running meetings

Making presentation

Stress Management

Time management :-

It is consider as one of the most important skill under the manger’s requirement. A proverb has been said ‘Once the time has gone it never comes again’. In this fast moving world time is precious and it’s been consider as money so time should be utilize in a proper way. The main features of the time management are to organize the work in a proper way and in a proper time, handling the meeting in a specific time period, to utilize the free time. In this business world everyone is concerned about the time management to achieve their success. The time frame which is available in this world for each person is 24 hours. Thus it is not possible for every individual to achieve their goal in the specific time period if it’s not been managed properly.

Components of Time Management are as follow:-

The leader/manager should set their priorities as per the time frame and should try to achieve their goal in a specific time with proper monitoring and feedback.

Prioritize goal according to their importance.

An time log of daily/weekly basis should be made to utilize time effectively

Leader/Manger should give motivate and should give guidance to their staff to develop and to achieve goals.

Running meetings :-

Meeting lead to achieve the goal effectively probably meeting can be successful one or unsuccessful one. While running the meeting all the features are been consider so that the meeting will not be unsuccessful one.

The agenda of the meeting should be clear. In which the meeting timing, points to be discussed, last meeting discussion and also the concerned person to carry out meeting should be mentioned properly.

The important factor for the meeting is the time .It is necessary to mention the ending and the starting time of the meeting. A proper planning may lead to success of the meeting.

For a successful meeting environmental condition should be nice enough. Such as, location, room and the availability of the equipment to carry out the meeting.

It is a duty of a manager to maintain a quorum .And to consider the point’s discussion for the meeting by the subordinates.

At the end of the meeting the points discussed by the subordinate should be ensure to all the members and the summary of meeting should be circulated to all the members.

Making Presentation_:-

It is pattern to shown or present the data in front of audience .presentation should consist of appropriate information related data and should be provided in an under stable language .

The manager should be actively take part in the meeting and should be confident enough to carry out the meeting.

The meeting starting and ending time should be considered by the manager while running the meeting.

The physical presentation by the manger should be good enough he/she should dress them self properly and should be confident to carry out the meeting.

While carrying out the meeting manager should make an eye contact with the members and should ask the questions if necessary.

To make the meeting interesting it should be more of visuals either than the lectures so the members will not get bored of the meeting.

Stress management:-

It plays a vital role in the life of the mangers. It’s normally been distinguish in two types it is personal and professional. The personal is been related to money problem, sickness, family problems etc while the professional will be the completion, business problems, large workload.

To get release with the stress manger should follow the following steps:-

He should identify the problem is it a professional or personal stress.

A proper solution should be made to reduce the stress.

Normally the main reason of the stress is time .If the time is managed by anyone he/she can reduces stress in a proper way.

Regular exercise ,yoga, and meditation also help to reduce the stress and increases energy and strength

In managers time log there should be some time for his hobbies or for the favorite thing to carry out so that he will be fresh to perform his task.

Proper planning should be there for the task which is not the simple. So by the study of it proper notes, remark should be made to reduce stress.

Thus by achieving these steps manger can reduce the stress and can achieve its goal in a proper plan time which can leads to an organisation profit.

Task 2

(1.1b)

The leader /manager have to know himself first mostly in terms of his weakness and the strength to perform the work in the proper way. Following are the practical methods of skills for developing or improving are as follow.

Proper time frame should be made to carry out work efficiently in a proper and organized way. By these it become easily t carry out or too run the meetings easily and effectively.

With the help of logs like daily and weekly it become easy to identify the problems or the jobs which was carried out and with the help of logs it can be sorted out easily.

Proper planning should be there to carry out work easily so that the stress will be get reduced .Normally work is been carried out as per the as per the indivivals satisfaction.

Proper planning or using of phone calls or the internet should be specific so that there will be no delay for the work.

Proper backup or the files should be saved in a computer data as if it becomes easy to sort out the problems.

Outcome 2

Task 3

(1.2a)

By personal development it makes us understand to know our strength and weakness. As most of the people are unaware about their sturdy and fragile areas. Due to which the work get spoiled and do not get completed properly. So that’s why the term personal skill audit is been used in management studies so that the employee will able to know their weakness and strength so that he can able to overcome with it easily. Due to which it become easy for the organisation to complete its goal.

After having a study Advanced Professional Development I came to know that I am pragmatist.

My Strength is as follow:-

I like to know about the recent things happening around me relates to books and technologies.

Most of the times I try to make out some new ideas from the job to make it easy.

I make my plan for each work and try to make most of it to complete it.

I utilize the option available to me.

Most of the time I like to work independently to complete any task.

My weakness is prescribed below:-

I am very eager to complete the task without considering caution.

Most of the time the group task is not performed by me because I try to dominate others.

Without involving other people I like to do my work.

I try to keep control on other because of which it may underestimate others.

With the help of my strength it becomes easy to do work in a proper way. Gathering the information may help to complete the task. With the help of these it become easy to perform or to run the meeting easily. Also proper arrangement of agenda which includes the figures and facts help to make meeting successful. And also some time working alone or to perform the work help me to complete it properly as I don’t have to rely on other to complete my work or task.

As without considering the caution may leads to crash the task. Because of these act normally it direct me to the way of failure. Due to independent working stress and the mental pressure get increase because of which leads to work failure. Because of underestimating other people by me lead to differences between family, subordinates with me. These differences may cause nervousness, stress to mental condition. Due to which it take directly to the way of failure.

After knowing to my weakness and strengths, I will try to overcome with it with the help of four skills which can also reduce the individual and proficient efficiency. I will plan my work in a proper way to compete it. Also I will persistence to my work or task and will study it properly to overcome it. And also I will frame out the related caution which may arise so that’s I can overcome it.

By utilizing strength I can achieve the goals successfully to hike the company in the right direction

Outcome 3

Task 4

(1.3a)

Before to be linked with the ‘Personal Development Plan’, I have constructed SMART and SWORT analysis to identify my objectives in life and to know my strength and weakness which will help me out to achieve my MBA and to be a successful manager in future.

SMART -:

It stands for S-Specific, M- Measurable, A-Achievable, R-Relevant and T-Time. Considering these all things I have set my goals for future.

Specific-: To gain and implement four skills they are Time Management, Running Meetings, and Making Presentation, Stress Management which will help me out to complete my MBA.

Measurable-: To complete the assignment successfully in APD/MBA.

Achievable-: To complete and submit the assignment successfully in a specific time period and to get passes through it.

Relevant-: As I have gained a perfect group of teachers because of which I have 100% interest and commitment for my subject which aim to concentrate and to put my efforts to achieve my goal.

Time-Bound-: To obtain MBA degree by the end of March 2011.

SWOT ANALYSIS

Strengths-:

I try to find out more options

To disclose the facts I use my detective skills

I am eager to find and implement the ideas, techniques and theories.

I perform the work well when I am independent.

I set the goal and act to meet them

I take my opportunities for experiment

I am good to gather the information from the entire source available

I am good in performing oral presentation which holds the attention of the audience.

Weaknesses-:

I proceed without caution

I underestimate personal feelings

I require full control

I am impatient

I dominate task which is given to others

I like to do work/task alone

I am not good in making logical disputes for the essay format

I am not good in presenting the assignments professionally

I am not good in evaluating the progress of any work.

Opportunities-:

Facilities which are available from our college -Live campus update, advanced technology for teaching like Smart Board, computers,projectors,library with all the books and facilities, the best teachers/staff.

Special service for the student that is tutorial service in which we can interact our problems with the tutor.

Performing practical workshops by our lecturer Mrs. Ginny Cox at our College.

Through workshop it makes us easy to perform and practice our skills

Threats-:

Problems evaluating like login for live campus and collage computer systems

Cannot take books outside the library

Time consuming student services token system and limited time period for tutor service

Because of newcomers and unprepared members in the group lecture cant able to concentrate on the workshops properly.

Workshop cannot be get completed in time

Professional Development Plan-:

Learning and development need

Weaknesses to be overcome and strengths to assist the outcome

Learning actions to be taken including resources needed to achieve them

Monitoring and feedback point

Time frame for success

Time management

Weaknesses-:

Have to wait for the last moment

Always work alone

To keep reminder or alarm for the deadline

To do split up the small task and the large task first and then to do the important one.

To decide and frame out the deadline and important

dates.

To record the summary at the end of the day

To study and implement on daily action plan.

To study and get on to the result time period of two months is needed.

Strengths-:

To perform the work on time

Working hard for the work

Proper planning and techniques can avoid wastage of time.

It is hard to meet time constraint by working out daily.

Approximately 1 month

Running meetings

Weaknesses-:

Do not practice before performing

Do not consider other people effectively

Have to be prepare by own first before discussing the matter and implementing the decision assigned to him.

To check the others works and allocate work to them.

To take the survey in between and to ensure the progress of the work interval check is required.

Up till the proper decision is implemented

Strengths-:

Able to make own decision

Able to make control on others

To set the goals and try to achieve them

To stuck up with the decision and make a use of an employee to achieve the target.

Through financial reports, sales reports and annual reports of an company

In an interval of 3, 6, 9, 12 months.

Making presentations

Weaknesses-:

Always in hurry

Underestimate personal feelings

To communicate properly

To explain the topic rather than continuity of speech

To take the survey in between and to ensure the progress of the work interval check is required.

While presentation

Strength-:

Good speaker

To find the facts by using detective skills

Proper use of multimedia and PowerPoint in the presentation and getting the feedback from the subordinates/colleagues

Through financial reports, sales reports and annual reports of an company

After 1 month of presentation

Stress management

Weaknesses-:

Always in hurry

Wants the result instantly

acts without caution

Internal cure

Taking break from work and assigning the work to subordinates/colleagues

Mental stress progress

continuously

Strength-:

Without depending on others for the work

Utilizing essential and useful techniques to do task.

Proper planning techniques make it easy to do work

Mental stress programs

continuously

Task 5

(1.3b)

Monitoring and feedback-

As per the condition changes in the plan is been made to complete the work these skills is been effectively monitored and the feedback is been carried out to achieve the outcome. The confirmation of these monitoring and feedback is represented below.

TIME MANAGEMENT-:

In the starting weeks of the lecture I was asked to fill the daily/weekly time log table as during which we dint had any assignment to do so I used to utilize my time like with the friends, internet, gaming, watching TV, listening music (please see appendix 1).As after certain weeks I adjusted my time log table because of the assignments and exam were coming closure to submit and write it so using time log I planned my time properly. Also by comparing with the past time log table I come to know what mistakes I have made and how I can make a change in it.Therfore considering the sitivation I have made changes in my study hours which will be helpful for me to prepare for exam and assignment were as I have reduced my hours from the TV and music section to utilize them for studies. (Please see appendix 2).These time log I have done to do the things at time considering their priorities instead of leaving them at the end. Thus with the help of these I will be able to complete my work in time as if effective time management.

MAKING PRESENTATION

As in the lectures we had a presentation in which I had performed one presentation as a workshop in which I was making a mistakes continuously like less speech volume, repeating of the words or the mixture of the words which was not proper enough. After few days I had a presentation for the work shop for which I performed it quite well and I got a very positive results from my friends and teachers. For this presentation I had a very good preparation like to understand the subject pre-planned the matter and performed it at home and recorded it then I saw the mistakes and tried to overcome it. My main intention was to make a good presentation which should be liked by everyone. Thus after these I had many presentation and the results very quite well enough. Thus from these I have secured very good skill.

Task 6

(1.3c)

Conclusion

Thus after completion of these task I came to know about my learning style due to which my strength and weakness is been easily identified though which it is possible for me to work out on any task easily. Also the four skills play a vital role with the help of which it may leads to a successful and good manger. As it is a part of Master of Business studies it shows the importance of time management, preparation of successful meetings which may be helpful as a part of life. Thus though these assignment I have learned also the thing that to respect the others ideas and views and use them effectively for the task which may reduce the stress.

Health Risks of Coronary Heart Disease: Literature Review

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Coronary Heart Disease (CHD) is the main cause of death and disability in the United Kingdom (UK) and the sole most frequent cause of early death. In spite of a drop in CHD mortality in recent years, there are approximately 120,000 deaths per year in the UK making the quotient amongst the uppermost compared to the rest of the world (British Heart Foundation (BHF), 2003). Additionally, more than 1.5 million people in the UK are living with angina and 500,000 have heart failure (Department of Health (DH), 2004) commonly, although not wholly, caused by CHD. The World Health Organization (WHO) has forecast that by 2020, CHD will be the principle cause of death and morbidity throughout the world (Tunstall-Pedoe, 1999).

However, not only does CHD affect the increasing rates of early deatjh, it can also cause individuals to experience “long-term chronic health problems”. There are numerous different kinds of cardiac illnesses that include: “congenital abnormalities, heart rhythm disturbances, valvular disease, acute coronary syndromes and heart failure” (Jones, 2003). It is important to note that the latter two conditions are more likely to affect older people and are the most prevalent among those with CHD (Rawlings-Anderson and Johnson, 2003). This essay will critically analyse the literature pertaining to the one of the most relevant health risks of CHD, that of chronic heart failure. The literature to be reviewed will analyse the issues that affect self-care in heart failure.

To enable this review a comprehensive search of relevant databases such as CINAHL and the British Nursing Index was undertaken. Similarly, a thorough search of relevant nursing journals such as Nursing Standard, Nursing Times, British Journal of Cardiac Nursing, and British Journal of Nursing was also carried out. Also a general internet search using the keywords CHD, BHF, long-term chronic health problems, acute coronary syndromes, chronic heart failure, prevalence and associated factors was also employed.

The rationale for choosing heart failure is that every year 63 000 new cases are reported in the UK and it is increasing in prevalence and incidence affecting more than 900 000 people per annum (Petersen et al, 2002). Heart failure presents a major predicament with regard to its effect on the individual sufferers, their significant others and also on healthcare measures and supply. People with heart failure by and large suffer from recurrent episodes of acute exacerbation of their symptoms. As a consequence, admission to hospital is great and accounts for approximately 5 percent of all admissions to general medical or elderly care hospital beds within the UK. Readmission rates are as high as 50 percent in the six months following the original stay in hospital (Nicholson, 2007). It is posited that experience of illness and grim clinical outcomes are fundamentally as a result of uncontrolled symptoms through non-adherence to suggested medication and lifestyle modifications (DH, 2000a).

There are various current Governmental guidelines that expound the virtues of self-care of long-term conditions. However, The Department of Health’s (DOH, 2006) Supporting people with long-term conditions to self-care: A guide to developing local strategies and practices guide proposes that self-care is any actions or behaviours that help individuals to cope with the effects that their long-term condition has on their activities of daily living. These actions or behavioural changes hope to empower sufferers to deal with the emotional aspects, adhere to treatment routines and maintain the important aspects of life such as work and socialising.

A thorough research of the literature surrounding self-care for long-term conditions such as heart failure has shown that several factors are in existence that influence self-care in heart failure. These include: socio-economics, condition-related, treatment related and patient related factors (Sabate, 2003, Leventhal et al, 2005).

Socio-economic standing, degree of education, monetary restrictions and social support have all been emphasised as effecting self-care in patients with heart failure.

Low socio-economic status and lack of education have been established to be significant factors relating to non-adherence and inadequate self-care (Gary, 2006; Van der Wal et al, 2006). Wu et al (2007) found that those on minimal incomes were regarded as high risk for non-adherence to medication. While a superior level of education was also found to be a major predictor of adherence in research papers by Evangelista and Dracup (2000) and Rockwell and Riegel (2001).

Financial restraints connected to the price of medication have been acknowledged as a hindrance to adherence (Evangelista et al, 2003; Horowitz et al 2004; Wu et al, 2008). However, these reports have been performed in the United States (US) and in the main correlate to lack of medical insurance under a Medicaid scheme. It is therefore suggested that additional research is required to ascertain whether the price of medication notably impacts on adherence in the National Health Service (NHS).

A number of studies have observed that social support is an important issue in influencing self-care (Ni et al, 1999; Artininan et al, 2002; Scotto, 2005; Schnell et al, 2006; Wu et al, 2008). Ortega-Gutierrez et al (2006) found a significant contrary relationship between perceived level of social support and level of self-care. Similarly, Chung et al (2006a) examined the bearing of marital status on medication adherence and found that married patients had considerably enhanced adherence to medication than those living by themselves.

Patients with a partner took more doses, were aware of the importance of taking medications on time and were more knowledgeable about names and doses. By contrast however, Evangelista et al (2001) found no association between social support and adherence to medication and lifestyle behaviours, although the authors suggest this may be due to the high levels of social support reported in this sample.

The method of social support has been illustrated in numerous qualitative studies. Stromberg et al (1999) explained the important role spouses performed in medication

management such as giving their partners their tablets at prescribed times. Wu et al (2007) found that a supportive family helped with medication adherence by collecting medications from the pharmacy and filling dosage boxes. These authors deduced that those devoid of the effective commitment of relatives in self-care, some patients would have trouble sticking to their drug routine. The high intensity of social support was also

shown to be a feature of patients considered to be knowledgeable in self-care (Riegel et al, 2007a).

A number of factors relating to specific aspects of the condition have been described in the literature. These include the nature and severity of symptoms, functional ability, prior experience, the presence of comorbidities and cognitive functioning. Severity of symptoms and functional ability are important indicators of behaviour. Symptom

severity was an independent predictor of self-care in a study by Rockwell and Riegel (2001). Wu et al (2007) found that patients with poor functional ability as measured by the New York Heart Association functional classification (NYHA) had poorer self-care.

However, prior experience of hospitalisation may also affect self-care with patients having prior hospitalization episodes more likely to carry out self-care effectively. It is suggested that this may be due to a high level of motivation to stay well and avoid hospitalization. Level of experience or time since diagnosis may also be important factors in determining self-care ability (Carlson et al, 2001). Although the precise mechanism is unclear, it may be related to an enhanced ability to recognise changing symptoms and the use of tried and tested strategies in response to symptoms. The presence of comorbidities, especially if symptoms are similar to those of heart failure, makes the recognition and subsequent management of symptoms difficult. Chriss et al (2004) found the number of comorbidities to be a significant predictor of self-care, those with few comorbidities having enhanced self-care.

Self-management requires patients to make decisions and take actions in response to recognition of symptoms. However, cognitive deficits in heart failure have been well documented (Ekman, 1998 and Bennett, 2003). It is estimated that between 30 percent and 50 percent of heart failure patients have cognitive impairment (Leventhal et al, 2005). Wolfe et al (2005) found specific cognitive deficits of memory, attention and executive functioning, which were not related to illness severity. These deficits may impair the perception and interpretation of early symptoms and reasoning ability required for self-management. This is supported by Dickson et al (2007b) who found a correlation between impaired cognition and individuals inconsistently demonstrating effective self-care behaviour. Paroxysmal nocturnal dyspnoea, common in heart failure, also deprives the body of sleep and has consequences for cognitive functioning and decision-making (Trupp and Corwin, 2008). Perhaps as a result, sleepiness during the day has also been linked to poor self-care (Riegel et al, 2007b).

Adherence to medication and lifestyle guidance has been linked to treatment-related factors such as the effects of medication or treatments, the intricacy of regimes and numerous changes in treatment. Riegel and Carlson (2002) and Van Der Wal et al (2006) found that adherence to a low sodium diet was hindered by the foul-tasting low salt food and problems when eating out in a restaurant. Limiting fluid intake was also controlled by thirst. Bennett et al (2005) found that the taking of diuretics disrupted sleep and this was a significant factor in non-adherence. Concerns about medication side effects are also of major concern to patients (Stromberg et al, 1999; Riegel and Carlson, 2002). The complexity of the treatment regime as indicated by a high number of administration times, for example, has been shown to decrease medication adherence (Riegel and Carlson, 2002; George et al, 2007; Van der Wal et al, 2007).

It is suggested that individual patient characteristics have a major part in self-care behaviour. Age and gender may have some bearing on behaviour although there is relatively limited evidence. The presence of depression also had a negative impact on self-care ability.

Chung et al (2006b) examined gender differences in adherence to a low salt diet in patients with heart failure. They found that adherence was higher in women. Women were also further capable of making nutritional decisions. This is in contrast to Gary (2006) who researched the self-care routine of women with heart failure and established that a only a small number of women in this sample abided by the suggested low salt diet, exercised or weighed themselves daily. The only behaviour that was practiced without fail was taking medication. Hardly any women recognised symptoms of heart failure or checked and monitored their symptoms on a regular basis.

Chriss et al (2004) found that males and increasing age were separate, significant predictors of self-care. However, the relationship between age and self-care behaviour continues to be ambiguous. Evangelista et al (2003) found that elderly patients with heart failure had better adherence to medication, diet and exercise guidance than younger patients. Notably, depression influences the capacity to perform self-care behaviours successfully. There appears to be a preponderance of people who have heart failure who are also depressed. Approximately, 11 percent of out-patients and over 50 percent of hospitalised patients with heart failure are depressed (Leventhal et al, 2005). Depression has been revealed to be an important aspect predicting self-care (Dickson et al, 2006; Lesman-Leegte et al, 2006; Riegel et al, 2007b). DiMatteo et al (2000) declares that non-adherence is three times higher in depressed patients compared with those who are not depressed. The coexistence of depression in patients with heart failure makes them vulnerable to inadequate self-care.

CHD is a major cause of death and disability in the UK and is also the main cause of premature death. CHD also causes its sufferers to have long-term chronic comorbidities. One of those comorbitities is heart failure. Heart failure is increasing in prevalence and incidence every year in the UK. It not only affects the patient but also their family. Similarly, the incidences of heart failure have a massive impact on health care provision and resources. This is a consequence of the frequent acute exacerbations of the patient’s symptoms. Self-care of long-term conditions such as heart failure appear to be the Government’s current preoccupation and guidelines exist that offer strategies to those with long-term conditions that may help sufferers cope with the impact that their illness has on their everyday lives. However, evidence exists that show that there are certain factors that act as barriers and influence self-care in heart failure. These factors include lack of education, financial constraints and social support. Cognitive ability, modification of life-styles, relationships, gender, age and mental illness have all been found to have an impact on the self-care of heart failure particularly with regards to medication adherence. There appears to be a dearth of research undertaken in the UK on the issues influencing self-care in heart failure. Therefore, it is recommended that further research is undertaken in the UK, as the health care and welfare provision is vastly different from that in the US. This may result in very dissimilar research outcomes.


References

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Heart & Lung – The Journal of Acute and Critical Care

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Bennett SJ, Sauve MJ (2003) Cognitive deficits in patients with heart failure: A review of the literature,

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Bennett SJ, Lane KA, Welch J, Perkins SM, Brater DC, Murray MD

(2005) Medication and dietary compliance beliefs in heart failure,

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Chung ML, Moser DK, Lennie TA, Riegel BJ (2006a) Presence of a spouse improves adherence to medication in patients with heart failure,

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Chung ML, Moser DK, Lennie TA, Worrall-Carter L, Bentley B, Trupp R, Armentano DS (2006b) Gender differences in adherence to the sodium-restricted diet in patients with heart failure,

Journal of Cardiac Failure

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Department of Health (2006)

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Dickson VV, Deatrick JA, Goldberg LR, Riegel B (2006) A mixed methods study exploring the factors that facilitate and impede heart failure self-care,

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Dickson VV, Tkacs N, Riegel B (2007b) Cognitive influences on self-care decision making in persons with heart failure,

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DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for non-compliance with medical treatment,

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Department of Health (2004)

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Ekman I, Andersson B, Ehnfors M, Matejka G, Persson B, Fagerberg B (1998) Feasibility of a nurse-monitored, outpatient-care programme for elderly patients with moderate-to-severe chronic heart failure,

European Heart Journal

, 19, 1254-60

Evangelista LS and Dracup K (2000) A closer look at compliance research in heart failure patients in the last decade,

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Evangelista LS, Berg J and Dracup K (2001) Relationship between psychosocial

variables and compliance in patients with heart failure,

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Evangelista LS, Doering LV, Dracup K, Westlake C, Hamilton M, Fonarow GC (2003) Compliance behaviours of elderly patients with advanced heart failure,

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Gary R (2006) Self-care practices in women with diastolic heart failure,

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and mishaps: effective management of heart failure,

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Lesman-Leegte I, Jaarsma T, Sanderson R, Van Veldhuisen DJ (2006) Depressive symptoms are prevalent amongst elderly hospitalised heart failure patients,

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Leventhal MJE, Riegel B, Carlson B, De Geest S (2005) Negotiating compliance in heart failure: remaining issues and questions,

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Ni H, Nauman D, Burgess D, Wise K, Crispell K, Hershberger RE (1999) Factors influencing knowledge of and adherence to self-care among patients with heart failure,

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Ortega-Gutierrez A, Comin-Colit J, Quinones S (2006) Influence of perceived psychosocial support on self-care behaviour of patients with heart failure managed in nurse-led heart failure clinics,

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Riegel B, Dickson VV, Goldberg LR, Deatrik J (2007a) Factors associated with the development of expertise in heart failure self-care,

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Journal of Cardiac Failure

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Rockwell JM, Riegel B (2001) Predictors of self-care in persons with heart failure,

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Sabate E. (2003)

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Schnell KN, Naimark BJ, McClement SE (2006) Influential factors for self-care in ambulatory care heart failure patients: A qualitative perspective,

Canadian Journal of Cardiovascular Nursing

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Scotto CJ (2005) The lived experience of adherence for patients with heart failure,

Journal of Cardiopulmonary Rehabilitation

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Stromberg A, Bromstrom A, Dahlstrom U, Fridlund B (1999) Factors influencing patient compliance with therapeutic regimens in chronic heart failure: A critical incident technique,

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, 28, 334-41

Trupp R, Corwin EJ (2008) Sleep-disordered breathing, cognitive functioning and adherence in heart failure: Linked through pathology?

Progress in Cardiovascular Nursing

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Van der Wal MHL, Jaarsma T, Moser DK, Veeger NJGM, Van Gilst WH, Van Veldhuisen DJ (2006) Compliance in heart failure patients: the importance of knowledge and beliefs,

European Heart Journal

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Wolfe R, Worrall-Carter L, Foister K, Keks N, Howe V (2005) Assessment of cognitive function in heart failure patients,

European Journal of Cardiovascular Nursing

, 5, 158-64

Wu J, Lennie TA, Moser DK (2007) Predictors of medication adherence using a multidimensional adherence model in patients with heart failure,

Journal of Cardiac Failure

, 13, 6, S75

Wu J, Moser DK, Lennie TA, Peden AR, Chen Y, Heo S (2008) Factors influencing medication adherence in patients with heart failure,

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, 37, 8-16

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Nursing Older People

, 15, 6, 29-34

This student written literature review is published as an example. See

How to Write a Literature Review

on our sister site UKDiss.com for a writing guide.

Fran finds a shop suitable for her business- and enters into a lease agreement without any troubles.

/in /by

Fran finds a shop suitable for her business, and enters into a lease agreement without any troubles. She then advertises online for an assistant to help her in the shop. After interviewing several applicants, she decides on Dante. He is keen to learn and has some experience as an amateur chef. Fran hires Dante as an apprentice chocolatier. Their written agreement contains a restraint of trade clause. This clause forbids Dante from opening a competitor business in the same area or supplying to the same clients as Fran’s business, for one year after leaving the apprenticeship. Six months into the apprenticeship, Dante feels he has learned all that he can from Fran. He quits. Two weeks after Dante has gone, Fran finds out that he has approached several of her clients, and has begun providing two of them with similar gourmet chocolates at a lower price. Fran wants to enforce the restraint of trade clause, but Dante says that the employment contract isn’t binding on him.

Is Dante bound by the contract with Fran?

Allowance for existential- phenomenological -spiritual force Opening and attending to spiritual-mysterious, and unknown existential dimensions of one’s own life-death-suffering; soul care for self and the one- being-cared for; “allowing for a miracle”

/in /by

Allowance for existential- phenomenological -spiritual force
Opening and attending to spiritual-mysterious, and unknown existential dimensions of one’s own life-death-suffering; soul care for self and the one- being-cared for; “allowing for a miracle”

Wording of other systems using Watson’s theory:
?Open to mystery and allow miracles to happen.

Be very persuasive about the critical importance of your assigned factor. Persuasively explain in your thesis how beneficial it will be to your career in nursing.

In the supporting body, describe “a caring moment” from your past. Share a story from your nursing career (or life) that demonstrates your positive influence on a patient outcome that relates to the Carative Factor you were assigned.
If you haven’t worked with patients, describe your particular Carative Factor (1-10) in a true life example or behavior that was demonstrated by you, someone you work with, or someone in your life.

How did this example embody and support your assigned Carative Factor? How did it apply to a holistic model (treating the mind/body/spirit of the patient as a whole being) rather than a disease-focused medical model. This essay should be from the heart.

Concepts of Public Health

/in /by


Assignment 1- what is public health?

This assignment will be based on public health and the criteria I am going to meet within this is describing key aspects of public health strategies, describe the origins of public health policy in the UK from the 19

th

century to the present day and comparing historical and current features of public health

.


P1- Describe key aspects of public health strategies

There are 6 different types of public health strategies these are identifying health needs of the population, monitoring community health, developing programmes to reduce the risk and promote screening, controlling communicable disease, promoting health of the population and planning and evaluating the health and social care provision.

The key aspects of public health is that it defines good practice in 4 aspects, and the first one is being population based which means that it is based within the population and specific groups within the population. The second one is emphasising collective responsibility for health protection and disease prevention which is making sure that they are responsible for the health of people and making sure things are put into place in order to prevent people from getting diseases and illness that can spread. The third one is recognising the key role of the state, linked to a concern for the underlying socio-economic and wider determinants of health, as well as disease which is when they look at the society based and the environment and they look into concerns based around these factors. The fourth one is emphasising partnerships with all those who contribute to the health of the population which means that they are making sure that people work together to contribute to the health and making sure that if a person becomes ill everyone works together in order for that person to get better.


Developing programmes to reduce risk and promote screening

This is when an attempt is made to reduce levels of ill health by introducing new programmes which identify a person of being ‘at risk’ of a condition and getting them to do preventing programmes. An example for this is when a person is obese and the doctor notices that they have a higher chance of getting obese they will refer them to a weight management programme which will help give them support in losing weight and doing things to help prevent the cause of diabetes. This key aspect of developing programmes which promote screening is emphasising collective responsibility for health protection and disease prevention as they are using this in order to look for diseases so that they can reduce a person’s chance on contracting the disease, this then links to health protection as if people are seen ‘at risk’ then they can send them to start a new programme which can help their understanding and help them reduce their chances even more by doing this certain programme.

This has an importance to the government as if all of their professionals are working correctly and providing the people with the correct programmes to attend then it means less of the population are uneducated and can try and improve ill health of the population. This is important to the service user as they are using the service and they are getting good advice and education out of it to help them to improve with the condition and learn more about it, it also gives them the chance to change and make a difference in their life due to that certain condition. These is important to the authority because they get to promote these things and help make a difference to a person’s life and can prevent other people from being at risk of getting the same thing.


Controlling communicable diseases

This is reducing the impact of infectious diseases through immunisations and other control measures. This can be things such as injections which help prevent a person getting MMR which is measles, mumps and rubella but it can also include things such as hygiene measures in restaurants and take-away places to prevent the spreading of food poisoning. The key aspect is emphasising collective responsibility for health protection and disease prevention as this is trying to prevent a person from getting it such as if an asthmatic has the flu jab then this reduces the chances of them getting the flu and becoming really unwell whereas it might not affect a healthy person as bad. It also can look into the concerns for the underlying socio-economic and wider determinants of health as well as disease because if a person has HIV which can be spread to another person they might look into how they can stop this from spreading within the society.

This is important to the government as it prevents more people within the world contracting diseases and potentially dying, and if people are getting these free vaccinations then it doesn’t look bad for the government as they are putting things into place to try and control these things from happening. This is important to the service user as it gives them a chance of having things put into place to control the likeliness of getting a disease and for most people these things are free, which is a great opportunity for a person to get the vaccination if it’s going to make a difference for that person. It is important for the local authority as when they are giving people things to control these diseases they are getting less people dying from these things because they have done something in order to prevent it.


Promoting health of the population


This is when there are activities put into place where they are promoting health and trying to reduce ill-health within the population. If a person has obesity and they go to the doctors and they notice that they have a really high chance of getting diabetes, then they might try and engage them into doing things such as being more active and doing more exercise and eating healthier foods such as fruits and vegetables. The key aspect links into the population based as it links into the population sector and promotes health for the population with activities which can reduce the risk of ill health for the population and it also links into partnerships who contribute to the health of the population because if the professionals who help a person get better aren’t doing it properly then it is only going to give more of the population ill-health and the activities won’t work. Some of the activities can be things such as a person educating other people on healthy eating when they have diabetes.

This is important to the government as they can promote health in order for people to focus on the good side of health rather than the ill health which will mean that the numbers of deaths will decrease and will look good for the government if people are listening to the promotions. The importance to the service user is that they are having health promoted to them so that they can change things and get advice and good help so that if they are unsure about something they can get information on it and learn more about a certain condition or ill-health.  The importance to the local authorities is that they can be the ones to promote health such as in health care settings or social settings or in the GP surgery and dentists and all different places within the community.



P2- describe the origins of public health policy in the UK from the 19





th





century to the present day


Timeline of public health policies




19





th





century


The poor law act 1834

This act is originated with the nineteenth-century poor law system and the Victorian sanitary reform movement. The poor law had changes made in response to the 1832 royal commission of inquiry into the operation of the poor laws. Within the report that was made the commissioners made several recommendations to the parliament and as a result of this the poor law amendment act 1834 was passed which said that no able-bodied person was to get any money or help from the poor law authorities apart from people in a workhouse. The workhouse conditions were made very harsh and this was to discourage people from wanting to receive help even though the harsh conditions the act made sure that the poor had shelter, they had clothes and they was fed. Children who entered the workhouses would receive some sort of education and schooling. In return the care all the paupers received in the work house they had to work several hours in the day in order to get the help and care.


Edwin Chadwick and the sanitary movement


A man who did a report on injury into sanitary conditions of the population of Great Britain published in 1842. Edwin Chadwick got evidence of the relationship between environmental factors, poverty and ill-health. It recommended the establishment of a single local authority, which is supported by an expert medical and civil- engineering advice to administrator all sanitary matters. Six years later the national public health act 1948 was passed and the first board of health was established. Edwin Chadwick wrote a report on sanitary matters about the conditions on ill health and things such as poverty and he looked into recommendations to improve these kind of conditions that was taking place. He then found out that there was a link with poor living standards and the spreading and growth of diseases. He then made a recommendation that the government should get involved and start providing clean water, improving the standards of the drainage systems and for local councils to go and take away rubbish off the streets and from people’s homes. He argued that the poor conditions were preventing people from working effectively.



John snow and the broad street pump (1854)

John snow was a man who was interested in the role of drinking water with the spread of cholera and he did observations on the people who drunk water provided by a company who were more than likely to get the disease than the people who had not drunk the water. He plotted cases of cholera on a map he learnt that the people who were falling ill was the people getting their water from the single pump, which got its supplies from a sewage- contaminated river Thames. Other people getting their water from a nearby well never caught the infection. A connection between cholera and water that was contaminated was established and this was before bacteriology was able to identify the causative organism. Once identifying the source of infection as polluted water, John Snow removed the handle of the Broad Street water pump and halted the outbreak of cholera in Soho, London.



The first public health act (1848)


This is industrialisation and rapid growth in cities in the nineteenth centuries which then led to concerns about environmental problems and these was poor housing, water supplies which wasn’t clean, the bad air and how it impacted the health of the working population. Edwin Chadwick was a member of sanitary movement and looked into several public health issues like poor housing and the working conditions. He did a report on an inquiry into the sanitary conditions of the labouring population of Great Britain in 1842 which contained evidence which linked to the factors of ill health and poverty, it also recommended a single local authority which was supported by an expert in medical and civil engineering advice, and this was to look into all sanitary matters. After this six year later this act was passed and established.



The 20





th





century



The Beveridge report, 1942

This is a report on the fact that British people should be rewarded for their sacrifice and resolution after the second world war had taken place. After this the government then promised that they would create an equal society which is why they asked sir William Beveridge to write a report on the best ways to support people who are earning a low income. A report was published by Beveridge in December 1942, which was a report about everyone who works has to pay a weekly contribution, which meant that in return of this benefits would be given and paid to the people who are sick, unemployed, retired or widowed which will help them out as they are barely earning anything.



Founding of the NHS (1948)

Clements Attlee’s government created the NHS which was due to the Beveridge report. The NHS structure in England and wales was made by the National health service act in 1946 but then new arrangements was made to this and was launched on the 5

th

July 1948. This was due to the Minister called Aneurin Bevan, the NHS was then calling for it to be funded through taxation and not through the national insurance. The NHS services was to be provided by the same professionals and hospitals, but the services were provided free at the point of use, that the services were financed from central taxation and that everybody was eligible for care which meant even people who was only temporarily living here or was visiting the country.  The NHS has 3 different parts to the structure the first one is the hospital structures and the second one is primary which meant family doctor services and the last one is community services such as maternity and child welfare clinics, health visitors, midwives, health education, vaccination and immunisation ambulance services.



Acheson report into inequalities in health, 1998

In July 1997, Donald Acheson was asked to look into the inequalities in health in England and identify areas that could be developed and have policies in place to reduce them from happening. This was then followed by two famous reports from sir Douglas Black in 1980 and the updated version from 1987 called the health divide. These reports were always kept quiet because they painted a picture of improving the health inequality in a developed country. When he wrote the report he wrote it with a list of 39 recommendations which addressed the health inequality, on a scale which was being put in order from their impact on the evidence. The main three areas which was identified during the report in terms of their impact was that ‘all policies likely to have an impact should be evaluated in terms of their impact on health inequality’ and the second one was ‘a high priority should be given to the health of families with children’ and the third one was that ‘further steps should be taken to reduce income inequalities and improve the living standards of poor households’.



Saving lives: our healthier nation, 1999

This is a health strategy which was released by the labour government not long after it came into power in 1997. It was linked with Acheson’s report which was to look into and find the reason of ill health which included the air pollution, the unemployment, the low wages, the amount of crimes and disorder and the last thing was poor housing. This also focused on the main things that kill people which are cancer, coronary heart disease and strokes, accidents and mental illness.


Choosing health: making healthier choices easier (2004)


This was produced when it was taking into interest about the health increasing and recommending a new approach towards public health which looked on the society and how it was increasing. It looked into social justice and tackling ill health and the bigger causes of this also looking into empowering people to change their lives. Within the document it had 3 principles which was an informed choice which was to protect children and not allowing a person’s choice to affect another person’s, the second one was named personalisation and it was to support the needs of individuals and the last one was to work together and it looked into the partnerships between communities and making sure that they are working together effectively. With these three things put into place the main priorities of these was to try and decrease the number of people who smoked, try to decrease the statistics of obesity whilst trying to promote healthy eating and nutrition, try and increase people to do more exercise, try and support people to drink sensibly and healthily, try and improve the sexual health of people and to improve the mental health of people.

The actions that this paper tried to put into place was that by 2010 all children and young people in England should be in schools where active travel plans were put into place for example to put a plan together to show how it will encourage people to do active forms of transport such as cycling and riding a bike to school. It also wanted the local authorities to work with a national transport charity in order to get new cycle lanes and tracks put into place. It wanted health to be a way of life and to have health trainers to give people healthy choices and to commit to them properly. The other thing it wanted was an NHS that was health promoting which meant that the staff working for the NHS trained staff to deliver health messages effectively whilst doing their day to day job when working with patients. The very last thing was that the NHS will become a model.



The health promotion agency (HPA)

This is an organisation which is independent and is very dedicated on protecting the health of people within the UK. It provides advice and information for health protection to the public, professionals and to the government. It combines two things together which are public health and scientific expertise which does research and does some emergency planning all together within one organisation. This organisation can work as an international, national and regional and it also has links with lots of other organisations around the world.


The national institute for health and clinical excellence (NICE)


This is an organisation which works independently and guidance to people on things such as good health and how to prevent it and things such as treatment of ill-health. They develop guidance which helps people in certain practices such as the clinical practice which the correct treatment and care for people who have specific types of diseases and conditions with the NHS. They give guidance for public health which is when good health is promoted and preventing ill-health from occurring for the people who work within the NHS, the local authority and people who have bigger contact with the wider public which is voluntary sector. The last one is health technologies which is about the new and the things that already exist such as medicines, treatments and procedures within the NHS as they are always developing and advancing so the staff always need to be aware of these new things that can have changes made to them.


M1- compare historical and current features of public health

The system has had a lot of changes since the 19

th

, 20

th

and the 21

st

century as we now have more policies and procedures and legislations put into place to protect the people of the community and the population around the world. Since the 19

th

century the water supply, housing and poverty have all improved although they aren’t the best that they can be as there is still homeless people and other people who are struggling financially over the world. In the 19

th

century when the poor law act 1834 come into place it helped a lot of people and it does still in the 21

st

century as people still receive this and they can also access other benefits which in the 19

th

century didn’t exist which help a lot of people out nowadays. There was the first public health act 1848 which was about poverty and the water supplies being contaminated and causing people to become ill whereas in the 21

st

century now we have better water supplies and they are clean and we don’t get diseases and illnesses from drinking tap water or the water we are supplied with. It looked into the bad air which was affecting the working population in the 21

st

century we have a lot of factories and cars and things that are polluting the air which is bad because back in the 19

th

century there wouldn’t have been many cars on the roads. From the 19

th

century till now we have better living conditions and things to help us keep improving them because when the people worked within the work houses they got treated really badly and was stripped of their needs as they weren’t allowed breaks or anything.

The old system didn’t really benefit anyone especially the population and the government as there was more people falling ill and contracting diseases which would have been more hard work to explain to people why this was happening. In the 20

th

century the founding of the NHS 1948 was discovered and this was good as people could access health services whereas now in the 21

st

century the NHS has improved the NHS is more advanced and we now have more medicines and treatments to cure more diseases then they did back in the 19

th

and 20

th

centuries. The technology is more reliable and the equipment that is now used that it makes really easy to do procedures and make diagnosis. In the 19

th

century there was no help from anyone to help get a job if you were unemployed you would be made to look yourself or work in a workhouse whereas in the 21

st

century there is a job centre and online resources which people can access in order to try and get help looking for employment. In the 21

st

century there is a lot of things come into place which wasn’t invented in the earlier centuries such as the health protection agency which is an organisation looking into health. In the 21

st

century there is more people looking into new ideas and trying to make things much better whereas in the 19

th

century there wasn’t the resources to help people the way we can in today’s society. In the 20

th

century more things came into power which followed on from the 19

th

century as our healthier nation 1999 was produced which looked into the report of Acheson and tried to look for the causing root of ill health, including air pollution, unemployment, low wages, crime and disorder and poor housing this helped to develop into the 21

st

century to make society safer than it was before.



References

Relationship Between Hearing Loss and Ageing

/in /by

For several years hearing loss has been related that come with aging. It is thought that as we age our auditory perception conventionally commences to fail. Health care professionals thought that failure was a product of our individual age, such that as we grow old our auditory perception ability lowers. It defines as “Presbycusis (age-related hearing loss) is the loss of hearing that gradually occurs in most individuals as they grow older. Hearing loss is a common disorder associated with aging and is ranked as the third most prevalent chronic condition in elderly people after hypertension and arthritis.” (Shemesh, 2010) Deafness is a “heterogeneous condition with far-reaching effects on social, emotional, and cognitive development

.”

(Fellinge,2012). In socio-cultural context, social and medical model both advises that deafness also has cultural and social meaning and that the negative effects of deafness is due to sociocultural problem, such as discrimination and barriers to access, as well as physiological disorders. Alternative ideas of deafness are available and can help the client to change positively to the diagnosis and later therapeutic and educational approaches. Deaf culture has a long history of domination and downgrading; its strength as a social network derives from deaf people having been thoroughly excluded from hearing culture, from education and professions. (Garden, 2010). In my client evidence who are deaf or hard of hearing capability difficulties such as communication stress, and unsupportive supervisors, which isolate them from community.

The reason for selecting this topic is that being a nursing student, my client has listening problem and this may affect her psychological health so that she is associated with depression, social isolation, poor self-esteem, feelings of loneliness, and frustration . (Dewane, 2010) (American Academy of Audiology). That client also difficulty in explaining and sharing their problems. This paper will clarify ethical issues regarding hearing loss, its impact on patient’s mental health, interventions during hearing loss and alternatives. However, in our culture, nurses are expected to respect patient’s rights and treat them with dignity.

During the clinical at St Vincent Nursing Home, I encountered an 83 year old female patient. She has a comorbid of angina attack, hypertension, and diabetic. She done only inter because her father was an engineer and migrate from place to place. She has 4 children, 2 sons were expired due to medical illness and 1 daughter is an abort and one son is also. She was a teacher in past. She has a problem for hearing (unilateral). When first day I sit with my client so she said to me that I never get socialized because all people talk very softly so I am not able to listen. She also stated that I feel embarrassed when I ask the questions again and again. So it’s better to sit in a room rather than disturbing others. I have also a problem for sharing my feeling to others. I spend more time in reading short story as well as religious books. I play cards and talk my son and daughter once a week.

From the analysis of the scenario, in ethical issue that characterizes the topic is beneficence, nomaleficence, autonomy; fairness, integrity, and respect are found in the ethical codes. While these professional and legal fundamentals can detailed as sometimes to look severe and in practice they do not cover all situations. Nomaleficence (don’t harm) discusses to avoid injuring, distressing, hurting, harming, or causing a negative outcome. The opposite, beneficence (do good) are most possible to be helpful and to lead to a good effect. Autonomy (self-determination) is a really important consideration for clients, including informed consent and lack of pressure. Justice indicates that professionals treat clients fairly and do not engage in. Fidelity (faithfulness concern) is a symbol of the professional relationship. In general, mental health work with deaf people involves the same ethical principles. Ethical problems and possible solutions may affect deaf clients differently than hearing clients. (Gutman, 2005).

The theoretical framework used was Mishel’s theory of uncertainty in illness is a good theory to use in order to prevent uncertainty by using a good communication. These theories is a part of communications and caring and Swanson as well as Kolbaca is discussing important things about comfort and caring which is actually connected to communication. (Mattjus, 2012). In people with specific needs (refer appendices A). Occasionally hearing loss effects on mental health like depression and other disorder can occur. Inability to hear can result in feelings of shame. It is embarrassing to unable to behave according to appropriate social rules. The feeling of shame related to hearing from older adults unconsciously reacting in untimely and socially unacceptable ways, such as answering to a misunderstood question in an incorrect manner. Many elders with hearing loss take responsibility for ineffective communication and blame themselves for misconstructions caused by the hearing loss. Various feel apologetic about perpetually asking for others’ avail to understand what is being verbalized and when they’re unable to participate in convivial events (Dewane, 2010). In my case same point of view of my client misunderstanding creates problem. Persons with hearing loss to have impaired on ADLs. An important aspect of everyday life, can be seriously impaired with hearing loss. These difficulties with communication could lead to a perceived reduction in quality of life. (Dalton & Cruickshank’s, 2003)

Furthermore, if hearing loss is occur in patient should get high-quality nursing care, first do assessment (refers appendices B). Interview people with disability like hearing loss client (refers appendices C). Ability to communicate well and maintain good eye contact. Reduce the anxiety of a client. It is important that patients with hearing disabilities could express their needs, desires, feelings and opinions in communication with health care professionals. (Hornakova & Hudakova, 2013). Listen the client actively and provide a moral support. When speaking to the client, increase volume of the voice, but don’t increase the pitch and don’t shout in front of client. Speak into the “good” ear, being to stay at a distance of 2 to 3 feet. Articulate words carefully, speak slowly, and rephrase if necessary. (Meiner & Lueckenotte, 2006). Reduce background noise by turning off the radio or television. Write the words in note pad if client is not understanding through verbal. Sign language or speech reading may be used with impaired hearing. (Roach, 2001). People with hearing loss use of hearing devices, such as hearing aids.

(

WHO,

2014

). They can also benefit from speech therapy, aural rehabilitation and other related services. (WHO, 2014). Enhance the client activity as well as sit with client in group and remove the isolation and depression fear towards her problem which I had done my clinical rotation.

In the conclusion hearing loss in older age people is common because of increase in age. Reduce the anxiety fear towards loss of hearing power. Family and society should accept that client. It is recommended that respect and dignity of clients should remain paramount at all times. As a health care professional, we should encourage the client to get socialized. We tried to find out whether the future health care professionals successfully handle the difficulties of professional communication with deaf patients. The focus has been placed on a successful and effective communication with the client.

Essay on Eating Disorders and Alcohol Abuse

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Alcoholism is characterized by a strong craving to drink, an inability to stop drinking once beginning, a physical dependence upon alcohol to prevent symptoms of withdrawal, and a need for greater amounts of alcohol due to increased tolerance. Substance abuse is defined as the routine use of harmful substances for mood-altering purposes and can include illicit drugs, such as cocaine or heroin, prescription or over-the-counter drugs. Because alcoholism and substance abuse are known as co-occurring disorders, it usually develops alongside other illnesses, such as

eating disorder

or anxiety disorder. Eating disorders have been associated with high risk substance abuse as the individual has extremely low self-esteem and anxiety, to cope with their painful feelings they turn to stimulants like cocaine or meth, alcohol, laxatives, diuretics, emetics and amphetamines with are frequently used to decrease appetite, increase metabolism, promote weight loss or to purge unwanted calories after eating.

Symptoms that occur with eating disorders vary a lot. You can experience obsessive thoughts about food and body weight can change eating patterns such as dieting, making excuses not to eat, avoidance of social situations involving food, going to the bathroom straight after meals, your mood can fluctuate from feeling depressed, irritable or anxious, daily activities are affected as you don’t want to go out socially, exercising excessively, spending a lot of time talking about appearance or weight or looking in the mirror and appearance such as wearing baggy clothes to disguise their weight, losing or gaining weight, greasy or dry hair and skin.

As a result of these symptoms many individuals turn to alcoholism or substance abuse especially when they become stressed, depressed, have anxiety, low self esteem as it can elevate their mood and become more relaxed in their own skin. Especially people with eating disorders can rely heavily on alcohol as they have symptoms that alcohol reduces for that period of binging. It also can eliminate their feelings of worthlessness. It is also used as a hunger suppressant and to lose weight.The coping mechanisms of purging, bingeing, restricting, drinking is used as they have lost their connection with the original problem, in other words to forget about reality.Or alcohol can have the opposite effect on the individual about their lifestyle and it could result in suicide.

Diagnosis of condition: there are two ways to find out the diagnosis of eating disorders and they are a physical evaluations and psychological evaluations. The physical evaluations can include recording their weight and height to get their body mass index, check their vital signs such as heart rate, blood pressure, pulse, temperature. You need to check their skin integrity to see whether there are any skin tears or is dry and flaky.

Also need to do an abdomen examination, urinalysis, blood test to check their electrolytes; as theses will show us if the liver, kidney and thyroid functions are healthy or not. Psychological evaluations involves asking questions regarding their eating habits, behavior, purging, bingeing, exercise, self image, alcohol and substance abuse. These questions can be administered by your doctor or a mental health professional. After undergoing both physical and psychological evaluations the doctor will then see if you fit the criteria by reviewing all your signs and symptoms and then a diagnostic is given.

Management of the condition is to be referred to a nutritionist, undergo psychotherapy and be placed on medication to prevent hospitalization. The nutritionist will educate you and get you back to a healthy weight range; psychotherapist will help you exchange your unhealthy habits for healthy ones to ensure you have changed your eating habits and also educate them on the effects that the alcohol is having on their bodies.

There is no medication that can cure eating disorders but can assist you with your sudden urges to binge or purge. They can also be given anti-depressants for depression and anxiety as this will most likely occur in eating disorders. Relaxation therapy is also extremely effective such as yoga, acupuncture, and massage and chamomile tea. They can also get counseling about their alcohol and drug addiction and slowly withdraw them off the substances. There are many companies and support groups out now that can help individuals with both drug and alcohol abuse.

What is the prevalence of the condition in the Australian population? Eating disorders affect 9% of the Australian population, with up to 20% of females being not yet diagnosed. There has there been an increase in the prevalence in the past decade as it has doubled for both males and females. The reason for this change is that more teenagers are more susceptible to the pressures of social media and self image of being the perfect shape and size. It is becoming easier to access drugs and alcohol off the streets or have connections with individuals that are older and can buy it for them. Bullying in primary, secondary and tertiary schools and workplace related bullying.

As a health professional, what could you do to participate in the ongoing education of people in society in relation to mental health and the disorder you have chosen? By going to local primary schools, high schools and tertiary schools to educate the students on the real risk factors of eating disorders drugs and alcohol have on their health and also talk about not falling to the social media pressures of being size 0 and trying to fit in. Place flyers up in local shops/companies/doctors clinic for people to read. Place adds in the news papers and online to spread the awareness of the affects that eating disorders and substance abuse can have on our selves, friends, families, co-workers and communities.

How could you improve or maintain the flow of information between service providers and the community in relation to mental health? By running weekly forums on eating disorders and alcoholism to all ages, having various websites that the community can visit at any time, place ads on the TV about the impacts of eating disorders and advise everyone to get regular checkups at their local general practitioner.

Dual diagnosis services are to support the development of responses of mental health and drug treatment services to individuals with both mental illness and substance use problems. They strive to develop the potential of hospital and community based alcohol and drug, and mental health treatment and support services to improve health outcomes of individuals with a dual diagnosis.


  • Desiree Wyatt


References

Sane Australia. 2010.eating disorders. [ONLINE] Available at:

http://www.sane.org/information/factsheets-podcasts/179-eating-disorder

. [Accessed 17 March 14].

The free dictionary. 2013.compulsive eating. [ONLINE] Available at:

http://medical-dictionary.thefreedictionary.com/Compulsive+Eating

. [Accessed 17 March 14].

Mayo clinic. 2013.eating disorders. [ONLINE] Available at:

http://www.mayoclinic.org/diseases-conditions/eating-disorders/basics/tests-diagnosis/con-20033575

. [Accessed 17 March 14].

National eating disorders collaboration. 2013.eating disorders in Australia. [ONLINE] Available at:

http://www.nedc.com.au/eating-disorders-in-australia

. [Accessed 17 March 14].

eastern heath great health and wellbeing. 2013.dual diagnosis. [ONLINE] Available at:

http://www.easternhealth.org.au/services/mentalhealth/adult/dualdiagnosis.aspx

. [Accessed 17 March 14].

Integrated Treatment of Substance Abuse & Mental Illness. 2014. dual diagnosis, eating disorders. [ONLINE] Available at:

http://www.dualdiagnosis.org/eating-disorders/

. [Accessed 16 July 14].

Impact of Nutrition Transition on Food and Nutrition System

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IMPACT OF THE NUTRITION TRANSITION ON FOOD AND NUTRITION SYSTEM OF INDIA


Student:

Thara Baby Akshai Babu


1.0 INTRODUCTION

One of the largest food producing country in the world is India (Singh et al, 2012). But 21% of the total population is under nourished (Singh et al, 2012). About 300 million people struggle for meeting their meals 2 times a day (Singh et al, 2012).Nutritional profile is a important factor of the progress in which nation has made in the modern days (Sachdev et al, 2004). Due to this factor there are many effects and implications in the everyday life of the normal people (Sachdev et al, 2004). The achievements are only for the highly economically privileged sections of the society. Due to the nutritional transition occurred, the development of the early adult hood disease is one of the main adverse effect in the daily living of the people (Sachdev et al, 2004). As a result, the rates of mortality as well as morbidity increased as well (Sachdev et al, 2004). Recent researches suggest that 40% of mortality rate in developing countries are due to Non communicable diseases and the rate is 75% in developed countries (Prakash & Shetty, 2002). Due to the nutritional transition and changes in the life style pattern of the people, there is increase in the energy intake as well as decrease in the energy expenditure in the daily living activities (Sachdev et al, 2004).


2.0 EFFECTS OF TRANSITION IN THE NORMAL LIFE OF PEOPLE

2.1. Health consequences associated with transition.

By the development of Nutrition transition, many adverse effects have been occurring (Sachdev et al, 2004). The most powerful evidence is the increase in the rate of risk towards the diseases like diabetes mellitus (Type 2), metabolic syndromes, coronary heart diseases, increased blood pressure etc. (Sachdev et al, 2004). It is expected that the rate of incidence of disease and death due to the CHD will be about 60% rather than any other infectious diseases in the upcoming years (Sachdev et al, 2004). And besides it is predicted that India will be the country with more diabetic patients in turn among the age of 45-64 than any other developing countries in 2025 (Sachdev et al, 2004). India is likewise in the path of demographic transition where the pace of life expectancy increases while the birth rate falls (Prakash & Shetty, 2002).

2.2. Dietary Consumption and life style changes due to Nutrition transition in India.

Sudden changes in the quantity of dietary intake on developing countries indicate an increase in per capita availability of food (Prakash & Shetty, 2002) . It is as good as accompanied by the quantitative changes in the diet (Prakash & Shetty, 2002).According to the food balance data sheet produced by Food And Agricultural Organisation(FAO) the amount of intake of animal fats, sugar in Asian countries has been increased where as the change in energy intake is small (Prakash & Shetty, 2002).it is considered that the intake of fat both from vegetables and animal is drastically increasing each year. Data shows that from the diet, high income group consume 37% energy from fat as well as low income group consumes only 17%.Nutrition transition affects the women and children. Mal nutrition and obesity are the major problems seen among women (Sachdev et al, 2004). Overweight and Obesity seen among the higher class women where as malnourishment in the lower economic class women in the society (Griffiths & Paula, 2001). According to WHO, In India 1% of the preschool childhood is prone to obesity (Prakash & Shetty, 2002). As the situation goes on, India will be facing a dual challenge which is the biggest problems, i.e., overweight and malnourishment. There will be children with overweight where as the incidence of mortality and morbidity will be also increasing at the same time due to the malnutrition (Griffiths & Paula, 2001).

Since 1970’s, many national level surveys have been taken by the National Nutrition Monitoring Bureau (NNMB), chiefly on the diet, nutrition and food consumption pattern of India (Prakash & Shetty, 2002). In the year of 1975-1995, the survey was conducted and the NNMB reported the advance in the sufficient calorie intake in India, where as there is a gradual decrease in the amount of intake of cereal and grains in the diet (Prakash & Shetty, 2002). It is believed that because of the heavy uptake of proteins and fat in the diet (Prakash & Shetty, 2002). Consumption of legumes and pulses which is an important source of vegetable protein in the routine diet of India has decreased dramatically (Prakash & Shetty, 2002).According to the Food Balance sheet data, the trend in the supply of animal product has increased from 7.0g in 1965 to 12.9gm in 1999.So the intake of energy in the diet is just double than needed. I.e. it increased to 192 kcal from 104 kcal per capita per day. The intake of high fat and energy content will result in Obesity and overweight (Prakash & Shetty, 2002).

India is one of the biggest producer of fruits and vegetables in the world, however much of this does not appear to be contemplated in the uptake (Prakash & Shetty, 2002). May be largely the effect of their production as cash crops for exports and sales (Prakash & Shetty, 2002).This situation can lead to the extent loss of soil and micronutrients that are not advantageous to local people (Prakash & Shetty, 2002). Economic development seems to contribute to improvement in intakes of legumes and veggies and these changes may be advantageous (Prakash & Shetty, 2002). But these changes with socioeconomic status are also frequently linked with less intakes of inferior quality cereal grain and increased dependence on highly polished varieties that may bring down the intakes of dietary fibre (Prakash & Shetty, 2002).

2.3. Changes in Physical Activity.

Due to the increased mechanisation in the world, the level of physical activity has been decreased. Humans are more relied on automatic machines and motor cars rather than manual operating system and bicycles (Singh et al, 2012). Decrease in the productive manual work and decreased energy spend in work leads to the development of diseases. Now days, the trend is like more leisure time and less working time (Singh et al, 2012). And most of the people spend their leisure time for the sedentary activities such as watching TV, computer games and so on, thus changing the construction of leisure time and encroaching on the time usually allocated to other activities including weekday sleep (Singh et al, 2012).


3.0. FOOD DISTRIBUTION SYSTEM OF INDIA (FDS

)

One of the largest food producing country in the world is India (Singh et al, 2012). But 21% of the total population is under nourished (Singh et al, 2012). About 300 million people struggle for meeting their meals 2 times a day (Singh et al, 2012).it shows the problem of receptiveness to the sufficient nutritive food to the poor class in past(Singh et al, 2012). The report suggest that between the period of 1960-2009, there is a dramatically decline in the public investment to the agriculture (Singh et al, 2012). Certain measures are taken by the government among the states in the country (Singh et al, 2012).

In India Public Distribution of Food is through FCI (Food Corporation Of India) (Singh et al, 2012). And through this system India reduced the risk of famine but the sufficiency, the quality and nutritive value of food is still a big challenge (Singh et al, 2012).The food management aims at processing food grains from farmers at profitable prices, supplying food grains to the consumers, especially the poor and the affected sections of the society at affordable prices and maintain food buffer for food security and price stability (Singh et al, 2012). The main important factor in public distribution system is minimum support price (MSP) and central issue price (CIP) (Singh et al, 2012). The uneconomical rise in the inventory of food grains with FCI has given rise to the overall economic cost of food grain to FCI and has had an untoward impression on the efficacy of food based safety nets in India (Singh et al, 2012).

4.0

CONCLUSION

In this review, I am attempting to establish some important determinants that characterize the nutrition and development transitions that is happening in a country like India. The transitions especially demographic, nutritional, epidemiological transitions affects the normal life pattern of the people and it changes the followed methods of consumption of food, physical activities, which leads to the path of sedentarism which leads to the greatest problems obesity and other non communicable diseases (Singh et al, 2012). There are some other factors contributing to the emergence of chronic diseases in India. Contamination of food sources of pesticides, chemical fertilizers, and toxic contaminants is common in rapidly industrializing societies. Globalization of trade encourages cash crops for export and the consequent movement of important micronutrients, which are now not available to the local population and at the same time promotes increased vulnerability with agricultural production subjects to the pressing of global free trade and competition (Singh et al, 2012, p. 133). Thus, economic development contributes to increasing inequalities and exposure to factors that are harmful to health and may thus contributing to increasing NCD risk in developing societies in sudden developmental transition like India

The Government should plan of carrying on a continuous and exhaustive research to track the need and supply of food grains selling in the market. This would ensure future forecast onfoodprices and would facilitate the Governmentinpolicy making. Universalisation of food grain distribution needs an alternative clean and transparent/ PDS method other than through the FCI at the national level and Fair Price Shops at the bottom level. This calls for developing suitable operational policies for FCI to rationalize its buffer stocks, slowly unload more inventory of cereals and strengthening of the existing PDS by bringingin transparency andaccountabilityat the ultimate distribution point. This first step will improve supply situation and prevent price rise. Thus, while the proposed NFSA will address the supply driven distribution side of the food grains, the nation needs to develop an appropriate system of food management keeping in perspective the overall demand and supply situation.


5.0 REFERENCES

:

  1. Prakash, Shetty. (2002).NutritionTransition in India.

    Public

    Health Nutrition. 5 (1), 175-82.
  2. Sachdev, HPS. (2004).Nutritionaltransition in theback drop of early life orgin of adult diseases: A challenge for the future.

    Indian journal of

    medical Research. 119 (4), iii-v.
  3. Griffiths, Paula, L. (2001). TheNutritionTransition is underway in India.

    The journal


    of


    NUTRITION

    . 131 (10), 2692-700
  4. Singh. (2012).Food securityin India’s issues and challenges.

    Anusandanika

    . 4 (2), 128-133.