Endoscopy Nurse Practitioner
Evidence shows that endoscopy nurses are relevant in health care services simply because they have specialized role in the provision of endoscopy services. Responsibilities and roles in endoscopy nurse setting are wide ranging from research, stock requisition, and audit, and staffing, budgeting, training, diverse procedures, management of the unit activities, disinfection, and technical expertise in complex procedures. I am currently an endoscopy nurse working full time as Bronchoscopy nurse in University of Miami Hospital, Florida. In five years from now, I will have graduated with a master’s degree in nursing education meaning that I will have a number of roles in the endoscopy nurse setting, (Cohen et al. (2012). I will be assisting nurse specialists when they are using endoscopy on a patient.
Whenever a patient wants to know about anything I know I will be the first person to be contacted. My work will involve specialized services that cover pre and post endoscopy care in nursing setting. I will be providing nursing care based on instructions provided by the doctor in charge. Some areas of concern that I will be focusing include but not limited to supporting management, training, health education, and supporting disease prevention. I will be required to have the ability to assist the operator during patient procedures and take care of the patients who are under endoscopic examinations, (Cohen et al. (2012). There are several skills that need to obtain in order to achieve this future goal. I will have to receive task specific training based on endoscopy responsibilities.
Some of the trainings required include practical components and didactic training. During the training, I will be required to observe several endoscopic procedures. In the same time, I will be required to complete a series of didactic sessions on topics that relates to discharge procedures, post procedure monitoring, pre-procedure assessment, informed consent, and emergency drugs among others. The training will be monitored by a senior endoscopy nurse so as to validate on all practical trainings that I will go through. After the training, I will be required to pass a sedation qualifying test so as to proof my competent in the field of endoscopy, (Cohen et al. (2012).
Different competencies and skills will be required so as to prepare me obtain the future dream goal. It is advisable to acquire certification in basic cardiac life support. During the training period, I will complete and acquire certification in advanced cardiac life support so as to help and serve patients in the best manner possible. I will require skills in assessing patients after and before sedation which include proper discharge criteria and the recovery phase. I need to be competent in the principles of respiratory knowledge of airway equipment, airway assessment, oxygen delivery, and physiology. It is a requirement that I possess the ability to identify all medications that are needed for reversal and sedation in potential side effects, administration guidelines, and pharmacology, (Cohen et al. (2012).
Cohen, L. B. et al. (2012) Propofol for endoscopic sedation: a protocol for safe and effective administration by the gastroenterologist. Gastrointest Endosc 2003; 58(5):725–32
Interview a Nurse Leader
Leaders are people who can be of positive influence towards anyone’s life. Leaders are individuals who provide a role model to the society making others imitate their behaviors or wish they could have lived such a life. Evidence shows that a leader exerts some influence to the society by giving flexible personal behavior reports, as well as strategies. A leader is simply a future oriented person who is defined and challenged by organization changes and has the ability to develop effective strategies and plans that help drive the firm in a forward direction.
The leader I selected to interview is FP who is an endoscopy nurse in University Hospital in Miami, Florida. The leader works in endoscopy unit as Bronchoscopy nurse leader. A leader is someone who has subordinates or followers who works closely with the leader in order to achieve goals and objectives of the organization. Just like in any other organizational setting, effective leadership is required in nursing environment so as to help practitioners provide quality patient care services to patients and at the same time guarantee safe patient outcomes. The paper will focus on the responses that will be provided by FP nurse leader in the endoscopy unit. FP has been the best nurse in the endoscopy nursing setting simply because the leader ensures that protocols inpatient services are followed and adhered to be based on the needs of the patient.
The interview of a health care leader was on FP nurse. FP work in University Hospital in Miami, Florida, in endoscopy unit as Bronchoscopy nurse as a leader. Just like a good number of leaders, FP has integrated principles of transformational leadership in the process of her style of leadership. According to FP, a good leader can either be born with the natural abilities of being a leader or one can be developed and groomed with relevant, training, mentorship and timely education so as to become perfect. A leader is someone who is as good as the team being lead and should be in a position to identify problems, develop strategies for identified problems, implement, and monitor those strategies on proper ways to solve the problems, (Cegarra-Navarro et al., 2011).
An effective leader is someone who should have the ability to guide the team, have effective communication skills, and be developed with proper education in order to manage to effectively lead a given group. On top of this, my leader feels that, in order for someone to become someone effective, one must have the ability to show good examples, have the ability to develop proper and sound working environment with others, and learn on how to do what is asked or wanted from the leader at any given time without any complains. Based on my leader’s argument, effective leaders are people who have the ability to work with employees given any condition and can request them to work either beyond or above the required state and employees have no objection towards the situation, (Parker & Hyrkas, 2011).Patient in the nursing setting is the most relevant component.
A leader in the nursing setting should be in a position to understand a patient and develop the required measures to be taken to the patient. The most vital and relevant qualities that leaders should have is on educational experience, clinical experience, and their knowledge so as to serve patients in the best manner. In nursing setting, there several organizational learning impacts such as patient safety, job satisfaction, and nursing care that should always be addressed and monitored in the best approach. A relational leader is someone who has the ability to work with employees without a lot of problems plus she, or he can bring the team together for the purpose of achieving goals and objectives in serving the patient. Leaders who are ethical always function in the best direction and will always deliver quality health care services plus establish strong relationships and collaborations within the working environment, (O'Connor & Stodard, 2012).
Changes in Leadership Style
The evolving leadership role in the nursing setting has seen current nurses do some modification in their leadership style plus they have adopted receptive styles such as the transformational style in their leadership activities. Leaders who are transformational in their working environment involves in the nudging teammates to be creative so that they can establish an environment that favors patients needs at any given time. They are people who value the working environment of other employees and always inquire for the right measures to be put across in the establishment of the best patient, working conditions. Such leaders also think of effective strategies, which can be implemented in order to improve and transform the performance of the nursing setting. The field of nursing is ever growing; thus there is a constant need to the improvement of services offered to patients.
This means that there exist the needs to engage and encourage employees in the health care setting to suggest as well as to be innovative in developing ways that will be of help in improving patient care in the nursing setting. Based on the transformational leadership, the required emphasis should be to adhere to the status quo as well as set rules that establish new directions in performing different health care tasks and activities. A good transformational leadership system is one that allows the leader to provide support to the team members, (Sullivan & Decker, 2009).Evidence shows that a positive relationship can be established by a leader who genuinely shows concern towards his or her team. In an environment where team members are given a chance to share their views, it has been discovered that proper and sound activities are established.
A good leader in the nursing health care is someone who opens the channels of communication to followers and also encourages them to share their contributions and ideas in order to change their working environment. Improving the environment of nursing setting is establishing and environment where team members feel their contributions are respected and appreciated. Subordinates must realize that they are worth enough in building and developing the organization. In nursing environment, transformation leadership is of essence simply because allows leaders feel their role plus make them a source of inspiration to the followers. In the health care setting, nursing leaders should have the ability to demonstrate a high level of commitment to the health care setting by setting a deep set of values and ideas that the rest of the group in the nursing setting desire and admire to emulate, (Cegarra-Navarro et al., 2011).
Based on my leader suggestions, there are a number of challenges and problems that currently affects the field of nursing health care. The issue of staffing is one of the key challenging situations in most of the health care environments. The current nurse work ethic is different compared to the past work ethic that was used by nurse experts. My leader argued that the entire nursing industry faces one of the greatest problems which are on the proper measures required to solve the problem of nursing staffing. This is not a secret any more simply because there is a great shortage in nurses in health care and those available are overworked making it difficult to establish the required staffing system. Nursing shortage according to PF is a challenge that will elevate to drastic levels if the problem is not corrected any time soon. When I asked my leader if she had any suggestions on how to solve the problem, her response was very simple and direct to the point. She argued that leaders in the health care setting should listen to their followers and discover on the problems that these people face.
They should also learn and discover their wants and needs thus develop ways on how to deal with the challenges. According to the leader, irrespective of the position you hold in the nursing setting, a leader should always show support to the staff something that will cultivate a sense of moral support and loyalty, (Parker & Hyrkas, 2011).Apart from the issue of a nursing shortage, another challenge is based on the development of future nurse leaders. It is with no doubt that molding and developing future nurse leaders have become a significant challenge in nursing setting. The issue develops from the fact that current nursing industry is working with few nurses. These nurses have tight schedules that prevent them from getting time to train them on becoming future leaders. Their schedules are always busy something that pose a great risk in developing future leaders in the health care setting. Lack of morale and motivation because of the amount of workload they encounter, current nurses face problems of becoming future leaders. The current nurse pool is aging meaning that a good number of nurses are nearing the retirement, and the upcoming generation is not serious in entering healthcare environment. Nurse leaders have the obligation to provide directions to the next level of nursing healthcare setting, (Sullivan & Decker, 2009).
Formal and Informal Power
Formal and informal types of powers are relevant and required in the field of nursing healthcare. Formal power is the authority that someone holds within an organization. The responsibilities and roles of a leader with formal power are recognized by the organization management through an elaborated organizational chart. The position held by this leader is demonstrated in a chart that shows power, duties, and role held by each of the leader in the organization. In a formal power setting, leaders are defined within their duties and proper indications are shown and who holds where and who is superior to whom as well as the chain of command. For the informal power setting, leaders in health care setting believe that this is a dominant situation. This is seen in those people who have exposure and experience in the nursing setting. Nurses are required to be answerable and have the ability to handle different problems and issues that develop in the health care setting, (O'Connor & Stodard, 2012).
Cegarra-Navarro, J. G., Wensley, A. K., & Sanchez-Polo, M. T. (2011). Improving quality of service of home healthcare units with health information technologies. Health Information Management Journal, 40(2), 30-38
O'Connor, T., & Stodard, K. (2012). Nursing leadership qualities come in many guises. Kai Tiaki Nursing New Zealand, 18(5), 14-17
Parker, S., & Hyrkas, K. (2011). Priorities in nursing management. Journal of Nursing Management, 19(5), 567-571
Sullivan, E. J., & Decker, P. J. (2009). Effective leadership and management in nursing (7th ed.). Upper Saddle River, NJ: Pearson Prentice Hall
The increasingly changing and challenging healthcare environment calls for all healthcare professionals, including nurses, to develop their leadership skills. A leader can simply be defined ad a future orientated individual who is challenged by change and is able to make effective plans and strategies that drive the organization forward. A leader has followers/subordinates whom he or she works with to achieve an organizational goal. Effective leadership skills ensure that nurses are able to deliver quality patient care and guarantees safe patient outcomes.
Effective leadership also enhances job satisfaction levels. This assignment focuses on the responses provided by a nurse leader. The interview focused on the nurse leader leadership style and challenges involved in being a leader in the healthcare sector. Nurse RF is an endoscopy nurse who is in charge of the endoscopy unit at the Regional Medical center hospital in Miami, Florida. RF is highly experienced and professional having held the leadership post for close to three years. RF strives to be a guide and ideal example to other nurses by ensuring that all patient care protocols are adhered to the letter. Her dedication and emphasis on quality patient care has seen her gain respects and recognition among her peers, as well as patients.
A leader must ensure that he or she adopts the ideal leadership style within the institution. An effective leadership style will guarantee that employees within the organization work towards the same goal. In a healthcare facility, the need for an appropriate leadership style is crucial as it determine the overall running of the facility. Nurse leaders must ensure they adopt a leadership style that fosters cooperation and the provision of quality patient care. The leadership style adopted by nurse leader RF is the relational leadership style.
The relational leadership style emphasizes on bringing people together to work towards achieving a common goal. Nurse RF believes that the relationship leadership style is appropriate as it encourages leaders to bring employees to work in unity. The nursing profession is a teamwork rather than individual work. Nurses are expected to work together when handling patients, assigning medication or caring patients. Nursing involves a lot of interconnectivity among nurses hence the need for the spirit of teamwork rather than individualism. Relational leadership is inclusive and involves integration of other people’s ideas and point of views. As a leader RF engages her colleagues in discourse on suggestions and ideas on improving patients care (Malloy, & Penprase, 2010). All nurses get the opportunity to contribute and make input, which is then discussed and adopted.
Relational leaders also operate on the principal that all employees have something to offer/contribute if given a chance hence the leader encourages learning at the individual and team level. A relational leader also brings employees together and ensures there is a commitment towards a goal. In the nursing profession, for instance, the ultimate goal is to enhance patient care and ensure the delivery of quality healthcare services. Relational leaders are also ethical, and their functioning is based on the values and moral standards of what are right. Overall, a relational leader focuses on establishing strong collaborations and relationships within the workplace. A Relational leader thus appeals to his or her colleague’s emotions and beliefs in order to form strong bonds and relationships.
Changes in Leadership style
The evolving leadership role in nursing has seen current nurses modify their leadership style and adopt receptive styles such as the transformational style of leadership. RF has integrated principles of transformational leadership to her leadership role. Transformational leadership involves nudging followers to be creative and think of effective strategies that can be implemented so as to improve performance. In the nursing profession, the need for improvement of quality is constant hence the need to encourage nurses to be innovative and suggest ways to improve patient care. Under the transformational leadership, emphasis will not be only adhering to set rules and the status quo, but establishing new ways of performing different tasks (Crosby, & Shields, 2010).
Transformational leadership also involves offering support to followers. A leader can foster a positive relationship with his followers if he genuinely shows concern for his followers. A transformation leader can also open the channels of communication and encourage his followers to share their ideas sand contributions. A transformational leader must make his subordinates feel worthy. In nursing practice, transformational leadership is mandatory as it ensures that a leader is flexible to the changing face of healthcare management. The transformational leader is also a role model and a source of inspiration to his followers. In nursing practice, the leader should demonstrate a high level of commitment, as a deep set of values and ideas that followers admire and desire to emulate.
The healthcare industry has changed significantly in the past decade. The continuing changes pose numerous challenges to leaders who have to find ways to accommodate these changes. As a nurse leader, the main challenge that RF has faced is staff constraints. The issues of nurse shortage have been an overbearing burden in the healthcare industry for many decades. Nurses are overworked as there is hardly any department within a single facility that has adequate nurses.
Nurses have had to work extra hours so as to cover for shortages. Unfortunately, the continued overwork and nurse shortage in healthcare facilities demoralizes interested students from taking nursing as a profession. Nurses’ shortage is a critical issue that can interfere with the quality of services that patients receive.Nurses are also at risk of fatigue, burnout and sleep deprivation which can further hamper their ability to be productive. There is a need for nurse leaders to a source of inspiration and motivation for leaders (Hintea2006). Nurse leaders must work with available nurses to build a strong force that is still able to offer quality services despite shortages.
Older and experienced nurses should also act as a role model to the new nurses who are yet comprehend the profession. Most new nurses give up due to lack of on-the-job training, which affects their self esteem and confidence levels. A nurse leader should ensure that new nurses get adequate on the job training and guidance. This will motivate them and encourage them to stay on as nurses. A nurse leader, together with his followers must create a duty roster, which will ensure that work is evenly distributed across the available nurses. Distribution of work minimizes the risk of fatigue, burnout and stress related illnesses (Sanford, 2010).Another significant challenge in the nursing profession involves the development of future nurse leaders.
It has become increasingly difficult to find and mould future nurse leaders. This is attributed to factors such as nurse shortages that see healthcare facilities work with very few nurses. The few nurses are unable find time to train and become nurse leaders due to their busy schedules (Crosby, & Shields, 2010). The lack of motivation and morale due to work overload further puts off most nurses from taking leadership positions. Additionally, the nurse-pool is aging, and the young generation is not keen to take up nursing a profession. This means that there are many nurses who are nearing the retirement age and very few young nurses. There is a need for nurse leaders to provide direction to the available nurses.
Formal and Informal Power
Formal power refers to the actual authority that, different leaders within an organization hold. There positions and responsibilities are recognized by management, which provides an elaborate organizational chart. The organizational chart demonstrates the positions held, duties and power held by each leader. The organizational chart also demonstrates who each leader is in charge of and which superior leader he is answerable to. Informal power, on the other hand, refers to power that originate from influence. An individual can have informal power and be able to lead and exert authority among his colleagues.
In any healthcare facility, there exists formal and informal power (Hintea, 2006). Persons with formal power such as nurse leader are charged with the duty of overseeing other nurses within their department. As the formal leaders, it is the responsibility of the nurse leaders to ensure that all followers perform their duties as required. Formal power thus gives the organization some form of guidance and direction ensuring that all subordinates work towards achieving a common goal.Informal power, on the other hand, is dominant in healthcare organizations.
In nursing practice, for instance, informal power is seen among nurses that have experience and exposure in the profession. With experience, these nurses are able to handle different challenging situations that may arise within the department. The experienced nurses are also a source of inspiration to new nurses who are inexperienced and need the guidance of professionals (Malloy, & Penprase, 2010). The formation of groups within a facility can also lead to the rise of informal powers. Nurses, for instance, form groups among themselves. The nurses use these groups to share their grievances, concerns and views. It is the responsibility of formal nurse leaders to reach out to these nurses and form lasting relationships based on understanding and making the nurses’ work environment right.
Effective nursing leadership style is mandatory for the delivery of quality healthcare services to patients. Effective nursing leadership also ensures that nurses work in an environment that fosters positive development, motivating and growth. Leaders who integrate relational leadership styles with transformational mode of leadership are able to witness increased motivation at work, job satisfaction, self-confidence, low employee turnover and improved work performance.
Crosby, F. & Shields, C. (2010). Preparing the next generation of nurse leaders: An educational needs assessment. The Journal of Continuing Education in Nursing, 41(8), 363
Hintea, C. (2006). Leadership and management in healthcare systems. Transylvanian review of administrative sciences. P89-104
Malloy, T. & Penprase, B. (2010). Nursing leadership style and psychosocial work environment. Journal of Nursing Management, 18(6), 715-725. Doi:10.1111/j.1365-2834.2010.01094.x
Sanford, K. (2010). Overview of nursing leadership. Chapter 1. Catholic health initiative
Obesity in San Joaquin
Health Preparedness in San Joaquin County, California
San Joaquin is one of the populous counties in California, with a population of over 680,000 people (San Joaquin County Public Health Services, 2012). The human population of this county has grown significantly with the largest proportion of growth exhibited among minority ethnic groups. Approximately, 28% of adults in San Joaquin lack health insurance. The rate of uninsured is much higher among African American and Hispanic Americans than other ethnic groups (San Joaquin County Public Health Services, 2012). Lack of healthcare insurance affects the ability of these individuals to maintain health. The region is characterized by high preterm birth rates and low birth weight, which have increased the rate of infant mortality.
The region suffers from various communicable disease including AIDS, Amoebiasis, tuberculosis, Chlamydia, and gonorrhea. There are huge ethnic disparities in terms of the spread of communicable diseases, with the African American community recording the highest rate. Chronic disease such as coronary heart disease, stroke, cancer, and diabetes are the major health concern in the region (San Joaquin County Public Health Services, 2012). These diseases are not only the major causes of deaths but also the major causes of disability. Diseases of the heart are the number one causes of death in the county followed by cancer. There are also significant ethnic disparities in terms of prevalence of chronic illnesses. African Americans have the highest rates.
Sociopolitical, Economic and Ethnic Characteristics affecting Health
Economic status is one of the factors that have a significant impact on the health of African American community. Generally, San Joaquin is poorer that California as whole. A large percentage of the population lives below the federal poverty line (San Joaquin County Public Health Services, 2012). In Addition, African Americans have lower median income than whites and Asian American. Statistics reveal that 30% of African Americans in San Joaquin while living in poverty as compared to 8% of white Americans and 15% of Asian Americans (San Joaquin County Public Health Services, 2012).
Consequently, many African American have low standards of living that white and Asian American. Due to their economic status, many African Americans live in neighborhoods that have fewer opportunities for physical activities, high insecurity, and poor sanitation (Blanchard, 2009). Black neighborhoods are least likely to have parks, beaches, pools and green spaces. Other barriers to physical activities include transportation problems, and neighborhood safety.The social economic status of African American communities also limits their access to affordable healthy foods (Blanchard, 2009).
A study revealed that white neighborhoods have 4 times as many supermarkets than Black neighborhoods. The presence of supermarkets is often associated with accessibility to vegetables and fruits. It has also been noted that African American children spend more hours on television that their white and Hispanic peers. Spending many hours on television not only limits the children’s physical activities, but also exposes these children to food advertisement, which influence their eating habits. Spending many hours on television is also associated with increased intake of food. Researches indicate that an extra hour spent on television leads to consumption of 127 additional calories per day.
Low socioeconomic status is also associated with high levels of stress, especially among African American women (Blanchard, 2009). Research indicates that high stress level may lead to the development of metabolic syndrome that alters the capacity of the body to clear glucose. Poverty also leads to social withdrawal that reducing participation in physical activities. Ethnic patterns also have an impact on the health status of African American people. African American parents use the term “big bone” to refer to their obese children (Stevenson, 2011). They encourage obesity among children by claiming that the obese children take after them. They view obesity as of little health concern. Genetics is also a major risk factor for the development of obesity among African American (Alio & Salihu, 2006)
Educational Level of African Americans in San Joaquin County
Education level of African Americans living in Stockton was assessed by comparing education attainment of the African American with that of other ethnic community. The assessment revealed that though education attainment among African American was lower compared to Asian and Non-Hispanic Whites, the rate of attainment was higher than in Hispanic and Native Americans (National Center for Education Statistics, 2013). Education attainment of this community was also assessed by comparing education attainment of Stockton population with that of the entire country. The education level in Stockton City is lower compared to the general education level in the entire country. For population above 25 years, only 75% have attained a high-school level education compared to rate of 90% in the entire country (City Data.com, 2013).
Only 17.3% of residents who are above 25 years have attained the bachelor’s degree level of education as compared to a rate of 33% in the entire country. There is a close relationship between education level and obesity. Communities with lower levels of education exhibit high rates of obesity. This is because education has a significant impact on income and economic status. For instance, the median household income in Stockton City was $ 44,310, in 2011, compared to a median household income of $57,287 in the entire California region (City Data.com, 2013). As already explained in previous sections, socioeconomic status has an impact on healthcare status of communities. In addition, education limits the capacity of the community to understand health implication of various practices.
Community Health Diagnosis
One of the global health problems that exist in Stockton City is obesity. Obesity is a condition that is characterized by increased levels of body fats. The assessment revealed that chronic diseases are the major health concern in Joaquin County. All these chronic ailments are associated with diabetes. The rate of obesity, in the state of California, has increased by two folds in the last 15 years. In 2011, 24.8% of adults met the threshold of obesity while 61.4% of adults were classified as overweight and obese (Center for Disease Control, 2013).
With a population of 37.2 million people, an overweight rate of 61.4% implies that over 23 million adults living in California are overweight. The consequences of increased cases of obesity and overweight are dire. The California Healthline (2012) predicts that the rate of obesity in California will double by the year 2030. Obesity has led to increased prevalence of other chronic diseases. Illness such as hypertension, diabetes, heart failure, and cancer are on the increase. Heart disease has now become the largest killer in the state and the country. It is also projects that healthcare related cost will increase by $ 66 billion by the year 2030 if the current obesity trends in state prevail (California Healthline, 2012).
Obesity rates in California differ from county to another. San Joaquin County, whose center is Stockton city, has been identified as one of the counties with obesity rates of over 30%. Obesity rates in California also vary from one ethnic group to the next (Center for Disease Control, 2013). According to the Kaiser Family Foundation (2013), the African American ethnic group had the highest overweight rate in California, in 2011. The percentage of overweight adults in the state of California stood at 72.1%. Hispanic Americans and Native American also had a high overweight rate standing at 70.1% and 69.2% respectively (Kaiser Family Foundation, 2013). The Asian and Pacific Islander had the lowest rates at 38.3%.
The intervention program focuses on addressing obesity problem among African American people living in San Joaquin County. Specifically, the program will target the city of Stockton, the largest urban center in San Joaquin County. The proposed intervention is a family outreach program that targets African American families with children with obesity problem. The student will work together with education institutions within the city to identify African American children with diabetic problem. The identified children will direct the intervention team to the family members where the educational program will be conducted. The students and the intervention team will move to different schools across the city within the 6 week period.
- To conduct nutritional education in 500 African American households within the 6 week period.
- To conduct physical education in 500 African American households within the 6 week period.
Support for the Effectiveness of this Program
Many studies have shown a close relationship between physical activities and obesity. Individuals who have low levels of physical activities are likely to become obese. According to Jakicic and Otto (2005), obesity is a condition that is brought about by an imbalance between energy intake and energy expenditure. Individuals who have low levels of physical activities often have energy expenditures that are lower than their energy intake.
Thus, it is reasonable for any program that seeks to address the challenge of obesity to promote physical activities. Similarly, there is a close connection between obesity and nutrition. A study conducted by Swinburn, Caterson and Seidell (2004) revealed that people who take diets that are characterized by energy-dense foods, sugar sweetened foods, and micronutrient poor food have a high likelihood of become obese. The study also linked fast food culture to increased prevalence of obesity in the country. Thus, any program that seeks to address the challenge of obesity needs to consider enlightening the target population about the nutritional effects on obesity.
This intervention program focuses on involving families and community in the obesity awareness campaign in order to enhance the effectiveness of this program. Research has revealed that; when it comes to addressing obesity, community based approaches have the highest positive outcome (Hopkins, 2013). This is because apart from being a medical problem, obesity is a social problem. Thus, interventions need to address social and environmental factors that promote this condition in order to realize the desired goals. Community based interventions take a comprehensive approach in addressing this problem. Apart from eliminating individual risks factors, community based approach eliminate social and environmental risk factors for obesity.
Two main teaching aids with be used in this program; the nutritional manual and physical activity manual. The nutritional manual will contain a list of healthy foods including fruits and vegetables. The nutrition manual will also provide information about portion sizes of every food for a given age group. The nutritional manual will be tailored to reflect locally available and affordable foods in order to cater for the social economic status of this ethnic group. The purpose of the nutritional manual is to educated families about healthy nutrition. A copy of the nutritional manual will be left with the family for reference.
The physical activity manual will contain simple direction of physical activities in which African American families can participate. The manual will identify activities that reflect the social economic status of the African American people. These activities will not require heavy investment of finances in order to encourage all families to participate. The goal of this manual is to promote physical exercise within this community. A copy of the manual will also be left with the family for future reference. Other teaching aids include video files and charts.
Evaluation of Results
Results of this intervention program will be evaluated based on the objectives of the program. Both formative and summative evaluation will be conducted. Formative evaluations are usually conducted when the program is in progress in order to establish whether the program is on track. Key milestones will be identified that will assist in the formative evaluation. For instance, the first milestone may target to reach 100 families at the end of the first week. A formative evaluation that is based on this milestone will enable the intervention team to determine whether the progress is on course in terms of meeting the objectives.
Summative evaluation is performed at the end of the program to examine the effectiveness of the program in meeting its target. For instance, the summative evaluation may focus on examining the number of families that the program was able to reach at the end of the 6 weeks period. Evaluation will also focus on assessing the impact of the outreach program on the target population. Impact evaluation will focus on assessing the obesity trends among African American with the city. However, it will take time before the impact of the outreach program become visible and, therefore, impact assessment can only be conducted a few months after the program is completed.
Alio A. & Salihu H. (2006). Obesity Research and the Forgotten African American Child. Ethnicity and Disease. 16: 569- 574
Blanchard S. (2009). Variables Associated with Obesity among African-American Women. The American Journal of Occupational Therapy. 63 (1): 58- 68\
California Healthline (2012). California Obesity Rate to Double by 2030. November 5, 2013. http://www.californiahealthline.org/articles/2012/9/19/california-obesity-rate-to-double-by-2030-new-report-projects
City Data.com (2013). Stockton, California. November 5, 2013. http://www.city-data.com/city/Stockton-California.html
Hopkins J. (2013). Community-based Intervention Programs more effective at Preventing Obesity on Children. Bloomberg School of Public Health
Jakicic J. & Otto A. (2005). Physical Activity Considerations for the Treatment and Prevention of Obesity. American Journal of Clinical Nutrition. 82 (1): 2265- 2295
Kaiser Family Foundation (2013). Overweight and Obesity Rates for Adults. November 5, 2013. http://kff.org/other/state-indicator/adult-overweightobesity-rate-by-re/
National Center for Education Statistics (2013). Education Attainment. November 5, 2013. http://nces.ed.gov/fastfacts/display.asp?id=27
San Joaquin County Public Health Services (2012). Community Health Status Report. November 5, 2013. http://www.sjcphs.org/disease/documents/FINAL%20Updated%20Health%20Status%204-1-11.pdf
Stevenson N. (2011). Family Environmental Factors associated with Obesity among African Americans. November 5, 2013. http://drum.lib.umd.edu/bitstream/1903/10727/1/Stevenson.pdf
Swinburn B. Caterson I. and Seidell J. (2004). Diet, Nutrition and the Prevention of Excess Weight Gain and Obesity. Public Health Nutrition. 7 (1): 123- 146
The Center for Disease Control (2013). California’s Response to Obesity. November 5, 2013. http://www.cdc.gov/obesity/stateprograms/fundedstates/california.html
Appendix I: Obesity and Overweight Rates in California by Ethnic Group
Problems And APN Interventions In Pregnant Women With Diabetes.
The role and use of advanced practice nurses has greatly expanded in the global as a result of the increased need for care providers with increased knowledge and skills. This increase and expansion of the role of advanced practice nurses, for patients with chronic health problems and high risk of poor outcomes, has been important for patients with limited access to care. Diabetic women during pregnancy are such a group of patients that requires the attention of nurses. Negrato & Brito notes that diabetes is the most common metabolic disorder affecting pregnancy. According to Noctor & Dunne (2011), some of the predisposing factors for gestational diabetes include a family history, body mass index greater than 30, maternal age above 30 years, previous unexplained perinatal death, current glycosuria and long-term use of steroid.
As the prevalence of diabetes is increasing, the number of pregnancies complicated by pre-existing diabetes or gestational diabetes is rising. Diabetic women during pregnancy encounter many pregnancy discomforts. For those who enter pregnancy with diabetes, maintaining appropriate diets and blood sugar is challenging given the increasing physiological changes, including those that compromise insulin use. Women suffering from gestational diabetes must learn about diabetes and how to manage it. According to Dorothy et al (2012), most of previous research on pregnant diabetic women has focused on providers’ directives regarding adherence to specific medical treatment plans such as monitoring blood sugar and the use of insulin. The postpartum management is focused on directives to stabilize preexisting diabetes and monitoring the effects of gestational diabetes.
Health problems and APN interventions.
Dorothy et al (2012) conducted a content analysis of interaction logs containing the process of APN care during tow clinical trials. The study compared health problems and advanced practice nursing (APN) interventions in two types of APN care provided to childbearing women. The study explored two models of care that included the additive APN care and the APN substitution care. Results of the study indicate that, the 41 women involved in the study suffered 61,004 problems with the majority of the problem being experienced antenatal. The problems were identified and classified using the Omaha system’s Problem scheme. Each of the problems was assigned to Omaha scheme as environmental, psychosocial, psychological and health-related behaviors.
Health-related behaviors are the most common problems. Antenatally, psychological problems were many in the APN substitution group. In postpartum, physiologic problems are the majority followed by psychological problems. During antenatal, diabetic women suffers from environment-related problems from income and sanitation. They suffer psychosocial problems related to caretaking or parenting, and child neglect. They include challenges in coping with body changes, rest, exercise, diet and fearing regarding delivery. In addition, women also suffer from elevated blood pressure, cramping, coughing and difficulties in breathing. The lead health-related problems include nutrition, prescribed medication regimen and health care supervision.
Nutrition problems include elevated blood sugar, weight gain and adherence to the prescribed diet.Most of the APN interventions are provided antenatally. The predominance interventions in both antenatal and postpartum include health teaching/guidance and counseling, treatment and procedures, case management and surveillance. The leading surveillance interventions include reporting and intervening with laboratory findings such as blood sugar, hemoglobin and white blood cells. The case management focused on medical or dental care and communication.The study offer important insight about APN practice in caring for women with diabetes in pregnancy and potential differences between additive and substitution model of care.
The additive model involved collaboration between APN and physicians, APN care was added t o the routine physician prenatal and postpartum care. In the APN substitution model, antenatal and postpartum care was shared equally between APNs and physicians.The study provided a range of problems encountered by diabetic women. The distribution of health problems in APN reflects physiologic problems of women with diabetes in pregnancy. These women require close monitoring of their health behavior so as to optimize maternal and newborn outcomes. The psychological problems reflect problems often encountered by low socioeconomic women and single. Surveillance is the predominant APN function in providing care to women with diabetes.
In addition, APN provides health teaching, guidance and counseling. According to the study, the role of APN in treatment and procedures was minimal. The APN surveillance, early detection and focused health teaching and counseling of women, regarding prevention and early detection of problems increases pregnancy outcomes and reduces health related charges. The role of APNs, knowledge, well-developed assessment skills and effective teaching and communication play an important role in reducing morbidity and health care charges.Therefore, when APNs share care with physicians, they intervene differently in type and number of interventions. The broad skills and the depth of their understanding in clinical practice, health systems, family and personal issues allow nurses to intervene early and effectively.
Dorothy B., JoAnne M., Hanna J et al (2012). Health problems and APN interventions in pregnant women with diabetes. Pacific Rim International journal of nursing research. Vol.16, issue 2: p 85-96.
Negrato, A. Marilia Brito (2013). Historical facts of screening and diagnosing diabetes in pregnancy. Diabetology & Metabolic Syndrome. Vol. 5 Issue 1, p1-8
Noctor E. & Dunne F (2011). A practical guide to pregnancy complicated by diabetes. Diabetes & Primary Care. Vol. 13, issue 5, p22
Qualitative Studies in Health Services Research
Qualitative studies have not been common in health services research. However, they are gradually becoming popular due to researchers interest in using description to understand a health related phenomena. Qualitative studies in health service research strive to develop concepts that aid in the understanding of a phenomenon. Special emphasis is accorded to meaning, experience and the view of participants involved in the study (Gagliardi, & Dobrow, 2011). Qualitative research thus emphasizes on finding the meaning that people place on events, processes and structures revolving around their lives.
Similarly, qualitative research enables a researcher to gather data on the participant's perception and assumptions of various health related issues. Data for a qualitative study is thus collected using methods such as observations and interviews.The two common qualitative research approaches are grounded theory and phenomenology. Grounded theory is a qualitative method used to establish a theory based on collected data. Grounded theory has its roots in sociology and functions on the basis that people attach meaning to events through experience and social interaction. It is the meaning that people attach to their experiences that eventually shape their behavior.
Grounded theory, therefore, strives to develop theories and also modify existing theories depending on the data collected. Phenomenology, on the other hand, focuses on understanding how participants understand the phenomena of experiences they face (Al-Busaidi, 2008). Phenomenology strives to understand the psychology of participants. Phenomenology does not strive to create a theory from collected data, but strives to understand the structures of consciousness as experienced by participants of a research study. Phenomenology emphasizes on the description of the world through the experiences of participants of the study. Researchers cannot, therefore, use external literature as supporting evidence.
Al-Busaidi, Z. (2008). Qualitative research and its uses in healthcare. Sultan Qaboos university medical journal. Vol. 8(1): 11-19
Gagliardi, A. & Dobrow, M. (2011). Paucity of qualitative research in general medical and health services. BMC Health Services Research. 11:268 doi: 10.1186/1472-6963-11-268
A Nurse’s Fundamental Duties
The Hippocratic Oath and the Nightingale pledge are vows that nurses take upon their graduation from nursing school. Many student nurses do not comprehend the magnitude of these oaths at the time of their graduations. It is only after the nurse begins to professionalism executing his or her duties as a nurse that the importance of the oath becomes clear. The fundamental duties of a nurse require that he is able to execute his nursing duties to the best interest of the patient. Nurses are also required to engage in activities that promote the health and well-being of the patient.
Nurses can execute this task by engaging, in preventive measures to eliminate the risk of illness or by alleviating the suffering of the sick. The Hippocratic Oath and Nightingale pledge guide nurses in their profession and the quest to provide quality patient care. Nurses also use the oaths to practice nursing with integrity. Integrity refers to the ability of a nurse to perform his nursing roles while at the same time upholding the privacy and confidentiality rights of the patient (Kilpi, 2000). Similarly, the oaths are fundamental in the process of decision making. Nurses are tasked with the duty of patient care. It is nurses who note any significant changes in the health of a patient.
Nurses are thus tasked with the duty of making decisions that influence the patient’s well-being. Nurses must make ethical decisions that advocate for and protect the patient’s safety and health, and at the same time uphold the rights of the patient. Nurses follow the code of ethics when making decisions that relate to patient care. The code of ethics was created using the Hippocratic and Nightingale oaths as its basis. The decisions that nurses make are in the best interest of the patient and recognize the role of the patient’s family and community (Kilpi, 2000).
Kilpi, H. (2000). Patient’s autonomy, privacy and informed consent. IOS press
Tenet Healthcare Foundation
The issue of medical fraud is massively sensitive towards the provision of quality health care services across the country. Within the framework of this research, the fraudulent billing detected at the Tenet Healthcare Foundation is the main issue of analysis in terms of medical fraud. Based on the immense significance of this analytical framework, it is pertinent to evaluate the most effective theoretical perspectives that are aligned to the issue of medical billing fraud. In view of this perspective, the fraud management lifecycle theory will be the fundamental theoretical framework. This theory is massively essential in terms of dissecting the pertinent issue of medical billing fraud. It provides excellent elements for addressing the extensive challenge of medical billing fraud even from the perspective of the Tenet Healthcare Foundation. In addition to an evaluation of the theoretical foundation, the analysis includes an elucidation of the main research question of the study.
The fraud management lifecycle theory is the core of the entire research. In essence, this theory provides an exceptional platform for a systematic evaluation of the issue of medical billing fraud. This theory has essential components or elements which may be integrated into the analytical framework of medical fraud at the Tenet Healthcare Foundation. This theory can be integrated into the issue of medical billing fraud based on eight stages. The first phase based on this theory is deterrence (Baker & Baker, 2010). During this stage, the theory emphasizes on the need to strategize and implement adequate mechanisms for averting potential fraud.At the Tenet Healthcare Foundation, numerous platforms of deterrence were available. These mechanisms would have been massively beneficial in terms of averting medical fraud even before it had rocked the organization. The second stage within the framework of this theoretical mechanism is the prevention stage.
In this stage of the theory, immense emphasis is placed on the establishment of the relevant avenues for protecting an organization from any fraudulent actions. While the preventive and deterrence stages are different, they can be combined especially if an organization is experiencing one or more constraints in terms of resources (Baker & Baker, 2010). When an organization has sufficient platforms for preventing fraud, extensive resources can be protected. The third pertinent stage of this theory involves detection. This is a pertinent phase that involves the accurate identification of potential threats of fraud. It is massively essential to enhance the accuracy levels of the detection system.
High levels of accuracy facilitate for the relevant interventional strategies. In contrast, the absence of the relevant mechanism of accuracy contributes negatively towards the efficiency of the chosen intervention.Detection occurs when the previous two stages have not been implemented accordingly. This perspective is an indicator that the detection stage occurs when there in an element of fraud within the organizational system. It is massively essential for an organization like the Tenet Healthcare Foundation to have an effective framework for detection. For instance, early detection facilitates for adequate intervention for the fraud (Baker & Baker, 2010).
Mitigation is the next phase within the framework of the fraud management lifecycle theory. The mitigation phase is focused on the reduction or stoppage of the different causative factors for fraud. Mitigation is also essential in that it prevents an escalation of the fraud in an organization.The next stage involves analysis. This stage zeros in on a comprehensive evaluation fraud in terms of the causative attributes, the responsible employees, and implications on organizational performance. For instance, analysis would have helped in determining the actual ramifications of fraud on the organizational performance of Tenet Healthcare Foundation.
The next phase involves policy. This is vital in terms of changing the overall legal framework and administrative mechanisms used by an organization. Investigation is the penultimate stage of the theory. It caters for the determination of the liable employees and the extent of fraud. Prosecution is the final stage of the theory. Excellent standards of balance in the different eight phases are massively pertinent in fraud management in health care organizations such as the Tenet Healthcare Foundation (Baker & Baker, 2010). The theory has been widely integrated into the interventional framework for fraud across numerous organizations.
What strategies can be used to prevent medical billing fraud at the Tenet Healthcare Foundation?
This research question is highly extensive since it involves numerous variables. Firstly, the question will greatly bolster the mechanism of evaluating the different causative factors of medical billing fraud. The second aspect involves the evaluation of the implications of fraud on an organization like the Tenet Healthcare Foundation. Additionally, this research question will help in determining the efficiency of different interventional measures.
The analysis provides an excellent theoretical foundation of the issue of medical billing fraud. The fraud management lifecycle theory has been identified as an essential basis of the research. The different stages of this theory can be integrated into the preventive blueprint of fraud at any health care organization. The analysis has also provided an overview of the research question. The question is vital in that it involves an evaluation of numerous variables on the issue of medical billing fraud.
Baker, J. J., & Baker, R. W. (2010). Health Care Finance: Basic Tools for Nonfinancial Managers. Boston, MA: Jones and Bartlett Publishers.
Professional Moral Compass in Nursing
A nurses’ professional moral conduct is essential as it plays a vital role in decision making processes. Nurses are often faced with tough situations where they have to make decisions that are ethical in nature. Ethical dilemmas arise when a nurse’s personal values, worldview and philosophy contradict each other. However, most nurses overcome ethical dilemmas in their line of duty by following the nurse’s code of ethics as provided by the American Nurses association. For this assignment, I will describe my professional moral compass and how it shapes my nursing practice.
Philosophy, Morals, Ethics and Values in Nursing
My nursing philosophy is to provide patients with holistic care ensuring that they recover physically, spiritually and emotionally. The nursing profession gives me an opportunity to make a difference is someone’s life. A patient depends on his or her nurse for care until he or she recovers. I, therefore, take pride in ensuring that patients and his immediate family receive quality care and are satisfied with the nursing services I render. My ability to provide holistic care lies in my ability to build a relationship with my patients (Ludwick, & Silva, 2000). A successful patient nurse relationship can be build based on trust. My patients have to trust my judgment and nursing practice. They also have to trust that all my actions are guided by my adherence to the ethical code of practice. As a nurse, I strive to maintain patient trust by providing patients with optimal and satisfactory patient care.
Personal cultural and spiritual values play a significant role of influencing nursing practice as it determines the nurses’ way of live and choices they make. Personal values are developed gradually from childhood, adolescence and adulthood. My personal values that I have integrated into nursing practice are respect, compassion and honesty. I handle all my patients and their next of kin with respect. I also exude compassion when handling my patients. I ensure that I encourage them to fight and remain strong so that they can overcome their illnesses. I am also honest in my practice as I prefer to give patients and their families a true picture of their medical condition. I also have a Christian religious background, and I use my religious beliefs to execute my nursing profession.
My Christian beliefs teach that we should practice love, honesty and accountability for actions. I execute these values in my nursing practice. I, for instance, take time to consider the consequences of all actions I undertake. This enables me to evaluate the potency of decisions before execution.Aspects of value, morals and ethics also play a considerable role in nursing practice. Values are enduring attitudes about the worth of a person, an idea or action. In nursing practice personal, professional and religious values influence the decision and actions that a nurse undertakes. Beliefs, on the other hand, represent the interpretations that a person holds as true (Murray, 2010). A person’s beliefs can be a source of conflict as they may differ/contradict with each other.
Finally, ethics refers to the rules that govern a nurse’s conduct. In nursing practice, ethical dilemmas occur when there is a difference is the perception of what is right and what is wrong. When faced with an ethical dilemma, in nursing practice, I normally resolve it by choosing the option that will result to minimal harm to a person. However, when I encounter complex ethical dilemmas, I often seek the guidance of physicians and the ethical committee so as to make the ethically appropriate decision. When, for instance, a patient refuses to take medication because he believes that his condition is incurable hence recovery is not an option, I seek the guidance of colleagues.
In conclusion, I value life and as a nurse I make it my priority to do all humanly possible so as to save the life of a patient. I believe the fundamental of nursing professional revolves around minimizing pain and suffering of patients, and upholding human dignity when handling patients (Ludwick, & Silva, 2000). I enjoy my nursing profession as I am able to apply my strong ethical, values and morals when handling patients. As a Christian, I believe every mankind has a purpose in life hence the need to safeguard life until when one has served his purpose. This personal philosophy has often been put to the test when executing my work as a nurse.
Controversial issues such as abortion and end-of-life decision have always conflicted with my personal philosophy of upholding life. A patient has the right to decide whether he or she can end his life, as in the case of terminally ill patients. Similarly, a woman has the autonomy to decide whether to keep a pregnancy or have an abortion. Patients who choose to procure abortions or end their lives often leave me at conflict with my beliefs of life and not playing God by determining who lives and who dies. In such situations, I respect the patient’s wishes as prescribed in the nursing code of conduct. However, I engage other medical professionals in making such a decision. I also ensure that the patient is in the right mental status as the processes are irreversible.
Ludwick, R. & Silva, M. (2000). Ethics: Nursing around the world. The online journal of issues in nursing. Vol. 5(3)
Murray, J. (2010). Moral Courage in Healthcare: Acting Ethically Even in the Presence of Risk. The Online Journal of Issues in Nursing.Vol. 15, No. 3
Schizophrenia is a serious and challenging type of disorder that makes it difficult for a person to distinguish between a real thing and the unreal thing, relate to others, manage emotions, function normally, and think clearly. Although this disorder is that serious, it doesn’t mean there is no hope for someone suffering from that condition. Schizophrenia is managed and treated well it can be handled, and the person returns to normal. The first thing suitable for this disorder is to identify symptoms and signs. After signs and symptoms are identified, the person should seek help without delay to a qualified profession. The patient should stick to the medications provided in order to fight the situation.
Evidence shows that, with proper support and treatment, an individual suffering from schizophrenia can be managed and get a better life, (Gallagher & Jones, 2013).Study shows that Schizophrenia is type of disease that affects an individual’s perception of thinking and reality. Experts in healthcare say that this disorder can be strong, and there are times when it’s difficult to notice it. Scientists who have studied this type of disorder have a good number of reasons why they doubt the exact factors that cause the disease. Based on their analysis, it is with no doubt that individual affected by this type of disorder feel, see, and hear what others in their surroundings can’t. Schizophrenia is a disease that can affect women and men irrespective of the age.
Population above the age of forty-five is at lower risk of getting this disorder as compared to young people. Schizophrenia is not easy to be noticed to the young people. This is a very serious disease whose causes and symptoms require care and attention. Study shows that if the situation is not treated in accordance, it develops unpleasant effects to the patients, (Bender, 2010).People with Schizophrenia have a significant loss of contact with reality something that makes their life difficult. The illness of Schizophrenia has its unique symptoms that are used to determine whether a person is sick. Symptoms of this illness are seen between the age of sixteen and thirty years. Study indicates that Schizophrenia symptoms develop slows over a given period.
A patient with this illness may have few symptoms, and in some instances one may have many symptoms. Individuals suffering from Schizophrenia have a tendency of keeping work and friends. They suffer from challenges and problems of suicidal thoughts, depression, behaviors, and anxiety. Some of the early symptoms of Schizophrenia include trouble sleeping, trouble concentrating and tense feeling and irritable. Experts have discovered that when the condition continues, the patient may have challenges with behavior, emotions, and thinking in a positive manner, (Peterburs et al., 2013).People who feel some of these symptoms should be very careful as well as seek medical help.
The reason why they should be careful is due to the fact that these symptoms come and go something that may be difficult to tell exactly what one is feeling. This illness mostly makes people very agitated, and in some instances they feel immobile. There are positive and negative symptoms of Schizophrenia. Both positive and negative Schizophrenia symptoms should be viewed in a critical approach in order to provide the right treatment to the patient, (Maguire, 2002).Scientists have no idea on what causes Schizophrenia. According to researchers, they have come across a number of chemical differences possible in the brains of humans that can develop the disease.
There are also some genes that exist in human biology that extends the risk of getting Schizophrenia. Some of the experts believe a number of factors contribute to the development of Schizophrenia. It has been discovered that this illness can develop from strong congenital traits. Individuals from families with a history of mental illness have high chances of contracting Schizophrenia. Genes plays a major role in influencing this illness although they do not determine its occurrence. Despite that Schizophrenia runs in families, a large percentage of people who suffer from the illness (60%) don’t have any history of the disease in their families. Stress is also another factor that contributes to the development of this illness.
Experts believe that high level of stress play a role in the disease development because they increase the production of the hormone cortisol that ignites or triggers the development of Schizophrenia. Another cause of Schizophrenia is the abnormal brain chemistry and brain structure. Physicians have observed big brain ventricles in patients suffering from this disorder, (Bender, 2010).Treatment of Schizophrenia is easy provided that symptoms are discovered in early stages, and right measures are put into consideration.
Study shows that symptoms of this illness should be properly treated simply because if they are not treated in accordance, the effects not only affect the patient but also those who are around. Among these effects include schizophrenics, suicide risk increase, and self isolation that affect once relationship. The person suffering from Schizophrenia should always stay in the hospital in order to get right treatments as well as for safety reasons. Antipsychotic medicines are used for the treatment of Schizophrenia since they do change the balance of chemicals in the brain plus they do help control symptoms, (Fortugno et al., 2013).
Bender, K. J. (2010). New Recommendations for Treatment of Schizophrenia. Psychiatric Times, 27(2), 54
Fortugno, F., Katsakou, C., Bremner, S., Kiejna, A., Kjellin, L., Nawka, P., & ... Priebe, S. (2013). Symptoms Associated with Victimization in Patients with Schizophrenia and Related Disorders. Plos ONE, 8(3), 1-9. doi:10.1371/journal.pone.0058142
Gallagher III, B. J., & Jones, B. J. (2013). Childhood Stressors and Symptoms of Schizophrenia. Clinical Schizophrenia & Related Psychoses, 7(3), 124-130. doi:10.3371/CSRP.GAJO.020113
Maguire, G. A. (2002). Comprehensive understanding of schizophrenia and its treatment. American Journal Of Health-System Pharmacy, 59S4
Peterburs, J., Nitsch, A. M., Miltner, W. R., & Straube, T. (2013). Impaired Representation of Time in Schizophrenia Is Linked to Positive Symptoms and Cognitive Demand. Plos ONE, 8(6), 1-7. doi:10.1371/journal.pone.0067615
Updated PORT psychopharmacological treatment recommendations. (2010). Brown University Psychopharmacology Update, 21(4), 1-7
Healing Hospital Paradigm
Many hospitals are adopting the healing hospital paradigm as a new approach in providing medical care. Though the modern medicine has managed to achieve the desired effects on the progress and revival of patient’s health, the inclusion of the healing paradigm provides the additional benefit. Most importantly, patients are able to respond in a faster way to the modern medicine treatment when combined with the healing hospital paradigm. Healing is a process of becoming healthy and sound according to the Oxford English Dictionary.This definition has not used the word medicine as being an important factor in the attainment of the healing process.
However, it shows that healing is a process that involves tapping into one’s spirituality and these results to inner tranquility and peace. A patient with this inner spirituality is able to respond faster to the medication and treatment that he or she is given. The dedicated healing division has, however, not been incorporated, by many hospitals, to be part of their responsibility. In fact, the sense of profit making to healthcare organizations has clouded their fundamental medical profession of proving patients the compassion their need before subjecting them to treatment.
This paper urges the importance of incorporating the healing hospital paradigm for health care organization. I will show the components of healing the difficulty involved in maintenance and setting up of this paradigm and an example of a biblical representation to show how healing is closely related to spirituality. Healing is not just the source of bring healthcare and love, but a source of loving care to patients.
The human body is divided into three main parts which are the body, mind and soul. The soul is the immaterial and spiritual part of an animal and human being, and it is perceived to be immortal. A person’s spirituality and soul are made from a person’s sense of identity and emotional or moral nature. The mind element enables human beings to be aware of their experiences and the world around them, to feel and think. The body forms the physical structure. These elements have to be in a balance so that a patient attains optimum health.Certain elements have to be kept fundamental or take place in order for the true love towards the patient is shown. The first element is the environment which has to be conducive.
Such an environment is essential f and is defined by the true love and compassion showed by staff members. The healthcare providers have a task of seeking best ways of improving their patients well being so as to show them compassion. Nurses, therefore, should not view patients as the source of burden to their daily tasks or working so as to get paid (Sacredwork.com). Instead, they should know that nursing is a discipline based on the need to show compassion and kindness. If these values are lost, it means that the wellbeing of patients will be negatively impacted. The environment has to be a place with limited commotions and pollution. It should be a wonderful scenario bout outdoor and indoor so as to instill a sense of tranquility and peace to patients (Sacred work. Com).
Another vital element is technological advancement that forms the matrix on healing hospital paradigm. Technology helps to deal with the medical conditions that are unique to patient’s needs. The best and highly advanced technologies are essential in addressing these needs (sacred work journal.com).The last element is the full dedication of physician and nurses in providing patients a loving care. This loving care is the most important, and it is in charge of giving patients the treatment they need. Without the same goal, healthcare practitioners, then all the other elements will not properly function (sacred work.com).
Establishing a hospital design that is healing hospital paradigm is always faced with various challenges. An article by Zborowsky Terry indicates that studies have shown that the closeness to nature supports patients suffering from excessive anger and stress in meditation (Zborowsky. et. al, 2013). Hospitals do not view the importance of this closeness to nature in assisting patients to relax. Another critical element that is often ignored by hospitals is providing patients with rooms with controllable lighting and room temperatures.
The designing of hospitals do not fit the specification that forms a conducive environment. Instead, most hospitals are designed like jail houses or school dormitories. This challenges patients by increasing their stress levels; inability to move with ease, lack of privacy and see that time passes slowly (Zborowsky, et. al, 2013).Simple paintings representing nature and the landscape can help. The main challenge for hospitals to create such an environment is expenses especially now that the healthcare system is faced with the means of reducing costs.
The limited number of nurses is also another challenge for developing a healing hospital because nurses have to care for many patients within a short time. This means that patients end up receiving no any social assistance (Zborowsky, et. al, 2013). Hospitals do not have a system that supports a patient centered approach, and this leads to patients being identified in numbers just like prisons. Patients are also not visited at any time by their families, and this makes them feel like hostages. This leads to an environment which operates in bureaucracy or machine like the kind of way (Chapman 2010, p. 36). Therefore, there is the need to change the healthcare organizations culture to a better healing that encompasses spiritual, physical and emotional well being of patients.
Biblical passage or parable
Jesus in James 5:14-15 inquired if there is a sick person in the crowd and if they are there, they will be anointed by the sacred oil given to them by church leaders. It is through their faith and power of prayer that they will be healed. This is a passage that is closely related to the healing hospital paradigm. It shows the link between prayer and one’s healing process. Healing for this case is based on the spiritual ground of prayer and is a means of giving hope to patients and families.
Healing hospital paradigm, being a new model for the medical profession, is gaining popularity. It is a model that supports patient centric attention to enhance the overall wellbeing of patients. The healing hospital focuses on compassionate care and radical love and draws on coping strategies and hope via spirituality. This has enhanced support of religious, secular and community practices.
Chapman, E (2010) building the healing hospital in America. Nashville, TN: Vaughn Printing.
Zborowsky, T., Kreitzer, M. (n. d.) Creating Optimal Healing Environments in a Health Care Setting. Minnesota Medicine Home. Retrieved, from http://www.minnesotamedicine.com/Current
Oxford Dictionaries Online. (N.d.). Oxford Dictionaries Online. Retrieved from http://oxforddictionaries.com/
The Journal of Sacred Work (n.d) Radical Loving Care Top Ten Healing Hospital. The Journal of Sacred Work. Retrieved from http://journalofsacredwork.typepad.com/journal_of_sacred_work/2009/04/days-102103.html
Family Nurse Practitioner
I am an endoscopy nursing working full time at a hospital in Miami, Florida. I am currently pursuing my master in nursing education, and I expect to acquire essential theoretical and practical training in preparation for taking more demanding duties as a nursing care professional in the future. I then expect to further my studies and acquire a post master’s degree so as to be certified and licensed as a family nurse practitioner. Five years from now, I expect to be a qualified family nurse practitioner with a specialty in endoscopy.
As a family nurse practitioner, I will be able to cater for patient needs despite their ages. Similarly, I will be the primary care giver of a patient from infancy to adulthood. I expect to have responsibilities beyond my current roles as a registered nurse specializing in endoscopy. In 5 years, I also expect to be able to provide care to patients with acute illnesses as diagnosed in endoscopic procedures. In an effort to become a family nurse practitioner, I have to complete my master’s degree then later acquire post-master qualifications.
It is a mandatory requirement for any person wishing to be a family nurse practitioner to have a master’s degree in an advance practice role. Additionally, it is mandatory for me to have practical hours. Currently, I am working as a full time endoscopy nurse in a Miami hospital thus getting adequate exposure in my field of expertise. In terms of competencies, I am expected to be familiar with the different types of endoscopies that patients require. Familiarity with endoscopy refers to the ability to perform these endoscopies with hardly any supervision (McDonald, & Schreiber, 2005). I am also required to be competent in suctioning procedures such as those done in the endotracheal, oral-pharyngeal and tracheotomy.
I am also required to be an expert in conducting hemodynamic monitoring, as well as reprocessing tasks such as manual cleaning. I am also required to be competent in handling and using different types of endoscopy equipment. Other than academic skills a nursing practitioner must have the basic skills of compassion because s/he deals with patients. The nurse practitioner must also have excellent communication skills so that s/he can address patients and their kin appropriately. A nurse practitioner must also be a critical thinker because s/he will be faced with diverse situations that require critical thinking for effective decision making. The nurse must also be flexible and easy to work with different professionals, as well as patients from diverse background (Nevin, 2005).
McDonald, M. & Schreiber, R. (2005). Exploring new roles fort advanced nursing practice. Canadian nurses association
Nevin, C. (2005). Mini doctors or advanced nurse practitioners? Journal of gastoemterol nursing. Vol 28(4): 285
Health Care Costs
Health care costs have continued to escalate over the past few years. The federal and state expenditure on healthcare programs such as the Medicaid and Medicare remains substantial. Policy makers and institutions have been struggling with how to balance the need to meet the high demand for high quality care services within limited resources. According to the recent figures from the centers for Medicaid and Medicare services (CMS), the cost of health care increased with more than 2.7 trillion dollars in 2011. The institute of medicine approximates that 30% of these costs are as a result of wasteful spending in poor care delivery, excessive administrative costs, high prices and fraud.
Some of the identified areas of reducing waste include streamlining administrative costs, improving the efficiency of the hospital, preventing avoidable hospital admissions, preventing avoidable hospital readmissions, preventing medical errors, preventing fraud and abuse and promoting shared-decision making. In order to improve the efficiency of the clinic and maintain quality health care services, economic evaluation is crucial for the organization. The economic evaluation aims at informing policy makers and health care institution administrators about the costs and effects of medical interventions, to support their decisions on the allocation of resources (Feenstra T & Brouwer W, 2004). Decision makers are called to combine information on cost-effectiveness with preferences and the possible constraints for the allocation of resources. Therefore, they need to specify optimization criteria and all possible budget constraints. The clinic will need to evaluate its operations so as to identify areas where saving can be achieved. Therefore, the first step will involve conducting an economic and efficiency evaluation to determine areas of wastage. The second step will involve conducting a survey to identify strategies that be applied in this scenario.
According to the Rundall toolbox of decision making, six steps should be used in making evidence-based decisions. The steps include formulating the question behind the decision, finding sources of information, assessing the accuracy of information, assessing the applicability of information, assessing the actionability of the information, and determining whether the information is adequate (Rundall et al, 2007). These steps will be applicable in the economic and efficiency evaluation of the clinic.
Decision making in health care should be based on sound research and facts. The Rundall’s first step in making an informed decision is formulating the question behind the decision. This step is essential in this case. The main question is what clinical services should be eliminated or introduced to best address healthcare needs of a Medicaid population within the clinic. As stated above, there is the need to conduct an evaluation of the clinic to identify areas of waste. This will require finding sources of information about the operation of the hospital in terms of the number of employees, cases of readmission, administrative costs, and cases of fraud, medical errors, and areas likely to affected most by the 15% budget cut. It is important to find information about costs that are within the control of the hospital so as to identify areas where budget cut can be instituted within the state and federal regulations.
The third step is assessing the accuracy of the information. Good data for decision making should be accurate enough for the intended purpose. It should be relevant to the decision, should be timely, accessible and digestible (Stewart, 2002). Caring about the quality of the information being used is an essential part of practicing evidence-based management. Assessing the accuracy of the information will help overcome some obstacle to using information. A common reason for not getting accurate or right is information is narrowing the view of what to know. Therefore, assessing the accuracy of the information will prevent underestimation of the subject. It will also ensure adequate and unbiased information.
After confirming the information is accurate and adequate it will be analyzed to identify areas where saving can be realized. After areas of wastage, the organization will conduct another survey, in which it will evaluate strategies that have been applied in other counties, states or nations. This survey will be the ultimate solution to the problem because it will offer strategies that can be applicable in this scenario. The survey will follow the Rundall decision toolbox. The first step will be formulating the question for the survey. The survey will investigate mitigation measures to deal with budget cut. Resources will be obtained from institutions that have managed to operate within budget restrictions, yet achieved good patient outcomes. The credibility of the information or sources will be ascertained by ensuring only credible primary and second sources of data or information are used. The accuracy of the information will be achieved by using standard data collection methods and instituting quality assurance and control mechanisms (Tyson & Thomas, 2009). The applicability of the different strategies identified from the survey will be assessed within the context of the organization and the available resources and infrastructures.
The use of the decision toolbox will help decrease the gap between clinical practice and decision making about groups, population and care process. It helps in undermining overenthusiastic adoption of interventions of unproven efficacy or even proven ineffectiveness. It is will also avoid adoption of interventions services that have demonstrated to be ineffective, and adoption of interventions without adequate preparation. The toolbox will help in evaluating and selecting various options available for the organization. It will offer credible support for any decision taken by the management to control expenditure. It will also enable the management to identify the various challenges or shortcoming associated with the available options. It will enable the institution meet the need for accountability, evidence-based practice and efficiency. It will help the clinic overcome numerous barriers to use of evidence in decision such as time pressures, threats to autonomy, preference for informal knowledge based on personal experiences, difficulty accessing the applicable evidence base, and reliance on external consultants to establish the worth of the information, and lack of resources. The use of the toolbox will enable the clinic to recognize and respond to the rising demand for accountability as a strategic issue, set up organizational structures and processes for knowledge transfer, build an inquiring organizational culture, and build clinic’s research capabilities.
Evidence-based management: A practical guide for health professionals. Radcliffe Medical Press Ltd. Oxon, UK.
Feenstra T. & Brouwer W (2004). Decision makers’ view on health care objectives and budget constraints. Health Policy. 2005 Sep 28; 74(1):111.
Institute of Medicine (2013). The cost of healthcare. Workshop Series Summary. Retrieved from http://www.iom.edu/Reports/2011/~/media/Files/widget/VSRT/healthcare-waste.swf on 30/10/2013.
Rundall, T.et al (2007). The informed decisions toolbox: Tools for knowledge transfer and performance improvement. Journal of Healthcare Management, 52(5), 325-342.
Tyson H. & Thomas S (2009). The comprehensive review guide for health information. Jones and Bartlett Publishers. Sudbury, USA.
Health Information Systems Adoption for Proper Health Care
Blavin, F., & Beeuwkes Buntin, M. (2013). Forecasting the Use of Electronic Health Records: An Expert Opinion Approach. Medicare & Medicaid Research Review, 3(2), E1-E15. doi:10.5600/mmrr.003.02.a02
The current focus of health care facilities and experts is to promote the widespread use and adoption of electronic health records. The center for medical services in 2010 developed making Medicaid and Medicare incentive payments to health care facilities that demonstrated the use and meaningful development of certified EHR systems. The combination of technological diffusion framework, a modified Delphi technique, and an expert opinion method explains the forecast estimates of the level of office based users who will eventually become adopters and reliance of health information technology. Results are that the projected outcome of the adoption of health care information system in health care is highly expected in the near future. There is a high meaningful use of current technology and EHRs services to most health care facilities.
Follen, M., Castaneda, R., Mikelson, M., Johnson, D., Wilson, A., & Higuchi, K. (2007). Implementing Health Information Technology to Improve the Process of Health Care Delivery: A Case Study. Disease Management, 10(4), 208-215. doi:10.1089/dis.2007.104706
This study admits that integration of health information system is something critical towards the provision of quality, effective care in the current fragmented health care setting. There has been an increase prevalence of chronic conditions which develops the demands for a comprehensive knowledge of patient’s health on the area of providers. In order to address such challenges, integration of health information through the aspect of electronic health information systems is highly required and recommended. The study gives an example of distinct health information systems and they has managed to respond to the needs of the patients in the required approach. Based on this study, it is clear that the integration of the system will contribute a lot in the efficient management of health information as well as improve the quality of health care services offered to the society. Lack of real time information has been a great problem in the current health care setting and that is the reason why health care facilities should focus on the issue of health information system adoption for proper health care.
Grogg, J. E. (2008). ELECTRONIC RESOURCE MANAGEMENT SYSTEMS IN PRACTICE. Journal Of Electronic Resources Librarianship, 20(2), 86-89. Doi: 10.1080/19411260802272784
This study gives common responses of current health care information systems adoption for proper health care services to the community. The article gives common responses of electronic resource management (ERM) vendors and electronic resource librarians. Information presented in this article is offers reliable data simply because an informal interview aimed to gauge the state of ERM landscape in healthcare was established and data collected. Interviewees in this study gave a number of pressing issues that are thought to be facing ERM in health care where all the responses expressed a desire for more and greater interoperability.
Lee, S. M., Zoonky, L., & Jinyoul, L. (2007). Knowledge transfer in work practice: adoption and use of integrated information systems. Industrial Management & Data Systems, 107(4), 501-518. Doi: 10.1108/026! 5570710740661
The adoption of enterprise resource planning (ERP) for health care setting is one of the key focuses in the current health care system. Adoption of this system in an organization helps emphasize on the knowledge transfer from one employee to another. Current health care system is in need of this system simply because it will allow the smooth knowledge transfer. With the help of case study, the article explains how organizational members strive in the adoption and use of integrated information systems.
Katsma, C. P., Spil, T. M., Light, E., & Wassenaar, A. (2007). Implementation and use of an electronic health record: measuring relevance and participation in four hospitals.International Journal Of Healthcare Technology & Management, 8(6), 625-643. doi:10.1504/IJHTM.2007.014194
There are several advantages and relevance of the implementation of electronic health records (EHR) in health care setting. The study provides investigations of health information system through the study of participations and relevance of the situation during the implementation process of electronic health records in four different health care setting. Results of the study indicate that electronic health records are of relevance in health care setting simply because they avail information at any place and at any time.