Premature infants are infants born before the 37th week of gestation. The organs of such newborns are not developed enough to enable the infants body to function normally in the postnatal period. Therefore, such babies face a number of challenges and need special intensive care to survive and avoid health complications.
Analysis
The body structure of premature infants determines the way the organs function. One of the main body systems affecting the survival of such newborns is the respiratory system. The lungs of premature infants are not yet fully developed, which leads to their inability to function properly in the postnatal period. Neonatal respiratory distress syndrome is one of the most common consequences of the immaturity of the lungs. Other examples of possible complications include Transient tachypnea, Bronchopulmonary Dysplasia, and Pneumonia (American Pregnancy Association par. 7). Two more examples of the features of premature babies are little fat and immature skin.
Such specifics lead to the inability of the infant to maintain normal body temperature. Gastrointestinal and digestive systems of such babies are also immature, which makes them unable to absorb the nutrients properly (American Pregnancy Association par. 17). The structure of the heart in premature babies is also distinctive, as an open blood vessel called the ductus arteriosus is open during the prenatal period due to the high level of prostaglandin E, and the changes occur only at the last weeks of gestation when the baby becomes ready to breathe after the birth (American Pregnancy Association par. 19). A cardiac disorder called Patent Ductus Arteriosus is the example of the direct consequence of the high levels of prostaglandin E keeping the vessel open.
The process of remembering the challenges met by premature babies can be easier if it is conducted with the help of structuring the knowledge according to the body systems. Most of the body systems of preterm born infants are not well-developed, which serve as the cause of problems in the functioning of the organism. For example, the immaturity of respiratory, gastrointestinal, immune, cardiovascular, hematologic, auditory, ophthalmic, and central nervous systems of premature babies usually serves as the basis for consequent challenges faced by the organism (Committee on Understanding Premature Birth 1). Knowledge of the specifics of the functioning of these systems can make recalling of the discussed information easier.
The preterm birth and complications faced by such infants comprise the topic that has millions of illustrations in real life. Every year nearly fifteen million babies are born premature, and such birth remains one of the most common causes of infants deaths all over the world. Therefore, knowledge of this topic is essential for every person as it can help to prevent the complications caused by premature labor in real life.
The current research on the topic reveals that the rates of premature births are growing each year (Gulland Fifteen Million and Rising e.3084). Other researchers try to explore the possible risk factors related to the discussed issue, including gynecological procedures (e.g. dilatation and curettage procedure) (Kmietowicz h3261), drinking in the first trimester (Gulland Drinking in First Trimester g2058), repeated abortions, inadequate intake of vitamin D during pregnancy (Grant e00022), etc.
Conclusion
The importance of the discussed topic naturally derives from the notion that human life is priceless and needs to be protected in every situation. The risks put to the life of infants by their premature births illustrate the danger of preterm labor and the necessity to search both for the ways of assisting such newborns in overcoming the challenges met by them and lowering the risks of such situations.
Committee on Understanding Premature Birth and Assuring Healthy Outcomes Board on Health Sciences Policy. Preterm Birth: Causes, Consequences, and Prevention, Washington, D.C.: The National Academies Press, 2007. Print.
Grant, William. Adequate Vitamin D during Pregnancy Reduces the Risk of Premature Birth by Reducing Placental Colonization by Bacterial Vaginosis Species. MBio 2.2 (2011): e00022-e00022-11. Print.
Gulland, Anne. Drinking in First Trimester is Linked to Premature Birth and Babies Small for Gestational Age. British Medical Journal 348 (2014): g2058. Print.
. Fifteen Million and Rising the Number of Premature Births Every Year. British Medical Journal 344 (2012): e.3084. Print.
Kmietowicz, Zosia. Dilatation and Curettage Procedure Raises Risk of Premature Birth in Subsequent Pregnancies, Study Finds. British Medical Journal 350 (2015): h3261. Print.
The provision of quality healthcare services has become a consistent challenge that has baffled nurses, leaders, and civilians. People have explored chances of ensuring Americans get good health services but most of their efforts have not produced good results (Barr 2011). This essay discusses the views presented by Professor Amitabh Chandra regarding the challenges facing healthcare policy makers in America.
Discussion
The professor is shocked that almost 80% of Americans pay taxes that are directed to the provision of healthcare services. This means that the country is spending a lot of money in providing healthcare services that are not even affordable or available to all patients (Chandra 2012). He identifies three major challenges that make the American healthcare system to experience frequent failures despite efforts by policy makers and other stakeholders to revive and improve this sector.
These challenges include the presence of a huge population that is not insured and which spends a lot of money to access health services when it falls sick. People have not developed the culture of seeking health insurance covers offered by public and private institutions and this means that they have not secured their future against health complications. He argues that in 1999 less than 14% of the population was not insured and by 2010 this figure had increased to 16.3% and the trend seems to be moving upwards (Chandra 2012).
In addition, he claims that most uninsured people do not seek regular medical examinations since they fear incurring heavy costs. Therefore, when they get old they have various health complications that would have been managed if they had sought medical services earlier (Barr 2011). He believes that medical insurance covers are preventive measures that ensure people invest in preventing unnecessary huge medical bills during old age.
Secondly, he argues that health facilities should ensure their services are proportional to their costs. This means that there must be policies to ensure that patients get quality services at affordable prices. He believes that most Americans are paying a lot of money and getting compromised services that do not reflect their costs (Chandra 2012). Therefore, he proposes that doctors should be paid a lot of money not because they do a lot of work but because they ensure their patients are kept healthy, happy and alive.
Thirdly, he identifies technology as an important aspect of improving healthcare in modern societies. He claims that America is busy re-allocating funds from education to healthcare and this poses a great risk to the future of healthcare services (Chandra 2012). He believes that money should not be diverted from schools to healthcare since this hinders knowledge development and research on issues that affect human health.
He offers a detailed explanation of the dilapidated healthcare system of the United State and proposes remedies to help alleviate the challenges facing this sector. His arguments reflect the evils of the introduction of free trade in America that gives private health insurance providers chances to exploit civilians while the government thinks that it is creating a good environment for investors.
Conclusion
Healthcare is an indispensable human need and people must give it priority over other requirements. The challenges facing this sector are attributed to lack of public awareness and incentives for people to take medical insurance covers, high costs of medical services and poor technology used in managing various health complications. However, these challenges are manageable and eliminated through regulating the activities of private health insurance companies, investing in research and using improved technology in healthcare facilities.
References
Barr, D. (2011). Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America. Maryland: The Johns Hopkins University Press.
Chandra, A. (2012). Amitabh Chandra on U.S. Healthcare System. American Conversation Essentials. Bendigo, Vic.: YouTube.
The case of Pfizer is one of the most interesting studies in the pharmaceutical business. One major reason is that it almost fell into near-death situation, a paradox considering that its mission is treatment of diseases. What happened to this once the biggest global pharmaceutical firm? Who or what was responsible for this fall?
Pfizer has been a leading drug company, involved in manufacturing of new medicines to treat popular human diseases, like cardiovascular and metabolism diseases.
Half of its total revenues were attributed to prescription drugs. Pfizers mission and goals were to provide cutting edge research and development in the different operating segments, from product development to the patients therapeutic stage, which encompass the products life cycle. Pfizer also became actively involved in biotechnology with the acquisition of some biotechnology firms.
It has been said that the life-blood of a pharmaceutical firm is in research and development (R&D). Although this has to be corrected, since R&D is sometimes the killer of a pharmaceutical firm, Pfizer became a leader in the industry because of its R&D centers in many parts of the world. These centers created blockbuster drugs and produced profits, but just as many also caused losses for the firm.
The fact is Pfizer had many problems the usual and unusual problems which pharmaceuticals face in the course of inventing new medicines for new diseases, recovering the costs for inventing and pre-testing those medicines, maintaining the hold as the leader of top pharmaceutical firms, among others.
Pfizer lost profits by inventing one drug after another; the main causes were the usual ones side effects, human safety concerns, etc. The causes were internal and external ones a scenario all managers abhor and would love to close shop.
Analysis and evaluation
From its financial report for the year then ended 2012 (2012 Financial Report, 2012), Pfizer had total revenues of $58.986 billion. The medicines that were originally manufactured in Pfizers manufacturing plants, ranging from the Lyrica and Viagra to the Primarin family, produced those revenues.
Some of the products lost their momentum along the way, creating a negative impact costing millions of dollars in research and development and in the pre-clinical testing and actual testing processes. A recapitulation of the expenses and income generated from the invented/manufactured medicines is shown in Appendix 1. The calculations in this attachment were rounded off to provide simplicity in the figures.
The overall performance showed that revenues went down in 2012. Appendix 1 shows that Pfizer had an operating profit margin of $0.67 billion, which is short of saying that this is what (or how) the company got from its invested money without charges. The amount is rather low if we have to consider the resources that the company had spent and exerted.
The explanation in the financial report stated that the losses were due to the negative impact made by its major product, the Lipitor, amounting to $7.7 billion, equal to 12% of the total revenues for the year (2012 Financial Report, 2012, p. 15).
The financial report made mention of the negative impact of the manufactured drugs, and the decrease of sales of the drugs (2012 Financial Report, 2012, p. 2).
Kindler announced the dismissal of 10,000 employees, mostly from European branches and R&D centers. Those who were retained came from the US branches. This is because the United States and North America have largely contributed to the annual revenues. US Per capita spending on pharmaceutical products is 728, which is larger than the European countries even those from France and Germany.
SWOT Analysis
Strength
Pfizers assets have been earned and built through the years: it has adequate financial resources to counter the tides of weak sales or any downturn. Its strength lies in its standing in the industry it is a recognized leader. Its commitment to R&D is also well recognized as it spends millions to invent and manufacture medicines for emerging diseases.
The period of Kindlers entry in the company was described as slow growth the company was in the verge of a sharp decline from all its sales of the various manufactured drugs, to include the Lipitor. But Kindlers entry was seen as strength because of the changes he introduced which produced positive results.
Weakness
The drug Lipitor was a problem; a paradox because they used to call it a blockbuster. At first, Lipitor contributed to the firms sales, reaching up to US$13 billion, equal to 40% of Pfizers total profit. The firm developed another medicine called Torcetrapib , believed to be the successor of Lipitor, but the drug also created a problem in the human safety aspect.
Opportunity
From the case analysis and perusal of the 2012 Financial Statement, we can conclude that Pfizer is capitalizing on the manufactured drugs for the various diseases. These drugs are the lifeblood of the company. While some drugs made some setbacks, most of them are selling good and have provided profits. The expired patents still earned profits for Pfizer considering that it has rights to the sale of generic drugs.
Threats
As it has always been said, theres strong competition in the pharmaceutical industry. Firms compete to introduce new drugs and manufacture patented drugs and generic drugs. Pfizer is strongly competing with GSK, Sanofi-aventis, Novartis, J&J, which are giants in their own right. Before a drug is introduced in the market, firms already compete to manufacture and own the patent for the still undeveloped drug.
Discussion of alternatives
The inside and outside factors provided a negative environment for Pfizer. There were many changes that Pfizer had to deal with; one concerned price setting. For example in 2005, the German government reduced the prices for all types of drugs. This paved the way to reimbursing the medical expenses of those who took Lipitor. The drugs price also had to be reduced. The price reduction and the reimbursement produced a negative impact on Pfizer.
Price continued to pressure in other parts of Europe, particularly in the United Kingdom whose government issued the Pharmaceutical Price Regulation Scheme (PPRC) which set profit ceilings on all kinds of drugs. It created a unified reaction from the different pharmaceutical firms, while others considered it extortion. Pfizer was very much affected by the price scheme.
The invention of drugs, to include research and development, pre-clinical testing and testing, and manufacturing, takes about ten to fifteen years. When it is introduced in the market as a safe drug, a considerable amount of time, money, and resources of the company have already been spent.
When the drug has to be withdrawn from the market because of safety issues, the investing firm will already have lost millions of dollars. But this is not to say that it losses every time it manufactures medicines. Return of investment also provides millions, if not billions, of dollars.
Pfizer introduced innovations to counter the negative image and also to minimize unnecessary costs and increase profits. The alternatives were said to be revolutionary because they were introduced by a new brand of management, that of Kindler. But the innovations proved to be effective, even if it cost firing thousands of jobs.
Regarding its products, it appears that Pfizer will continue to earn profits from the manufacture of medicines. This is its prime source of revenues and will continue to be so in the future.
Recommendations/Implementability
Pfizer had to continue this strategy of convincing doctors to prescribe branded medicines to their patients because this is where most of their profits for drugs come. Moreover, Pfizer has been promoting their drugs through advertisements and the Internet. This year, Pfizer promoted vaccination in Ireland. Although it was a marketing strategy, it was also part of the firms corporate social responsibility. Health care for children is one of Pfizers primary goals.
Kindlers goals have become Pfizers mission health care for the different segments the firm has targeted. Research and development has been very much improved ever since the company has streamlined, modified the corporate structure and introduced changes and innovations, particularly in the R&D centers all throughout the world.
By continuing the changes in the area of R&D and the focus on the five segments, Pfizer will continue to recover the losses and regain the leadership in the pharmaceutical industry. Competition continues in this industry, but focusing on servicing and providing health through the introduction of new medicines, this firm will continue to recover and maintain the lead. Pfizers drugs have helped the ageing population and the fight against cancer and AIDS which formerly had no cure.
However, by continuing on their cutting-edge method in R&D and the operating costs in the millions and dollars, it may affect the firms goal of increasing profits. The goal of service to humanity has to continue but it may affect profits.
Kindlers aim was to minimize losses in the R&D areas by conducting collaborative efforts with other companies. In short, Pfizer had to focus on transparency by opening to the public and acquiring more acquisitions. Kindler motivated the new sales force to boost sales. But all these efforts tended not to help Pfizer. When Kindler announced the dismissal of thousands of employees, the stock market negatively responded with a sharp fall.
Paraplegia is described as a complete or incomplete paralysis of the lower body, including legs, bowels, and possibly the trunk. According to the national surveys, over four million people in America suffer from spinal cord injuries. Out of them 300,000 are paraplegics. ( How many People are affected by Spinal Cord Injury (SCI) par. 2). The life of a paraplegic is hard and full of challenges. Mundane tasks suddenly become troublesome, such as moving around the house or going downstairs (York par. 1). Allowing these people to perform mundane tasks without additional help from someone else would make them feel capable and independent once more ( Spinal Cord Injury Paraplegia par. 8).
This design project is orientated towards paraplegics, and might be of interest to people who have a friend or a relative suffering from paraplegia. Sometimes families do not realize how much they could do for a disabled person. It is not impossible to help them live a relatively normal life. Many different devices and mechanisms could be used to make a paraplegics life easier, such as rails, ramps, personal elevators, and bathroom aides.
One of the more challenging tasks that paraplegics have to face is bathing. Getting into a bathtub could be hard for people with limited mobility. However, it becomes an impossible task should one attempt it without extra help or specialized equipment. It requires not one but two strong people to put a paraplegic into a bathtub. This is a very uncomfortable procedure due to the exposure and the physical strain put on the body. In addition, this method has a very high risk of causing additional trauma, leaving it highly unfavorable.
Personal hygiene is very important for the paraplegics due to how they go about their bladder and bowel program ( Bowel Management After Spinal Cord Injury par. 8). They are required to wash frequently. Being able to do so alone without additional assistance is a major step to improving the quality of life for the paraplegics since not only would they be able to feel independent, but it would also protect their pride and privacy.
Not everybody is comfortable with being naked in the presence of another person, even a family member. Some feel humiliated and think they are a burden, even if their family and caregivers do not think that way. Paraplegics may not say it aloud, but it is how they feel, and their feelings must be respected (Dezarnaulds 8).
Fortunately, there are devices that allow a paraplegic with the reasonable upper-body strength to perform the act of bathing on their own. They are called tub lifts. These devices are relatively simple and safe. The majority of the mechanisms are operated by either gears and levers, or by an electric engine that does the heavy lifting (Bonecutter par. 18). The latter is recommended for the elderly or those who do not possess the necessary upper-body strength.
A tub lift allows the paraplegics to lift themselves up from the wheelchair and then lower their body down into the tub without putting any extensive pressure on the spinal cords. Tub lifts are available in a varied price range to accommodate different social groups. Possessing a tub lift would be of great help to a paraplegic, and an important step towards personal independence.
A survey by the Center for Family, Policy, and Research (2010) revealed an increase in federal expenditure on people with developmental disabilities in the United States. For instance, in 2004, the national annual expenditure on developmental disabilities had exponentially increased from 8.3 billion dollars in 1965 to 82.57 billion dollars in 2004. This was a marked increase since the Kennedy Panel of 1961. While the increase in the number of people with developmental disabilities is attributed to the rising numbers of the aging population, disabilities may arise in childhood and affect the entire lives of people (Hallahan & Kauffman, 2003).
Persons who are developmentally disabled experience difficulty in performing activities such as learning, mobility, and self-care routines. Some authors e.g., Smart (2009) has expanded the term developmental disabilities to include mental retardation and other neurological disorders. This report aims to highlight the prevalence, effects, and challenges of developmental disabilities and my experience during my internship at Light House Home.
As a student of health care and medicine majoring in healthcare, I work as an intern employee at Light House Home, an assisting living facility that cares for developmental and disabled people located at 1201 Davis Street San Francisco. I work hand in hand with the administration under the close supervision of Mrs. Elizabeth Smith, the administrator of Lighthouse Home for the Developmental and Disabled. In the facility, the members of staff work with three main divisions of disabled people.
The first division is from comprises those from infancy to about three years old, the second division comprises children and youth of school-going age and the third division comprises developmental and disabled people over 21 years old. Working hand in hand with the administration, especially Mrs. Elizabeth Smith is reflective of my major interest in becoming a health care manager and administrator and it solidifies my commitment towards enhancing the health status and the quality of life of developmentally disabled people through holistically addressing their needs.
Method
As an intern dealing in health care management administration, my responsibilities include making sure developmentally disabled people access high-quality care and better quality of life. In addition, I ensure that all departments function efficiently and effectively by overseeing different departments such as nursing, dietary, social services, housekeeping, building maintenance, admissions, laundry, resident activities, records, and business office. With the broad range of duties to oversee, I delegate some responsibilities to the departmental heads, especially regarding issues and responsibilities which concern their departments.
I also balance the needs and quality of life of developmentally disabled individuals with the needs of their families, staff, and the facility and make sure that records are well maintained by overseeing operations of the records department. In collaboration with staff members, I help the developmentally disabled and their families to deal with the end of life issues e.g., depression, settling issues in their families, and complexities of different medical conditions.
I also ensure that counseling sessions are active and disabled people are attached to support groups. A bottom line to all my responsibilities is that I balance the needs and quality of life of disabled individuals with the needs of their families, staff, and the facility. Working at Light House Home has acted as a foundation in my career as I have developed numerous skills, especially regarding how issues of the developmentally disabled should be addressed (i.e., from a holistic perspective).
Literature Review and Analysis
Literature review
The literature review focuses on the prevalent numbers of people with developmental disabilities, the challenges they face, and the likelihood that they will seek the services of assisting facilities like Light House Home for the Developmentally Disabled. According to the Center for Family, Policy, and Research (2010), the majority of people above 65 years old are likely to be affected by developmental disabilities and most of them are poor and have experienced traumatic events or possess existing health challenges which make them enter foster health care or rehabilitative system.
Further studies by Smart (2009) also point out that approximately 22.2 million persons with disabilities in the United States are aged between 21 and 64 years, though the majority who visit help facilities are adults above 30 years. In addition, Smart points out that the majority of people including health care providers are aging and this has established the need for new employees and family caregivers to provide rehabilitative care for people who are significantly affected by disability (Smart 2009).
According to Braddock (2007), 17% of children below 18 years are affected by developmental disabilities. Braddock further points out that developmental disabilities are more common in populations that live in poverty. Research studies by Braddock (2007) have also estimated that approximately 20-25% of households that receive welfare donations have a child or adult who suffers from a developmental disability.
In addition, Braddock also points out that people who are developmentally disabled e.g., youth are more likely to suffer abuse and as such, their influx into the foster care system is high. Similar literature has also been posed by Scally (2003) who conducted a study at the University of California, San Francisco in 1996. According to Scally (2003), the rise in disability in older individuals is due to chronic diseases such as arthritis, bronchitis, and diabetes. Scaly further reveals that 60% of disabled individuals in the United States lied between the age of 18 years and 64 years.
Analysis
The situation at Light House Home is similar to findings by the Center for Family, Policy, and Research (2010) (explained in the literature review) regarding the health challenges and traumatic events experienced by developmental and disabled people. This is because, at Light House Home, approximately 80% of the developmental and disabled people experience other health challenges apart from disability. Furthermore, 5% of the developmental and disabled people in the facility experienced trauma either psychologically or physically apart from the challenge posed by disability.
The impact of the health challenges and traumatic events (mentioned above) on the lives of the developmental and disabled people at Light House Home was also similar to findings by the Center for Family, Policy, and Research (2010) as almost half of the population of disabled people experienced other health challenges and some were readmitted into the facility because of these challenges. However, about studies conducted by Smart (2009) (explained in the literature review) which revealed that the majority of disabilities in the United States are aged from 21-64 years, the situation at Light House Home was contrary as the majority of the cases of disability were aged below 20 years.
The situation at Light House Home is similar to studies by (Braddock, 2007) as a majority (about 85%) of the developmentally disabled come from poor backgrounds. Regarding Braddocks findings on the likelihood of abuse and influx into the care institution, the situation is Similar at Light House Home as 30% of the adults (especially youth) in the institution have a history of abuse, either physically or emotionally which prompted them to seek care at the institution.
Of the 30% of adults, two-thirds came from a poor background, which agrees with Braddocks position. The case at Light House Home is also similar to Scallys position, as the majority i.e.,75% of the adult disabled people had chronic conditions such as arthritis, and diabetes which caused disability. Since Scally (2003) conducted her study in San Francisco, the situation at Light House Home has been and is almost similar to Scallys position regarding the relationship between chronic health conditions and disability.
Conclusion
With the increasing numbers of developmental and disabled people in the United States of America and the world, the role of assisting and rehabilitative facilities (such as the Light House Home for the Developmentally Disabled People) is almost imperative and inevitable. The above report has explained and focused on the prevalent numbers of people with developmental disabilities, the health challenges (and other challenges) they face, and the likelihood that they will seek the existing services of assisting living facilities.
The above issues have been explored concerning Light House Home which is an assisting living facility that cares for developmental and disabled people of different age groups from different parts of the United States. The internship experience at Light House Home (located at 1201 Davis street San Francisco) has been instrumental and has exponentially shaped my health care management and administration skills, especially about understanding and addressing issues of developmental and disabled people from a holistic perspective.
References
Braddock, D. (2007). Washington rises: Public financial support for intellectual disability in the United States, 1955-2004. Mental Retardation and Developmental Disabilities Research Review, 13, 169-177.
Center for Family, Policy and Research (2010). Poverty and Developmental Disabilities: Improving the Lives of Families and Individuals. Web.
Hallahan, D.P. & Kauffman, J.M. (2003). Exceptional learners: Introduction to special education. Boston: Allyn and Bacon.
Scally, R. (2003). Nurses Caring for the Disabled and Chronically Ill Find Work Challenging, Fulfilling. Web.
Smart, C. (2009). Disability, society, and the individual. Texas: Austin Publishing.
Disasters are unexpected events that have the potential to disorient lives and destroy property. The American federal government has implemented various mechanisms intended to support the manner in which different agencies respond to such public health challenges. The ongoing coronavirus disease of 2019 (COVID-19) pandemic has compelled those in leadership positions to activate the National Guard and the military in an effort to contain and reduce the spread of the virus. This paper describes these pertinent issues and how they relate to public health. The discussion also proposes evidence-based measures that different agencies can implement to mitigate some of the existing challenges for emergency management.
Deployment of Troops
The occurrence of disasters that have the potential to overwhelm local responders can trigger a new strategy to deliver desirable results. The deployment of troops becomes an effective approach when the affected local agencies and governments lack adequate financial capabilities and resources to protect lives and support rescue efforts. The governor in a specific state is the one who has the power to activate the countrys National Guard to a status known as State Active Duty (Garrett, 2019). The selected officers will respond to manmade or natural disasters and remain under the full command and guidance of the states governor. At the federal level, the President of the United States (POTUS) is authorized to activate such troops to pursue international and local missions.
Laws for Domestic Deployment
The concept of public health revolves around the implementation of evidence-based practices and ideas to prevent anticipated disasters and protect lives. Natural and man-made catastrophes are occurrences that can trigger the activation of military forces to maintain order and safeguard both private and public property. However, the United States has unique laws that dictate the manner in which domestic deployment is usually done. Specifically, the Stafford Act describes the procedures state governors can follow to deploy such troops and support relief operations (Born et al., 2011). However, this law forbids such politicians from relying on the military to pursue law enforcement activities. This expectation is in accordance with the Posse Comitatus Act (PCA). Additionally, the Insurrection Act allows the American President to use the available troops to support the execution of the established law whenever there is unrest. When those in power deploy troops to pursue the intended missions, the PCA law states that such officers should not pervade civilians missions and activities.
Nature of Command
The demand for additional aid and support during disasters explain why the government chose to form the National Guard. This kind of reserve means that the military personnel are usually not in full time duty. Instead, those in power will only deploy them whenever there is an authentic need (Garrett, 2019). However, those in active duty have to pursue and complete their responsibilities depending on the nature of the intended aims. These striking differences are critical since they guide analysts understand how troops providing the best support during national disasters receive their command.
After deployment, the governor who has made the request to the president is expected to monitor the operations of the deployed troops and liaise with the relevant commanders to ensure that positive results are recorded. Specifically, the law requires that the Secretary of Defense collaborates with the secretary of the army to provide instructions to the Director of Military Support (Public Health Emergency, n.d.). The action agent can collaborate with different departmental heads to provide the required details to the designated chairman of the Joint Chiefs of Staff (CJCS). The commander-in-chief (CINC) will then offer timely instructions to the officers and ensure that they focus on the anticipated tasks while following the formulated policies.
The issued Executive Order is usually expected to designate the relevant CINC and CJCSs and describe the best command relations depending on the nature of the disaster. The CINC will go further to appoint an experienced officer to coordinate and monitor all operations (Public Health Emergency, n.d.). The nature of this command system is usually essential since it makes it possible for the National Guard to operate efficiently, identify possible challenges and address them accordingly, and eventually provide the best support.
Deployment of Troops: Challenges for Emergency Management and Public Health Entities
The occurrence of disasters in any given region requires that the relevant authorities identify and guide public health professionals to be involved and provide the best medical aid to the affected communities or citizens. Their actions and involvement are critical since they transform the nature of response, minimize deaths, and reduce some of the possible negative outcomes to the affected populations (Dunlap, 2017). In worst case scenarios, governors request the president to deploy troops in an effort to improve service delivery, protect property, and reduce deaths. Similarly, emergency responders and managers are expected to mitigate, maximize preparedness, respond to the occurrence, and implement powerful recovery measures.
Unfortunately, past observations in the United States have exposed some of the weaknesses that tend to affect the roles and goals of emergency responders and public health professionals whenever the existing disaster overwhelms local resources. For example, the issues recorded during the infamous Hurricane Katrina in 2005 revealed that there was a need for the government to formulate a superior plan for improving communication after the successful deployment of troops to provide the required support (Dunlap, 2017). During this event, observers and experts revealed that the level of communication was disoriented since most of the agencies and public health officials were unable to focus on the common goals and share their findings with the military personnel (Public Health Emergency, n.d.). Consequently, the responders took longer to achieve the intended goals while affecting the experiences and outcomes of most of the affected victims.
The events surrounding the ongoing COVID-19 pandemic and the Black Lives Matter (BLM) unrests experienced in the country following the death of George Floyd presented harsh realities that could guide future policies regarding the deployment of the National Guard. Spherically, it was evident that the countrys governors were divided over the issue since the majority of them were unaware of the nature of the challenges and how they could unfold. These issues indicate that the military usually focuses on the primary role of defending and allowing the country to record the required peace (Public Health Emergency, n.d.). However, such an approach results in additional misunderstandings since the different authorities are required to provide guidelines and instructions through any ongoing disaster.
Past researchers and findings have presented undeniable facts that explain how the decision to deploy military troops complicates the work of emergency professionals and public health workers. Specifically, Dunlap (2017) believes that first responders who are expected to provide the best support and medical aid to victims remain concerned that the recorded involvement of the military will affect the nature of communication, reduce the effectiveness of resource allocation strategies, and undermine the process of sharing critical information that can support the entire rescue plan (Margesson, 2015). These challenges explain why all stakeholders should collaborate and present timely suggestions to ensure that positive results are recorded whenever disasters strike.
Suggestions
The deployment of troops during emergencies is an effective strategy for supporting response processes, protecting property, and safeguarding lives. However, some of the identifiable challenges in coordination, communication, and focus on the anticipated goals should not be taken lightly. These gaps explain why the relevant stakeholders should propose and implement superior guidelines for dictating the manner in which all officials and military personnel communicate and pursue their aims. An integrated model can streamline the process of sharing information and classified messages (Margesson, 2015). Experts should design such a strategy in such a way that all professionals are capable of coordinating efficiently while respecting operations of all involved agencies. The participants should also be ready to engage in activities that complement each other if positive results are to be recorded.
Conclusion
The above discussion has supported the deployment of the National Guard during natural or manmade disasters as an effective approach that has the potential to help protect property and lives. Such an integrated model has worked effectively in the past to support the implemented rescue and recovery operations. Unfortunately, some of the emerging gaps in communication and coordination disorient the performance of emergency responders and public health officials. The proposed strategies are, therefore, evidence-based and capable of streamlining the activities of all agencies involved in such catastrophes.
For many years, the U.S. has been the country of immigrants and their descendants living next to the local population and each other. However, the cultural clusters of ethnic groups still exist due to social inheritance and circumstances. According to the U.S. Census Bureau (2019) data, most modern citizens are Caucasian (over 70%). The growing Hispanic population is currently around 18%, followed by blacks (13%), Asians (6%), American Indians and Alaska Natives (less than 2%), and other categories. Since the group division criteria are not always clear, the numbers do not add to 100%, but the overall trend is visible.
Besides the ethnic background, U.S. residents can be divided into minorities and majority based on other factors. For example, LGBTQ group members are the minority, while the straight population is the majority. There are also more people living in the cities, as opposed to rural areas. Other criteria can be used as well, however, the ethnic background historically has a significant influence on the groups needs and challenges.
Rural Non-Hispanic Blacks and Hispanics
Sociologists analyze the data about minorities living in rural areas to understand the difficulties they face in several spheres, including medical care. The study of non-Hispanic black communities outside of the city showed that they experience more mental distress than non-Hispanic Caucasians from the same communities. They have also reported activity limitations due to problems with their health or emotional state. Besides, about a quarter of the respondents could not see a doctor in the last year due to the high costs (James et al., 2017). Similar to all Americans, people who live in the suburbs need access to medical care. However, due to less income and further distance to the hospitals, they experience more stress and cannot visit the specialists as often as necessary to maximize the health benefits.
Hispanics are the largest minority population in the U.S. at the moment. They have successfully integrated into the American way of living, however, one of the main challenges for Latino communities is the language barrier (Steinberg et al., 2016). Being family-oriented, Hispanic communities often have at least two children per family, and finding a bilingual doctor can be a challenge for them. Since this minority group is relatively large, U.S. hospitals started to incorporate language services and staff that can speak Spanish ( Steinberg et al., 2016). In addition, Hispanic communities are often located in rural areas, which adds to the problems of transportation and high medical costs.
Comparison to Caucasian Americans
Since the Caucasian population of the U.S. stays the majority, most medical services are readily available for them both physically and economically. White citizens, in general, can access medical facilities and afford to pay for the services. In addition, a statistically higher percentage of the Caucasian population graduate from college (King et al., 2016). Higher education allows citizens to earn more money and understand the logistics behind economics and healthcare better.
The ethnic and rural minorities, on the other hand, have to face financial difficulties, transportation problems, and cultural misunderstandings continually. Sometimes even living in the U.S. for several generations does not guarantee a well-paid stable job and reliable means of transportation. All these factors make obtaining the necessary medical care challenging for them. Some decide against preventive screenings and treating chronic diseases, which leads to further health problems and financial disparity between the income and the cost of services.
Currently, one of the main challenges for rural hospitals is the lack of intensive care unit (ICU) capacity. As Davoodi et al. (2020) state, this factor makes rural communities especially vulnerable to COVID-19 pandemics. Sepkowitz (2020) also states that American rural healthcare systems lack surge capacities in general, and the pandemic times have exposed this. Rural hospitals used to rely on urban ones closest to them to use their capacity, but today, even the latter experience hard times. Thus, the lack of ICUs in rural hospitals revealed itself in severe numbers: The Society of Critical Care Medicine reported on resource availability stating that of the 2,704 U.S. hospitals with ICU services, only 9% (244) are in rural areas (defined as a population < 10,000) (Davoodi et al., 2020, p. 5). At the same time, urban hospitals have been trying to adapt and develop strategies for expanding ICU capacity.
Currently, almost any hospitals tactics come down to increasing the number of beds, which heavily relies on statistics and probabilistic measures. In planning how many beds a hospital will need, organizations rely on epidemiological data and infection cases prediction. For example, in March, New York City required 40 000 beds, and in May, there was no need for them anymore since the peak case count was passed (Goldman, 2020). Rural hospitals have also been trying to keep pace with pandemics. For example, New Ulm Medical Center has built new delivery systems to enhance its capacity of taking patients four times (Davoodi et al., 2020). Another strategy involves reopening previously closed rural hospitals with the help of local businesses to provide medical supplies. Although such hospitals are already equipped with adequate fixtures and have satisfactory infrastructure, the problem still lies in the lack of medical personnel.
It is hard to disagree that medical leaders may encounter a vast number of different challenges. Sometimes, employees have personal problems or conflicts that prevent them from fulfilling their duties productively and correctly. In other cases, a client may violate the offices policy, and it is essential to resolve the matter ethically. The purpose of this paper is to explore and discuss two case scenarios.
Evidently, when having to work together, workers may experience difficulty finding compromise or maintaining good relations. Thus, numerous conflicts may arise, and it is the task of an ethical and responsible leader to manage any emerging conflict and try to solve the situation correctly. In the first case scenario, an employee known for being vindictive and manipulative accuses another worker with an exemplary record of taking drugs from the supply cabinet. According to Booth (2020), it is possible for Katherine to refer to the five-step problem-solving model (p. 1253). First, she has to identify the problem, meaning that both employees should tell their own truth, and it is especially important that Katherine allows the accused worker to explain the situation. Second, the supply cabinet should be assessed to determine whether any drugs are missing, and CCTV cameras need to be checked.
Next, depending on the investigation results, either of the two workers should be punished for their actions. If the first employee lied about the theft or the second worker actually took the drugs, Katherine can reprimand them in writing (Booth, 2020). A stricter policy about accessing the supply cabinet should be created, and Katherine needs to evaluate the relationships between the two employees and be more careful with the vindictive and manipulative one. Since the problems between them affect the workplace, it is of vital importance to identify the initiator of the conflicts and issue a warning. Finally, their future performance should be carefully evaluated after the measures are taken.
Further, it may also happen that a challenging situation emerges because of a clients actions. In the second case scenario, the office has a certain policy about copayments being collected at the time of service. Indeed, this requirement is supported by Booth (2020) the author says that copayments have to be charged at each visit, either before or immediately after the consultation. However, Christine, a regular patient of the facility, has been skipping her copayments for the last three visits, and it is challenging for the office to decide whether Christine should be denied services for future appointments. On the one hand, the office is indeed protected by policies that highlight their right to collect copayments for each visit (Booth, 2020). On the other hand, it is not recommended for the office to deny services because this is unethical and can also be illegal.
First of all, since Christine has been a patient of the medical center for ten years, it is possible for the facility to consider her situation and make an exception for her. Second, if the office does not want to make an exception, the medical center needs to verify that Christines copayments are not optional; in case they are, she cannot be denied services. Further, if her copayments are mandatory, it is recommended for the center to inform the patient about her debt. Then, the office needs to give Christine a receipt or bill with the total sum she owes and provide her with a reasonable time to pay this debt. If she refuses to do that, the office should deny services for future appointments.
Reference
Booth, K. A. (2020). Medical assisting: Administrative and clinical procedures (7th ed.). McGraw-Hill Higher Education.
A Brief Summary on One of the Healthcare Models Reviewed in the Article
The RWJF report, How nurses are solving some of primary cares most pressing challenges, provides several primary care models that utilize nurses strengths to offer safe, integrated, quality, and accessible healthcare services that match the needs and preferences of the patients. Based on the report, Pennsylvanias Chronic Care Initiative (CCI) is a fundamental primary care model geared at generating outstanding patient outcomes and enhancing cost savings. The models introduction resulted from increased charges for preventable hospitalizations within the state on chronic disorders, making it difficult for some patients to afford healthcare services. As a result, the states health reforms revolve around improving affordability, quality, and accessibility (Robert Wood Johnson Foundation, 2012). The CCI provides financial incentives and ensures that patients obtain effective care management to control chronic diseases.
The state offers medical home payments, regional conferences, and patient registries and also trains the nurses to match the needed innovation and ensure the model is successful. According to the report, the model eradicates political and legal obstacles related to providing services, standardizes outcome measures, promotes care management, funds patient registries, and supports learning collaborations (Robert Wood Johnson Foundation, 2012). The states model has generated positive patient outcomes such as better cholesterol, blood pressure, and blood glucose control. Additionally, the model has helped in reducing emergency room visits leading to cost savings.
A Current Article on a Primary Care Model
The article Addressing common challenges in the implementation of collaborative care for mental health: The Penn integrated care program, by Courtney Benjamin Wolk and other authors, reveals how adopting the Penn Integrated Care model has helped refine mental healthcare in Pennsylvania. The model uses referral management and triage to offer the proper support to clients with mental health desires, thus encouraging collaborative care provision. The process of implementing the PIC (Penn Integrated Care) model has aided in augmenting collaboration and expanding services and training (Wolk et al., 2021). I selected the article to demonstrate how Pennsylvania has significantly invested in innovation to improve patients healthcare services. This is because the state has seriously focused on providing quality care that aligns with the patients needs to improve the quality of life.