The comfort of patients is the responsibility of every medical facility.
To ensure that patients are at ease, the hospital administration has to adopt a holistic approach in caring for patients.
Oral hygiene is one of the important things that must be addressed by hospitals. A study of existing literature clearly shows that oral hygiene ensure that patients are comfortable and helps to speed up their recovery.
Consequently, it is imperative for nursing practitioners to devote part of their time to oral care for patients under their care.
Introduction
Generally, oral hygiene has to do with taking care of teeth and mouth. It is usually undertaken to ensure that the mouth is kept in a healthy oral condition. Hygienically, the mouth is supposed to clean and completely free from any form of infection.
Drawing from a study by Salamone, Yacoub, Mahoney and Edward (2013), oral hygiene is very critical in guaranteeing the comfort of a patient. On the contrary, a patients ability to communicate is greatly affected by poor oral health.
According to Soh et al. (2012), it is common knowledge among nursing practitioners that every good nursing includes oral health care.
Despite the fact that stakeholders understand the benefit of oral care to patients, research indicates that oral hygiene is often overlooked and given very little importance (Quinn & Baker, 2015). To a large extent, this neglect is due to lack of proper procedures for reinforcing the practice. Oral care is thus not effectively offered in a number of medical facilities or not offered at all.
Many variances can be singled out with regards to quality and frequency of oral care given to patients by different nursing professionals (Soh et al., 2012). Consequently, it is imperative to come up with a common standard to be followed by all practitioners in the nursing profession.
Importance of Oral Hygiene
The importance of oral health for hospital patients cannot be underestimated. According to Quinn and Baker (2015), having an effective oral care program is a must for every hospital in order to protect patients from contracting infectious diseases.
In the absence of an effective oral care program, the possibility of patients getting infected increases and their health deteriorates. Certainly, there are serious consequences of having a poor oral care program.
The condition of a patients oral health can have a very significant impact on their overall improvement.
As noted by Salamone, Yacoub, Mahoney and Edward (2013), it is impossible for any health facility to survive without a good oral care program. Arguably, a good oral care program helps to improve the well being of patients. It makes the patients comfortable and gives them confidence.
A good oral care program permits patients to communicate clearly. Salamone, Yacoub, Mahoney and Edward (2013) posit that an effective oral health program helps to meet the nutritional needs of patients and speeds up the recovery process.
According to Quinn and Baker (2015), equipping nurses with the right skills will enable them to protect patients from getting infections. Research indicates that without proper oral care, the condition of patients gets worse when they are admitted.
Among others, oral care supports efforts by hospitals to lessen hospital acquired infections such as pneumonia and urinary associated infections. Providing comprehensive oral care for hospital patients using the right equipment and procedures is regarded as an effective way of ensuring that patients do not get infected once they are admitted.
To promote good health and improve the rate of recovery among hospital patients, it is necessary to have a good oral care program.
The success of the oral care program, however, depends so much on the knowledge, experience, and commitment of nursing staff.
To a large extent, a well managed oral health program helps in lessening the level of new infections for hospital patients. Consequently, hospitals must see to it that they have a good team on the ground to implement and manage their oral care programs.
Implications for Nursing Professionals
According to Soh et al. (2012), oral care is an integral part of the patient treatment. It is particularly useful for patients who require support with activities of their daily lives.
Nursing professionals are thus expected to go out of their way to meet the needs of patients who are not able to fend for themselves.
Clearly, managing effective oral care requires the services of hard working and flexible nursing practitioners.
Nursing practitioners be fully equipped with skills that are necessary for effectiveness and commitment.
Effects of Poor Oral Hygiene
As noted earlier, oral health is often neglected by many health care facilities. This is regardless of the fact that oral health is quite important for effective management of patients.
A poor oral care program majorly makes patients vulnerable to attacks by other infections.
In addition, the work of patients is made very difficult in the absence of a well managed oral care program.
In many hospitals, laxity in implementing a well organized oral care program has been blamed for the increased number of new infections once a patient is admitted.
Proper oral care must thus be implemented in order to strengthen the patients immune system and ensure that they do acquire new infections that eventually compromise their treatment process.
Conclusion
Without a doubt, every hospital must have a well organized oral care program to effectively meet the needs of patients.
Oral care is a very important component of the nursing practice and must therefore be supported by all means.
However, the implementation of a good oral care program requires enormous resources.
As explained earlier, variances exist in the way nurses offer oral care services. There is thus a need to come up with standards to manage the provision of oral care to hospital patients.
References
Quinn, B. & Baker, L. (2015). Comprehensive oral care helps prevent hospital acquired non-ventilator pneumonia. American Nurse Today, 10(3), 18 23.
Salamone, K., Yacoub, E., Mahoney, A. & Edward, K. (2013). Oral Care of Hospitalized Older Patients in the Acute Medical Setting. Nursing Research and Practice 2013, 1 4.
Soh, K. L., Ghazali, S. S., Soh, K. G., Raman, R. A., Abdullah, S. S. S. & Ong, S. L. (2012). Oral Care Practice for the Ventilated Patients in Intensive Care Units: A Pilot Survey. Journal of Infection in Developing Countries, 6(4): 333 339.
Educational lessons targeted at teaching how to overcome the burden of Chronic Obstructive Pulmonary Disease (COPD) will include three types of learners, such as patients, family members, and the healthcare staff. The three-fold approach towards addressing this issue will result in more cohesive efforts for tackling the complications associated with COPD.
The role of the patient will be linked with self-management and implementing measures that he or she can do by him or herself to deal with the array of adverse health outcomes of COPD. The role of the family will be supporting the patient in his or her self-management as well as providing care in cases when the patient cannot. Lastly, the role of the staff in the context of elevating the burden of COPD will be associated with providing further education to the patient and his or her family members, assessing the state of the patient, and ensuring a smooth integration of treatment/intervention procedures targeted at improving the condition of the patient with COPD.
Educational Setting: Patient, Families, and Staff Education
Since the educational course will include three distinct types of audiences, the educational environment will also be divided into three settings: patient education, family education, and staff development. Through effective patient teaching, a health educator helps patients to develop and sustain a healthy lifestyle, active behaviors, and knowledge regarding when and how to seek medical help (Bauldoff, 2012). Without educating patients on how they can deal with the adverse effects of COPD, the treatment or intervention will not be as effective due to the lack of patient knowledge on how to maintain and promote their health by themselves.
It is also important to mention that patients with chronic diseases such as COPD will get an exclusive benefit from lessons because for them being informed about their condition and developing an effective plan, patients should be well educated. Moreover, patient education is needed for ensuring that the patient is motivated to follow the treatment plan, as it will directly affect the health outcomes. It is important to take into consideration such factors as learning readiness, patients learning environment, teaching methods, as well as the characteristics of the population to which the patient belongs.
With the increase of a number of adults with chronic illness, there is an increased need for involving family members in providing support for their care. Despite the fact that many health providers and policymakers are interested in creating a cohesive program for involving family members in the process of care, there is an insufficient number of resources available to them (Rosland, 2009).
Family education is essential for ensuring patients well being since they provide the daily setting for patient self-management by affecting daily physical activities, diet, bad habits, and even stress management. According to Rosland (2009), family members can have both positive and negative impacts on patients self-management, especially when it comes to diet and lifestyle, so it is crucial to educate them on how they could help patients overcome the burden of COPD.
Staff development is another important point when it comes to developing a lesson plan for elevating the burden of COPD. The role of the health team in dealing with the burden of COPD is associated with providing patients with care and support that their families or they personally cannot ensure. Staff development with regards to COPD management is also closely linked to procedures of diagnosis and screening, which are needed for assessing patients health. When designing an intervention or a treatment plan for COPD management, the staff should possess the required knowledge and skills on how they can improve patients functional capacity and prevent secondary complications, as well as it will enhance the quality of patients lives through the management of symptoms (Rosland, 2009).
Learner Assessments: Readiness, Educational and Developmental Level
When assessing learners progress as well as their ability to acquire new knowledge, it is important to take into account such factors as readiness to learn, developmental level, and educational level. In order to determine learner readiness, it is important first to ask him or her what they already know about COPD, how the chronic illness is managed, as well as what questions does the learner have (Speros, 2009). To assess the developmental level of the learner, it is necessary to use all resources for a better understanding of which teaching strategies will be effective and which will not.
For instance, a teacher may ask whether the learner has any cognitive needs that affect information processing (e.g. patients may struggle to memorize medical terminology, or family members may become anxious when they hear about the processes that occur in their relatives body). Regarding the educational level, it can be effective for the teacher to ask the patient (family member or the staff) about their high education and specialization so it is clear how the educator should present the information (i.e. on a more advanced or intermediate level).
Purpose and Rationale: Raising Awareness of COPD
Chronic obstructive pulmonary disease is a growing health epidemic that unfortunately received not enough attention from healthcare providers, policymakers, the pharmaceutical industry, and government (Bauldoff, 2012). Thus, immediate action is required for recognizing the disease, which is predicted to become a major cause of disability and death.
Patients health is directly affected by the level of their education and knowledge about their disease (Farahani, Mohammadi, Ahmadi, & Mohammadi 2016), so developing a lesson plan to target patients with a specific condition will have a positive impact on the success of the intervention or treatment. Because COPD is a disease that has often been overlooked and understudied, it will be an effective strategy to provide patients with knowledge and information that could enhance their self-management skills to elevate the burden of COPD. Educating family members about how they can support their relatives is another objective that the lessons will pursue because families provide a basis and support for patients self-management.
The purpose of selecting the topic of COPD is associated with the fact that it is a progressive disease, which means that its development can be delayed through the treatment of symptoms. Therefore, by educating patients, their families, and health providers on how to effectively manage COPD, it will be possible to overturn the progression of the disease and elevate the burden of health complications that reduce the quality of patients lives.
Theoretical Basis for the Teaching Approach: Promoting Self-Efficacy among Patients, Families, and Health Providers
The goal of the patient, family, and staff teaching is influencing the change in behavior, although such changes are complicated to make. For this reason, it can be beneficial to use theories that explain human behavior as teaching guidelines, which can help educators find answers to questions regarding motivation and learning, as well as aid in predicting the implications of targeted interventions. Relating to the context of teaching patients how to overcome the burden of COPD, the self-efficacy theory is the most effective.
Self-efficacy theory explains that the belief in ones ability to follow a particular course of action used for managing the different situations, i.e. self-efficacy refers to an individuals belief in how he or she can use personal skills for dealing with a specific situation (Artino, 2012). Following this logic, individuals are more likely to engage in certain behaviors and activities for which their self-efficacy is higher (e.g. a person that used to roller skate is more likely to try skating on an ice rink that riding a horse). Therefore, the objective of the teaching approach will be associated with increasing the level of the patient, family, and staff self-efficacy regarding the management of COPD symptoms and elevating the burden of the disease.
Patient, family, and staff efficacy can be effectively increased through the practical approach towards teaching. It will be effective to provide all three types of learners with practical advice, real-life examples of how people deal with the burden of COPD, strategies and an action plan that they can follow in their daily lives (Fromer, 2011). When learners are provided with practical knowledge that can be applied in real-life situations, they will subsequently enhance their level of self-efficacy and improve their skills when dealing with the management, control, prevention, and elimination of COPD symptoms to eventually eliminate the burden of this chronic disease.
References
Artino, A. (2012). Academic self-efficacy: From educational theory to instructional practice. Perspectives on Medical Education, 1, 76-85.
Bauldoff, G. (2012). When breathing is a burden: How to help patients with COPD. American Nurse today, 7(8), 1-5.
Farahani, M., Mohammadi, E., Ahmadi, F., & Mohammadi, N. (2013). Factors influencing the patient education: A qualitative research. Iranian Journal of Nursing and Midwifery Research, 18(2), 133-139.
Fromer, L. (2011). Implementing chronic care for COPD: Planned visits, care coordination, and patient empowerment for improved outcomes. International Journal of COPD, 6(1), 605-614.
Rosland, A-M. (2009). Sharing the care: The role of family in chronic illness.
Speros, C. (2009). More than words: Promoting health literacy in older adults. Online Journal of Issues in Nursing, 14(3), 68-75.
The human lung is a respiratory organ made up of secondary lobules and Broncho vascular bundles, alveoli and blood vessels, and an interstitial. The diseases affecting the lungs, a primary respiratory organ in human beings, are called lung diseases. Most fatal lung diseases affect the interstitium. A Prolonged affliction of the interstitial by a lung disease may result into a fatal condition known as fibrosis (Schwarz and King 4).
The Interstitial lung diseases have a variety of causes which maybe an array of other lung diseases or exposure to chemical substances. Furthermore, the possibility of curing an interstitial lung disease depends on the nature of the underlying cause. An advanced case of fibrosis may result to a chronic condition with minimal applicable control measures (Schwarz and King 6). In addition, an advanced development of fibrosis may require a patient to be equipped with oxygen support to maintain basal respiration.
A patient with fibrosis can be diagnosed through the laboratory testing of his or her blood for indicating factors. The conventional methods of imaging the thoracic cavity are additional diagnostic procedures normally used. If the nature of the fibrosis cannot be ascertained, then a biopsy is conducted to assess the condition of the lungs. While most of lung diseases can be cured, some of the conditions presented by these diseases are chronic (Schwarz and King 7).
The Inflammation of the lungs causes breathing and general respiratory problems. In addition, it may lead to the rupture of the alveoli, the basic respiratory organ element in the lungs. Diseases with this kind of behavior are known as obstructive lung diseases. The obstruction of the respiratory system indicates an abnormal condition in the lungs (Voelkel and macnee 6). The Interstitial diseases of the lung differ with the obstructive diseases because of their primary symptoms. The obstructive diseases cause difficulty in breathing by the patient in their onset period whereas the interstitial diseases are likely to interfere significantly with the breathing process in their terminal stage.
The interference with the breathing process exhibits its signs when an interstitial lung disease has developed a fibroid condition in the lung tissue making the lung stiff. Thus, the disease remains unnoticed for most of its development period. At the fibroid stage, the process of respiratory failure has already commenced. This factor makes the interstitial diseases of the lung fatal with a high mortality rate (Voelkel and Macknee 9).
Another fatal cause of lung disease is the development of cancerous tumors in the lung tissue. Cancerous tumors are known as malignant tumors and are usually a result of prolonged exposure of the lung tissue to foreign chemical substances and particles. Alternatively, lung cancer can be a result of a spreading cancerous condition in another part of the body. Cancerous growths in close proximity of the lungs are almost certain to spread to the lung tissue (Schwarz and king 9). The most significant feature of cancerous tumors that make them fatal is their ability to spread to other parts of the body without adverse symptoms of tumor development exhibiting. The growth of cancer can be arrested in the early stages of its development, but fatalities normally occur with advanced tumors. Benign tumors may also develop in the lung tissue, but have low rates of occurrence (Schwarz and King).
Sometimes, rapidly deteriorating conditions can develop if a foreign material such as a product of blood thrombosis causes the obstruction of blood flow in the lungs, especially after a rupture of a blood vessel in another part of the body. A severe obstruction will cause the instant death of the affected person. Cardiac failure, often results to the blockage of the respiratory surface of the lungs by a fluid in a condition known as edema (Voelkel and Macnee 3). The combined effects of cardiac failure and respiratory obstruction are usually fatal.
Works Cited
Schwarz, Marvin I., and Talmadge E. King. Interstitial lung disease. 5th ed. New York: McGraw-Hill Medical ;, 2010. Print.
Voelkel, Norbert F., and William MacNee. Chronic obstructive lung diseases. Hamilton Ont.: BC Decker, 2002. Print.
Communicable diseases represent an almost inescapable phenomenon, especially in the modern setting of the global community where members of different social classes and economic background can converse. With the advent of tuberculosis and the threats that it has created, the global panic seems to have reached its peak, the world is in desperate need for guidelines in increasing health levels and developing an understanding of the tuberculosis infection, the threats that it poses to average citizens, and the ways of avoiding tuberculosis contraction.
Disease Description
Tuberculosis as a potentially fatal disease has been known for a while, gaining an extraordinarily poor reputation as one of the leading causes of death at some point. Therefore, knowing the factors that trigger the development of tuberculosis, as well as the symptoms that allow diagnosing the disease and the existing treatment options that allow fighting it is essential. According to Öhd et al. (2019), tuberculosis may come in two forms, namely, active and latent TB. The latter is particularly dangerous since it remains formant for a certain period of time until it is activated and begins its destructive activity (Öhd et al., 2019). While the dormant TB does not have any specific symptoms and is extraordinarily rate to spot, the active one can be identified by noticing the symptoms such as the cough that lasts up to three weeks and results in a patient spitting blood; chest pain and fatigue; night sweats and loss of appetite. When observing at least two of the listed issues simultaneously, on should visit a doctor and ensure that the latter immediately runs the necessary tests to establish whether a patient has tuberculosis.
Being a respiratory disease in the first place, tuberculosis is transferred as a droplet infection, namely, as people inhale the air that contains the virus. The specified method of disease contraction is particularly difficult to control for obvious reasons, which is why tuberculosis is quite hard to spot at its early stage and, thus, very difficult to manage. However, treatments against tuberculosis exist and can be considered quite effective.
Although tuberculosis used to be very difficult to treat not so long ago, it is currently quite manageable as long as patients address healthcare services before the disease progresses to the point where it can no longer be handled. As a rule, tuberculosis requires immediate and rather harsh actions, which include antimicrobial drugs such as isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA) (Zhang, Shi, Feng, Zhang, & Zhang, 2017). The specified four medications constitute the core of the approved treatment options for tuberculosis. The current mortality rates for tuberculosis make 3%, which is a slight improvement compared to previous years (World Health Organization, 2020). In turn, the levels of morbidity have dropped to 12% (World Health Organization, 2020). The current incidence among the target groups makes 169 cases per 100,000 people, whereas the prevalence constitutes 57% (World Health Organization, 2020). The specified trend can be considered as a positive shift in the spreading of the disease, yet the speed of progress needs to be increased.
Due to the high contagion levels and the effects that tuberculosis has on patients immune system, children and aging people are under particularly high threat. Moreover, underprivileged members of society, which may include homeless people and people living in poverty, are also under significant danger as far as the development of the disease is concerned (Alffenaar et al., 2017). Each of the specified populations has its unique characteristics, yet they share the one of being exposed to the threat of tuberculosis to the greatest extent due to the weaknesses in their immune systems (Alffenaar et al., 2017). Therefore, the specified members of local communities should be seen as the main target of the campaign aimed at preventing and fighting tuberculosis.
Social Determinants of Health
Although the risk of contracting the tuberculosis virus cannot be obliterated completely, there are several crucial social determinants of health that lead to minimizing the threat of tuberculosis in most vulnerable groups. First and most obvious, the focus on financing the healthcare support for the said populations needs to be mentioned among the key determinants of health. The specified factor belongs to the range of political ones due to the necessity to establish a statewide chain of healthcare services that offer free testing and diagnosis. In addition, the presence of equipment that allows for high-quality bacteriology testing is also on the list of key health determinants. Another important factor that leads to effective management of public health is the well-developed treatment framework paired with patient support. Consequently, regular drug supply and systems for monitoring the target audiences are the remaining two social determinants of health, which hinge upon the extent of technological development within the target community, as well as the presence of decent financing in it.
Epidemiologic Triangle
The concept of the epidemiologic triangle was introduced into the contemporary medicine in order to study the development of a disease and the manner in which it spreads within a specific community. Therefore, a traditional epidemiologic triangle contains three main elements, which are the agent the host, and the environment. In the specified framework, the agent represents the virus or bacterium that causes the disease, whereas the host includes the types of organisms that can contract the specified agent (Khan, 2017). In turn, the environment incorporates the factors that contribute to the spread of the virus and the development of the epidemiologic outbreak within a specific community (Onuka et al., 2018). However, since there are several types of tuberculosis, applying the specified model to the disease may be quite difficult.
In case of tuberculosis, the agent is represented by the TB organism, namely, the virus that incites the process of tuberculosis development. However, since there are several strains of tuberculosis, several variations of the epidemiologic triangle exist, each being represented by a specific type of an agent (Rachlis et al., 2016). Approaching the issue from a generalized perspective, one may represent the agent by the tuberculosis organism as a generic concept of a virus that causes the disease (Meehan et al., 2018). As far as the host is concerned, nearly every community member falls under the category of a possible victim of tuberculosis (Rachlis et al., 2016). Indeed, the disease is highly contagious and will not spare anyone once it reaches the scale of an epidemic (Meehan et al., 2018). One could argue that homeless people, children, and aging people, as well as those that represent the underserviced population are at the higher risk of contagion (Meehan et al., 2018). Moreover, people with low immunity, patients with comorbid diseases, and undernourished people are especially vulnerable to the virus (Rachlis et al., 2016). Finally, the environment in which tuberculosis becomes rampant can be described as that one with bad sanitation and poor ventilation. In addition, the density of the place, namely, the presence of multiple people and the lack of space, is a huge factor in contracting tuberculosis (Meehan et al., 2018). As shown in Figure 1, these are the main elements of the epidemiological triangle for tuberculosis. Although there are several types of tuberculosis, the specified ones are the most common elements of the triangle, which one is likely to come across in most cases.
Figure 1. Tuberculosis: Epidemiologic Triangle
Given the fact that the epidemiologic triage depicted above points specifically to poor living conditions and economic concerns, namely, the presence of poverty and the lack of resources, the specific issues should be central to the development of the program that will allow addressing the needs of the target population. While the age issue mentioned above should also be taken into account as a critical characteristic of the vulnerable groups, one should also ensure that people from disadvantaged communities and remote areas receive the maximum support. Providing assistance to the specified population will require offering extensive social support and financing, which is why it will be necessary to locate investors.
Role of the Community Health Nurse
When addressing the issue of tuberculosis, a community health nurse needs to assume several roles, including the one f an educator, the role of a leader, and the one of healthcare services provider. Namely, a nurse will have to provide the target population with an opportunity to test for the possibility of tuberculosis, as well as offer exhaustive, detailed information about the symptoms o the disease and the methods of managing it. Since the problem of literacy stands particularly prominently in the target demographic, mostly due to the lack of enthusiasm and access to learning, it is the responsibility of a nurse to ensure that the required knowledge is cemented in vulnerable populations. Moreover, as a nurse, one has to offer an unlimited access to testing options, including X-raying, sputum samples, the TB skin test, and the TB blood test.
The latter two tests represent a particularly important part of addressing tuberculosis and determining the extent of the disease progress. However, a nurse has to remember that both of the tests above do not allow confirming exactly whether a patient has tuberculosis o not; instead, they show the presence of TB bacteria in a patients body (Rachlis et al., 2016). Therefore, in case the skin or blood test delivers the results that may imply the presence of the disease in the patient, it is essential to continue testing by offering them X-raying or sampling the patients sputum in order to state with certainty that the observed issues a case of tuberculosis.
National Agency
As a global concern, tuberculosis has been the focus of attention and research of multiple global and national health organizations. The National Tuberculosis Controllers Association (NTCA) is one of the best-known agencies that deal with the problem of tuberculosis on the nationwide scale (The National Tuberculosis Controllers Association, n.d.).Being a part of the Centers of Disease Control and Prevention (CDC), NTCA follows a coherent and homogenous framework for managing the issue of tuberculosis and increasing awareness concerning the disease among vulnerable groups. However, given the current rates of tuberculosis contraction, the undertaken measures do not seem to be enough (Zhang et al., 2018). Indeed, according to the WHO report, tuberculosis has not become any less of a problem despite the efforts to educate communities (World Health Organization, 2020). Specifically, while there has been a 2% change in the global rates of tuberculosis contagion, the expected 4% drop set in the Healthy People 2020 project has not been achieved, which means that more efforts have to be put to attaining the goal of global public health improvement.
Global Implication
Although tuberculosis cannot be considered a new threat to the well-being of the community, its persistence, especially in impoverished areas, is a rather troubling sign. Therefore, the global implications of introducing services with a greater extent of access for disadvantaged members of the community are likely to be quite positive and substantial. Moreover, the focus on education and the promotion of health literacy among target audiences will allow detecting the cases of tuberculosis comparatively early and address them appropriately before the disease spins out of control and takes the size of an epidemic. Additional options for free or, at the very least, cheaper screenings will lead to a drop in the extent of disease contagion, which, in turn, will help to reduce the levels of mortality and allow to
Conclusion
Although tuberculosis has gained massive notoriety within the first several months of is premiere, a lot of people remain unaware or uncertain of the effects that the disease produces, the symptoms with which it manifests itself, and the changes that it causes to a patient, including the challenges and multiple complications that it means for an individuals health (Zhang et al., 2018). Among the key dangers that the tuberculosis virus represents, the fact that it is prone to mutations and, therefore, may not be identified as such during the first stages of its development represents the greatest threat to the promotion of public health and the management of the disease.
Therefore, there is an urgent need in providing the target audience with health education and key information so that they could improve the levels of their health literacy. With the focus on promoting awareness, people will develop the behaviors that will allow reducing the rates of the disease contagion and, thus, help to fight tuberculosis effectively.
Moreover, a well-developed testing system that will allow determining the cases of tuberculosis fast and with high degree of trustworthiness needs to be established so that vulnerable groups could use it accordingly. Presently, people from disadvantaged backgrounds, mainly homeless people, as well as those living in poverty, are particularly susceptible to the contraction of the disease. Therefore, opportunities for people with low financial resources have to be provided so that tuberculosis could be eradicated from local communities.
In addition, the fact that the disease affects children and aging people particularly strongly needs to be brought up as an important piece of information that should shape the framework for patient education. Namely, parents and legal guardians should be provided with clear and accurate information about the factors leading to the contraction of tuberculosis, as well as the key symptoms and the sources of support that parents with TB children can use. Similarly, information and support services have to be established of aging people so that they could access it freely. Given the difficulties with mobility of the target demographic, introducing digital services such as online consultations, as well as the opportunities for contacting healthcare representatives by phone has to be offered. The latter may be needed in the scenarios in which aging people may have difficulties using digital tools to access the required assistance.
Rachlis, B., Naanyu, V., Wachira, J., Genberg, B., Koech, B., Kamene, R.,& Braitstein, P. (2016). Community perceptions of community health workers (CHWs) and their roles in management for HIV, tuberculosis and hypertension in Western Kenya. PloS One, 11(2), pp. 1-13. Web.
The National Tuberculosis Controllers Association. (n.d.). Tuberculosis.
Managing diseases is extremely significant, to an individuals health or well being. Disease management entails the excellent healthcare interventions that aim at regulating the effects of a disease. It is, therefore, imperative for patients or individuals to manage their diseases to maintain their well being or wellness.
Body
In United States, the healthcare industry is subject to numerous challenges such as the aging population, expensive medical therapies, escalating chronic conditions and the governments deficit budget (Nuovo, 2007, p.1). Coming up with solutions to these setbacks is not easy thus the emergence of disease management. The primary aim of disease management was to help minimize healthcare costs but, on the other hand, maintain excellence in healthcare services and remedies.
Disease management primarily aims at persons suffering from chronic conditions. It entails a continuous patient education, a lasting management and frequent monitoring to prevent severity. Such measures also reduce the frequency of hospital visits, which tremendously reduces hospital or healthcare cost. Disease management is also boosted by the governments financial support via Medicaid, which supports many patients, in various perspectives.
Disease management societies are engrossed in a professional association known as DMAA (Huber, 2005, p. 4). The association was founded in the late 90s as a nonprofit organization. The primary aim of this organization was to advance management of diseases such as breast cancer, in various capacities. It aimed at providing standard definition of disease management, promote and develop high-quality programs that effectively manage diseases. It also intended to educate and provide for material support as a way of promoting disease management. Ultimately, the organization aimed at helping patients, to reduce hospital costs but uphold excellent healthcare.
Disease management plan can be obtained from healthcare organizations, vendors or by developing them domestically (Meyer, Kobb, & Ryan, 2002, p. 87). Managing diseases reduces health complications, which is extremely beneficial to the patient. Medical cost is tremendously reduced by when diseases are well managed. This is because the costs of managing diseases are less costly as compared to the expenses incurred when treating diseases or complications.
One of the chief strategies for ensuring disease management is upheld by many patients is through positive outreach. Such outreach should be executed primarily by nurses, in order to realize their fruitfulness. Private communication, for instance, between a nurse and a patient is of massive significance when striving to uphold disease management (Huber, 2005, p. 3). This is because; private communication develops a strong and healthy association between the nurse and the patient. Such associations help in promoting the management of diseases such as Congestive Heart Failure, Diabetes and, COPD. It further helps in noting what a patient lacks in the process of managing his diseases, which can be remedied by educating or counseling a patient. Close association also helps in monitoring treatment adherence and the progress of the patient. This promote quick interventions incase of any problems noted from patients.
Breast cancer, for example, requires a healthy association between doctors, patients and nurses for its excellent management. This is due to the crucial stages that follow the management of the disease. Cancer management begins with consultations between the patient and the breast surgeon who is expected to carry out the mastectomy. After satisfactory consultations, the plastic surgeon proceeds to perform the surgery by restructuring the damaged areas, in a theatre. However, the successfulness this surgery does not mean complete wellness; therefore, a patient should pay regular hospital visits for check ups, to monitor his or her progress. Often at this stage, patients are subjected to chemotherapies, which are also accompanied with several nursing services. Some of the nursing services include caressing and also giving advices and encouragement words that may boost a patients appetite for food. Also, the presence of nurses at this stage helps in identifying other complications or to provide certain nursing services, in case there is need for other procedures i.e. either hysterectomy or oophrectomy. However, apart from frequent visits, sometime patients are advised to stay in hospitals as part of the disease management process. At this stage, they are often given a social worker, if it is necessary for them to have one. Moreover, rehab can also be an option as pert of managing the disease, in case the patient faces difficulties in removing ROM.
Such strong associations are critical to private nurses, since it helps in developing trust, in both professional and personal relationship. Trust is extremely key, since it helps in the free flow of conversation and information between a nurse and the patient. Through trust, a nurse can obtain all the necessary information from the patient, which can be useful in managing his or her diseases. Trust is necessary especially when the disease affect sensitive parts such as the breast (breast cancer) or any other sensitive parts (Schwartz et al. 2008, p. 2627).
Conclusion
Managing diseases is extremely necessary for the maintenance of an exceptional healthcare and also in controlling the effects of diseases. Disease management came about as an outcome of the attempts of providing excellent and less costly medical services. Proactive outreach is the best approach that nurses should practice, when campaigning for disease management. Excellent association and trust between a nurse and a patient is vital, in promoting disease management.
References
Huber, D. (2005). Disease management: a guide for case managers. Florida: Elsevier Health Sciences. pp. 3-5
Meyer, M. Kobb, R. & Ryan, P. (2002).Virtually healthy: chronic disease management in the home. Journal on disease management. 5(2) pp. 87-94.
Nuovo, J. (2007). Chronic disease management. New York: Springer science +business media. pp. 1-8.
Schwartz, G. F., Hughes, K. S., Lynch, H. T., Fabian, C. J., Fentiman, I. S., Robson, M. E., Domchek, S. M., Hartmann, L. C., Holland, R. and Winchester, D. J. (2008). Proceedings of the International Consensus Conference on Breast Cancer Risk, Genetics, & Risk Management. Journal on American cancer society. 113(10) 26272637.
Gastroesophageal reflux disease (GERD) is a medical condition characterized by a frequent flow of stomach acid back into the esophagus. The backwash is known as acid reflux or acid indigestion irritates the lining of the esophagus and can cause a number of physiological issues as well as general discomfort. While everyone experiences acid reflux periodically, GERD is identified at mild stages at least twice a week (Mayo Clinic, n.d.). During an episode of GERD, an individual may taste food and stomach acid at the back of the throat causing discomfort. One of the most recognizable symptoms of GERD is regular heartburn, resulting in a burning, painful sensation in the chest. Other symptoms that adults may experience include respiratory problems, vomiting, bad breath, and nausea (NIDDK, 2020).
While the condition is not critical, over time GERD may cause serious complications including esophagitis which is the inflammation of the esophagus and a risk for precancerous changes. An esophageal stricture is also possible, narrowing the esophagus, causing issues with swallowing. GERD may cause breathing stomach acid into the lungs leading to respiratory problems such as asthma or recurring pneumonia (Mayo Clinic, n.d.).
Overall, GERD is a prevalent condition, affecting approximately 20% of adults in Western countries on a mild basis, with a third of that population having damage to the esophagus (NIDDK, 2020). GERD is a condition which must be studied and understood by medical professionals due to its prevalence and hidden risks, and a detailed analysis of its pathophysiology will be presented in this report.
Normal Anatomy of the Major Body System Affected
The esophagus is a muscular tube which connects the pharynx to the stomach, acting as a channel for transporting food and is also meant to prevent reflux of gastroduodenal contents. It extends 18-26 cm within the posterior mediastinum to the lower esophageal sphincter (LES). The esophageal wall is different morphologically from the rest of the gastrointestinal tract because it has no serosa and consists of mucosa and other elements. The muscles are arranged into an inner circular and outer layers. The muscle portions are connected by the vagus nerve which controls peristalsis depending on physiologic conditions (Menesez & Herbella, 2017).
The anti-reflux barrier is a sophisticated anatomical structure which creates a high-pressure zone via a synergy between the lower esophageal sphincter (LES) and a crural diaphragm. The function of the barrier is supported by the structure of the gastroesophageal flap valve consisting of the pharyngoesophageal ligament and gastric sling fibers of the gastric cardia. These elements position the intrinsic LES within the extrinsic crural diaphragm so that they overlap and create an effective barrier. The LES consists of a short tonically contracted muscle at the distal end of the esophagus. The resting tone for healthy people ranges from 10 to 30 mmHG. Typically, this creates a strong barrier to offset gastroesophageal pressure gradient across the esophagogastric junction (EGJ) (Tack & Pandolfino, 2018).
Normal Physiology of the Major Body System Affected
The upper esophageal sphincter (UES), the LES, and the esophagus function in a coordinated manner to allow for swallowing. When food is ingested, the UES is opened and then closed, propelling the item through the esophageal body and the relaxed LES into the stomach, and the LES then closes to prevent movement back into the esophagus. There is a mechanical effect of peristalsis which cleans the esophagus, and a secondary peristalsis occurs without swallowing.
At rest, the UES and LES are tonically contracted. Contraction of LES is the function of the muscle, not neural intervention. Therefore, when inhibitory fibers are stimulated in response to secondary peristalsis, transient LES relaxation occurs (tLESR) for 10-60 seconds spontaneously, relaxsing the LES and crural diaphragm. tLESR is a vagally mediated reflex which is normal and is triggered by gastric distention (Menesez & Herbella, 2017).
Reflux occurs through 4 mechanisms: transient lower esophageal sphincter relations (tLESRs), low LES pressure, swallow associated LES relaxation, and straining periods with low LES pressure. Prevention mechanisms against reflux vary due to the physiologic circumstances and anatomy of the EGJ. As an example, the crural diagphragm controls increases in intra-abdominal pressure and straining, while basal LES pressure helps manage reflux during resutful recumbency. Larger fluctuations exceeding 80 mmHG may occur. LES pressure is affected by myogenic and neurogenic factors impacting intra-abdominal pressure such as gastric distention, hormones, food, and medications (Tack & Pandolfino, 2018).
Mechanism of Pathophysiology
The pathological mechanisms of GERD are a reflection of imbalance between symptom-eliciting factors and defensive mechanisms. Extent of symptoms and mucosal injury is dependent on frequency of reflux events, and duration of mucosal acidification. GERD develops when the reflux of noxious gastric juice occurs into the esophagus. Excessive reflux exposure is prevented via the function of an anti-reflux barrier which is impaired in the condition.
If any of the 4 protective mechanisms described in the normal physiology are compromised, the harmful effects are increased along with number of reflux events and abnormal esophageal reflux exposure. The most common cause is LES dysfunction which occurs via mechanisms of transient relaxation, permanent relaxation, or a transient increase of intra-abdominal pressure which overwhelms the LES pressure capabilities.
In the context of diminished LES pressure, GERD occurs through strain-induced or free reflux. Strain-induced reflux results to a hypotensive LES being released due to abrupt increase in intra-abdominal pressure. This rarely occurs with LES pressure >10 mmHg or in patients without hiatus hernia. Meanwhile, free reflux is identified by a decrease in intra-esophageal Ph without change in pressure (Tack & Pandolfino, 2018).
The most frequent mechanism of tLESRs occurs during normal period of LES pressure, therefore independent of swallowing. tLESRs are characterized by diaphragmatic inhibition and persist for longer than typical LES relaxations during swallowing. The stimulus for tLESRs is a distention of the proximal stomach which stimulates the intraganglionic lamellar found at receptor ends of vagal afferents. The process is a complex mechanism of neurotransmitters and receptors which result in integrated motor response involve LES relaxation through reflex inhibitory actions and longitudinal muscle contraction which reduces EGJ obstruction and LES positioning, ultimately causing the GERD reflux (Tack & Pandolfino, 2018).
Delayed gastric emptying is another mechanism which leads to GERD. The delay leads to an increase in gastric contents which created added intragastric pressure that eventually collides with the LES. The LES is unable to withhold the pressure, resulting in acid reflux. Hiatal hernia is often mentioned in the context of GERD mechanisms, as it is a frequently encountered element in patients with symptomatic reflux but not a necessity. In hiatal hernia, the LES can migrate into the chest and lose the abdominal high-pressure zone. Furthermore, the diaphragmatic hiatus is potentially widened by a large hernia, disabling the crura function. Furthermore, gastric juice may be trapped in the hernial sac, and lead to reflux once the LES is relaxed (Tack & Pandolfino, 2018).
Prevention
Some of the underlying causes and risk factors of GERD come from lifestyle factors. Obesity is one of the primary due to excess belly fat which creates pressure on the stomach as well as the possibility of developing a hiatal hernia. Hormonal changes associated with obesity is also associated with GERD. Therefore, one of the primary prevention strategies is to maintain a healthy weight. Smoking is a causal factor as well since nicotine causes LES to relax unnecessarily. Eliminating smoking is a prevention strategy as well. For most individuals, changing food consumption habits is helpful to prevent mild GERD by eating smaller and more frequent meals, avoiding high fat or fried foods, and avoiding meals before bedtime or lying down (Mayo Clinic, n.d.).
Treatment
Most practitioners will recommend implementing lifestyle and dietary changes described above in cases of mild GERD. However, there are also treatments through medication, endoscopic therapy, and surgery. Medications such as antacids and histamine blockers which decrease acid levels and prokinetic agents which increase motility in the upper gastrointestinal tract are common prescriptions.
Transoral incisionless fundoplication (TIF or endoscopic therapy is a less invasive measure to a surgery and consists of using an endoscope to repair or recreate the valve which is the natural barrier to reflux. Finally, if none of the above work, surgery is an alternative which allows to strengthen the anti-reflux barrier through a procedure known as a Nissen fundoplication, providing permanent relief from reflux (John Hopkins Medicine, n.d.).
Conclusion
GERD is a common condition characterized by the release of acid reflux into the esophagus. This causes damage to the tissue and a number of side effects such as heartburn. An analysis of the anatomy and physiology shows that there is a natural barrier in the form of LES and crural diaphragm which are meant to prevent acid reflux. However, in a number of physiologic circumstances, the barriers are overwhelmed resulting in GERD. The condition is not serious and can be prevented and treated by lifestyle changes in most cases. However, pharmacological and surgical options exist which can regulate the acid reflux levels in the gastrointestinal tract.
Modern medicine achievements have reached a level that allows for treatment for multiple diseases threatening the lives of mankind. However, there still remain a number of ailments the cure for which has not been discovered. Among those, a group of brain diseases is recognized, occurring both in humans and animals and generally called prion diseases. The first public interest in such diseases arose in the mid-1980s when there was an epidemic of bovine spongiform encephalopathy (BSE) affecting cattle in the United Kingdom. Consequently, concern over whether BSE could be passed on to humans grew and waste research on prion diseases was being carried out in world laboratories. According to up-to-date medical data, prion diseases are transmissible and render a spongy appearance to the brain tissue due to its destruction; for those reasons such diseases are also called transmissible spongiform encephalopathies or TSEs, the typical signs of which are loss of coordination and in humans dementia. There exists a number of diseases falling into the category of TSEs, among them being: CreutzfeldtJakob Disease, variant CreutzfeldtJakob Disease, Bovine Spongiform Encephalopathy, Kuru, Gerstmann-SträusslerScheinker disease, Fatal Familial Insomnia, Scrapie and some other animal TSEs (Kimball).
A more widespread form of prion diseases in humans, CreutzfeldJakob disease (CJD), was first described much earlier than the BSE epidemic occurred, in 1920, by a German neurologist Hans Gerhard Creutzfeldt, and a bit later by his colleague Alfons Maria Jakob, thus acquiring a double name. Being extremely difficult to diagnose, CreutzfeldJakob disease is annually reported to affect on average one person per million worldwide. Thus, it appears of vital importance to establish the causes and the pathophysiological features of this disease in order to be able to trace its development in an attempt to find a cure for it.
In their attempts to find the cause and essence of Creutzfeld-Jakob disease, scientists noticed that transmission of CJD occurred during injections of brain tissue from an animal or human patient with a prion disease into another animal. This suggested the causative factor for the CJD to be an infectious agent such as a virus. But despite multiple efforts, including treatment of the infected tissues with heat and ultraviolet (which still did not reduce their infectiousness), no evidence of the viral nature of CJD was found. Only in the 1980s the current director of the Institute for Neurodegenerative Diseases at the University of California, San Francisco, and a 1997 Nobel Prize Laureate, Stanley Prusiner, discovered and pioneered the research of prions, a class of infectiousself-reproducingpathogens primarily or solely composed of protein, and claimed them to be the cause of Bovine Spongiform Encephalopathy ( mad cow disease ) and its human equivalent, CreutzfeldtJakob disease. Thus, originally considered to be a virus infection, CreutzfeldJakob disease is now recognized to be the consequence of an abnormal form of a specific protein called a prion (shortened form for proteinaceous infectious particle).
In order to efficiently understand the mechanism of prion diseases, it is essential to trace how they originate. A major and crucial role in the development and functioning of the human body is played by proteins molecules made up of thousands of smaller chemical units called amino acids, joined together like beads on a necklace (CreutzfeldJakob Disease Foundation 7). Being flexible, protein molecules can adopt a number of shapes a quality that is decisive for the development of prion diseases. As such, prion protein molecules are normal cellular proteins present in many organs and tissues, including the brain, spinal cord, and eyes of healthy humans and animals. Compared to normal body protein molecules, prion proteins appear to have changed their three-dimensional configuration (Kimball).
According to Prusiner, there are two possible forms of the prion protein:
The normal isoform of prion protein (PrPc) is protease-sensitive and is expressed in many tissues, but chiefly in neurons. Protease resistant form of this protein, found in diseased brains is designated PrPsc where sc stands for Scrapie isoform. (qtd. in Prabhakar and Bhatia 325)
The abnormal prions, PrPsc, possess a number of characteristics that distinguish them from the normal ones: firstly, they are not broken down by enzymes, and secondly, they are prone to forming tiny fibers called scrapie associated fibrils (SAFs) highly infectious tissues which, when congregated, make up a chemical structure called amyloid. As autopsy examinations have shown, amyloid deposits are frequent in the brain of patients who have fallen victims to CreutzfeldJakob disease (CreutzfeldJakob Disease Foundation 7). Primarily, the PrPsc structure reminds that of the PrPc, but the secondary structure of PrPsc is dominated by beta conformation. Moreover, PrPsc is almost non-solvent and are highly resistant to digestion by proteases, which makes them quite impossible to destroy (Kimball).
To make matters worse, Prusiner discovered the dangerous nature of PrPsc reveals itself in the way PrPsc molecules behave when encountering the normal PrPc molecules:
& a single molecule of PrPSc can convert molecules of PrPC into the abnormal form. These newly converted molecules can in turn corrupt more normal molecules leading to a cascade effect which would eventually cause brain damage. (CreutzfeldJakob Disease Foundation 8)
Thus, the abnormal prion functions as an infectious agent due to its ability to convert normal prions into abnormal forms. The interaction of the normal and the abnormal prions leads to a dramatic increase in the latter amount consequentially causing a plaque in the brain. The mechanism of encounter is illustrated in the following scheme:
Fig. 1. Conversion of a PrPc molecule to PrPsc, leading to a cascade of PrPsc, and eventually brain damage. Source: CreutzfeldJakob Disease Foundation. Creutzfeld-Jakob Disease and Other Prion Diseases. 4th ed. Akron, OH: Creutzfeldt-Jakob Disease Foundation, Inc., 2009.
The danger of the PrPsc, therefore, consists in its ability to promote refolding of native PrPc proteins into the diseased state. This process occurs in two steps: firstly, the alpha-helices are unfolded; and secondly, the matter refolds to beta-pleated sheets. As a result of the exponential increase in the misfolded protein molecules, a large number of insoluble prions is accumulated in the affected cells disrupting cell membrane function and causing cell death. Being practically indigestible, Proc proteins are produced in a kind of self-sustaining feedback loop, spreading and multiplying at an extremely rapid rate and in most cases leading to the death of the patient within a couple of months.
Bearing all the aforesaid in mind, it is all the more essential to understand the origins of CreutzfeldJakob disease in the body and to trace the ways it is transmitted, i.e. the ways the PrPsc prions appear in the affected tissues. In this case, scientists single out several options of possible CJD transmission, depending on the type of disease in each specific instance. The most widespread occurrence of CreutzfeldJakob disease observed (around eighty eighty-five percent of cases) is the so-called sporadic, or spontaneous CJD, the cause of which is still claimed to be unknown (Prabhakar and Bhatia 325). This type of CJD affects mostly patients 5565 years of age and is characterized by a short course during which ataxia and dementia are observed.
Another ten to fifteen percent of cases are the familial CJD, caused by an inherited mutation of the PrP gene. This type of disease is passed on from parent to child at conception through the DNA and can be usually recognized from a family history of the illness in brothers, sisters, or parents. There can be occurrences when the disease is not passed on: each child born from a parent carrying genetic CJD has a fifty percent chance of inheriting the disease-causing mutation. As compared to sporadic CJD, familial CJD usually starts at an earlier age and lasts longer.
The final, third type of CJD is acquired CJD, responsible for about five percent of all cases. It comprises two subtypes: a) the iatrogenic CJD, occurring when a person is contaminated through brain surgery, corneal transplant, dura mater graft, or growth hormone (here the contamination risk is extremely high when instruments are applied which had previously been used on a CJD-contaminated person; even after two years they still bear the infectious matter; thus nowadays instruments which have been used on the brain of someone with suspected CJD are destroyed); and b) the variant CJD, which starts as a result of exposure to BSE through consumption of infected beef or blood or plasma transfusion. Variant CJD was first identified in 1995 in two teenagers and since then has attracted specific attention due to peculiarities of its occurrence: much earlier age of the affected people and a potential epidemic risk caused serious legislative measures to be taken about cattle-based foods in the human food supply. Action has been taken since 1989 to remove those parts of cattle where the greatest concentrations of an infective agent are found, including brains and spinal cords, from the human food chain.
All-in-all, a heated debate over the actual cause of prion diseases is going on, with prion being ascribed status of the agent which causes disease or a mere symptom caused by a different agent. In 2007 a Yale University neurologist, Laura Manuelidis, claimed to have found a virus-like particle (without finding nucleic acids so far) in less than ten percent of the cells of a scrapie-infected cell line and a mouse cell line infected by a human CJD agent. However, Prusiners protein-only hypothesis is so far mostly based on the evidence thus holding a leading position in the explanation of the prion diseases cause.
With new variants of Creutzfield-Jakob disease being discovered, and the threat of its epidemic impending the world unless duly managed, it becomes one of the significant public health issues to properly establish the true causes and pathology of the disease so that a true and efficient cure could be developed for providing patients with hope for convalescence and relieving the menace of contamination from the healthy part of the population.
Works Cited
CreutzfeldJakob Disease Foundation. Creutzfeld-Jakob Disease and Other Prion Diseases. 4th ed. Akron, OH: Creutzfeldt-Jakob Disease Foundation, Inc., 2009.
Prabhakar, Sudesh and Rajinder Bhatia. Diagnosis of CreutzfeldtJakob Disease. Neurol India 49.4 (2001): 325-8.
Prion Diseases. Kimball, John W. Kimballs Biology Pages. 2009. Web.
This paper is a project proposal for the management of heart disease and stroke in Minnesota. It outlines a leadership and strategic plan for addressing the high incidences of the health conditions in the state. The first section of the paper describes the communitys health problems and explains why they are leadership problems. This section of the paper also explains how the leadership and strategy plan complements Minnesotas Community Healthy 2020 objectives. Lastly, the second section of this paper explores the budget issues surrounding the program.
Description of Community Health Problem
Heart disease and stroke are leading causes of adult mortality in many American states (Bisognano, Baker, & Earley, 2009). Compared to the national average, Minnesota has a relatively high incidence of heart disease and stroke (Bisognano et al., 2009). The graph below shows that both conditions are among many other non-communicable diseases that affect Minnesotans.
Figure One: Prevalence of Chronic Diseases in Minnesota
According to 2010 statistics, heart disease, stroke, cancer, diabetes and unintentional injuries account for more than half of the main causes of death in Minnesota (Minnesota Department of Health, 2012b). These diseases come with a high social and economic cost to their victims because they require costly health care services, shorten life, and cause human suffering (Public Health Leadership Society, 2002). Based on this background, there is a need to change these health outcomes through leadership.
Why is this Health Issue a Leadership Problem?
Heart disease and strokes are both health conditions caused by lifestyle factors, such as binge drinking, smoking, poor diet and such like factors (Bisognano et al., 2009). These lifestyle factors come from personal factors and environmental conditions, which are subject to cultural and economic conditions. Leadership could influence the outcomes of these health concerns because it can change peoples lifestyle choices and behavioral risk patterns (Thomas, 2004). This assertion reinforces the views of the Minnesota Department of Health (2012b) which says three-quarters of all causes of death in America stem from lifestyle factors (mostly attributed to tobacco use, poor diet and sedentary lifestyles). Therefore, heart disease management is a leadership problem that resonates at individual and institutional levels (Jennings, Kahn, Mastroianni, & Parker, 2003). This paper highlights this fact because it emphasizes the healthy choice as the easiest choice.
How the Health Problem relates to the Healthy 2020 Objectives
The aim of the proposed health leadership program is to reduce the incidence of heart disease and stroke in Minnesota. The Minnesota Healthy 2020 plan strives to promote community health through a shared common sense approach that builds on past and present health initiatives (Minnesota Department of Health, 2012a). The health leadership program for heart diseases and strokes will complement the Healthy 2020 objectives because it focuses on two key areas cardiovascular disease prevention and reducing injuries (disabilities caused by chronic health conditions). The health plan outlined in this paper also aligns with the Healthy Minnesota 2020 plan by complementing its broader effort to create a revolutionary health improvement framework for residents of Minnesota.
List of Potential Sources of Data
Health Statistics
Behavioral risk factor surveys
Meta-analyses
General Social Surveys
Online data archive for population studies
State Departmental Health Surveys
Government publications
Corporate reports
Economic handbooks
Funding Proposals
Public Health Reports
Funding Issues
Funding Issues often derail health care programs. The leadership program highlighted in this paper could similarly suffer the same fate. However, different funding issues affect the program. Some may affect its long-term effectiveness, while others may only affect its success in the short-term (Johnson, 2014). Funding issues may also affect different stakeholders in different sectors of the health leadership program. Key stakeholders that may experience its effects, in this regard, include the Minnesota community and health care workers. Funding issues may also affect accessibility as a key area of the health care program. The following section of this paper categorizes these factors into short-term and long-term challenges.
Long-Term
Poor Accessibility
The main aim of starting the leadership program outlined in this paper is to reach many people. Minnesota is an expansive area and the 21st most populous state in America (Anderson & Watkins, 2009, p. 115). In this regard, the region needs an elaborate leadership program that would reach all people, effectively (Public Health Leadership Society, 2002). However, health workers and stakeholders need enough resources to come up with such a program (Suarez, Lesneski, & Denison, 2011). Resource limitations (funding limitations) may affect their performance in this regard. Stated differently without proper financing to implement this program, the health care workers would only reach a few people. Funding issues may emerge because of several reasons. First, if a program depends on state or federal funding, the competition for public resources may cause the government to reduce program funding. Secondly, if the health program is private-sponsored, economic challenges, or the withdrawal of a key sponsor, may affect the sustainability of the project. The main stakeholder that is likely to experience this challenge is the Minnesota community because the leadership program aims to improve its welfare through the reduction of heart diseases and stroke. Therefore, with poor funding, residents of Minnesota would not understand the value of adopting lifestyle changes that would reduce their risk of suffering from heart diseases and strokes.
Short-Term
Loss of Vital Services
The health leadership program strives to provide several services for residents of Minnesota, which directly affect their risk exposures to factors that cause heart diseases and strokes. These services may include education, screening, and health management services (Minnesota Department of Health, 2012a). Most of these services depend on proper funding to attain their goals. For example, health education requires adequate funding to pay workers, advertise for seminars and promote other platforms of interaction. Therefore, inadequate funding could lead to the loss of these vital services. However, this challenge is short-term because health care workers could seek alternative and inexpensive services to meet the same goals of the program.
Poor Access to Medications and Crisis Services
As highlighted in this report, the leadership program proposed in this paper strives to provide a holistic approach to health care services. Therefore, besides providing preventive services to the residents of Minnesota, it also strives to provide pre-diagnostic services for disease management. Since heart diseases and strokes are incurable diseases, most patients usually subscribe to a treatment regime to manage such conditions (Minnesota Department of Health, 2012a). Usually, this strategy involves giving patients adequate access to medications. However, such a strategy depends on institutional commitments and the willingness of sponsors to provide medications to patients. Albeit a last stage of the health leadership program, funding challenges may undermine the program goals. The main stakeholder affected by this process is the patients because they use medications.
Recommendations for Potential Funding Sources
Finding the right partners to finance a project could be a daunting task. In fact, Bisognano et al., (2009) say many potential sponsors do not fund a project without inviting applicants, first. Therefore, the approach that a project manager takes when seeking potential sponsors affects the financial success of a project. This paper proposes that the best candidate for sponsorship includes those that offer free grants to undertake health projects. The following alternatives are the best choices for funding the Minnesota health program
Federal Funding
Federal funding could be a good source of funding the Minnesota health plan because this government source strives to improve community health outcomes (part of the objective of government). Proponents of the program could make their applications through the official website for seeking grants (Grants.gov, n.d.). The Public Health Finance and Management (n.d.) supports this assertion by saying that seeking for funds through this website (Grants.gov, n.d.) is the quickest way of seeking federal funding and conducting a federally funded research. The main advantage of seeking federal funding is the possibility of receiving huge financial support through only one application. In this regard, the U.S. Department of Health and Human Services (2014) says federal funding could provide millions of dollars for one health program. Therefore, it could cover most of the financial obligations of the Minnesota health program. Furthermore, programs that receive funding from federal sources improve their credibility to other potential and alternative sponsors, such as private organizations (Grants.gov, n.d.). Therefore, it is the first step of seeking health care funding for the Minnesota health care program. Lastly, government funding has low variability (stability of funding over lengthy periods). In fact, the U.S. Department of Health and Human Services (2014) says there is a low likelihood that the government would default on paying (throughout the programs lifetime) after approving funding. Therefore, although getting federal funding is subject to bureaucracy (Minnesota Department of Health, 2012b), it is still an attractive source of funding for the Minnesota community health project because it builds the programs credibility to seek other sources of funding, such as corporate funding.
Corporate Funding
Corporate funding could include a group of investors who share the same goal, or view, of the Minnesota health care plan. This investment strategy is advantageous to the Minnesota health care program because it raises funds for the program without placing the risk on one entity alone (or the proponents of the program) (Bisognano et al., 2009). The main disadvantage of this funding strategy is the increased control of the corporate sponsors on the health care project. Bisognano et al., (2009) adds that although some of these corporate organizations may be silent partners, proponents of the program always need to make them happy. Compared to federal funding, corporate funding is variable because most corporate organizations prefer to peg their funding on results. Therefore, if the program fails to meet some specified goals, the organizations may withdraw their financial support (Bisognano et al., 2009). However, corporate funding is still an attractive source of funding for the Minnesota health care project because the program intends to achieve its goals. Therefore, undoubtedly, the corporate sponsors would be happy to collaborate with the community in improving health outcomes.
References
Bisognano, J., Baker, M., & Earley, M. (2009). Manual of Heart Failure Management. New York, NY: Springer Science & Business Media.
Jennings, B., Kahn, J., Mastroianni, A., & Parker, L. S. (2003). Ethics and public health: Model curriculum. Web.
Minnesota Department of Health. (2012a). Healthy Minnesota 2020: Statewide Health Improvement Framework. Web.
Minnesota Department of Health. (2012b). Healthy Minnesota 2020: Chronic Disease and Injury Plan. Web.
Public Health Leadership Society. (2002). Principles of the ethical practice of public health. Web.
Thomas, J. (2004). Skills for the ethical practice of public health. Web.
Anderson, P., & Watkins, S. (2009). The State Economic Handbook 2010. New York, NY: Palgrave Macmillan.
Bisognano, J., Baker, M., & Earley, M. (2009). Manual of Heart Failure Management. New York, NY: Springer Science & Business Media.
Grants.gov. (n.d.). About Grants.gov. Web.
Johnson, T. D. (2014). Prevention and public health fund paying off in communities: Success threatened by cuts to fund. Web.
Minnesota Department of Health. (2012a). Healthy Minnesota 2020: Statewide Health Improvement Framework. Web.
Minnesota Department of Health. (2012b). Healthy Minnesota 2020: Chronic Disease and Injury Plan. Web.
Public Health Finance and Management. (n.d.). Search for Funding. Web.
Suarez, V., Lesneski, C., & Denison, D. (2011). Making the case for using financial indicators in local public health agencies. American Journal of Public Health, 101(3), 419425.
U.S. Department of Health and Human Services. (2014). Grants/funding. Web.
Effective prevention of chronic kidney disease (CKD), clearly, requires different approaches to lessen the number of deaths in the world. Health promotion deals with empowerment of people to make healthy lifestyle selections, as well as encourage them to become better self-supervisors (Raingruber, n.d.). Before discussing the health promotion model, it is vital to conceptualize the frameworks of the health promotion model as indicated in the figure below.
What Is the Health Promotion Model? Definition & Theory, 2014.
The health promotion concept requires people to have ways of comprehending and interpreting occurrences. The approach enables people to have full control over the contributing factors of health. As a rejoinder, the health promotion theory helps in this idea by presenting a systematic method of understanding procedures; the theory has different concepts of the events that demonstrate the association and correlation between the variables (Parker, Baldwin, Israel, & Salinas, 2004).
Markedly, the theory notes that peoples proficiencies influence their actions. For this reason, promotion a healthy behavior is the expected result in this concept. Even though scholars and students have clear objectives for learning ways of devising and implementing health promotion interventions, the concept of health promotion remains unclear not straightforward. An empowered society is likely to minimize chronic kidney disease infections, as they will put into practice the required intervention measures.
What Is the Health Promotion Model?
Health practitioners can use the theory to help people understand the nature of CKD. Since the theory helps in understanding the motivations and wants of the target population, it can give practical suggestions on how to change health-related conducts. In addition, the theory can inform the target population of the measures to apply in monitoring and evaluating health promotion concepts. With social-economic determinants having great influence on the occurrence of this complication, it is important to understand the social structure of different people for proper intervention measures (Poland, Green, & Rootman, 2000). For instance, the nature of social environment and structures can affect the eating habits of people.
Understanding the chronic kidney disease requires complete involvement of communities and individuals. Although the current community is quite dynamic, it is easier to provide multi-level intervention programs than single-track programs. An intervention program touching on a community based on the eating habits will clearly limit the amount of sugar intake among the population. In addition, the communal approach will enable the entire community to engage in an activity like workout to keep fit, as well as reduce instances of cardiovascular diseases. Different models illustrate how environmental structures like occupational, educational, recreational, and health shape human behavior and well-being (What Is the Health Promotion Model? Definition & Theory, 2014).
Intervention Plan
A proper intervention for the dynamic society involves educating them on the importance of maintaining healthy eating habits. The target audience in this intervention plan is the American Community. The population should avoid foods with a lot of cholesterol and stop eating junk foods like hamburger and chips. This intervention prevents development of conditions like high blood pressure and obesity. These complications always provide room for the set in of CKD.
Definitely, this intervention plan will limit the number of occurrences in the American population. Given the strong relationship between CKD and diabetes, the need for a lively empowerment program as elaborated in the health promotion theory remains indispensable. This plan is appropriate for the identified role given that self-driven actions are easily rooted in the behaviors of the target population. From this approach, the highlighted numbers of new cases of CKD are likely to go down tremendously.
References
Parker, E. A., Baldwin, G. T., Israel, B., & Salinas, M. A. (2004). Application of Health Promotion Theories and Models for Environmental Health. Health Education & Behavior, 31(4), 491-509.
Poland, B. D., Green, L. W., & Rootman, I. (2000). Settings for health promotion: Linking theory and practice. Thousand Oaks, CA: Sage Publications.
Raingruber, B. (n.d.). Health Promotion Theories. Web.
Fig.1 above is a microscopic representation of the Ebola virus belonging to the filioviridae family in the order of mononegaviruses (CDC,2021a). The virus is single-stranded and exhibits a distinct heterogenous threadlike structure (CDC,2021a). Upon entering the body, the virus causes cells death, which weakens the immune system (CDC,2021a). Subsequently, it hinders blood clotting cell formation leading to uncontrollable bleeding (CDC,2021a).
Figure 2. Ebola Virus replication stages
The figure above represents the virus replication stages, including attachment, whereby the cell binds the surface proteins and enters the cell (Yu et al. 2017). The next phase is the viral entry characterized by micropinocytosis, whereby the virus attaches itself to the hosts plasma membrane through invagination (Yu et al., 2017). Also, viral entry can occur through clathrin-mediated endocytosis, whereby the clathrin enables the attachment of the virus to the host cell using glycoproteins. The third step is transcription, whereby the RNA genome binds with the polymerase complex, and together they form an individual viral gene (Yu et al., 2017). The fourth phase is replication, whereby as the viral proteins increase, the positive single-stranded RNA is synthesized, resulting in rapid encapsidation. The last step is assembly and budding, in which the viral particles begin to form the nucleocapsids (Yu et al., 2017). They accumulate within the perinuclear space and are later transferred to the budding site within the plasma membrane resulting in the local concentration of the virions. The last phase is the release phase, in which the fully constituted virion is released to the host cells, and destruction begins (Yu et al., 2017).
Susceptible Population
According to World Health Organization, first responders are usually pre-exposed because of the high chances of getting into contact with bodily fluids such as blood (WHO, 2021). Also, healthcare practitioners working at bio-safety organizations are vulnerable because they interact with the live Ebola virus in the laboratory, making it easier for them to be infected (Selvaraj et al., 2018). Additionally, health workers taking care of infected patients may be prone to infection because of the probability that they may be in contact with the body fluids (WHO,2021). Persons showing symptoms of Ebola should be tested immediately to curb the spread of the disease.
Figure 3. Ebola virus infection trend among healthcare workers
Healthcare frontline workers are prone to Ebola infection because of the environment in which they operate. In comparison, non-health workers are more affected by the virus, mostly contracted from patients (Selvaraj et al. 2018). In 2014, the USA had a total of 149 cases of infected health workers (Selvaraj et al., 2018). Sierra Leone had 2402 cases and Guinea 2210, representing the vulnerability of health workers working within the zoned countries (Selvaraj et al. 2018).
Symptoms, diagnosis, and vaccine side effects
The immunosorbent assay (ELISA) test determines whether a patient has antibodies related to some Ebola disease. (Niemuth et al. 2020). Symptoms of post-Ebola treatment include swelling in the area of injection, muscle pain, headache, and fever (WHO,2021). The treatment period may vary, just like the incubation period that lasts for 2-21 days (Niwmuth et al. 2020).
Prevention and treatment
Ebola can be prevented by following public health guidelines such as washing hands, avoiding contact with body fluids, and unnecessary travel (WHO,2021). The drug used to treat Ebola is Immazeb, approved by the U.S. Food and Drug Administration (CDC,2021b).
References
Center for Disease Control and Prevention. (2021a). Ebola (Ebola virus disease). Web.
Center for Disease Control and Prevention. (2021b). Prevention and vaccine. Web.
Niemuth, N. A., Rudge Jr, T. L., Sankovich, K. A., Anderson, M. S., Skomrock, N. D., Badorrek, C. S., & Sabourin, C. L. (2020). Method feasibility for cross-species testing, qualification, and validation of the filovirus animal nonclinical group anti-Ebola virus glycoprotein immunoglobulin G enzyme-linked immunosorbent assay for non-human primate serum samples. PloS One, 15(10), e0241016. Web.
Selvaraj, S. A., Lee, K. E., Harrell, M., Ivanov, I., & Allegranzi, B. (2018). Infection rates and risk factors for infection among health workers during Ebola and Marburg virus outbreaks: a systematic review. The Journal of infectious diseases, 218(suppl_5), S679-S689. Web.
World Health Organization. (2021). Ebola virus disease. Web.
Yu, D. S., Weng, T. H., Wu, X. X., Wang, F. X., Lu, X. Y., Wu, H. B.., Wu, N. P., Li, L. J, & Yao, H. P. (2017). The lifecycle of the Ebola virus in host cells. Oncotarget, 8(33), 55750. Web.
