Category: Health & Medicine 13691

Improving Access Discussion

Oral disease remains one of the major chronic diseases affecting many children in the United States (Borchgrevink, Snyder, & Gehshan, 2008). This condition also affects many people in every low-income society. Several strategies should therefore be identified and implemented in order to improve access to dental care. According to the California Healthcare Foundation (CHF), the decision to increase reimbursement rate has been necessary towards improving dental care. However, the strategy has failed to support the dental health needs of more people. This essay describes the merits and challenges of various strategies that can be used to improve access to dental care for Medicaid recipients.

Increasing Reimbursement for Care

Reimbursement for dental procedures can ensure every practitioner supports the needs of every Medicaid patient. This approach ensures that more dentists are empowered to provide the best care. This strategy will also encourage dentists to participate in Medicaid. However, such reimbursement rates have been ineffective thus affecting access to various dental services (Borchgrevink et al., 2008). Proponents of this strategy have also failed to appreciate the importance of effective program administration. Budgetary increments might not deliver positive results without embracing the roles played by other participants.

Program Administration

Healthcare experts believe that effective program administration can produce positive results. This kind of administration will ensure every health challenge is identified and addressed. The right players will be encouraged to support the changing dental needs of more citizens. Medicaid agencies should be aware of the major challenges affecting different communities and populations. This approach will ensure there is even distribution of resources thus supporting the countrys citizens. However, this strategy can be challenging because of the bureaucracies associated with Medicaid programs. The government will also have to incur numerous expenses thus compromising the quality of care and resources availed to the targeted patients.

Partnering with Dental Societies

This strategy has worked effectively in different states across the country. Building strong relationships with various dental societies presents a wide range of opportunities. For example, the strategy ensures that different practitioners are aware of the major dental problems affecting different people. Different dentists will be able to acquire relevant data and information from such societies. A new wave of collaboration will improve the dental health outcomes of many patients. Oral health coalitions will ensure new medical practices are identified thus supporting every citizen (Borchgrevink et al., 2008). However, some societies have strict rules that discourage them from interacting with other organizations. New legal frameworks and policies will also be required in order to support such partnerships.

Improving the Usability of Gathered Data

A powerful toolkit can be used to gather quality oral health statistics. A Quality Improvement (QI) tool will identify the strengths and gaps affecting the delivery of quality dental health services (Medicaid/CHIP Health Care Quality Measures Technical Assistance and Analytic Support Program, 2014). New approaches will then be outlined to improve the quality of care. Relevant leaders will be able to implement the best interventions using the gathered data. This method presents several merits. For instance, more people will be able to receive the best dental care. Every affected population will be given priority. The approach will reduce costs and ensure more people receive quality dental care (Borchgrevink et al., 2008). However, this strategy can be expensive to implement. As well, it can be impossible to gather accurate data. This is the case because many practitioners and institutions might not give accurate information.

Reference List

Borchgrevink, A., Snyder, A., & Gehshan, S. (2008). Increasing access to dental care in Medicaid: Does raising provider rates work. Web.

Medicaid/CHIP Health Care Quality Measures Technical Assistance and Analytic Support Program. (2014). Improving oral health care delivery in Medicaid and CHIP: A toolkit for states. Web.

Study Summary

In the article titled, Physical Activity, Sedentary Behavior, and Cause-Specific Mortality in Black and White Adults in the Southern Community Cohort Study, Matthews et al. (2014) strived to understand the causality between physical activities and adult mortality among male adults from two ethnic groups (African-Americans and Whites).

The primary exposures were sedentary lifestyles and physical activities. Adult mortality was the outcome of interest. Here, the authors used different measures to analyze the dependent variables and their influence on adult mortality in the country (Matthews et al., 2014).

The study was prospective because it was watching out for health outcomes that emerged because of environmental exposures. Its structure could also help to explain the etiology of many chronic diseases that affect many adults in America (Matthews et al., 2014).

Matthews et al. (2014) recruited 85,000 male adults from the southern part of the United States (U.S.). Particularly, the study focused on 12 key southern states  Florida, Alabama, Mississippi, Louisiana, Arkansas, Tennessee, Georgia, South Carolina, North Carolina, Virginia, West Virginia, and Kentucky (Matthews et al., 2014, p. 395). About 86% of the respondents worked in community health organizations within their locality. These health centers mainly provided their services to low-income and uninsured people. The participants ages ranged from 40 years to 79 years. The overall study started in 2002 and ended in 2009. However, 14% of the respondents participated in the study for only two years (2004-2006). The studys design was a cohort study that occurred between 2002 and 2009 (n=63,308).

Cox proportional hazard was the main statistical instrument used to estimate hazard ratios. It showed that the relationships analyzed in the study had more than a 95% confidence level. This confidence level was mainly applicable to all participants of each cohort entry (in relation to quartiles of physical activities and sedentary behaviors among respondents from the two ethnic groups sampled). The researchers came up with these findings after using age as the main time metric (Matthews et al., 2014). When formulating the findings, the researchers analyzed data regarding all respondents separately. Effect modification tests involved likelihood ratio tests to analyze the behavioral exposure of each racial cohort that caused death. This analysis excluded race-behavior interactions. The authors also assessed confounders (that affected physical activity) using backward modeling processes. Particularly, the researchers paid attention to model-building procedures that had more than a 10% estimation change (Matthews et al., 2014). The analysis further extended to include an assessment of dietary factors, such as energy nutrients and fats. Other confounding factors that they assessed using the same process included marital status, work status, and the diagnosis of life-threatening diseases/conditions (such as diabetes and hypertension). Based on their overall analysis, the researchers only included diabetes and employment status in their final models (Matthews et al., 2014). To make sure there was no possibility of pre-existing diseases clouding the results, the researchers conducted a sensitivity analysis that excluded participants that did not participate in a follow-up assessment, 12 months before the study began (Matthews et al., 2014).

Sometimes, background factors affected the quality of research findings because they introduce irrelevant factors that could affect the quality of factors (Rothman & Greenland, 2005). The main confounding effects identified by the researchers included age, sex, race, educational level, annual household income, and marital status (Matthews et al., 2014, p. 395). Other confounding factors included personal health, physical activities, lifestyle (drinking and smoking) and occupational factors.

To mitigate these confounding factors, the researchers made sure that most of the respondents were black people (two-thirds) (Matthews et al., 2014). Therefore, white respondents were a control group.

Effect modifiers differ from confounding factors because they are third-party factors that affect the relationship between primary exposures and the examinable effects (Brownson, Chriqui, Burgeson, Fisher, & Ness, 2010). Reverse causality is one such effect modifier. Particularly, the researchers paid attention to how racial differences could affect causality. For example, some respondents could not identify their races, as either white or black. To mitigate such effect modifiers, the researchers excluded such participants from the study. This excluded sample was 4.9% of the participants (4130 participants) (Matthews et al., 2014). Reverse causality could also occur if the researchers sampled respondents who had a history of illness. Therefore, the authors excluded respondents who suffered from heart disease, cancer and stroke. The researchers also excluded people who suffered from Parkinsons disease, lupus, and multiple sclerosis from the study (Matthews et al., 2014). To minimize (further) the studys effect modifiers, the researchers excluded the findings of respondents who had inclusive physical activity data. Similarly, they excluded respondents who had inadequate data regarding their sedentary lives from the final report.

The mortality rate among the respondents was 3613 (blacks) and 1394 (whites) (Matthews et al., 2014). Based on these statistics, the researchers found out that physical activity reduced the incidence of the main causes of adult mortality, such as cardiovascular diseases and cancer (Matthews et al., 2014). However, this finding was only unique to blacks because white men did not report a decreased incidence of cancer through increased physical activities. The study also found out that physical activity varied across different age groups, sex and educational levels (Matthews et al., 2014). Other factors that affected sedentary behaviors and physical exercising were smoking status, marital status, and employment status. Cancer and cardiovascular diseases were the leading causes of adult mortality. However, HIV, diabetes, and cerebrovascular diseases were other causes of death among the respondents (Matthews et al., 2014). However, many black people (than white people) died from these diseases. Diabetes, liver disease, and respiratory complications were other causes of death among white people, compared to black people. After adjusting for sex, body mass index (BMI), and other covariates in the study, the authors found out that a high level of physical activity was correlated to lower mortality rates among black people (across all causes of death) (Matthews et al., 2014). Generally, the authors found out that increased physical activity reduced the risk of death from diabetes and cardiovascular diseases by 24% (Matthews et al., 2014). However, the authors found that this percentage varied across different disease clusters. For example, they found out that there was a 19% reduction in the risk of developing cardiovascular diseases among black people. They also found out that there was a 24% decrease in the risk of developing cancer among this racial group (Matthews et al., 2014). Lastly, the researchers found out that the reverse trend was monotonic for all-cause mortality. However, cardiovascular and cancer diseases were exceptions. Based on these findings, the authors found that a sedentary life had a high correlation with an increased risk of all-cause mortality in both races. Similarly, their findings suggested that most public health campaigns should encourage people to engage in more activities that are physical because they increased their chances of living longer (Matthews et al., 2014).

Critical Analysis

Random errors often occur when a studys findings are inconsistent with the findings of similar tests (Brownson et al., 2010). The term random comes from the unpredictability of the findings. Although most measurements are prone to random error, our case study shows that unpredictable dependent and independent variables could cause have caused inconsistent findings. Different interpretations of the instrumental reading could also have caused inconsistent findings. Partly, environmental factors could fan these problems. Precision concepts closely align with random errors. Stated differently, high precision measures often lead to lower variability levels.

Besides random errors, selection bias could also have affected the sampled results by lowering the possibility of randomization, which would have increased the probability of extrapolating the findings across a large geographical area (Matthews et al., 2014).

Using race as a classification metric in the study could potentially have undermined the credibility of the information obtained from the study because the researchers relied on self-reporting measures to classify people according to different racial profiles. Other researchers have experienced the same problem by noting inconsistencies in their findings. For example, Bryan, Tremblay, Perez, Ardern, and Katzmarzyk (2006) say Wolf and Walsh (two researchers) reported significant differences in physical reporting by race. Matthews et al. (2014) admit that this challenge could have affected the quality of their findings because although they found comparable validity for white and black males in the Southern United States, their validity coefficients were low. Part of the problem could have stemmed from measurement errors for analyzing physical activities and sedentary behaviors among the respondents. Research shows that such errors could easily attenuate observable risk estimates (Ibrahim, Alexander, Shy, & Farr, 1999).

The small number of deaths across both racial groups could also have undermined the credibility of the research findings because it lowers the statistical power for comparing the relationship between physical activities and adult mortality among blacks and whites. Nevertheless, more than 1,400 deaths noted among the respondents (about physical activities and sedentary lifestyles) provided a statistically significant correlation between the dependent and independent variables.

The discussion section of the paper adequately addressed the strengths and limitations of the study. For example, the representative cohort sample of more than 60,000 people is among the largest samples used to understand the relationship between physical activities and adult mortality (Matthews et al., 2014). The long follow-up time (6.4 years) also increases the studys reliability because it provides an accurate measure of the effects of lifestyle choices on human health. This reliability emerged from the 5000 deaths reported during the study period (Matthews et al., 2014). Measures to control the confounding factors in the study also contributed to the studys reliability because there was less interference from these factors. Demographic and dietary factors are a few confounding issues that the authors controlled this way. Using trained interviewers to sample some of the respondents also improved the credibility of findings received from the respondents because they were able to extract information that would have otherwise been difficult to obtain. Particularly, using these professionals was instrumental in assessing a broad range of physical activities that could affect the overall health of the respondents

Matthews et al. (2014) concentrated their study on the Southern United States. Although they used a largely representative sample of more than 60,000 adults, they did not select all the respondents randomly (Matthews et al., 2014). For example, they sampled many respondents who worked in the health sector. Therefore, it would be difficult to extrapolate the findings of this study to people from other economic sectors. Similarly, it would be difficult to generalize the findings of the study to people from other parts of the United States because the study mainly focused on understanding the relationship between physical exercises and adult mortality among black and white males in the southern United States. To generalize the findings across the country, the researchers would have to sample adult men across the country.

Given the studys findings, the authors conclusions were appropriate. They found out that the decline in physical activities within America, partly contributed to the high number of adult mortalities in the country (Matthews et al., 2014). Similarly, they found out that the increase in chronic conditions within the country could stem from the decline in physical activities within the country (Matthews et al., 2014). In the same way, the study found out that there were insignificant differences in the above relationship, across both races (blacks and whites). Their findings provide much-needed empirical data to understand the importance of physical activities in promoting overall health standards.

Future studies should investigate the same relationship across other states in the country to find out if the same findings would suffice nationally. Using respondents from southern states alone is insufficient to draw up a holistic understanding of the relationship between physical activities and adult mortality among black men. Therefore, future studies should include respondents from other racial backgrounds. Particularly, these studies should investigate the relationship between the same dependent and independent variables among Hispanics because they live in (almost) similar conditions, and fall with the same economic cluster, as African Americans do. This way, there would be fewer confounding factors when investigating the study issue.

References

Brownson, R. C., Chriqui, J. F., Burgeson, C. R., Fisher, M. C., & Ness, R. B. (2010).Translating epidemiology into policy to prevent childhood obesity: The case for promoting physical activity in school settings. Annals of Epidemiology, 20(6), 436444.

Bryan, S., Tremblay, M., Perez, S., Ardern, C., & Katzmarzyk, P. (2006). Physical Activity and Ethnicity Evidence from the Canadian Community Health Survey. Canadian Journal of Public Health, 97(4), 271-276.

Ibrahim, M., Alexander, L., Shy, C., & Farr, S. (1999). Cohort studies. ERIC Notebook. Web.

Matthews, C. E., Cohen, S. S., Fowke, J. H., Han, X., Xiao, Q., Buchowski, M. S., && Blot, W. J. (2014). Physical activity, sedentary behavior, and cause-specific mortality in black and white adults in the Southern Community Cohort Study. American Journal of Epidemiology, 180(4), 394-405.

Rothman, K. J., & Greenland, S. (2005). Causation and causal inference in epidemiology. American Journal of Public Health, 95(1), 144-150.

Evidence-based research implies retrieving and analyzing objective data that is not based on researchers opinions or subjective vision but on numerical and impact-based findings. For that matter, the statistical and clinical significance of studies is essential to demonstrate the validity of results and their relevance to the clinical setting or academic world in general. Since both measures are important in research, they are not equally valuable to the clinical setting and treatment improvement options (Fleischmann & Vaughan, 2019).

Indeed, a study finding might have a high level of statistical significance, demonstrating that two variables are interdependent. Although such a relationship is statistically significant and true, it does not imply that the proved dependence will apply to the treatment of patients effectively. For example, if a study involving 200 individuals showed statistically significant results of medication intake, which shifted the recovery by only one day, it would not be clinically relevant (Lira & Rocha, 2019). Such clinical irrelevance is validated by the lack of specific treatment- and evidence-based ground for better patient outcomes (Fleischmann & Vaughan, 2019). Therefore, such a study might apply to the academic world to further research in the area but would not significantly change the currently used treatment and practice-based interventions.

Given the essential role of clinical significance in evidence-based practice research, researchers should properly analyze the goals of their studies to use relevant designs, variables, sample sizes, and other factors. One of the important elements is the properly asked research question that implies clinical relevance. For example, when conducting a clinical trial, which is considered one of the most effective study designs in the medical field, using a PICOT (Population, Intervention, Control, Outcome, and Time) model is recommended (Lira & Rocha, 2019). In such a manner, at the very stage of study planning, a researcher is capable of foreseeing the clinical significance of potential findings, which helps increase the viability of research results.

References

Fleischmann, M., & Vaughan, B. (2019). Commentary: Statistical significance and clinical significance-a call to consider patient reported outcome measures, effect size, confidence interval and minimal clinically important difference (MCID). Journal of Bodywork and Movement Therapies, 23(4), 690-694.

Lira, R. P. C., & Rocha, E. M. (2019). PICOT: Imprescriptible items in a clinical research question. Arquivos Brasileiros de Oftalmologia, 82(2), 1-1.

While being oriented toward the well-being of the American nation, it is necessary to provide all citizens with the right to receive healthcare services in spite of their social and economic status. The rationale behind this position is that only a healthy nation can contribute to the further development and prosperity of the country. In the situation when the healthcare system has the features and elements of a market or a highly competitive industry, it is rather problematic for many Americans to access healthcare services when they need them. The problem is that many citizens in the United States still remain uninsured and unsupported despite receiving some community aid (Austin & Wetle, 2017). As a result, health issues can become unresolved for them, leading to dramatic consequences for families.

Even if the full health care coverage for all Americans can be unachieved at the current stage of the healthcare systems development, it is still possible to work on promoting more resources for citizens. The problem is that, currently, the socio-economic status of individuals and their insurance play the most critical role in determining their access to high-quality medical and nursing services. As a consequence, health problems for disadvantaged groups of the population remain unresolved (Austin & Wetle, 2017). Furthermore, if a person becomes unemployed, he or she is also at risk of losing an appropriate insurance plan (Legido-Quigley et al., 2019). From this perspective, many Americans can feel unprotected and unsupported in relation to their health status. Therefore, if the citizens of the United States receive free access to health care and the full medical coverage, their well-being will improve as well as their potential contribution to the nations progress.

References

Austin, A., & Wetle, V. (2017). The United States health care system: Combining business, health, and delivery (3rd ed.). Pearson Education.

Legido-Quigley, H., Pocock, N., Tan, S. T., Pajin, L., Suphanchaimat, R., Wickramage, K., McKee, M., & Pottie, K. (2019). Healthcare is not universal if undocumented migrants are excluded. The BMJ, 366, 1-12.

Sodium is an example of an electrolyte that promotes the normal functioning of the body. In particular, sodium is essential for nerve and muscle function, with the entrusted health specialists emphasizing that the correct sodium level is key to ensuring an individuals well-being. However, the lack of enough sodium results in nausea, vomiting, fatigue, and dizziness. According to Ahmad et al. (2019), the level of blood sodium below 135 mEq/L is known as hyponatremia and is related to cell damage by the enlightened health specialists. For example, in organs such as the brain, the cells swell with too much water to make them toxic.

Fortunately, preventive and curative treatment options are available to help ensure the balance of electrolytes. Each individual should consider taking moderate amounts of sports drinks after exercise or exertion to monitor the impact of electrolyte loss. Besides, sweating while maintaining a well-managed diet reduces the risk of electrolyte shortage. Sources of sodium include tomato juices, sauces, pickles, and table salt. However, the hyponatremia therapy choices differ depending on the underlying condition. For example, a variety of IV medications will allow the body to regain the balance of electrolytes quickly.

Medical experts believe that the medicines protect the individuals affected by an alternative treatment strategy from the adverse effects. Unfortunately, Birukov et al. (2016) argue that electrolyte imbalance resulting from kidney disease cannot be avoided and therefore needs extensive treatment options. Hemodialysis, for example, uses an automated waste remover from the blood of a person. It also plays a crucial role in restoring a weakened kidneys daily function to maintain the bodys proper functioning.

References

Ahmad, N. J., Ishak, N. A., & Bunyamin, M. A. H. (2019). Learning demand and classroom discourse design tools to improve studentsconceptual understanding of the nature of electrolytes. Asia Pacific Journal of Educators and Education, 34, 187-218. Web.

Birukov, A., Rakova, N., Lerchl, K., Olde Engberink, R. H., Johannes, B., Wabel, P., Moissl, U., Rauh, M., Luft, F. C., & Titze, J. (2016). Ultra-long-term human salt balance studies reveal interrelations between sodium, potassium, and chloride intake and excretion. The American Journal of Clinical Nutrition, 104(1), 4957. Web.

A preventable error occurs when a different or wrong medication or medical procedure is given to a patient even though there exists a correct treatment for that condition. These mistakes may alter the patients health entirely, add other medical expenses, or even cause death. For instance, in our healthcare facility, an expectant mother needed urgent attention due to her unusually severe labor pain but the health worker on duty assumed it to be a normal case. By the time the lady got help her condition had worsened and she had to go through a cesarean operation for safe delivery. Thus, to improve the process communication can be enhanced in several ways including nurses letting patients well-being be their priority. Proper introduction by the caregiver to the patient and explaining how they will be assisting that particular patient (Marshall, 2019). One should use a friendly and quiet voice and show respect to everyone including the client. The healthcare worker should remember to pay full attention when the patient is stating their problem. In this scenario, one should do it without making a judgment or interrupting, and also by maintaining eye contact. Clinicians should always be mindful of the patients body language such as eye contact, gestures, and facial expressions. It is always good to acknowledge the ailing persons emotions and ask questions using simple non-medical language.

Moreover, caregivers ought to be cautious about the queries they raise in that, they must be open-ended and should not have a psychological effect on the patient. One can also use images or written materials to express what they are trying to convey to the sick person. To avoid some errors, the health care policies should be modified or the procedures changed to allow a smooth patient-caregiver interaction. For instance, in my above case, a policy change would work best. This is because the previous guidelines were that patients should be attended to according to the first-come-first-served protocol. This was unfair and extremely risky for patients who needed urgent treatment. Thus, the above occurrence led to an implementation of a more suitable policy that stated that patients with urgent conditions should be attended to first. Health workers are now required to provide equal and unbiased attention to all patients regardless of their condition.

Reference

Marshall, D. (2019). What are patient preferences, how do you measure patient preferences and how can I apply them in clinical practice for patients? Osteoarthritis and Cartilage, 27, S15-S16.

Registered nurses (RNs) continue to complete non-nursing tasks because of a lack of sufficient ancillary personnel and organizational role deficiencies in the healthcare system. Nursing works actual meaning is misunderstood because RNs lack an appropriate lexicon to define their specific roles (Grosso et al., 2019). Non-nursing tasks imply performing medical care functions outside the treatment role, including administrative activities, which separate nurses from patients. RNs perform non-nursing jobs to extend their obligation to offer more services to patients, to meet understaffed nursing issues, and because of the poor structuring of roles in healthcare.

Role overlapping among RNs reflects a change in health systems. In particular, the challenging economic situations have contributed to more complex and costly medical facilities. In response, physicians are also redefining their roles to more challenging and demanding ones. The cost of education is also rising, making access to healthcare courses more challenging. Consequently, the number of employed RNs does not match the increasing demand for treatment care services (Grosso et al., 2019). RNs also perform risky jobs that expose them to contaminable diseases such as COVID-19 which claimed several hospital workers lives, ultimately affecting staffing levels. In response, existing nurses shift their roles to non-nursing ones to meet patient demands.

Registered nurses are not reluctant to delegate non-nursing tasks to ancillary personnel but are compelled by insufficient support personnel. The work experience is not appropriate for substituting formal education and training as most of these tasks require fewer skills. An experienced RN can identify the skill gap due to job dissatisfaction. Overall, there is a need to restructure the healthcare roles to avoid nursing overload and provide education costs to healthcare courses to meet the current staffing needs.

Reference

Grosso, S., Tonet, S., Bernard, I., Corso, J., De Marchi, D., Dorigo, L., Funes, G., Lussu. M., Oppio, N., Mori, D. P., & Palese, A. (2019). Nonnursing tasks as experienced by nurses: A descriptive qualitative study. International Nursing Review, 66(2), 259-268.

The research work that is going to be analyzed and discussed covers the topic of treatment methods for the use of addictive substances, such as alcohol, cannabis, and other. The article is published in the Drug and Alcohol Review journal in May of 2021. The title of the article is: Facilitators and barriers to integrating physical health care during treatment for substance use: A socio-ecological analysis (Osborne et al., 2021). The study focuses on the identification of the facilitators and barriers in applying physical health when treating alcohol and other drugs (AOD) use disorders within the socio-ecological model. There are several limitations of the study, which are addressed in the following paragraphs.

The importance of the study is that it focuses on the integration of the physical treatment with AOD related disorders, which was not conducted before. The article should have a better explanation of the importance of the research work. The article shows the importance of the work by just describing the negative consequences of a patients poor physical conditions. The direct relationship of the patients physical health conditions and AOD related treatments should be described to highlight the significance of the present studys goal.

The hypothesis of the study is not clearly mentioned in the article. The article has a small literature review about the treatment methods of non-government organizations (NGOs), but it does not suggest the hypothetical outcome of the study. It leaves a reader with a sense that the authors are not sure about the outcome of the research work. The extensive literature review of current treatment technologies and systems and their analysis would be an efficient way to come up with a hypothesis of the study.

The method of the study includes interviews with clinicians and clients of NGOs AOD services. The format of the interviews was face-to-face with audio recording. The study includes three NGOs representing both urban and regional AOD treatment services. The NGOs chosen for the research work should have been justified by compared all types of NGOs treatment methods and by explaining why the choices are the best representatives of the urban and regional treatment services. The number of clients who were interviewed in 20 patients, and the number of clinicians are 13 workers. There is a potential selection bias in a group of patients. More than half (11) of the clients were alcohol-addicted patients. The effect of addiction on the physical condition of the patient depends on the substance that is being addicted to. Hence, the importance of and significance of physical treatment in AOD related disorders are varying. Thus, the group cannot fully represent all patients for achieving the study goals.

A dependent variable of the study is the enhancement of the AOD services. At the same time, independent variables were identified as the result of the study. The factors and issues that facilitate or hinder the integration of physical health treatment into AOD services are independent factors of the study. The major independent factors, which were found in the study, are discussed in the next paragraph.

The major findings of the study are that the clinicians find it difficult to address the physical problems of the clients and problems with encouraging the clients the improvement of their physical health. Another barrier hindering physical health promotion is a lack of knowledge and skills of the health workers. Clinicians do not fully understand how to properly analyze the information regarding the physical health of the patient and which decisions to make based on the information obtained. Also, another finding is that even if some clinicians believe that clients are not motivated to improve their physical health, some clients indicated that they would appreciate any opportunity or effort, which would benefit their physical health. Moreover, the visit of an external healthcare practitioner was indicated as a facilitator of physical health from the perspective of clinicians, but not clients.

Reference

Osborne, B., Kelly, P. J., Robinson, L. D., Ivers, R., Deane, F. P., & Larance, B. (2021). Facilitators and barriers to integrating physical health care during treatment for substance use: A socioecological analysis. Drug & Alcohol Review, 40(4), 607616.

Introduction

Children with cerebral palsy possess complex and challenging needs that require proper management. Nutritional management is one of the issues that require adequate attention from health care providers, parents, and their communities. Eating a healthy diet is an important aspect of maintaining the overall health and quality of life of children with cerebral palsy (CP). It is especially important for a 12-year-old male with CP who is confined to a wheelchair and wants to play basketball. There are various evidence and best practices applied in the nutritional management of children with cerebral palsy. They provide simple and practical suggestions to non-experts like parents to assist them in managing their childrens nutrition needs. The solutions are aimed at ensuring that the children are not at risk of undernutrition leading to negative consequences. It is also possible for the children to engage in physical activity through the nutritional assessments that ensure specific nutritional requirements are met.

Main Text

The child with (CP) confined to a wheelchair and intending to play basketball will require nutritional interventions. This will involve individualized meal plans aimed at improving his nutritional health and engaging in physical activity effectively. The interventions assist in assessing the current nutritional status and determining the specific nutritional requirements (Kuperminc, et al., 2013)

The first step in ensuring the healthy nutrition of the child entails interpreting his nutritional status. This is done through an assessment based on multiple methodologies such as examining his diet history, physical examination, and anthropometry. Next, it is essential to ascertain the childs target weight or the target multiple skins folds in a clinical setting (Kuperminc, et al., 2013). Moreover, the child should start a safe eating experience, with food containing the proper level of nutrients and enough fiber. The food should also have a palatable texture or allow proper digestion to take place. In some cases, supplemental diets and nutrition will be required to meet the necessary nutritional needs. The assessments conducted will also assist to find out the feeding difficulties and oral motor dysfunction the child may have. Treatment will then be provided to prevent or treat existing undernourishment while at the same time improving the childs oral motor skills (Kuperminc, et al., 2013).

The childs energy needs, protein needs, and fluid requirements are considered while determining the specific nutritional requirements. There are specific standards applied to estimate energy, proteins, and fluid needs in children with CP. For instance, the DRI equation of estimating energy needs may be useful for this child. This is because it is adjusted to meet an individuals needs and includes the Physical Activity Coefficients. The childs protein needs can be estimated using the DRI and the appropriate weight for height. Fluid requirement estimations may be done using the childs actual weight. This is particularly important since there is a lot of fluid loss through sweating while playing basketball. After conducting these estimations, appropriate adjustments are made in food intakes to meet specific nutritional requirements (Kuperminc, et al., 2013).

Conclusion

Nutrition health is important for children with CP; it is even more important for a 12-year-old male, who is wheelchair-bound and intends to engage in physical activity. Conducting a nutritional assessment and determining specific nutritional requirements are essential in ensuring the nutrition of this child is properly maintained.

References

Kuperminc, M. N., Gottrand, F., Samson-Fang, L., Arvedson, J., Bell, K., Craig, G. M., & Sullivan, P. B. (2013). Nutritional management of children with cerebral palsy: a practical guide. European journal of clinical nutrition, 67, S21-S23.

Background

Aromatherapy has been used for thousands of years and is documented in biblical accounts for spiritual rituals and burials (Smith & Kyle, 2008). Hippocrates, the founder of modern medicine, used lavender in baths and massages. Rene Maurice Gattefosse, a French chemist, used it for healing burns in 1930 and Dr. Jean Valnet used its healing powers on wounded soldiers during World War I (Thomas, 2002). Florence Nightingale also used lavender during wartime on the wounded soldiers of the Crimean War in 1856. Madame Marquerite Mauray was another prominent nurse who used aromatherapy and successfully established aromatherapy clinics in Paris, England, and Switzerland (Smith & Kyle, 2008).

Science of aromatherapy

Aromatherapy is defined as treatment using scents to reduce stress and promote relaxation. This therapy is delivered through the inhalation of the essential oils derived from plants. The reaction of the human nervous system of the olfactory nerve which is connected to the limbic system that controls human emotions occurs when one inhales scents from aroma plants. It is thought that aromatherapy is effective because the effects of the scents on mood and behavior. Rarely are smells associated with neutral experiences (Thomas, 2002). Smells associated with these experiences can influence behavior by eliciting feelings of either excitement or relaxation (Duan, Tashiro, Wu, Yambe, Wang, Sasaki, Kumagai, Luo, Nitta & Itoh, 2007).

Study results related to aromatherapy

The effectiveness of aromatherapy has attracted attention for decades. Florence Nightingale was probably one of the earliest nurses to perform a study using aromatherapy. She utilized 10 nurses and placed a fragrance called Joy de Jean Patou on their upper lip and observed a difference in their behavior (Smith & Kyle, 2008). Walsh and Wilson reported reduced psychological distress in a study group involving severely disable patients when they were exposed to lavender (Thomas, 2002). Duane et al (2007) on the other hand performed a study in which participants were treated with lavender and then had PET scans performed to gather quantitative data related to the effects of lavender on the brains. The researchers also measured cardiovascular responses such as the heart rate, blood pressure, electrocardiograms, and respiratory status of the participants. The results of their study showed changes in both the cardiovascular system and the brain. The results of this study abided with other research works in this filed that that lavender did cause relaxation and happiness. These feelings were accompanied by an increase inactivity of the parasympathetic nervous system and a decrease in the sympathetic nervous system.

McCaffrey et al (2009) performed a study using graduate nurses to see how lavender affected their perceived levels of stress while taking a test. The results of the qualitative study showed a reduction in mental stress and anxiety. It also showed an effect on the parasympathetic nervous system resulting in lower blood pressures. In fact, the participants in this study found that they became too relaxed; a feeling that compromised their ability to focus on the test. Chiu (2009) performed a secondary study which led to similar results. Her review of lavender studies found reported feelings of relaxation, improved sleep quality, and a decrease in depression amongst participants of the study. Pemberton & Turpin (2008) performed a qualitative study on nurses working in the intensive care and self-reported their stress levels. The results of the study demonstrated that there was a 75% reduction in perceived stress amongst these nurses after being exposed to the scents of lavender. The last study for this report was performed on mice through the administration of caffeine as a stimulant. After stimulating process, the mice they were given lavender to inhale. The results of this study showed the mice returned to their pre-stimulated state, as well as decreased cortisol levels found in the blood (Denner, 2009).

My Plan for implementing therapy

My plan for implementing therapy included the involvement of friends and family. I selected a bottle of lavender essential oil from a local department store and used it on all my friends and family members who volunteered to participate. I prescreened my participants for three conditions: pregnancy, blood pressure disorders, and allergies. These form the list of contraindications to aromatherapy (Chiu, 2009). Once I established, they recorded negative results to the conditions. I admnistetered two drops of lavender oil on a two-by-two gauze and instructed them to lace them where they could smell the lavender throughout the day. I collected the results of the study at the end of the day.

Analysis of my experience

My study involved a total of nine participants. Only one participant reported a negative response and stated the lavender scent reacted negatively with her system and made her experience headache. Two other participants reported the oil had no effect on them at all and the other six participants reported that the therapy did help them experience a feeling of relaxation. Three of my participants may have been biased by the fact they use lavender at home on a routine basis for the purpose of relaxation. The funniest response came from my five-year-old daughter. She was an unintended participant in this study because she climbed into my bed while the lavender soaked in gauze. She demonstrated profound likeness to it and requested to sleep with it every night. Whereas I would have loved to comply with her request, I could not because lavender has been reported to cause pre-pubertal gynecomastia in children (Denner, 2009). One participant stated she felt she was in heaven and wanted to share it with everyone. The rest of the responses reported a feeling of relaxation after inhaling lavender scent.

What I learned from this experience

This experience expounded my knowledge base on the importance of knowing your participant before a study and the effectiveness of aromatherapy in stress reduction and relaxation enhancement. I also learned that relieving stress should be a goal in nursing practice because stress is correlated to the general well being of an individual. Some effects of stress I learnt from the study include mental distraction, difficulty with memory, nausea, headache, diarrhea, and increased heart rate (McCaffrey et al, 2009). Relieving stress can also help to increase the overall health of a person by promoting wellbeing of the mind, body, and spirit (Denner, 2009). I therefore believe that we have a duty as nurses to create an environment that stimulates such healing by utilizing essential oils such as lavender in the treatment of our patients (Smith & Kyle, 2008).

Last, this experience reinforced my belief on the need for concerted research endeavors on aromatherapy as an alternative means of achieving well being. The effects of lavender on the cardiovascular system are an interesting area of study that should be explored. I believe lavender should be explored as an alternative medicine.

References

Chiu, T. (2009). Aromatherapy: the challenges for community nurses. Journal of Community Nursing, 24(1), 18-20.

Denner, S. (2009). Lavandula Angustifolia Miller: English Lavender. Journal of Holistic Nursing Practice, 23(1), 57-64. Web.

Duan, X., Tashiro, M., Wu, D., Yambe, T., Wang, Q., Sasaki, T., Kumagai, K., Luo, Y., Nitta, S., & Itoh, M. (2007). Autonomic nervous function and localization of cerebral activity during lavender aromatic immersion. Technology and Health Care, 15, 69-78.

McCaffrey, R., Thomas, D., & Kingelman, A. (2009). The effects of lavender and rosemary essential oils on test-taking anxiety among graduate nursing students. Holistic Nursing Practice, 23(2), 88-93.

Pemberton, E. & Turpin, P., (2008). The effect of essential oils on work-related stress in intensive care unit nurses. Holistic Nursing Practice, 22(2), 97-102.

Smith, M. & Kyle, L. (2008). Holistic foundations of aromatherapy for nurses. Holistic Nursing Practice, 22(1), 3-9. Web.

Thomas, D. (2002). Aromatherapy: mythical, magical, or medicinal. Holistic Nursing Practice 17(1), 8-16.