Category: Health & Medicine 13691

Summary

A survey is a valuable research instrument allowing for the in-depth examination of different problematic situations, conditions, or topics of interest by querying a specific group of people and analyzing the gathered data. In this regard, surveys help scholars or organizations to raise discussions about disturbing issues, reveal solutions, build effective strategies, and make decisions. In the case of Anytown struggling with opioid misuse and widespread incidents of pneumoconiosis due to work in coal mines, the most appropriate type of survey is an online survey. The rationale for this choice is that online surveys are both simple for a researcher in terms of design and application and comfortable for respondents. As a result, their simplicity allows for questioning a larger population.

Questions

The intended survey will consist of several types of questions, including closed-opened, multiple-choice, and open-closed questions. The first questions will concern the background information of participants to determine their name, age, sex, and employment. Demographic data can help detect the most vulnerable group of people exposed to opioid use and some important differences in answers in terms of sex and age.

1. What is your name?
2. How old are you?
3. What is your sex?
4. Where and how long have you been working (your position)?
5. Do you have children? How many?

The last question aims at determining the potential impact of parents opioid use on children. The following unit of questions is related to reasons and circumstances contributing to opioid use or abuse.

1. When did you first begin using opioids? At what age?
2. What reason or circumstances urged you to turn to drugs (chronic or acute pain, illness, including pneumoconiosis)? Was it connected with your work conditions?
3. Have you ever heard about opioid dependence?
4. Did your doctor warn you about this severe problem?  Questions 8 and 9 will help evaluate the populations awareness of this issue.
5. Did you use opioids during pregnancy?  This question is explained by that the number of newborns experiencing abstinence syndrome because of opioid use during pregnancy has increased over the last years (What is, 2021).
6. What narcotic(s) do you use on an everyday basis?
7. Have you ever used heroin and synthetic opioids, such as fentanyl or methadone? What do you know about their side effects?  These questions are stipulated that the death rate for synthetic opioids has increased by 15% from 2018 to 2019, even more than the rate for heroin grown by 6% (Understanding the epidemic, 2021).
8. How many times per day or week do you use a drug(s)? In which cases?

The next two questions are addressed to doctors.

1. How often do you prescribe drugs to patients? What are the most frequent causes?
2. Have you ever suggested drugs containing fentanyl for individuals? Are you aware of the potential harm of this substance?

The last question will concern the potential strategies that respondents consider effective and helpful:

1. How do you think which practical interventions or activities are needed to mitigate or resolve the current situation?

Distribution and Validity of the Survey

Since the opioid crisis in Anytown has acquired an alarming scope, the given survey should be distributed through all possible means of communication. Specifically, invitations can be sent to the citizens emails, primarily healthcare providers and those who work in coal mines. Additionally, it is relevant to publish the post about the survey on the towns website, including on social media, and in local newspapers to enhance peoples awareness. The data will be collected using both a paper form and SurveyMonkey, an Internet-based program, the access to which can be performed via personal computers or smartphones. The surveys validity will be ensured and assessed by asking respondents and experts whether the questions correspond to their primary intention (Tsang et al., 2017). The surveys reliability will be estimated by repeating the same survey over a particular period of time. The extensive coverage of participants due to online instruments will also give added value to the study.

References

Tsang, S., Royse, C. F., & Terkawi, A. S. (2017). Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi Journal of Anaesthesia, 11(1), 8089. Web.

Understanding the epidemic. (2021). Centers for Disease Control and Prevention, Web.

What is the U.S. opioid epidemic?. (2021). The U.S. Department of Health and Human Services (HHS). Web.

Nurse delegation is a critical process in the provision of nursing care. Delegation is the process by which nurses assign tasks to other persons to conduct nursing activities and tasks. Registered nurses (RNs) and licensed practical nurses (LPNs) have to delegate tasks at various career stages. Some nursing facilities lack clear policies on the delegation roles of LPNs; therefore, it is essential to develop a new policy that establishes the responsibilities of LPNs in assigning tasks to other medical personnel.

LPNs have to utilize their nursing judgment to evaluate the suitability of task delegation. When selecting what task to assign to unlicensed assistive personnel (UAP), LPNs should consider the probability for patient harm, task complexity, predictability of medical outcomes, personnel and equipment resources available, and the level of communication required (Toney-Butler & Martin, 2018). Additionally, when delegating to a specific UAP, LPNs consider the UAPs regular assignments and verify their training and education.

The delegation process must include constant communication with the UAP, which specifies the expectations of the assigned roles. For instance, communication identifies the authority limits, desired outcomes, the delegations time frame, verification of supervision and monitoring, and the delegates assignment understanding. LPNs should also understand that the original allocation of a task to a delegate and the inspection of the assigned activity remains their responsibility (Toney-Butler & Martin, 2018). LPNs usually delegate their tasks to the assistive personnel, who include the certified nursing assistant (CNA), home health aide, certified medication aide (CMA), and a patient care technician.

The licensed practical nurse can delegate various duties, which include the following:

1. Assisting a patient with the aspects of their daily living like hygiene, bathing, grooming, dressing, and ambulation.
2. Gaging and recording fluid output and intake, vital signs, weight, and height.
3. Provision of nonmedical pain relief and comfort interventions like creating and sustaining a conducive and comfortable environment and providing a patient with a therapeutic and soothing back rub.
4. Observing and reporting changes and current patient status in regards to their condition and responses to care.
5. Assistance with feeding, making beds, bladder and bowel functions, transfers, and motion exercises.
6. Transport of patients, specimens, and other tasks like stocking supplies.

The LPNs must understand which tasks to assign or when they are not supposed to delegate activities required by Floridas Nurse Practice Act. The licensed practical nurse shall not delegate the original or subsequent nursing assessments and the activities that are not within the LPNs scope of practice. Furthermore, LPNs should not assign tasks that the UAP has shown no competence or nursing activities that require special knowledge and skills of the practical or registered nurse (Nurse Practice Act, 2020). Roles that require determination or interpretations of diagnosis and assessments should not be assigned to the UAP.

The rationale behind the LPNs role in delegation is related to healthcare. Delegation is a critical skill that LPNs can perform safely and effectively to provide quality and affordable care through the utilization of resources. The current healthcare industry necessitates the need to delegate certain nursing functions to multiple personnel with different knowledge, training, cultural competence, and educational preparation. All delegation-related decisions are founded and based on protecting the publics safety, welfare, and health. LPNs take accountability and responsibility for the provision of nursing care (Nurse Practice Act, 2020). As a result, LPNs should ensure that the assisted personnel have the appropriate competency, skills, and knowledge for the delegated functions they accept.

In conclusion, most LPNs do not have clear delegation policies to follow; therefore, it is necessary to develop a new policy. LPNs delegate their duties to the assistive personnel provided they understand the tasks expectations and successfully perform the functions. LPNs should effectively communicate to the assistive personnel to facilitate successful task delegation. LPNs delegate duties such as motion exercises, ambulation, utilizing comfort devices, and data gathering. Delegation is essential because it improves the quality of care. The LPN has to ensure the assistive personnel has the necessary competence to accept various delegated tasks.

References

Nurse Practice Act 2020. Web.

Toney-Butler, T. J., & Martin, R. L. (2018). Florida nursing laws and rules. StatPearls Publishing.

Introduction

Northwell Health Care System is a healthcare institution that provides health-related services to a consortium of at least 800 hospitals and care centers. Northwell Certified Home Health Agency (CHHA), a constituent of the Northwell Health Care System provides a range of professional home health services to its clientele. Medication errors are among the leading causes of morbidity and mortality during transitions from hospital to home care. These oversights hamper the smooth transition of patients from hospital to home settings and impact the performance of CHHA negatively. The purpose of this project was to improve medication safety and reconciliation in-home care settings post-discharge. Nurses were trained on the medication reconciliation process as well as the use of medication management time tools. The implementation of medication reconciliation by nurses was low. The reported rate of implementation was 12% instead of the targeted rate of 25%. The low rate of adoption of medication reconciliation was attributed to resistance and time constraints. However, the project led to the development of a medication management form that was incorporated into everyday practice. Furthermore, patients who received medication reconciliation services reported better outcomes in terms of few adverse drug events and lower rates of hospital readmission. It was recommended that CHHA should ensure adequate staffing to increase the likelihood of the adoption of evidence-based practice interventions and improve patient outcomes.

Background and Objectives

Organization

Northwell Health Care System is a healthcare organization that provides health-related services to a network of more than 800 hospitals and care centers. Northwell Certified Home Health Agency (CHHA) is part of the Northwell Health Care System whose role is to offer different home health services, for example, medical supplies, home health aides, occupational and speech therapists, medical and social services, in addition to nutritional services. Northwell Health Care System is devoted to the delivery of quality healthcare services to its customers in all spheres of operation. The organization accepts reimbursements for services rendered from Medicare, Medicaid, as well as private insurance companies. The mission of the organization is to improve the health and quality of life of the people and communities it serves through the provision of world-class service and patient-focused care.

Project Objectives

The overall goal of the project was to improve medication safety and reconciliation in-home care settings post-discharge. Four specific objectives were developed to achieve the overall goal. The first objective was to improve the medication safety and reconciliation rate by 25 percent by the end of February through the training of field nurses. The second objective was to develop a medication schedule time tool that would increase the patients ability to take medications on time and in the right doses by the 20^th of December. The third objective was to increase patient participation in medication management by the end of February. The fourth objective was to improve the transfer of medication information during the transition from hospital to home care by the 30^th of January.

Reason for Project

The New York State Department is mandated to monitor the services rendered by CHHAs through quality measures, which are indications of how well home health agencies cater to their patients. HHCAHPS surveys, Medicare claims, and OASIS provide the data used in the development of quality measures. OASIS stipulated that federal evaluations should be done every time patients who were covered by Medicare or Medicaid were referred to home care, after 60 days of admission, and after discharge from the care provided by professional staff. Pharmacological intervention is the mainstay of treatment for most health conditions. The efficacy of this intervention is determined by correct drug use, which is in turn influenced by patients adherence to prescription instructions. The incorrect usage of medications leads to negative events such as polypharmacy, medication errors, adverse drug reactions, and unremitting illnesses, which may warrant the readmission of patients back to health facilities. Such occurrences contribute to poor performance in quality measures used to monitor CHHAs. Therefore, it is necessary for healthcare professionals in CHHAs to ensure that patients take their medications correctly the following discharge from hospitals. Therefore, this project strives to improve medication practices in home health settings as part of strategies to improve performance in terms of quality measures.

Issues and Documented Needs

Medication errors are common problems during the transition of patients from hospital to home-based care (Hale et al., 2015). About 75% of elderly patients aged 65 years and older are usually referred to home health care upon discharge from hospitals (Jones et al., 2017). The probability of medication errors increases significantly during the transition from hospitals to home-based care (Kee et al., 2018). Polypharmacy is a major problem among home-based patients, with some taking more than 12 medications concurrently (Champion et al., 2020). This problem is prevalent among elderly patients due to the likelihood of multiple comorbidities with advancing age. The lack of proper discharge planning affects the transition from hospital to home-based care, which ultimately contributes to high readmission rates due to medication errors, polypharmacy, and adverse drug events among other related issues (Mickelson & Holden, 2018; Zurlo & Zuliani, 2018).

As a home care nurse, it was noted that most patients encounter confusion regarding what medications to take at home following discharge from hospitals. The most common assumption made by patients is that they should continue taking all medications that they took while in the hospital. Such practices often lead to polypharmacy, missed drug doses, and wrong medication doses, which result in negative health outcomes that warrant hospital readmissions. Another negative outcome of incorrect usage of medication is poor patient satisfaction, which impacts negatively on an organizations reputation and quality indicators. Northwell Certified Home Health Agency has reported numerous cases of medication-related adverse events in its home care patients. These occurrences signify a gap in patients knowledge of medication use and the need for home care nurses to fill this void through appropriate interventions.

Expected Results

The expected outcome of the project was a 25% improvement in medication safety and reconciliation in-home care settings post-discharge. This outcome was expected to be achieved through the development of a medication schedule time tool aimed at promoting the correct usage of medications by patients. Other expected outcomes included increased patient involvement in medication management and enhanced transfer of medication data during hospital-home transitions.

Approach

Detail Scope of Project

The project covered components of medication-related care in home health settings. Precise aspects included training of nurses on medication reconciliation, implementation of the procedure on patients before discharge, and monitoring the effects of the intervention post-discharge. The project also looked at the medication management of patients by providing discharge instructions.

Implementation Plan and Its Component Parts

The first process in the project was stakeholder identification. Identifying stakeholders provided a clear understanding of the people who were going to be affected by the outcomes of the project directly and indirectly and allowed the researcher to provide periodic updates and feedback as required. The stakeholders for the project included home health nurses, patients, their families, and part of the Northwell Certified Home Health Agency administration. The stakeholders were then engaged to get their perceptions regarding the problem. Home health nurses were briefed about the issue of medication errors among patients and asked to explain some of the challenges they faced and what could be done to address them. Similarly, patients were asked to state some of the issues they faced when taking medications at home following discharge from the hospital. This information was helpful to customize the evidence-based interventions to match the precise needs of the stakeholders.

The second process was a literature search and evaluation. Evidence-based practice entails gathering, processing, and executing findings from research to improve clinical practice and patient outcomes (SkelaSavi
et al., 2017). Peer-reviewed articles were searched from databases such as PubMed, Google Scholar, and CINAHL using key search phrases such as medication reconciliation, home health care, and medication safety. The search was narrowed down to full-text articles published in the last five years. The abstracts were skimmed to identify relevant articles for subsequent use. A literature matrix table was used to summarize the key recommendations from the articles.

The third step was the collection of baseline data on medication errors, polypharmacy, and hospital readmissions associated with medication errors. These data were critical during the evaluation stage to determine the efficiency of the project. The fourth step involved training of staff members and the development of the medication schedule and time tool using information from the evidence-based research, whereas the fifth step was the implementation of the project, which entailed the actual use of the medication schedule time tool and medication reconciliation. The fifth step was data collection, which was followed by a final step of evaluation. Project evaluation denotes the methodical and objective appraisal of a continuing or completed project to determine the importance and extent of the attainment of project objectives, effectiveness, effect, and sustainability. Outcome evaluation was used to determine the effectiveness of the interventions and the attainment of project goals.

Method of Evaluation

Outcome evaluation provides data on project results and the extent to which those outcomes are attributed to the project. This form of evaluation also assesses the effectiveness of the project in achieving the expected results. The outcome evaluation was used in the appraisal of this project because it details project upshots and determines whether the initial goals were achieved or not. This form of evaluation would determine whether the project was successful or if further improvements were needed.

Results

Summary of Outcomes

Out of the total number of nurses who were trained on the medication reconciliation protocol, only 12% adhered to it in their subsequent encounters with patients. The intervention showed a substantial increase in patient self-management and knowledge of medication and safety. The proportion of patients who received the best practice of medication reconciliation showed a significant reduction in the potential readmissions after hospital discharge compared to the patient group that received usual care. For older patients who refilled their prescription medications after discharge from the hospital, completion of medication reconciliation processes and communication with the pharmacist was associated with a small decrease in deaths as well as low hospital readmission rates within 30 days of discharge. Findings from the literature search and appraisal led to the development of a medication schedule time tool, which was adapted for use as part of interventions during the transition of care.

Outcomes Analysis

The implementation of medication reconciliation by nurses as part of routine practice was 12%. The first project objective was to have a 25% increase in medication reconciliation by the end of the study. Therefore, the findings indicated that this objective was not attained. However, the adoption of the medication management time tool, which was referred to as the medication sheet in simple terms, was 100%. The second objective was to develop a medication schedule time tool that would increase the patients ability to take medications on time and in the right doses by the 20^th of December. In contrast, the fourth objective was to improve the transfer of medication information during the transition from hospital to home care by the 30^th of January. The successful development and acceptance of the medication sheet implied that the second and fourth objectives were achieved. The third objective was to increase patient participation in medication management by the end of February. Reductions in mortality and readmission rates following increased patient interactions with the pharmacist during the medication reconciliation process signified increased patient involvement in medication management. Nonetheless, it was not possible to track the precise extent to which this goal was attained.

Discussion

Lessons Learned

One notable observation was the low adoption of medication reconciliation by nurses as part of routine care, which implied that system inefficiencies have a negative impact on the acceptance and success of evidence-based interventions (Pas et al., 2020). The inability to determine the extent of patient involvement in the medication management process indicated a flaw in part of the methodology. Furthermore, it was noted that changing patients attitudes towards medication was the key to their increased positive involvement in medication management. It had been anticipated that client habits would pose a challenge to the project by disregarding specialists recommendations and depending on their perceived knowledge of medications. The overall duration of the project was inadequate to realize the outcomes of the intervention fully. Such quality improvement projects should be planned with more time to permit the researcher to observe a true reflection of the impact of the intervention.

Interpretation

The low rates of nurses following the medication reconciliation protocol (12%) in the study suggest that there may be challenges with the current implementation of the program. Additionally, low rates of nurses embracing the medication reconciliation process suggest resistance to change. Resistance is a common occurrence in most change initiatives because new procedures disturb the status quo and require adjustments (Shahbaz et al., 2019). A possible explanation for the reluctance is that the nurses were faced with large workloads, which resulted in time constraints and limited time to complete the best practice of medication reconciliation.

It was noted that late or the lack of medication reconciliation after discharge was associated with increased physician and emergency department visits but no reduction in the rates of readmission. Medication reconciliation by nurses is more effective at preventing adverse medication events. However, delayed medication reconciliation increased the incidence of adverse drug events, leading to increased hospital visits (Liu et al., 2019). In contrast, late-presenting patients may be sicker and more likely to experience negative outcomes regardless of medication reconciliation efforts. A newly developed medication sheet was included as a component of transitional care interventions, which led to reductions in readmission rates. This observation corroborated findings by Grigg et al. (2017) where an anesthesia medication template led to a reduction in medication errors in the course of anesthesia.

Recommendation

To address the issue of clients habits, future studies should look into interventions to promote positive changes in the medication practices of patients. The low rates of implementation of medication reconciliation were attributed to increased workloads and time constraints among nurses. Therefore, CHHA needs to ensure that the organization has adequate personnel and efficient technology as well as logistics to leave nurses with ample time to achieve these goals.

Conclusion

The findings of this study indicate that medication reconciliation enhances patient safety and reduces the rates of hospital readmissions. Additionally, patient engagement with clinicians before discharge increases the efficiency of medication management reduces adverse drug events and lowers the rates of mortalities and hospital readmissions. However, low rates of medication reconciliation by nurses can be attributed to system inefficiencies such as understaffing, which leaves nurses with heavy workloads and reluctance to embrace new interventions meant to enhance the quality of care. Furthermore, addressing clients attitudes was essential to ensure compliance with professional advice on medication use. Therefore, clinical settings, including CHHAs should address these inefficiencies to increase the acceptance of beneficial quality improvement interventions such as medication reconciliation.

References

Champion, C., Sockolow, P. S., Bowles, K. H., Potashnik, S., Yang, Y., Pankok Jr, C., Le, N., McLaurin, E., & Bass, E. J. (2020). Getting to complete and accurate medication lists during the transition to home health care. Journal of the American Medical Directors Association, 4, 1-6. Web.

Grigg, E. B., Martin, L. D., Ross, F. J., Roesler, A., Rampersad, S. E., Haberkern, C., Low, D.K., Carlin, K., & Martin, L. D. (2017). Assessing the impact of the anesthesia medication template on medication errors during anesthesia: A prospective study. Anesthesia & Analgesia, 124(5), 1617-1625. Web.

Hale, J., Neal, E. B., Myers, A., Wright, K. H., Triplett, J., Brown, L. B., Kripalani, S., & Mixon, A. S. (2015). Medication discrepancies and associated risk factors identified in home health patients. Home Healthcare Now, 33(9), 493-499. Web.

Jones, C. D., Jones, J., Richard, A., Bowles, K., Lahoff, D., Boxer, R. S., Masoudi, A., Coleman, E., & Wald, H. L. (2017). Connecting the dots: A qualitative study of home health nurse perspectives on coordinating care for recently discharged patients. Journal of General Internal Medicine, 32(10), 1114-1121.

Kee, K. W., Char, C. W. T., & Yip, A. Y. F. (2018). A review on interventions to reduce medication discrepancies or errors in primary or ambulatory care settings during care transition from hospital to primary care. Journal of Family Medicine and Primary Care, 7(3), 501-506. Web.

Liu, V. C., Mohammad, I., Deol, B. B., Balarezo, A., Deng, L., & Garwood, C. L. (2019). Post-discharge medication reconciliation: Reduction in readmissions in a geriatric primary care clinic. Journal of Aging and Health, 31(10), 1790-1805. Web.

Mickelson, R. S., & Holden, R. J. (2018). Medication adherence: Staying within the boundaries of safety. Ergonomics, 61(1), 82-103. Web.

Pas, E. T., Johnson, S. L., Alfonso, Y. N., & Bradshaw, C. P. (2020). Tracking time and resources associated with systems change and the adoption of evidence-based programs: The hidden costs of school-based coaching. Administration and Policy in Mental Health and Mental Health Services Research, 47(5), 720-734. Web.

Shahbaz, M., Gao, C., Zhai, L., Shahzad, F., & Hu, Y. (2019). Investigating the adoption of big data analytics in healthcare: The moderating role of resistance to change. Journal of Big Data, 6(1), 1-20.

SkelaSavi
, B., Hvali
Touzery, S., & Pesjak, K. (2017). Professional values and competencies as explanatory factors for the use of the evidencebased practice in nursing. Journal of Advanced Nursing, 73(8), 1910-1923.

Zurlo, A., & Zuliani, G. (2018). Management of care transition and hospital discharge. Aging Clinical and Experimental Research, 30(3), 263-270. Web.

Mrs. Schwartz is an 89-year-old lady who has come to your long term care facility. She has Type II diabetes. She has also recently been diagnosed with Alzheimers disease. So far, she has exhibited mild cognitive impairment, as she is oriented to person, but not place or time. She is generally alert, and occasionally has episodes of sun-downing. Her medications are as follows: metformin 500 mg po bid, galantamine 4 mg po bid, lisinopril 5 mg po bid, bupropion SR 100 mg po od, calcium carbonate 400 mg po od, ferrous fumarate 100 mg po od, Betoptic 0.25% 2 gtt OS bid, Seroquel 100 mg po prn hs and Percocet i-ii tablets po prn q6h, docusate sodium 100 mg po od.

Seroquel is referred to as a trade name because the name given by the producing company is known as quetiapine (Kizior & Hodgson, 2018). Additionally, the drug is produced by the same ingredients as that quetiapine.

The most common side effect of Percocet is constipation. It refers to a condition where there are reduced bowel movements, and thus it becomes difficult to pass stool. The condition is caused by less fiber intake and dietary changes (Kizior & Hodgson, 2018). Docusate sodium is administered to the patient to treat constipation. This medication works by softening the stool; the effect of softening is enhanced by increasing water reabsorption in the alimentary canal, thus facilitating the stool to be soft and for an easy passage throughout the alimentary canal.

The patient is administered galantamine, which is a drug used to treat mild confusion. Regarding the case study, the patient had mild confusion due to a lack of orientation of place and time. The drug works by balancing neurotransmitters such as acetylcholine elevated in the brain (Kizior & Hodgson, 2018). The medicine does not cure Alzheimers disease but rather reduces the symptoms such as confusion, memory loss, and capacity to perform daily activities that manifest due to the Alzheimers disease process.

Betoptic works by altering the functions done by the sympathetic nervous system. Lowering the eye pressure prevents optic nerve damage and blindness that precedes and becomes harmful to patients who have increased intraocular pressure in the eyes resulting from glaucoma (Kizior & Hodgson, 2018). Additionally, the drugs lower the intraocular pressure that is found in the eye. The reduction of intraocular pressure has achieved the drug preventing watery fluids movement that fills the front eye between the cornea and crystalline lens.

The healthcare provider should monitor blood pressure, heart rate, and if the patient is tolerating oral food intake. If the patient has increased blood pressure, raised heart rate, and no sign of diarrhea, then the patient should be administered the drug.

Poor transferability is related to perception impairment as evidenced by the patients disorientation to place and time, exhibiting sundowning, moderate cognitive impairment, and taking lots of medication (Ladwig et al., 2019).

The patient taking bupropion insinuates that the patient may be suffering from depression which can be major or persistent depressive disorder. Bupropion is classified as antidepressant medication regarding the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). Cognitive behavior therapy is the other care that l will recommend for Mrs. Schwartz. Psychotherapy entails the patient having short sessions that allow her to share information with the psychotherapist and identify factors that contribute to depression, which are not logical, leading to depression (Kizior & Hodgson, 2018). Prevention techniques such as controlling thoughts that are not logical, how to adjust to challenging situations, and evaluating a problem before any action, among other contributing factors, will help in depression management.

The letters SR means sustained-release, which is also referred to as controlled release. Administering of bupropion sustained-release will need a nurse to know more about technology and be informed about the rate through which drug concentration levels are assessed and evaluated in advance. The nurse is expected to be familiar with the formulas of ingredients that make up the drug. Stroke causes lesions that affect the function of the thalamuss structures, limbic system, basal ganglia, and cortex. Additionally, lesions formed in the thalamus lead to the disconnection of the thalamic circuits. The disconnection, therefore, leads to loss of connection of transmitting signals, thus tampering with nerves that transmit information within the central nervous system. (Kizior & Hodgson, 2018). Affected nerves will lead to interference of administration and actions of the bupropion sustained-release pathway.

Sources

Kizior, R. J., & Hodgson, B. B. (2018). Saunders nursing drug handbook 2019 e-Book. Elsevier Health Sciences.

Ladwig, G. B., Ackley, B. J., & Makic, M. B. (2019). Mosbys guide to nursing diagnosis. Elsevier Health Sciences.

Albinism is a group of inherited diseases in which melanin deficiency occurs. Melanin levels determine the color of the skin, hair, and eyes. Melanin is also involved in developing the optic nerves, which is why people with albinism encounter serious vision issues. Unfortunately, in some cases, the nurses are not qualified enough to pinpoint the type of albinism. This can lead to negative consequences such as inappropriate treatment. The purpose of this paper is to discuss the different types of albinism, diagnostic methods, and treatments.

The cause of albinism is a mutation at the genetic level. The most typical mutation occurs in the tyrosinase enzyme (tyrosine-3-monooxygenase), which synthesizes melanin from the amino acid tyrosine (Chowdhury et al., 2019). Depending on the mutation, melanin production can either slow down or stop completely. The types of albinism are distinguished based on which gene is mutating. These include oculocutaneous albinism, ocular albinism (found only in men), Hermanski-Pudlak syndrome, and Chédiak-Higashi syndrome. Each type of albinism requires a particular approach to treatment, so it is necessary to identify it already at the stage of diagnosis correctly.

The first sign of albinism is altered hair and skin color. People with albinism often have white or blonde hair, although some may have dark blonde or red hair. Pale skin that burns quickly but does not darken in the sun is also characteristic of albinism. In some cases, only the color of the eyes is affected. With albinism, people may have light blue, gray, or brown eyes. Eye color depends on the type of albinism and the amount of melanin (Jorde et al.,, 2019). People from ethnic groups with darker pigmentation have darker eye color. Vision problems are another critical symptom. A decrease in melanin levels can also cause the following vision problems: poor vision  either myopia or farsightedness; astigmatism; photophobia; nystagmus (Estes et al., 2019). In addition, strabismus may develop in patients with albinism.

Diagnosis of albinism is based on examining the patient for signs of lack of pigment and comparing the patients skin color to their relatives. After that, a more detailed study should be carried out. This includes a fundus examination by an ophthalmologist, a hair bulb incubation test (tyrosinase analysis of the bulb), and a skin and hair follicle biopsy. It is also often necessary to consult a geneticist to determine the type of disease.

Pigmentation changes can also cause other diseases, but there will be no vision problems. That is, the presence of pigment changes and visual disturbances allows the doctor to diagnose albinism. Since albinism is a genetic disorder, a complete cure is not possible. Treatment is based on minimizing symptoms and observing changes. The main treatment methods are an annual examination by an ophthalmologist and wearing corrective lenses (Barnhill et al., 2019). In some cases, eye muscle surgery may be required to minimize the symptoms of nystagmus or correct strabismus. Skincare and skin cancer prevention play an essential role, such as being screened annually for skin cancer or identifying abnormalities that are likely to result in cancer. In addition, people with Hermansky-Pudlak or Chédiak-Higashi syndrome usually need constant monitoring to provide timely care and prevent complications.

The general recommendations of doctors for people with albinism are pretty general. These people should use at least an SPF 30 sunscreen to minimize the effects of the sunbeams. For the same reason, these people should avoid prolonged sun exposure, wear closed clothing (such as long-sleeved shirts, long pants, and socks), hats (preferably wide-brimmed hats), and sunglasses. Thanks to this, patients will keep their skin in good condition and not be exposed to additional negative environmental influences.

References

Barnhill, R., Crowson, N., Magro, C., & Piepkorn, M. (2019). Dermatopathology, 4^th ed. McGraw-Hill Education.

Chowdhury, M., Katugampola, R., & Finlay, A. (2019). Dermatology at a glance. Wiley.

Estes, M., Calleja, P., Theobald, K., & Harvey, T. (2019). Health assessment and physical examination. Cengage Learning Australia.

Jorde, L. B., Carey, J. C., & Bamshad, M. J. (2019). Medical Genetics E-book. Elsevier Health Sciences.

Tina Cassidy provides a historical account on the issue of childbearing. The author offers lively, informative, and well-researched cultural history of childbearing. While the childbearing practice is present in every culture, each culture has adopted unique ideas on the best way to give birth. Central issues present in her discussion include the complexities of childbearing, trends in the perceiving the role of midwives, and the historical accounts of famous obstetricians. This paper identifies trends in cesarean section (CS) to be the most surprising issue discussed by the author. In addition, as an editor at the New York Times, I will state whether I would recommend this book to students and parents. Lastly, the most important lessons learned from the reading will be discussed.

Although there are several surprising issues presented in Cassidys text, trends in CS are the most surprising. The author highlights patterns of giving birth via cesarean section. Cassidy argues the cesarean section, initiated by Julius Caesar was a practice for wealthy women. Out of every three, two babies are born through CS in the developed countries. These statistics prove that despite the risks involved, women in the developed countries are willing to perform CS than virginal births. The author argues that women who go through CS do so because they do not wish to put their vaginas at risk.

As a future doctor, Cassidy examines concrete arguments against the CS and for virginal birth. In a physiological sense, there are long-term drawbacks associated with CS. Childbearing via the CS exposes a mother to the risk of damage by a scalpel. There are high chances of developing post-partum depression and severe placental irregularities. The severe placental defects can significantly affect future pregnancies. CS involve a long recovery period and rigorous healing process. On the other hand, virginal-births are of great benefit to a mother in the sense that it signifies the power of a woman. Despite the positive attributes associated with virginal childbearing as argued by Cassidy, it is surprising that most women have opted for CS. In line with the importance of the highlighted issue, it is necessary to conduct more research to understand this trend to offer reliable childbearing approaches for these mothers.

I would have chosen an Obstetrics and Gynecology (OBGYN) instead of a midwife for parental care before reading this book. OBGYN are informed approaches to caring for the female reproductive organs and thus provide obstetric difficulties management. Unlike midwives, OBGYN offers increased opportunity for a successful childbearing. My opinion on OBGYN as the safest childbearing approach has not changed after reading this book. I still view the OBGYN as the most useful individuals for childbearing because, through their knowledge, they lessen complications associated with giving birth.

As a New York Times editor, I find Cassidys text informative not only for the nursing students, but also parents. Cassidys book is relevant to nursing students because it accounts for a wide range of issues that surround childbearing. For instance, by focusing on the trends in the use of CS, it equips nursing students with knowledge on childbearing approaches. Through this knowledge, nurses can determine the direction for successful deliveries. I would also recommend this book to parents because it provides relevant information that would guide them in making sound decisions on a childbearing approach. For this reason, Cassidys book on the history of childbearing is not only important for parents, but also useful to nursing students.

The Institute of Medicines (IOM) report on To Err is Human increased awareness of the importance of improving healthcare services quality. The IOM developed a framework that underscored the need to establish healthcare strategies that emphasize safe, patient-centered, effective, efficient, and equitable healthcare to all patients (Robertson-Preidler, Biller-Andorno, & Johnson, 2017). I would use the above-mentioned structure created as a guide to enhance better health outcomes and quality of healthcare services offered in the workplace setting. Adhering to the scheme recommended by the IOM means promoting patient-clinician communication and relationships, providing culturally-competent care, and fostering shared decision-making. Another strategy for delivering the appropriate patient care level involves applying the Triple Aim initiative principles, which emphasizes improving patient experiences. In the COVID-19 pandemic context, I would ensure that individuals needs are catered for regardless of the surge in infected patients.

System improvement initiatives may also be utilized to improve the quality of healthcare provided in the healthcare setting. According to a recent IOM report, most medical errors and patient safety issues in the U.S. typically emanate from defective healthcare systems and processes (Robertson-Preidler et al., 2017). With this in mind, I would develop a quality improvement initiative that aims to ensure that the hospital offers the proper care level to patients. The aforementioned project will involve developing a clear vision and strategy to guide the organization in the right direction. As change managers, nurse leaders are expected to identify areas of improvement, develop a vision for organizational transformation, and steer the workforce towards attaining this goal. Performance indicators would later be created to measure best practices; this approach will help determine the programs successful nature. I would use the transformational leadership approach to implement the identified strategies. The aforementioned management style emphasizes various fundamental principles, including individual consideration, intellectual simulation, inspirational motivation, and idealized influence.

Strategies for Protecting Healthcare Personnel and Non-Covid-19 Patients

Protecting healthcare workers (HCW) physical and psychological well-being and patients is a crucial responsibility for all nurses. According to the Center for Disease Control (CDC), a considerable percentage of HCW in the U.S. are older adults, who, according to Ehrlich, McKenney, and Elkbul (2020), are at a significant exposure risk for COVID-19 and its complications. In addition to the physical health threats, the HCWs have been subjected to high mental stress emanating from an increased workload, isolation from their families, and fear of the virus. According to Ehrlich et al. (2020), this psychiatric distress can lead to depression, anxiety, and posttraumatic disorder. Given that quality patient care heavily depends on caregivers well-being, it is essential to protect HCWs health.

Creating a safety culture within the workplace can help safeguard HCWs health and other patients. According to Roussel, Thomas, and Harris (2016), organizational safety culture can influence safety behaviors throughout the workforce. I would standardize the organizations best practices and develop procedures that ensure patients safe passage from admission to discharge to establish the hospitals safety culture. Techniques such as daily briefings and safety huddles may also be used to embed this tradition in the healthcare setting. I would also engage the appropriate staff in developing scientifically reasonable work schedules that prioritize patients well-being while considering healthcare workers individual needs and the nursing shortage scenario. The aforementioned strategy might help reduce work fatigue and mental distress associated with the increased workload caused by the outbreak.

Safety training would also be conducted to improve awareness regarding the pandemics psychological effects on healthcare workers. Furthermore, an infection control framework, such as the observing system adopted by the Guangdong Second Provincial General Hospital in China, may also be established (Huang, Lin, Tang, Yu, & Zhou, 2020). This innovation offers real-time monitoring and facilitates the instant correction of safety-related mistakes. The democratic leadership principles will be used to ensure the effective implementation of the above-mentioned strategies. These principles include collaboration, shared participation in decision-making, shared accountability, ongoing-training, and mutual respect through open communication.

Preparing for a Surge in Patients with Respiratory Infections

Nurses play a critical role in preparing and reacting to disasters. All healthcare organizations are expected to create systems that emphasize the effective response to threats, especially during an outbreak. In preparation for a surge in the number of patients, I would optimize nursing resources within the organization and prioritize staffs safety. According to Martland, Huffines, and Henry (n.d.), ensuring the nursing staffs resilience and safety is key in disaster preparedness. In anticipation of nurse shortages, I would identify alternate staffing sources, including identifying nurses with prior clinical experience, such as retired or qualified nurses who have transitioned to other healthcare settings to supplement the existing workforce. A team-based approach will also be developed to increase the skill mix and the hospitals team capacity. Establishing a mechanism to address nurse and patients concerns might help handle staff mental health issues (Martland et al., n.d.). I would also train staff on personal protective equipment (PPE) utilization and self-care to improve their safety and oversee a safety officers recruitment. The strategic management principles, including shared responsibility, honesty, open communication, collaboration, self-awareness and improvement, on-going learning, and hiring for transformation, will be applied during the implementation of the identified strategies.

Staff and Equipment Shortage

Recently, CDC reported that increasing PPE in hospitals would significantly reduce the pandemics transmission. Unfortunately, many healthcare organizations have failed to provide adequate PPE to their patients and HCW due to poor budgeting models. According to a review by Cohen and van der Meulen Rodgers (2020), many U.S-based healthcare settings costing models are dysfunctional because they prioritize cost-minimization rather than workers health. Since healthcare organizations are reimbursed for implementing strategies that help reduce healthcare costs, most institutions defray costs at the expense of workers safety. To resolve this problem, I would eliminate the profit motive when buying and maintaining PPE inventories. Instead of focusing on decreasing expenses to enhance better corporate profits, I would prioritize workforce safety. This approach will probably trigger increased healthcare costs and, therefore, might face resistance from various stakeholders. Although all nurses are mandated to be advocates, nurse leaders are at the forefront of advocating for their patients and staffs safety. With effective advocacy, I will ensure that adequate resources are allocated to purchase necessary medical equipment, including PPE.

The nursing shortage is increasingly becoming problematic in the healthcare industry. Following the pandemics onset, several nurses resigned from the workforce, worsening the existing problem. Given that nurse shortage is a national problem, meeting the organizations staffing needs requires creativity. To resolve this issue, I would create a positive working environment to retain existing staff. The aforementioned approach involves improving communication practices, reduce work-related stress, and empowering nurses through professional development programs. According to Haddad, Annamaraju, and Toney-Butler (2020), a positive work environment can rejuvenate and retain the nursing workforce. Haddad et al. (2020) also recommend providing nurses with the autonomy in deciding staffing ratios and patient acuity to reduce nurse burnout. The democratic leadership precepts will be used to ensure the effective implementation of the above-mentioned strategies. These principles include collaboration, shared participation in decision-making, shared accountability, and mutual respect through open communication.

Leaders Who Would Collaborate with My Team

• Clinical leadership such as medical and clinical service directors and the chief executive officer
• Billing department head
• Finance manager
• Practice manager
• Operations manager
• Patient representatives
• Case managers

References

Cohen, J., & van der Meulen Rodgers, Y. (2020). Contributing factors to personal protective equipment shortages during the COVID-19 pandemic. Preventive Medicine, 141, 115. Web.

Ehrlich, H., McKenney, M., & Elkbuli, A. (2020). Protecting our healthcare workers during the COVID-19 pandemic. The American Journal of Emergency Medicine, 38(7), 15271528. Web.

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2020). Nursing shortage. Web.

Huang, L., Lin, G., Tang, L., Yu, L., Zhou, Z. (2020). Special attention to nurses protection during the COVID-19 epidemic. BMC Critical Care, 24, 13. Web.

Martland, M., Huffines, M., & Henry, K. (n.d.). Surge priority planning covid-19: Critical care staffing and nursing considerations. Web.

Robertson-Preidler, J., Biller-Andorno, N., & Johnson, T. J. (2017). What is appropriate care? An integrative review of emerging themes in the literature. BMC Health Services Research, 17(1), 117. Web.

Roussel, L. A., Thomas, T., & Harris, L. J. (2016). Management and leadership for nurse administrators (8^th ed.). Burlington, MA: Jones & Barlett Learning.

Society is currently living in the dawn of the nanomedicine age. Nanoparticles and nanodevices are increasingly used in the development of drug delivery systems, cancer treatments, and surgeries. Operating at atomic and molecular levels, nanotechnology comprises the fields of science, engineering, and technology. One of the major medical advances in recent years has been the application of nanotechnology in tissue engineering, which allows for healing or replacing damaged tissues and improves the functions of the normal ones.

The biggest challenges that make tissue engineering an important field to develop include the short supply of donor tissues and organs, as well as high transplant rejection rates. In order to solve these problems, scientists have found a way to form new tissues using isolated host cells (Hasan et al., 2018). To minimize the risks of rejection, special structures, or scaffolds, should be used as a support for tissue formation. Being able to mimic their bio environments, nanostructures are essential to produce engineering scaffolds, which then serve as the basis for tissue growth (Nobile & Nobile, 2017). When cells are taken from the body, they require these scaffolds to direct them to grow in certain shapes. Nanostructures can have different helpful functions that vary according to their design. Depending on the tissue or the organ needed, the materials for the scaffolds may differ: metals, ceramics, synthetic polymers, and natural polymers are used to develop different tissues.

To conclude, it can be stated that using nanostructures in tissue development is an extremely beneficial technology, as nanoparticles can mimic environments that are specific to certain tissues. They are used to correctly shape cell growth, avoiding obstacles that may cause inhibition. Scientists believe that with the help of nanotechnology-equipped devices even complex issues could be regenerated and transplanted successfully.

References

Hasan, A., Morshed, M., Memic, A., Hassan, S., Webster, T., & Marei, H. (2018). Nanoparticles in tissue engineering: Applications, challenges and prospects. International Journal of Nanomedicine, 13, 5637-5655. Web.

Nobile, S., & Nobile, L. (2017). Nanotechnology for biomedical applications: Recent advances in neurosciences and bone tissue engineering. Polymer Engineering & Science, 57(7), 644-650. Web.

The paper summarizes a current nursing research article in terms of its aim, methods, results and conclusion, before examining how the authors have used the ANOVA statistical tool to inform its conclusions and recommendations.

The aim of the study by Florin et al (2012) was to investigate Swedish university students experience of educational support for research utilization and capability beliefs regarding evidence-based practice skills (p. 890). The study utilized a cross-sectional survey design, and the sampling frame comprised the total population of Swedish nursing students (n = 2107) in all the countrys universities in their final semester before graduation in the autumn of 2006. It is important to mention that only 1440 nursing students responded to the survey, representing 68% of the national population of nurses in their 6^th and final semester that year (Florin et al., 2012).

In summarizing the results, the study found that (1) university education supported the nursing students to a greater level than clinical education, especially in following the development of knowledge in a sphere of interest, using research findings, and acquiring knowledge on how to pursue shifts in clinical practice, (2) perceived support during university education differed between national universities, and (3) nursing students reported high capability beliefs concerning evidence-based practice skills, but huge variations were noted between universities for coming up with a searchable question, seeking out relevant knowledge, and critically appraising and compiling best knowledge (Florin et al., 2012).

A number of statistical tests were undertaken to analyze the data arising from the questionnaires using the Statistical Package for the Social Sciences (SPSS) version 17.0; however, this section illuminates one inferential statistical test known as ANOVA. While inferential statistics are applied in quantitative data to determine the statistical significance between the measured variables, ANOVA specifically determines if there is a significant difference in means of a continuous dependent variable given the diverse levels of the categorical variable (Burns & Grove, 2009), hence the statistical test should only be used when the researcher wants to analyze continuous dependent variable(s) and categorical independent variable(s) (Bergen, n.d.).

In the study under review, it is clear the author used ANOVA to establish if the relationship between campus and clinical education (independent variables) was statistically significant to a number of dependent variables including following the development of knowledge in areas of interest, using research-based knowledge, and acquire knowledge on how to pursue changes in clinical practice (Florin et al., 2012 p. 892). The relationship between campus education and the mentioned dependent variables was found to be statistically significant since the p-value in all three results was less than 0.05. However, the relationship between clinical education and the mentioned dependent variables was not statistically significant since the P-value was more than 0.05 in all three results. The researchers also used ANOVA to establish if there was a significant relationship between educational support for research utilization and capability beliefs regarding EBP skills (independent variables) across a number of continuous dependent variables such as formulating questions to search for research-based knowledge and seeking out relevant knowledge using other information sources (Florin et al., 2012 p. 892).

Overall, it can be argued that ANOVA statistical tool assisted the authors in making the conclusions mentioned above based on the significance of the relationships, and in recommending that nurses should be exposed to university-level education as this helps in improving their capability concerning evidence-based practice and research utilization. Additionally, the statistical tool assisted the authors to underline the importance of providing support and encouragement for nursing students research utilization in clinical education owing to the insignificant relationship reported between clinical education and a variety of continuous dependent variables supporting evidence-based practice.

References

Bergen, B. (n.d.) Inferential statistics: Metaphor in language and thought. Web.

Burns, N., & Grove, S.K. (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence (6th ed.). St. Louis, Missouri: Saunders Elsevier.

Florin, J., Ehrenberg, A., Wallin, L., & Gustavsson, P. (2012). Educational support for research utilization and capability beliefs regarding evidence-based practice skills: A national survey of senior nursing students. Journal of Advanced Nursing, 68(4), 888-897.

Health Outcomes in Japan Are Significantly Better Than Those in the US, Even Though the US Spends Much More on Health Care

After the devastating consequences of the World War II the population of Japan was suffering from very poor level of health. Today this country turns out to have the highest life expectancy in the whole world (Bezruchka, Namekata & Sistrom 2008). This massive improvement happened due to the re-establishment of Confucian principles of state structure.

What Can the US Learn from This Country?

The countrys leaders worked on creating special programs that launched waves of health promotion in Japan. The waves were directed at stimulation of growth of health industry (Okamoto 2008). This is what the United States could learn from the Japanese idea of health promotion. The American leaders could spend less money advertising medications, and put more effort into promotion of healthy lifestyle.

Japans Heath Status

Health care in Japan is very developed. This countrys life expectancy is over eighty four years (Life Expectancy at Birth n. d.). Total population of Japan includes over one hundred and twenty eight million people (Japan 2014). The Japanese are very proud of the quality of their health care system (Health Care in Japan 2011). The statistics also show that even though the average life expectancy is long, the population of Japan is shrinking due to rapid ageing (Ikeda et al. 2011).

How Reconstruction after World War II Contributed to Japans Contemporary Health Status

After the World War II Japanese country leaders had to employ many changes. The political structure of the country became more democratized. The feature that makes this country stand out is the lack of focus on individual gains. This helped the Japanese leaders achieve better health status.

One Significant Political Feature and One Legal Feature of Japans Contemporary Health Care System that Contributes to Japans Population Health Status

Japan succeeded at building and maintaining egalitarian society due to the legal practice of a life-time employment (Kawachi, Fujusawa & Takao 2007). Social capital is the political practice that helped raise the health status in Japan (Hamada & Takao 2008). This practice is based on high democratic polity.

Two Reasons of the Disparity between the Japanese and the American Populations in Health Achievement

Culturally the people of Japan have the group mentality that makes them think about the better outcomes for the whole society, instead of being individualistic. American society is very individualistic and most people of the United States are taught to achieve their own happiness, being self-sufficient and independent. These are two very different sets of values. Besides, the level of income equality in Japan is higher, while the gap between the rich and the poor in the United States is huge and growing.

Two Lessons Other Countries Can Learn from the Japanese Experience

First of all, the idea of group mentality is a great practice for any society. New policies in any field are accepted quicker and work better in a society with the group mentality. The second lesson is the importance of health promotion. The main effort should be put into the practice of healthy lifestyle, healthy eating and sport.

Insights

The scientists notice that Japanese peoples behavior is very unusual for a Western observer (Bezruchka n. d). The people of Japan are always in groups; their workplaces have strict organization and precise structure. The developed system of social support and the Confucian principles in the political built of the state have increased the productivity of health care policies in Japan. Social inequality in Japan is growing these days and it seems like their very strong health care has a tendency to fail in several aspects (Aida et al. 2011).

Conclusion

Japanese health care is considered one of the strongest in the world, Japanese life expectancy is very high. It took this countrys leaders several decades to achieve impressive results and develop very productive policies to improve the populations health status after the World War II.

Reference list

Aida, J., Kondo, K., Sheiham, A. & Tsakos, G. (2011). Income Inequality, Social Capital and Self-Rated Health and Dental Status in Older Japanese. Social Science & Medicine, 73(10), 1561-1568.

Bezruchka, S., Namekata, T., & Sistrom, M. G. (2008). Interplay of politics and law to promote health: Improving economic equality and health: The case of postwar Japan. American Journal of Public Health,98(4), 589594.

Bezruchka, S. Health Status in Japan. Web.

Hamada, J. & Takao, S. (2008). Policy Implications of Social Capital for the Japanese Social Security System. Acta Medica Okayama, 62(5), 275-283.

Health Care in Japan. The Economist. Web.

Ikeda, N. Saito, E. Kondo, N., Inoue, M., Saton, T. (2011). What Has Made the Population of Japan Healthy? Lancet, 378(9796), 1094-1105.

Japan. World Health Organization. Web.

Kawachi, I., Fujisawa, Y., & Takao, S. (2007). The health of JapaneseWhat can we learn from America? Japanese National Institute of Public Health, 56(2), 114121.

Life Expectancy at Birth. CIA. Web.

Okamoto, E. (2008). Public health of Japan 2008. Web.