Category: Health & Medicine

Abstract

Various nursing degrees have different benefits and drawbacks. An Associates Degree in Nursing (ADN) can be completed quickly and is not as expensive as a Bachelors Degree (BSN). The BSN, however, offers more opportunities to nurses and results in higher-paying jobs and more available positions. A Masters degree is a necessary step for one to become a nursing manager and advance ones career. Nursing educators may choose to receive a doctoral degree which allows them to influence healthcare policies. Each degree has its own implications for nursing practice. A push towards postgraduate degrees can be explained by the advanced range of competencies and deep understanding of the field that they offer.

Introduction and Purpose

Different paths of the nursing career require individuals to complete many levels of training to become professionals in their fields. Thus, education for future and current nurses offers many types of degrees and programs, each teaching new skills as well as theoretical and practical knowledge. The first possible degree leading to the status of a Registered Nurse (RN) is the Associates Degree in Nursing (ADN) (Auerbach et al., 2015b). The second type is the Bachelor of Science in Nursing (BSN), which grants similar opportunities but with a broader sphere of implementation (Buerhaus, Auerbach, & Staiger, 2016). The next steps in nursing can open many possibilities for future educators and community representatives. Thus, a Masters or a doctoral degree in nursing may also be helpful to a professional in this field. Each of these degrees has a specific purpose and also possesses various benefits. However, their disadvantages should also be outlined for nurses who are thinking about their future.

Choosing the right path for nurses can heavily influence their practice. Moreover, the rate of nurses pursuing certain degrees also affects nursing as a whole (Giddens, Keller, & Liesveld, 2015). Each degree has both advantages and drawbacks. Therefore, it is vital to define them and establish the impacts that each of these degrees can have on nursing practice. Another issue that can be outlined in this sphere of discussion is the push towards obtaining doctoral degrees for nurse practitioners. The purpose of this research paper is to analyze various types of nursing degrees, their implications for nursing practice, and the reasons behind nurses needing a more advanced education for their work.

Literature Review: Different Nursing Degrees

ADN

Many authors compare the success and performance of nurses pursuing different degrees. The first level of education that a nurse can go through to obtain the right to become an RN is the ADN. This particular degree usually takes a student two years to complete. After receiving an ADN, a graduate can pass the NCLEX exam to become an RN (Auerbach, Buerhaus, & Staiger, 2015a). This program focuses on practical skills and has a limited amount of theoretical knowledge in its courses. In general, an ADN offers a basis for becoming a working nurse.

The main advantage of this degree is its duration, as it is the shortest program available for students who wish to be practicing nurses. In addition, it may be less expansive due to the time it takes and the limited number of subjects that are covered. However, an ADN cannot offer a broad range of possibilities to its graduates as it does not give future nurses the theoretical knowledge necessary for a more advanced degree. RNs that want to move forward in their career are usually required to receive a BSN to pursue other academic programs (Auerbach et al., 2015a). Thus, this program can be helpful for individuals who want to finish their education and start working faster. However, it does not prepare nurses for future scholarly education and training.

BSN

A BSN degree provides nurses with a similar basis for becoming an RN (Giddens et al., 2015). However, it has some differences and takes more time to complete. The average duration of getting a Bachelors degree in four years, which is twice as long as the length of an ADN. Thus, some differences are to be expected from this extended and more focused program. First of all, a BSN gives students enough information to become RNs, as well as including courses such as adult health, pediatrics, maternal health, and others is its curriculum. In addition, future nurses pursuing a BSN degree often have more opportunities to learn about nursing theory and research. They may also study nursing technology in more detail, preparing to work in advanced hospital settings (Buerhaus et al., 2016). This program takes more time and gives nurses a stronger foundation for future study.

The main advantage of a BSN lies in the future options open for its graduates. Nurses with a Bachelors degree may have more hiring opportunities as many hospitals want to hire RNs with a more advanced knowledge base (Giddens et al., 2015). Furthermore, according to Auerbach et al. (2015a), the rate of RNs with an ADN being employed in hospitals is dropping, as they shift to working in long-term care. It appears that the qualification of an RN with a BSN degree appeals to employers more than the previously described program. Another benefit of obtaining a BSN is the preparedness of a nurse to pursue other academic degrees. A Bachelors degree allows one to achieve specialization and become a registered nurse practitioner (RNP), a nurse anesthetist, or a midwife. Higher positions in a hospital or other medical establishments are also available to nurses with a higher degree. The drawbacks of this program are its duration and possible cost.

Masters Degrees

Nurses with a BSN degree can move forward in their education and receive a Masters degree. Usually, this means earning the title of a Master of Science in Nursing. This degree allows them to become educators, mentors, and administrators and helps them to advance in their practice and teaching (Massimi et al., 2016). In fact, it is a necessary step for nurses who want to work on managing positions. A Masters degree offers more specific courses, where nurses can choose a specialty in pediatric or adult care, gynecology, obstetrics, and palliative care. Furthermore, psychiatric care is also a subject of training in this step of education.

Individuals with a Masters degree can further their careers in nursing and take on more management responsibilities. This is the primary benefit of this program since it provides nurses with more hiring opportunities. Furthermore, nursing administrators can enjoy a higher-paying position and more ability to influence healthcare. For example, a nurse can become an educator and raise awareness about the state of nursing in the community and the sphere of politics (Massimi et al., 2016). This program also gives one a chance to pursue the next step in ones education, a doctoral degree. However, its disadvantage may lie in the fact that this degree may provide nurses with skills and knowledge that are not used by them in full. Thus, it is essential for nurses to decide whether they need to acquire this degree for their career and whether they want to become educators, managers, or administrators.

Doctoral Degrees

By getting a doctorate in nursing, one can impact the future of nursing and make a difference in the research and practice of other specialists. This degree requires significant time and commitment from nurses and requires them to acquire in-depth knowledge of the theoretical side of nursing (Auerbach et al., 2015b). Nurses with a doctorate can influence healthcare policies, represent communities, and community issues while speaking with government officials and become educators for future practitioners to relieve the shortage of nurses. There are some options for nurses who want to pursue a doctoral degree. Some may choose to receive a Doctor of Philosophy (Ph.D.), while others may focus on education, becoming a Doctor of Education in Nursing. Nurses may also become Doctors of Nursing Practice and influence the conditions and training of other working nurses.

A nurse with this degree can be hired to the highest administrative positions or even open his or her own practice. The range of opportunities open to nurses with a doctoral degree is a definite benefit of finishing this program. However, this level of education may be strenuous for nurses as it requires much time and energy to complete. Xu and Song (2016) state that nurses often develop problems with psychological well-being due to being overburdened with work, education, and other responsibilities.

Data Analysis: Implications for Nursing Practice

As was mentioned above, each step of nursing education can influence nursing practice in its own separate way. Nurses with ADN and BSN degrees are the majority of all working specialists employed in hospitals and long-term care settings. However, nurses with a BSN have more abilities to contribute to the development of healthcare practices due to their extensive theoretical knowledge. Therefore, the academic community often moves towards creating more programs for Bachelors degrees to benefit nursing practice (Buerhaus et al., 2016). Additionally, nurses with a Masters degree can directly contribute to the development of nursing education as they become mentors for other workers and teach them necessary skills and practices. The evolution of nursing as a profession is highly dependent on nurses with doctoral degrees. Their influence on healthcare policies and decisions of the government can significantly improve the state of nursing practice as well as highlighting the issues that nurses face.

Switching from a Masters to a Doctoral Degree

According to Auerbach et al. (2015b), a doctorate of nursing practice (DNP) is considered to be the most appropriate degree for advanced practice registered nurses (APRNs) by the American Association of Colleges of Nursing (AACN) (p. 3). Moreover, this degree is said to be more beneficial than a Masters degree for APRNs who want to work within clinical practice. This belief is based on the fact that a DNP has more value regarding knowledge and the capabilities it can give to nurses. Therefore, it results in many qualified educators and researchers who can advance nursing practice and influence all of its aspects.

Summary

Various levels of nursing education offer different sets of skills and knowledge required for successful practice. RNs with an ADN can practice and contribute to their experience in hospitals and long-term care settings. However, a Bachelors degree can open more opportunities to RNs to advance their practice and base it on a more substantial theoretical foundation. A Masters degree allows nurses to become managers and mentors to other workers, while a doctoral level of education turns nurses into influencers and representatives who can impact healthcare and change the future of nursing. All career paths available to nurses have an impact on their practice. Nurses may be inclined to choose a DNP as a way to become the most qualified professional.

References

Auerbach, D. I., Buerhaus, P. I., & Staiger, D. O. (2015a). Do associate degree registered nurses fare differently in the nurse labor market compared to baccalaureate-prepared RNs? Nursing Economics, 33(1), 8-12.

Auerbach, D. I., Martsolf, G. R., Pearson, M. L., Taylor, E. A., Zaydman, M., Muchow, A. N.,& Lee, Y. (2015b). The DNP by 2015: A study of the institutional, political, and professional issues that facilitate or impede establishing a post-baccalaureate doctor of nursing practice program. Rand Health Quarterly, 5(1), 3.

Buerhaus, P. I., Auerbach, D. I., & Staiger, D. O. (2016). Recent changes in the number of nurses graduating from undergraduate and graduate programs. Nursing Economics, 34(1), 46-48.

Giddens, J., Keller, T., & Liesveld, J. (2015). Answering the call for a bachelors-prepared nursing workforce: An innovative model for academic progression. Journal of Professional Nursing, 31(6), 445-451.

Massimi, A., Marzuillo, C., Di Muzio, M., Vacchio, M. R., DAndrea, E., Villari, P., & De Vito, C. (2016). Are knowledge and skills acquired during the master degree in nursing actually put into practice? A pilot study in Italy. Epidemiology, Biostatistics and Public Health, 13(1), e11684-1-e11684-4.

Xu, L., & Song, R. (2016). Influence of workfamilyschool role conflicts and social support on psychological wellbeing among registered nurses pursuing advanced degree. Applied Nursing Research, 31, 6-12.

Nursing Practice Identification

Charting by exception, the record-keeping or paper documentation method we use currently in my clinical setting (Intensive Care Unit) to keep key patient clinical information based on predetermined standards of practice requires change for improved patient outcomes.

Nursing Practice Description

Clear and elaborate nursing communication contributes to better patient outcomes. In the charting by exception method, the nurse records key information about the patients progress on a chart (Syed et al., 2013). The chart usually captures the patients medical history, assessment outcomes, lab results, and the medication received, among others. It is designed to reduce clerical work through the documentation of findings that deviate from the baseline data. Therefore, the method is quicker as data thought to be unfavorable or already recorded are not documented. In addition, the abatement or aggravation of the patients condition is easily identifiable through a shorthand notation made on the chart.

Why Nursing Practice Needs to Change

Although charting by exception usually gives a complete patient record, the shorthand notation implemented without appropriate flow sheets creates information deficits, increasing the medication error risk. Patient records with little explanations or health checks lacking pertinent information could amount to negligence on the part of the nurse. Moreover, providing an incomplete picture of the patients condition affects patient safety. A complete patient record contains current information about his/her condition as well as indicators of future health changes to inform subsequent interventions.

A secondary reason for adopting an Electronic Health Record (EHR) to replace the current paper documentation is to enhance the timely retrieval of patient records to support care coordination and efficiency. This paper addresses the following PICOT question to support a practice change: in ensuring a timely retrieval of patient records, does electronic documentation, compared to paper documentation, enhance quick access to patient data for coordinated and efficient care?

Key Stakeholders

The implementation of the charting by exception, including the flow sheets, at the unit, involved a multidisciplinary team. Its key stakeholders include physicians, ICU nurses, administrative staff, and laboratory staff.

Stakeholders Roles

Representatives from each of the stakeholder groups will play a role in the successful EHR adoption. A physician champion or representative will serve as a link between clinicians and the EHR implementation team. He or she will give input to the developers from a clinical perspective to ensure a physician-friendly EHR program, promote physician buy-in, and keep the physicians abreast of the projects progress. The physician champion will also support meaningful use practices for the EHR program.

The nurse lead will be a leader respected by fellow ICU nursing staff. The individual will help the developer integrate clinical workflows into the EHR program. As an inspirational leader, the nurse leaders will be expected to influence the nurses to embrace change (EHR). The individual will also strike a consensus among the nurses on issues of nursing workflows. He or she will act as a super-user who will train other nurses after receiving advanced training on the program.

An implementation manager drawn from the administrative staff will oversee the entire project. His or her administrative roles will include monitoring the EHR implementation to avoid delays, ensuring timely procurement of requisite hardware, vendor selection and vetting, and role assignment, among others. The individual will also keep the staff updated on the projects progress.

The lab lead will be responsible for promoting the EHR program among the laboratory staff. The individuals input will ensure the application captures all lab workflows and support transition management. He or she will advocate for eHealth and the adoption of EHR in the hospital and address concerns raised by fellow staff.

Evidence Critique Table

Evidence Summary

One advantage of electronic healthcare documentation is that it enhances the quality and accessibility of clinical records compared to paper-based records. However, an effective transition is needed for a successful EHR implementation. In a study by Colligan, Potts, Finn, and Sinkin (2015), computer attitude scores of most nurses were found to initially correlate with increased workload perceptions during a top-down EHR implementation to replace a paper documentation system. This finding shows that negative or variations in attitudes should be expected during the early stages of EHR adoption. The authors conclude that long-term technical support, coupled with individual-centered training, can support the transitioning and meaningful use of EHRs by the clinical staff (Colligan et al., 2015, p. 474).

Meaningful use requires users/providers to embrace best practices in electronic record keeping. Beach and Oates (2014) hold that nursing documentation practices should be aligned to the changing clinician-patient relationship. Drawing on recent public inquiries and legislations such as the Health and Social Care Act, the authors advocate for multidisciplinary collaboration in using EHRs to plan and evaluate care and involve patients as a key aspect of professional best practices.

The collaborative working should extend to the writing of patient records, which should reflect professional standards of the Health and Social Care Information Centre (HSCIC) with regard to terminology, structure, and content (Beach & Oates, 2014). Another suggested best practice in EHR implementation is effective information governance to ensure safe storage and sharing of patient health information to satisfy privacy requirements.

Further, the use of EHRs has been shown to improve the sharing and availability of clinical data to authorized clinical staff. A study comparing hand-held paper records (PHRs) and EHRs in a maternity clinic found that more complete records of urine culture, glucose tolerance test, nuchal screening, tobacco smoking, domestic violence assessments, and immunizations, among others, were captured using the EHRs than with the PHRs (Hawley, Jackson, Hepworth, & Wilkinson, 2014, p. 561).

However, records of blood pressure, levels of antibodies, and rubella diagnosis did not differ significantly between EHRs and PHRs with regard to completeness. These findings show that EHRs give quality, complete, and up-to-date antenatal data to improve patient safety. Additionally, electronic documentation facilitates information exchange between providers, as it supports authorized access to the system by staff to retrieve patient information.

A systematic review by Razaeibagha, Win, and Susilo (2015) examined the privacy issues related to EHRs. An analysis of the findings of 55 studies based on ISO standards yielded 13 key aspects of EHR security and privacy. Among the key technical features were access control, compliance with security, interoperability, policies and regulations, and scalability, among others (Razaeibagha et al., 2015, p. 26). Technical features that ensure authorized access can protect the privacy of patient health records. In addition, institutional policies and guidelines to govern the use of EHRs can help the provider/clinician attain meaningful use requirements. The interoperability aspect of the systems supports the sharing of patient data securely, billing, and reporting to federal agencies.

Effective management of attitudes and perceptions can reduce resistance to change in clinical settings. In a prospective study by Shriner and Webber (2014), up to 80% of pediatric residents preferred the CPOE tool in the EHR to paper orders a year after its implementation. In contrast, a non-significant number (3.3%) held that the hospital should revert to the paper documentation system. Further, no significant differences were found in the time spent entering admission orders using CPOE vs. paper records 12 months post-implementation.

This finding shows that EHR adaptation by the clinical staff requires adequate technical support and training to make them more knowledgeable and reduce negative perceptions about the product. Therefore, adequate technology resources and ongoing technical support are required for effective utilization of EHRs, especially during the transition period.

Recommend Best Practice

The adoption of EHRs enhances access to complete clinical records, which results in improved patient care and operational efficiency. However, inadequacies associated with the software learning curve during the initial stage of EHR implementation can limit its use (Colligan et al., 2015). I would recommend change management, which is a classic best practice for transitioning staff when implementing new technology.

The concerns of EHR users, including high workload perceptions and attitudes, could be addressed through change management. A successful change management strategy entails defining the business case for the change. For the ICU setting, a unit-level business case could be to enhance physician access to patient records while on call. It also encompasses continuous monitoring of risks and emergent issues, having an effective communication plan to update stakeholders, education and training, and personal counseling to manage concerns and attitudes.

The smaller ICU practice setting should seek to support personal skills and dedication to collaborate and share patient data during EHR implementation. The change management strategy should stress the practical aspects of the new technology to promote buy-in from the stakeholder groups. Wide consultations with the stakeholders right from the planning phase is required to capture lab/nursing workflows and support a smooth transition, as opposed to a top-down approach. Further, post-implementation technical support and training are needed to enable physician practice groups to use other EHR features such as CPOE. Most importantly, a practice-level ownership of the change process and EHR implementation is important, as change is often an intrinsically generated behavior.

Practice Change Model

Kotters multi-step change management model is appropriate for the transition from paper documentation to electronic documentation in the ICU practice. The three-phase model requires one to conceptualize change as a journey for the entire organization that would transform the current practice, i.e., paper documentation, into an envisioned practice that utilizes technology to support efficiency in care delivery (National Learning Consortium, 2013, p. 4). Its three phases include establishing pro-change conditions, engaging and empowering the institution, and adopting and sustaining the successes (National Learning Consortium, 2013).

Model Justification

An EHR initiative is an impetus for an institutional culture change to reflect the state envisioned by the practice. Kotters change model is relevant to the proposed change at the ICU unit because it focuses on changing how people work to achieve and sustain anticipated levels of practice efficiency. The EHR program will replace the paper records currently in use at the ICU unit. It will promote staff effectiveness and efficiency, and therefore, support practice transformation. A holistic ICU practice change must be supported by technology and innovation (Hoonakker et al., 2013). The EHR will not only automate the current paper records, but it will also integrate the ICU processes into improved practice.

Another important dimension of the change model is its focus on people. Managing human resources is crucial to achieving a successful change process because it promotes organizational culture change. Most technology initiatives fail because project leaders do not consider people factors and dynamics in the organizational context (National Learning Consortium, 2013). A change initiative may cause uncertainty, breed the fear of possible job loss, and create negative perceptions towards the technology. One way of overcoming these challenges during the proposed EHR project at the unit is through staff involvement during the planning, execution, and evaluation stages.

Model to Guide Implementation

One of Kotters principles is establishing a vision for the future state when planning for a change initiative (National Learning Consortium, 2013, p. 6). Moving from paper to EHR would require clear communication of the vision or goals of the project to the ICU staff. The model also holds that one must identify a guiding coalition and create a sense of urgency to create pro-change conditions. Similarly, in EHR implementation, one must identify nurse/physician champions to spearhead the change and create a project plan. Therefore, the ICU unit must define a vision for the change initiative that reflects its goal of achieving a fully automated and integrated EHR system at the unit.

In the second phase, the implementation team is required to engage and empower staff in order to realize a predetermined future state of affairs. It further requires constant communication of the envisioned state through vendor demonstrations and staff visits to facilities already using EHR to the stakeholders (National Learning Consortium, 2013). Similarly, in implementing EHR at the unit, staff involvement during system selection and adoption as well as usability evaluation would be considered a best practice. It also requires staff training to equip users with relevant skills, dispel fears related to a possible job loss, and assure them that the initiative is in their best interests.

The final phase of Kotters model emphasizes sustaining the changes through staff retraining, technical support, and staff motivation (National Learning Consortium, 2013). This principle can be realized in the EHR implementation at the unit through a feedback mechanism, rewarding key staff, and retraining of staff for improved workflow efficiency.

Barriers to Implementation

The top barrier to the successful implementation of EHRs, as cited by clinicians, relates to the costs versus benefits of the technology (Ajami & Arab-Chadegani, 2013). The failure uses EHRs meaningfully at the facility and practitioner levels mean that the institution may not benefit from the federal incentive program or reimbursements (Ajami & Arab-Chadegani, 2013). EHR adoption requires a major resource investment; hence, it may be a costly undertaking for the smaller practice setting, such as the ICU. Furthermore, there is a feeling that EHRs ultimately benefits the patient and payers, not the providers.

Technical malfunctions and limited interoperability also present another set of challenges to users. The issue of privacy of patient health information is paramount in healthcare settings. Therefore, concerns about the privacy of electronic patient records can be a barrier to effective EHR implementation. Commercial EHR programs are not standardized, i.e., they use different code sets (Ajami & Arab-Chadegani, 2013). This multiplicity of data standards makes it difficult to share or transmit information across multiple platforms.

Institutions implementing an EHR project often lack a well-trained workforce to drive the process. It is essential to have nurse/physician champions skilled in healthcare informatics to inspire staff to embrace the technology. It would be difficult to obtain a consensus among staff over the content or structure of the EHR code sets without having an influential physician/nurse champion. EHR implementation initially disrupts normal workflows within a practice area. Therefore, challenges associated with software used during the early phase of the implementation process may create the perception that the technology is difficult to use and raise calls for a reversion to paper records (Colligan et al., 2015).

Ethical Implications

The electronic health record contains vital information related to the patient. Therefore, while the physician and the facility may own the EHR, the ultimate owner of the data in the record is the patient (Ozair, Jamshed, Sharma, & Aggarwal, 2015). The planning or implementation of the EHR project at the ICU unit has potential implications for the privacy and confidentiality of patient information. Patient health data is protected from other people or institutions unless through his/her consent or a legal requirement.

An interoperable EHR should support information sharing across platforms or between providers. This feature may compromise patient confidentiality if institutions, e.g., insurance firms, are able to access the information. To overcome this problem, in planning for the EHR project at the unit, each user will be assigned a username and password that grants a certain level of access to the patients health record based on the individuals roles.

The EHR project may also be prone to security breaches, potentially releasing patient records to unauthorized people. Portable EHRs contained in mobile devices are vulnerable to hacking when not properly encrypted (Ozair et al., 2015). This issue may arise in the proposed project, leading to unauthorized access to patient records in violation of the privacy policy. The problem could be prevented through data encryption, the use of passwords, and storing data in a cloud (Ozair et al., 2015).

The project could also have implications for system implementation. Successful implementation requires one to involve the clinical personnel in workflow design, choice of EHR, and performance improvement (Ozair et al., 2015). The failure to involve users could result in a dysfunctional user interface, which will reduce efficiency and increase the medical error risk. Prior testing of the EHR application may be necessary to identify malfunctions that may cause practice disruptions during implementation.

References

Ajami, S., & Arab-Chadegani, R. (2013). Barriers to Implement Electronic Health Records (EHRs). Materia Socio-Medica, 25(3), 213-215.

Beach, J., & Oates, J. (2014) Maintaining Best Practice in Record-keeping and Documentation. Nursing Standard, 28(36), 45-50.

Colligan, L., Potts, H., Finn, C., & Sinkin, R. (2015). Cognitive Workload Changes for Nurses Transitioning from Legacy System with Paper Documentation to a Commercial Electronic Health Record. International Journal of Medical Informatics, 84(7), 469-476.

Hawley, G., Jackson, C., Hepworth, J., & Wilkinson, S. (2014). Sharing of Clinical Data in a Maternity Setting: How do Paper Hand-held Records and Electronic Health Records Compare for Completeness?. BMC Health Services Research, 14(1), 547-563.

Hoonakker, P., Carayon, P., Brown, R., Cartmill, R., Wetterneck, T., & Walker, J. (2013). Changes in End-user Satisfaction with Computerized Provider Order Entry over Time among Nurses and Providers in Intensive Care Units. Journal of the American Medical Informatics Association, 20, 252259.

National Learning Consortium. (2013). Change Management in EHR Implementation. Web.

Ozair, F., Jamshed, N., Sharma, A., & Aggarwal, P. (2015). Ethical Issues in Electronic Health Records: A General Overview. Perspectives in Clinical Research, 6(2), 73-76.

Razaeibagha, F., Win, K., & Susilo, W. (2015). A Systematic Literature Review on Security and Privacy of Electronic Health Record Systems: Technical Perspectives. Health Information Management Journal, 44(3), 23-38.

Shriner, A., & Webber, C. (2014). Attitudes and Perceptions of Pediatric Residents on Transitioning to CPOE. Applied Clinical Informatics, 5(3), 721-730.

Syed, S., Wang, D., Goulard, D., Rich, T., Innes, G., & Lang, E. (2013). Computer Order Entry Systems in the Emergency Department Significantly Reduce the Time to Medication Delivery for High Acuity Patients. International Journal of Emergency Medicine, 6(1), 20-31.

Food Scientists and nutritionists encourage people to consume foods that are rich in various nutrients, vitamins, and mineral salts. The issue of nutrition must also be taken seriously by patients and their care providers. A persons caloric needs must be delivered using these two unique methods: parenteral and enteral nutrition. This paper discusses why enteral nutrition is appropriate over parenteral nutrition in critically ill patients who have a functional gastrointestinal (GI) tract and are hemodynamically stable.

Enteral and Parenteral Nutrition

Hyeda and da Costa (2017) define enteral nutrition as any feeding method that delivers an individuals caloric requirements via the GI tract. Examples of this method include normal eating and tube feeding. On the other hand, parenteral nutrition is the delivery of required nutrients or calories into a vein due to a number of reasons. For instance, the method would be appropriate for patients affected by Crohns disease, bowel obstruction, and ulcerative colitis (Elke et al., 2016). This kind of administration is usually performed using indwelling catheters or injections.

Enteral Nutrition in Critically Ill Patients

Enteral nutrition is usually recommended in critically ill persons whose gastrointestinal tracts are functional and are hemodynamically stable. Weimann et al. (2017) suggest that enteral nutrition is a natural technique of feeding that improves healing and growth. Nutritionists and health scientists acknowledge that some patients might have difficulties whenever eating certain foods. However, such individuals should be guided and encouraged to embrace enteral nutrition because it has significant benefits over parenteral nutrition. The use of the GI tract for feeding purposes is known to improve the effectiveness of the immune system.

The method is appropriate for patients who are hemodynamically stable. Since such individuals do not have problems with their blood circulation systems, the use of enteral nutrition will ensure that the body benefits from different minerals, calories, and nutrients absorbed throughout the GI system. This feeding method also results in improved intake of nutrients. Past studies have revealed that patients who can be fed using the technique will record positive health outcomes within a short period (Elke et al., 2016). The natural method is also inexpensive and maximizes the quantities of calories and nutrients absorbed by the body (Elke et al., 2016). Enteral nutrition is also recommended since it ensures that patients consume various food materials in different forms such as liquids and solids. The method also boosts other body functions, thereby speeding the healing process.

In some patients, enteral tube feeding (ETF) can be considered in an attempt to meet their health needs. The decision to use parenteral nutrition in patients whose GI tracts are working properly can result in reduced calorie intakes (Weimann et al., 2017). That being the case, parenteral feeding should be selected for patients who are unable to eat. Beneficiaries include patients whose GI tracts are not functioning properly. This method is also expensive and complicated (Hyeda & da Costa, 2017). These issues explain why the technique should be available to patients who are hemodynamically unstable and have problems with their digestive systems.

Conclusion

This discussion shows that practitioners and physicians should ensure that patients with functional GI tracts should be fed using the enteral technique. Such patients should also be hemodynamically stable. The targeted patients will benefit from increased calorie intakes, improved immunity, and normalization of body functions. Parenteral nutrition should, therefore, be considered when a patient has problems with his or her GI tract.

References

Elke, G., van Zanten, A. R., Lemieux, M., McCall, M., Jeejeebhoy, K. N., Kott, M., & Heyland, D. K. (2016). Enteral versus parenteral nutrition in critically ill patients: An updated systematic review and meta-analysis of randomized controlled trials. Critical Care, 20(117), 1-14. Web.

Hyeda, A., & da Costa, E. S. (2017). Economic analysis of costs with enteral and parenteral nutritional therapy according to disease and outcome. Einstein, 15(2), 192-199. Web.

Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hubner, M., Klek, S., & Singer, P. (2017). ESPEN guideline: Clinical nutrition in surgery. Clinical Nutrition, 36, 623-650. Web.

Describe the nature and causes of the employee health insurance cost problem in this case

The case study details problems that organizational managers encounter when solving the problems of healthcare insurance costs against the background of economic performance. In the context of Leimberg and McFaddens (2012) study, the problems causing the health insurance cost problems include higher taxation rates, large catastrophic-illness claims, high technology medicine, increased use of mental health and substance abuse services, increased use of medical services, shifting costs from government programs, and the recent premium increases of traditional and managed care plans.

Leimberg and McFadden (2012) reinforce the facts that the AIDS menace, the demographics in the Auto industry, and high physician fees contribute significantly to the problems facing the Quality Auto Parts organization in the provision of health insurance for its employees. All the above-mentioned problems are against the poor financial performance of Quality Auto Parts Company.

What information should the employee health benefits committee gather before making any recommendations? Why?

Before making decisions, the employee health benefits committee should gather information on the insurance options employees want to adopt, detailed information about the available health insurance plans, and any available programs that could be combined to provide the best option suitable for the employees. In the views of Leimberg and McFadden (2012), to make the decisions, the committee has to collect information on all cost containment plans including self-insurance, the health savings account, pre-admission certification for surgery, utilization reviews, implementation of disease control programs, wellness programs, the use of retail clinics, flexible clinics, financial incentives for outpatient services, managed care programs, and the mail-order drug prescription programs (Miller, 2004).

Given the desire of most employees to protect themselves from high healthcare costs, is there any way for Quality Auto Parts to continue to attract the best employees while containing health benefits cost?

In view of the need to keep the health insurance costs down, there is a way Quality Auto Parts can continue to attract highly qualified staff while containing health costs. One of the solutions is to identify the best insurance plan that fits well with new employees who want to join the Quality Auto Parts. According to Leimberg and McFadden (2012), the basis of making the most appropriate choice is the previously gathered information detailing the health insurance plans that fit into the health insurance plan of the organization and individual employees (Miller, 2004).

Leimberg and McFadden (2012) argue that embracing available and proven techniques on pension and benefit planning could provide Quality Auto Parts with the best option to adopt in providing employees with the health insurance program while keeping insurance costs as low as possible. The option should reflect the need for Quality Auto Parts to keep the health insurance costs as low as possible while being acceptable for both the employer and the employee.

On the basis of what you know about Quality Auto Parts, which of the four specific proposals would you be likely to recommend?

Typically, one of the best options is to come up with a health insurance plan establishing an insurance fund, and engaging the local providers using the providers preferred arrangements. The strength of the proposed scheme bases on offering price discounts to the Quality Auto Parts organization for each employee directed to the local providers. That could significantly be beneficial to the organization. However, there is a range of other options, but the information gathered could provide the best platform in decision making on the best option to adopt. I recommend a combination of the major insurance plans because of the major medical expenses that could be costly to the company having a health savings account option to address the needs of less costly routine healthcare options.

References

Leimberg, S. R., & McFadden, J.J. (2012). Tools & Techniques of Employee Benefit & Retirement Planning, 12th edition (Tools and Techniques of Employee Benefit and Retirement Planning. New York: The National Underwriter Company.

Miller, J. E. (2004).The Tools & Techniques of Employee Benefit and Retirement Planning, New York: The national Underwriter Company.

Introduction

Taking care of the elderly people is a task that calls for much learning and experience on the side of the care provider. As a process in an individuals life, learning is a continuous activity that kicks on immediately someone is born. Learning is about acquiring knowledge on how to do different things in life. Because knowledge is a wide area, at no point will one ever learn everything. There are different modes of learning that different individuals go through to gain knowledge. One of them is experiential learning where people gain knowledge through the experiences they go through in life. They are able to make a meaning from these experiences as well as concrete decisions. Kolbs experiential learning theory defines the process people undergo in such circumstances showing how they reach decisions. Caring for the elderly calls for experiential learning because each individual case is unique on its own. Therefore, one has to combine the education acquired in class together with the experiences he or she is undergoing in a bid to make proper decisions. The paper focuses of the lifelong learning elderly care.

Dealing with Physical Changes in Elderly Patients

When individuals grow up, they start with their motions from moving slowly in an imbalanced and less coordinated way to moving fast and in full control of their bodies. The situation will then change back to a slower movement, which now becomes more rigid and coordinated as the elderly progresses in age. Elderly people lie in this category. They even lose their mobility completely as they grow up while others may be able to retain it as their ages advance. Lose of mobility in elderly people is due to the weakening of their body muscles as they can no longer redevelop as before. Therefore, most elderly people tend to seek help or need in their movement as a way of making their lives normal.

Dealing with their Ambulation

Ambulation is simply the act of walking. When caring for the old, the caregiver has to consider how they (the old people) will be walking in their daily activities. In fact, elderly people tend to move slowly as their ages advance because of their gradual loss of their mortar abilities. Their muscles tend to contract and relax slowly in that any motions that occur happen at a very low pace. Elderly people will therefore need a lot of space in the places they are living to allow them space that is enough to make movements from one place to the other. Therefore, their places of living should not have many obstacles like chairs and tables allover because the obstacles can easily trip them as they move around. As a caregiver for the elderly, one needs to make observations on the movement abilities of the elderly persons in their care in an attempt to come up with the best ways to arrange their places of living. One arrangement that should come out as standard should be having most of the furniture in the living area placed at the edge of the room close to the walls so that there is enough space for free movement. Elderly persons tend to grow tired very fast thus limiting their movements.

This situation leads to most of them staying in single positions for so long, which further makes their muscles become rigid. Therefore, elderly persons need to be assisted to move outside the house by having them take a walk that would enable them exercise their muscles and or improve the reflexes of their muscles. As part of exercising, Rimbert et al. point out how ambulance enables the body of a person to increase its metabolic activities thus burning excess fats in the body while providing energy to the body to do other activities (2006, p. 322). A person working with the elderly needs to apply active experimentation and reflective observation in that, while helping the elderly, they have to watch them while thinking of a better way of doing the activity they are doing. Elderly persons should therefore be housed in houses where they will not need to scale stairs or have to climb over raised areas. The caregivers should be in a position to judge whether they can walk on their own, need a walking stick to support them, or need to be held by another person in their aid to walk.

Range of Motion

The range of motion is the maximum distance the joint of an average person can take towards a certain direction. In the elderly people, their range of motion is highly reduced due to weakening of muscles of their bodies as well as strength. This limitation affects greatly the movement of their joints in terms of how much they can stretch their hands in certain directions, how much they can bend, and how much they can turn. This case therefore requires that a caregiver puts measures in place to enable the elderly persons do their activities without many problems. Because of the loss of energy, their joints become weak. Therefore, they cannot hold their weight at certain angles or generally weights to a certain capacity. Therefore, a caregiver should ensure that the operating surfaces of the elderly are made to heights that will allow them to use them without so much struggling. Seats used by the elderly should be at a height that will not make them have to bend too low to sit on them.

They should be in a position that is high enough for them to sit comfortably as well as stand up without much struggle. Most of the furniture in the house should be at a height that will enable them reach out without much assistance. The elderly persons should be given exercise as a way of stretching their joints and or making them much more flexible. Surfaces such as toilet surfaces should also be raised enough to comfortable levels that will enable them use them contentedly. The bed of the elderly should be at a height that will allow them to climb without using a lot of energy or force them to bend so much. Very low beds will make it difficult for the elderly persons to stand up when sitting on the bed. They should use soft surfaces for things such as chairs because hard surfaces are too uncomfortable for them.

Use of Assistive Devices

Most assistive devices used by the elderly are meant assist them in their motion. They are mostly made as tools for leaning on or for creating balance to the elderly because, as they grow old, they tend to become weak easily thus losing their balance. Depending on an individual elderly case, the caregiver should find out the best tool for the elderly person to use. The caregiver can only find out the best assistive device for the elderly persons by observing them or talking to them to find out what is comfortable for them. The attendant will apply part of Kolbs theory of reflective observation versus abstract conceptualization together with active experimentation. The caregiver should provide the elderly persons with walking canes that come in different ranges. The walking devices should be light in weight and strong enough to hold the weight or load to which they will be subjected. Stable elderly persons should have simple adjustable canes for walking while the next level of this group should have a four-base walking cane. Elderly persons who cannot walk properly on their own should be provided with adjustable walkers for holding when necessary. All these assistive devices should have a non-slip grip as well as a base so that there is no possibility of slipping while in use.

Bathing, Toileting, and Grooming

Elderly persons under care can do some duties for themselves depending on their mental as well as physical state. Those who cannot help themselves when it comes to taking a bath, going to the toilet, and grooming amongst others will have to be assisted in doing them. Elderly persons who cannot go to the toilet on their own should be assisted and be cleaned afterwards for hygienic purposes. Some elderly persons cannot control themselves. Thus, they have to be tied with diapers for the sake of controlling their toilet needs. Elderly persons who can help themselves in this area should have their bathrooms and toilets fixed with appropriate handles in the right places as for them to hold on to any time. They should also be supplied with special bath seats that will make them comfortable when having a bath.

How to Content with Mental Changes in an Elderly Person

Cognitive changes are known to happen to a number of people when they grow old. However, the changes alter them from the persons they are known to be. Mental changes in the elderly come in different forms with some being easily diagnosable while others take time to be diagnosed. Different elderly people suffer from different mental changes, which can occur in diverse combinations that can be challenging for a caregiver to understand. Because most of these mental changes are psychological, it is prudent for a caregiver to have a psychology background that will enable him or her to handle some of the cases. Changes in aging people can be found in the following areas: sensation, intelligence problem solving, perception, language, memory, and thought. Aging in elderly persons comes with medical conditions that would require constant medication as a way of controlling the situation in the elderly persons.

Mental changes in these people lead to slow decoding of information in the elderly persons, which further can lead to slow understanding or lack of it on particular issues thus translating to slow thinking. Some elderly persons suffer from such conditions like dementia, anxiety disorders, amnesia, and sleep disorders. Caregivers need to take their time to understand the condition of the elderly person they are dealing with to enable them come up with a way that will create a good understanding with the person they are taking care of. The first quality any person working as a caregiver needs to have is patience, which is the ability of one to take time to understand something that is happening without making any decisions before understanding anything. In the case of mental deterioration, the elderly persons will tend to change their patterns from what is normal to what can be described as abnormal.

They can also change from what is standard to what can be described as unique. It is therefore prudent for the caregiver to make an observation of the elderly person to establish a pattern that the elderly person has adopted in an effort to come up with a framework that will help the elderly person or enable caregivers to discharge their duties. The caregiver should apply abstract conceptualization versus reflective observation. Conceptualization will allow caregivers to think about a situation they are dealing with in a bid to understand it in the best way possible. It will make the caregiver have an opinion on what is going on and or how it can be approached. Reflective observation will make the caregiver watch the situation keenly, record any characteristics that may be happening, and come up with an understanding of a pattern that may be forming.

Mental changes in elderly persons may make them nice people. However, they may also make them very irritable to work with. The caregiver should always approach the person in a manner that makes him or her (the caregiver) retain control of the situation. The nurse should be devoid of emotions that might lead him or her towards losing control of the situation while dealing with the elderly person because a caregiver becoming emotional might impair his or her judgment thus leading them into taking inappropriate actions (Barbosa et al., 2011, p. 490). In this case, the caregiver should not use his or her emotional cognitive strategies because they are less efficient. A mental change in elderly persons under care is an aspect that all caregivers should be on the lookout for because it is seen to be most prevalent in elderly people who are under care. Most elderly persons tend to start experiencing mental changes at the age of 65 years old. At this point, most of them are not yet under care for the elderly.

Therefore, it means that most of the people under care are very old and vulnerable to mental changes at any time. The caregiver therefore needs to be very observant and keen on any telltale signs that some change is happening. They should not ignore any signs that they come across however mild they are even if the occurrence of the sign is wide apart because minor signs might lead to bigger underlying conditions that the elderly person might be going through. Caregivers should be strong enough mentally for them to withstand different changes that might be happening to the persons they are nursing. To cope with such situations, caregivers need to have other engaging interests outside care giving to engage their minds and bodies and or make them forget some of the incidents they might have experienced. Too much engagement with care giving might lead to breakdowns to the caregiver.

The Need to Change the Environment for Safety and Accessibility Needs

There is a need to change the environment where the elderly persons live for ensuring their safety as well as their accessibility within their areas of operation. The need to change the environment for the elderly is necessary because their body systems change with time. As they age, their systems tend to become weaker and weaker. Elderly persons need to live in areas where there are no hazardous components in the whole environment, be it air or soil, because their immune systems tend to grow feebler as they advance in age. Thus, they become more allergic to many pollutants that can be found in the air, which can be withstood by people of younger ages. Most elderly persons tend to suffer from respiratory problems whenever they are exposed to pollutants. It is prudent for a caregiver to ensure the location where the elderly persons are living is environmental friendly.

There is a need to change the environment where the elderly live so that it fits their daily schedules and movements. In this case, all raised areas should be smoothened while those with steps should be made in a ramp form so that they do not have sharp gradients. Raised edges on the paths where the elderly move about can be fatally dangerous in case of a fall. They should therefore be evened out to reduce chances of falling. Elderly persons are delicate and brittle. Any fall can lead to fractures, which may take time to heal. Elderly persons reaction or reflexes are too slow to stop them from falling. Thus, it is prudent to avoid situations that may expose them to any types of falls as much as possible. The floor surfaces that the elderly are supposed to walk on should not be too smooth like tiled surfaces. Such surfaces can lead to an individual slipping.

Therefore, they should be changed for the sake of the elderly person. In case of their abode having smooth surfaces such as tiles, such surfaces should be covered with floor stickers that give them a coarse surface or provide more grip to the person walking on the surface. Walking surfaces in the rooms where the elderly persons live should also be covered with soft materials like carpets that should act as a cushion in case of a fall. On the other hand, carpet materials on the floor act like insulating materials against cold and hence a surface that preserves warmth in the rooms the elderly stay. Due to their deteriorating health, hearing, seeing, and other senses, the elderly persons should be located in an area where there is minimal noise so that their communication is not hindered. The area where the elderly persons operate from should be well lit for proper vision.

The lighting should not be too bright for their eyes to the extent that the light blinds them. Old peoples vision is usually diminished. Too much lighting or too dimmed lights can lead to temporary blindness. The outside environment for the elderly should be a peaceful environment that can allow them to have peaceful moments as they age. Too much noise can lead to insomnia because it ends up disturbing the peace that they need in case they want to have a nap. Pavements within compounds where the elderly live should be well paved. The pavements should be wide enough for their easy movement. Elderly persons require more space to move around compared to much younger persons. Most elderly persons use walking aids some of which are wide and hence requiring more space. Walkers and wheel chairs need space for maneuvering. Therefore, the environment where the elderly are living should have large spaces enough to allow movement. Areas where the elderly live should have rails all over along the wall to offer support to them as they move around.

The environment where elderly persons live or operate from should be set up in such a way that, at any one moment, the elderly persons should have something to lean on when they need it. The general topology of the compound should be flat so that the elderly persons can move about without the risk of falling down or without the problem of laboring. Raised surfaces can make it difficult for the elderly persons to walk on due to their diminished energy levels. Therefore, there is a need to fashion the general environment where the elderly persons will be operating from so that it can suit them and their movement as well as safety. The caregiver will therefore need to apply abstract conceptualization as well as reflective observation, which are part of Kolbs theory to come up with the best ways possible for each individual case. This strategy will be dependent on the caregivers observation and judgment on what is the best for the elderly individuals.

Challenges to Nutrition, Feeding, and Eating for the Elderly

Nutritional Needs for the Elderly

Nutrition and feeding comprise one of the greatest challenges that caregivers for the elderly have to face everyday due to the complications that come with age. Elderly peoples bodies tend to be choosy with the nutrition that is required for them thus calling for specific diet requirements for them. According to Weetch (2007), elderly people need a nutritionally sound diet that will provide their bodies with the specific needs that the bodies require (p 60). Weetch further states that up to 40% of acute elderly patients are malnourished. Therefore, they are very weak because of dietary problems and not because of lack of feeding. As such, the elderly persons should be fed on specific foods that will provide them with specific nutrition that is fundamental to their bodies. Due to their advancing age, many body functions of the elderly tend to slow down thus leading to slow processes in their bodies.

For instance, the metabolic rates of the elderly persons tend to slow down with age thus affecting the amount of food they eat, the type of food they eat, as well as the specific nutritional requirements that their bodies need. Therefore, elderly persons are required to have a nutritional diet full of vitamins, proteins, minerals, and fluids. These nutritional elements are essential for the rebuilding of the body cells. In addition, due to their slow rebuilding, most of these nutrients are required especially proteins. Due to their diminished immunity and high rate of infections, vitamins become essential to their bodies because they are a source of immunity to their bodies. Malnourishment in the elderly has been known to lead to many other problems such as pressure and ulcers developing in the elderly persons that slow down the healing of wounds on their bodies as well as leading to higher rates of infection.

Feeding the Elderly

Feeding the elderly is a big challenge because of a myriad of problems that the elderly develop as they advance in age. It therefore requires that each case be treated according to its needs because different people have different complications as well as needs. The care provider will therefore be required to observe each individual case in an effort to come up with a mode of operation that will suit the individual elderly person. Feeding for the elderly person will depend on whether the persons can feed themselves, or should be fed. Some cases, which are not too dependent, will not require the care provider to feed them but only to supervise them as they eat. This strategy is meant to ensure that the elderly persons have eaten well the food that they are supposed to eat in the right period. The care provider will therefore need to be there to keep them company and or encourage them to eat the right amounts of food to the finish. In the case of an elderly person who cannot eat on his or her own, the care provider will be required to feed him or her the food he or she is supposed to eat.

While eating, the elderly person needs to be placed or seated in the right position to avoid incidents of choking or food reflux. The amounts of food portions they take per mouthful should be considered so that they have just enough food in their mouths to chew and swallow. Too much food in the mouth can lead to tiring of jaw muscles, which will then lead them to eat very little meals while too little mouthfuls lead to a lot of time being spent on feeding. Feeding times should be strictly observed so that they do not overlap. The care provider should ensure that the food the elderly persons are eating has fiber most of times so that the soft food they eat most of the time do not lead to constipation. Due to teeth problems experienced by most elderly persons as well as their inability to chew, it has been observed that most of their foods are mostly soft for easy chewing and swallowing. However, this soft food is responsible for constipation.

Eating for the Elderly

Eating can be a big challenge to the elderly because advanced ages come with different complications. This situation calls for the application of the three Kolbs learning styles, which are reflective observation, abstract conceptualization, and active experimentation. The care provider should observe the elderly persons as they eat. From there, he or she should deduce the best way they (elderly people) can eat the food that they have been given because most elderly persons have problems with eating due to different problems. For instance, most elderly persons have lost most of their senses and specifically the senses of smell and taste. This loss leads to them feeling that their food is flat and tasteless thus reducing their appetite. Eating time should be scheduled at the best time possible when the elderly persons are fully awake and alert so that they feed optimally. Eating can be a problem to many of this category of people because of their teeth situation. This situation should be put into consideration because it affects the way they eat and the speed of eating. The position of the elderly person while eating also matters because old age leads to the weakening of the gastro-esophageal sphincter, which leads to frequent reflux of the gastric acid and food. To control this situation, the speed of eating should be moderate and that there should be enough rest after eating.

The Need to Transition the Elderly

At times, in the life of the elderly, there is a need to move them from one place they are staying to the next stage. This strategy usually leads to problems because of the way the elderly persons will react to such moves. Schumacher et al. (1999) describe it as a passage between two relatively stable periods of time (p. 2). Due to mental changes that happen in their brains, their understanding of situations tends to be limited. They might fail to understand straightforward situations that lead to whatever is happening in their lives. Transitioning the elderly persons is necessary for making them more comfortable. Simply, transition helps to meet certain obligations that would make them move. Transitioning of elderly persons depends strongly on their physical as well as a mental state because these factors will dictate how the transitioning will occur.

Rooney and Arbaje (2013) find, transitioning can be a vulnerable time for elderly adults and for people with complex needs because it is a problem that remains common, costly, and complicated (p. 63). The need to transition the elderly is because they are less flexible to changes due to their old age. A change in the set up where they stay can easily lead to confusion in their lives thus becoming a source of frustration into their daily routines. Therefore, in case of any changes to where they have been living, there is a need for a proper transition period that should allow them to adjust according to their mental and physical capabilities. They will therefore need to be guided through the transition patiently having in mind that their brains may take a lot of time to re-adjust and fit fully in their new environment. Transitioning should also happen at a psychological point in that the elderly person should be prepared psychologically for the changes that are going to happen. Elderly people tend to be psychologically fearful of being abandoned or being disenfranchised thus making them fearful of any intentions that the people around them might be having for them.

They will therefore be emotional to any idea that suggests they be moved. They can thus fall into depression, which might lead to other health complications. Transitioning will prepare them psychologically for the move. In fact, it should be done in a way that will make them embrace the idea on their own. Elderly people have an attachment to different things that they have. The attachment can easily lead to them resisting ideas of having their homes sold or just them moving out. They therefore have to be convinced on the importance of moving so that it does not influence them negatively. The importance of transition on one hand is to enable the elderly person change their routine albeit slowly. Many elderly persons have established specific routines that they religiously follow in their everyday activities. This case creates a sort of pattern in their movement within their areas of stay. Therefore, any disruption of this pattern can lead to lots of confusion. Part of the transitioning program should involve close supervision by the care provider for directing them and explaining to them what they should do as well as answering some of the questions that the elderly might need answers for.

Transitioning allows the caregiver to make observations on the different changes that might occur and come up with the best way of dealing with them. This strategy will allow the care providers to come up with decisions with regard to the observations they have on the elderly persons. Because different persons have different challenges, the care providers will have to deal with each case individually because there is no standard manual on how to deal with the different problems that they might encounter. This situation therefore calls for reflective observation and active experimentation on the side of the caregivers. Reflective observation according to Kolb will involve watching whatever is happening and or thinking about it in such a way that the care providers weigh options to be applied to the challenge that is unfolding before them. Active experimentation according to Kolb will involve taking action that the care providers deem appropriate as a solution to the problem they are facing.

It might take heuristics for the care provider to come up with a solution because some challenges that will emerge will require him or her to think fast on what to do. On the other hand, the care providers should be flexible enough to change options if the one they had applied fails. Therefore, transitioning is a way of enabling the elderly to adjust to changes that they face. The changes are known to have a significant impact on the lives of the elderly. A poorly managed transition or lack of it has been found to have very grave effects on the elderly because such situations lead them into mental breakdowns that might lead to deterioration of their health. The person doing the transitioning must be one who has been working with the elderly persons, and who the elderly persons trust because a person who does not understand the person he or she is dealing with can easily make assumptions, which can lead to grave mistakes.

Family Homecare as the Best Living Arrangement

Family homecare is the best living arrangement for the elderly persons especially those suffering from old age ailments like Alzheimer. Alzheimer is a mental condition that affects elderly persons. It can lead to them being forgetful to the extreme level. Persons suffering from Alzheimer tend to forget many things at particular times. They therefore need to be cared for because they no longer have total control of their lives. In many cases, it does not necessarily affect the physical health of an individual elderly person. Rather, it affects the elderly peoples memory to the extent that they can even forget who they are. Such persons therefore require close supervision in everything that they are supposed to do and a constant reminding of the same. Without close supervision, such patients might end up doing wrong things like toddlers or forget completely to do what is necessary. Therefore, most families tend to take them under the care for people with Alzheimer from where their needs are catered for by caregivers.

Alzheimer can be either mild or extreme depending on the individual case. Different care options can be applied depending on the individual case. Although such persons tend to lose memory, they can also have lucid moments in that their conditions can improve and or get them back to their normal selves. Such persons should be placed under home care with measures being put in place to monitor them so that they are well taken care of when they relapse. The family members of a person living with Alzheimer are best placed to understand their patients conditions more than any other persons. They can collaborate with doctors to provide medication to the elderly persons because Alzheimer being a medical condition can be controlled through medication and therapy as a way of alleviating it so that it does not lead to extreme conditions.

The writer has a first experience dealing with an Alzheimer case in her family. She has come up with flexible arrangements that allow her to take care of her patient while doing her daily chores fulltime. The writer and her sister opted to provide homecare for their mother who sufferers from mildly severe Alzheimer. They two had to device a way of balancing between taking care of their elderly mother who is physically fit and working full time. Their mother is able to do most of the activities on her own. Therefore, she cannot be said to be extreme as long as she is supervised and directed accordingly. Therefore, the arrangement adopted in this case was home care and daycare combined. Many elderly persons loath the idea of being taken under institutional care since it makes them feel that their own families have rejected them for being a burden due to their old age. A similar experience applies to persons with Alzheimer because they tend to feel abandoned whenever they are taken under the care when they have their lucid moments. The thought of being abandoned leads to deterioration of their health due to factors such as depression.

Homecare for such a person is prudent because it helps them to recover or stop them from falling further into the condition. Homecare combined with daycare allows family members to take care of their own without them having to change their schedules so much as Patrick and Wendy (2009, p. 53) confirm. It is cost effective economically. For the case of the writer, the arrangement made with their sister was that their mother be taken to a daycare where she is picked in the evening. The writer and her sister would take turns to look after her. The two also arranged for doctor visits so that the doctor would come to attend to their mother at home. This strategy has enabled them to take better care of their mother as compared to when she would have been taken to an institutional care where she would be given general care. Homecare on the other hand is only good if the relatives of the elderly person are committed to taking care of the person because it takes sacrifice to dedicate their time and resources.

Reference List

Barbosa, A., Figueiredo, D., Sousa, L., & Demain, S. (2011). Coping with the Care Giving Role: Differences Between Primary and Secondary Caregivers of Dependent Elderly. Aging & Mental Health, 15(4), 490-499.

Patrick, F., & Wendy, M. (2009). Cost and Caring: Policy Challenges of Alzheimer. Generations, 33(1), 53-59.

Rimbert, V., Montaurier, C., Bedu, M., Boirie, Y., & Morio, B. (2006). Behavioral and Psychological Regulation of Body Fatness: A Cross-sectional Study in Elderly Men. International Journal of Obesity, 30(1), 322-330.

Rooney, M. & Arbaje, A. (2013). Changing the Culture of Practice to Support Care Transitions-Why Now? Journal of American Society on Aging, 36(4), 63-70.

Schumacher, K., Jones, P., & Meleis, A. (1999). Helping Elderly Persons in Transition: A Framework for Research and Practice. School of Nursing Departmental Papers: University of Pennsylvania.

Weetch, R. (2001). Feeding Problems in Elderly Patients. Nursing Times.net, 97(16), 60-68.

Life Expectancy in South Sudan

Life expectancy in South Sudan is relatively low compared to other countries. According to the estimates made by the World Health Organization (WHO), the population of South Sudan was 12,801,237 people by the end of 2015 (South Sudan). During the mentioned year, it is increased by approximately 536 thousand people. Considering that the population of South Sudan at the beginning of 2015 was estimated at 12,340,568 people, the annual increase is about four percent. The number of men and women increased approximately equally. There were about six million people under the age of 15, seven million people over the age of 14 and under the age of 65, and 350 thousand people over 64 years of age (3. Population by sex, the annual rate of population increase, surface area and density). The age pyramid of South Sudan has a progressive or growing type that is characteristic of developing countries.

Demographics of South Sudan is characterized by a relatively short life expectancy due to high mortality and fertility, which are primarily caused by poor health care and education as well as war conditions. Namely, the average life expectancy in the given country is 59 years in females and 56 years in males (South Sudan). The civil war in South Sudan lasts about four years. Data on the victims vary, but they are estimated in hundreds of thousands. More than 1.5 million people were forced to leave the country, and over 80 percent of them were women and children (3. Population by sex, the annual rate of population increase, surface area and density). The duration of a healthy life, the period during which a persons quality of life will not decrease because of the development of certain diseases, is also growing. However, due to poor living conditions, the time span of severe health disorders as well as disability in people is raising. The main causes of these disorders are heart disease, pulmonary infections, and strokes.

Income Distribution and Life Expectancy

The recent study by Chetty et al. shows the increasing gap in the standard of living of the poorest and richest residents of the United States, while the high income increases the life expectancy of the population (1759). The authors compared the life expectancy of one percent of Americans with different incomes and came to negative conclusions (Chetty et al. 1759). The richest Americans live significantly longer than the poorest residents of the country do: among men, this difference was 14.6 years, among women  10.1 years (Chetty et al. 1760).

In the study, the researchers processed 1.4 billion anonymous tax returns and combined data on the income of the US residents with death statistics in each of the US states for the period from 1999 to 2014 (Chetty et al. 1762). While one considers income inequality in the US, it is clear that low-income Americans cannot afford to buy the same homes, living in the same neighborhoods, and receiving services as Americans with high incomes. However, the fact that they can expect to live on average 10 or 15 years less shows the level of inequality that has arisen in the United States.

The mentioned study also illustrates that this gap is growing every year as well as the average life expectancy in the country. Over the past 15 years, the life span of the upper and lower five percent in the income table has increased disproportionately. Namely, for those who earn more than $100 thousand, life has become noticeably longer  almost two and a half years for men and almost three years for women. At the same time, Americans with incomes below $29 thousand a year could not notice significant improvements as they will live 0,4 years longer on average (Rasella et al. 464). Consistent with the role of income distribution in the US, the low-income population in South Sudan has a low life expectancy. This is largely associated with armed conflicts occurring on an ethical basis.

Given that the state is populated by representatives of a number of ethnic groups that claim to be of paramount importance in the country or are offended that other ethnic groups are in power, it is evident that South Sudan became the arena of the internecine struggle of opposing ethnic groups after the proclamation of independence. Arabi and Abdalla argue that the most serious confrontation unfolded in 2013-2014 between Nuer and Dinka peoples (43). According to international organizations, only in the period from the end of December 2013 to February 2014, 863 thousand civilians in South Sudan have become refugees, while at least 3.7 million people are in dire need of food (Arabi and Abdalla 44). All the efforts of international mediators to ensure the conduct of the negotiation process between the opponents end unsuccessfully since there are uncontrolled groups that continue the further escalation of violence.

Ways to Increase Life Expectancy

As stated by the United Nations, the standard of living is a system of several indicators, among which there are health care, demographic conditions, food, clothing, consumption and accumulation funds, employment, education, social security, etc. (Ho 465). The standard of living reflects the degree of development and satisfaction of the needs of a person living in a given country (Chetty et al. 1762). In general, people with low income tend to smoke more, have inadequate access to health care, and work under inappropriate conditions. The average life expectancy of people with low income is interrelated with the proportion of immigrants and college graduates. Therefore, the first way to improve the dependence of life expectancy on income is additional money to be allocated for health care services, and these funds are to be used much more efficiently than the main budget expenditures for this sphere.

Much attention to be paid to improving health care services and large hospital complexes are to be introduced in the countries. In many regions, salaries of doctors, clinics, and hospitals should be improved and equipped with modern appliances (Ho 464). Along with stability and the annual increase in funding, it is possible to suggest that political measures are needed to reduce this gap between the life expectancy of low-income and high-income populations.

Second, the life expectancy correlates with the behavior of a person with respect to ones own health  for example, with smoking. At the same time, the quality of primary health care, labor market conditions, and psychological environment do not show a significant correlation. Ho notes that the results of the study do not indicate a direct causal relationship and cannot be interpreted unambiguously (466). For example, it is stated that it is difficult to explain whether wealth affects the health of people or vice versa, while health is an important condition for the accumulation of wealth. Most likely, this is a complex interaction of various factors, which requires further research.

Third, social and financial factors also play an important role in increasing life expectancy. The improvement in lifestyle leads on average to an additional two months of life of the population, and the increase in personal income is likely to lead to the same result. Education is another essential factor in increasing life expectancy. People with education above the school curriculum live six years longer than those who studied only at school (Chetty et al. 1761). Education accounts for approximately ten percent of the difference in deaths of people as they are more informed about the risks and consequences of running a particular way of life.

More importantly, such people smoke less, drink less alcohol, control their nutrition, do sports, and try to live in a more environmentally friendly environment. Nevertheless, discussing ups and downs along with pros and cons, one should clarify that income growth has less effect on life expectancy than its reduction. As soon as income is reduced, it is more difficult for a person to maintain his or her habitual standard of living and monitor health. A one-time improvement in income leads to more risky behavior such as drug and alcohol use, and so on.

Conclusion

To conclude, one should emphasize that income significantly affects the life expectancy of populations. Having compared data of the US and South Sudan, one should note that the former presents more people with a high income, whose life expectancy is longer than those of the residents of South Sudan. While wealthy people are expected to live longer than those with low income, their chances depend on the place of residence and lifestyles. People with high income not only take the information into account but also they are ready to act and make decisions based on the information received. Political, social, and economic improvements should be made to increase life expectancy rates based on adequate access to health care, education, and working environment.

Works Cited

Arabi, Khalafalla Ahmed Mohamed, and Suliman Zakaria Suliman Abdalla. The Impact of Human Capital on Economic Growth: Empirical Evidence from Sudan. Research in World Economy, vol. 4, no. 2, 2013, pp. 43-53.

Chetty, Raj, et al. The Association Between Income and Life Expectancy in the United States, 2001-2014. JAMA, vol. 315, no. 16 , 2016, pp. 1750-1766.

Ho, Jessica Y. Mortality Under Age 50 Accounts for much of the Fact That US Life Expectancy Lags that of Other High-Income Countries. Health Affairs, vol. 32, no. 3, 2013, pp. 459-467.

Rasella, Davide, et al. Impact of Income Inequality on Life Expectancy in a Highly Unequal Developing Country: The Case of Brazil. Journal of Epidemiology Community Health, vol. 67, no. 8, 2013, pp. 661-666.

South Sudan. WHO, 2017. Web.

3. Population by sex, annual rate of population increase, surface area and density. UNSD, 2017. Web.

Introduction

Purpose

This paper seeks to address the sharp increase in the use of psychotropic medications among children. The paper will review various articles to analyze the contributing factors based on the pediatric psychopharmacology literature that explores the increased awareness of various health issues among children and the establishment of intervention measures that are viewed as safer as compared to that of adults. This paper will also evaluate controversies in clinical management to establish the way forward to finding sustainable solutions and make recommendations.

Significance

The current trends in the field of medicine have been purely evidence-based, thus, compelling health practitioners and child welfare advocates to involve in a keen assessment of the danger and significance of applying psychopharmacological interventions in young children. Much attention on this issue has accumulated, thus, causing a strong wave of curiosity and confusion. This attention seeks to identify if the ongoing application of psychotropic products is undertaken appropriately to eliminate bad impulses and feelings among children. The proper use of these treatments should consider potential effects on neurological growth, personality development, and behavior (Alavi & Calleja, 2012).

However, suspicions persist that this pattern may be facilitated by a profit-induced demand generated by drug companies and unscrupulous medical practitioners. Despite the increased awareness about the use of psychotropic drugs in the United States, cases of overuse of such medications among children persist. This clinical misappropriation has the potential of exacerbating careless or hazardous treatments and lead to unwanted health care costs.

Meanwhile, the prescription of psychotropic drugs to reduce emotional and behavioral challenges among children in the U.S has been on the rise in the recent past. These medications have been used widely to treat children with mental problems. However, studies indicate that when applied properly, psychotropic medications can be very beneficial (Huefner & Griffith, 2014). On the other hand, the overuse of such drugs has proved detrimental to young children regarding severe side effects.

Unfortunately, today, most young patients receive medications without being assessed using evidence-based procedures. Most Americans visit their physicians and receive medications without being evaluated using cognitive behavioral therapy that might be effective. This trend can be linked to the low level of collaboration between mental health care workers and the patient population.

Following the increased awareness of critical mental health challenges among children, society has increased its expectations based on the improved experience of practitioners. Even though this field has made profound progress in managing adverse psychiatric problems amongst young children, relying solely on pharmacological interventions might worsen the situation. Thus, the need for an evidence-based and thoughtful plan for the application of psychotropic drugs with young children is inevitable.

During a review of advancements in pediatric psychopharmacology, Shelton, Ehret, Wakai, Kapetanovic, and Moran (2010) identified that psychiatric problems are likely to be more pronounced and unresponsive to treatment if their emergence coincides with childhood as compared to old age. Sharma et al. (2016) backed these claims by showing that psychiatric disorders are related to severe functional impairments if they emerge during young age.

Although this aspect may explain why critically ill children should be given psychiatric drugs, it does not warrant overtreatment or address claims about treatment inefficacy. Zakriski, Wheeler, Burda, and Shields (2005) posit, Extensive prescription of psychotropic drugs among children should be understood in relation to the evolving mental health sector (p. 19).

Scope

This paper will evaluate the contemporary literature on the overuse of psychotropic medication among children. This milestone will be achieved by exploring various sub-sections including issues in clinical managerial operations, cautionary measures for increased use of psychotropic drugs, and drug influence on nervous system development. This paper will also explore the context for prescribing psychotropic drugs as well as critical stages in treatment when such medications are used.

The focus will be mainly on mental health among children in foster care. However, treatment measures that do not entail the use of psychotropic drugs will not be addressed. Similarly, psychotropic treatment for patients above the age of 16 years will be excluded. This paper will conclude by providing recommendations for managerial considerations towards ensuring effective psychiatric health care provision.

Terms

• Psychotropic medicine  These are drugs prescribed to improve the socio-emotional and behavioral well-being of a young child suffering from a mental health problem (Hieber, 2013).
• Bio  Bio defines physical wellbeing as well as genetic composition. According to Nguyen and Shapiro (2015), psychotropic drugs influence biological factors by changing the concentrations of chemicals in the brain that assist in managing the functioning of brain cells that define emotions.
• Psycho  Psycho defines the psychological aspects of the children that influence emotional and behavioral changes such as feelings and thoughts.
• Social  Social describes the environmental issues that contribute to a childs functioning. These environmental factors include child welfare services, family relationships, and natural support (Kalikow, 2008). Natural support comes from peers, friends, and the mainstream community.
• Foster care  Foster care entails placing a minor in a care facility, or private home of a legally certified caregiver. The goal of foster care is to provide services and opportunities that a child had been previously denied through either neglect or fate (Raghavan & McMillen, 2008).
• Polypharmacy  Polypharmacy entails administering two or more psychotropic drugs at once. This situation occurs when a patient is diagnosed with more than one psychiatric condition. Besides, some conditions need to be enhanced by a second medication particularly when treatment is not working.
• Psychopharmacotherapy  This term refers to the management of mental health problems such as bipolar disorders or post-traumatic stress disorders (PTSD).

Literature Review

This section is a review of the contemporary findings of the overuse of psychotropic medications among children and particularly in the United States. Findings of about fifteen articles will be reviewed to shed light on this controversial topic. In preparation for developing this paper, articles providing information regarding child-serving agencies will be assessed in depth. The literature review targets to address the areas as outlined in this chapter.

Since this field has been changing drastically, the available literature may not be sufficient, and thus, data from domestic organizations that serve psychiatric issues among children will be considered. Research on managerial operations including the influence of their decisions on this field will be highlighted. Finally, a summary of the best practices in the area of psychotropic medication among children will be reviewed.

Psychotropic Cases and Medications among Children

According to Memari, Ziaee, Beygi, Moshayedi, and Mirfazeli (2012), psychotropic medication is prescribed to promote the emotional and behavioral well-being of the patient suffering from a mental disorder. These scholars claim that psychotropic drugs have been over or under-prescribed for young children, thus, calling for more research in this area. Therefore, prescribing psychotropic drugs for children needs an experienced practitioner with expertise in the application of such medications to young ones.

Appropriate medication eliminates psychologically-based impediments to change by facilitating the childs efforts to be more significant. Besides, prescribing psychotropic medication highly depends on the context that the prescription occurs. Many children benefit highly from psychotropic medication if it occurs in a comprehensive treatment approach. Such an approach can allow children to utilize community intervention plans while in their homes and learning institutions.

The overuse or misuse of any form of medication has been associated with various side effects. Side effects fall into three classifications namely minor, medium, or severe. The minor side effects include headaches and nausea. The medium ones include the lack of appetite, restlessness, and concentration among others. On the other side, severe side effects include overweight and deformations among young children.

Various issues can lead to the overuse of drugs including poor prescription or failure to follow prescription orders. Some prescribers may initiate polypharmacy when more than two psychiatric conditions are detected. Initiating more than one medicine is not recommendable because it might be challenging to identify the medicine that is beneficial or lead to side effects (McMillen, Fedoravicius, Rowe, Zima, & Ware, 2006).

In spite of the limited skills among providers, there has been a lot of pressure to prescribe due to the severe cases among the youth. This pressure has contributed to either under or over-prescription. Consequently, serious side effects have been manifested, thus, compelling caregivers to seek alternative ways to medicate. The benefits gained from medication should be assessed against the potential risks before deciding if a drug should be used. Parents and legal custodians should be enlightened concerning the possible risks, benefits, and loopholes in medication before introducing psychotropic medications.

Children in Foster Care

Currently, the American public health care sector is facing an emerging pattern where children in foster care have become more exposed to unscrupulous drugs and over-prescription of psychotic medications (Longhofer, Floersch, & Okpych, 2011). This patient population has an array of emotional and psychological needs arising from the environment that they have experienced in the past. For example, children in foster care might have typically undergone child abuse in neglectful or conflicting backgrounds.

These chaotic caregiving settings are often associated with posttraumatic conditions that have the potential of causing severe mental disorders. Research work by Sharma et al. (2016) indicates that being in foster care increases the probability of inappropriate administration of psychotropic medications. This study supports its claims by indicating some factors that contribute to this misappropriation. These factors include being needy, in a population of psychiatric patients, and institutionalized.

In most states in the US, children in foster care using psychotropic drugs must seek the permission of a caregiver. This provision seeks to address the increasing cases of overuse and misuse of psychotropic drugs among children. Unfortunately, the state continues to face cases where psychotropic medication is administered in the absence of the needed legal consent. Care providers, as well as foster child activists, view this aspect as a critical area that requires adequate attention. Strict measures need to be put in place given the significance of psychotropic drugs when prescribed appropriately (Raghavan & McMillen, 2008).

It is important for the legal caregivers to familiarize themselves with the childs emotional needs, the intervention measures being used, as well as the predicted outcomes. However, some of the foster care facilities indulge in fraudulent deals with pharmaceutical companies targeting children in foster care. Apparently, there is a growing misconception that children in foster care desperately need psychotropic drugs. This perception is not always true, but it has been used to overprescribe psychotic drugs to children for purposes of making a profit. Besides, not all children in foster care need to use psychotic medication for therapeutic purposes. Therefore, professional assessment should be done before prescribing any psychotropic medication to children.

Managerial Operations and Strategies for Addressing drug overuse

Several key areas of psychopharmacological treatment continue to raise concerns among researchers as matters of significance to providers. As indicated earlier, the field of psychotropic medication among young children continues to face a lack of congruent evidence. This problem is compounded by the lack of proper decision-making towards reliable and sustainable psychiatric therapy among young children.

One of the major controversies that need to be addressed is the question of the long-term perspective reliability of psychotropic drugs among young populations. Potukuchi and Li (2013) emphasize that in most cases, post-traumatic stress-related disorders continue to manifest in most children during development. This assertion implies that most children experiencing mental health challenges will still use psychiatric medications in their later years.

Besides, most psychiatric drugs are not prescribed by weight, as is the case with other pediatric prescriptions. This situation puts children in need of psychiatric attention at the risk of over-prescription. Therefore, when giving children such drugs, the prescribers should start with small dosages and proceed gradually to ensure safety in consumption.

Another managerial controversy that needs to be addressed in pediatric care revolves around the treatment of depression in children. A study by Nguyen and Shapiro (2015) suggests that practitioners addressing depression among young children lack comprehensive training and skills in behavioral science. Consequently, these care providers might fail to identify the disorders correctly as manifested by their patients.

Despite this lack of critical knowledge and compromised comfort level of prescribing different psychiatric conditions, most providers do not hesitate to diagnose mental disorders. Due to this evident shortage of skilled providers, it is necessary for organizations to ensure appropriate and continued training for child psychiatrists. Besides, the issue of continued care and progress tracking of the mental condition among children is a matter that should be prioritized by the management.

Education and training

Education should target creating awareness for the children, families, and most importantly the prescribers. Education and training promote a shared understanding of treatment goals and responsibilities. Cooperation is promoted when there are common goals and clarity concerning each stakeholders role. Organizational training improves communication skills. Effective communication is the main factor in collaboration and building sustainable relationships between patients and pediatrics (Longhofer et al., 2011).

When all involved parties have an adequate level of education, there is ease in decision-making, and the consensus is easily attained. Enhancing knowledge for the children and families enables appropriate decision-making when choosing mental health care services.

Enhancing the quality of mental health care relies on the informed cooperation of all mental health care providers in ensuring evidence-based care for the young population. Increasing education and training may assist in the reduction of the chances of overuse and risk of antipsychotic drugs. Besides, drug companies are compelled to avoid bad practices since people are aware of the agenda to make a profit.

Flexibility in professional roles

As it has been evidenced in the psychopharmacology practice, to achieve quality mental care requires the review of professional responsibilities. This review should focus on shifting of roles and the expansion of skills to cover emerging mental health care issues. Health care workers should be trained to possess the diverse knowledge, which is requisite in resolving new tasks brought by developments in medication, insufficiency of health care providers, and the need to optimize resources. However, changes in roles are not easy, and it is often uncomfortable for mental health care providers. Consequently, it is essential to offer education and training in flexibility and cooperative skills to avoid role confusion and conflict.

Leadership

Good leadership is widely recognized to be a significant aspect of the prosperity of any quality improvement plan and a necessary factor in mental health care coordination. Good leadership helps in the shaping of the personalities that are in line with an organizations culture and goals. Organizations that have the right leadership are less likely to engage in unethical practices. On the contrary, they are responsible for securing the needed care, ensuring abidance to health care standards, and promoting patient satisfaction through collaborative practice.

Issues in Psychopharmacotherapy Practice

The prescription of psychotic drugs has spiked mainly due to the increased awareness of mental health challenges among children. Unfortunately, the system is not always prepared to abide by the best practices. Drug companies have chosen to overestimate the benefits of these drugs without indicating the potential risks. During the last three decades, the Food and Drug Association (FDA) has approved various antipsychotic medications for use amongst children suffering from schizophrenia or bipolar disorder. Unfortunately, studies indicate that most of the children given antipsychotic medications do not use them to eliminate one of those disorders (Loewit-Phillips & Goldbas, 2013).

According to Huefner and Griffith (2014), schizophrenia is mostly associated with adulthood while bipolar disorder is approximated to influence about 3 % of children. However, practitioners continue to prescribe antipsychotic drugs for other reasons including disruptive behavior or post-traumatic stress disorder. Behavioral problems affect a large population of children during adolescence. Consequently, children are given these drugs by their pediatricians instead of a psychiatrist.

Medication Influence on Neural System Growth

Despite the increased research on the influence of psychotic medication among young children, there is still insufficient knowledge about the long-term consequences of these drugs. There are no evidence-based studies to highlight the potential effect of these drugs on growing organs, the brain, and the nervous system. Nonetheless, in a review of psychopharmatherapy practice, Kalikow (2008) suggests that psychotropic drugs have a potential risk of the development of the central nervous system, particularly when patients are overprescribed. Thus, overdose or chronic exposure to psychotic drugs has the potential to cause developmental deformations in children.

Summary

The findings in these reviews clearly indicate that children in foster care, as well as those in other support services, require careful monitoring to ensure that the administration of psychoactive is within the required limits. Prescribers working for childcare services should be aware of the possible abuse of psychotic drugs in this patient population. Thus, it is vital for these prescribers to assess the profiles for the affected children for any signs of adverse consequences, overdose, prolonged use, and sufficient evidence for a prescription.

Reaching children in foster care might be hard, and thus, proper prescription review before medication and training of providers can assist in the elimination of the abuse of psychotropic drugs in this patient population.

Furthermore, drug companies have used the loopholes in the medical research about the use of psychotropic drugs to maximize profits by targeting the young patient population. Therefore, the state government should review laws and administrative practices to eliminate all loopholes that propagate misinformation between drug companies and the patient population. Administrative practices in the mental health sector should provide leadership collaboratively to eliminate all possibilities of fraudulent activities (Hieber, 2013).

Recommendations

Due to the need for scientific data on psychiatric conditions, further research on this field must offer guidelines identifying precise assessment procedures. Second, there is a need to build accurate benefit and risk estimates associated with psychotropic medication among the affected children. Current studies are yet to offer consistent reports about the exact benefits or risks linked to certain drugs. Third, there is a need to conduct more research to build knowledge on the impact of high concentrations of psychotropic drug exposure during early childhood development.

A clinical study based on these factors is vital if the US is to achieve a sustainable psychopharmacological practice. Besides, more insights will support the increasing need for personalized medication, particularly among the young population. Some of the principles that can be implemented by the managers or organizations for optimal psychomacotherapy practice include the following.

• Before introducing a patient to psychotropic medication, an evidence-based evaluation must be conducted.
• Evaluation results should be supported by a medical history before introducing children to psychiatric therapy. The prescriber should liaise with any professionals involved with the patient to get a historical background. Children are very sensitive, and thus, great care should be taken when introducing psychomacotherapy.
• The prescriber should create a plan to ensure follow-up exercises and determine the efficacy of the medication. Therefore, prescribers must be keen when initiating a treatment approach that cannot be tracked accordingly.
• The consent discussion should not encourage prescribers to engage in malicious activities. On the contrary, it should focus on the risks and benefits of the treatment plan.
• The prescriber should reassess the child if s/he does not respond to the first treatment. Besides, the prescriber must offer a justification for initiating medical combinations.
• Finally, discontinuing medication needs an elaborate plan to avoid relapse.

These principles are essential for safe and reliable intervention, and they should assist in the prevention of medical malpractices targeting to over-prescribe drugs for profit-making. These reliable principles should further protect patients against initiation to unnecessary changes in psychiatric treatment to prevent the overuse of pharmacological treatment procedures among children. Besides, these principles should motivate the affected children and families experiencing inappropriate treatment to desist from dropping out, but rather show concern for quality treatment in the future.

It is necessary for the parent of the affected child, legal custodian to find an alternative treatment plan if there are serious side effects, or no improvements are observed. Various cases may indicate the need for an alternative plan. Such scenarios may involve weight gain, particularly when drugs are used for a long time. Parents or custodians should not hesitate to consult their primary prescriber before seeking an alternative treatment plan. The primary prescriber should collaborate with the parent in seeking and informing the alternative plan. Prescribers of psychotropic drugs to children must be licensed to administer coupled with being exposed to continued learning to stay aware of the evolving benefits and risks linked to the use of such medications (Fontanella, Hiance, Phillips, Bridge, & Campo, 2013).

However, these milestones cannot be stated and achieved without action. Collaboration and coordination among children, families, and providers must be enhanced. The patient or the parents should be made aware of all communications and interactions aimed at providing care. Continued sharing of information regarding the patients needs and progress is essential to avoid unintended overuse or prolonged use of drugs. Since children are actively involved in many programs, it is necessary for prescribers to coordinate their activities with those of different institutions such as schools.

Lessons Learned

I have established various reasons behind the antipsychotic boom among the young population in the United States. Based on a study by Alavi and Calleja (2012), highly aggressive marketing behavior involving prescribers in fraudulent deals is a key determinant for the overuse of these drugs. Due to the lack of quality mental health services, poor families have been caught in this wave of substandard prescriptions. Similarly, children in foster care have fallen victims due to the lack of enough resources to deal with critical emotional and psychological challenges. Based on these challenges, I have identified that there is a societal mindset to seek a quick fix to rectify abnormal traits.

Based on contemporary literature, over-prescription is not a mistake, particularly when prescribing to children in foster care. Huge profits are made in prescribing drugs to children particularly when those drugs are meant to be used for a long period. I have realized that the long-term effects of the overuse of psychotropic drugs are yet to be clarified. Children under foster care have been identified as the most affected as opposed to other children under regular care or Medicaid. However, this trend is largely influenced by pharmaceutical companies. Drug companies target practitioners at the foster care facilities and lure them to prescribe more medications with an intention of making a profit.

Further Research/Questions

Psychotropic drugs play a critical role in psychiatric management among children. However, for children taking psychoactive medications, the demerits tend to be more than the merits, particularly when an evidence-based evaluation is overlooked. This trend is very worrisome given that very little is known regarding the long-term effects of using these drugs. Therefore, further research should focus on determining the possible long-term effects among the young patient population. Besides, studies should focus on revealing the reasons behind the antipsychotic drug boom and identify lasting intervention measures.

Further research should also focus on answering questions such as if these drugs help. Fontanella et al. (2013) suggest that even for the approved purposes such as schizophrenia and bipolar disorder, it is uncertain to what extent the drugs are effective and if they can be reliable in the long-term. The second issue that should be addressed touches on the safety of these medications. Following the increased awareness of psychiatric conditions among children, drug companies have taken advantage of this multi-billionaire industry.

It has become very hard to determine the genuine version of antipsychotic drugs. Besides, there is little research to determine the safety level of the conventional versions endorsed by the FDA. Third, it important to determine what happens when medications are combined coupled with the safety of this practice. Despite the fact that doctors prescribe more than one drug at the same time, very little is known regarding the outcome of this practice.

Summary

The ongoing dissemination of childcare practices and the substantial research in psychopharmacological practice may assist in the intervention of over-prescription among children with mental problems in the US. Ideally, the task of ensuring that young children are prevented from medical malpractices requires a sustainable approach where children can access evidence-based mental health. Practitioners need to acquire vital skills and abide by the ethics that discourage any form of medical malpractice. Since mental health care spreads out to cover various stakeholders, it is necessary to forge relationships among families, psychiatrists, and primary care providers to deliver evidence-based care.

Further research, education, and training are needed in this field. Quality education is the key to effective collaboration that seems to be lacking in the current system. Drug companies continue to benefit from the poor relationship between prescribers and patients by using the latter to give more drugs regardless of the risk. When people are enlightened and forge collaborations with prescribers, there will be an increased need for evidence-based practices to eliminate bad practices. Given the increased cases of psychiatric cases in the US, the search for more evidence-based health information on pharmacological practice is needed urgently.

References

Alavi, Z., & Calleja, G. (2012). Understanding the use of psychotropic medications in the child welfare system: causes, consequences, and proposed solutions. Child Welfare, 91(2), 77-94.

Fontanella, C., Hiance, D., Phillips, G., Bridge, J., & Campo, J. (2013). Trends in psychotropic medication use for Medicaid-enrolled preschool children. Journal of Child and Family Studies, 23(4), 617-631.

Hieber, R. (2013). Toolbox: Psychotropic medications approved in children and adolescents. Mental Health Clinician, 2(11), 344-346.

Huefner, J., & Griffith, A. (2014). Psychotropic medication use with troubled children and youth. Journal of Child and Family Studies, 23(4), 613-616.

Kalikow, K. (2008). Psychiatric medications for children. Psychiatric Times, 25(13), 18-19.

Loewit-Phillips, P., & Goldbas, A. (2013). Psychotropic medications for the nations youngest children. International Journal of Childbirth Education, 28(1), 32-37.

Longhofer, J., Floersch, J., & Okpych, N. (2011). Foster youth and psychotropic treatment: Where next. Children and Youth Services Review, 33(2), 395-404.

McMillen, J., Fedoravicius, N., Rowe, J., Zima, B., & Ware, N. (2006). A crisis of credibility: professionals concerns about the psychiatric care provided to clients of the child welfare system. Administration and Policy in Mental Health and Mental Health Services Research, 34(3), 203-212.

Memari, A., Ziaee, V., Beygi, S., Moshayedi, P., & Mirfazeli, F. (2012). Overuse of psychotropic medications among children and adolescents with autism spectrum disorders: Perspective from a developing country. Research in Developmental Disabilities, 33(2), 563-569.

Nguyen, M., & Shapiro, M. (2015). Topiramate for weight loss in children and adolescents prescribed psychotropic medications. European Psychiatry, 30(1), 694-702.

Potukuchi, P., & Li, C. (2013). National trends in psychotropic medications use among children with attention deficit hyperactivity disorder (ADHD) in the United States. Value in Health, 16(3), 56-57.

Raghavan, R., & McMillen, J. (2008). Use of multiple psychotropic medications among adolescents aging out of foster care. Psychiatric Services, 59(9), 1052-1055.

Sharma, A., Arango, C., Coghill, D., Gringras, P., Nutt, D.,&Hollis, C. (2016). BAP position statement: Off-label prescribing of psychotropic medication to children and adolescents. Journal of Psychopharmacology, 30(5), 416-421.

Shelton, D., Ehret, M., Wakai, S., Kapetanovic, T., & Moran, M. (2010). Psychotropic medication adherence in correctional facilities: a review of the literature. Journal of Psychiatric and Mental Health Nursing, 17(7), 603-613.

Zakriski, A., Wheeler, E., Burda, J., & Shields, A. (2005). Justifiable psychopharmacology or overzealous prescription? examining parental reports of lifetime prescription histories of psychiatrically hospitalized children. Child and Adolescent Mental Health, 10(1), 16-22.

Guthrie Neonatal Screening

Robert Guthrie first suggested one of the earliest methods for the identification of phenylketonuria in neonates in the 1960s and, since then, Guthrie screening became one of the most commonly used techniques of early health evaluation used in the National Healthcare Programs worldwide. Guthrie neonatal screening is conducted through the analysis of the blood sample collected through the pinprick puncture in a heel of an infant and soaked into a specifically designed sample card (Blau, Van Spronsen, & Levy, 2010).

The examination of the newborns blood samples helps to examine the amount of phenylalanine contained in the organism, and the excess level of this vital element indicates the development of the metabolic disorder. The screening procedures are usually conducted within the first days after birth, and the early assessment proved to be effective in the identification of almost every case of phenylketonuria. The false assessment outcomes can be easily corrected by repeating the test at the later developmental stages because it is observed that the level of phenylalanine in the exposed children gradually increases within a week (Van Sprosen & Enn, 2010).

Therefore, it is possible to say that the time of Guthrie screening completion may significantly affect the accuracy of assessment results, and it is suggested to examine the infants after the second day of their postpartum development.

Phenylketonuria

Phenylketonuria is a genetic disorder provoked by the inherent defects in phenylalanine metabolism that can provoke cognitive underdevelopment and mental retardation (Van Sprosen & Enn, 2010). It is observed that phenylketonuria occurs in 1 per 10-14 thousand children, and about one-sixth of the individuals carry the pathologic gene. Every day, 74 infants are diagnosed with phenylketonuria (U.S. National Library of Medicine, 2016).

Phenylalanine plays an essential role in protein synthesis, but the excess amounts of the amino acid in the organism cause the metabolic block that leads to the accumulation of toxic elements in the body. These toxic derivates affect the central nervous system and provoke the protein metabolism that interferes with the development of brain structure (Blau et al., 2010). The researchers suggest that this mechanism may be a reason for the consequent progressive mental and intellectual retardation (Van Sprosen & Enn, 2010).

Along with the mental retardation, which can become manifested approximately in the fourth month of infancy, the disorder invokes some physiological symptoms such as skin lesions and seizures (Blau et al., 2010). Phenylketonuria has many medical complications, but the early diagnosis and the optimal treatment that includes dietary intervention help to prevent developmental delays. Thus, the implementation of Guthrie screening procedures can help to avoid adverse outcomes.

Recommendations for Intervention

The treatment of the disorder and the prevention of cognitive underdevelopment is based on the dietary intervention that is meant to limit the intake of phenylalanine with food. Phenylalanine is an important amino acid, which takes part in protein synthesis, the supply of this element with food is vital for every human being (Van Sprosen & Enn, 2010). But the excess level of the element in the blood is toxic, and regular monitoring of the childs blood composition is required.

Thus, the parents of a child with phenylketonuria need to control the amount of phenylalanine intake in a way to maintain the normal growth and development and avoid the accumulation of phenylalanine and the products of its metabolism in the organism of an infant because, otherwise, its cognitive and intellectual functioning will become impaired. The neurocognitive impairment caused by the disorder is irreversible, and the efficiency of the intervention depends on the rapid response to the manifested symptoms.

Since infancy, patients with the disorder need to intake phenylalanine-free products for the replacement of maternal milk (Blau et al., 2010). As the child grows older, he/she should adhere to a low-protein diet and avoid food containing aspartame, flour, soya, etc. The findings in the recent studies demonstrate that the dietary intervention is effective in the normalization of phenylalanine level and the consequent intoxication of the organism that is perceived as a potential cause of the neurocognitive impairments and biochemical imbalance in the patients (Van Sprosen & Enn, 2010).

Impacts of Genetic and Prenatal Technology on Health

Along with the neonatal assessments, the advanced genetic and prenatal tests allow finding the developmental abnormalities in the fetus. In a span of a few decades, the researchers obtained a large amount of information about genetic diseases and human health. The expansion of knowledge in the field of genetics assisted in the elaboration of new innovative technologies that now allow women to receive the early prenatal diagnosis.

The advanced genetic testing became safer, and through the implementation of multiple non-invasive screening techniques, it became possible to examine the fetus DNA and predict developmental outcomes with a high level of accuracy (Farrell, 2013).

Similar to the early neonatal assessments, prenatal screening provides many advantages for the improvement of the infants health conditions. In comparison to the invasive genetic technologies, such as chorionic villus sampling and amniocentesis, the non-invasive technologies are primarily based on the maternal blood analysis and cause less physical and psychological stress to a mother and, in this way, they are associated with a lesser risk of provoking a negative impact on the infants health (Farrell, 2013).

The safety and easiness of the modern prenatal tests increase their accessibility, and many women thus have an opportunity to predict their infants health conditions and undertake the measures to prevent negative pregnancy outcomes in a timely manner. It is observed that women become more interested in the non-invasive testing procedures, and many families express willingness to undergo the prenatal analysis for an increasing number of health conditions unrelated to the genetic disorders (Farrell, 2013).

However, there is some uncertainty about the benefits and harms of genetic and prenatal technology implementation. The ethical and social concerns about implications of genetic testing or influence of genetic information on the pregnancy outcomes and prenatal decision-making are worth consideration as they provoke many controversies. But, at the same time, the non-invasive prenatal technologies, their availability, and lack of significant harmful effects on the health of mothers and infants provide many medical and diagnostic advantages. With the advanced genetic and prenatal technologies, there appeared more opportunities for the improvement of health conditions and quality of the infants life.

High-Tech Neonatal Intensive Care Units (ICUs)

HICU is another form of neonatal treatment for the premature infants of neonates with severe congenital or genetic abnormalities. Nowadays, HICU is among the most expensive medical procedures in the USA, and its costs can exceed over $300.000 per child (Lantos & Meadow, 2011). The high costs of specialized neonatal care are the core aspect invoking multiple ethical concerns related to the factors of HICUs accessibility and survival rates.

Many people dispute the effectiveness and usefulness of HICUs due to high rates of neonates deaths. Prematurity and congenital abnormalities are the common causes of neonatal deaths, and the lethal outcome can occur even after the completion of the intensive care course. Nevertheless, despite its high costs and low neonatal survival levels, HICUs are still among the most cost-effective intensive care treatment practices (Lantos & Meadow, 2011). The intensive neonatal interventions are important because they provide the opportunity for the improvement of health condition especially in patients whose disorders can be resolved in a shorter period.

The parents may experience many difficulties in caring for newborns with serious health issues, and their decision on care may be influenced by socioeconomic and cultural factors. High costs of HICU treatment significantly reduce the availability of the service for the lower-income socioeconomic groups who cannot have an opportunity to maintain the life functions of a child in a critical condition without governmental financial support.

The lack of social and family support may incline parents to refuse to care for a child as well. Decision-making in similar cases is usually influenced by several factors such as psychosocial, socioeconomic, medical, and personal ones. Psychosocial factors are those related to the stress of becoming parents and feeling responsible for the well-being of an infant. The strain is worsened if a child has serious health concerns such as phenylketonuria. Medical factors include attitudes to medical treatment and various tests and screenings, which would be necessary while taking care of an infant. Socioeconomic factors are determined by the socioeconomic status of a family, i.e. the level of parents incomes and the welfare of the family unit.

Finally, personal factors are a combination of personal experience and perceived knowledge. They cover all beliefs from medical issues to bringing up children (Lipstein et al., 2010; Nicolls & Southern, 2013). So, it is possible to say that the decision can be affected by the combinations of these factors. However, the most significant factors are personal ones because they determine the perception of the situation and socioeconomic factors because of HICUs expensiveness.

Multicultural Considerations

Different cultural and social aspects of an individuals life may significantly affect the process of decision making related to prenatal and neonatal assessments. While counseling a patient, it is important to comply with the principles of informed consent, avoidance of harm and discrimination, privacy, and confidentiality (Potter et al., 2008). It is important to take the interests of the patients into account because, in this way, it will be possible to give a relevant recommendation that will be accepted by a person.

The perception of the harms and benefits of prenatal and neonatal assessment can significantly vary in different individuals. The consideration of the linguistic and cultural differences ensures that a person will receive the provided information well, will understand it, and will make a reasonable choice based on personal values and beliefs. Cultural sensitivity is essential for compliance with the principles of fairness and beneficence because it ensures equality in the provision of information and offering screening procedures. That said, it is vital to bear in mind the cultural factors affecting decision-making.

For example, some cultures do not recognize a womans right to making vital decisions, so that all significant decisions are made by men. Other cultures do not trust conventional medicine or promote belief in destiny. For example, indigenous Mexican Americans believe that any health concern is a punishment for sins. So, if an infant is ill, God might be punishing his/her parents. The same can be said about Muslims, who believe that everything happens for a reason and was predetermined by Allah. So, these factors should be taken into consideration when working with parents of children, who suffer from phenylketonuria.

References

Blau, N., Van Spronsen, F., & Levy, L. (2010). Phenylketonuria. The Lancet, 376(9750), 1417-1427. Web.

Farrell, R. M. (2013). Symposium: Women and prenatal genetic testing in the 21st century. Health Matrix: Journal of Law-Medicine, 23(1), 1-13.

Lantos, J. D., & Meadow, W. L. (2011). Costs and End-of-Life Care in the NICU: Lessons for the MICU? Journal of Law, Medicine & Ethics, 39(2), 194-200 7p. Web.

Lipstein, E. A., Nabi, E., Perrin, J. M., Luff, D., Browning, M. F., & Kuhlthau, K. A. (2010). Parents decision-making in newborns screening: Opinion, choices, and information needs. Pediatrics, 126(4), 696-704.

Nicolls, S. G., & Southern, K. W. (2013). Parental decision-making and acceptance of newborn bloodspot screening: An exploratory study. PlOs One, 8(11), 1-10.

Potter, B. K., Avard, D., Entwistle, V., Kennedy, C., Chakraborty, P., Mcguire, M., & Wilson, B. J. (2008). Ethical, legal, and social issues in health technology assessment for Prenatal/Preconceptional and newborn screening: A workshop report. Community Genetics, 12(1), 4-10. Web.

U.S. National Library of Medicine. (2016). Phenylketonuria. Web.

Van Spronsen, F. J., & Enns, G. M. (2010). Future treatment strategies in phenylketonuria. Molecular Genetics and Metabolism 99(Supplement 1), S90-S95. Web.

What Insights did I Find Helpful or Interesting?

Throughout the article, I found the concept of the microsystem useful to my understanding of how to provide health care in a complex environment characterized by multiple forces, including, but not limited to, culture, technology, and people (DeNisco & Barker, 2015). Particularly, the articles findings explain how to navigate through these forces and influences in health practice.

In what ways did the Reading Improve my Understanding of a Functioning Health Care System?

This reading enhanced my understanding of the main tenets of a functioning microsystems because it outlined the key characteristics of such a system. For example, the authors said the key driving forces of a functioning microsystem are leadership, organizational support, staff focus, education, training, interdependence, patient focus, community focus, market focus, performance results, process improvement, and information technology (DeNisco & Barker, 2015). Based on my academic work, I find that these tenets outline the pertinent aspects of a functioning health care system. However, I find it interesting that the authors did not mention patient quality as a key driving force of the health care microsystem. I believe it should be the focus of the microsystem.

What Points do I Agree or Disagree with?

I agree with the researchers that a well-functioning microsystem would enhance patient safety, which should be a top priority for health providers. In the article, the authors say that although patient safety should be a priority for the organization, different health care service providers should formulate innovative strategies to improve patient safety (DeNisco & Barker, 2015). I disagree with this view because I believe patient safety is universal because regardless of the area of practice, all patients have the same safety needs. Therefore, the concept is not only paramount but also standard throughout all areas of practice. Consequently, I believe health care service providers should subscribe to universal practices of patient safety, as opposed to formulating their own.

What Points did I Find Confusing?

In the article, the authors argued that a functioning microsystem has both business and clinical goals (DeNisco & Barker, 2015). I find this point confusing because both goals often clash. In other words, the pursuant of clinical goals may not necessarily align with the pursuance of business goals. Indeed, the provision of health care services is mostly a calling for most health care professionals and is driven by the quest to improve human welfare.

However, business goals promote a profit-making focus, which has mostly seen health care providers overlook the goal of improving patient safety and human welfare for the selfish goal of making a profit. Although there have been attempts to bridge this divide, I find it confusing that the authors argue that a functioning microsystem would sufficiently accommodate both business and clinical goals.

Reference

DeNisco, S., & Barker, A. (2015). Advanced practice nursing (3rd ed.). Burlington, MA: Jones & Bartlett Publishers.

Sonographer

Medical sonographers focus on different parts of the body, such as the neurological system, the abdomen, musculoskeletal system and the breasts as well as fields such as obstetrics. The major role of a sonographer is the use of a transducer for the administration of ultrasound waves to various body parts for examination (OBrien 2007). Since technology has involved the development of the device and efficient processes, sonographers need to be tech savvy to safely use the technology on patients (Ambrosini et al 2007). Based on their understanding and judgment of pathology, sonographers record and interpret images to determine abnormalities in the parts under examination.

Although the images recorded may not make sense to lay people, they are very useful to sonographers. In other words, sonographers turn sound images into useful medical information used for diagnosis and assessment of patients (Burnside, Brown & Kline 2008; Daneman, Epelman, Blaser & Jarrin 2006; Islam & Mostafa 2013; Scheel et al 2006). To understand this, the current study examines the pathways to becoming a sonographer in the United States.

Pathways to becoming a sonographer

The two major pathways to becoming a sonographer in the United States are the primary pathway and the post-primary pathways.

Primary pathway

For candidates to qualify for the primary pathway of becoming sonographers, they are required to complete an accredited sonography educational programme successfully. The accreditation body must be certified by the American Registry of Radiologic Technologists (AART). Sonographers using this pathway must attain a bachelors degree before certification. To make the pathway more reliable, accreditation by ARRT follows certification from other agencies certified by USDE and/or CHEA. In the primary pathway, candidates have educational qualifications that indicate their didactic competency. Furthermore, candidates in the primary pathway must be adequately competent in various clinical procedures under ARRT in areas of clinical competency and sonography didactic requirements (Harris 2009).

The post-primary pathway

The pathway requires an individual to have completed sonography clinical requirements as well as qualifications in MRI and/or radiography (Linton 2008).

Accreditation of sonographers in the United States

Sonographer accreditation in the United States requires candidates to have adequate educational requirements, achieve compliance rules and regulations, ethical standards and pass the sonography examination administered by ARRT (Wilson & Wilson 2009). Education requirements in sonography include successful completion of programs in related areas such as physiology and anatomy at the certificate or bachelors degree level (Janson, Michael, Berg & Anderson 2005). Sonography educational programs must be accredited. Having acquired the necessary education requirements, candidates must undergo practical training, where they use different technologies and understand images developed in various medical specialties (Islam & Mostafa 2013). On the job training is necessary to give students first-hand experience in procedures and policies, details of the field and equipment specifics.

Ethical requirements are major aspects of accreditation. In addition to compliance with ARRT ethical standards, rules and regulations, candidates must have an unquestionable moral character with a positive history in sonography practice and education. Before full accreditation, candidates must successfully undertake an examination administered by the ARRT with regard to sonography. The examination mainly tests the candidates cognitive skills and knowledge necessary for intelligent performance of tasks as a sonographer at an entry level (Hart & Dixon 2008). Candidates have three chances, at most, to pass the examination within a period of three years. Following successful completion of the educational, ethical and examination requirements, successful candidates are given the Candidate Status Report, which provides information about the candidates eligibility and provides information for scheduling for clinical examination in a period of not more than 90 days.

Regulation of sonography in the United States

Sonography that is used for diagnostic or therapeutic reasons is regulated in the United States of America by the Food and Drug Administration, whose standards are also acceptable in most parts of the world (Harris 2009). The Food and Drug Administration body uses various metrics to limit the acoustic output from sonography equipment. At the state level, it is the only New Mexico that regulates the practice of sonography in the state. In the regulation, FDA ensures sonography equipment comply with the established standards and sonographers complete successfully educational, examination and ethical requirements set by bodies such as the American Registry of Radiologic Technologists (ARRT). In equipment use, the major measures for regulation include the Mechanical index and the thermal index.

The mechanical index relates to the cavitation bio-effect while the thermal index relates to tissue heating bio-effect. According to FDA requirements, sonographers must not exceed the set standards in the metrics (Hart & Dixon 2008). The field of medical sonography also requires regulation. The purpose of regulation is to ensure the procedure is safe for both sonographers and patients (Sherer, Visconti, Ritenour & Haynes 2013). The regulatory body and other agencies offer public recognition to sonographers and their facilities and promote their commitment to high quality standards. Regulation ensures maintenance of qualification credentials and annual compliance to established procedures. The regulation includes requiring sonographers to continually undergo training and renew registration on after two years (Hart & Dixon 2008).

References

Ambrosini, R, Barchiesi, A, Di Mizio, V, Di Terlizzi, M., Leo, L, Filippone, A,& & Carriero, A, 2007, Inflammatory chronic disease of the colon: how to image, European journal of radiology, vol. 61, 3, pp. 442-448. Web.

Burnside, PR., Brown, MD., & Kline, JA, 2008, Systematic Review of Emergency Physicianperformed Ultrasonography for LowerExtremity Deep Vein Thrombosis, Academic Emergency Medicine, vol. 15, 6, pp. 493-498. Web.

Daneman, A, Epelman, M, Blaser, S, & Jarrin, JR, 2006, Imaging of the brain in full-term neonates: does sonography still play a role?, Pediatric radiology, vol. 36, no. 7, pp. 636-646. Web.

Harris, GR, 2009, FDA regulation of clinical high intensity focused ultrasound (HIFU) devices,Annual International Conference of the IEEE, vol. 1. No. 2, pp. 145-148. Web.

Hart, A, & Dixon, AM, 2008, Sonographer role extension and career development; a review of the evidence, Ultrasound, vol. 16, no. 1, pp. 31-35. Web.

Islam, MS, & Mostafa, MG, 2013, Interpretation Of Ultrasound Image, KYAMC Journal, vol. 3, no. 2, pp. 301-305. Web.

Janson, M, Michael, K, Berg, J, & Anderson, JC, 2005, The role of intraoperative sonography in neurosurgery, Journal of Diagnostic Medical Sonography, vol. 21, no. 2, pp. 148-151. Web.

Linton, O, 2008, American Registry of Radiologic Technology, Academic Radiology, vol. 15, no. 9, p. 1211. Web.

OBrien, WD, 2007, Ultrasoundbiophysics mechanisms, Progress in biophysics and molecular biology, vol. 93, no. 1-3, pp. 212-255. Web.

Wilson, M, & Wilson, A, 2009, What Does Government Regulation Really Mean?, Journal of Diagnostic Medical Sonography, vol. 25, no. 2, pp. 88-92. Web.

Sherer, MA, Visconti, PJ, Ritenour, ER, & Haynes, K, 2013, Radiation protection in medical radiography, Elsevier Health Sciences, Amsterdam, Netherlands. Web.

Scheel, AK, Hermann, KA, Ohrndorf, S, Werner, C, Schirmer, C, Detert, J.,& & Backhaus, M, 2006, Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints, Annals of the rheumatic diseases, vol. 65, 5, pp. 595-600. Web.