Category: Health & Medicine

Introduction

The history of conducting clinical trials on inmates in the United States has long been marred with cases of prisoner abuse and exploitation. Nevertheless, the Nuremberg Code and Belmont Report led to the development of research ethics, which highlighted the oppressive practices of the researchers. This led to the establishment of 45 C.F.R. part 46, subpart C, which categorizes inmates as vulnerable populations, limiting the circumstances under which they would be used for clinical research (Huang et al., 2017). Under this regulation, prisoners can only be used as subjects in research studies involving criminal behavior, inmates conditions, or experiments that aim to enhance their well-being (Christopher et al., 2017). In addition, convicts may participate in clinical trials aimed to determine an illnesss prevalence or its probable risk factors. However, the issue of experimenting on prisoners continues to elicit mixed reactions among the public. The supporters of both sides argue that the principles of justice, respect for persons, and beneficence are in their favor. Inmates should not be involved in medical experiments because they lack free, informed consent and barely benefit from the research.

Arguments Supporting Clinical Trials on Inmates

The prison population may benefit from the discoveries made in clinical trials. Research indicates that compared to the general public, most inmates suffer from chronic diseases such as HIV/AIDS, hepatitis, tuberculosis, and diabetes (Huang et al., 2017). Therefore, denying this population the chance to participate in medical experiments may deprive them of life-saving treatment approaches. Some prisoners may view medical experiments as an opportunity to receive high-quality healthcare services that are almost inaccessible to the incarcerated population. Similarly, based on respect for persons, prisoners should be regarded as autonomous beings with the freedom to choose whether or not to be involved in medical trials (Christopher et al., 2017). In this case, some inmates may participate in medical experiments to benefit society. Not to mention, the main limitation linked with experimenting on convicts is the scientists unethical practices. Hence, if stringent regulations are implemented to further protect the inmates, such research studies may yield positive results that benefit the prisoners and the general public (Huang et al., 2017). Thus, clinical trials can profoundly enhance the welfare of convicts by developing diverse treatment plans to manage or cure their ailments

Arguments Opposing Clinical Trials on Prisoners

Most of the inmates are unable to give free and informed consent. Due to the oppressive nature of prison facilities, convicts hardly have the right to self-determination. This implies that the incarceration conditions encourage prisoners to participate in studies they would not consent to if they were free. Additionally, some inmates involvement in clinical trials may not be due to free consent but to various motivating factors, such as rewards and better treatment. Many prisoners participate in research to obtain reduced sentences, finances, better living conditions, and medical aid (Christopher et al., 2017). For example, most inmates who participated in the Holmesburg prison experimentation were attracted by the monetary incentives, promises of reduced sentences, and Dr. Albert Kligmans assurance of the studys safety (Tanenbaum, 2022). Such motivations encouraged the prisoners to test different skin creams and be exposed to toxic chemicals such as dioxin resulting in long-term illnesses. This rules out the idea of informed consent because the inmates did not know they were testing on chemicals that would adversely affect their health. Therefore, prisoners cannot give free and informed consent due to the constraints involved in the prison system.

Most research studies do not aim solely to benefit the inmate population. The push for inmates experimentation is mainly influenced by the drive for scientific discoveries and business priorities, including profits and expediency but has no regard for the convicts well-being. For instance, in the Tuskegee study, the experiment intended to monitor the full progression of syphilis and disregarded the prisoners welfare. Even though penicillin became the recommended drug for treating syphilis in 1947, the researchers continued administering supplements to the prisoners until 1972, when the study was ended (McVean, 2019). Consequently, some inmates suffered insanity and blindness; by the end of the Tuskegee experiment, 128 prisoners had died from syphilis or related complications, with some having infected their spouses (McVean, 2019). In addition, the ailment had been transmitted to at least 19 children during birth. In another case, the Holmesburg experiments on skin chemicals resulted in huge research breakthroughs which profited pharmaceutical companies such as Dow Chemicals and Johnson & Johnson (Tanenbaum, 2022). Therefore, the trials benefited big organizations while predisposing the inmates to various health complications, proving that experimenting on prisoners defies beneficence and justice principles.

Position

Clinical trials should not be performed on inmates due to the lack of free and informed consent. Prisons or correctional facilities are coercive environments where a convicts free choice has been heavily compromised (Christopher et al., 2017). Therefore, the decision on whether or not to participate in medical research is influenced by motivating factors such as cash rewards or fear of disciplinary actions by correctional officers but not by consent. With such limited choices, it is challenging for prisoners to opt out of clinical trials. Some critics may argue that with proper government oversight, medical experiments may be conducted safely to safeguard prisoners rights (Huang et al., 2017). However, current laws present a lot of loopholes for scientists to continue exploiting the incarcerated population. Therefore, medical experimentation should not be conducted on inmates because they have limited rights, which deter them from withdrawing from research if it adversely affects them.

Although some researchers suggest that medical experiments may significantly benefit the prisoners by availing various treatment plans, evidence indicates that inmates welfare is the least priority in research. For instance, the Tuskegee, Guatemala, and Holmesburg experiments are characterized by immense suffering of the inmates resulting in high fatalities and adverse health conditions. In addition, Dr. Kligmans description of inmates as acres of skin shows that researchers are only interested in making medical discoveries to benefit themselves but not the inmates (Tanenbaum, 2022). Furthermore, studies conducted on prison subjects take a prolonged period, implying that some inmates may die in the process and thus fail to benefit from the medical experiment that led to their demise. Therefore, medical experimentation on convicts should be banned because it does prioritize their welfare.

Conclusion

In conclusion, the issue of inmates involvement in clinical trials continues to elicit public debates due to its long history of prisoners exploitation. On one side, proponents maintain that experimenting on convicts may result in significant scientific discoveries that may benefit both criminals and society. The respect for person principle also safeguards a prisoners right to participate in medical research. Alternatively, the opponents argue that inmates should not participate in research studies because they are coerced or motivated by different constraints in the prison environment. Similarly, most research studies are driven by the need for scientific breakthroughs or company profits and hence are not aimed at solely benefiting the incarcerated populations. Although there is a possibility that clinical research on inmates may provide high-quality treatment approaches to help manage their conditions, scientists may exploit the loopholes in existing laws to continue abusing prisoners. Therefore, clinical trials should not be performed on prisoners because they lack free, informed consent that allows them to withdraw from research if necessary.

References

Christopher, P. P., Garcia-Sampson, L.G., Stein, M. D., Johnson, J. E., Clarke, J., Rich, J. D., & Lidz, C. W. (2017). Enrolling in clinical research while incarcerated: What influences participants decisions? Hastings Center Report, 47(2), 2129.

Huang, E., Cauley, J. & Wagner, J.K. (2017). Barred from better medicine? Reexamining regulatory barriers to the inclusion of prisoners in research, Journal of Law and the Biosciences, 4(1), 159-174.

McVean, A. (2019). 40 years of human experimentation in America: The Tuskegee study. McGill. Web.

Tanenbaum, M. (2022). Philadelphia apologizes for deplorable history of medical experiments on Holmesburg prison inmates. PhillyVoice. Web.

Introduction

The financial framework for the given project links to the cost of BIS monitors. At the moment, they range in price from $4,000 to about $5,000. Because of the existence of several surgeries in one health unit, their cost can be high. However, the risk of side effects and treatment of complications that emerge during the anesthesia will demand even more investment (Zhou et al., 2018). Additionally, the inappropriate use of drugs and medicines during interventions is used to file a lawsuit against a hospital. From this perspective, the offered project meets the Quadruple Aim as the final costs will reduce. At the same time, patients and health workers will benefit from better outcomes preconditioned by BIS monitors (Sikka et al., 2015). In such a way, the projects financial analysis shows that considering this solution is a beneficial tool for the healthcare sector to cope with the problem and guarantee that all four goals of the current paradigm are achieved. The reduction of costs, better outcomes, and patient and clinicians experiences will be enhanced by relatively low costs presupposing new BIS monitors for various units.

Expected Financial Return

Several benefits are associated with the given project. First of all, the costs needed to provide care to patients with complex conditions after surgeries or to mitigate the adverse effects reduce because of the lower incidence and the improved quality of care delivery. Second, monitoring the depth of anesthesia will guarantee better outcomes, help save patients, and protect them from adverse effects. Simultaneously, following the Quadruple Aim principles, patients and clinicians experiences will improve because they will benefit from reduced stress and better outcomes (Sikka et al., 2015). Finally, another significant benefit of the project is creating the environment for new improvements as BIS monitors employment will open space for further achievements and upgrades during surgeries.

Executive Summary

As stated above, the projects central goal is to implement BIS monitors as the standard of care during general anesthesia to decrease intraoperative awareness, raise client satisfaction levels, and reduce postoperative complications. The achievement of the given goal demands the utilization of resources available in hospitals, mobilization of human resources, and reconsideration of the existing approaches to practice to ensure better outcomes. From the perspective of the quality assurance (QA) segment and patient experience, the Quadruple Aim might also guarantee improved outcomes because it focuses on clients several factors. It is critical to note that increasing customer satisfaction is one of the primary goals of the given method, which is also achieved by providing clinicians with better working conditions and new means for delivering care.

The proposed intervention presupposes the use of BIS monitors as the tool to attain improved outcomes during anesthesia. In general, the Bispectral Index (BIS) is one of the most effective technologies to control anesthesias depth. The use of the given equipment during surgeries or other interventions allows anesthetists with the improved opportunity to adjust the number of anesthetic agents and ensure that it meets the needs of the patient (Seo et al., 2019). In such a way, it is expected that the implementation of this strategy into practice will contribute to significant improvement. BIS monitors are an essential tool providing anesthetists with multiple opportunities to control the state of patients (Lapaine, 2020). Simultaneously, the improvement can also be viewed if speaking about patients as the number of adverse effects will be significantly reduced, which is the key to better patient experience and satisfaction.

Several benefits can be associated with the given project. The costs needed to provide care to patients with complex conditions after surgeries or to mitigate the adverse effects will be reduced because of the lower incidence and the improved quality of care delivery. The ability to monitor anesthesias depth will guarantee better outcomes, help save patients, and protect them from adverse effects. Simultaneously, following the Quadruple Aim principles, patients and clinicians experiences will be improved because they will benefit from the reduced level of stress and better outcomes.

References

Lapaine, M. (2020). Embracing the Quadruple Aim: One hospitals experience. Healthcare Management Forum. doi:10.1177/0840470420942791

Seo, K., Kim, K., Lee, S., John, H., & Lee, J. (2019). Comparative analysis of phase lag entropy and bispectral index as anesthetic depth indicators in patients undergoing thyroid surgery with nerve integrity monitoring. Journal of Korean Medical Science, 34(20), e151. doi:10.3346/jkms.2019.34.e151

Sikka, R., Morath, J., & Leape, L. (2015). The Quadruple Aim: care, health, cost, and meaning in work. BMJ Quality & Safety, 24, 608-610. doi:10.1136/bmjqs-2015-004160

Zhou, Y., Li, Y., & Wang, K. (2018). Bispectral index monitoring during anesthesia promotes early postoperative recovery of cognitive function. It reduces acute delirium in elderly patients with colon carcinoma: A prospective controlled study using the Attention Network Test. Medical Science Monitor, 24, 7785-7793. doi:10.12659/MSM.910124

Vascular cognitive impairment no dementia (VCIND) is a condition characterized as an early stage of VCI in individuals who are at higher risk of developing dementia. The article written by Yang et al. (2019) focuses on the study which evaluates the effectiveness of acupuncture treatment in patients with VCIND. Treatment of VCIND presents one of the possible methods for the prevention of dementia. One of the common medicines used for the treatment of cognitive disturbances in patients with VCIND is citicoline. On the other hand, acupuncture is a practice from traditional Chinese medicine which gained significant popularity for its beneficial effects on patients undergoing rehabilitation from stroke and patients with cognitive disorders (Yang et al., 2019). The articles findings suggest that acupuncture presents a more effective medical treatment alternative than citicoline.

Firstly, the methodology of the study is designed in accordance with the randomization principle. The benefits of the randomized controlled trial method include the elimination of the bias component and more accurate results in defining the connection between intervention and its effect on treatment compared to other study designs (Hariton & Locascio, 2018). The primary task for researchers in randomized controlled trial is to carefully select the population to ensure the balance in the randomization of participants characteristics. The study conducted by Yang et al. (2019) recruited participants through posters and newspaper advertisements. Furthermore, the potential candidates had to pass several requirements to be included in the trial. The requirements included age criteria, education, cognitive functioning, presence of neurological or psychiatric disorders, and brain injuries.

Next, the choice of participant recruitment methods used in the study could have influenced the research outcomes. According to Bracken et al. (2019), advertising strategies for recruiting trial participants are more effective in women than men, and mailing can be more effective in older adults. Moreover, community outreach can provide assistance in recruiting participants from vulnerable populations. Thus, utilizing more inclusive recruitment strategies in the study could have increased the accuracy of the trial results.

Furthermore, the authors provide insufficient information regarding the therapy process in explaining the methodology of acupuncture treatment received by one of the participant groups. In particular, the description of the procedure is limited to the list of 16 acupuncture points where sterilized needles were inserted into participants during the treatment process (Yang et al., 2019). The specific 16 points of needle insertion for the therapy were provided in the recommendations of an expert panel. However, the authors do not mention which experts they consulted for selecting acupuncture therapy methods, and the study does not provide an evidence base for choosing specific acupoints. The problem with acupuncture research in the lack of substantial terminology and scientific validity of acupoints was previously addressed by Langevin and Wayne (2018). Thus, while the study presents a significant insight into the alternative methods for treating patients with VCIND, it does not address the scientific validity of acupoints in the context of acupuncture research.

In conclusion, this essay identified two significant drawbacks in the article. Firstly, the authors did not provide an explanation of their choice in the recruitment of participants; using a combination of several recruitment strategies could improve the accuracy of the research results. Lastly, the article does not include an evidence base explaining the role of specific acupoints in improving cognitive performance, which negatively impacts the articles findings.

References

Bracken, K., Askie, L., Keech, A. C., Hague, W., & Wittert, G. (2019). Recruitment strategies in randomised controlled trials of men aged 50 years and older: a systematic review.BMJ Open, 9(4), 1-17.

Hariton, E., & Locascio, J. J. (2018). Randomised controlled trials  the gold standard for effectiveness research: Study design: randomised controlled trials.BJOG : An International Journal of Obstetrics and Gynaecology, 125(13), 1-4.

Langevin, H. M., & Wayne, P. M. (2018). What is the point? The problem with acupuncture research that no one wants to talk about.The Journal of Alternative and Complementary Medicine, 24(3), 200-207.

Yang, J. W., Shi, G. X., Zhang, S., Tu, J.-F., Wang, L. Q., Yan, C.-Q., Lin, L. L., Liu, B. Z., Wang, J., Sun, S. F., Yang, B. F., Wu, L. Y., Tan, C., Chen, S., Zhang, Z. J., Fisher, M., & Liu, C.-Z. (2019). Effectiveness of acupuncture for vascular cognitive impairment no dementia: a randomized controlled trial.Clinical Rehabilitation, 33(4), 642652.

Atrial fibrillation is the physical state during which a heart rate of a patient is irregular, and in some instances, beating too fast. For example, it can be raised considerably high such as up to 100 beats per minute. Some symptoms include dizziness, shortness of breath, and exhaustion or tiredness. Heart palpitations may be noticed; this consists of the feeling of pounding, fluttering, or beating in any way that is not considered to be the patients normal heart rate.

Such episodes can last between a few seconds to a certain amount of minutes. Nevertheless, certain cases of atrial fibrillation do not present any symptoms, and the patient does not become aware of their irregular heartbeat. It is suggested to seek medical help in the case of chest pain, a sudden change in a heartbeat, and a consistently low rate of below 60 or a constant high rate of over 100 beats per minute.

Atrial fibrillation is often the result of a sequence of events. When the heart is beating normally, its muscle tissue walls tighten and contract the blood until they relax for the chambers to refill with blood (NHS, 2018). However, in a patient with atrial fibrillation, the hearts upper chamber, called the atria, contracts at random intervals and at irregular speeds. Because of these discrepancies, the heart is unable to relax and decreases its production of it. The random contractions of the atria chamber are caused by electrical impulses. These pulsations disrupt the natural pace of the heart to the point where the chambers cannot control the beating. Commonly, this affects people over the age of 65 disproportionately. Additionally, atrial fibrillations can also be triggered by certain circumstances or actions such as imbibing too many alcoholic beverages or smoking.

Treatment varies with patients and the type of atrial fibrillation that occurs. Though it is usually not life-threatening, it can cause serious discomfort and requires treatment in most cases. Common treatment involves different medicine that prevents heart strokes, medicine to control the rhythm of the heart, cardioversion, or catheter ablation. The primary focus of medicine, such as beta-blockers, works to control martial fibrillations once they occur. The aim is to lower the patients heart rate to below 90 beats per minute or 110 in some cases. Some beta-blockers used for control over atrial fibrillations include bisoprolol and atenolol, or calcium channel blockers, such as diltiazem or verapamil (American Heart Association, n.d.).

Additionally, digoxin can be prescribed if the beta-blockers need assistance in calming the heart rate. It is usual for one of the prescriptions above to be given out before attempting to use a catheter ablation. Furthermore, the beta-blockers could cause some side effects such as tiredness, lowered blood pressure, nightmares, impotence, and cold hands and feet. Flecainide can cause nausea, vomiting, and heartbeat disorders. Verapamil may be responsible for lowered blood pressure, swelling in the ankle, heart failure, and constipation.

Beta-blockers may also affect allergy symptoms and cause them to be more prevalent. This includes changes to nasal congestion, allergic bronchitis, and asthma. A patients allergic reactions may also become more severe due to beta-blockers, including reactions to insect stings or allergy treatments. If experiencing an allergic reaction while on beta-blockers, the patient may find it difficult to get any effectiveness from their allergy medication.

References

NHS. (2018). Atrial fibrillation. Web.

American Heart Association. (n.d.). Atrial fibrillation. Web.

Nursing is considered a practice profession and needs various components such as patients, environment, and community. The practice involves nurses involving fellow healthcare workers and available resources for the optimum healthcare system provision (Allen, 2018). However, the lack of one aspect to be incorporated leads to alteration of the nursing practice. Additionally, the practice requires a nurse to be an advocate, researcher, and provider, bearing in mind the components of nursing practice.

The practice of nursing involves nurses using holistic approaches in the provision of therapeutic interventions to ill patients. In addition, nurses will also need clinical judgment through knowledge acquired in their careers to provide care to individuals and families in a community to achieve wellness. In the process, the nurses will need to cooperate and communicate with patients and their relatives for efficient care delivery (Allen, 2018). For instance, if the patient cannot talk, the family member will give a brief history regarding the patient to the nurse to provide care to the patient. Therefore, the nursing practice entails nurses ability to have communication skills and use all components to provide adequate care to patients.

For effective practice, the environment should be conducive for the nurse to provide services and the patient for optimal healing. Encouraging tidiness of floors, well-ventilated windows, and clean linens stimulate health activities to run smoothly. The environment entails the communitys beliefs, customs, and values. As the nurse provides services, the communitys culture and values should be respected. In return, the community will enhance a peaceful environment free from noise and other factors that can lead to disturbances (Hopkinson & Wiegand, 2017). In conclusion, the nursing practice is likened to an ecosystem that needs to incorporate nurses, people, the environment, and the community in order to enhance a practical and goal-oriented approach.

References

Allen, D. (2018). Translational mobilization theory: A new paradigm for understanding the organizational elements of nursing work. International Journal of Nursing Studies, 79, 36-42. Web.

Hopkinson, S. G., & Wiegand, D. L. (2017). The culture contributing to interruptions in the nursing work environment: An ethnography. Journal of Clinical Nursing, 26(23-24), 5093-5102. Web.

Pembroke Pines Demographics

According to U.S. Census Bureau (2019) estimates:

• Population (July 2019) 173,591;
• City size  34.4 square miles spread west and east;
• High school graduate or higher, percent of persons age 25 years+, 2015-2019  93.1;
• Median household income (in 2019 dollars), 2015-2019  $68,745;
• Persons in poverty, percent  9.3.
• Total health care and social assistance receipts/revenue, 2012 ($1,000)  952,976.

Pembroke Pines is a fairly big city located in Broward County Florida. With its total estimate of population being around 174 thousands, Pembroke Pines is the Floridas 11th and the U.S.s 149th largest city.

Pembroke Pines Relevant Epidemiological Data

According to Cleveland Clinic Florida Weston (2019) assesment:

• 11.7 percent of citys adult population are smokers;
• 5.7 percent of the population have a chronic obstructive pulmonary disease;
• 12.3 percent of the population have asthma, which is worse than Florida average;
• 7.9 and 2.5 percent of the population are prone to heart disease and heart failure respectively.

The Centers for Disease Control and Preventions (CDC) Behavioral Risk Factor Surveillance System (BRFSS) of the U.S. reports moderately high rates of smoking associated diseases in adults. Seeing as almost 12 percent of the citys population over 18 years are smokers, it is not unusual to see high rates of pulmonary and heart diseases among the citys total population. This could contribute to the topic of tobacco use among adolescents.

Problem Description  Tobacco Use among Adolescents

• Persons under 18 years, percent  20.3 (2019 U.S. Census Bureau);
• Percent of children under age 18 in poverty  18.3 (Cleveland Clinic Florida Weston 2018);
• Percentage of households with at least 1 of 4 housing problems  26.0 (Cleveland Clinic Florida Weston 2018).

Tobacco use among adolescents occupies one of the leading positions among the modern problems of the younger generation. The starting age of smokers is 7-10 years old, but every year the age limit is decreasing. The majority of smokers are high school students between the ages of 14 and 16.

Florida Youth Tobacco Survey Data (2020) reports that the percent of students who have ever tried cigarettes, cigars, or smokeless tobacco (All Middle and High School Students) was 16.2% (pp. 3). The rates of children living in poverty or in households with severe housing problems are quite high  the latter being in the bottom quartile among Florida cities. These factors contribute significantly to the problem of adolescent tobacco use in Pembroke Pines.

SBIRT Description

• SBIRT refers to Screening, Brief Intervention and Referral to Treatment.
• SBIRT can be used as a tool for detection and subsequent monitoring of adolescent tobacco use.

The Screening part of SBIRT is oriented on recognizing and cataloguing the adolescents who use tobacco or are in the risk groups for it, as well as determine appropriate intervention strategy. Subsequently, the stage of Brief Intervention results in a motivational discussion designed specifically for targeting adolescents who use or have a potential of using tobacco. Finally, the Referral to Treatment is the last step, which provides patients with the information about more specialized treatment and specialists.

SBIRT Use Example and Outcomes

• SBIRT could be a motivational interviewing skill that nurses can use to engage with college students who use electronic cigarettes (Holden and Simerson 2021).
• SBIRT allows nurses to make early interventions with the potential tobacco users.

The potential of SBIRT use is very wide. Holden and Simerson (2021) provide an example how it can be implemented by nurses in the college setting. College students remain one of the vulnerable parts of society due to the high stress, college debts, separation anxiety and overall U.S. environmental problems such as polluted air and high noise level.

The general outcomes of SBIRT use in any setting are the awareness enhancement, potential for recovery from tobacco use, as well as improved prevention and treatment means. Moreover, it reduces the cost of treatment by offering early screening and intervention, while the consequences of tobacco use are still low.

Community Resource

• Compass Health Systems Pembroke Pines Clinic 1601 North Palm Avenue, Suite 211, Hollywood, FL 33026.
• Phone number: (888) 363-2855.

Compass Health Systems Pembroke Pines Clinic is a mental health facility which specializes in treatment of children and adolescents. The clinic offers a variety of Tobacco/Screening services, and can help with counseling on smoking cessation, as well as with specific medication for it. The treatment is quite affordable due to the fact that the clinic accepts all kinds of payments and insurances, including Medicaid, Medicare and even other state-financed health insurance plans. Seeing as this is primarily a mental health facility, both the psychological and functional acceptability are covered in the clinics various services. The clinic is easily assessable: it has hearing impaired patients support and options for Spanish-speaking population. Finally, the clinics website provides the information about each and every service the facility offers for their potential and current clients awareness.

Implications for Practice

• The problem of adolescents tobacco use remains significant for Pembroke Pines city;
• SBIRT is a functional and useful tool for adolescents tobacco use detection and prevention.

Smoking causes pathological changes in the teenagers bodies, and may result in diseases such as chronic obstructive pulmonary disease, heart stroke and even heart failure. For health care workers, the issue of tobacco use among adolescents is one of the most significant, and it calls for the development of more efficient prevention and intervention means. SBIRT proved to be an effective tool for the nursing intervention. Addressing the EC use among college students with SBIRT, nurses gained knowledge and improved their intervention skills significantly (Holden and Simerson 2021).

Conclusion

• The rates of smoking population and smoking-associated diseases are moderately high in Pembroke Pines city, Florida.
• Tobacco use among adolescents is still a significant problem for Florida state.
• SBIRT can be used as a means for early detection and intervention to reduce the problem.
• Compass Health Systems Pembroke Pines Clinic is a relevant community resource.
• Health care workers need to address the problem on a more specialized level.
• It is important to solve the problem due to the fact that it would improve the health of the younger generation and reduce the health risks for its future adulthood.

According to world studies, the smoking habit is usually formed in young years. Most adult smokers started smoking when they were teenagers: only a small part of smokers today started smoking after 18 years. Therefore, youth smoking should be a special concern of health care workers and community resources. The greatest effect is achieved if tobacco prevention efforts are focused on adolescence. SBIRT is a comprehensive program that helps preventing and treating tobacco use in adolescents.

References

Cleveland Clinic Florida Weston. (2019). Community Health Needs Assessment 2019. Weston; Broward Health.

Holden, J., & Simerson, D. (2021). Screening, brief intervention and referral to treatment (SBIRT) by nurses to college students who use electronic cigarettes. Journal of American College Health, 16. Web.

United States Census Bureau. (2019). Pembroke Pines city, Florida. Web.

Purpose: The purpose of this evidence brief is to prove that the utilization of registered nurses as primary team members interacting with patients during telehealth visits in an outpatient setting will improve patient outcomes.

1. PIO In the outpatient clinical setting, will the utilization of registered nurses as a primary team member to perform telehealth visits improve patient outcomes?
2. Background: Due to the increasing demand to access care, there is increased demand for telehealth during the pandemic. The issue is to meet the demand. Registered Nurses need to become Primary Team Members to interact with Patients during Telehealth.
3. Objective: The objective of this research is to discover information on how registered nurses can play a role as primary team members during telehealth visits through Evidence-Based Practice to improve patient outcomes.
4. Search for evidence was done in databases CINAHL Plus, Pubmed, ***Search words used were registered nurse and telehealth,  role of the nurse in telehealth, and*** The selection criteria of articles were English language and peer-reviewed articles. was The specifics of articles used were within the last 10*** years, with a majority of them in the last 5*** years, incorporating all evidence levels, I to VII
5. Summary of research-based evidence:
   1. Yliluoma, P., & Palonen, M. (2020). Telenurses experiences of interaction with patients and family members: nursecaller interaction via telephone.
      1. Nurses capabilities and communication skills, including their ability to listen and be sensitive to their patients, nurses control of the interaction to keep it relevant improved telephone interactions with the patients. However, background noises when a caller calls, communication problems such as inadequate communication, callers inappropriate behavior, inability to conduct an assessment, callers inability to describe the symptoms, issues such as family members providing different information than information provided by callers, technical issues, lack of appointments to accommodate all the callers, and long queues all these make it difficult to have effective interactions (Yliluoma & Palonen 2020). Level V1
   2. Mataxen, P. A., & Webb, L. D. (2019). Telehealth nursing: More than just a phone call.
      1. The article discusses that Telehealth is not just a phone call, but it is a resource for patients and families and nurses play an important role in providing those services to patients via technology. Nurses are a good resources, and they can provide effective care by using good communication skills and competencies (Mataxen & Webb, 2019). Level V
   3. Robeznieks, A. (2021). How to implement telehealth in your practice with equity in mind.
      1. Many people are interested in utilizing Telehealth but there are several barriers on both patients and clinicians sides. Patients lack digital skills and literacy, have no access to the internet, or limited data plan which makes it difficult to have a quality telehealth visit. Similarly, many healthcare settings are unable to provide video-enabled devices to their clinicians, use difficult apps, or have security issues (Robeznieks, 2021). (Expert Reviewed)
   4. Javanparast, S., Roeger L., Kwok Y., Reed RL. (2021). The experience of Australian general practice patients at high risk of poor health outcomes with telehealth during the COVID-19 pandemic: a qualitative study.
      1. This study explored the experiences of telehealth for vulnerable patients in general practice during the pandemic. The significant findings of this study concluded that patients are satisfied with telehealth for its convenience and efficiency. However, patients expressed that this only works if the patient and provider have already developed a relationship prior to the transformation of care. Another finding is that the common use of telehealth is for medication refills, follow-ups and reviewing diagnostic results. (Javaboarast, Kwok, Reed & Roeger, 2021) Level VI
   5. Song, Y., Reifsnider, E., Zhao, S., Xie, X., & Chen, H. (2020) A randomized controlled trial of the Effects of a telehealth educational intervention on medication adherence and disease activity in rheumatoid arthritis patients.
      1. This study is to explore the results of medication adherence rate and disease process on patients with rheumatoid arthritis via customized telehealth education versus patients discharged home with standard care instructions. The telehealth education includes disease process, treatment goals, how to take medication properly and side effects. The results of this study concluded that customized telehealth education after discharge leads to a better medication adherence rate and, therefore, better symptom control and prohibits the progression of the disease. (Chen, Reifsnider, Song, Xie & Zhao, 2020) Level II
   6. Asiri, A., AlBishi, S., AlMadani, W., ElMetwally, A., & Househ, M. (2018). The use of telemedicine in surgical care: A systematic review. Acta Informatica Medica, 26(3), 201.
      1. Although telehealth is typically associated with remote care in therapy and related procedures, the paper by Asiri et al. (2018) establishes that telehealth can also be used in a surgical context. Specifically, the authors of the study prove the importance of incorporating telehealth as the device for patient evaluation after the surgery, thus, assessing the efficacy of the surgery and the extent of its success. Moreover, the threat of nosocomial infections and the associated concerns can be avoided with the help of the proposed technique. The study proves the role of telehealth in modern nursing.
   7. Ramaswamy, A., Yu, M., Drangsholt, S., Ng, E., Culligan, P. J., Schlegel, P. N., & Hu, J. C. (2020). Patient satisfaction with telemedicine during the COVID-19 pandemic: Retrospective cohort study. Journal of Medical Internet Research, 22(9), e20786.
      1. The study assesses the extent of telehealth efficacy in the environment of the COVID-19 pandemic. According to the results of the study, the range of telehealth applications by APNs has expanded to embrace a variety of patient-specific needs, which has led to a rise in patient satisfaction rates. Compared to in-person visits, the use of telehealth has proven to be much more popular with patients as the tool that allows APNs to establish a rapport with the target population quickly. Moreover, the accuracy of the diagnosis and the opportunity to minimize medical errors when performing the assessment of a patient and to administer the required treatment have been noted as important factors in improving the performance of APNs.
6. Summary of expert evidence from professional organizations, experiences, or experts in the specialty
   1. The Future of Nursing: Leading Change, Advancing Health. Institute of Medicine. (2011)
      1. In the section Examples of Redesigned Roles for Nurses, the Department of Veterans Affairs recreated and extended nurses roles in the health care system to collaborate with Advanced Practice Registered Nurses, and the result exceeded its expectation. RNs are assigned to coordinate care and chronic disease management, while APRNs are the primary care providers. The result of this collaboration showed VA patients are getting better care, as evidenced by many quality-of-care indicators in comparison to Medicare patients. (Institute of Medicine, 2011)
   2. Jnr, B. A. (2020). Use of telemedicine and virtual care for remote treatment in response to the COVID-19 pandemic.
      1. Representing an important voice in the community of experts on the subject matter, Jnr (2020) explains in his paper that the role of nurses in promoting the use of telehealth in the healthcare context is vital in fighting the coronavirus pandemic. The study outlines the challenges associated with providing virtual care and offers solutions based on the promotion of nurse-patient communication. In turn, Telehealth is seen as a central tool in assisting nurses in building connections with patients. According to the results of the study, telehealth and other tools for remote healthcare during the COVID-19 pandemic has a largely positive effect.
   3. Lowe, G., Plummer, V., OBrien, A. P., & Boyd, L. (2012). Time to clarifythe value of advanced practice nursing roles in health care.
      1. The paper by Lowe et al. (2012) details the significance of support and professional performance by advanced practice nurses in the healthcare setting. Specifically, the research illustrates the role of APNs in the healthcare context has been debated quite profusely and shaped significantly over the past decade. However, the authors agree that the role of an APN in the nursing setting should expand to include of patient education and raising awareness. However, the authors also warn that, with the blurring of the lines between nurses roles, certain ambiguity about the functions of an APN emerges. Therefore, the study encourages examining the expansion in the range of APNs responsibilities and functions, implying that alleviation of the workload may be needed.
   4. Woo, B. F. Y., Lee, J. X. Y., & San Tam, W. W. (2017). The impact of the advanced practice nursing role on the quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: A systematic review.
      1. The study shows that APNs have a critical function in the context of modern healthcare. Specifically, APNs contribute substantially to the extent of a patients access to critical care by improving the efficacy of communication and precision in service delivery. Furthermore, the study proves that the inclusion of APNs into the critical care context leads to reduced length of hospital stay, as well as an increased rate of patient satisfaction. Promoting innovation in the hospital setting and encouraging autonomy in nurses, APNs contribute to a significant rise in the efficacy of critical care. Thus, the research establishes an important shift in the perception of APNs and their function in the nursing context, transforming their role in critical care toward a more meaningful one.

References

Asiri, A., AlBishi, S., AlMadani, W., ElMetwally, A., & Househ, M. (2018). The use of telemedicine in surgical care: A systematic review. Acta Informatica Medica, 26(3), 201.

Jnr, B. A. (2020). Use of telemedicine and virtual care for remote treatment in response to the COVID-19 pandemic. Journal of Medical Systems, 44(7), 1-9.

Lowe, G., Plummer, V., OBrien, A. P., & Boyd, L. (2012). Time to clarifythe value of advanced practice nursing roles in health care. Journal of Advanced Nursing, 68(3), 677-685.

Ramaswamy, A., Yu, M., Drangsholt, S., Ng, E., Culligan, P. J., Schlegel, P. N., & Hu, J. C. (2020). Patient satisfaction with telemedicine during the COVID-19 pandemic: Retrospective cohort study. Journal of Medical Internet Research, 22(9), e20786.

Woo, B. F. Y., Lee, J. X. Y., & San Tam, W. W. (2017). The impact of the advanced practice nursing role on the quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: A systematic review. Human Resources for Health, 15(1), 1-22.

Introduction

Billing and coding rules are standards, practices, and strategies healthcare providers use to reimburse. The job of health care providers is to execute transactions according to the rules to avoid unnecessary costs, preserve financial capacity and make a pleasing appearance (Recycle Intelligence, 2021). Billing is aimed at determining reimbursement amount, and coding refers to the entire process from enrollment to reimbursement. For processes to be balanced and stable, following rules is essential. There are many rules currently in use by medical organizations. This paper will examine the critical differences between the rules and determine their impact on the reimbursement process.

Different Billing and Coding Regulations

Quite a few organizations write rules and integrate them into medical organizations. Among them is the Center for Medicare and Medicaid Services (CMS), which is in the business of writing procedure and cost matching plans. CMS will only pay the patients bill if the procedure/diagnosis/treatment is warranted according to their guidelines. The Office of Inspector General (OIG) is the Office of Program Oversight that evaluates the rules of CMS, individual payers, and other organizations. The OIG focuses on federal compliance review procedures. Individual payers are insurance companies that may provide coverage to a small number of people. Usually have their billing processing policies and their rates for individual plans.

Legislation used for billing and coding is at the federal level. The Health Insurance Portability and Accountability Act (HIPAA) protects confidential patient information. It is necessary to properly code diagnoses and patient information that can be shared with insurance companies for billing purposes (Recycle Intelligence, 2021). Sections III-V govern cost accounting principles, the health plan, and insurance policies. Unlike the other acts, HIPAA primarily seeks to preserve confidentiality through the IBC system. Since 2009, all HIPAA-covered entities must use ICD-10 for coding (CMS, 2021b). The standards by which transactions must be conducted have been updated to version 5010.

Another coding set is the Current Procedural Terminology (CPT), which describes medical procedures accurately. It provides administrative and financial consistency between providers and insurance companies (Recycle Intelligence, 2021). It has been used to develop the Common Healthcare Procedure Coding System (HCPCS), which is necessary to ensure standardization. The American Medical Association (AMA) holds the CRT rights, requiring organizations to pay for the three-section coding. HCPCS is a publicly available resource that HIPAA must use.

Impact of the Regulations on Reimbursement to the Medical Organization

It is worth beginning with a discussion of the potential negative impact of the rules on reimbursement. Different coding rules (IBC, CPT, and HCPCS) can create incompletely understood and objective relationships between providers and payers. It results in losses in transferring financial and analytical data that could have been used to provide reimbursement. Unfortunately, there can be the problem of lengthy processing and disrupted transfer processes because the coding is not entirely consistent. Different coding systems force one to look for more automated billing systems.

Now we should discuss the positive impact, primarily due to the presence of a proven effect on savings and efficiency. It has been noted that coding systems allow for the formation of standards of care, improving the speed and quality of service delivery. The use of codes is necessary for forming a unified logistics chain, allowing the transfer of information without losses for the provider and payer. In addition, HIPAA provides for dispute resolution issues, allowing providers to avoid costs in case of patient misconduct. Along with it comes the No Surprises Act, which establishes procedures for notifying the provider of a service (Recycle Intelligence, 2021). It allows the provider to avoid costs for services that are not covered by the patients insurance and thus withholds from operations that the patient is unwilling to pay for.

Impact of Prospective Payment Systems

Prospective Payment Systems (PPS) is a new reimbursement system that allows payment of a prearranged amount based on Medicare insurance. CMS approved payment rates for outpatient services for hospitals and surgery centers on November 2, 2021 (CMS, 2021a). It will create transparency in billing for services provided and standardize reimbursement processes. PPSs target specific services (e.g., heart or liver transplants), allowing control over expensive surgeries (Harrington, 2019b). Different PPSs target specific categories of patients: for example, Home Health PPSs assist individuals who wish to be homebound (Harrington, 2019a). PPSs are developed based on payment status indicators, allowing standardization of care processes and making them easier to implement.

With PPSs, providers are expected to be able to control the pricing of services. A predetermined amount of a service or surgery will allow organizations to represent possible treatments and allocate resources more intelligently (Harrington, 2019b). PPSs are a proven reimbursement tool, so regulating regulations will keep the organization out of penalty fees (CMS, 2021a). PPS will also likely be able to provide processes to verify compliance with standards and relevance based on proven practices. It means that PPS will keep staff and administration from using unnecessary or harmful resources for a particular operation.

Conclusion

Thus, reimbursement and coding systems are governed by HIPAA regulations and the various IBC, SRT, and HCPCS coding systems. Through them, providers can control the cost of the resources and surgeries that need to be provided to the patient. Although the multiplicity of coding systems can cause confusion and lengthen reimbursement periods, automated systems and PPS allow for economic benefits. Coding makes it easier to provide services and differentiate them according to code, making reimbursement processes efficient and fast.

References

CMS. (2021a).CY 2022 Medicare hospital outpatient prospective payment system and ambulatory surgical center payment system final rule (CMS-1753FC).

CMS. (2021b2). Statute and regulations.

Harrington, M. K. (2019a). Hospital outpatient prospective payment system. In Health Care Finance and the Mechanics of Insurance and Reimbursement (2^nd ed.). Jones & Bartlett Learning: 141-156.

Harrington, M. K. (2019b). Medicare prospective payment systems. In Health Care Finance and the Mechanics of Insurance and Reimbursement (2^nd ed.). Jones & Bartlett Learning: 117-140.

Recycle Intelligence. (2022). Exploring the fundamentals of medical billing and coding.

The current COVID-19 situation is still unresolved in many countries, including the USA. Although the vaccination process has started, diverse restrictions for various groups of people are still in place, so the use of technology is relevant these days. Telehealth medicine has not lost its relevance as hospitals are overcrowded, and many people face numerous issues when reaching their doctors or other healthcare professionals (Hirko et al., 2020). It is also quite clear that telehealth medicine is positively accepted by stakeholders, but its use in the future remains rather obscure (Wosik et al., 2020). The way to implement incentives involving the increase in the provision of virtual care needs further research as healthcare facilities are often unprepared due to the scarcity of resources and skilled employees. Therefore, it is essential to investigate hospitals preparedness and potential to use telehealth medicine effectively and cater to patients needs.

It is noteworthy that nurses should play an active role in this process. In addition to implementing research, they should advocate for the necessary changes at their facility and in the entire healthcare system. Andrews et al. (2020) note that patients and healthcare professionals report their satisfaction regarding the use of virtual care during the pandemic. The majority also express their willingness to utilize such services in the future as well, although some challenges still exist. The lack of resources to ensure the availability of technology and the corresponding specialist is a considerable issue. Nurses can become more involved in the process and provide a wider range of services online, which will contribute to the development of telehealth.

Research and advocacy in this area are my professional plans for the near future. In addition to implementing my research and working on my DNP project, I intend to become a member of a nurse organization. First, it is necessary to note that DNP projects should be an indispensable part of nursing practice as they facilitate the change and ensure the development of practice (Laureate Education, 2011). Membership in a professional organization leads to employees; empowerment, connectedness, and zeal to change oneself and the system.

The organization I want to join in the National League for Nursing (NLN). This organization unites approximately 40,000 individual members and 1,200 institutional members (National League for Nursing, 2021). My choice is justified by my focus on research and professional development. I wish to continue my learning, so I will benefit from sharing information with colleagues, and accessing numerous resources. I would also like to join projects related to virtual care promotion and even apply for a grant to implement my research on the matter. Being a member of this organization will help me gain knowledge and reach people who are willing to advocate for the further development of telehealth.

In conclusion, it is necessary to note that an increase in the use of telehealth medicine was caused by the pandemic. However, the provision of virtual care unveiled diverse opportunities for the healthcare system to evolve and for nurses to become more active participants in the process of change. Membership in the National League for Nursing is an opportunity to continue nursing research and connect to like-minded people and those who can help in research implementation. I will join the organization and will be able to access resources and communicate with people, which will help me in my professional development and my input in the development of the healthcare system.

References

Andrews, E., Berghofer, K., Long, J., Prescott, A., & Caboral-Stevens, M. (2020). Satisfaction with the use of telehealth during COVID-19: An integrative review. International Journal of Nursing Studies Advances, 2, 1-8. Web.

Hirko, K. A., Kerver, J. M., Ford, S., Szafranski, C., Beckett, J., Kitchen, C., & Wendling, A. L. (2020). Telehealth in response to the COVID-19 pandemic: Implications for rural health disparities. Journal of the American Medical Informatics Association, 27(11), 1816-1818. Web.

Laureate Education (Producer). (2011). The DNP project [Video file]. Web.

National League for Nursing. (2021). Overview. Web.

Wosik, J., Fudim, M., Cameron, B., Gellad, Z. F., Cho, A., Phinney, D., Curtis, S., Roman, M., Poon, E. G., Ferranti, J., Katz, J.N., & Tcheng, J. (2020). Telehealth transformation: COVID-19 and the rise of virtual care. Journal of the American Medical Informatics Association, 27(6), 957-962. Web.

Introduction

Veterans belong to a distinct category of population, which needs a specific curing approach due to the obtained intense adverse experiences and their long-lasting or, sometimes, lifelong effects. This treatment should be diverse, multi-faceted, and based on substantial, trustworthy evidence that can enhance and update therapists understanding and knowledge of the problems. This paper aims at comparing and analyzing two scientific pieces of literature, one of which is Object Relations Family Therapy and PTSD: Family Therapy with Four Generations of a Vietnam Veterans Family by Nancy Errebo. The second work is Back from the Front: Combat Trauma, Love, and the Family by Aphrodite Matsakis.

The Work by Errebo

Errebo Nancys article in-depth examines the relationship problems in a Vietnam Veterans Family consisting of four generations and explains the value of object relations family therapy (ORFT) in this case. The author focus on revealing particular issues of family members, family dynamics, the intense effect of the war on the veteran, and his behaviors impact on the family environment. One of the primary causes for conducting the study was that substantial evidence existed that veterans traumatic experiences received in wars or related events, influenced their children and familys atmosphere overall (Errebo 421).

The applied treatment method, that is, ORFT, served as an effective intermediary between systematic family therapy and psychoanalytic therapy and considered the context of the affected family. The technique also allows for alleviating or treating posttraumatic stress disorder (PTSD) by exploring veterans perceptions of traumatic events and their related adverse, consistent feelings.

This particular case is useful for counseling practice since Errebo indicates the main obstacles that therapists can encounter during sessions, including patients and families resistance to the treatment or the problem disavowal. In this regard, ORFT is specifically designed for family-associated issues, providing flexibility and identification of frequently neglected points that still reflect on relatives. Herewith, the method requires therapists to work not only with specific patients but also with their environments, especially children and spouses (Errebo 422). Overall, despite the failure to treat PTSD completely, the therapy attained noticeable outcomes. The patient could discuss his war-connected experience and even ceased using narcotics for pain relief. His family also endured significant changes, particularly in understanding the veterans problem and the importance of supporting him.

The Work by Matsakis

The work by Matsakis is much more extensive in terms of factual material, encompassing many different mental problems linked to veterans returning from the Afghanistan and Iraq fronts. Back from the Front: Combat Trauma, Love and the Family is an excellent resource that offers fervent hope and cure for soldiers, their families, spouses, healthcare professionals, and other related individuals. The author herself is concerned with this issue and gives valuable advice, necessary information, obvious examples, and practical strategies that can successfully help patients and their families. Overall, the book grants readers a sense that the author is a real expert in her field and profoundly knows her subject and problem.

In the initial chapters, the book provides comprehensive but comprehensible insight into combat trauma and its consequences, both positive and negative. Specifically, Matsakis describes various types of PTSD and draws a clear line between combat-related trauma and trauma because of natural calamities, indicating the former is more likely to cause losing belief and trust in humanity (Matsakis 24). The specialist also addresses the most frequently asked questions about war and combat trauma and specifies the physical and psychological aftermath emerging in the different severity levels of trauma.

Besides, Matsakis pays special attention to veterans relationships with spouses, especially regarding intimate, sexual life, family members, and overall society. In this regard, the author explains patients most prevalent emotional expressions, including excessive anger, violence, and rudeness, that can be manifested as a response to caretaking. Finally, the work dedicates chapters to women in the armed services, veterans children, and veterans increased suicidality.

Work Cited

Errebo, Nancy. Object Relations Family Therapy and PTSD: Family Therapy with Four Generations of a Vietnam Veterans Family. Legacy of Vietnam Veterans & Their Families. Survivors of War: Catalysts for Change by Dennis K. Rhoades, Michael R. Leaveck, and James C. Hudson, DIANE Publishing, 1996, pp. 420-427.

Matsakis, Aphrodite. Back from the Front: Combat Trauma, Love, and the Family. Sidran Traumatic Stress Ins., 2007.