Category: Health & Medicine

Abstract

Falls are common threats to the health and wellbeing of older adults, aged 60 years and above. Currently, at least one in every three older adults suffers from a fall incident every year. Considering the consequences of falls in terms of injuries and increased direct medical costs, it is important to prevent falls beforehand to minimize suffering and unnecessary hospital visits.

The article, Factors Associated with falls during Hospitalization in an Adult Population explores the major risk factors, both medical and non-medical, that contribute to the occurrence of falls among older adults.

More specifically, the article presents the findings of a recent study, which shows that various variables including patient characteristics, clinical conditions, nursing unit characteristics, and nursing interventions contribute to the occurrence of falls among older adults. Summaries and critical analyses of these research findings as well as their significance to current nursing practice are provided in the subsequent sections of this paper.

Fall-related injuries are common among the elderly population. Currently, one out of three older adults aged 65 years and above encounters a fall incident that results into moderate-to-severe injuries (Centers for Disease Control and Prevention [CDC], 2013). Moreover, falls contribute to an increase in emergency room visits and hospitalizations among older adults.

Furthermore, the direct health care costs arising from fall injuries among older adults are very high (CDC, 2013). This shows that there is the need to address falls among older adults to prevent unnecessary injuries and minimize the direct medical costs associated with such events.

Different studies have addressed the issue of fall prevention, and current strategies include medical, pharmacy, and nursing interventions. In the article, Factors Associated with falls during Hospitalization in an Adult Population the authors examined the key variables and nursing interventions that might cause falls in study involving older adults (Titler, Shever, Kanak, Picone, & Qin, 2011).

The authors determined the contribution of several variables including patient characteristics, clinical conditions, and the characteristics of nursing units as well as medical, pharmacy, and nursing interventions to the occurrence of falls among a sample of older adults (Titler et al., 2011).

The abovementioned study is very important to nursing practice as it sought to generate evidence on the causes of falls among hospitalized adults and the strategies for preventing them. This evidence is significant to nurses in their quest to inform Evidence-Based Practice (EBP) in their current practice. The subsequent sections of this paper will highlight the findings of the above-mentioned study with the aim of determining the purpose and significance of the study to professional nursing practice.

Purpose

The purpose of the afore-mentioned study was to determine the major variables underlying the occurrence of falls among hospitalized older adults (Titler et al., 2011). More specifically, the authors wanted to address the lack of sufficient effectiveness studies on specific interventions that could contribute to falls among hospitalized adults.

According to Titler et al. (2011), the specific research question [for their study] was; What patient characteristics, clinical conditions, nursing unit characteristics, medical, pharmacy, and nursing interventions are associated with falls during hospitalization of older adults? (p. 129).

Accordingly, both the purpose and research question are clearly stated in the research article, and they all related to a gap in the current literature. However, the authors did not define the specific variables that they wanted to measure; hence, it is difficult to determine why the authors settled on the chosen variables instead of others.

On the other hand, the authors developed a clear theoretical framework that offered sufficient background to the study. The authors used an effectiveness model to connect various variables to specific patient outcomes.

As a result, the theoretical framework identified the specific independent variables, intervening variables, and dependent variables and their relationships. The only problem with the theoretical framework presented in the study is that it is not based on sufficient literature studies; hence, it may not find sufficient support in the current nursing practice.

Literature Review

Titler et al. (2011) provided a good background to their study by reviewing various primary and secondary sources. The authors noted that the issue of falls among hospitalized adults was a matter of concern for different stakeholders including family members, patients, and health insurance companies. Moreover, the authors observed that fall injuries were becoming more prevalent among the adult population, and that they were causing anxiety and loss of confidence besides increasing medical costs.

Additionally, based on a review of previous studies, the authors found out that the major risk factors, which contributed to the occurrence of falls among older adults, included mobility limitations, the use of some varieties of medications, and cognitive impairment among others (Titler et al., 2011).

On the other hand, Titler et al. (2011) discovered that most of the studies they had reviewed focused on the development of risk factors and preventive interventions or guidelines. As a result, few studies had explored the relationship between specific interventions and patient outcomes. Accordingly, Titler and colleagues designed their study around the afore-mentioned background information and the existing gap in literature.

As a result, the studies reviewed are quite relevant to the current study as well as the theoretical framework, and they are predominantly primary sources. Nonetheless, the literature review seems to be one-sided since the authors did not attempt to analyze the strengths and weaknesses of specific studies to demonstrate their value to their research project.

Methods

Design

In order to achieve the above-mentioned research purpose, Titler and colleagues used a quantitative research design, and more specifically, an exploratory outcomes effectiveness research design. This research design falls under the first S or Studies in the pyramid of evidence because it is a quantitative study in nature (Schmidt & Brown, 2011).

The importance and appropriateness of this design to the current study is that it enabled the researchers to determine the effectiveness of various nursing interventions associated with falls among older adults. Effectiveness studies tend to evaluate the efficacy of a given intervention in a population that may not have been part of other efficacy studies such as randomized controlled trials (RCTs).

This implies that the evidence level of effectiveness studies is almost similar to that of RCTs because both study designs tend to perform complementary purposes (Ho, Peterson, & Masoudi, 2008). Nonetheless, an outcomes effectiveness research design can be problematic because it is susceptible to the Hawthorne effect, meaning that some participants may change their behavior in the presence of the researchers; hence, the findings may be unreliable (Ho et al., 2008).

Population and Sample

The sample used in the study comprised at least 10,187 hospitalizations involving about 7,851 older adults, aged 60 years and above (Titler et al., 2011). All the participants came from a single tertiary care hospital whereby they were receiving acute care services, and the researchers studied them over a period of four years. Moreover, the sample included individuals who had undertaken the Nursing Interventions Classification (NIC) and those who were at an increased risk for fall injuries (Titler et al., 2011).

Generally, the sample was sufficient and large enough to guarantee the researchers ability to gather enough empirical data to answer the research question. However, due to the need for patient consent before commencing a study of this magnitude, the researchers may have considered selecting only the willing patients, and this could be a major cause of selection bias. Nonetheless, the authors did not address issues of selection and any problems they encountered.

Reliability and Validity

The authors did not address issues of reliability and validity in their study. However, since the study used a large retrospective sample, it is possible that the study findings are highly reliable. On the other hand, it is obvious that the issue of confounding is a major threat to internal validity in this study (Schmidt & Brown, 2011). Moreover, the authors may have achieved ecological validity by using a large sample, but this sample is also problematic because it came from a single institution; hence, there is low generalizability.

Lastly, the authors used generalized estimating equations (GEE) statistical analyses to determine the relationships between different variables. While this analytical approach was sufficient in establishing the associations between independent and dependent variables, it was not appropriate in terms of addressing the problem of confounding (Ho et al., 2011).

Results and Discussion

The study findings reported in the article provide compelling evidence, which practicing nurses can use to inform clinical practice. The research analyses indicate that many variables and nursing interventions contribute to patient falls among older adults. For example, the authors discovered that the co-morbidity of depression was significantly associated with falls among hospitalized older adults (Titler et al., 2011). This implies that depression is a major risk factor in the occurrence of patient falls among hospitalized older adults.

Furthermore, the study findings show that registered nurse (RN) skill mix is a major nursing unit characteristic that has a significant relationship with patient falls. More specifically, the higher the number of RNs who are attending to the same group of hospitalized older adults, the less the number of patient falls among that group (Titler et al., 2011).

On the other hand, the authors discovered that certain medical treatments had a significant relationship with patient falls. For instance, patients who received CT scans of the head or those who had therapeutic radiology were at an increased risk for falling. Furthermore, the study findings showed that the more the number of medical treatments, the higher the rate of falls among older adults (Titler et al., 2011). Moreover, the use of some medications had a significant relationship with patient falling among hospitalized older adults.

Generally, the research article presents various pieces of evidence in a clear and succinct manner. Besides, the article presents both significant and non-significant findings; hence, it allows readers to explore all aspects of the study. The above-mentioned findings are very important to current nursing practice because they provide sufficient evidence to inform EBP in relation to fall prevention.

Strengths and Weaknesses

The study presented in the article is unique in that it is among a limited number of studies that have established statistically significant associations between specific nursing interventions and patient falls among older adults. As a result, this study is very important to current nursing practice because it forms a good foundation for the use of Evidence-Based Practice (EBP) in current practice.

Moreover, it highlights the complexity of the issues underlying fall prevention; hence, it may enable nurses to understand the risk factors underlying patient falls in order to develop effective prevention strategies. Nonetheless, the study findings are limited to the extent that the study sample included patients from a single health care institution. This means that the research findings may not generalize to entire populations or those populations that are beyond the study site (Titler et al., 2011).

Significance to Nursing and Conclusion

Overall, the research article presents a very important study that explores the relationship between different medical and nursing interventions, which have a significant relationship with falls among older adults. The study findings support the authors theoretical framework, which sought to connect various medical and nursing interventions with patient falls. More specifically, the study findings show that both the number and type of medical and nursing interventions are very important toward the development of patient falls.

This type of evidence is imperative to current nursing practice because it may go a long way to inform Evidence-Based Practice (EBP) in relation to the prevention of falls among older adults. Furthermore, the evidence presented in the study will help patients as well as other healthcare professionals to understand the major risk factors that cause falls among older adults in order to take preventive measures beforehand.

Nonetheless, there is need for further research to determine the contribution of patient characteristics and behaviors to the occurrence of falls as this may be important toward enabling patients to change personal attributes that may cause falls during their hospitalization.

References

Centers for Disease Control and Prevention. (2013). Falls among older adults: An overview. Atlanta, GA: U.S. Government Printing Office.

Ho, M. P., Peterson, P. N., & Masoudi, F. A. (2008). Key issues in outcomes research: Evaluating evidence  is there a rigid hierarchy? Circulation, 118, 1675-1684.

Schmidt, N. A., & Brown, J. M. (2011). Evidence-based practice for nurses: Appraisal and application of research. New York, NY: Jones & Bartlett Publishers.

Titler, M. G., Shever, L. L., Kanak, M. F., Picone, D. M., & Qin, R. (2011). Factors associated with falls during hospitalization in an older adult population. Research and Theory for Nursing Practice: An International Journal, 25(2), 127-152.

From the NURS240 course syllabus, I learned a lot about nursing, leadership, effective communication, and building proactive relationships in different practice setting. From the course work, I learned that nurses should possess a wide range of skills and competencies in order to offer evidence-based care to their patients. Such nurses should embrace the concept of lifelong learning since nursing is an ever-changing profession (Sullivan & Garland, 2010). New nursing ideas and concepts emerge every day. Nurses can use such ideas to provide competent care to different clients. Nursing informatics and evidence-based concepts also emerge every day. They should therefore have professional developmental plans (PDPs). Such Action Plans will show their strengths, gaps, and weaknesses. They will also use such plans to develop new goals that can support their career objectives. A proper PDP should be in accordance with the nurses professional background. According to the Keiser School of Nursing Philosophy, students should receive quality education in order to become providers of evidence-based and holistic care to their clients (Casey & Wallis, 2011). This philosophy can support my short-term and long-term goals. Such goals have the potential to widen my skills and eventually make me a competent provider of quality patient support.

As discussed in the NURS240 unit, the nursing professional code of ethics summarizes the professional act in nursing as functioning on inter and intra personal interactions with the patients. However, there are ethical dilemmas which often arise. For instance, procuring abortion goes against life and denies the unborn baby the right to life. On the other hand, the action of a sick Jehovah Witness member to decline blood transfusion may also become an ethical dilemma, especially when this action is likely to result in death of the person. In the above examples, a nurse has to apply rational judgment to analyze the extent and threats when making decisions in the best interest the clients (Casey & Wallis, 2011).

The primary relationship between legal and ethic issues facing nurses in their practice is very dynamic. For instance, the nurses have the responsibility of maintaining confidentiality, professionalism, and due care within the confines of what is morally upright. However, this goes against the situational ethics. For example, a nurse has the responsibility of trying his or her best in addressing emergency situations without necessarily having to consult the patient. The two least ethical dilemmas that nurses face in their practice are provision of sensitive information to patients and balancing the diagnosis and appropriate treatment. These conditions have been improved over the years and are no longer a big challenge to nurses. When a nurse is confronted by an ethical dilemma, employing accountability and responsibility will introduce the elements of rationale and moral judgment within the laws to ensure that the action taken is in the best interest of the patient

As indicated in the NURS240 course, there is need for a caring attitude and ardent personality. Training encompasses basic care services and preventive treatment. The training is done in hospitals equipped with necessary care materials. Upon graduation, a nurse has to pass through a three months nursing practice program before being confirmed a nurse. The ideal training involves practical administering of drugs and injections recommended by a doctor. Besides, competent knowledge on first aid care is vital in practicing nursing. An individual undergoing training must be proficient in preparing and administering oral medications. An individual undergoing training must be proficient in administering medications through intradermal, subcutaneous, intramuscular and Z-track injections (Sullivan & Garland, 2010). The right education is offered in medical related schools. In addition, personal desire to provide care is instrumental in practicing nursing. Education must be accompanied by the right credibility from government bodies. An extensive consultation process and collaboration between mental health and emergency department clinicians determines the success of role execution for a nurse. For instance, emergency staff should receive specific training in mental health assessment and are supervised by a more experienced colleague. For those that are located in the mental ward itself should even be properly trained including topics of assessment methods, assessment of risk, medico-legal issues, engaging consumers and careers and regarding cultural sensitivity.

From the NURS240 course, I also learned that working as a team comprising health assistance, nurses, medical officer assistant, paramedics, and physicians is important in order to provide expectant and acute care. This reality can be reflected in the increased emphasis placed by healthcare providers on evidence-based practice, not only in the field of nursing, but also in medicine. In a way, medicine and nursing are two fields that are so interlaced: the nurse has an important function that can affect the ability of the patient to heal. In relation, nurses also have the ability to affect the well being of the patient once they are unable to perform their function. The nursing working environment should be that which promote hygiene. The working environment must envision preventive care initiative. Working condition should encourage proactive skills. Exercising leadership and intrinsic management in the nursing environment is critical towards handling different patient cases within the code of guideline for practicing nursing. Specifically, it is important to integrate the code of nursing practice with different environments to ensure that ethical dilemmas do not arise (Casey & Wallis, 2011).

The external factors which influenced my decision making and actions were the need for quality nursing care service within the accepted standards, and the need to take control as the charge nurse (Kulbok, Thatcher, & Meszaros, 2012). The internal factors which influence decision-making and actions are inspired by principles of nursing practice, sensitivity of the work environment, and team work through proactive leadership and professionalism. The main source of knowledge which influences nursing actions is the application of the evidence-based practice on SBAR. For instance, during my brief attachment in emergency room, I came across a patient who was put on a cardiac monitor and an ECG was done as the team and I awaited the A&E doctor. I had the alternative of directly taking the patient to resuscitation without applying the evidence-based SBAR practice. However, this alternative would attract ethical dilemmas such as poor observance of the standards for nursing practice and even death of the patient (Sullivan & Garland, 2010). The decision I made to facilitate stabilization of the patient was the most professional and necessary when responding to the emergency. Through the lens nursing leadership practice, I believe I made the best decision and took the most appropriate actions.

From the experience and the NURS240 course, I learned that it would be necessary to roll out patient-based initiatives for addressing the normative and comparative needs of the patient in the quickest way possible, especially in the emergency response environment. Besides, it is important to note that leadership inspires the need to contribute proactively towards creation of a suitable environment for closing the gap that may exist between a challenge and its solution (Kulbok et al., 2012). A nurse participating in a similar experience, as a charge nurse, may offer creative leadership which is a rich recipe for acceptance, sustainability, and relevance of the proposed stabilization or treatment from several alternatives.

The experience of stabilizing patient ABC was an eye opener into the critical factors to consider when delegating duties in the health care environment. Besides, I learned the importance of rationality and high quality decision making as the prerequisite for minimizing potential ethical dilemmas within an emergency response unit in a healthcare environment. As a result of properly structured communication ethics, the work environment was holistic, soft, and socially friendly to the staff since I applied valence in my leadership approach (Judith, Baile, & Docherty, 2011). Besides, healthy ethical communication culture between the team and I created structural goals which develop norms, expectations of specific behavior display, and appropriate guideline controlling interaction with one another. From this experience, I took it upon myself to ensure that whenever I am working with others, there is team involvement, proactive relationship, and professional association as the blueprint for quality service delivery to patients (Hornby & Atkins, 2013). From this experience, I have improved on my knowledge in nursing practice on the best ways of employing accountability and responsibility as the elements of rationale and moral judgment within the laws to ensure that the action taken is in the best interest of the patient.

As indicated in the theory of human caring, the character and values that have a positive impact on leadership nursing practice include confidentiality, rationality, good communication, high morals, respect, and promotion of equality as part of the helping relationships. Basically, these elements form the strength of a successful nursing leadership career. On the other hand, social relationships deal with positive ethical aspirations within the rational leadership model to ensure that the interaction between nurses is healthy. This model is supported by experience of the individual in question since performance and ethical decision making process is skewed towards experience with a situation (Fielding & Briss, 2012). The ethical aspirations which were achievable through action oriented respect, mutual coexistence, and deeply entrenched social values, which are vital in rational decision making. These values were readiness and inclination to jump into actions which considered the morality of the decisions to me, the team, and most importantly to the patient.

Apparently, perception review offers the most ethically viable option for proactive leadership management of behavior in the health care environment as part of social relationships. This identifies the aspects of effort-performance expectancy, valence expectancy, and performance-outcome expectancy. The nurses have the responsibility of maintaining confidentiality, professionalism and due care within the confines of serving the best interest of the patient as part of the helping relationships. Through application of the evidence-based SBAR practice, a nurse is able to follow the guideline in delegating duties, alerting the doctor, explain the patients condition. Exercising leadership in the nursing environment is critical towards handling different cases within the guidelines for practicing nursing (Casey & Wallis, 2011). From the course unit, I learned that it would be necessary to roll out goal based initiatives for addressing the normative and comparative needs in the quickness way possible. Apparently, perception analysis offers the most ethically viable option for proactive leadership management of behavior in the health care environment.

References

Casey, A., & Wallis, A. (2011). Effective communication: principle of nursing practice. Nursing Standard, 25(32), 35-37.

Fielding, J., & Briss, P. (2012). Promoting evidence-based public health policy: Can we have better evidence and more action? Health Affairs Journal, 5(4), 969-978.

Hornby, S., & Atkins, J. (2013). Collaborative care: inter-professional, inter-agency and inter-professional. Oxford: Blackwell Publishing.

Judith, A., Baile, E., & Docherty, S. (2011). Nursing roles and strategies in end-of-life decision making in acute care: A systematic review of the literature. Nursing Research and Practice, 2(5), 45-67.

Kulbok, P., Thatcher, E., & Meszaros, P. (2012). Evolving public health nursing roles: Focus on community participatory health promotion and prevention. The Online Journal of the American Nurses Association, 17(2), 12-38.

Sullivan, E., & Garland, G. (2010). Practical leadership and management in nursing. London, UK: Pearsons Education.

One of the critical factors that influence patient satisfaction in healthcare setting is the patient waiting time. Patient waiting time refers to the period it takes before a patient gets medical attention after arriving at the medical facility. Therefore, every hospital that wants to improve the satisfaction of patients must find ways of keeping the patient waiting time as low as possible. This paper proposes to reduce the patient waiting time in a primary healthcare clinic by reducing the time spent in the triage.

The paper has five sections. First, it looks at the current process in detail, with a view of justifying the choice of the triage as the place to improve patient waiting time (Mukherjee, 2006). Secondly, the paper uses Total Quality Management (TQM) principles in analyzing the problem (Mukherjee, 2006). The third area of interest is the technology that will lead to timesavings in the facility. The paper them looks at the solution in detail, then concludes by presenting a critical appraisal of the project.

Current Process Analysis

The current process used by the primary healthcare facility to provide healthcare services has three stages. These stages are registration, vital signs measurement, doctor consultation, and accessing pharmaceutical services.

The registration process usually entails three main things. First, the receptionists find out whether the patient has used the primary healthcare facility before. If yes, the receptionist retrieves the patients records. The receptionist then inquires on how the patient intends to pay for the service. If the patient is new to the facility, the receptionist creates a new record based on the patients details, and then finds out how the patient plans to pay for the service. After thus stage, the receptionist puts the patient in the queue for the next stage.

The second stage is the triage. All patients that visit the primary healthcare facility must pass through the triage. The triage nurse calls out the patients according to the order issued by the receptionist. The patient goes into the triage room and the nurse records all the vital signs and feeds these details into the electronic data retrieval system. The nurse then sends the patient to the doctors queue in the waiting bay.

The third stage is consultation with the resident doctor. Each patient sees one of the duty doctors for consultation. The consultation process usually results in three outcomes. First, the doctor may send the patient to the laboratory for medical tests to find out medical reasons for symptoms displayed by the patient. Secondly, the doctor may refer the patient to a specialist if the patient needs specialized attention. In the majority of cases, the doctor prescribes medication for the patient and sends the patient to the pharmacy.

The pharmacy is the final stop for the patient. The pharmacist usually checks whether the drugs prescribed by the doctor are in stock. The pharmacist may send to patient to a nurse for injection, or may give oral medication for self-administration. The patient then passes by the billing section to pay their dues if they are paying for themselves. In many cases, the primary healthcare facility records all the services rendered and bills the patients medical insurance provider.

Problem Analysis

The problem that needs a solution in the Primary Healthcare facility is the lengthy patient waiting time that leads to patient dissatisfaction. In the four-stage process of accessing services in the primary healthcare facility, the second stage can benefit from improvements. This stage is the vital signs measurement in the triage. The problem in this section is that the triage nurses use several types of equipment to measure vital signs.

The process takes an average of ten minutes per patient. The four main measurements they take include blood pressure, temperature, pulse rate, and respiratory rate. The solution that can help to reduce the time a patient spends in the triage is to find a way of taking all the measurements simultaneously using the same equipment. This will give concurrent readings, and will take away some time from the treatment process.

This problem exists because of the use of specialized tools to measure each vital sign. The primary healthcare facility did not change its approach to the measurement of vital signs when new equipment came to the market. The result is that the hospital keeps a large inventory of equipment used to measure different vital signs.

Technology Appraisal

Medical professionals use various tools to measure vital signs. A thermometer is the standard equipment used to measure temperate in a healthcare setting. In the past, medical professionals used thermometer placed in either the mouth or the armpits to measure body temperature.

At the time, a clinical mercury thermometer was the standard piece of equipment for the work. In recent times, infrared thermometers are becoming more popular. These thermometers take instantaneous readings based on the infrared signature of a patients body. They are fast. However, they may be inaccurate because they measure skin temperature, which can be higher or lower than the surrounding.

Secondly, medical professional use aneroid sphygmomanometers or electronic sphygmomanometers to measure blood pressure. Blood pressure refers to the difference between the pressure during the systolic phase and the diastolic phase of the heart.

The normal blood pressure range is somewhere between 80 (diastolic) and 120 (systolic). Patients with variances from these values can show signs of either high blood pressure (hypertension) or low blood pressure. Either of these conditions is dangerous and usually requires careful medical attention.

The measurement of the pulse rate can take place using a range of equipment. This is because the pulse is easy to feel. In fact, a doctor can measure the pulse rate of a patient using a wristwatch. The doctor counts the number of pulses felt by touching certain parts of the body per unit time. The ease of measurement of the pulse has led to the development of many types of equipment for its measurement.

The measurement of the respiratory rate is also easy. It involves counting the number of time a patient inhales or exhales per unit time (Sinreich & Marmor, 2005). In this sense, a nurse can measure a patients respiratory rate using any watch or timer.

In the case of the primary healthcare facility under review, the time it takes to measure these vital signs comes from the need to mount and dismount the equipment used to measure the vital signs. In addition, the nurse must take time to record each vital sign. The nurses also need time to make corrections in case of an inaccurate reading. This increases the total time needed to measure the vital signs.

Propose Solution

The proposed solution for the problem raised in the preceding sections is the use of a single equipment to measure the vital signs. The main causes of delays in the current process are as follows. First, the nurses must mount each piece of equipment on the patient. Each device needs attention to ensure that it records the vital signs correctly.

Secondly, the nurses must take the readings from each device and post them in the patients electronic records (Sinreich & Marmor, 2005). Thirdly, the nurse must remove dismount each equipment from the patient, and prepare them for use by the next patient. This means that the nurses repeat the process four times since each piece of equipment has its own strapping mechanism.

Equipment that measures all the vital signs at once will improve the patient waiting time in the following ways. First, the nurses will have to mount the equipment on the patient only once. This saves the time spent on mounting of equipment. Secondly, the nurse will also dismount the equipment in one move. This will reduce the time spent in dismounting the equipment.

Thirdly, the nurse will read all he measurements at once from the same screen. This will eliminate three out of four reading sessions the nurse went through initially. After releasing the patient, the nurse can attend to the next patient quicker because she will reset the equipment once. In the current case, the nurse must reset each device separately. Table 1 and table 2 below compare the benefits of this project.

Table 1: Current Process

Table 2: Proposed Process

Project Critical Appraisal

The main benefits of this project will be as follows. First, the project will reduce the overall time it takes to treat a patient by 5 minutes. This will be a 9% improvement from the current cycle. This should translate into greater patient satisfaction leading to better performance by the healthcare facility.

The second benefit is that the process will increase the productivity of the nurses working in the triage. This will result in better customer service standards. Thirdly, the accuracy of the vital signs readings will increase because the nurses will be dealing with only one piece of equipment. This will convert to better healthcare standards in the facility.

The criticisms against the project are as follows. While the project should reduce the time it takes to read the vital signs, the new equipment should not just be a collection the existing ones. Otherwise, the time it takes to mount it may remain at the current levels.

Secondly, the gains made in the triage can be lost if there are no changes in the consultation and pharmaceutical services stages. The rate of transfer of patients may simply increase from the triage queue only to decrease in the doctors queue. In other words, more changes are necessary in the process to ensure that the healthcare facility enjoys all the benefits of this initiative.

Conclusion

The two main lessons from this assignment are as follows. First, it is possible to improve any process by focusing on it. Secondly, gains in one process may require changes downstream and upstream to have the desired overall effect.

References

Mukherjee, P. N. (2006). Total Quality Management. New Delhi: PHI Learning Pvt. Ltd.

Sinreich, D., & Marmor, Y. (2005). Ways to Reduce Patient Turnaround Time and Improve Service Quality. Journal of Health Organization and Management, 4(2), 88-105.

The article reviewed for this paper was posted on Natural News online portal on the 7th of September 2014. The title of the article is United Nations: Eating insects is good for health, can create job opportunities and it was written by Michelle Raw, a natural health researcher.

Summary

The author of the article explores the advantages of the addition of insect-based products into the diet of contemporary Americans. Raw notes that insects are extremely healthy and nutritious food sources. The author emphasizes that insects are very rich in protein and iron; besides, some species could replace milk according to their calcium content (Raw par. 7, 10). The author adds that the United Nations currently have a list including 1900 kinds of edible insects.

The organization plans to raise public interest in insect-based products and their flavors. Raw also maintains that farming and consumption of insects is cheaper and more eco-friendly than farming animals and poultry for food. Besides, it would lead to new job creation opportunities.

Finally, the author reviews ideas concerning the introduction of insect-based products to the Western society which include the production of bars containing exoskeleton, using the name sky prawns for locusts, and creating cricket chips called Chirps (Raw par. 9, 11).

Response

In my opinion, the article is very futuristic and progressive. The contemporary world inevitably moves towards the exhaustion of its natural resources, which currently is one of the most frequently discussed ecological issues. This is why the search for new resources and eco-friendly methods of their acquisition is rather popular. Insects are known to be a healthy source of protein and other nutrients necessary for a balanced diet of human beings. This makes them a highly promising future food source.

At the same time, while the theory is screaming about the use of edible insects, the practical introduction of this food source stumbles upon the extremely negative attitude towards insects in the West. The vast majority of Americans is disgusted by insects and would refuse even to touch them, let alone consume them as a meal. Insects are generally perceived as dirty, unsanitary, ugly and scary.

As for the job creation opportunity, insect farming for sure would add some vacancies to the labor market, but we must not forget that if insects become a popular food source, many animal farms could go out of business and increase the national unemployment rates. Besides, farming insects do not require much effort.

Insects breed very quickly and do not need any particular care. Insect-farms in Asia just contains multiple huge tanks with insects and a couple of workers keeping an eye on them. This way, insect farming does not seem to have a chance to become a well-paid career field.

Finally, I agree that farming insects are an eco-friendly practice, but transforming them into products appreciated by the Western consumers might not be as safe. Eating insects is convenient in Asia, where they are fried with the addition of spices and sold right in the streets. In the West, processing, shaping, packing and adding various flavors to the insect-based products is likely to become as environmentally harmful as making modern candy.

In conclusion, I chose this article because the subject of using insects and food source is fascinating to me. The article has made me hopeful that the introduction of insects as a food source in the West actually might happen during my lifetime. In my opinion, it is time for the Western people to become open-minded and stop being unreasonably disgusted or terrified of these tiny creatures.

Works Cited

Raw, Michelle. United Nations: Eating insects is good for health, can create job opportunities. 2014. Web.

Introduction

Hospice care is an organized system that offers proficient, reliable, and empathetic services to people with compound, persistent, or life-threatening conditions. The system focuses on reducing suffering, improving quality of life, and creating chances for spiritual and personal development.

Hospice or palliative care is offered through a joint endeavor of an interdisciplinary team with patient, caregivers, and relatives as the core stakeholders (Kastenbaum, 2012). The care should be delivered simultaneously with disease-modifying treatment. Palliative care comprises sympathetic and active treatments, which are designed to support and relieve a patient, relatives, and other involved parties.

Requirements for Hospice Service

For one to be admitted for palliative or hospice care, s/he has to meet a number of requirements. First, a physician has to certify that a patient is suffering from a chronic or terminal illness. Besides, the patient should have a diagnosis of at most six months if the illness takes its ordinary course (Lynn, 2001, p. 927). In addition, a patient should have not acquired pre-election palliative services or made a palliative election in the past.

A patient who cannot do most of his/her daily chores without assistance is also eligible for hospice services. In some cases, people suffer from illnesses that deter them from walking, cleaning, or feeding themselves. Such patients depend on family members to be taken care of during the time of sickness. Hence, it is imperative to enroll patients for hospice services in a bid to allow family members to attend to other responsibilities.

Barriers to Hospice Services

Hospice services are popular across the world. Nevertheless, a lot needs to be done to overcome obstacles to hospice services. One of the primary barriers to hospice services is education (Lynn, 2001). Patients, health practitioners, and families are not aware of the advantages of hospice services. Moreover, they do not understand the requirements for hospice services. Many regard hospice institutions as a home for terminally ill patients.

Hence, they do not take their patients to the institutions, thus denying them an opportunity to benefit from health services that hospices offer (Lynn, 2001). Another barrier to hospice services is communication. It is hard for even medical professionals to initiate a conversation about hospice.

Consequently, many doctors hold back the topic of hospice services and prefer to talk about it after they try all available alternatives. Doctors fear that talking about hospice may discourage a patient. Therefore, patients do not access hospice services since they do not know about their existence.

Hospice care has numerous enrollment policies, which prevent patients from accessing palliative services. Hospice institutions encounter financial challenges. Hence, they are unable to offer the majority of delicate health services. For instance, the institutions do not cater for patients who require a blood transfusion. Besides, they do not deal with patients under chemotherapy (Lynn, 2001). Hence, their policies deny access to hospice care for patients under these treatment procedures.

Cultural practices act as significant barriers to hospice care. For instance, some patients are unable to access hospice care due to the language barrier. It is hard for some patients like Hispanics to relate to caring providers in the United States. Moreover, distrust towards hospice care makes many not to go for the services.

For example, the percentage of African Americans who go for hospice care is low despite the majority of them suffering from primary hospice diagnoses. In addition, Chinese-Americans fail to seek hospice care due to spiritual beliefs.

How Hospice Serves Children

Children suffering from chronic or terminal diseases require both pediatric palliative care and disease-modifying treatment. Hospice facilities assist children because they offer both services. The primary goal of hospice care is to comfort a child. Consequently, apart from relieving children from pain and other upsetting symptoms, hospice care offers spiritual and psychosocial assistance.

Spiritual and psychosocial relieves are crucial not only for children with chronic diseases but also for their relatives (Davies, Brenner, Orloff, Sumner & Worden, 2002). Hence, hospice incorporates psychosocial and spiritual cares to help children achieve their distinct physical, educational, psychological, and spiritual objectives.

According to hospice care, terminal illness should not deprive children of their happiness. Instead, they should continue with their normal life until their last days. This assertion underlines the reason why care providers are always conscious of the childs personal, spiritual, and cultural values and practices. They use the values to relate to children and help them to overcome their anguish. In other words, hospice care serves children by focusing on their most cherished beliefs and practices.

Children with hospice care needs vary in age. Hence, they require varied services. Hospice facilities have pediatric subspecialists who are trained in various fields. Besides, they have pediatricians who deal with children suffering from physical and developmental challenges. The fact that a team comprising of individuals with varied skills offers palliative care enables hospice institutions to address children without challenges.

For many children, their understanding of illness changes as they continue to grow (Davies et al., 2002). Additionally, they start to make critical decisions as they continue to develop. Hence, hospice care helps and prepares children to cope with their circumstances, as they continue to recognize themselves.

How Hospice Serves people with HIV/AIDS

Hospice facilities comprise teams of experts that evaluate patients with HIV/AIDS and revise the approach of care as conditions and signs change daily. The primary objective of hospice care is to alleviate emotional and physical suffering so that patients can preserve their self-esteem and remain happy. Hospices manage to serve patients with HIV/AIDS because they control and ease pain (Lynn, 2001). Individuals with HIV/AIDS contract opportunistic illnesses, which subject them to pain.

Hospices have experts in pain management who guarantee that patients are comfortable. In addition, they offer customized services. As the illness progresses, patients are unable to express themselves. For this reason, hospices have specialists who understand all universal problems related to HIV/AIDS. The experts develop policies to address all the emerging problems.

Another way that hospices serve patients with HIV/AIDS is that they visit patients at their homes (Lynn, 2001). A patient may not necessarily be taken to a hospice institution. Hospice staff members visit patients in their homes and administer necessary treatment. Their flexibility makes them the best for HIV/AIDS patients.

Hospice institutions serve people with HIV/AIDS in partnership with doctors. They develop a treatment strategy in consultation with a patients doctor. Thus, they offer synchronized care at all levels. Hospice staff members ensure that doctors, social workers, and nurses get information about a patient (Lynn, 2001).

Moreover, they may inform a priest on a patients demand. Lynn (2001) alleges, Hospices manage and distribute all medical supplies and equipment associated with HIV/AIDS to guarantee that patients receive all necessary treatments (p. 930). Apart from treatment, hospices help patients to preserve their religious and emotional well-being.

Meaning of Death

When individuals are unable to trounce a particular challenge, they tend to allocate it a meaning. Bowker (1991) alleges that when faced with the definitive quandary and unchangeable truth that life ends, humankind hastily tries to identify some meanings in death. The consciousness of death stirs queries that focus on the nature of existence. What does life entail? Where do people go after death? What is the purpose of living? Human beings ask these questions in an attempt to understand death.

Through such questions, humankind has come up with numerous meanings of death. Some cultures regard death as a continuation of life. They maintain that the soul gets reincarnated after its 7th death (Bowker, 1991). They argue that the soul enters a fruit or mushroom and becomes reborn based on what consumes it.

If consumed by human, the soul is reborn as a human being. Similarly, a soul can be reborn as an animal. Since my childhood, I have heard my parents and the community associating childrens habits with those of their deceased great grandparents. Others allege that some animals are cunning and they behave like human beings. The experience has compelled me to believe in reincarnation.

Some cultures regard death as cycling and recycling (Bowker, 1991). Such cultures hold that death is a short-term condition that prepares people to transit from one form of life to another. They believe that once a person dies, s/he assumes a different life. Nevertheless, the cultures do not give reference to any concrete form of life that one assumes after death.

During my childhood and adolescence years, I came across numerous people who resembled my deceased relatives, either physically or behaviorally. Today, I come across many children who resemble my grandfather. Therefore, I have developed the opinion that one may be reborn in a different form after death.

The majority of communities see death as an event in waiting. Such communities believe that after death people wait for the next ensuing stages. In western civilization, people maintain that death precedes three phases (Bowker, 1991). First, an individual is assumed to be in a sleeplike condition waiting for the judgment day. Second, a person proceeds to judgment day where one is charged based on his or her behavior. Third, after judgment, the soul goes to the final destination.

The final destination may be good or bad based on how one spent his/her life (Bowker, 1991). Despite believing in the possibility of reincarnation, I have been brought up from a religious background. I believe in life after death. Besides, no case of reincarnation has ever been proved. Thus, based on my spiritual teachings and experience, I hold the opinion that death only prepares people for a better life to come.

Among the three meanings, I consider the third one as the highly consoling and acceptable. In spite of some children exhibiting behaviors similar to those of the dead, it is hard to tell if they represent reincarnated souls. In addition, based on the challenges that people encounter on earth, no one would be comfortable to learn that s/he will revisit the same in the future.

However, the idea that people assume a better life after death is consoling. Everyone would like to have a happy life after death. Thus, people strive to live well on earth hoping that the reward will be fulfilled after death.

References

Bowker, J. (1991). The meanings of death. Cambridge, UK: Cambridge University Press.

Davies, B., Brenner, P., Orloff, S., Sumner, L., & Worden, W. (2002). Addressing spirituality in pediatric hospice and palliative care. Journal of Palliative Care, 18(1), 59-67.

Kastenbaum, R. (2012). Death, society, and human experience (11th ed.). Boston, MA: Pearson.

Lynn, J. (2001). Serving patients who may die soon and their families: The role of hospice and other services. Journal of the American Medical Association, 285(7), 925-932.

Introduction

In our day more and more people resort to alternative or, so-called, natural medicine. Many people often have to admit that conventional medicine does not always work (Buchhaus 24). Natural medicine has gained its popularity due to the assumption that people have failed to create the necessary cure, but nature has the necessary healing capacity.

There are different definitions of natural medicine, but the main concept is that natural cure is not contaminated by peoples activity. Nevertheless, it is difficult to define nowadays natural medicine as truly natural since human activity has intervened in almost all natural processes.

The goal of natural medicine

Admittedly, the popularity of natural medicine has increased. Numerous books and articles on natural medicine have appeared recently. Scientists, scholars, doctors and journalists reveal advantages and possible downsides of this newly discovered ancient type of medicine. Buchhaus, considering existing literature on natural medicine, suggests a general, accepted concept of natural medicine stating that it is based on the assumption that every individual has an innate healing capacity (23).

The goal of natural medicine is to restore this capacity through the use of a variety of natural treatments, ranging from massage to the use of herbs and water (Buchhaus 23). Therefore, natural medicine presupposes treatment with natural materials like herbs, water, air.

Leon Kass provides a more specific definition to natural in his book: natural is true to life as found and lived (qtd. in Guinan 121). Thus, natural medicine exploits natural materials for healing: herbs, for instance. Natural materials are opposed to human-made materials, drugs and chemicals. In fact, Kasss definition is more appropriate for the modern natural medicine.

It is important to state that Kass cautiously claims that it is necessary to move toward a more natural science (Guinan 121). It is quite difficult to establish natural medicine at once, but it is possible to gradually move towards it. Admittedly, the mastery of man over nature which was promulgated by people since the time of Enlightenment has left a deep trace on medicine and nature itself.

The level of contamination

It goes without saying that people have contaminated the planet greatly for the past two hundred years. Air, water and soil are contaminated, so herbs which are used in the contemporary natural medicine are not that natural anymore.

For instance, test implemented by Congressional investigation reported that nearly all herbal dietary supplements tested contained trace amounts of heavy metals and other contaminants (Harris). Therefore, the concept of natural should apparently be reconsidered by many people. Of course, the level of contamination was not dangerous for peoples health, but those natural supplements cannot be regarded as truly natural.

Unfortunately, truly natural materials are not common for the majority of developed countries since the mastery of people over nature in these countries was significant. Examples of absolutely natural medical supplements are usually found in wrecked ancient ships. For instance, recently scientists managed to reveal many secrets of ancient medicine when tested tablets which were found on a Roman ship which wrecked about 2000 years ago (Higgins). Of course, the tablets contained only herbs. There could be no chemicals or contaminants.

Popular natural health products

Many people may argue that it is possible to use the experience of ancient Romans and Greeks to create effective natural health products. More so, ancient Egyptians, Babylonians, Chinese and Indian scripts can be also helpful. Besides, in such countries as China, India or African countries natural medicine still prevails.

Therefore, it is possible to use this experience in developed countries like the USA, Canada and European countries. In fact, there are even more easy ways which are extensively being used now: health products are imported. Many people think that since these products contain (according to labels) only herbs without any man-made chemicals, so they can be regarded as natural since they are true to life as found and lived as defined by Kass.

However, this cannot be regarded as a natural medicine at all since the quality of these health products is often of low quality. Thus, popular natural health products contain dangerous chemicals and can cause health problems instead of healing (Harris). It is impossible to call a product natural only because it is said that it contains herbs. It is essential to check these products and only when it is reported that there are no contaminants (or at least the content is insignificant) these products can be regarded as natural.

Conclusion

On balance, it is possible to state that the major concept of natural medicine is that the cure should not contain man-made products, but herbs and other natural materials should be used.

However, this concept should be reconsidered, or rather specified. Natural health products should contain natural materials and do not contain contaminants. Only such definition of natural can be regarded as complete and precise. More so, it is essential to take into account this definition only since health products based on natural materials contaminated by chemicals are not truly natural and often cause health problems. People should know whether natural health products they consume are truly natural.

Works Cited

Buchhaus, Erich. Alternative Medicine Explored. Librarian 50.3 (2006): 23-25.

Guinan, Patrick. Toward a More Natural Medicine. Journal of Religion and Health 41.2 (2002): 121-126.

Harris, Gardiner. Herbal Supplements Commonly Have Traces of Contaminants, a U.S. Study Finds. New York Times 2010. Web.

Higgins, Adrian. Ship Wreck Reveals Ancient Secrets of Medicine. Washington Post 2011. Web.

Sexuality is still one of the most controversial areas in the western world. There are many rules, conventions and prejudices which divide people into two major camps: those who think sex is nothing more than a basic need which should be satisfied and those who think it is something sinful. Many think that sexuality is not even an important issue to consider while others understand the importance of finding answers to certain questions (Rubin 143).

As far as I am concerned, I have not spent much time thinking about my own sexuality. I have not paid much attention to the issue as I thought it was quite insignificant. In fact, this is the very first time I am considering the issue with such a precision and I find it very important and beneficial for me. I think sexuality is a very important part of peoples life and it influences peoples behavior.

I feel I need to understand what sexuality is in my life. I need to know what role it plays in my life. I want to understand what I should expect in my future. Of course, it is necessary to answer certain questions to understand what role sexuality plays in my life. These questions are as follows:

• How was affection expressed in my family? Does this affect me now?
• How did I learn about sexuality? How did I feel about it then? Today?
• How was nudity treated in my family?
• How have my sexual relationship experiences affected me?
• Do I think I understand my sexual self as well as I would like?

Interestingly, many people argue that Freud was an insane as he paid too much attention to childhood experiences. Nonetheless, when it comes to sexuality, parents behavior plays a very important role in sexual development of an individual.

Thus, somehow I do not remember how exactly affection was expressed in my family when I was a child. I do not remember that my parents hugged me very often. I cannot recollect the times when parents kissed me. I think this is the reason I do not like kissing and embracing other people. The only people I like kissing and hugging are my two sons and my husband. In fact, I noticed that I can hug and kiss children (my sons, my niece or even completely unknown kids) and the man I have sexual relationship with.

At this point, it is important to note that children should be placed in a very special place as my eagerness to kiss and hug them is nothing more than a maternal instinct. It does not mean I do not kiss or hug anyone. If a person tries to hug me, I will not protest and I will not start telling about my theories. However, I do not feel comfortable when kissing or hugging other people with some exceptions (mentioned above).

I think the reason for this feature of my character lies in the terrain of my childhood experiences. I am simply unaccustomed to kiss and hug other people. Sometimes this feature of character makes my close people feel uncomfortable. I have started noticing that my mother now tends to kiss and hug me very often. I do not protest but I feel there is something wrong with that. I also believe some of my relatives think I do not like them as I do not like kissing and hugging them.

What is more, I think this feature of mine has influenced the way I feel about sexuality and sex. I do not think I am ready to let a stranger touch me. I feel that there should be a very special connection between me and the other person to make me eager to embrace him/her.

Perhaps, I feel certain lack of parental (especially paternal love) and this makes me feel trust towards the man I love. I have heard that massage is so popular nowadays as people do not hug or even touch each other. This may be true in my case. I feel I try to remove the lack of embraces in my past by hugging my husband all the time.

Some may think I am quite a reserved person. Some may even think I am a very conservative person in terms of sexual relationships. This is quite true to certain extent. I do not like emphasizing my sexuality. I do not think I can be a sexual liberal. However, I do not condemn any sexual relationship. I do not condemn people who have lots of partners. In bed with my husband I am quite free. I think roots of this kind of duality can be found in my childhood as well. The way I learnt about sexuality has affected development of my character, too.

Sex was never discussed in my family. It was some kind of a silent taboo. My mother talked to me about sex (or even about the necessity to be careful) when I was 13, right after I told her that I had had my first menstruation. Of course, this was quite a belated conversation as I had already known quite a lot on the subject. We had classes on anatomy at school.

We learned about female and male bodies and we also learned about pregnancy. However, I would not call that a sexuality education. It was only about peoples bodies. I do not consider this knowledge valuable for my sexual development, or especially my first acquaintance with sexuality.

I guess I learnt a lot about sexuality while reading romance novels. I read a lot of this kind of books at the age of 12. There were many episodes which made me feel rather weird. Of course, even then I understood that the state I sometimes found myself in was excitement.

I have to admit I liked the feeling. It is also important to note that I have fertile imagination. I pictured all those scenes when the main characters were kissing and making love. I should also admit that I did not have a particular vision of the sexual intercourse itself (especially the penetration part). Nonetheless, I am sure that I had my first acquaintance with sexuality when I was reading these books.

As has been mentioned above sex was a kind of a taboo in our family so I could not watch sex scenes when my parents were watching TV. It is also necessary to note that the majority of films I watched with my parents as the rest of the day I was busy with my studies and extracurricular activities. Thus, I could not see those scenes on TV, but I could only imagine them.

I think it is also important to mention the specific attitude towards nudity. My mother could change in the same room with me. She did not hide her breasts when she was changing clothes (like I always do now). However, I have never seen my father naked. The only time he was half-dressed was the time we spent on a beach. I believe this also affected me.

Thus, I have often felt uncomfortable when I saw a naked man (on TV). In fact, I do not like watching pornography and I do not find male genitals that attractive (some of my female friends find these organs stunning). However, I like looking at an attractive female body. This even made me think I was a lesbian.

I do not think I feel more comfortable looking at a female body because I am a female myself (I do not like looking at my own body). I think this is all connected with the distant years of my childhood when I was accustomed to see a female body and never saw a male body.

I do not think that influenced my sexual orientation but I guess this contributed greatly to my sexuality. I know that I will feel uncomfortable even if I will need to undress in front of another man (I cannot even imagine that I can have sex with another man).

In fact, I thought it would be difficult for me to have sex, in the first place. I would not say I was really conservative when I was a teenager but I did not have sex until I was almost 20. I thought I was the last virgin in the world. When I met my future husband he was a very nice young man, so I thought it was high time to become a woman. I cannot say I had really serious feelings to the young man but we did it and it was very nice. I can say that my first sexual experience was successful. I often think that I could dislike sex (just as some of my friends do) if my first experience was not that pleasant.

Though I cannot say I passionately loved my husband when we first made love, I can say that now I love him very much and there is very special connection between us. Now I see sex as a way to bring joy to my husband and enjoy the act myself. I do not think that sex is one of everyday tasks like eating or sleeping. I think sex is possible between people who have a specific emotional connection. I guess all the factors mentioned above contributed greatly to my sexual development.

I think now I understand my sexual self quite well. I understand that I belong to people who accept that the issues concerning sexuality cannot be analyzed in black and white (Rubin 167). I know that I accept sexual freedom if it does not hurt anyone. However, I remain quite conservative when it comes to myself and my relationships with other people.

Of course, it is important to note that there is quite a lot to be learnt. I believe I will find out more about myself in the course of time. In fact, I think each year will bring more knowledge about my sexual self. However, at present I am quite satisfied with what I already know. I know why I am quite reserved. I know what I can expect and what I want to get from my sexual partner. Finally, I know that my sometimes weird behavior has certain explanation. I feel quite comfortable since I know that my sexual behavior is based on my childhood experiences.

Works Cited

Rubin, Gayle S. Thinking Sex: Notes for a Radical Theory of the Politics of Sexuality. Culture, Society and Sexuality. Ed. Richard Parker and Peter Aggleton. Philadelphia, PA: Routledge, 1999. 143-179. Print.

Introduction

Technology is associated with various opportunities in any field, and it is critical to health services delivery. Nursing is one of the areas that benefit significantly from the use of technology. This is especially true for community and public health nursing that is characterized by the use of big data, extensive communication, collaboration, as well as the need to mind the geographical locations of patients. All these features are becoming less worrisome for public health and community nurses due to the use of technology (including nursing informatics and telehealth).

Importance of Informatics and Technology

It has been acknowledged that technological advances have brought new drugs, equipment, and strategies that enable healthcare professionals to provide high-quality care to people. Hughes (2014) notes that people are now living longer lives and healthcare professionals provide more services due to the availability of technology. Information management is one of the areas that have been developed considerably.

Martin and Utterback (2014) state that nursing professionals are able to collect and analyze vast amounts of data. Public health and community nurses can easily access the necessary data and develop strategies to address the most burning issues. Importantly, nurses can provide services irrespective of patients locations, which is specifically important in treating people with chronic health conditions who decide to stay home rather than live in specialized facilities.

Telehealth in Current Community and Public Health Nursing

Telehealth is another example of the way technology can bring nursing and healthcare services delivery to a new level of quality. Telehealth can be defined as the use of electronic communication for transmitting healthcare data to people located at different geographical locations (as cited in Hughes, 2014, p. 340).

Singh, Mathiassen, Stachura, and Astapova (2010) explore the benefits of telehealth in the public health setting and stress that it has a significant positive impact on the collaboration and communication of stakeholders involved (nurses, patients, other healthcare professionals, officials). Home health has evolved considerably due to the use of telehealth as nurses can provide the necessary consultations or even simply check on patients within minutes. Patients can also access a lot of information and improve their quality of life without staying in a healthcare facility.

Cost-Effectiveness of the Approach

It is undoubtful that the use of telehealth in home health is cost-effective and beneficial for patients as well as local budgets. The technology is available as facilities have the hardware and software as well as devices that can be used in telehealth. Patients can also afford to buy the necessary device or, more likely, the device is already available. At that, the budgets cannot afford to employ a significant staff of nurses to meet the needs of communities. Martin and Utterback (2014) claim that the industry went through layoffs and budget cuts, which means that community and public health nurses have to deliver care to more patients and focus on larger populations. Telehealth makes it possible to reach all stakeholders as the Internet can help the stakeholders communicate and collaborate effectively.

Conclusion

In conclusion, it is possible to note that the use of technology (for example, telehealth and nursing informatics) is beneficial for the development of the healthcare system. Information is one of the central aspects of nursing professionals operations. Therefore, it is critical to managing data effectively. Technology provides the tools to bring nursing professionals and patients closer, and help them communicate and collaborate efficiently.

References

Hughes, C.K. (2014). Informatics and technology in professional nursing practice. In K. Masters (Ed.), Role development in professional nursing practice (pp. 325-348). St. Louis, MO: Jones & Bartlett Learning.

Martin, K.S., & Utterback, K.B. (2014). Home health and related community-based systems. In R. Nelson & N. Staggers (Eds.), Health informatics: An interpersonal approach (pp. 147-163). St. Louis, MO: Elsevier Health Sciences.

Singh, R., Mathiassen, L., Stachura, M.E., & Astapova, E.V. (2010). Sustainable rural telehealth innovation: A public health case study. Health Services Research, 45(4), 985-1004.

Introduction

Spinal muscular atrophy (SMA) is a disease that prevents individuals from maintaining routine actions. It affects children mainly but can start even before birth or in the young adulthood. The disease has genetic nature and is characterized by muscle weakness that worsens with the course of time. It happens because those nerve cells that control voluntary movement are lost due to the genetic deficiency of protein. SMA is classified in relation to the age of individuals who have it into five types (SMA 0  prenatal onset; SMA IV  adult onset). This paper will discuss SMA I, which is usually diagnosed by the age of 6 months (Hardart & Truog, 2003).

Spinal Muscular Atrophy

Spinal muscular atrophy (SMA) type I, which is also known as Werdnig-Hoffman disease is an autosomal recessive disorder of childhood that causes profound weakness and death from respiratory failure, typically by the age of 2 years in the absence of mechanical ventilation (Hardart & Truog, 2003, p. 848). It is basically found due to the fact that the child never turns out to be able to sit. Still, some of them may learn to roll. They can even live without enteral nutrition and respiratory issues for a couple of years. However, such things happen rarely, and these children require special nutrition and treatment of respiratory failure. Before the age of two, they can also require ventilatory assistance. In the most severe cases, it can be needed even before 5 months of age. Basically, they can just partially move their finger and facial muscles (Bach, Vega, Majors, & Friedman, 2003). Expected outcomes for SMA are defined not by its type but by the severity of symptoms that is why it is difficult to presuppose what will happen with one. Still, these children cannot live without special treatment and often die before they are 2 years old when it is not provided.

Signs, Symptoms, and Treatment

Children with SMA may reveal different symptoms depending on the severity of the disease. It is defined by the amount of protein that the nerve cells receive for normal functioning. Still, those who have SMA I tend to reveal noticeable symptoms from the very birth. They are extremely weak and cannot breathe decently. Eating is also a problem for them, as they cannot suck and swallow like their peers. The most critical symptom is their inability to sit without external assistance, but they also have mild joint contractures. As a rule, the disease affects proximal muscles at first and then moves away from the center of the body. Thus, the muscles on the fingers and feet are often much stronger than those on the back. The diaphragm and heart are not affected mainly till the time when SMA I is in the late course.

Considering those issues that children with SMA I have, they require constant support and care. They need mechanical ventilation (at night or on the routine basis) and enteral nutrition with the help of feeding tubes. They require support while moving, especially sitting. Due to the development in treatment options, patients with SMA I can now live longer. Unfortunately, such opportunities are expensive and cost thousands of dollars, which prevents many families from obtaining them, as their insurance fails to cover everything. Thus, basically a child receives treatment when being at home with the involvement of a pediatric palliative care team (Garcia-Salido, Paso-Mora, Monleon-Luque, & Martino-Alba, 2014).

Nursing Actions

Children with CMA I require constant care and support provided not only by their parents but also by healthcare professionals. Hardart andTruog (2003) state that 16 hours/day of nursing care are needed to provide a child with invasive mechanical ventilation, which means that family is to spend more than $100 000 a year (p. 849).

Nurses can also educate childs caregivers regarding the way one should be treated and then develop a schedule of visits needed to ensure that the patient is in a decent condition. They are usually held on the weekly basis (Garcia-Salido et al., 2014). They can also provide help when receiving calls from the family or e-males. Even though children with SMA I are rather weak, and they are not able to act as other infants, professionals and caregivers believe that the effort needed for raising them is not excessive. The thing is that children under the age of 2 always require much attention, assistance, and support. In this way, the care that is needed for a patient with SMA I differs mainly only in the particular nutrition and respiratory needs. As a rule, they are satisfied by the members of the family that is why the main activity that the nurse is to consider is educating them.

Patients Education

As a rule, individuals with SMA I are little children who are not able to take care of themselves at all that it why nurses do not educate them. Instead, they are focused on the parents and other members of the family. Nurses should have a meeting with them, during which they need to explain the most critical issues. The caregivers need to realize the disease process and what causes it. It would be advantageous if they know the classification of SMA not to be misled by the information they found. Nurses should explain the prognosis and give the family members several authoritative sources of information about the disease. They can also pay attention to research studies focused on SMA I. The intervention plan is also required, as it will serve as a guideline for the family. Parents should know where they can receive help if something happens. A genetic test should be made. Peculiarities of pulmonary and nutrition are to be underlined and discussed step by step. Orthopedic and rehabilitation interventions can also be considered.

Complications/Adverse Effects

SMA I had an adverse influence on the childs overall condition due to the respiratory and nutrition issues that are caused by it initially. One cannot be fed in a natural way, which can be a great problem if the disease is not identified. Lack of nutrition may lead to undernourishment and further complications. Except for that, SMA I limits childs movement greatly, which prevents musculature development and strengthening. One cannot deal with basic actions and required constant support provided by the family members. Even though children with SMA I already have particular problems with breathing, their condition can worsen with the course of time. Because of the muscles inability to support the body, the diaphragm can be affected, which leads to respiratory complications. Those muscles that are necessary for breathing turn out to become weaker. Issues can deal with spine also. Muscle weakness often leads to scoliosis that affects body image and can even interfere with breathing.

References

Bach, J. R., Vega, J., Majors, J., & Friedman, A. (2003). Spinal muscular atrophy type 1 quality of life. American Journal of Physical Medicine & Rehabilitation, 82(1), 137142.

Garcia-Salido, A., Paso-Mora, M., Monleon-Luque, M., & Martino-Alba, R. (2014). Palliative care in children with spinal muscular atrophy type I: What do they need? Palliative and Supportive Care, 13(2), 313-317.

Hardart, M., & Truog, R. (2003). Spinal muscular atrophytype I. Archives of Disease in Childhood, 88(1), 848-850.

International medical staffing firms have been developing over the past three decades because of technological advancement. Movements of medical professionals have increased as opportunities increase oversees. With modernization of medical tools, the medical fraternity has increased in terms of efficiency and service delivery. For instance, laser equipments developed over the past decades have enabled seamless surgery of patients suffering from eye problems.

This is a major technology which has enhanced medical development in the past few years. Despite these efforts, negative words have been a stumbling block to the development of international medical staffing firms. Negative words have had depressing effects on progression of the international medical firms in terms of efficiency and reliability.

Negative words uttered within and outside the medical fields negate the fundamental functions of the medical fraternity. Such words undermine the functions and progress of international medical staffing. The main function of international medical staffing firms is to increase medical services around the world through provision of medical staff and technological tools.

The function of international medical services cannot be undermined, our health care system within and outside the country is fostered by the efforts of these medical personnel (Connell, 2007). However there are a number of long term implications of increased negative words on international medical staffing. Some of the long term effects are elaborated in this analysis in order to shade more light on the magnitude of their implications.

The morale of the medical staffing firms will decline in the long run because of lack of appreciation to the medical staffs around the globe. It is natural for human beings to reduce their efficiency as a result of being undermined in their course of service delivery.

A number of cases that undermine medical staffing around the clock have been reported, such reports indicate less trust to medical staffs and thus less regard to their elementary functions in the society. This has not only destroyed the morale of the medical staff firms but also decreased the efficiency of the entire medical fraternity. The long term effect of increased negative words will thus lead to decline in the morale of the entire medical staffing which will lead to reduced progression of international medical staffing firms.

Increase of negative words will also have a long term implication on the public perception of international medical staff firms. This is because as the negative words increases in the public media, the public will have negative perception about the progression of international medical staffing firms.

With consideration that the entire globe is driven by the media, any negative dissemination of information concerning international medical staffing will obviously affect the public perception about the medical fraternity. The long term effect will result in limited progression of medical staffing as a result of the publics low regard on the functions of these medical staffing firms internationally (Connell, 2007).

According to Birn (2009) the elementary goal of the international medical staffing firms is to increase in terms of scope and thus be in a position to offer medical services to majority of the worlds population, negative words will affect this goal. This goal will be affected since there cannot be a substantial progress if the public has negative perception on the development of the medical staffing around the globe.

The growth of international medical staffing around the world is highly depended on the perception of the public; this is so because the public is the major beneficiary of the services offered by the medical staff.

Dissemination of negative words through the public media and even through the internet will result in reduced long term growth of medical staffing around the globe. Reduction of international medical staffing firms around the globe will therefore lead to decreased health care services which will consequently lead to increased medical insurance.

As analyzed in this discussion, negative words have had adverse effect on the development of international medical staffing firms. Decline in the medical staff morale, increased public negative perception and reduced growth of international medical staffing firms is the long term effect of increased dissemination of negative words about international medical staffing firms. It is natural for humans efficiency and reliability to be thwarted by negative words.

The medical fraternity will be discouraged to carry out their service delivery if the public has negative perception on them. In essence, their growth will also be affected as a result of public negativity.

International medical staffing firms aims at reaching more people worldwide through their medical services; this will not be the case if their services are undermined through propagation of pessimistic information about their services. It is thus important for the public and the media to know that their negative perception about the functions of international medical staffing will result in decreased medical health care and thus increased medical insurance.

References

Birn, A., & Pillay,Y. (2009). Textbook of international health: global health in a dynamic world. New York, NY: Oxford University Press.

Connell, J. (2007). The International Migration of Health Workers. Michigan, MA: Routledge.