Category: Health & Medicine

Abstract

It is evident that the agony from chronic stable angina (CSA) highly affects the livelihood of the personnel. Therefore, it is important that the relevant stakeholders collaborate in the development of an effective remedy for the patients due to the profound effect on the bodys health index. The initiative fosters a significant impact by empowering the clients with dynamic knowledge and skills to utilize in the alleviation of the soreness. The research design was a randomized controlled trial that involved both short-term and long-term tests among the participants. Data were collected within a span of three and six months with a progressive follow-up initiative to justify the effectiveness. The findings indicate that the intervention program showed minimal impact on the resourcefulness approach compared to other perspectives. The initiative poses a significant effect on the general health, self-efficacy, pain symptoms, and physical functioning of the victims.

Statement of the Problem

Heart-related diseases significantly affect the quality of living among the victims. The research by McGillion et al. (2008) focuses on the effect of psychoeducation on the pain relief experience among ailing individuals. In this case, the author articulates that the major entity encompasses the determination of the dynamic variables. It is evident that the agony from chronic stable angina (CSA) highly affects the livelihood of the personnel. Therefore, it is important that the relevant stakeholders collaborate in the development of an effective remedy for the patients due to the profound effect on the bodys health index. The initiative fosters a significant impact by empowering the clients with dynamic knowledge and skills to utilize in the alleviation of the soreness.

Hypotheses

A standardized psychoeducation program fosters improvement in the patients quality of living, resourcefulness, and self-efficacy practice.

Literature Review

Chronic stable angina (CSA) is a heart-related disease that proficiently affects the quality of living among the personnel hence the prominent option to establish the variables that foster the alleviation of the pain. According to McGillion et al. (2008), there were at least 6,500,000 victims in America between 1992 and 2002. The high prevalent rate fostered the development of preventive measures to alleviate the dangers among the patients. One of the major challenges posing the necessity for this research engulfs the management of the disease. A significant percentage of the characters individually manage the aches without assistance from the community.

Method

Protection of Participants Rights

The protection of the participants rights lies in the provision of consent to engage in the project. McGillion et al. (2008) utilize dynamic strategies to enhance the optimal coordination and the selection of the respondents. In this case, the researcher exploits three-phase procedures. The first step entails the clinicians identifying the eligible patients for the study. The second move is providing crucial details regarding the random test and its effects on the quality of living among the patients. The initiative empowers the counterparts with adequate insight regarding the significance of the process to the well-being of treatment and recovery. The final approach is the promotion of the communitys participation in the practice by posting the advertisement to the local newspapers.

Research Design

The research design was a randomized controlled trial that involved both short-term and long-term tests among the participants. McGillion et al. (2008) optimally utilized the follow-up approach to ensure the assertion of the concepts effectiveness among the test subjects. Further, the researchers quantitatively analyzed the outcomes to objectively and statistically justify the efficiency of the program among the personnel.

Population and Sample

The sample population that participated in the randomized trial involved 117 individuals whose mean age was 68 years old. There was a distinct gender ratio due to the 80% composition of males and 20% females. McGillion et al. (2008) focus the study among people victimized by heart-related disease to understand the effectiveness of the intervention program. The sample size was adequate based on the dynamic exposure to the observational approach among the counterparts. In this case, the snippet is based on a power analysis to enhance the relative correlation to the impact of the psychoeducation ideology.

Data Collection and Measurement

Data were collected within a span of three and six months with a progressive follow-up initiative to justify the effectiveness. The intervention program involves empowering the personnel with necessary approaches to assert the treatment and recovery of cardiac pain. As a result, McGillion et al. (2008) established the dynamic determinant values for measuring effectiveness. The entities include making of an action plan, self-management and chronic angina overview, cognitive symptom relaxation, common emotional responses, feedback, fitness, better breathing, fatigue, healthy heart, monitoring angina symptoms, communication, and future plans.

Procedures

The researchers used the different entities for the procedure under the spectral view of week one to week six. During the period, a research assistant that is a qualified nurse engages the participants in interviews to determine improvement or deterioration from the intervention program. The use of expertise during the practice and the recruitment of the patients using adequate information fostered the alleviation of bias. In this case, staff participating in the process were appropriately trained.

Results

Data Analysis

The researchers utilized quantitative analysis to derive information from the collected data from 117 participants. It is an effective approach that enhances the quantification of the measure regarding the effectiveness hence rendering the objective overview. Type I and Type II were minimized using a marginal error during the derivation of statistic overview, and the researchers performed an intention to treatment scrutiny for the characters. As a result, the missing values were optimally evaluated and addressed during the interpretation of the results.

Findings

The findings indicate that the intervention program showed minimal impact on the resourcefulness approach compared to other perspectives through a presentation of statistical significance. The initiative poses a significant effect on the general health, self-efficacy, pain symptoms, and physical functioning of the victims. The researchers optimally utilized effect size, confidence intervals at 95% to accommodate errors, and an in-depth analysis using figures and tables. In this case, the interpretation of the findings facilitates a meta-analysis due to providing adequate details for evidence-based practice.

Discussion

Interpretation of the findings

The results indicate that the psychoeducation program is an essential treatment and recovery concept for patients due to the prominent positive effect on the individual health index. According to McGillion et al. (2008), it is the responsibility of the relevant stakeholders to establish mechanisms that alter the attitude among victims to enhance self-efficacy and the determination of the future plan. The independent management of pain fosters an improvement in the quality of living due to the proactive measures taken to adjust to a better environmental perception.

Implications/Recommendations

It is recommended that different institutions implement the program across different departments to assess the effectiveness of the treatment and recovery among patients. In this case, the medical practitioners play a significant role in elevating the quality of services to the clients. Primarily, the researchers align the studys focus for clinical practice and further investigation by academics to enhance the in-depth comprehension.

General issues

Presentation Researcher Credibility

The presentation involved the use of a CONSORT flowchart that indicates the process in the participatory activities during the study. The approach boosts the comprehension of the research design and the findings.

The research is credible due to the objective and subjective integration of details to render the provision of proficient results. McGillion et al. (2008) utilize secondary literature to justify the purpose of the study. The researchers use the expertise of a nurse as a research assistant during data collection to improve the quality of the derived information. Therefore, the research poses a profound credibility value and contribution to the context for further studies.

Summary Assessment

Cardiac pain is an issue that significantly affects the quality of living among patients. Due to the prevailing soreness, it is important to determine the approaches that enhance the alleviation of the experience. The study findings are valid due to the integration of strategies to improve the credibility hence boosting my confidence in the value of the outcomes. The incorporation of the psychoeducation program contributes meaningful evidence to be used in nursing practice for effective treatment and recovery.

Reference

McGillion, M. H., Watt-Watson, J., Stevens, B., LeFort, S. M., Coyte, P., & Graham, A. (2008). Randomized controlled trial of a psychoeducation program for the self-management of chronic cardiac pain. Journal of pain and symptom management, 36(2), 126-140.

The product under focus of this paper is a resistance band. The analysis of the resistance bands market is conducted at the national level. Before February 2020, the average price was 5 dollars for a three-meter long resistance band, while the overall market size was worth 712.8 million $ (Resistance bands market size, n.d.). Before the pandemic, the market was not in equilibrium, since the there was a product surplus. The pandemic-related restrictions have led to the sudden consumer interest towards home fitness equipment and resistance bands in particular.

Once the lockdowns began, the situation changed rapidly, as people were forced to find alternatives to gyms. Randle (2020) reported in his article a sudden shortage of fitness equipment, which included resistance bands. The first explanation is that people who regularly attended gyms needed to maintain their physical form, and resistance bands allow working out with intensity comparable to gym equipment. Second, quarantined people were advised to exercise, and the resistance bands were cheap and accessible. Ultimately, the lockdown, which closed all gyms and forced people to stay at home was the specific event that precipitated the upsurge in demand.

Although the government did not directly regulate the resistance band market specifically, its lockdown policies did influence it. Joffe (2020) reported a story about a gym owner being charged with five misdemeanors for being open during the states shutdown orders (para. 1). Naturally, the government did not target fitness equipment itself, but the increase in demand for alternatives to gym equipment was anticipated. Unable to visit gyms, people started to buy more resistance bands, which unsurprisingly led to the expansion of the market.

The period between February and August 2020 was marked by a sharp increase in the demand for resistance bands. Business Wire reported that sales of fitness equipment grew by 170% (Fitness equipment sales grow by 170%, 2020). Two changes were observed during this period, the first one of which was the greater availability of resistance band due to the quick production process. The second change was the expansion of sales of resistance bands on online retail services. Combined with the governmental shutdown of sport facilities, people used the only available option left to continue workouts  do them at home.

Even though strict lockdown measures were lifted, the demand for resistance bands remained. The current market size for resistance band is over 200 million $ (Resistance bands market size, n.d.). Given the new-found popularity of home workouts, the demand for bands has remained. The only relevant policy that was implemented was that the government allowed sport facilities to reopen, but it did not reduce the demand for resistance bands. Instead, the market is now in equilibrium due to more people doing home workouts.

Altogether, it is evident that the pandemic has positively impacted the resistance bands market. If before the pandemic, the market size was 712.8 million $, now it worth more than 200 million $. Governmental shutdown of gyms had an indirect impact on the growth of home fitness equipment. The governmental response was ideal for the producers of resistance bands, because more people became aware of them and bought their products. Had the government decided not to close gyms, resistance bands suppliers would not have gained a sizable part of the consumer base, who preferred gym workouts.

References

Fitness equipment sales grow by 170% during coronavirus lockdown. (2020).

Joffe, M. (2020). How government-mandated gym closures hurt public health and the economy. Reason Foundation.

Randle, A. (2020). New York Citys kettlebell shortage: People are kind of freaking out. The New York Times.

Resistance bands market size | Global industry report, 2019-2025. (n.d.).

Nurses, like other professionals, progress through a series of stages of development that reflect their increasing ability to make sense of their work. Benners novice-to-expert model provides a framework for understanding how nurses develop their individualized care perceptions and practices. According to Benner, nurses move from novice to proficient to expert over the course of their careers (Ozdemir, 2019). Novices are new to the profession and have little clinical experience. They rely on rules and procedures to guide them in their work. Proficient nurses have more clinical experience and can apply knowledge and reasoning skills to their work. Experts are those who have reached the highest level of proficiency and can think critically and creatively in order to solve problems and make decisions under pressure (Baljoon et al., 2018). The article raises nurses knowledge of Benners Novice to Expert Model Perspective as a useful tool for developing their own unique care awareness and practices, as well as to shed light on nursing-specific research.

As a nurse, I have read the article and found it very helpful in understanding the theoretical foundation for the personalized approach to nursing care. I applied this theory in the past in a clinical setting when I had to care for an elderly patient struggling with dementia. I took the time to get to know her as a person and tried to understand her individual needs and preferences. This made it much easier for me to provide her with the best possible care. Similarly, the article states that nurses who exhibit holistic care behaviors have better patient outcomes. It also suggests that nurses need to be aware of their own biases and assumptions when providing care in order to provide personalized care to their patients. I had practiced this when I was handling an HIV/AIDs patient whose family and friends isolated following his condition.

After close engagement with the patient, I realized that he was suffering from stigmatization, I accepted him, and we became friends. I took care of Kennedy (patient) as a patient and as a brother; I accommodated him for two months during his recovering process. I subjected him to special meals since I felt that the meals provided in the hospital were not good enough. He needed more fruits while the hospital was only offering coffee and three slices of bread, while no family was ready to offer him financial help. The kind of attention I gave to Kennedy contributed to his faster healing and positive mindset; he currently works at Max Hospital in India in the guiding and counseling department. I know of many cases where some nurses mistreat HIV/AIDs and call them names, thus leading them to depression which slows down their healing process or death.

The article discusses how nurses are increasingly individualizing their care plans to meet their patients needs better. This caught my attention because it showed that nurses were taking on a more active role in patient care and not just following a set plan. This is important because it demonstrates the importance of personalized care and shows that nurses are willing to go above and beyond to make sure their patients receive the best possible care (Roy, 2018). It is also important because it highlights the importance of collaboration between nurses and doctors, which can lead to improved patient outcomes as well as nurses roles in patients recovering process.

Another thing that caught my attention was the authors discussion of the need for nurses to develop a personal understanding of how they construe their care. This is an important point, as it is essential for nurses to have a personal connection to their work in order to provide quality care. Nurses who take the time to reflect on their own caregiving beliefs and practices will be better equipped to provide individualized care that meets the needs of their patients. This point is also crucial since sit clarifies to the nurses that some of the patients may be dying not because of their ailments but due to nurses abusive personalities.

References

Baljoon, R. A., Banjar, H. E., & Banakhar, M. A. (2018). Nurses work motivation and the factors affecting it: A scoping review.International Journal of Nursing & Clinical Practices, vol. 5, no. 1, pp. 10-15. Web.

Ozdemir, N. G. (2019). The development of nurses individualized care perceptions and practices: Benners novice to expert model perspective.International Journal of Caring Sciences, vol. 12, no. 2, pp. 1279-1285. Web.

Roy C. (2018). Key issues in nursing theory: Developments, challenges, and future directions.Nursing Research, vol. 67, no. 2, pp. 8192. Web.

Among a large number of unresolved public health problems, those of the most significant research interest are those associated with chronic patient disease. One such pathophysiological condition is diabetes mellitus, which is a severe dysfunction of pancreatic activity. By 2014, about 8.5% of adults worldwide suffered from this condition, and this figure is on an increasing trend (World Health Organization, 2021). It should also be emphasized that diabetes mellitus includes two forms of manifestation, the first of which is associated with genetic mutations of the genes responsible for insulin biosynthesis and the second with gradual disruption of pancreatic activity. It is the second type that is a manifestation of a low-quality lifestyle, irrational diet, and low physical activity, manifesting as obesity (World Health Organization, 2021). Although there are general dietary and behavioral guidelines for patients with diabetes, most patients tend to ignore these rules (Jannoo et al., 2017). Consequently, there is an urgent need for the technical development of such an innovative device that would effectively combine the functions of a blood glucose sensor and effectively optimize diet and behavioral habits in real-time based on this metric.

By now, many of the worlds leading laboratories have come up with their unique designs to measure blood levels. The conservative local puncture blood collection is gradually being replaced by instruments that allow blood glucose concentrations to be measured without such fluid collection, that is, without the need to disturb the skin. The concepts of such most popular ideas consist of infrared sensing of this concentration in the type of spectroscopic measurements or isolation of intercellular fluid through hair follicles. In doing so, such devices are proposed to be attached to the skin either as a sticker or to be worn as an electronic watch.

The concept discussed in this proposal is qualitatively different from existing analogs because it is a non-invasive method of glucose sensing based on a unique combination of three types of measurements. First of all, it should be said that existing developments are generally not highly accurate and can create tangible measurement errors. In the case of diabetic patients, such measurement errors can be critical because a deviation of even a few percent of the sugar level can cause a hyperglycemic crisis. The proposed device combines Raman and infrared spectroscopy techniques and a pyroelectric sensor to monitor the slightest fluctuations in heat dissipated by the human body. In particular, the use of Raman spectroscopy is justified by the high value of the method in determining the chemical composition of blood without the need for a puncture. Thus, the laser beam of such a sensor penetrates through the skin to a depth of several millimeters and registers the light signal reflected from the intercellular fluid washing the cells. This data allows an indirect estimation of the glucose concentration in the blood. A similar method of operation underlies the infrared reading of sugar levels in the epidermis, and it should be understood that glucose produces one of the weakest signals when exposed to near-infrared radiation. In this case, it is necessary to choose such a place for signal collection, closely connected with blood vessels. Finally, the use of a pyroelectric sensor is tied to the idea of a micro increase in body temperature during the metabolic conversion of glucose into ATP energy. The microsensor makes it possible to monitor the dynamics of the internal body temperature and describe the glucose concentration in the blood according to the increase of this indicator.

The idea of combining three types of reading may seem like a technically complex solution, but it is the right strategy to cover the most pressing problem of non-invasive monitoring methods. In this case, all three sensors  two for optical measurement and one for temperature measurement are located on a compact electronic device the size of a coin, which the patient must attach to the inner surface of the lip for the duration of the reading. This location solves several issues at once, including the impermeability of light, which drowns out optical signals, as well as proximity to the bodys blood vessels. For convenience, the integrated sensor should have a wireless communication module that allows the measurement results to be linked to the app on the phone in real-time or with minimal signal delay. The interface of the application and its functionality are of secondary research interest. At the same time, it is clear that the combined use of the three sensing systems requires energy, so such a sensor must meet the following requirements:

1. A built-in rechargeable battery or storage battery.
2. IP67 or IP68 waterproof
3. Not heated during operation (if it heats up, the temperature ADC must correct for this)

References

Jannoo, Z., Wah, Y. B., Lazim, A. M., & Hassali, M. A. (2017). Examining diabetes distress, medication adherence, diabetes self-care activities, diabetes-specific quality of life and health-related quality of life among type 2 diabetes mellitus patients. Journal of Clinical & Translational Endocrinology, 9, 48-54.

World Health Organization (2021). Diabetes. Web.

As part of this course, health promotion strategies have been discussed, and a particular focus has been placed on the relationship between public health and the environment. The article The relationship between social cohesion and urban green space: An avenue for health promotion examines the impact of urban green spaces on the health behavior of citizens, which positively affects their psychological and physiological well-being (Jennings & Bamkole, 2019). The authors pay special attention to social cohesion as a factor of public health. Jennings and Bamkole (2019) conclude that increased social cohesion is positively associated with the psychological well-being of individuals. This factor can also support health-related behaviors such as decreased smoking, less alcohol consumption, and increased use of preventative healthcare services (Jennings & Bamkole, 2019, p. 3). On the contrary, socially isolated citizens are subject to greater stress, risk of depression, and cardiovascular disease. Social capital, that is, social networking and trust, is also an important health determinant. In particular, people less involved in social interactions tend to report poorer health outcomes (Jennings & Bamkole, 2019). In addition, residents of urban areas are susceptible to more stressors, which can also be associated with a negative impact on health.

The article also emphasizes that the context of place has a significant role in health promotion among urban residents. Social relationships can influence public health through social engagement, social support (e.g., perceived and actual), social influence (e.g., developing norms), access to information, and increased contact with others (Jennings & Bamkole, 2019, p. 3). Urban green spaces can be drivers of social networking and, as a consequence of cohesion. Additionally, they can promote increased physical activity and health behaviors. It is also important that urban green spaces as environmental factors are positively associated with a reduction in the level of stress (Jennings & Bamkole, 2019). The course also discussed determinants of health, among which factors such as mental health and environmental quality were noted. Thus, urban green spaces are directly related to health promotion strategies, as they allow improving psychological well-being, stimulating health behaviors through the aspects of the environment.

The main implication of the content of the article is the exploration of how urban green spaces affect public health promotion. In particular, the authors, through the theory of social cohesion and capital, explain the potential positive effects of these objects of the urban environment on both psychological and physical health. Significantly, at the community level, urban green spaces can also serve as means of intersection for different social and ethnic groups. This aspect also has an indirect positive effect on health promotion as it reduces social tension and associated stress. The article describes in sufficient detail both the features of urban green spaces and their relation to the health behaviors of citizens. However, the authors draw on theoretical evidence, focusing on examining research literature on social cohesion and capital. At the same time, the main flaw of the article may be the lack of empirical data that would be based on actual observations. It would be informative to utderstand how green spaces affect health promotion in practice. However, the authors indicate this direction of research in the future research section.

The authors could make the article better by doing at least a small but empirical study of one of the communities. As part of this experiment, they could explore the association between health promotion and urban green spaces. This could even be done by collecting quality data from the community. At the moment, the article, while providing important insights into the role of the urban environment on the health of citizens, provides an overview of the existing literature. Additionally, the focus on green space as a factor in social cohesion and social capital has not been fully disclosed. It would be better if the authors paid increased attention to the discussion of the direct relationship between environment and health, while determinants such as social cohesion, as well as social capital, could act as secondary.

The authors have provided quite comprehensive information on the relationship between the discussed concepts and health promotion. At the same time, information about which strategies and interventions in the context of the environment are used is probably missing. It would be helpful to learn about how existing organizations and governments are currently using different elements of the health promotion environment if this happens. In particular, the authors could expand the results presented in the article by discussing real or potential strategies. At the moment, the research lacks practical implications that could form the basis of health promotion. The article offers a fairly detailed theoretical framework but does not consider how it can be implemented in practice. Thus, the article contributes to knowledge of the relationship between the environment and health promotion rather than suggesting the design of specific interventions.

The article certainly has a connection with both my professional and personal life. First of all, I, as all urban residents, am part of the urban community. In this regard, it is important for me that the environment in which I live contributes to my health. The concepts presented in the article helped me to look differently at my daily life and think about my place in the community. Primarily, I consider my interaction within it and its influence on the development of the environment around me. I can probably experience increased stress due to the lack of relationships with both community members and the environment. Thus, I should pay increased attention to the development of my social networking. It is also important that I was also interested in further research on the role of urbanism in health promotion.

In terms of professional activity, as a specialist in the field of public health, after reading the article, I realize the importance of a holistic approach to health. As discussed in the course, the different areas of health are interrelated, which is well illustrated with social cohesion and capital. Such a link between proud green spaces, social interaction, and health outcomes is not obvious. Thus, for me, as a professional, it is important to realize how multifaceted factors are determinants of public health and what mechanisms lead to various influences. In particular, it was useful for me to find out exactly how the environment can affect human health and what factors matter. The correlation between the extent of social cohesion and possible stress was the most important insight for me. Professionals often talk about the importance of communicating with loved ones when discussing psychological health support. However, too little attention is paid to the position of a person within the community and social azimuth as the basis of psychological well-being.

Reference

Jennings, V., & Bamkole, O. (2019). The relationship between social cohesion and urban green space: An avenue for health promotion.International Journal of Environmental Research and Public Health, 16(3), 1-14.

Patient Information

Mrs. JM, 47, female, not identified

This paper aims to gather information from the patient to reveal the symptoms and review the body systems, which would allow for identifying differential diagnoses.

S

CC (chief complaint): pain and numbness in wrist and fingers

HPI: A 47-year-old woman presents with right wrist pain, complaining about numbness and tingling in the index, middle, and thumb fingers during the last 2 weeks. The patient has obesity and states that her complaints make her drop her hair styling equipment since she cannot hold them.

Location: wrist and fingers
Onset: 2 weeks ago
Character: tingling, numbness
Associated signs and symptoms: frustration, reduced grip strength
Timing: the symptoms are more pronounced in the evening
Exacerbating/ relieving factors: overuse of the hand make the symptoms worse
Severity: 5/10 pain scale

Current Medications: Metformin to reduce weight (2,000 mg daily), Ibuprofen occasionally for headache treatment

Allergies: Aspirin causes anaphylaxis

PMHx: Influenza immunization (Fall 2020), Tetanus vaccination (8 years ago)

Soc Hx: Mrs. JM is married and works as a hair dresser for the last 15 years. She has 3 grown-up children, one of which lives with her, and others have their own families; all the family members live in the same city; their relationships are good. The patient drinks alcohol on weekends with her husband and friends. Mrs. JMs living environment seems to be appropriate as she reports that she has awesome neighbors and a beautiful house.

Fam Hx: Hypertension and heart attacks are present among grandparents. The patients mother and father are alive and suffer from hypertension as well.

ROS

GENERAL: The patient states that she had no recent diseases, rapid weight loss or gain, and weakness, and fevers, but she recognizes that she has excessive weight.
HEENT: Eyes: Wears contact lenses for astigmatism and myopia. Ears, Nose, Throat: hearing is intact; the patient denies having running nose, sore throat, and congestion.
SKIN: Mrs. JM complains about age-related changes only (wrinkles, skin elasticity).
CARDIOVASCULAR: No palpitations and edema; the patient denies chest pain and any related symptoms.
RESPIRATORY: No issues regarding breathing.
GASTROINTESTINAL: The patient has frequent problems with constipation that is accompanied by pain in her intestines.
GENITOURINARY: No burning on urination, no pregnancy; last menstrual period 12/20/2020.
NEUROLOGICAL: Headache appears several times per week; numbness and tingling in the extremities (right wrist only). Bladder and bowel control is adequate.
MUSCULOSKELETAL: No arthritis, traumas, gut, or any muscle pain in the back.
HEMATOLOGIC: No bleeding disorders, blood transfusion, and clotting problems.
LYMPHATICS: Nodes are intact.
PSYCHIATRIC: Mrs. JM has a history of depression when her husband was severely traumatized in a car accident 5 years ago.
ENDOCRINOLOGIC: No endocrine disorders and hormonal therapies; the patient denies polyuria and polydipsia.
ALLERGIES: No asthma, eczema, or hives.

O

Physical exam

Vital Signs: Vital signs: B/P 140/80, right arm, sitting; P 80 (regular); T 98.1 orally; RR 16; Wt: 245 lbs; Ht: 59; BMI 36

GENERAL: The patient is alert and oriented; seems to be mildly uncomfortable and anxious because she cannot yet understand her current condition.
NEUROLOGICAL: The patient is frustrated yet well-oriented (answers all the questions with understanding); her reflexes are symmetric; she is able to maintain balance with closed eyes.
MUSCULOSKELETAL: Numbness and tingling on the right wrist and three fingers only ().

Diagnostic results

Carpal tunnel compression test (Durkans test): the compression of the right wrist in the area of the median nerve passage within 30 seconds causes numbness and pain in half of the fingers of the hand, which means that the test is positive (Padua et al., 2016).

Tinel test: the tapping with a neurological hammer on the right wrist (over the place where the median nerve passes) causes a tingling sensation in the fingers and radiation of pain to the fingers (Vahed et al., 2018). In this patient, pain is not felt in the tapping area, but tingling is present.

Ultrasound of the right wrist: It is the most widespread peripheral nerve entrapment (Vahed et al., 2018). The ultrasound revealed the disappearance of median nerve areas in the right wrist of the patient, as well as hypo echogenicity of the involved nerve, which points to the carpal tunnel syndrome.

A

Differential Diagnoses

1. Carpal tunnel syndrome. It is quite common in women between the ages of 30 and 50. The risk factors include rheumatoid arthritis or other types of wrist arthritis. According to Padua et al. (2016), the work that requires multiple flexion and extension movements in the wrist plays a role. The symptoms of carpal tunnel syndrome include pain in the arm and wrist, which is characterized by tingling and numbness and usually distributed along the median nerve, but possibly involving the entire arm (Padua et al., 2016).
2. Arthritis of the carpometacarpal (CMC) joint. In this pathology, the articular cartilage between the first metacarpal bone and the trapezium bone is damaged. Constant pain, inflammation, and stiffness at the base of the thumb are the main symptoms (Donato et al., 2019). Mrs. JM lacks a characteristic manifestation of arthritis that is pain during rotation and pressure of the first metacarpal bone towards the wrist (Donato et al., 2019). During this movement, the patient does not feel unpleasant sensations of friction between bone and bone.
3. Cervical radiculopathy (C6). In this case, reflex, sensory, and motor changes are associated with neck pain, while, in carpal tunnel syndrome, these changes are limited to distal manifestations, which is characteristic for the given patient (Thoomes et al., 2018).
4. Diabetic polyneuropathy. It is usually a bilateral, symmetrical process involving other nerves (not just the median). The peripheral nervous system is affected, namely, the nerves that go to the trunk, limbs, and head. Since the loss of skin sensitivity to temperature and night pains are not mentioned by the patient, quantitative sensory testing is necessary to exclude this diagnosis. This method becomes popular globally as it allows accurately determining the state of the sensory nerves, taking into account the individual characteristics of the patient (Ponirakis et al., 2016).
5. Flexor carpi radialis tenosynovitis. As stated by Bolles et al. (2016), this disease clinically mimics carpal tunnel syndrome. However, it also presents some swelling on the back of the wrist joint, which is absent in this patient. Differential diagnosis is carried out through several sessions of ultrasound and controlling laboratory tests.

Primary diagnosis: Carpal tunnel syndrome.

To conclude, this SOAP analysis shows that Mrs. JMs primary diagnosis is carpal tunnel syndrome, which was established based on her complaints, objective examination, and diagnostic tests. The review of the relevant literature allows for creating a list of differential diagnoses that should be taken into account while treating the patient and monitoring the progress and future symptoms. Mrs. JM should be clearly explained about her diagnosis and its future manifestations, while the risk factors, such as obesity, her profession, and family history, should also be clarified, which is important to address the patients frustration and anxiety about her health.

References

Bolles, C. L., Abdella, A., & Battaglia, P. J. (2020). Flexor carpi radialis tenosynovitis mimicking carpal tunnel syndrome diagnosed and monitored with ultrasound: Case report. SN Comprehensive Clinical Medicine, 2, 797-801.

Donato, D., Abunimer, A. M., Abou-Al-Shaar, H., Willcockson, J., Frazer, L., & Mahan, M. A. (2019). First carpometacarpal joint denervation for primary osteoarthritis: Technique and outcomes. World Neurosurgery, 122, 1374-1380.

Padua, L., Coraci, D., Erra, C., Pazzaglia, C., Paolasso, I., Loreti, C.,& & Hobson-Webb, L. D. (2016). Carpal tunnel syndrome: Clinical features, diagnosis, and management. The Lancet Neurology, 15(12), 1273-1284.

Ponirakis, G., Odriozola, M. N., Odriozola, S., Petropoulos, I. N., Azmi, S., Fadavi, H.,& & Malik, R. A. (2016). NerveCheck: An inexpensive quantitative sensory testing device for patients with diabetic neuropathy. Diabetes Research and Clinical Practice, 113, 101-107.

Thoomes, E. J., van Geest, S., van der Windt, D. A., Falla, D., Verhagen, A. P., Koes, B. W.,& & Vleggeert-Lankamp, C. L. (2018). Value of physical tests in diagnosing cervical radiculopathy: A systematic review. The Spine Journal, 18(1), 179-189.

Vahed, L. K., Arianpur, A., Gharedaghi, M., & Rezaei, H. (2018). Ultrasound as a diagnostic tool in the investigation of patients with carpal tunnel syndrome. European Journal of Translational Myology, 28(2), 193-197.

Summary

Martha Rogers (19141994) was a professional nurse who devoted much of her life to researching and publishing theories and theses related to nursing techniques development. She designed the introductory theoretical foundations of nursing and advanced innovative views on patient perception and treatment. She is widely known in the medical area for her Theory of Unitary Human Beings. Martha had an innovative idea to transform the concept of nursing. Together with other professionals of the time, she changed the understanding of the medical field and how it functions. The significance and scope of her theory have considerably contributed to the patients care and the quality of life of medical personnel (Butcher, 2021). However, some aspects of the treatment approach still require further study in theory and practice.

The Objective of the Theory Development

The theory that Rogers was working on concentrates on how nurses see their work, the way they perceive their duties and assist patients. The Theory of Unitary Human Beings was supposed to demonstrate that the environment and persons interactions with it affect them in multiple diverse ways, creating a holistic unitary system. Patients primarily respond according to their environment and highly depend on its specific patterns. The environment has a direct impact on health and wellbeing (Maki & DeVon, 2018). In the right circumstances, it positively contributes to the creation of conditions in which the patient and other people live and interact in harmony.

The Introduction into the Theory

Rogers theory states that the person and the environment are considered to be related energy fields. Each environmental domain is individually specific to each human energy field. Rogers confirmed these two concepts constantly change, influencing each other. The energy field of a person allows him to interact with the environment and shift in intensity, density, and degree. Medical staff is supposed to analyze and adjust all the circumstances and help drive positive transformation. A patient care, in this case, focuses on human interaction and goes far beyond the classic understanding of medicine. Nurses are encouraged to use both traditional treatment methods and bioenergetics. Most of the strategies are non-tactile and are aimed solely at maintaining a proper psycho-emotional state of the patient. The theory may include techniques such as meditation, color therapy, music, and other non-surgical and procedural procedures (Maki & DeVon ,2018). It can be a valid addition to traditional medicine to calm the patient.

The Theory Principles

Rogers theory is known as the science of individuals. Its main principles include the following:

• Nursing is both a science and an art; the uniqueness of nursing, like any other science, lies in studying and researching the phenomenon
• Nurses longstanding concern for people and the world they live in is a natural precursor to an organized abstract system that embraces people and their environment.
• The irreducible nature of individuals is greater than the sum of the parts.
• The integrality of people and environments that coordinate with the multidimensional universe of open systems points to the identity of nursing as a science.
• The purpose of nursing is to promote the health and well-being of all people, wherever they are.
• The science of a unitary person is based on the idea that man and the environment are energy fields, which are characterized by four-dimensionality  a non-linear area without spatial or temporal attributes (Malinski, 2018).

Despite the amount of scientific background, a large number of studies, and consistent analyses, the theory still demands comprehensive interrogation and additional exploitation by the specialists.

The Non-Contact Massage as an Example of Technique

Non-contact massage is usually taught and performed in a sequence of four steps. The procedure is sometimes called the yoga of the mind and is recommended in case of severe stress and inner imbalance. To prepare for the session, the healer must enter an intuitive state of consciousness in which he is relaxed and calm. The healer places his hands 2-4 inches away from the patients body and slowly scans the patient from head to toe, intuitively looking for areas of imbalance in the energy field. Painful areas, places of accumulated tension or inflammation are perceived by the hands in the form of tingling, increased pressure or pulsation, heat, or cold. These sensations indicate a blockage or excess energy. Then the movements of the hands become more active, and the healer makes wide circles to distribute the energy (Malinski, 2018). It is followed by the next step, modulation, which consists in moving the subtle healing energy from the healer to the patient or changing the direction of the flow of the patients energy.

The Attitude to Massage as a Procedure

The non-contact massage session ends when the healer intuitively feels that the patients energies have come into balance. As a rule, the procedure lasts five to fifteen minutes after the start of the session. Proponents of the method claim that almost everything can be achieved with it. From calming a crying baby and relieving a headache to lowering blood pressure and increasing hemoglobin levels. To the delight of adherents of a holistic worldview, this technique does not invade the human body, although this statement seems very doubtful to many. Using Rogers conceptual model of seeing people as an energy field, a generation of students have studied clairvoyance, precognition, oriental mysticism, and out-of-body experiences in addition to non-contact massage (Phillips, 2019). At the moment, the method is still distrusted due to the lack of data and practical research.

The Outcomes for the Medical Field

Early in the history of nursing, there was little formal knowledge about nursing. Nursing education has evolved, and the categorization of knowledge has led to the development of nursing theory that helps nurses evaluate increasingly stressful situations for clients. Nursing theory is a creative and rigorous structuring of ideas that project a preliminary, complex, and systematic view of phenomena. Through systems research, nurses gather the knowledge needed to detect cases. The theory of the unitary person has a great influence on the whole treatment process. It severely changed the approach to the human body, created a special connection between patient and staff, and took the patient experience to the next level. The theory implies the well-being of the patients and medical staff, which is frequently operating under severe conditions and much pressure. Constant overwork, nervous tension, and ongoing stress negatively affect the well-being and actions of nurses, which can be transmitted to patients. The theory of the unitary person takes into account all aspects and energies that affect the patient, including the medical staff (Phillips, 2019). It helps achieve a more effective treatment process and fulfillment for both parties.

References

Butcher, H. K. (2021). Unitariology: Theories and concepts derived from Rogers science of unitary human beings.Iowa Pressbooks. Web.

Maki, K. A., & DeVon, H. A. (2018). A nursing theory-guided framework for genetic and epigenetic research. Nursing inquiry, 25(3). e12238. Web.

Malinski, V. (2018). The importance of a nursing theoretical framework for nursing practice: Rogers science of unitary human beings and Barretts theory of knowing participation in change as exemplars. Cultura Del Cuidado, 15(2), 613. Web.

Phillips, J. R. (2019). Unitariology and the changing frontiers of the science of unitary human beings.Nursing Science Quarterly, 32(3), 207213. Web.

What additional information (e.g., clinical findings, laboratory test results) will confirm the diagnosis?

In addition to tenderness, patients often present with joint stiffness and swelling. This is because the condition is common in young athletes who overuse specific joints and inefficient biomechanics resulting from inflammatory systemic diseases or microtrauma (Bellew et al., 2017). In most patients, there is notable erythema on the skin overlying the tendon on the affected foot (Burke, 2019). Some cases are characterized by symmetric enlargement and baseline contracture of the posterior tibial tendon (Ray et al., 2021). It is worth noting that while plain film radiographs may show no evidence of fractures, there may be signs of inflammation, such as periosteal reaction and synovial membrane calcification (Ray et al., 2021). Ultrasonographic features such as thickening of the tension and accumulation of peritendinous fluid can confirm the diagnosis (Bellew et al., 2017). In addition, specific markers associated with autoimmune illnesses may help identify the illness.

What are your differential diagnoses for this patient?

The differential diagnoses include posterior tibial tendon dysfunction, inflammatory arthritis, traumatic disruption of midfoot ligaments, and Charcot arthropathy.

What is your likely diagnosis?

The likely diagnosis for this case is posterior tibial tendon tenosynovitis.

What is (are) the desired treatment outcome(s)?

It is expected that after completing treatment, the patient will resume normal activities without pain. Most patients experience complete relief within 6 to 10 weeks of treatment (Ray et al., 2021). Patients typically regain the full range of motion in the affected joints.

What non-pharmacological therapy would you recommend?

Non-pharmacological treatments are often used in the management of the disease. For instance, mechanical offloading of the affected tendon can be accomplished using custom-molded orthotics or ankle braces with deep heel cups and the required medial wedging (Whitney, 2019). Other treatment modalities include splinting and the use of cold or heated packs. Transcutaneous electrical nerve stimulation is commonly used to relieve pain. However, it should be noted that the procedure may cause skin irritation in situations where the current is high.

How would your pharmacotherapeutic plan differ based on special population patients (such as children, obstetrics, geriatrics, etc.)?

The mainstay of treatment in posterior tendon tenosynovitis is the administration of non-steroidal anti-inflammatory drugs and glucocorticoid injections. The latter are contraindicated in patients with cardiovascular diseases such as coronary heart disease. For instance, patients taking more than 7.5mg of prednisone daily have a high risk of developing myocardial infarction, heart failure, and angina (Alan & Alan, 2018). Individuals with a history of pre-diabetes or diabetes should avoid the use of glucocorticoids because these medications cause exaggerated post-prandial hyperglycemia and lead to reduced sensitivity to exogenous insulin (Alan & Alan, 2018). It is advisable to limit the use of these drugs in the elderly population because they cause secondary osteoporosis. It is vital to note that this class of drugs increases fracture risk in both men and women. Elderly individuals on glucocorticoid treatment have a 26-fold higher risk of developing vertebral fractures than younger individuals (Alan & Alan, 2018). Individuals with compromised immune systems should use glucocorticoids with caution. This is because treatment with these drugs leads to immune suppression, which increases susceptibility to infections.

Children are adversely affected when subjected to treatment with the aforementioned category of drugs. For instance, they suffer adrenal insufficiency caused by the suppression of the hypothalamic-pituitary-adrenal axis. This inevitably triggers adrenal cortical atrophy and insufficiency, which negatively impacts the affected individuals health (Alan & Alan, 2018). Non-steroidal inflammatory medications should be avoided in patients with gastroesophageal reflux disease since they may lead to gastric and ileal ulceration.

What pharmacotherapeutic plan (include prescription and non-prescription drugs) would you design for this patient (specific to the chapter you are currently reading)?

The first step of treatment involves conservative management with non-steroidal anti-inflammatory medications such as naproxen. In addition, glucocorticoid injections are administered to affected individuals to relieve inflammation. This step is taken in individuals who are poorly responsive to non-steroidal anti-inflammatory drug therapy. In the event the patient does not respond to disease-modifying antirheumatic drugs, surgery is considered after three to six months of treatment (Ray et al., 2021). Surgery involves debridement of inflammatory tissues and decompression of the implicated tendons.

The rationale for pharmacotherapy to include mechanism(s) of action list drug(s), dose, route of administration, frequency, duration of treatment, and one monitoring parameter.

Mild to moderate cases of tenosynovitis should be managed using non-steroidal anti-inflammatory (NSAID) medications. Orally administered naproxen at 550 mg twice daily is sufficient to manage the pain and inflammatory symptoms associated with the illness. NSAIDs are effective in view of the fact that they decrease soft tissue swelling and inflammation, thus alleviating nerve compression. In addition, they accelerate healing by facilitating the formation of cross-linkages between collagen fibers in the affected tissues (Nainwal & Arunmozhi, 2020). Glucorcoticoid sheath injections can be administered to patients in severe pain with poor response to NSAIDs. 100-500 mg of Hydrocortisone acetate is often administered intramuscularly depending on the inflammatory processs severity. These drugs inhibit inflammation by limiting prostaglandin synthesis and stopping the migration of white blood cells to the injured areas (Nainwal & Arunmozhi, 2020). However, these medications also inhibit collagen synthesis and may weaken the affected tendon.

What are the clinically significant adverse effects and drug interactions for the agents discussed?

Glucocorticoids cause a variety of adverse effects when used in the management of tenosynovitis. For instance, they have been implicated in depressing the immune system, diabetes, hypertension, and dyslipidemia (Alan & Alan, 2018). In addition, they cause weight gain, reduce insulin sensitivity, and may cause osteoporosis. Naproxen is an NSAID that may cause headaches, visual changes, and ringing in the ears. In addition, it may predispose susceptible individuals to the development of peptic ulcer disease.

How will you monitor the patients response to therapy?

Response to therapy can be monitored by conducting a repeat ultrasound to observe the resolution of symptoms. Reduced tendon thickening and the absence of echotexture changes are indicative of improvement (Ray et al., 2021). In addition, magnetic resonance imaging can be used to identify reduced fluid collection around the tendon (Whitney, 2019). The resolution or aggravation of clinical features is an effective modality for monitoring progress. Patients should progressively regain full functionality of the affected joint and experience a reduction in pain and swelling. It is vital to prevent and assess for the development of the stenosing form of tenosynovitis that causes flexion deformities and chronic contractures that may require surgical intervention (Ray et al., 2021). Finally, range of motion exercises may be used to assess the degree of healing.

How will you counsel your patient about the pharmacotherapeutic plan?

It is vital to highlight the mechanism of action and side effects associated with each of the drugs administered. This is vital because it will allow the client to differentiate between the symptoms associated with the disease and the sensations caused by the administered medicine. The patient must understand the importance of adhering to the outlined schedule because it determines how quickly they will recover. It is important to note that medical treatment goes hand in hand with specific behavioral changes. For instance, the affected joint must be rested, and the nature of the activity re-evaluated to find better and safer ways of exercising or running. The patient must also be advised to report worsening symptoms so that the medication may be altered or alternative modalities of treatment explored. Finally, it is crucial to inform the patient on when to stop treatment to avoid drug-related complications.

References

Alan, I. S., & Alan, B. (2018). Side effects of glucocorticoids. In Pharmacokinetics and Adverse Effects of Drugs  Mechanisms and Risks Factors. InTech.

Bellew, S., Colbenson, K., & Bellamkonda, V. (2017). Posterior tibial tendon tenosynovitis diagnosed by point-of-care ultrasound. Clinical Practice and Cases in Emergency Medicine, 1(4), 439440.

Burke, D. (2019). Tendon sheath inflammation (tenosynovitis). Healthline. Web.

Nainwal, D., & Arunmozhi, R. (2020). A literature review on De-Quervains tenosynovitis. International Journal of Advanced Research, 8(7), 824835.

Ray, G., Sandean, D. P., & Tall, M. A. (2021). Tenosynovitis  . StatPearls  NCBI Bookshelf. Web.

Whitney, K. A. (2019). Tibialis posterior tendinosis and Tibialis posterior tenosynovitis: Musculoskeletal and connective tissue disorders. MSD Manual: Professional Edition. Web.

Introduction

An Advanced Practice Nurse (APN) is a full-time nurse with specific training. These nurses work as general practitioners in hospitals and independently diagnose and treat patients. APN status is obtained through specialized education, extensive practice, and efficient patient care skills (Hu & Forgeron, 2018). They not only deal with ordinary cases but observe patients in severe lifelong conditions for many years. Advanced practice nurses have a lot of obligations and are accountable for a more comprehensive health area. They need the ability to adapt quickly and effectively manage the disease through pharmacological knowledge and appropriate treatments.

The Importance of Dexterity and Other APN Characteristics for Disease Management

Nurse practitioners are trained in the examination and treatment of general illnesses. During their extensive education program and practice in a healthcare system, APN learns how to work within the best treatment modalities for comprehensive and systematic disease management. This approach is already more relevant to the role of the doctor, but still, the services of a nurse in this position prevail. In the case of chronic diseases, nurses in the status of AP are involved in the process of treatment. This particular level requires decent dexterity and professionalism to move from regular patients to more complex cases instantly. It demands a high speed of adaptation and readiness for potentially stressful circumstances. APN might perform an important role in hospitals, schools, clinics, and long-term rehabilitation facilities. They operate as a diagnostic therapist and work as a link between the assigned specialist and the patient (Parker & Hill, 2017). These responsibilities demand such characteristics as versatility, flexibility, and stress tolerance. Thanks to self-discipline, high professionalism, and patience, nurse practitioners treat, diagnose and monitor patients according to the highest treatment modalities.

Responsibilities of an APN and Features of Work with Chronic Diseases

APN has the essential authority to examine and diagnose patients, track laboratory tests, record patients data, and participate in studies for research purposes. They also provide family counseling and referrals of patients to other health facilities if needed. All duties are accompanied by greater responsibility not only for their work but also for the quality of work of junior staff. APN performs diagnostic, therapeutic, and even administrative functions. Some cases might require additional professional skills, practice, and knowledge, specifically, when it comes to critical patients in long-term critical conditions (Goldsberry, 2018). This category of people is especially vulnerable and requires additional help and care. In this case, nursing practitioners need narrow-focused pharmacological knowledge of appropriate medical equipment, drugs, and treatment approaches. The development of a support and treatment program rests with the practitioner and APN, who are assigned to such a patient for an extensive time. The nurses set up an effective plan and help to determine the fittest treatment. In critical cases, treatment is carried out at home using the necessary equipment brought in, such as droppers, inhalers, oxygen masks.

Conclusion

APN nurses are an integral part of the healthcare industry due to their exceptional practice and multitasking ability. This position requires highly professional and efficient work with patients of different categories and conditions. Nurse practitioners are considered valuable personnel, they are mainly involved in specific cases requiring additional experience and education. A job of this level is impracticable without a high-quality medical education and proper specialized training. It is also necessary to consider the high workload of the medical sector, which can only be dealt with high adaptability and experience. Specific work algorithms and systemic checks of the organizations effectiveness are also aimed to minimize failures in diagnostics and risks in treatment.

References

Goldsberry, J. W. (2018). Advanced practice nurses leading the way: Interprofessional collaboration. Nurse Education Today, 65, 13.

Hu, J., & Forgeron, P. (2018). Thinking, educating, acting: Developing advanced practice nursing. The National Center for Biotechnology Information, 5(2), 99100.

Parker, J. M., & Hill, M. N. (2017). A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong Special Administrative Region (SAR), China. International Journal of Nursing Sciences, 4(2), 196204.

The article, Perspectives on the Delegation of Hygienic Care in the Context of Home Nursing: A Qualitative Study, is written by Dumitrescu et al. In this article, the authors conduct a study to determine how hygienic care delegation takes place in-home nursing (Dumitrescu et al., 2018). In todays healthcare systems, practices have evolved, including attending to patients in their homes. Similarly, nurses roles have changed to include delegating care to health care assistants, and hygiene is considered a vital component of nursing. The authors focused on understanding personal care, exploring home nurses experience concerning the delegation, and determining criteria that home nurses use to delegate or monitor services. The key points to be covered in this paper include professional delegation, hygienic care, and barriers to providing better care.

Professional delegation refers to a process by which a healthcare worker who owns legal authority to carry out controlled acts transfers their authority to another person. In most cases, nursing diagnostic practices are the basis for personal care delegation. From the study, the authors mention that the most common approach involves assessing a persons situation and needs per the diagnosis or nursing indicators (Dumitrescu et al., 2018). During delegation of nursing tasks, it is reported that the person who authorizes remains accountable despite the personal care involved. Authors report that the most common criterion for delegation used is a close collaboration between care providers.

Hygienic care refers to a cyclical care process where nurses continually invest in relationships with patients, assess their needs, and take necessary actions. The care process at home and its delivery should be mutually agreed upon with patients considering the environment or lifestyles. The author reveals that the decision to delegate hygienic care depends on assessments of patients needs using indicators or diagnoses (Dumitrescu et al., 2018). In nursing practice, hygienic care is essential and should be delated to assistants with apparent supervision.

Delegation of personal care can be hindered by factors such as financial and legal constraints identified by the authors (Dumitrescu et al., 2018). Care from community services incurs expenses to patients such that they might refuse services because the national insurance caters to nursing care at home. Also, community support and home care nursing have different jurisdictions: hence, the former cannot be integrated by the home nursing team, and a lack of proper supervision occur impeding communications

Personal care is a vital component of in-home nursing, and it is the basis on which professionals can establish positive relationships with patients, families, and the community. In my experience, home nursing care does not improve without the development of trust between patients and professionals. Once a bond has been established, it becomes possible to add value through observation, assessments, and evaluation of situations from a nursing perspective. However, effective delivery of personal care cannot be met with inappropriate delegations. For example, from a professional experience, I have witnessed situations where nurses failed to meet outcomes due to delegation of tasks that required too much supervision. From my perspective, effective delegation of hygienic care should be done while utilizing the five basic rights: right tasks, circumstances, person, supervision, and communication.

To conclude, this paper addressed professional delegation, hygienic care, and barriers to better care as key points identified in the article. Personal care should be delegated under well-defined conditions, bearing in mind that trust-building and collaboration are of significant importance for patients wellbeing. Hence for home nursing to be effective, appropriate delegation needs to be considered since it will determine the quality of service patients might receive.

Reference

Dumitrescu, I., De Vliegher, K., Maigre, A., Peters, E., Putzeys, D., & Cordyn, S. (2018). Perspectives on the delegation of hygienic care in the context of home nursing: A qualitative study. British Journal of Community Nursing, 23(5), 240-247. Web.