Trauma is an abnormal emotional response to specific situations and occurrences with long-lasting effects, which impair ones ability to lead a healthy and happy life. A crisis can be defined as a period or point in time, which lacks stability and safety, rendering them dangerous to the affected communities or individuals (Van der Kolk, 2014). Trauma informed schools could be identified as one of the crisis intervention and suicide prevention frameworks designed to promote a higher degree of attentiveness and trauma awareness among key school or community figures, such as staff, teachers, administrators, and even parents.
The effects of crises, disasters, and other trauma causing events can manifest themselves differently on the basis of the overall setting. For example, highly impactful settings can promote and facilitate a more severe case of traumatic experience, whereas less impactful conditions result in milder consequences and complications. In other words, the impact of crises, disasters, and other trauma-causing events is substantial since the effects can be long-lasting and even permanent. For instance, children can be considered as the most impressionable, and thus, vulnerable groups, whose trauma can severely impair their development, making them prone to other problems, such as depression, drug abuse, or suicidality (Van der Kolk, 2014). The key principles of crisis interventions are victim stabilization, understanding facilitation, problem solving, and self-reliance promotion. Therefore, it is important to be quick at identifying the victims and stabilizing their reaction towards an event, which is followed by more informative principles of improving the general understanding of the situation. Thirdly, the focus needs to be put potential solutions to the issue at hand, where the last stage is the encouragement of self-reliance and autonomy.
References
Van der Kolk, B. A. (2014). The body keeps the score: Brain, Mind, and body in the healing of trauma. Viking Penguin.
Symptoms and Intensity that Would Indicate a Consultation May Be Appropriate
Moderate and severe depression are the most often types of disorders for which antidepressants are described. The list of other diagnoses include bipolar disorder, obsessive-compulsive disorder, and panic attacks with general symptoms. The symptoms which would indicate that a consultation may be appropriate include a state of persistently bad mood (at least two weeks), which may be accompanied by apathy, low activity, and inability to enjoy or be interested in something. Often, other manifestations involve difficulty to concentrate and engage in usual activities, impairment of sleep and appetite, reduction of self-esteem and libido, and the increase in the feeling of guilt. The symptoms have to be present almost daily, most of the day, and at least two weeks (Seretti, 2018). At the same time, one symptome may be more persistent than others and an individual can have related complaints about anxiety, somatic issues, and pain.
Side Effects
The main side effects of antidepressants include anticholinergic disorders of the central and autonomic nervous system, cardiovascular system, complications from the hematopoietic organs, metabolic, endocrine disorders (changes in body weight, dysfunction of the genital area, allergic reactions) (Seretti, 2018). Side effects often appear at the initial stages of treatment (in the first two weeks) and sometimes persist for 3-4 weeks of therapy, and then undergo a reverse development. With more persistent and at the same time pronounced violations, a decrease in doses is indicated, and, if necessary, cessation of therapy.
Potential Benefits a Partner or Family Member May Notice
A partner or family member may notice a beneficial change in the individuals behavior. For example, in the treatment of depression, over time, the person begins to experience positive and negative emotions, which are usually dulled with this disorder. Antidepressants, unlike antipsychotics or other drugs that are used in psychiatry, cannot lead to lethargy or emotionlessness, but they do have other side effects. For example, a person may experience anxiety, and some begin to feel sleepy all the time; others find it challenging to control yawning. Sometimes changing the drug is sufficient, and the side effects go away.
Reference
Serretti, A. (2018). The present and future of precision medicine in psychiatry: focus on clinical psychopharmacology of antidepressants. Clinical Psychopharmacology and Neuroscience, 16(1), 1-6.
There are several reasons why the consultation can be dysfunctional. The doctor has the most responsibility for the atmosphere during the communication with the patient, and although sometimes extraordinary situations can happen, they usually lead the process. It is essential to consider that if the doctor starts performing poorly more often than usual, the root may be their disappointment in the job.
Main body
Continuously leads to a lack of motivation to try hard and build a healthy connection with patients. Moreover, it makes mistakes during the appointment while making diagnoses. According to Robida (2019), Such a system will eventually lead to intellectual and professional dishonesty; professionals will feel more pressure to cover up mistakes rather than discussing them openly and learning from them (p. 2). Therefore, a constant bad mood affects patients, causes negative impressions, and builds a bad reputation for the doctor. In turn, complaints start to appear more often, contributing to the negative public opinion of the doctor, and it can cause the rise in some harsh situations between the doctors and the patients. Every reason is connected, and while identifying the cause of the poor doctors performance, it is significant to consider the aggregate of facts.
Conclusion
In conclusion, the specialist should constantly study and practice to gain professional consultation skills because it only comes with experience. The doctor should be able to connect with the patient to start an open and honest dialogue. The best way is to communicate as partners who work together and discuss possible ideas and solutions. The doctor develops a personalized approach to the patient and works specifically on solving his or her problem. Thus, by creating a healthy environment, it becomes possible to improve the quality and productivity of consultations.
Reference
Robida, A. S. (2019). Failed Attempt to Improve a Decision Process in Pediatric Cardiac Service: Dysfunctional Organizational and Safety Culture. Austin Crit Care Case Rep, 3(1), 1014.
While the overall situation with healthcare in Gold Coast City and Australia, in general, is much better than in the world in total, there are still unresolved issues. Among them, this is a problem with inequity among Aboriginal and other native populations, which usually have less health literacy and limited access to healthcare (Pearson et al., 2020). In addition, Australia lacks specific policies for a healthy city environment (Lowe et al., 2020). In that way, the main issues are racial inequity and lack of clear policies; the experience of the Alliance for Healthy Cities can help with that.
Gold Coast City Policies
Among the 29 examined documents, 00 are the policies and 00 plans and strategies. Other 00 are licenses, reports, public information bulletins, or contests. For example, there is an ongoing contest Safer Suburbs, which proposes awards to those who help maintain the Golden Coast suburbs safer, as safety is one of the social determinants of health (Gold Coast City Council, 2021). According to the HEART approach, based on the World Health Organization (2010) book, there are four core indicators of health outcome: physical environment and infrastructure, social and human development, governance, and economics. The mentioned contest contributes to social development, increasing safety.
Other documents that contribute to human and social development are the Public Art Plan of the Gold Coast, Culture strategy, Community engagement plan; they all either promote culture or engage community members in beneficial actions. Other examples are Work Health and Safety Policy, Bus Stop disability access upgrade, Smoking in the workplace policy, Accessible & Inclusive City Action Plan, Domestic violence Action Plan, and Housing and homelessness policy. They ensure and maintain order in social life and help those who need it, such as homeless and violence victims. Bus Stop disability access upgrade is an example of both social and infrastructure policy, as it improves infrastructure and helps disabled people to live. City of Gold Coast Annual Report 2020-2021 Roads to Recovery is the report that shows the communitys health status, also contributing to human development.
Those documents that contribute to economics are Controlled Entities Policy, Entertainment and Hospitality Expenditure Policy & Procedures, and Community Grants Policy, which also connected with social development, as it proposes grants for social initiatives. Concession for water Usage by renal dialysis patients dialysing at home is another social and economic policy. It ensures rational water usage and helps patients who need renal dialysis. Economic Development International plan and Council of the City of Gold Coast annual plan are both financial plans that ensure rational cost expenditures and investments. Major events Gold Coast annual report is a report about government spending on significant events for each year; thus, it contributes to economics and governance.
Documents that contribute to infrastructure are the Gold Coast road safety plan, Park Usage Policy, Stormwater drainage management plan, Gold Coast city Transport strategy, Gold Coast water strategy, Our natural city strategy. They all direct the development of different infrastructure elements, such as parks, roads, a clean environment, and water access, providing good living conditions for people. Active Transport Plan, Traffic calming Devices policy, and Swimming pool licence are other examples that contribute to infrastructure development. An example of a governance document is Litter and illegal dumbing reduction plan. Other examples are different policies that direct or forbid something, such as Smoking in the workplace policy.
Alliance for Healthy Cities
The Alliance is an international structure, essential for providing healthcare and successful in many ways. Its experience in supplying and implementing policies to ensure health equity is vital for healthcare organisations and governments on different levels because it shows how to create networks between cities (Acuto et al., 2016). One of the main successes of the Alliance is that the good-working policies in the one city that belongs to the Alliance are implemented in other cities. It creates the synergic effect, increasing healthcare quality in all Alliance cities instead of only one (Alliance for healthy cities, 2021). SPIRIT framework, which stands for Setting and Sustainability, Political commitment and Policy, Information and Innovation, Research and Resources, Infrastructure and Intersectoral, and Training, is an essential achievement of the Alliance (Lee & Nakamura, 2021). The recommendation to local governments is to use the experience of the Alliance in producing their healthcare policies.
References
Acuto, M., Morissette, M., & Tsouros, A. (2016). City diplomacy: Towards more strategic networking? Learning with WHO Healthy Cities. Global Policy, 8(1), 1422.
Lee, A., & Nakamura, K. (2021). Engaging diverse community groups to promote population health through Healthy City approach: Analysis of successful cases in Western Pacific Region. International Journal of Environmental Research and Public Health, 18(12), 6617.
Lowe, M., Arundel, J., Hooper, P., Rozek, J., Higgs, C., Roberts, R., & Giles-Corti, B. (2020). Liveability aspirations and realities: Implementation of urban policies designed to create healthy cities in Australia. Social Science & Medicine, 245, 112713.
Pearson, O., Schwartzkopff, K., Dawson, A., Hagger, C., Karagi, A., Davy, C., Brown, A., & Braunack-Mayer, A. (2020). Aboriginal community controlled health organisations address health equity through action on the social determinants of health of Aboriginal and Torres Strait Islander peoples in Australia. BMC Public Health, 20(1).
World Health Organization. (2010). Urban HEART. World Health Organization, The WHO Centre for Health Development, Kobe.
The study investigates the complexity approach with the view of providing guidelines to clinicians on how it can be implemented. Evidence shows that most speech-language pathologists (SLPs) are not familiar with alternative treatment options and instead rely on traditional approaches. The paper provides resources that can be used to help assess the accuracy and stimulability of singletons. This essay will outline the main points of the research and relate them to clinical practice.
Main Points
One of the issues highlighted by the author is the need to select targets who acquire language late. This can be done by assessing the developmental norms of the child. Late-acquired targets are those that developed one year or more beyond the chronological age. Another aspect is that clinicians should focus on the implicational marked fricatives. This is because research shows that targeting marked fricatives enhanced the learning of unmarked stops. Children with the least knowledge are more likely to benefit from a broad system-wide change since it results in faster speech sound normalization. The paper also indicates that priority should be given to non-stimulable targets because treatment is needed to enhance accuracy.
The study suggests that clinicians should implement the complexity approach as a treatment option for phonological treatment. However, the method may present several barriers to therapists which have to be considered. One of the barriers is production accuracy and stimulability may not be a part of every assessment. Another issue is that the four tenets (age of acquisition, implication universals, production accuracy, and stimulability) present a lot of information for the clinicians which may be difficult to track. The paper provides illustrations of how the approach can be used using case studies of three children.
Relation to Clinical Practice
The complexity approach allows clinicians to focus on broad issues that are left out when using traditional methods. Using the complexity style may result in more time taken in assessment and treatment planning. However, the effectiveness of the approach may reduce the overall treatment duration. This is essential because the main purpose of using the tactic is to ensure that children with phonological challenges can transform within the shortest time possible. Clinicians have to assess targets for phonological treatments based on the four tenets identified in the paper. This can help the therapists to identify the goals and tailor the final selection to the childrens needs and abilities.
The study provides worksheets that can guide clinicians when assessing and treating children with phonological problems. One of the challenges highlighted by therapists is that the complexity approach requires the collection of a lot of information. This paper streamlines the process of selecting complex treatment targets by providing a tutorial. Therefore, it enhances the ability of clinical therapists to apply complex approaches during treatment. This method has the potential of stabilizing speech sound development and transitioning children with caseloads before school entry.
Conclusion
In summary, the selection of targets in a complexity approach is dependent on their characteristics and knowledge of the targets. In the past, clinicians have assumed the complexity method because it is labor-intensive. However, this study has provided a tutorial that can assist therapists during the selection of targets. Children with phonological challenges need to be assisted before school entry. This will ensure that they can learn without major challenges.
The problem of pressure sores has not diminished despite the advances in modern medicine. Studies point to the following data: Shiferaw et al. (2020) speaks of nearly 12% bedsores in the adult population. Li et al. (2020) state 8.9% total hospital-acquired bedsores and 12.8% total morbidity. The worldwide prevalence is about 1%, and this increases to almost 5% with age and peaks in men and women over the age of 95 (Zhang et al., 2021). Bedsores occur in hospitalized patients as well as in patients treated at home or in long-term care facilities.
Background
The main reason for the high prevalence of bedsores is the aging of the population and the increase in patients with comorbid pathology. The increase in life expectancy in the modern world is associated with improved living conditions in most countries and advances in health care (Zhang et al., 2021). The reverse side of the aging population is increasingly elderly and senile patients in hospitals. As a result, the number of potential bedsores is increasing, and the resources available may not be sufficient to respond quickly to the problem (Shiferaw et al., 2020). In addition, aging is also observed among medical staff, which also leads to a risk factor. The increasing risk is affecting the entire population simultaneously, putting each clinical organization in limbo.
Bedsores (ICD-10 code L89) are localized lesions of the skin and/or underlying tissue that usually occur over a bone protrusion as a result of, usually, long-term pressure or pressure combined with shear or friction. The most common sites of decubitus development are the skin covering the sacrum, coccyx, heels, and hips (Li et al., 2020). Other areas can also be affected: knees, ankles, back of the shoulders, or skull. Clinically, a pressure ulcer can be defined as a pressure ulcer. This pressure is caused by staying in one position for a long time, being in a wheelchair, or wearing a plaster for a long time.
The factors for the development of pressure sores are pretty varied, indicating the need to develop more specific preventive techniques. Continuous pressure, displacement forces, friction, and moisture are the most critical factors contributing to bedsores (Shiferaw et al., 2020). Limited motor activity, inadequate nutrition, and care also play a significant role in the development of ulcers. In addition, significant risk factors include age over 70 years, male gender, diabetes mellitus, paraplegia, or cachexia.
Evidence
Bedsores are a severe problem for patients and their relatives. Inadequate bedsores management significantly increases the direct and indirect medical and non-medical costs associated with the patients subsequent treatment due to bedsores and their infection (Li et al., 2020). Organizations allocate a lot of funds for dressings and medications, but when bedsores increase, resources may not be sufficient. In addition, the harm caused to the patient affects the patient physically, psychologically, and financially. For example, increased length of hospitalization, costs over insurance coverage for bedsores, and post-discharge expenses.
The relevance of bedsores is high worldwide, forcing researchers to continue to look for ways to address their prevalence. Questions arise as to which factors are leading to this problem and why the staff cannot yet meet them (Aydin Sayilan, 2019). In addition, the issue of bedsores prevention is being discovered since not all organizations can staff clinics during the post-coital period. Due to an aging population and increasing life expectancy, bedsores are also becoming a leading problem in nursing homes and clinical facilities on a preventive basis for the adult population.
Resources allocated to addressing bedsores are based on physically preventing high morbidity through interventions within the hospital. Medical staff is taking action and trying to educate patients, but general preventive measures are lacking. The lack of a public health agenda and the development of innovative methods of treatment of bedsores lead to a spike in morbidity in areas remote from high-quality hospitals (Afzali Borojeny et al., 2020). As a result, the problem of bedsores is solved point by point, and the measures taken do not improve the populations quality of life.
Outlining the Problem
According to a literature review, the incidence of bedsores in the elderly population is gradually decreasing. Various preventive measures are taken to prevent them: skin care, massage, and regular turning of the torso (Aydin Sayilan, 2019). Despite these actions, there is an unacceptably high incidence of bedsores, affecting both the young and the elderly (Zhang et al., 2021). It is recognized that this problem is faced by many clinical hospitals, including the study base. Based on the above, it is appropriate to frame the problem as follows:
In response to the high incidence of bedsores in the population, it is recommended that a qualitative study of risk factors for bedsores be conducted and a public health prevention agenda created. The current research plan will include a study of risk factor mitigation techniques and an analysis of their effectiveness.
Statement of Purpose
Research establishes that the incidence of bedsores varies among hospital wards, hence the gap in effective prevention (Afzali Borojeny et al., 2020). Thus, this study aims to validate different preventive techniques based on an analysis of the morbidity of the organizations wards under investigation.
References
Afzali Borojeny, L., Albatineh, A. N., Hasanpour Dehkordi, A., & Ghanei Gheshlagh, R. (2020). The incidence of pressure ulcers and its associations in different wards of the hospital: A systematic review and meta-analysis. International journal of preventive medicine, 11, 171. Web.
Technological development integrated various applications into the healthcare providence and nursing practice to make operations more efficient. Indeed, services that help quickly access crucial data, measure, track, and analyze the processes are valuable for proper differential diagnosis, treatment, and disease management (Warwick et al., 2020). This paper aims to critically appraise the medical application ICD10 Consult and assess how it improves healthcare providers work and clinical decision-making.
Name and Author
The medical application selected for a critical appraisal is called ICD10 Consult and is available for most modern mobile devices, desktops, and tablets. The author is Evan Schoenberg, who developed various apps for healthcare assistance and coding. The service is maintained by the creator and operational systems of devices to which ICD10 Consult was downloaded. The application also updates its version every time the ICD10-CM is renewed, and the 2022nd edition of codes, effective from October 1, 2021, has already been uploaded (Centers for Medicare and Medicaid Services, 2021). App Store (2021) states that The app draws the complete code database directly from the data files available at the Centers for Medicare & Medicaid Services (CMS). Consequently, ICD10 Consult is a trustworthy service for users who need to search the relevant codes quickly.
Endorsement, Operation, and Aesthetics
ICD10 Consult provides access to the recent ICD10-CM databases with convenient search and comment tools, and it does not require a governmental agency or administrations license to retrieve publicly available information. CMS allows application developers to load its data from the website and display it elsewhere, and the relevance of the contents can be checked by a separate search at CMS (Centers for Medicare and Medicaid Services, 2021). ICD10 Consult is developed for mobile platforms where a convenient search can be performed and the results saved as notes or comments. The application is not web-based, and even the desktop version requires downloading the service rather than opening it inside a browser. ICD10 Consult is relatively easy to work with, and navigation allows users to scroll all databases or use a search bar for quicker access to the codes (App Store, 2021). The application can be used without instructions because its aesthetics are simple, and the interface is similar to an online library or catalog. It is beneficial for ICD10 Consult because the users might be of different ages and devices use skills.
Purpose and Clinical Decision Making
ICD10 Consults purpose is instant access to all recent ICD10 codes necessary for differential diagnosis, studying diseases, and clarifying the symptoms. ICD10 is an international classification system created and maintained for diagnostic and statistical purposes (Khera, Dorsey, & Krumholz, 2018). The applications primary users are physicians and healthcare providers for whom the codes are required for clinical decision-making. Indeed, the quickly found results, comments, and notes for further use and the convenience of accessing ICD10 Consult can help choose the proper diagnosis, confirm specific symptoms, or study the epidemiological statistics.
Safety, Privacy, and Security
Although ICD10 Consult is an application for healthcare providers, a potential for patient harm exists if physicians mistakenly type the code or use the service as the only evidence for stating the final diagnosis. People searching for the symptoms through the application can hurt themselves by misinterpreting the results and reaching the incorrect physicians or treatment. The application has a privacy statement and policies with a clear explanation that the application tracks the identification information, usage, and diagnostic data. ICD10 Consult does not collect records that require encryption or could be shared with third parties (App Store, 2021). The users would be notified in the event of a breach or changes in the privacy policies because it is the requirement of distribution platforms such as AppStore or Google Play.
User, Distribution, Credibility, and Relevance
ICD10 Consult is developed for healthcare providers as their practice includes checking the international codes, comparing the symptoms, and being aware of all changes. It can be accessed and downloaded from several internationally available application stores; therefore, it is designed for wide distribution. ICD10 codes are verified by World Health Organization and used for statistics tracking, such as outcomes, mortality, or disease burden; thus, the ICD10 Consult is relevant for general use (Khera et al., 2018). The application sources information from CMSs publicly available databases and is considered credible (App Store, 2021). The developers timely upload the ICD10-CM updates published at official CMS/CDC websites and send notifications to the users to upgrade the application to access the recent information.
ICD10 Consult can be used by various healthcare providers in different clinical settings due to the universal nature of the information the application stores and manages. For instance, a physician who works at an acute care hospital with adult patients could frequently utilize the service on different occasions. If a 35-years old male with continuous severe headaches reaches the emergency room, a differential diagnosis might require quick clarification with the codes. A patients history of present illness includes dizziness, difficulty concentrating, blurry vision, and a recent accident with hitting the head at a gym. Based on this information, a physician will perform a differential diagnosis, and with the ICD10 Consult, they will instantly clarify the symptoms and possible diseases instead of trying to remember the materials from studies or practice (App Store, 2021). Consequently, opening the application, selecting the specification, and searching by name or patients conditions would provide a physician with evidence-based information critical for clinical decision-making.
ICD10 Consult can be implemented right during the assessment and differential diagnosis and impact the scenario as the results will help understand if immediate disease management is necessary. Moreover, the applications interface includes the option to leave notes or save the description of the ICD10 coded line for future exploration (App Store, 2021). In the scenario with headache, brain injury can be identified through searching by symptoms blurry vision or difficulty concentrating. Also, opening the S00-T88 segment related to the injuries or checking the diseases coded between S00 and S09 can be quickly and effectively performed throughout the application.
Injuries to the head require cautious assessment, and clinical decision-making related to diagnosis must be evidence-based to avoid the severe consequences or worsening of a patients conditions. The research conducted among patients with traumatic brain injury and physicians who used coding for differential diagnosis confirmed the benefit of reaching the ICD10 database (Warwick et al., 2020). Indeed, Warwick et al. (2020) claim that the positive predictive value of ICD-10-CM codes included in a traumatic brain injury (TBI) surveillance definition was high (p. 1768). Consequently, physicians who can access the most recent information through their mobile devices and quickly submit or clarify the diagnosis would work more efficiently and make better clinical decisions.
Modern clinical practice includes using various mobile and web services that help maintain operations and enhance healthcare providence and tracking. ICD10 Consult is the application that allows physicians, administrators, and nurses to quickly access the ICD10 database, search codes by numbers or symptoms, and save the records for further analysis. The app is helpful in the differential diagnosis as it allows to get to the validated information quickly and profoundly impacts clinical decision making.
The weeks health story is about birth alerts, where the Saskatchewan government made a firm decision concerning the topic. According to Mantyka (2021), the Canadian province has witnessed pregnant women, the majority of whom are first nations, labeled unfit to take care of their babies after birth. Birth alerts involve informing the ministry of social services about the newborns for apprehension when they are incapable of being nursed. The new change led by the minister of social services will include working with community stakeholders to devise ways of supporting expecting mothers. The ultimate goals will involve collaborating with community-based organizations that sometimes connect positively to pregnant women and develop proactive or front-end solutions.
Some Canadian provinces have reported significant number of birth alerts. As reported by Mantyka (2021), Saskatchewan received about 76 birth alerts in 2020, and out of this number, 53 mothers were indigenous people. In the same period, 98 newborns have been apprehended in the same region (Mantyka, 2021). Birth alerts to minority groups are perceived as a discriminatory practice, and ending this will require investing in preventing discrimination to indigenous families and supporting pregnancy expecting mothers. However, although apprehension of children is an alarming issue debated to come to an end, it is deemed necessary when there is a need to protect newborns. The most suggested approach to the issue is implementing a family-centered program, where mothers get supports after being discharged from healthcare facilities
Saskatchewan is not the only Canadian region that has stepped forward to address the issue of birth alerts. According to Latimer (2021), British Columbia announced an end to newborns apprehension in Manitoba and Ontario. Some factors in the communities have been pointed as to why social services ministry considers taking children from their mothers. For instance, issues related to homeless, addiction, or substance abuse create risks in child care as significant prenatal gaps in the community.
The health story on the impact of long-term isolation is crucial because it raises concerns on the discriminatory issue that must stop. Birth alerts can lead to trauma to indigenous women due to child apprehension after delivery. Ending the practice will mark progress towards truth and reconciliation-a Canadian call for action. To make meaningful child welfare progress, all territories and provinces should follow those practicing care for minority women (Vang et al., 2018). Otherwise, there will be cycles of intergenerational trauma, deterring at-risk women from getting vital healthcare services. Child apprehension after birth is a critical issue as it can make it difficult for individuals to turn around their lives. For instance, if a parent has had her child apprehended before for being flagged at high risk, in the future, she can fear becoming pregnant even if her life has changed. Also, social service ministry can find value in educating parents on the importance of good parenthood.
To achieve the goal of eradicating birth alerts, all processes, policies, or practices in the provincial jurisdictions relating to the informing risks of newborns should be revised. However, this approach might not be enough to facilitate smooth child welfare systems that affect indigenous mothers. Other discriminatory practices exist and need scrutiny to ensure fewer children from indigenous families end up in care. Promoting a trusting relationship can be an effective way forward where a focus on children should change from red-flagging pregnant women to voluntary commitments. In that way, trust will develop between service providers or Canadian child support systems and indigenous mothers for safe parenting.
It is important to note that detecting and identifying an occurrence or case of trauma can be a challenging endeavor, which is why the use of effective and accurate tools for screening and assessment can be highly critical, especially during major crisis events. The given informative piece will primarily focus on two such instruments, which are the Brief Trauma Questionnaire or BTQ and Trauma Assessment for Adults or TAA.
Although both methodological frameworks are based on self-report assessments, they have differences in regard to the areas of focus. In the case of BTQ, the emphasis is put on Criterion A of DSM-5, which is why it can be utilized in order to conduct a thorough and full evaluation of the given criterion (United States Department of Veteran Affairs, 2020). It is a 10-item self-report questionnaire derived from the Brief Trauma Interview (United States Department of Veteran Affairs, 2020, par. 1). The instrument assesses traumatic exposure on the basis of DSM-5 specifications, where the questions are centered around a serious injury, life threat, and relevant events (United States Department of Veteran Affairs, 2020). In the case of TAA, it is a 17-item self-report Trauma Assessment for Adults (TAA) examines different types of stressful life events (United States Department of Veteran Affairs, 2018, par. 1). The accentuation is put on stressful events, such as sexual assault, physical assault, accidents, or combat exposures (United States Department of Veteran Affairs, 2018).
In conclusion, both tools are useful since BTQ is beneficial for quick assessments, whereas TAA can be comprehensive for adults. These instruments are culturally appropriate because they are no indications of it being otherwise. Both instruments are similar in their ease of use because they focus on yes and no questions removing the complexity of answers, and the questionnaires include only ten items for BTQ and 17 items for TAA, which can be considered low.
Analysis of a specific theme is always associated with the search for sources that meet the necessary criteria. However, in addition to direct investigation, the critical assessment of the found material is essential. This process is important in the context of the health sector and various medical articles. They often describe various methods of treating diseases, and inaccuracies in these data can lead to severe consequences. Therefore, papers of this kind should be written as clearly as possible. The purpose of this paper is to critically assess a systematic review of non-pharmacological pain management in the elderly to assess whether the paper meets the necessary quality criteria for this type of work.
Critique
Problem Identification and Research Question
This paper by Tang et al. (2019) focuses on exploring a variety of pain management techniques that fit the theme of this report. Many people in old age suffer from daily pain, but pharmacological treatment is associated with specific side effects. Therefore, the main problem with the paper is the need to find non-pharmacological remedies for pain that are effective, suitable for use by the elderly in the community, and sustainable (Tang et al., 2019). This problem is not directly stated in the text, but its analysis is possible from the title and the Background section.
On the other hand, research questions in this paper are displayed in a separate block at the end of the Background. Since the text does not directly state the problem, it is difficult to assess how accurately the problem and the questions are related. However, the list of questions addresses three different components of the problem: the need for effective techniques, suitability for the elderly, and sustainability (Tang et al., 2019). Unfortunately, none of the three questions meet the criteria for the PICO (T) format. In all three cases, the parts of the question are rearranged: Intervention is brought to the first place, followed by the desired Outcome, and Population is included at the end of the question ( PICO (T), 2021). Nevertheless, the questions, the problem, and the general theme are relevant for nursing, as they touch upon a necessary topic of pain management.
Literature Search and Figure
The literature search for this systematic review is described in great detail. The authors used consulted search terms across five databases, which are well-known sources of medical and nursing articles, especially PubMed, so they can be considered appropriate. Using the deduced inclusion and exclusion criteria, special software, and the help of third-party experts, authors came up with a list of 10 articles on which they continued to work (Tang et al., 2019). As an initial selection criterion, a compiled search query was used. However, the wording pain treatment is found in two places, reducing its quality.
The authors also used the PRISMA technique, which can be seen from the checklist attached to the article and the graph included in the text. This flow chart reflects the process of selecting articles, indicating a precise number of works and a strategy for selecting texts, including the inclusion and exclusion criteria. However, as the authors themselves note in the Limitations section, some of these criteria may have led to selecting only ten articles for the final analysis. Such details do not allow concluding that the final sample of studies was strong enough.
Study Quality Evaluation
Nevertheless, the collected articles were subjected to a study evaluation procedure. This procedure has not received much attention in the text of the article. According to the authors, the study evaluation was carried out using the Jadad scale, and three out of four researchers were involved in this process. In addition, a table was compiled illustrating the assessment results. It is noted that the researchers reached an interrater agreement, and interrater consistency of 0.66 was observed (Tang et al., 2019). However, since the entire assessment process was limited to the Jadad scale, the level of evidence was not assessed during the study. The tool used is a relatively simple methodological assessment method widely used in various kinds of research. However, some researchers believe that it focuses too much on the blinding component, which increases the risk of bias (Halpern & Douglas, 2005). This factor somewhat reduces its credibility, especially given the fact that no additional measures were used.
Literature Review Table
Two tables, reflected in the text of the article, fall under the category of tables devoted to the materials considered in the article. Table 1 is a list of authors categorized by type of therapy, reflecting the authors of the article, the title of their work, goals, duration and type of intervention, as well as the presence of a follow-up assessment (Tang et al., 2019). The second table is a visual demonstration of the application of the Jadad scale. The information presented in the tables is concise and clear, which allows comparing the works following the available criteria: the type and duration of intervention for the first table and the presence of corresponding Jadad scale elements for the second. However, these sources lack vital elements, so they cannot be considered full-fledged literature review tables. Despite the clarity of this presentation, it is of little value to the reader.
Although these tables provide a general idea of the investigated papers, the reader cannot draw the same conclusions as the authors due to the absence of the summary columns. In the following sections, the authors refer to some additional table S1, which the reader does not have direct access to. Therefore, it is impossible to assess the validity of the conclusions and the usefulness of this study for practice based on the available data tables.
Synthesis of the Evidence
The description of the data synthesis process is complicated since the authors do not comment on how it occurs. According to the article, the selected articles were categorized, scored, and then the authors summarized the results of all ten papers (Tang et al., 2019). However, the following section can confuse the reader because although it is titled Summary of evidence, the following text traces the details of data synthesis. Authors highlight links to several different sources simultaneously, combine the results of several articles and form a general conclusion ( Synthesis, n.d.). Nevertheless, they do not mention the method they use for this process, so there is no way for the reader to know if meta-analysis or meta-synthesis is being used. Thus, the authors confuse the concepts of summary and synthesis, despite the significant differences between them.
In addition, most of the text lacks specific quotes, which makes it challenging to understand where information was taken from. This problem is possibly related to the lack of a conclusion and results column in the literature review tables. Moreover, this makes the conclusions drawn by the authors seem unfounded and unconvincing. Since the analysis process and its methodology have not been demonstrated to the reader, one cannot be sure that the information extraction process was complete and the analysis credible.
Conclusion of Evidence
The conclusion section summarizes the entire article, as the authors mention what they examined and put forward a hypothetical solution. The text highlights three main research questions related to effectiveness, suitability, and sustainability (Tang et al., 2019). Accordingly, the authors rate the quality of the articles studied following these three criteria. However, almost no attention is paid to the quantity and consistency of the evidence, which reduces these findings value. In addition, due to the lack of full-fledged data synthesis, the conclusion is weakly associated with this category, due to which the reliability of this section decreases even more.
On the other hand, the authors point out their works limitations, consisting of an insufficient number of researched works and possible search queries and criteria errors. In addition, they note the lack of proper categorization and consideration of the impact of different medical interventions. Finally, Tang et al. (2019) combine their shortcomings and their findings in inviting subsequent researchers to further develop the topic of non-pharmacological pain management following the outlined guidelines. Thus, the authors connect their work with medical practice, bringing a little more specificity into it.
Conclusion
Conducting a critical review of an article by Tang et al. allows concluding about the quality of the text as a whole and the importance of a full-fledged analysis in this area. Throughout the study, difficult moments were noted that reduced the quality of the article and interfered with its perception. There were serious gaps in the study towards the middle and the data collection sections of the study. Although the authors ultimately recommend the investigated methods for practical application, the degree of elaboration of this issue raises doubts about conclusions reliability. Thus, this study cannot be called complete and used as a practical guide. In addition, the investigated errors make it possible to more effectively assess the importance and necessity of adhering to all the details of the systematic analysis to create a high-quality work that can be used in the future.
References
Halpern, S. H., & Douglas, M. J. (Eds.) (2005). Appendix: Jadad scale for reporting randomized controlled trials. In Evidence-based obstetric anesthesia (pp.237-238). Blackwell Publishing.