Spina bifida is a neural tube defect (NTD) that is characterized by a gap in the spine due to improper development. It is apparent at birth and occurs during the process of neural tube development. The neural tube is a structure that eventually develops into the brain and the spinal cord. This structure forms during the early days of pregnancy and proper development is critical. However, in babies with spina bifida, the neural tube develops improperly and fails to close, therefore, leaving a gap that causes complications that affect the spinal cord and the spine. A portion of the tube either undergoes incomplete development or fails to close. There are three main types of spina bifida namely meningocele, spina bifida occulta, and myelomeningocele.
Signs and symptoms
The signs and symptoms of spina bifida include comprise physical and neurological problems. Physical problems include leg weakness and paralysis, abnormal eye movement, skin irritations, visible spinal defect, hip and joint deformities, bladder and bowel control challenges, skin irritations, poor kidney function, orthopedic abnormalities, and urinary tract infections. Studies have shown that people with spina bifida also have an abnormality of the cerebellum. In others, there is incidence of hydrocephalus that occurs due to the displacement of the cerebellum thus affecting the proper flow of cerebrospinal fluid. As a result, there is an accumulation of excess fluid in the brain. There is abnormal development of corpus callosum and cortex abnormalities emerge. Young people with spina bifida have difficulties with executive functions such as planning, memory, organization, and initiation. Other weaknesses include problem solving, visual planning, abstraction, and poor cognitive flexibility. Students with the disorder experience difficulties in school especially in areas such as mathematics and reading.
Treatment modalities
There is no definite treatment for spina bifida. However, there are several treatment modalities that treat its symptoms or associated conditions. Treatment options include surgery, therapy, the use of assistive devices, and treatment for bowel and urinary problems. Surgery is usually conducted immediately after birth in order to close the opening in the spine that is caused by improper development of the neural tube. In addition, it is conducted to treat hydrocephalus, prevent infection, and prevent further damage of the nervous tissue. Therapies such as physiotherapy and occupational therapy are used in order to help patients become independent and carry out their daily tasks effectively. In certain cases, treatment can be conducted during pregnancy. Prenatal treatment can be carried out in two ways namely open fetal surgery and fetoscopy. These methods are not common because of the high risks they pose to mothers and babies such as scarring of the uterus and preterm birth respectively.
Appropriate nursing actions
Appropriate nursing actions that need to be carried out with regard to spina bifida include provision of supportive care, proper monitoring of motor function, extensive and active treatment, and rehabilitative therapy. Providing patients with supportive care is necessary because many of them encounter problems with mobility. It is also important to monitor their motor function in the lower extremities. Nurses should conduct examinations such as muscle strength and joint range of motion. In addition, they should be monitored in order to identify any deviations from proper development. Other nursing actions include measuring head circumference, assessing the sac and measuring the lesion, assessing neurological system, assessing and monitoring for increasing ICP, and assessing the patient for hip and joint deformities. Rehabilitative therapies to encourage, develop, and maintain independence should be provided consistently.
Patient education
In providing appropriate to education about the defect, I would ensure that patients understand the causes, signs and symptoms, and the treatment modalities available for spina bifida. I would also make sure that they understand how to manage and prevent it. Bladder management, bowel management, bracing, and orthotics are important aspects of spina bifida management that patients need to know about. Patient education would aim at helping individuals become independent and lead happy lives without needing too much assistance from family members.
Complications and effect in the pediatric client
Complications associated with spina bifida include bladder and kidney problems, skin problems, latex allergy, and psychological problems. Spina bifida causes challenges with storing and passing urine due to bladder and kidney defects. These could lead to kidney stones, recurrent urinary tract infections and hydronephrosis. Reduced sensation in legs can occur due to destruction f nerve function. Many people with the disease develop allergy to latex and psychological problems because the experiences of the disease are traumatic.
Conclusion
Spina bifida is a serious defect that affects the central nervous system. It results from improper development of the neural tube during embryonic development. Common signs and symptoms include paralysis of the legs, altered bowel function, visible spinal defect, and hip and joint deformities. The most common treatment modality is surgery and can be done either during pregnancy or after birth. It is critical for patients to undergo physical and occupational therapies in order to help them become independent and live happy lives without too much assistance. Nurses can help patients by administering medication, assessing hip and joint deformities, and monitoring them regularly.
Works Cited
Anderson, Elizabeth, and Bernie Spain. The Child with Spina Bifida. New York: Routledge, 2016. Print.
Unfortunately, the role of nurses is often underestimated, despite the fact that these healthcare professionals must have a great number of skills and competences such as excellent knowledge of medicine, ability to communicate with people of various backgrounds, leadership, quick decision-making and, most importantly, compassionate attitude toward the patient.
Without these qualities, one definitely should not start a nursing career, as it will be a disaster both for him and his patients. This paper aims to discuss those standards and expectations that registered nurses (RN) have to meet on a daily basis. Furthermore, it is necessary to show the steps which a person should take, if he/she wants to become an RN.
In order to write this essay, I have interviewed Kathie Shankley, a close friend of mine and a practicing nurse. She agreed to speak about her work in a community hospital. She believes that the most difficult thing for her is the wide scope nurses duties. My friend says, It sometimes seems to me that I must do more than ten things at a time .
Judging from this statement, one can assume that a registered nurse must be able to prioritize the tasks in terms of their importance and urgency. Moreover, a nurse must be able to keep ones composure in critical moments. In Kathies view, a person, who does not have these abilities, should think twice or even thrice whether he wants to pursue a career in medicine or not. The thing is that there are moments when you have to act on the spur of the moment, and not everyone can do it.
Another thing, which Kathie finds particularly challenging, is the necessity to find an approach to every patient. She points out that language barrier can really be a great obstacle sometimes . According to Kathie, if a person is bilingual, he/she will really have an advantage over others.
Thus, it is quite possible to argue that cross-cultural education is of great importance for all medical workers, not only nurses. This is one of the reasons why medical students should study a foreign language. This is particularly relevant for such country as the United States, where people can speak Spanish, Italian, Russian and so forth. The knowledge of foreign language can be of great avail for an RN, although this is not a must.
Moreover, a registered nurse must be well-aware of the most recent research findings as this knowledge can greatly improve the quality of patient care. The thing is that treatment methods constantly evolve, a healthcare professional must always read books and academic journal in order to stay in the forefront and be in the know , as Kathie noted.
She also urged future nurses not to overlook their math classes because a RN has to know how to analyze statistical data. This is one of those skills, which one has to acquire, if he/she intends to take this career path. Kathie says that many nurses fail to achieve professional growth, because they do not take much interest in the on-going medical research.
Although, being a registered nurse is very prestigious, one must bear in mind that the responsibilities of these people are much heavier because they work in intensive care units and operation rooms and supervise the activities of other nurses. To become an RN, one should obtain Masters or at least Bachelors degree.
Again, as it has been mentioned before, a nurse must be versed in many areas of study: medicine, psychology, chemistry, pharmacology statistics and so forth. Without appropriate academic background, one can hope of becoming an RN. Kathie believes that the would-be students should carefully evaluate the training programs, offered by various schools of nursing as this choice can greatly impact their professional growth as well as salary.
During our conversation, I have also asked Kathie about the rewards of this profession or those things which bring joy and satisfaction. I intentionally avoided asking questions about monetary compensation, as I was more interested in the reasons why people decide to pursue the career of a nurse.
I am not quite sure that Kathies answer was very elaborate; she said, I just wanted to help people who are ill, and Im really glad when they recover . After a moment of hesitation she added You know, its one of those things that are very difficult to explain . Therefore, we can presume that an RN ought to feel compassion for the patient, and this is one of those in-born qualities which can be neither acquired nor elaborated.
In this paper I have tried to single out those skills, competencies and psychological traits that a student must have in order to become a registered nurse. There are as follows: 1) excellent knowledge of various interrelated disciplines; 2) ability to communicate with people of various cultural and ethnic origins; 3) cool-headedness; 4) willingness to improve ones professional skills and 4) genuine desire to help other people. One can hardly imagine an RN or other healthcare giver without these properties.
Issues of clinical nursing expertise and clinical wisdom have been found to play an important role in ensuring the delivery of quality patient care. Nursing expertise and clinical wisdom are influenced by individual-level factors such as nurses years of experience and level of education (McHugh & Lake, 2010), as well as contextual factors such as the educational and experience levels of coworkers, motivation and engagement, and the nursing practice environment (Uhrenfeldt & Hall, 2007). The present paper discusses several issues related to nursing expertise and clinical wisdom with the view of demonstrating the level of understanding and experience with the concepts.
Expertise in Nursing
Clinical expertise has been defined in the literature as a crossbreed of practical and theoretical knowledge that enables the clinically competent nursing professional to show an intuitive capability to not only make critical clinical decisions efficiently but also to understand the whole nature of any given condition or situation (McHugh & Lake, 2010). These authors argue that expertise influences nurses clinical judgment and quality of care and develops when a nurse tests and refines both theoretical and practical knowledge in actual clinical situations (p. 277). Nurses are expected to develop these skills and capabilities as they progress through the five expertise levels proposed by Benner, Tanner, and Chesla (2009), from novice nurses (entry-level) to expert nursing professionals.
From the perspective of nursing practice, an expert nurse can be characterized as a nurse professional who has developed the theoretical and practical capability to recognize unexpected clinical outcomes or potential problems before they occur and address them at the earliest convenience due to a deep understanding of the whole situation. This characterization is similar to Benners description of an expert nurse, particularly in terms of demonstrating an intuitive grasp of each situation (theoretical and practical knowledge), diagnosing and addressing the problems without wasteful consideration of unfruitful or unproductive alternatives (efficiency and convenience), and exhibiting the highest analytic ability to be able to understand situations and contexts from a holistic perspective (Benner et al., 2009).
Advanced beginner and competent nurses need to be supported and facilitated to progress through the clinical expertise ladder. For example, nurses in these expertise levels need to be exposed to more training and education opportunities so that they can develop the speed and flexibility needed in clinical decision making. Additionally, health care facilities should ensure that nurses in the advanced beginner and competent phases work under the direction of expert nurses and other professional mentors to develop their experience and analytical capabilities. Such exposure, according to McHugh and Lake (2010), will help the nurses to recognize clinical situations holistically and inclusively devoid of wasteful considerations.
Lastly, it is important to provide nurses with work-life balance programs and other work-related benefits to ensure their retention in the healthcare system and subsequent gains inexperience. These support systems are already been provided in my practice and other facilities, though financial constraints and individual-level factors such as lack of time and lack of interest continue to act as barriers in the journey to achieve clinical nursing expertise.
Clinical Wisdom
Clinical wisdom in nursing can be defined as the significant dynamic of reflexivity on the part of proficient and expert nurse professionals that provides them with the capability to base sound judgments on deep understandings in conditions and contexts of uncertainty due to their accumulated psychological, philosophical, existential and spiritual knowledge. Clinical wisdom is often acquired, maintained, and fostered (cultivated) in practice settings through experience and knowledge transfer, rather than being taught in a classroom context (McKie et al., 2012).
Clinically wise nurses must demonstrate the capacity to balance the good for another with the common good, recognize the balance between effect and intellect in solving existing problems and challenges, as well as acknowledge the role of tacit knowledge in wise clinical practice (Haggerty & Grace, 2008; Uhrenfeldt & Hall, 2007).
Some many examples and vignettes demonstrate how nursing professionals use clinical wisdom. In one such example, a leading expert nurse educator used narratives and evidence-based teaching narratives to engage learners in understanding the best fit for particular clinical evidence and protocols that could be used to address the symptoms of Parkinsons disease among the elderly. The educator used evidence-based narratives to help nurse students to not only understand and remember the real-world applications related to the management of the disease but also to visualize the concepts that allow for further thought and questions (Haggerty & Grace, 2008).
The main benefit resulting from this example is that nurse students were able to develop a deeper comprehension of what was being taught since clinical practice becomes more visible via narratives. Expertise and clinical wisdom in the practice of other nurses can be promoted through exposing these professionals to experiences that enhance their critical reflection, critical reasoning, as well as judgment (Benner et al., 2009). In nursing education, for example, an expert nurse educator can rely on evidence-based practices to construct learning experiences that help students to synthesize clinical knowledge, share content-specific wisdom with others, and visualize concepts in a holistic approach.
Conclusion
Drawing from this discussion, it is evident that nurse expertise and clinical wisdom are important elements in the provision of quality care. These elements appear to be acquired via experience and sustained knowledge transfer processes, rather than fragmented learning episodes.
References
Benner, P., Tanner, C., & Chesla, C. (2009). Expertise in nursing practice (2nd ed.). New York City: Springer Publishing Company.
Haggerty, L.A., & Grace, P. (2008). Clinical wisdom: The essential foundation of good nursing care: Journal of Professional Nursing, 24, 235-240. Web.
McHugh, M.D., & Lake, E.T. (2010). Understanding clinical expertise: Nurse education, experience, and the hospital context. Research in Nursing & Health, 33, 276-287. Web.
McKie, A., Baguley, F., Guthrie, C., Jackson, C., Kirkpatrick, P., Laing, A.,&Wimpenny, P. (2012). Exploring clinical wisdom in nursing education. Nursing Ethics, 19, 252-267. Web.
Human Papilloma Virus (HPV) is one of the most widespread sexually transmitted infections in the world. More than one hundred types of HPV have been described since 1930s when the infection was identified.
HPV can lead to such serious diseases as cervical intraepithelial neoplasia (CIN), cervical and other anogenital cancers (vulva, vaginal, anus, penile), head and neck cancers, genital warts, and recurrent respiratory papillomatoses (Brisson et al. 5399). More so, according to World Health Organization (WHO) some types of HPV are found in about 70% of cervical cancer samples worldwide (Human Papillomavirus Laboratory Manual 5).
Fortunately, Papanicolaou (Pap) smear screening programs have led to reduction of cervical cancer mortalities (Shors 263). One more effective way to prevent the development of cervical cancer was introduced in the early 1990s (Shors 265).
Vaccination has been regarded as one of the most effective tools to prevent cervical cancer. However, some researchers cast doubt on the cost-effectiveness of vaccination. For instance, many researchers point out that vaccination is more beneficial for vaccine producers rather than for those vaccinated (Lippman 570).
Admittedly, high prize of vaccines, the lack of the necessary research in the field and existence of other effective tools of prevention raise many questions concerning the need in vaccination or its effectiveness. The present paper touches upon biology of HPV infection and its natural history. It also deals with the effectiveness of the vaccination pointing out the most effective tools of the cervical cancer prevention.
The history of the virus dates back 1932 when Richard Shope identified the first papilloma virus demonstrating the the induction of papilloma in cottontail rabbits by a viral agent (Ou & Yen 7). Nowadays more than 110 papilloma viruses are described. Though, this virus affects mammals as well as birds, papilloma viruses affecting humans are mostly studied (Shors 263).
HPV infection often causes occurrence of papillomas in the skin (these papillomas occur in genitals, hands or feet). The virus gets to the organism through the damaged skin (Shors 263). HPV is a non-enveloped virus measuring 55nm in diameter. It only affects the cutaneous and mucosal epithelia of the anogenital tract or upper respiratory tract (Ou & Yen 263). HPV cannot affect other skin layers (e.g. dermis) because those cells are not metabolically active (Shors 263).
The virus particles have dsDNA which are about eight thousand base pairs. It is worth mentioning that the receptor of the virus is still unidentified, though it is believed that heparin sulfate is the mediator of the virus entry (Ou & Yen 8). Research of HPV infections has led to the development of a particular classification.
There are three major types of HPV infections: high-, intermediate- and low-risk types (Shors 263). Types 18 and 16 often lead to the development of cancer. These types of the infection often lead to lethal outcomes. There can be a four or twenty year latent period. Therefore, diagnosing can be complicated in many cases.
Notably, these types of HPV infections were detected in cervical carcinoma samples in 1980s. Low-risk types of HPV (types 11 and 6) do not cause the development of cancer. The intermediate-risk types (31, 33, 51, 52, 83) do not usually lead to the development of cancer.
Reportedly, HPV infection is the most widespread genital infection in the United States of America. According to WHO about 440 million people worldwide are infected (Dizon et al. 2). Dizon et al. also point out that younger women are especially vulnerable, noting that the infection is often acquired within the first months of the first sexual intercourse (2). However, the virus is also common for men as well as for women.
As far as the transmission of the infection is concerned HPV is transmitted by such types of sexual intercourse as vaginal, anal, oral. Importantly, the use of condoms cannot guarantee complete protection against the transmission. Notably, the cases of vertical transmission of the virus (i.e. the transmission from mother to child) are very rare (Dizon et al. 4).
It is worth mentioning that HPV can be cleared by the immune system. However, researchers estimate this process differently. For example, Dizon et al. point out that only antibodies are found in 50% of women (4). Whereas, Haug notes that almost all HPV infections are cleared by the immune system (795).
As has been stated above the major concern of the researchers, officials and ordinary people is the association of HPV with cervical cancer. Screening is believed to be a very effective tool of the disease prevention as it enables to detect the infection and start the necessary treatment. However, two decades ago it was suggested that vaccination is the most effective tool to prevent HPV. Thus, the statement of WTO reveals this trend:
WHO recognizes the importance of cervical cancer and other HPV-related diseases as global public-health problems and recommends that routine HPV vaccination should be included in national immunization programmes, provided that: prevention of cervical cancer or other HPV-related diseases, or both, constitutes a public-health priority; vaccine introduction is programmatically feasible; sustainable financing can be secured, and the cost effectiveness of vaccination strategies in the country or region is considered. (Human Papillomavirus Laboratory Manual 7)
The first attempts to create a vaccine against HPV were undertaken in the early 1990s. It is necessary to note that the target types of the infection were types 16 and 18, those which cause cervical cancer. Reportedly, Diane Harper and her colleagues implemented a profound research which resulted in the creation of one of the first vaccines (Shors 267.)
This vaccine was reported to be 100% effective against persistent HPV-16/18 infections (Shors 267). The vaccine was safe for women and it was effective for cervical cancer prevention.
The creation of this successful vaccine has led to the further development in the field. It also raised such questions as the need in male vaccination. It has been believed that both women and men should be vaccinated as men act as vectors for HPV. Interestingly, research implemented by Al V. Taira proved that vaccination was cost-effective for women, but it was not cost-effective in men (Shors 267).
There are many studies that explore the cost-effectiveness of vaccination in different countries. Thus, Brisson et al. consider the potential effectiveness of HPV vaccines in Canada suggesting that vaccines are potentially effective though the further research is necessary (5406). There are too many issues yet to be explored as it is still unclear whether routine vaccination can be regarded as fully cost-effective.
The researchers point out that policy makers should take into consideration a lot of factors before assigning this or that vaccine to routine vaccination:
& quantifying the duration of vaccine protection, estimating the QALYs-lost and costs related to genital warts to better understand the relative cost-effectiveness of the HPV-16/18 and HPV-6/11/16/18 vaccines, and using dynamic models to examine the efciencies and cost-efciencies of different screening and vaccine strategies in reducing HPV-related disease. (Brisson et al. 5406)
Another research implemented by Giuliano et al. focuses on the incidence and clearance of HPV in men (932). The researchers also state that vaccination is an effective tool of prevention, though it is important to develop the vaccines carefully taking into account many factors (Giuliano et al. 939).
Admittedly, researchers are still trying to evaluate the effectiveness of existing vaccines. The vaccine which draws much attention is HPV vaccine Gardasil which was manufactured by Merck. The vaccine was licensed by the Food and Drug Administration (FDA) in 2006. The vaccine was also approved in many other developed countries.
For instance, in Canada Gardasil was approved by the federal National Advisory Committee on Immunizations in 2006 as well (NACI). This vaccine is recommended for girls aged 9-12. The major goal of Gardasil is to reduce the number of cervical cancer cases (Shors 268).
However, the vaccine has faced a lot of criticism. Thus, Lippman argues that the decision to use the vaccine was made too hastily (570). It is pointed out that $300 million dollars allocated to launch vaccination program using Gardasil to immunize young girls is regarded as a highly disputable measure (Lippman 570).
Rapidly approved vaccination program raised questions concerning public policy. Lippman states that the vaccine and such prevention campaign is rather financially beneficial for certain people (570-571). It is also pointed out that the harmfulness of HPV is also overestimated. Such statements have the right to exist.
For instance, Haug states that the rate of cervical cancer cases is not that high as in the majority of cases the cancer was caused by HPV infections which persisted (795). Besides, it is still unclear whether HPV is the major factor which causes the development of cervical cancer. Apart from this, it is still not clear whether the vaccine has a long-term effect. More so, the effects of the vaccine are still underexplored. The vaccine itself can be harmful in particular cases, there were some publications considering such cases (Haug 795).
Admittedly, as long as such issues are discussed vaccination cannot be regarded as the most effective tool of cervical cancer prevention. Moreover, there can be no routine vaccination if it is still unclear whether the vaccine is effective or harmful. It is important to remember that the HPV vaccines long-term effects are still unknown as they were introduced quite recently.
Fortunately, there are two other effective ways to cope with the spread of HPV infections and the cervical cancer prevention. The first one to be mentioned is screening. There was a 70% reduction of cervical cancer mortalities during 1947 and 1984 due to Pap smear screening programs (Shors 263). Thus, early detection of HPV infections is a very effective tool to prevent the development of cervical cancer. Therefore, it is important to continue the program which is proved to be effective during several decades.
Thus, instead of vaccinating girls it is safer and more cost-effective to detect HPV infections occurrence. If to take into account that in the vast majority of HPV cases the immune system is capable of clearing the infection, it is possible to state that when the infection is detected it is easy to prevent more serious health problems. It is worth mentioning that screening was proved to be effective in developed countries. Therefore, such kind of programs can be also effective in developing countries.
More so, it is possible to state that screening as a program of cervical cancer prevention will be the most cost-effective measure in developing counties. Thus, HPV vaccines are unaffordable in developing countries due to the high cost of the vaccines. It is important to remember that cervical cancer is one of the major causes of death among females in developing countries and it is the second most common cancer among women in the world (Shors 263).
It goes without saying that screening programs are less costly but more effective than vaccination. Therefore, policy makers of all countries (be it a developed or developing country) should pay more attention to the development of such programs rather than allocating significant funds to support doubtful routine vaccination campaigns.
Admittedly, another effective measure to undertake is the proper education. Teenagers as well as their parents should be educated in terms of serious health problems associated with HPV infections. Many researchers mention the importance of providing the necessary information to people (Dizon et al. 2). Secondary education should play an important role in this process.
However, it is not enough to tell about the consequences of the infection. It can be helpful to launch campaigns promulgating sexual responsibility. Teenagers should understand the responsibility associated with the beginning of their sexual life. Apart from this it can be effective to launch similar campaigns in media.
At present sexual life is regarded as a way to prove the person is adult enough. It is important to change the attitude towards sexual life in media to make teenagers see that it is not only about having fun, but it is about responsibility and building healthy (in all respects) relationships.
On balance, it is possible to point out that HPV infections have been researched for several decades. HPV is a common genital infection in many countries worldwide. It is usually associated with the development of many oncologic diseases. The development of cervical cancer which is characterized by high mortality is also said to be caused by HPV infections.
There are three major tools of cervical cancer prevention: vaccination, screening and educating. HPV vaccination which is reported to be cost-effective is highly disputable at present. Many researchers point out that vaccination needs further research as its long-term effects are still unknown. Moreover, vaccines high prices raise many questions. Screening has been an effective tool of HPV detection and, as a result, cervical cancer prevention.
This is the most effective measures to undertake in developed and developing countries as they are less costly and there can be no negative effects. However, this measure should be also supported by a large-scale campaign in media. Teenagers and their parents should be educated. They should be aware of the HPV infections causes and effects. What is more, it is also important to change young peoples attitude towards sexual life. They should learn to be responsible: to care about themselves and to care about other peoples health.
Works Cited
Brisson, Marc, et al. The Potential Cost-Effectiveness of Prophylactic Human Papillomavirus Vaccines in Canada. Vaccine 25.29 (2007): 5399-5408.
Dizon, Don S., Ashley R. Stuckey and Michael L. Krychman. Dx/Rx: Human Papilloma Virus. Sudbury, MA: Jones & Bartlett Publishers, 2010.
Giuliano, Anna R., et al. Incidence and Clearance of Genital Human Papillomavirus Infection in Men (HIM): A Cohort Study. The Lancet 377.9769 (2011): 932-940.
Haug, Charlotte. The Risks and Benefits of HPV Vaccination. The Journal of the American Medical Association 302.7 (2009): 795-796.
Human Papillomavirus Laboratory Manual. 2010. World Health Organization. Web.
Lippman, Abby. Human Papillomavirus (HPV) Vaccination and the Development of Public Policies. Journal of Epidemiology & Community Health 62.7 (2008): 570-571.
Ou, Jing-Hsuing James and T. S. Benedict Yen. Human Oncogenic Viruses. Hackensack, NJ: World Scientific, 2010.
The science of human medicine is based on providing patients with the necessary medical advice, surgery or medication in order to help mitigate whatever malady they may apparently have. The use of placebos, while apparently sound for most doctors, is actually a form of deception since patients seeking treatment for a specific illness do so under an implicit form of trust with the doctor since they are leaving their bodies to his/her care (Biller, 2004).
Giving patients what is the equivalent of a useless sugar pill must be questioned since it is the equivalent of an ethically and morally irreprehensible practice (Streiner, 2008). Based on the latest surveys conducted on most physicians, 62% indicate that they do prescribe the equivalent of placebo pills and do so under the knowledge that there is no therapeutic benefit whatsoever in their consumption and that they believe the use of placebos is a sound medical practice that will continue well into the future (Scahill et al., 2008).
The reason why placebos work despite having no medical attributes lies behind ability of the brain to influence the physical health of a person. While it has yet to be clearly understood, psychologists and various other medical professionals have studied cases where what the brain apparently believes is happening to the body actually causes it to happen despite the lack of an external force used to induce the change (Streiner, 2008).
The placebo effect is actually an extension of this line of reasoning wherein patients that are given placebo pills and told that they would be effective in helping with their malady has actually resulted in marked improvements in the overall medical condition of several patients (Cahana & Romagnioli, 2007). Examples of this rather unique phenomenon can be seen in individuals with chronic joint pain, back pain or other maladies related to pain.
The patients describe a sudden feeling that the pain has lessened or gone away after they use placebos under the belief that the pills are actually the reason behind the loss of pain. In many cases physicians describe this as the power of belief wherein a patient believing that a pill will change his/her medical condition for the better actually causes a gradual improvement in overall physical health of the body.
This sudden improvement has thus been connected to the state of mind of the patient wherein improving their outlook on their prognosis and being given the possibility of it improving actually creates a sufficient level of elevated mood that it helps in the recovery process (Scahill et al., 2008).
Similar studies have been conducted on various patients in hospitals wherein families, friends and nurses are encouraged to talk to and relate with the patient thus improving their mood during their stay at hospital. The results show that improving the mood of the patient actually drastically increases their rate of recovery which shows an apparent connection between moods, positive thinking and the ability of the body to recover.
Based on this line of reasoning this paper will seek to investigate how placebos work and whether there are any negative consequences behind their use. It must also be questioned whether the use of placebos by doctors is an explicit violation of the trust in doctor patient relationships and whether its continued use should be banned in the future.
How Placebos Work: The Mechanism behind Expectation and Conditioning
The general use of medications has created such a form of implicit trust between patients and doctors that patients always assume that a drug will work. It is this very assumption that creates the feeling of expectation that results in people believing the drug will work which actually aids in the drug actually working.
The same feeling of expectancy can be seen with various patients who take placebos and then citing that they feel better or that their condition has remarkably improved (Louhiala, 2009). This effect is actually the result of the Pavlovian conditioning process wherein people are conditioned to expect a certain response when an appropriate stimulus is given (Benedetti et al., 2005).
Take for example the case of a cat and a lab assistant, a lab assistant can come into a room wearing a bright orange shirt and use an air horn on the cast in order to scare it. Moments later the same technician comes into the room this time wearing a blue shirt yet bringing the cat some food. Continuing this process over a period of several weeks will actually cause the cat to experience anxiety whenever it sees the color orange while adversely the cat will appear calm, relaxed and expectant whenever it sees the color blue.
This same level of conditioning is already apparent in society wherein people who have taken all sorts of medications throughout their lives for a variety of causes have already embedded the expectation in their minds that taking medicine that is told will work for their illness will actually work (Benedetti et al., 2005).
As a result of this conditioning process, placebos that should not have any effect whatsoever on the condition of a patient actually stimulates a certain mental response which associates the placebo as something which will help the body which actually creates a biological response that results in an improved condition for the patient (Louhiala, 2009).
While the results may vary from patient to patient depending on the claims of the doctor it has actually been shown that nearly 32% of the population in the United States is actually vulnerable to the mechanism behind expectation and conditioning which would make them susceptible to the use of placebos (Nunn, 2009).
Justification for using Placebos
There are three primary reasons behind the use of placebos: cases where normal medication would be useless, cases where the problem is all in the patients head and finally cases where the patient cannot afford the necessary type of medication that would actually work (Nunn, 2009). Placebo treatments have been used in a variety of treatments where modern medicine has yet to actually provide cures.
These range from Crohns disease, Parkinsons disease, various forms of cancer, and even erectile dysfunction (Gallahan, 2010). Due to the expectation and conditioning response evident in a large percentage of the population, patients who have nearly incurable cases by medical standards actually do start to feel better after the use of placebos.
There is noted improvement in overall health, appetite and physical performance. Even cases involving extreme cases of pain where no apparent pain killers work have been shown to actually lessen the degree of pain to an extent due to the belief of the patient in the use of these kinds of pills.
There are certain cases that apparently defy all medical examination where a patient has certain symptoms or levels of pain that apparently do not have any medical cause whatsoever. In such cases placebos are usually given in order to determine whether there is actually any pain or if the patient is merely trying to get a prescription to addictive forms of pain medication such as Vicadin.
Lastly, in the case of several communities throughout the U.S. there are various individuals suffering from ailments who cannot afford to buy normal types of medication due to their economic situation. As a result some doctors prescribe placebo pills to these individuals as a means of easing whatever symptoms they may have till a more affordable solution can be attempted.
Conclusion
The findings of this paper show that the use of placebos in some case are justifiable and are actually beneficial for some patients. The problem is though the practice is still based on violating the trust between doctors and patients. In cases where the patients were informed after placebos proved to be effective that they were actually on the palcebos the result was usually an immediate regression towards their old symptoms.
This shows that placebos cannot be used a permanent solution in some medical cases. On the other hand their continued beneficial use is evident and as such justifiable in light of the needs of particular patients. The best way to handle such situations is to regulate the prescription of placebos to such an extent that doctors do not regularly hand them out just to get rid of patients but rather use it as a method of last resort in order help patients deal with what ails them.
References
Benedetti, F., Mayberg, H., Wager, D., Stohler, C., & Zubieta, J. (2005).
Neurobiological Mechanisms of the Placebo Effect. Journal of Neuroscience, 25(45), 10390-10402.
Cahana, A., & Romagnioli, S. (2007). Not all placebos are the same: a debate on the ethics of placebo use in clinical trials versus clinical practice. Journal of Anesthesia, 21(1), 102-105.
Gallahan, W., Case, D., & Bloomfeld, R. (2010). An analysis of the placebo effect in Crohns disease over time. Alimentary Pharmacology & Therapeutics, 31(1), 102-107.
Louhiala, P. (2009). The ethics of the placebo in clinical practice revisited. Journal of Medical Ethics, 35(7), 407-409. Retrieved from EBSCOhost.
Nunn, R. (2009). Placebo Effects Without Placebos? More Reason to Abandon the Paradoxical Placebo. American Journal of Bioethics, 9(12), 50-52.
Scahill, L., Solanto, M., & McGuire, J. (2008). The Science and Ethics of Placebo in Pediatric Psychopharmacology. Ethics & Behavior, 18(2/3), 266-285.
Streiner, D. (2008). The Lesser of 2 Evils: The Ethics of Placebo-Controlled Trials.
Canadian Journal of Psychiatry, 53(7), 430-432. Retrieved from EBSCOhost.
Anaplastic astrocytoma (AA) is an astrocytic glioma which is characterized by high infiltration and shows increased cellularity. Other characteristic features of the WHO grade III glioma is pronounced mitotic activity as well as cytologic atypia. The composition of anaplastic astrocytoma among all astrocytic gliomas is roughly 10-25 percent and peak years for the condition are between 40 and 45 years (Tonn et al., 2006).
The anaplastic astrocytoma is a tumor that develops in the brain whereby the nerve supportive cell (astrocytes) develops the glioma. These brain tumors have the capacity to invade peripheral cells and therefore they have a potential to affect the brain hemispheres (white matter) adversely.
Being high grade gliomas, the anaplastic astrocytoma are said to develop from the low-grade gliomas and they differentiate over a given period of time (usually an interval of between less than one year to more than 10 years) to become the anaplastic astrocytoma (Drevelegas, 2010). Due to their diffusive nature, anaplastic astrocytomas tend to recur more frequently and their surgical removal is often difficult.
Moreover, surgery is accompanied by the risk of causing disability, depending on the location of the tumor in the brain. Some of the affected areas of the brain are areas that control speech, vision and motor actions and therefore anaplastic astrocytoma can be accompanied by mental problems (Bradle, 2004).
From the presentation of anaplastic astrocytoma and its accompanying symptoms such as seizures and epilepsy, the patient often undergoes a life altering experience that may leave the individual devastated. This paper discusses the structural and functional changes that come with anaplastic astrocytoma.
Moreover, personality and mental problems that accompany the condition are incorporated in this paper. The diagnostic and therapeutic steps that can be taken to address anaplastic astrocytoma as well as the prognosis of the condition are also discussed in this paper.
Development and Presentation of Anaplastic Astrocytoma
The WHO III tumors, anaplastic astrocytomas, are known to appear in a later age compared to low-grade astrocytomas, with the incidence peaking during the 40s and 50s. In a retrospective study involving 383 AA patients, Afra et al. (1999) identified the mean age for AA patients as 40.6 years. Anaplastic astrocytoma is more common in males than in females with Afra et al. (1999) reporting a male to female ratio of 106: 82 in a retrospective study involving 383 anaplastic astrocytomas.
Tonn and colleagues (2006) describe that AA are primarily found in the cerebral hemispheres. It is identified that most AAs are located both in the frontal and temporal lobes. However, it is also possible to find anaplastic astrocytomas on the brain stem as well as the thalamus of young adults and children.
Perifocal edema is seen to accompany the expanding lesions that represent anaplastic astrocytomas. It has also been reported that frontal lobe has the highest incidences of astrocytomas (about 46%) followed by the temporal lobe which makes roughly 31 percent of brain tumors while parietal tumors are the least, composing about 15 percent of the astrocytomas.
A histopathological presentation of AA indicates either focal or diffuse anaplasia as well as increased cell formation with no nucleus. The mitotic activity is often pronounced and tendency of the tumors progressing to secondary globiastoma is usually very high, with no necrosis or microvascular proliferation (Tonn et al., 2006). Anaplastic astrocytoma may contain violations in the cerebral lobes or contralateral hemisphere. The tumor often appears as gray red and has a soft texture and appears to invade surrounding tissues.
Symptoms
Anaplastic astrocytomas usually present with the symptom of an epileptic seizure. This symptom is also highly relied upon as an indicator of onset of astrocytomas with Afra et al. (1999) reporting epileptic seizures in 48% of all the 383 AA patients. In most cases, epileptic seizures may date up to 17 years with most cases occurring for a period of 3 years and rarely for more than 10 years.
Patients who have a relatively long duration of epileptic seizures have low number of fits, which are short-lived focal and/ or temporal fits and consciousness is hardly lost. Persistence of seizures for a very long period is said to be an indicator of progression of low-grade tumors to high-grade tumors (AA).
There are various behavioral characteristics that are encountered as symptoms of anaplastic astrocytomas, both in the developmental and progression stages. Cutts et al. (2002) report recurrent goosebumps attacks in a 49-year-old man and the attacks would be felt in form of tingling of the whole body and piloerection of the whole body, which are defined as pilomotor seizures. The pilomotor seizures were followed by impaired memory and insomnia followed due to more frequent (usually more than once daily) pilomotor seizures.
Other characteristics that followed pilomotor seizures, as reported by Cutts et al. (2002), included fatigue, metallic taste aura as well as losing sense of time. The patient also presented with numbness in the head and continued loss of memory.
These were characteristic features of anaplastic astrocytoma as confirmed by biopsies that showed a tumor in the fronto-parietal region with diffusion into the right temporal lobe. The size of the tumor continued to increase with time and memory loss was still persistent. It was therefore confirmed that AA affects the temporal lobes and usually invades the periventricular nuclei of the hypothalamus leading to abnormal piloerection (thermodysregulation).
While epilepsy presents in approximately 50 percent of the cases during onset, other symptoms have been demonstrated in most patients. These include headache, visual changes, dysphagia, psychiatric symptoms, somnolence, weakness of the limbs and vomiting. Health Writings (2008) demonstrated hemiplagia in 59 percent of study subjects, 47 percent of optic disc edema cases and 46 percent of cases with impaired brain performance.
In some cases, about 32 percent, it was identified that sensory loss occurred on one side of the body. Over time, certain symptoms become worse and these included intracranial pressure, nervous weakness, epilepsy as well as loss of memory and confusion. These are adverse presentations of AA as a result of brain damage by the invasive tumor.
Diagnosis and Treatment
Treatment of anaplastic astrocytoma takes different modes including radiotherapy, surgery and chemotherapy. Prior to the advent of computerized tomography (CT) and the magnetic resonance imaging (MRI), angiography was the commonest diagnostic procedure for anaplastic astrocytoma. Angiography was poor in detecting tumors at an early age and epilepsy attacks would be used as a predictor symptom AA (Afra et al., 1999).
Afra and colleagues argue that it would require repeat angiography to indentify the tumor which would have developed to an acknowledgeable size and then treatment/surgery would follow. Since the timing of surgery from the first time seizures are detected is important in determining the survival rate, the ability to detect the AA at an early age is crucial. Afra et al. (1999) mention that the longer the history of seizures, the higher the likelihood of presence of malignant transformations and the lower the survival rates.
This is an implication that the timeliness of diagnosis and treatment of AA affects the behavioral presentation caused by the tumors with seizures being more prevalent in untreated tumors. In fact removing the tumor at an early age has the potential to prevent recurrence and even the progression grade II to grade III tumors to some degree.
Prognosis and Recurrence
The prognosis of anaplastic astrocytoma is poor regardless of the treatment option, hence cases of recurrence are very common (Health Writings, 2008). The survival rate of AA patients is usually three years in average since the tumors exhibit a poor prognosis. Bradley (2004) mentions that the survival rates vary significantly from individual to individual with the age of the individual being a crucial determinant of survival rate. As such, younger patients have a remarkably higher survival rates compared to old patients.
The characteristic symptoms of AA are seizures and deficits in focal functioning. The prognosis of AA is observed to be poor and highly determined by several factors including age of the patient, location of the tumor, Karnofsky performance status (KPS), Ki67 labeling index, and amount of radiation among other factors (Nomiya et al., 2008).
The radiation dose that is most appropriate for AA is 72 Gy as it results into tolerable toxicity. Brain necrosis is reported to be a common occurrence if excessive irradiation is administered together with a high dose of chemotherapy. This may affect brain function and behavior with most cases resulting to reduced survival rates.
Recurrence accompanied by malignant progression is a characteristic of anaplastic astrocytoma as indicated by Sarkar et al. (2002). Among 10 cases of anaplastic astrocytoma that were studied by these authors to identify the recurrence rate as well as malignant progression of the tumor among other astrocytomas, it was identified that 64% of the AA cases recurred with malignant progression, which was associated with presence of p53 protein. The recurrence range of AA was identified to be between 6 and 30 months.
Usually, the malignant progression that recurs in AA cases is the development of the glioblastomas. This is an indication that AA patients who experience recurrence often experience more severe symptoms due to the malignancy nature of the recurred tumors as well as their progression to glioblastomas.
Conclusion
Anaplastic astrocytoma is a brain tumor that presents during mid-life, specifically during the fourth and fifth decades of life. These highly diffusive tumors affect the lobes of the brain with the frontal lobe and the parietal lobes being key targets. As a result of this, the functions of brain performed by these hemispheres are highly affected and they present as altered behaviors which form the symptoms of anaplastic astrocytoma. It is therefore identified that seizures, more so epileptic seizures, are the initial symptoms of anaplastic tumors.
Pilomotor seizures, impaired memory, visual distortions, headache, somnolence, confusion and weak limbs are also behavioral patterns that predict anaplastic astrocytoma and they signify impaired functioning of frontal and parietal lobes. Anaplastic astrocytoma can be diagnosed using CT and MRI among other techniques but angiography is poor in detecting AA in initial stages. While AA can be treated through surgery, radiotherapy or chemotherapy, the diffusive nature of the tumors inhibit complete cure.
As such, prognosis is poor and recurrence of the tumors, with malignancy in most cases, is common making the survival rate be as short as three years. Recurrence implies that the symptoms of AA also recur and malignancy as well as progression to glioblastomas is often exhibited. Brain damage is therefore extensive and brain function and behaviors controlled by the affected brain parts are severely affected.
References
Afra, D., Osztie, E., Sipos, L. and Vitanovics, D. (1999) Preoperative history and postoperative survival of supratentorial low-grade astrocytomas. British Journal of Neurosurgery, 13(3):0268-8697
Bradley, Walter George. (2004). Neurology in clinical practice: The neurological disorders (Fourth edition). Philadelphia, PA: Butterworth Heinemann.
Cutts, J., Lee, G., Berarducci, M., Thomas, C., Dempsey, P. K. and Kadish, S. P. (2002). Goosebumps. Lancet, 360(9334). Retrieved from EBSCohost.
Drevelegas, Antonios (ed). (2010). Imaging of brain tumors with histological correlations (second edition). Dordrecht: Spinger.
Health Writings. (2008). Anaplastic astrocytoma tumor. Web.
Nomiya Takuma, Nemoto Kenji, Kumabe Toshihiro Takai Yoshihiro and Yamada Shogo. (2008). Prospective single-arm study of 72 Gy hyperfractionated radiation therapy and combination chemotherapy for anaplastic astrocytomas. BMC Cancer, 8:11 doi:10.1186/1471-2407-8-11
Sarkar, C. A., Ralte, M. M., Sharma, C. and Mehta, V. S. (2002). Recurrent astrocytic tumours a study of p53 immunoreactivity and malignant progression. British Journal of Neurosurgery, 16(4): 335342
Tonn, J. C., Westphal, M., Rukta, J. T. and Grossman, S. A. (eds). (2006). Neuro-oncology of CNS tumors. Berlin: Springer.
It is the duty of healthcare providers to sustain the confidentiality of their patients. However, healthcare practitioners face a huge workload and sometimes find themselves taking part in discussions about their patients. The code of ethics for all healthcare practitioners prohibits any discussion on the healthcare of patients without their knowledge. Today, there are new technologies that enable people to engage in conversations without physically being close to one another.
Such technologies include social networking tools like Facebook and Twitter that allow two or more people to have a conversation and share multimedia content. The presence and ease of access of such social networking tools make it possible for healthcare practitioners to ease their workload pressures by instantly connecting to their social circles. Unfortunately, the solution does not come without drawbacks.
Leach (2009) reports in the Telegraph that out of 78 US medical schools, more than half had cases of students sharing information online in an unprofessional way. Moreover, the Telegraph report indicates that the number of guileless violations falls within the ratio of one for every ten students.
The main online forums that medical students used to share content unprofessionally were blogs and the social networking site, Facebook. According to the article, violations reported were in the form of profanity and the use of discriminatory language while describing patients or their conditions. Additionally, the report notes that the medical students behaved in a conduct that could not be justified given the fact that they were training to become physicians.
Impact
Behaviors such as being frequently drunk and disorderly contributed largely to the violation of patients trust and public trust in the medical students and the healthcare profession in general. Most of the information posted online breached doctor-patient agreement or expectation on confidentiality. Because of the violations of patient confidentiality, students receive informal warnings and when the violations become serious, medical schools have no other choice but to dismiss the particular students.
Arguments and Facts Used in the Article to Support Solution
The article indicates that it is important to instill the discipline expected of a medical practitioner to students. Therefore, medical students need to know practically the disadvantages and consequences of being careless with the information they give out while contributing to social conversations.
Additionally, students need to be extra careful when using online media to communicate because the internet exponentially increases the speed and access to information. The article indicates that a possible cause of the high number of student misconduct cases is a result of the lack of sound policies that cover engagements in social network and blogging services online (Leach, 2009).
Ethical and legal issues reported
The Telegraph article, discussed above, points out ethical misgivings that include the failure to ask for the patients permission before disclosing their status to other persons. Medical practitioners abide by the oath of Hippocrates that simply states that they should not speak of anything that they see or hear in the lives of their patients that is not acceptable. The US law protects a patients confidentially through the Health Insurance Portability and Accountability Act (HIPAA).
Under this law, medical practitioners and mostly physicians have to abide by requirements that regulate the handling and disclosure of patients health information transactions and their confidentiality. Moreover, the law protects a patients data through a number of guidelines directly related to the daily workings of a physician. The human rights act also assures everyone of respect to their personal lives together with their homes and correspondence (The UK Ethics Network, n.d.).
An Explanation of Managerial Responsibilities
Physicians have a responsibility of using resources, supervising or leading teams and working in managed systems in various institutions. Practically, all practicing physicians act as managers in their respective capacities. Healthcare managers have the responsibility of raising concerns in public community risks only after they have done the same within their organizations without finding a solution. However, this does not absolve them of their responsibility of not breaching patient confidentiality.
Therefore, it is important that practitioners keep abreast with new ethical and legal requirements regarding patient confidentiality. Healthcare institutions have to manage patient confidentiality properly by using well-structured systems. The systems should follow the law requirements of storing, using and disclosing patient confidential information. Likewise, institutions need record managers with the adequate training needed to provide data protection.
These record managers do not work in isolation; they need adequate support and cooperation that will allow them to perform as required. Other than record managers, staff having access to patient records should also have a proficient training on discretion and decent record keeping (General Medical Council, 2006). Lastly, staff contracts need to state explicitly the importance of respecting and maintaining patient confidentiality.
Generally, a medical practitioner should listen to patients and respect their personal health views. In addition, patients descriptions handling should be serious and the feedback provided to the patient should be in an understandable way. When patients complain, they should receive a prompt answer form their physician.
Additionally, the answer should be frank and beneficial. A proper way to manage patient information would be to make timely reports for the organization, which may be shared with other relevant bodies. This ensures that any blame arising shifts away from the practitioner after the resolution of the case.
Proposed Solutions
A possible solution to the students case of breaching patient confidentiality would be to introduce safeguards on Clinical Data Management (CDM) systems to prevent leak of information. The law needs amending to include harsh penalties even for student doctors as a way to instill the discipline of respecting patient confidentiality.
One major form, in which patient confidentiality breaches occur, is through negligence of other structures necessary for guaranteeing it. One such case is on patient privacy. When patient privacy structures have a poor implementation record in an institution, likely due to lack of dedicated resources, then patient confidentiality tends to suffer (Manning, n.d.).
In the students case, outlined in this essay, Leach (2009) reports that most of the medical schools covered in the study did not have any policy covering the use of blogging and social media networks online. This is an example of a case where the disregard of patients privacy has negative externalities to patient confidentiality.
If the medical schools had policies protecting patient privacy by restricting the use of online media and other channels of communication, then incidences of student breach of patient confidentiality would not be as high as reported. It is important to strengthen warnings against breach of patient confidentiality by having robust systems.
To sum up, patient confidentiality is a fundamental requirement of patient-physician relationships. Medical practitioners have an ethical and legal obligation to adhere to patient confidentiality. Each practitioner assumes managerial responsibilities for their departments, teams or institutions. Having a well-structured system allows these practitioners to fulfill their responsibilities easily.
Central phenomenon, concepts, or variables under study
The central phenomenon for this study is the concept of shared governance in clinical practice and especially in the nursing profession. This concept adopts a model that underscores the role of shared decision-making amongst all health professionals. In addition, the model is based on the principles of partnership, equity, accountability, and ownership (Anderson, 2011, p. 200). The tool adopted for the aforementioned model in this study is the RN-focused Index of Professional Governance (IPNG).
The healthcare profession has been facing challenges of staff shortage. However, reports indicate that the available workforce is mismanaged and underutilized. Therefore, this tool seeks to highlight the best way to apply the concept of shared governance in a bid to address the management problems facing the nursing profession.
The study purpose and the research questions or hypothesis
The study purpose of this research was to validate IPNG further by exploring the construct validity. The general hypothesis tested was, the construct of shared governance depends mainly on the leadership and the mission of the institution and not on the individual who assesses the level of governance (Lamoureux, Judkins-Cohn, Butao, McCue, & Garcia, 2014, p. 71). The IPNG gives room for group scoring by unit, and thus the researchers used this aspect to include a validity hypothesis, which stated, Units with intrinsic differences in their governance would score differently on the IPNG (Lamoureux et al., 2014, p. 71).
A review of the related literature
The researchers used numerous sources of related literature review. Even though the researchers did not place any section under the title literature review , they quoted many sources to support their arguments. They used seventeen sources for their literature review. Out of the seventeen sources, fifteen were scholarly journals, while two were from reliable departments, viz. the International Council of Nurses and the US Department of Health and Human Services.
The available literature indicated that whereas there is a record of 13 million nurses across the world, the nursing profession continues to face workforce shortage due to mismanagement and underutilization of the available nurses. However, given that IPNG is considered as the most reliable and valid tool for measuring governance as a multidimensional concept (Anderson, 2011, p. 201), the problem of mismanagement can be addressed effectively.
The theoretical or conceptual framework
The researchers used theoretical framework in this study. According to Masters, (2012), the theoretical framework is an explanation of a phenomenon or an abstract generalization that systematically explains the relationship among given phenomena for purposes of explaining, predicting, and controlling such phenomena (p. 67). The theoretical framework in this case sought to highlight the different theories surrounding the shared governance. The researchers noted that despite having over 13 million nurses across the world, the problem of nursing shortage is still prevalent. Therefore, the theoretical framework addressed this discrepancy between the two variables, viz. the existence of over 13 million nurses and nurses shortage.
The significance of or the need for the study
The study was significant due to several factors. Primarily, scholars and researchers have neglected the area of governance in the nursing profession for a long time. Therefore, due to this aspect, the available literature on the subject is minimal, which necessitates the need for this study as it adds to the much-needed literature on the issue.
In addition, the challenge of workforce shortage in the nursing profession is baffling given the over 13 million nurses across the world. This aspect underscores a gap in governance, and thus this study is pertinent as it addresses this dilemma. By using IPNG, the available nurses in the nursing profession can become effective, and thus reduce the workforce shortage experienced across the world in the profession.
References
Anderson, F. (2011). A Case For Measuring Governance. Nursing Administration Quarterly, 35(3), 197203.
Lamoureux, J., Judkins-Cohn, T., Butao, R., McCue, V., & Garcia, F. (2014). Measuring perceptions of shared governance in clinical practice: psychometric testing of the RN-focused Index of Professional Governance (IPNG). Journal of Research in Nursing, 19(1), 69-87.
Masters, K. (2012). Framework for professional nursing. Burlington, MA: Jones & Bartlett Learning, LLC.
It is the right of every citizen of this nation to access quality and affordable healthcare. The mandate of the provision of healthcare services lies with the central government; however, it is the responsibility of the citizens to play their roles in inspiring the government to achieve its objectives of universal healthcare provision (Amaratunga & Hockney, 2013). Currently, this neighborhood is facing huge challenges regarding the provision of healthcare to the locals; the escalating prices of accessing these services have not made things easier. In this regard, the government in partnership with foreign donors has decided to initiate a free public healthcare facility to cater to the neighborhood.
Economic issues
The cost of living is continually on an upward trend thus making it hard for the low-end class to save effectively for their healthcare needs. The introduction of Medical insurance schemes by the government was a bid to reduce the burden of costs in healthcare for the citizens (Evans, Wilson, & DePorter, 2011). The framework was to enable the masses to afford the services through cost-sharing of health costs with the government. However, most people are still unable to meet the financial responsibility of having an insurance company meet their medical expenses. This has necessitated the inception of the idea of the free clinic in this area; it will fill the lacuna created by insufficient funds to join the medical insurance schemes. The facility will cater to those who are unable to raise enough money for their treatment in society.
The health of the population
From the health-risk indicator survey of the last decade, this area has experienced escalating levels of typhoid cases. In addition, the increased attack of cases of Malaria has inspired the government and the leadership to establish a free clinic initiative. The commitment of the authority to care for the health of its people has led to the initiation of several productive health programs in the nation. The prevalence of Malaria and typhoid cases will double in the next five years in case the citizens do not take it upon themselves to curb these deadly conditions. The first responsibility is to take advantage of the free clinic to nip the spread of Typhoid and Malaria in the bud. This program is also aimed at reducing the mortality rate among children below the age of five years. The healthcare report released in the last three years has indicated that the mortality rate amongst toddlers is quite high courtesy of Malaria attacks. The operations of this clinic in the region are set to reverse this statistics and improve the healthcare of the inhabitants of these regions.
Processes involved
The free clinic initiative is restricted to those lacking Medical insurance schemes. A very strict vetting process to establish the eligibility of an individual to seek the services of the free clinic initiative shall be done. The first procedure will be the verification of the documents to evaluate the qualifications of an individual. The clinic is only restricted to the inhabitants of the neighborhood, therefore, a thorough substantiation of residency will be required. The citizens are expected to play their patriotic responsibility by displaying high moral and ethical standards throughout the vetting period.
After the verification process, individuals will be allowed access to use the services of the clinic responsibly. The services of the clinic are not limited to reducing Malaria and Typhoid only, but rather to tackle general healthcare issues in the neighborhood. The authority will also be able to collect very important data regarding healthcare issues in the area, and so the users of the facility would be requested to issue information regarding other health upshots in the area, but this will be for research purposes only.
Benefits of the program
The focus of the free clinic is to empower the citizens to be able to access healthcare programs without technicalities (Kelly, 2008). The government has enough proof that quite a significant portion of the citizens are struggling to meet the costs of their healthcare needs. In giving out free medical services, the government is meeting its responsibility of meeting the healthcare needs of the citizens without any discrimination along economic lines. The program is also targeting the low-earning class of citizens. The low-earning citizens must be insulated from the escalated costs of seeking for Medicare, and this facility will be very crucial in assisting them to acquire Medicare services and channel their earnings elsewhere to improve their lives.
Conclusion
Healthcare issues like Malaria and Typhoid, which are ubiquitous in the region, will be contained. Malaria and Typhoid have been responsible for several deaths in the area. The area suffers from increased mortality in toddlers and children; the need to initiate this free clinic program could have not come at a better time. It will improve the health conditions in the area. In addition, a free clinic is to educate the masses on the importance to enroll in insurance schemes to cater to individual healthcare needs.
References
Amaratunga, C., & Hockney, J. (2013). Beyond Partnering: Creating the Healthcare Community. Healthcare Management Forum, 16(4), 14-19.
Evans, C. J., Wilson, R. L., & DePorter, F. G. (2011). Integrated community healthcare: next generation strategies for developing provider networks. New York: McGraw-Hill.
Kelly, K. (2008). Proactive recruitment in local government. Journal of Management & Marketing in Healthcare, 1(4), 338-350.
Technology has significantly influenced the way some practices are carried out in most organizations. Moreover, the field of nursing has also experienced a major transformation in nursing practices as a result of the development in technology around the world. The increase in population in the country calls for the intense use of technology within the health care facilities. Comprehensive training should be adopted on various levels of nursing and strengthened to sustain the knowledge-based technology usage. Nurses have been forced to take advantage of computers in their workplace due to the increased nursing practices and roles. Some studies have provided some limitations of technology in nursing field, but they stated also that the benefits prevail over the drawbacks (Turale, 2011). The impact of technology includes the reduced documentation period as nurses carry out their routine activities to enable an improved productivity. This paper discusses the impact of advanced technology in nursing field.
Discussion
Technology comes with some benefits such as the capability of performing research regarding demographic analysis, diseases, medical care, introduced medicines, and nursing care. The use of technology is undergoing constant evolution, where practices linked to the transfer of information by the nurses within the institution and receiving responses from doctors via mail messages have developed significantly. The impact of technology is evident in nursing practices, but it is expected to advance increasingly in the health care sector. Additionally, some computerized nursing care practices provide an improved recording, but there was no notable change concerning the outcomes of the patients (Gerdin & Tallberg, 2007).
Nursing care planning experienced some challenges as health care providers transform their services into computerized systems. Currently, technology or computer use in nursing practices for the entire documentation has a narrow use and is undergoing some development. Issues regarding ethical and legal conditions are increasing in the medical sector. These legal issues should be kept in mind since computers are easily accessed by various departments within the health care system, as well as several employees. Privacy and confidentiality are the critical matters in the health care, where it may include a case in which a nurse accesses some documents in presence of another person. Integrity in health care may include the capability of a nurse to enter some details of a patient, but the same nurse may come to alter these details someday. Moreover, it can include the ability of a nurse to gain access and alter some details entered by another nurse. Another important issue is the extent in which facilities and services in the health care can be offered without physical contact with the patients. Therefore, nurses have considered computerizing their facilities instead of some clients visiting the facilities (Mastrian & Mahan, 2011).
Although technology has allowed easier and faster access and input of patients data to their database, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) has detailed the approaches in which the members should manage the data in their systems (Mastrian & Mahan, 2011). They should only access the details of the client that they require to carry out their duties. Therefore, these technology applications should ensure that an access to certain information should be specific and restricted to certain members only based on their needs. It has also helped in recording clients details using various techniques such as dynamic signature, voice identification, fingerprints, digital photos, and facial structure. Medical experts have stated that biometric signatures will provide a significant platform for the required security and privacy in the health care systems.
Electronic Healthcare Record (EHR) system has also influenced the way nurses perform their work in that they can get access to the patients details from multiple health care providers, which it enables an effective coordinated care. Another technology that has been greatly used in health care system is robotic technology. This has provided the enhanced diagnostic abilities that are effective and more comfortable for patients. Moreover, robots have been used as an attachment care provider for various psychological and physical care conditions (Mastrian & Mahan, 2011). Some health care providers have also allowed nurses to use their mobile phones at work, where nurses can easily communicate with patients families and friends. They can also use GPS to track clients undergoing dementia conditions. Moreover, nurses have benefited from telemedicine since it allows them to gain access remote areas.
Conclusion
Nurses have benefited most from advanced technology as they perform their duties. Health care providers have moved forward to provide services to the clients that are not able to gain access to the health care facilities by direct physical contacts with doctors or nurses. New technology has helped nurses as they perform documentation, although this has also brought some issues such as privacy and confidentiality. The demands for health care facilities have gone up as there is a rapid increase in population. However, the technology advancement has helped significantly in addressing the shortage of nurses in the country. Experts are expecting that technology advancement will enable nurses across multiple geographical settings to share information and work together for better delivery of health care for their clients.
References
Gerdin, U., & Tallberg, M. (2007). Nursing Informatics: The Impact of Nursing Knowledge on Health Care Informatics. Berlin: IOS Press.
Mastrian, K., & Mahan, W. (2011). Integrating Technology in Nursing Education: Tools for the Knowledge Era. New York: Jones & Bartlett Publishers.
Turale, S. (2011). Technology and its Impact on Nursing Education. Journal of Nursing Science , 29(1), 9-17.