Category: Health & Medicine

Introduction

To conduct various types of research, it is necessary to be able to select quality sources. They should not only correspond to the studied topic but also have several other criteria. For example, the most common standard for selecting articles is the date of their writing. Besides, they must be peer-reviewed and published either in well-known journals or in large databases. Finally, it is necessary to carry out a qualitative and critical assessment of the text, for which various kinds of tools, such as CASP, can be used. The purpose of this presentation is to select an article on the topic of road traffic accidents, a summary of it, and a critical assessment using the tool above.

The road safety situation is a complex problem, which is simultaneously influenced by many factors. However, over the past year, the COVID-19 pandemic is the largest global factor affecting all areas.

The economic one has suffered the most from these changes since, in many countries, the disease has led to the establishment of quarantine and lockdown. Accordingly, thanks to these measures, the roads have become significantly empty, and road traffic has decreased.

However, road safety is still relevant since reduced traffic simultaneously allows better compliance with traffic rules and provides dangerous driving opportunities.

The purpose of this paper is to develop questions for professionals about the impact of COVID-19 on road safety now and in the future.

Economic Downturns

The economy is directly related to road safety performance because, in an environment of increased risk of injury and death, economic communication cannot develop at a normal pace. However, the reverse is also true, as with reduced economic activity, traffic on the roads decreases.

In general, research suggests the following positive effects of economic downturns: reduced vehicle mileage, fewer drivers, more careful driving due to lesser consumption of alcohol, and fewer cars sold.

Research on the relationship between COVID-19 and road travel is sparse and contradictory. In different states, statistics say both increases in mortality and a significant decrease in road accidents. This difference is due to different topographic conditions, driving culture, police work, and other factors that must be taken into account and investigated to obtain accurate data.

Unprecedented Nature

However, to apply such data to the study of the current traffic situation, it is necessary not only to combine various regional factors but also to consider the peculiarities of the problem with COVID-19. Since all available research was carried out under normal conditions unrelated to a pandemic, it cannot be fully applied.

First of all, this is due to the economic crisis scale and the unprecedented drop in global GDP.

Secondly, the current situation is strongly influenced by the closure of state borders and the introduced social distancing measures. In the context of COVID-19, some groups of people are more sensitively affected by the economic downturn, such as emergency workers, who are at greater risk due to the need for contact.

Therefore, a detailed analysis of this situation requires using an interactive model that explores personal and situational factors to identify research questions about the impact of the pandemic on road safety.

Personal Factors

The news is full of regular speeding, stunt driving, news reports conducted mostly by young people. Statistics show that there has been a 30% increase in the number of drivers exceeding 100 miles per hour in the United States.

First of all, such risky behavior is associated with low traffic, which allows you to speed up more safely and perform various tricks without fear of affecting the surrounding stream.

On the other hand, there is the problem of novice drivers, for whom COVID-19 is a sudden change in the environment on the roads.

This factor can also be considered from two sides since the coronavirus simultaneously makes it possible to learn how to drive safely in a more relaxed environment but does not prepare drivers for heavy traffic conditions.

Other personal factors need to be addressed, such as the impact of COVID-19 on older drivers skills or the increased risks to children.

Therefore, it is necessary to investigate the general factors of mortality and violations of the law and trends related to gender, age, and belonging to one or another subgroup.

Situational Factors

General factors of the situation are manifested, for example, in the rejection of public transport, since it is difficult to maintain social distancing in it. Consequently, people use private vehicles, but it is unclear if people will return to using buses after the pandemic.

Besides, at the moment, the number of small vehicles like motorcycles, which are objects of increased danger, is rising.

The coronavirus situation also affects police units, whose staff is being cut due to illness, which reduces overall road safety. In addition, in an accident, people may be afraid to receive help from medical facilities due to the dangers of exposure to COVID-19.

Thus, it is necessary to investigate this situation at various groups to analyze the coronaviruss impact on them concerning road safety. This requires a massive analysis of the case from the perspective of different vulnerable societies.

Limitations and Strengths

This study raises many important questions and highlights the difficulties in analyzing traffic about COVID-19.

Economic factors are just one of many that can affect road safety. In addition to them, it is necessary to consider personal characteristics, including from the point of view of gender, age, culture, and situational, linking various subgroups of society with the general situation.

Studying these areas will allow road safety specialists to optimize both the current situation and develop measures for further work. Underlining a lot of problems and setting a lot of tasks is the strength of this paper.

Thanks to this work, many studies can be carried out that will help stabilize the traffic situation. However, this review suffers from a lack of statistics to back up the authors words. On the other hand, such data exist in minimal quantities, so the authors use other sources and previously developed concepts, citing many of them, which is also a strong point.

CASP (A, B)

This paper is not a randomized controlled trial; however, it meets part of the points for it.

The study addressed a directed question to analyze the factors affecting the traffic situation connected with COVID-19 to develop strategies to improve the situation.

By using a large number of sources, the potential for bias was eliminated.

All used sources included in the paper were taken into account after the study.

Since there were no specific participants, it is impossible to talk about someones blindness.

The sources reviewed were documents of various sizes; however, each was taken into account and considered with the same degree of attention due to a precise sequence of research and reasoning.

CASP (C, D)

All available research results were addressed intelligibly and detailed through careful analysis of each source.

However, it should be noted that some critical data are missing to help address this situation in more detail. In particular, there are no statistical results from studies on the impact of the economic downturn due to COVID-19 on road safety.

However, all results were analyzed as clearly as possible, and no prejudice or misunderstanding was revealed. Therefore, it can be noted that the advantages of the method used outweigh its cost.

Finally, the results identified can indeed help solve some of the problems at the local level. While the strategies identified are more applicable globally, if properly managed, they can be applied within the people of the system. Besides, due to the small number of studies on this topic, the current research is likely to be very useful for the study population.

Conclusion

Therefore, this article describes methods and strategies to improve the traffic situation concerning the effects of COVID-19. This area is mostly unexplored, so research on economic downturns was used for this analysis.

However, for the full development of effective methods, it is also necessary to consider the personal and situational impact of COVID-19, expressed in such factors as driving culture, age, and gender, the influence of specific groups of people in the general context. Collaborative efforts of researchers and public and private sectors are needed to collect data further, develop, and implement tactics in the realities of COVID-19.

Although this article is more of a systematic analysis, it can still be assessed for the most part using the CASP tool. This work has a defined question, although it does not correspond to the RCT type. It allows a specific study using a particular methodology, namely a systematic analysis of available sources. The results obtained have been correctly processed and are valuable for both local and global societies and populations.

Reference

Vingilis, E., Beirness, D., Boase, P., Byrne, P., Johnson, J., Jonah, B., Mann, R.E., Rapoport, M.J., Seeley, J., Wickens, C.M., & Wiesenthal, D.L. (2020). Coronavirus disease 2019: What could be the effects on Road safety?. Accident Analysis & Prevention, 144, 105687. Web.

Generally speaking, women have always had a lesser say in society, and have often been regarded as the powerless gender. In the field of nursing, the term power may have numerous meanings, one of them being the influence of a nurses caring practices on the patients (Manojlovich, 2007). The knowledge and skills that nurses possess have a significant impact on patient care. This is why it is necessary for them to comprise this trait, so that their power can influence patients, physicians, and other nurses too.

There are many factors that influence nurses power over their practice. These include social, educational, and cultural factors. Nurses without power are said to be ineffective, and have also been seen less satisfied with their jobs (Manojlovich, 2007). There may be certain elements due to which nurses may not show levels of power; one of them being the association of power with masculinity. 95% of nurses are females, due to which holding any type of power seems inappropriate, because females have always had a lower position in society. But in the case of nurses, they need to acknowledge their power in order to control their professional practice.

The empowerment of nurses results from the environment at the workplace, where the social structure is such that nurses are encouraged to work with maximum satisfaction, and more effectively. Chandler, in the year 1992, declared that empowerment of nurses does not pertain only to the influence or authority of the nurses, but is more importantly linked to the relationships of the nurses and patients. Even the outcomes of the patients are affected negatively if there is insufficient influence of the nurses on them and their treatment.

An atmosphere of excellence needs to be created for the nurses at work, so that they may give optimal outcomes, along with the attainment of patient care. The professional practice of the nurses automatically affects the health and results of patients (Girard, et al., 2005). The empowerment of nurses does not only imply the pressure of the nurses on the patients, rather, it is a whole process of understanding the inner self, and knowing and enhancing the amount of self confidence that persists within. It is necessary for empowered nurses to see themselves as strong and capable individuals (Perez, 2002). Once they recognize their strengths, and ignore their weaknesses, they can create an atmosphere in which there is immense confidence. Whichever way the nurses react in treating their patients, the outcome of the patients will be attained accordingly. Those nurses, who are empowered and believe in the confidence that lies within them, are more likely to provide better client care, and work more effectively, as compared to those nurses who feel low about themselves.

A feeling of self-esteem in any ordinary individual affects the way he or she performs; therefore the same would apply in the case of a nurse, the greater the feeling of empowerment, the better will be the performance at work. This would help achieve professional success in the long run. Empowerment includes the behaviors of both the giving party and the receiving group, and also varies with the positions of the nurses according to the designations. A head nurse having higher power and authority would be a better performer than subordinates. However, it is essential for any nurse employed at an institute, to be highly empowered, if she is to excel in her profession.

References

1. Chandler, G. E. (1992). The source and process of empowerment. Nursing Administration Quarterly, 16(3), 65-71.
2. Girard, F., Linton, N., & Besner, J. (2005). Professional Practice in Nursing: A Framework.
3. Hassan, F. Work Empowerment as Perceived by Nurses and Physicians Working at National Heart Institute.
4. Manojlovich, M. (2007) Power and Empowerment in Nursing: Looking Backward to Inform the Future.
5. Perez, P. (2002). In My Opinion: Empowering Women to Give Birth. Web.

Introduction

My Grandfather had been in the hospital for eight months whereby, visits to the hospital were of the most painful experiences that I have ever had; having known that, he was undergoing extreme mental and physical pain, of which I had little control over. To make it worse, I had painfully watched his health deteriorate day by day, bringing him to a state of hopelessness, with only one primary thing to live and endure; pain. Although we lived with hope, the doctors had made their verdict, because they had done all that was possible with no success. My prayers for his recovery seemed unanswered because; sometimes I could watch him hopelessly as he screamed loudly, due to the extreme pains that he enduring, with no help to offer. In addition, as I watched my grandfather closely, I could confirm that the once enthusiastic face was gradually losing interest in life. This worried me very much, as his ailment had reduced his life into a shell of suffering, making him loose hope and self-esteem. Sometimes the situation was too much for us to bear because, even recognizing his friends, and relatives (including me, his favorite grandson), was a problem. Hence, to end his long-suffering, we had to take the cruelest option of terminating his life, it being the only remedy we had. Surely, this was another most painful thing I have had to endure in my life, for I stood there helplessly as the doctor cut off his oxygen supply. As a transition to his new form of life, he struggled and finally stiffened with a weak smile on his face. Although five years have passed since then, the memories are still vivid in me; for I knew and I have always known that we made the right decision for him.

Mercy Killing

Mercy killing is a mechanism of relieving both the sufferers and their families from extreme pain and anguish; them being witnesses of such suffering (Grisez and Boyle, 509). Frankly speaking, my grandfather was enduring extreme mental and physical pain, which had left him a hopeless being, with one thing to live for; pain. This made me to question the purpose his living because; he was struggling to breathe even with oxygen tubes in his nostrils; hence a clear indication that we were forcing him to live against his wishes. In addition, our forcing him to live is questionable because; for which purpose was he living, when he could not even indentify himself, and had to endure such extreme pains? Considering this, it is not wrong for one to argue that, all we did was for selfish gains; that is, our fear of losing him overlooked the great pain that he was undergoing, as we forced him to continue living; hence, the importance of mercy killing.

Primarily mercy killing or euthanasia involves the ending of someones life either willingly or unwillingly. The entire process is painless to sufferers who are in a vegetative state; a case that is common in most medical scenarios, where medics; primarily doctors, have expressed no hopes of recovery of such patients. In addition, doctors mostly perform this operation to patients in extreme pain; hence, a merciful way of ending their anguishes and pain. For medics to carry out mercy operation, they have first to seek consent from such patients; if they are at a position of deciding for themselves, failure of which their relatives or close allies decisions take precedence.

Owing to the fact that, medics recommend this process to individuals who are experiencing extreme pain and suffering, and because it is not bad for one to endure emotional pain resulting from suffering of their loved ones, it is true that individuals sometimes make this process unnecessarily longer to people whose resting time has come. Therefore, although such individuals will have more time to see their loved ones, this increases the duration of emotional and mental suffering, and the magnitude of pain to sufferers. Further, it is important for all individuals to note that, such practices are not only delusional; hence making individuals to forego important aspects of their lives, but also they have many negative consequences, for example, trauma, family and occupational associated problems (Grisez and Boyle, 511).

To some extent, individuals lives can stop due to the failure or unwillingness to execute mercy killing. This is because; although such individuals may be sure that, it is that such suffering-loved ones have minimal chances of living, in most cases, they accept the reality of the situation after the demise of their loved ones, whom they never wanted to die. As the physiological fight or flight theory postulates, the human body has a natural control mechanism; mentally, physically, and emotionally energized; hence, giving individuals a way of dealing or adapting to environmental variations. In any life scenario, a change of environment encompasses change of circumstances in individuals lives hence, altering the common used to environments. Failure by individuals to adapt to such changes is a great impediment on individuals coping potentialities; hence leading to stress, which may result to dejection. Such scenarios are prevalent in most death-postponed cases, due to the fear of executing the mercy killing concept, despite the fact that, such cases direct individuals time and emotional resources towards a fruitless cause. In addition, the more individuals endeavor to cherish memories of their dead loved ones, the more their desperation worsens hence, leading to many negative impacts on individuals lives, more so the suffering. For example, for the suffering, such effects can commence with simple breathing problems, which becomes complex later on. Although medics always do anything at their disposal to save lives for instance, feeding of patients through the nostrils, whose failure leads to use of the most expensive pure oxygen, they fail to realize that, they are wasting resources on lives they are very sure they cannot save. On the other hand, analysis of the hospital environments, which includes an array of foot and air tubes and other patient supporting machinery, are clear evidences of holding on to a life that is desperate to rest. This fact is compounded by the expensiveness of the process not only to the suffering, but also to the supporting families hence, doing more damage than good (Heifetz and Mangel, 197)

Yes, to some extent the argument against mercy killing that, this process terminates ones life, something that only God should do is right however, their notion lacks a base of expression. This is because; avoiding the practice primarily means that, individuals must use any artificial means to preserve life, a life that should rest naturally. Therefore, this causes one question; why should individuals aim to prolong life; something, which they lack control on? No wonder, such efforts are always fruitless, and only lead to desolation, disappointments, loss resources, and suffering. This is the case because, death is not a clinical thing, but rather a natural process (Manning, 99)

On the other hand, considering the fact that, most suffering individuals have to endure extreme pain, with surety of death in the end, majority of such individuals die even before their natural deaths. Therefore, mercy killing never denies somebody life, but rather the problem is these individuals inability to accept reality. In addition, considering the quantity of resources wasted in sustain such patients, it practically beats logic, because such families can use such resources on constructive things; primarily because, there is no need of family accumulating debts in the name of saving an un-savable life. In this regard, it is important for individuals to note that, life never lasts forever; hence, the importance of cherishing every day and concentrating in saving savable lives for example, through resuscitation; a fact that mercy killing supports (Manning, 101)

Another argument against Mercy Killing, which is refutable, is that, majority of individuals use Mercy killing as a mechanism of eliminating family members they do not cherish. This lacks some concepts of logicalness; hence, individuals cannot apply it as a rationale to oppose this practice. This is because; egocentrism is generally individualistic, a fact that mercy killing never encompasses. In addition, mercy killing is a practice done out of love and care for loved ones as mechanism of ending their suffering. On the other hand, it is important to note that, majority of individuals who prefer this practice value their loved ones to whatever they own; hence, through saying that they should use that money to prolong life is wrong, because, such prolonging is of more harm than good. This is common in life, because such efforts are always fruitless and more painful than mercy killing. Considering this, antagonists of this concept are selfish, because they are prolonging suffering of individuals; they claim to love (Jenkins, 195)

Conclusion

In conclusion, mercy killing is one of the most controversial concepts in nature. Although some individuals oppose the concept, most of them fail to recognize a few realties about it namely; medics execute the process in extreme suffering situations, where the hopes or recovery never exists. In addition, postponing ones life wastes time, money, and it has other negative impacts to both the suffering individuals and their remaining families; which include depression, trauma, family and occupational problems. On the other hand, although the concept elicits many moral issues, it practically beats logic to preserve moral egos, rather than embracing reality. This is because, man has no power of prolonging life, but rather, avoiding mercy killing will imply that, individual love seeing others suffer.

Works Cited

Grisez, Germain, and Boyle, Joseph. Life and death with liberty and justice: a contribution to the euthanasia debate. Notre Dame: University of Notre Dame Press, 1979.Print.

Heifetz, Milton and Mangel, Charles. The Right to Die. Toronto: Longman Canada Limited, 1975.Print.

Jenkins, Joe. Contemporary moral issues; Examining Religions Series, (4^th e.d.). Portsmouth: Heinemann Educational Publishers, 2002.print

Manning, Michael. Euthanasia and physician-assisted suicide: killing or caring? Macarthur Boulevard, New Jersey: Paulist Press, 1998.Print.

Introduction

Tobacco is one of the most smoked plants globally with serious health problems, although most individuals never take them seriously. Globally, as approximated by the World Health Organization (WHO), annually health complications resulting from cigarette smoking cause more than five million adult deaths; a number that is likely to reach ten thousand by 2020 (Prokhorov et Al., 2006, p.1). In addition to such enormous adult numbers, globally, the use of nicotine products causes more than a quarter a million adolescent and children deaths annually; a case that is prevalent in developing nations. It is important to note that, effects resulting from tobacco smoking; be they social, health, environmental or economic affect both smokers and nonsmokers. This is because, through such deaths, a country not only loses its active, innovative, and resourceful population, but also the economic gap left behind by such individuals causes many financial strains to the health sectors and families(World Health organization, (n.d.), Para. 1).

Considering the adverse nature of effects resulting from tobacco smoking the WHO in 1998, came up with the Tobacco Free Initiative (FTI), as a scheme of creating global awareness on the consequences of using nicotine products. To implement this in respect nations, WHO collaborated with world governments in formulating tobacco control measures, aimed at controlling the production, distribution, and sale of tobacco products. Most Governments tobacco control initiatives center on price control (through taxation), advertising, and rehabilitation programs for individuals who want to quit smoking (World Health Organisation, 2010, p.1).

Discussion

Tobacco-Free Initiative (TFI)

Although individuals since time memorial have known the adverse nature of effects resulting from tobacco smoking, most smokers have always ignored such effects; a fact that led to the uncontrolled increase in numbers of smokers between the years 1967-1992 (from 2.8 trillion to 5.7 trillion). This is also evident presently; whereby, globally there exist more than 1.22 billion smokers globally. Due to such rapid increases, in 1998 the WHO came up with the TFI, as a primary measure of reducing the impacts of ailments and deaths resulting from tobacco consumption. It is important to note that, most TFI measures of tobacco control are a long time and aim to alleviate any environmental, health, social, and economic burdens caused by effects resulting from tobacco to both users and nonusers. WHO adopts such initiatives as primary mechanisms of protecting both the present and future human generations, as tobacco consumption poses a threat to the existence of the human species (Medicus Mundi Switzerland, 2010, Para. 1-2).

For the achievement of its primary mission, TFI provides international leadership guidelines, which are the primary promoters of sensitization campaigns in all global communities. In addition, because of the passing of the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2003, TFI provides methodologies of ensuring global communities implement Specifications in the WHO FCTC. Provisions in FCTC are very crucial in the World Health Organizations endeavor to control the consumption of tobacco products, for it provides mechanisms of ensuring global communities respect and offer required support to any tobacco control initiative (Tobacco Free Initiative Unit, 2009, pp. 1-2. On the other hand, to control the use of tobacco products, the WHO FCTC clearly spells out the legal dimension that all nations must follow in their endeavor to reduce tobacco consumption. Specifications in the convention include countries to adopt restrictive measures on tobacco manufacturers, distributors, advertisers, and salespersons, countries to adopt strategies of preventing second-hand smoking effects, and finally, all global communities should implement tobacco trade control measures, aimed at controlling the illegal tobacco trade (Roemer, Taylor & Lariviere, 2005, p.1).

On the other hand, for TFI to achieve its mandate it collaborates with other world nations hence, it has offices all over the world, which mainly plan and implement the WHO FCTC tobacco control strategies. In all global regions, it mobilizes the allocation of enough resources to support the tobacco control initiatives, through ensuring that regional areas incorporate tobacco control measures in all their health initiatives (WHO, 2010, p.1).

Why Global Tobacco Control is an Important Global Health Policy

According to the Central Diseases Control and Prevention (2010, p.1), health complications resulting from the consumption of tobacco products are one of the primary causative agents of the increased mortality rate. Globally, every year tobacco-associated health complications cause more than five million deaths, a figure that is bound to rise to approximately ten million, unless individuals change their tobacco consumption habits. In addition, tobacco consumption is one of the primary causative agents of most diseases globally. Although most individuals do not realize, such diseases have many associated negative economic effects, not only to individuals but also to countries. Governments spend millions of dollars in treating tobacco-related health complications, for example, cancer, coronary heart complications, mental problems, bronchitis, and premature deaths (Jha & Chaloupka, 1999, pp. 22-32). In addition to such enormous governmental expenditure, most victims of tobacco-associated illnesses are individuals in their early adulthood hence, such deaths robs nations its productive and working populations. According to the WHO report on the impacts of tobacco use on national economies, illnesses resulting from tobacco consumption made global communities lose more than the U.S. $ 200 million; whereby, the most affected were third world countries (WHO, 2010, p.1).

In addition to the economic strain on countries, there exists a close correlation between tobacco consumption and poverty; a fact that research attributes to the enormous amounts spent by families on tobacco. The majority of tobacco smokers are addicts, who require a constant supply of tobacco hence, leading to too much spending on tobacco. Such uncontrolled spending in most cases leads to many social problems that may include malnutrition of families, increased premature mortality rate, increased illiteracy rate, and poor health statuses of families. Considering these effects, the war against tobacco consumption is a primary global concern; hence, the widespread campaigns to reduce tobacco consumption (WHO, 2010, p.1).

Summary

In summary, effects associated with tobacco consumption are one of the primary causative agents of the ever-increasing children and adult mortality rates. In addition, considering the enormous amounts of resources spent by either families or governments on tobacco-related illnesses for example cancer, although proceeds from the tobacco trade can be of economic significance, its disadvantages are many hence, the increasing sensitization of the public on the effects of tobacco consumption. Such an economic burden and many social problems associated with tobacco consumption, the WHO adopted the Tobacco-Free initiative in its endeavor to provide solutions to many tobacco-associated problems. The treaty provides measures and strategies that nations should use, through collaboration with global communities. FTI also provides the legal framework under which tobacco trade should take place, a mechanism used by the WHO to mitigate illegal tobacco trade. To ensure that countries adhere to international standards of tobacco control, the WHO introduced the WHO Framework Convention on Tobacco Control, a pact the nations signed and agreed to adhere to in enforcing appropriate tobacco control measures (WHO, 2010, p.1).

Recommendation

Considering the adverse nature of effects associated with tobacco consumption, it is important for all governmental and non-governmental organizations to combine efforts in sensitizing communities on the effects of tobacco use. Such organizations must work in close collaboration with international organizations, which have joined the war on tobacco consumption. It is important to note that, because of the many funds spent by governments annually on health, environmental, economic, and social effects resulting from the consumption of tobacco, governments should come up with cost-effective methodologies. Such methodologies must be applicable in all economic sectors and scenarios, something that is achievable through governments implementing workable solutions. Common methodologies that governments can use include use of public policies and setting of strict laws on the tobacco trade. In addition, governments should formulate strict rules on tobacco advertising, a factor that will ensure organizations use appropriate marketing strategies hence, lessen chances of such adverts misguiding individuals.

In addition, to ensure nations implement fully provisions of the WHO FCTC, the WHO in collaboration with other global organizations for example Center for Diseases Control and Prevention (CDC), should formulate methodologies of strengthening countries capacities to control tobacco consumption. Such strategies include formulation of appropriate resource mobilization strategies, funding of public education programmes, and doing extensive researches on the effects of tobacco consumption. Adoption of these strategies will ensure that, regardless of a countries economic, social, or political situation, tobacco control measures achieve desired results and outcomes.

Reference List

Center for Disease Control and Prevention. (2010). Health effects of cigarette smoking. CDC. Web.

Jha, P., & Chaloupka, F. J. (1999). Curbing the epidemic: governments and the economics of tobacco control. Washington: the International Bank for Reconstruction, the World Bank. Web.

Medicus Mundi Switzerland. World Health organization. Medicus Mundi Switzerland. 2010. Web.

Prokhorov, A. V. et al. (2006). Youth Tobacco use: a global perspective for child health Care clinicians. Pediatrics, 118(3), 890-903. Web.

Roemer, R., Taylor, A., & Lariviere, J. (2005). Origins of the WHO Convention on Tobacco Control. American Journal of Public Health, 95(6), 936-938. Web.

Tobacco Free Initiative Unit. (2009). Effective implementation of the WHO Framework Convention on Tobacco Control through the MPPOWER policy package. TFI Newsletter, 2(2), pp. 1-8. Web.

World Health Organisation. (2010). Tobacco-free initiative. WHO. Web.

World Health Organization. (n.d.). Tobacco is a problem for everyone. WHO Regional Office for the Eastern Mediterranean. Web.

Introduction

The case study Fetal Abnormality consists of four individuals who present diverse views on the abortion of a fetus considered to have a higher chance of having down syndrome. However, the fetus also has no arms and has a lower chance of developing. The parties involved in this case include Jessica, the expectant woman, Marco, and Dr. Wilson, Maria. With the dilemma presented concerning decision-making, various theories are revealed and will be explored in this analysis.

The Christian worldview

The Christian viewpoint on life is that it is sacred and that its existence is based on the will of God. Man was created in the image of God, a mighty being that oversees everything that happens in the world. The Christian doctrine upholds the moral ethics of life preservation regardless of color, strength, statute, or aura. This means that everyone deserves to be valued and respected despite their distinctive characteristics or special needs. The Christian viewpoint aligns with virtue ethics, which presents the idea that an individuals character determines the rightness of an action. This is linked with human value and dignity because it shows that people with virtuous habits are likely to make the right choices.

Theories Used by Jessica, Marco, Maria, And Dr. Wilson and Impact On Their Recommendation

Dr. Wilson uses utilitarianism theory, which advocates for actions that promote happiness. As shown in the case, he supports abortion due to the quality of life that the child would have after birth. He believes that would save the child and parents from suffering that would arise from the condition diagnosed. The theory makes the doctor think that abortion is the best option because it would promote happiness and eliminate sadness (Crisp, 2018). The doctor is convinced that abortion would make the family happy and save the child from pain and suffering.

Marco also uses utilitarianism theory, which determines right from wrong based on the outcome. Although he says that he would support the decision of, Jessica, he believes that the pregnancy and the prospect of a disabled child as a burden and a hindrance to their economic security. Because of the theory, he believes that if the child lives, they might become broke and experience the burden of raising a disabled child (Crisp, 2018). The theory also makes him believe that the greatest happiness would be achieved if the child is aborted. As a result, abortion is considered a better option in this case.

Maria uses virtue ethics in her reasoning in regard to the fate of the fetus. Virtue ethics majors on the moral character of an individual performing the action (Crisp, 2018). In the case scenario, she urges Jessica to consider her responsibility as a mother and proceed with the pregnancy. Maria wants Jessica to make a decision from the perspective of being a mother. Virtue ethics theory is evident in Marias recommendation on the situation. This theory influenced her view that an individual is of noble character (Crisp, 2018). Therefore, the theory enabled her to bring the aspect of a responsible mother to decide.

Jessica is torn into two and uses utilitarianism and virtue ethics. She uses utilitarianism when she thinks that keeping the pregnancy would adversely impact their socio-economic status, which they have struggled to attain. In addition, she uses virtue ethics when she presents the view that all life is sacred. As shown in the case scenario, Jessica is still undecided on the matter. She does not know which direction to take because none of the theories has convinced her about the case.

The Chosen Theory

I agree with virtue ethics theory because it promotes human dignity and value as far as this case is concerned. The fetus deserves respect because of the life they carry and not because of acquired features or abilities, which we all have varying degrees of even when fully developed. Human development is a continual process, and there is no single point at which human existence suddenly becomes worthy of respect and human rights. Using virtue ethics, a virtuous individual would value the life the fetus carries instead of material things (Crisp, 2018). As a result, the fetus should not be exploited as a means to a goal, even if the end is desirable, such as finding solutions for diseases or saving another human life.

Conclusion

Human beings have their own beliefs, theories and philosophies, which determine the decisions they make. As a result, it is important to choose a theory that promotes morality at all ends. The individuals in the case study had their theories which influenced their recommendations. However, among the theories, I support virtue theory because of its value to humanity. Virtue ethics would enable Jessica to reason as a responsible mother and continue with the pregnancy. She should not fear ending socio-economically disadvantaged because they can get help from the government and other well-wishers. Therefore, the fetus should not be aborted because of deformity, or they are likely to make the parents poor.

Reference

Crisp, R. (2018). 8. Hume on virtue, utility and morality. In Virtue ethics, old and new (pp. 159-178). Cornell University Press.

Introduction

Medical errors, malpractices and improper billings are common in the medical field. The patient who is subjected for medical malpractices can approach the court in support of some of the theories in relation to medical setting. This paper analyses a case of such legal proceedings in the first part, presenting the facts of the case that the trial court ruling, the appellate court ruling and how the ruling impacts health care administrators and workers in the US. The second part of the paper deals with a controversy in the US health care. It is a subject for debate that health care organization leaders should be held personally, responsible for fraudulent billing that occurs within their organizations.

The Facts of the Case

On September 12, 2001 a patient named Gary Vivone has under gone two major surgeries from the Broad Lawns medical center. The surgeries were the removal of gallbladder and the small cyst in the forehead. Both the procedures were carried out successfully on the same day. After the surgery, Vivone noticed the swelling of his forehead. Dr. Phan re-opened the wound and re-stitched it and placed a pressure bandage on Vivones fore head. He was then discharged from the hospital. On September, Vivone visited the hospital again and Dr.Phan removed the bandages and replaced them with a new pressure bandage. Vivone returned again on September 24 and he could know that he had tissue necrosis. He has a resulting permanent indentation in his forehead. Vivone filed suits against De. Phan, Dr. Mansour Hadali, Dr. Robert Banister, and Broadlawns on alleging medical malpractice. Later based on defendant superior, he dismissed all others and claimed Broadlawns was responsible under the followed legislative laws.

1. The Doctrine of Respondeat Superior
2. The borrowed servant Doctrine
3. Vicarious liability under the case of Wolbers

The above case is happened because of the mere negligence of the health care professionals. The common law of Respondeat superior is formed in England, which later is adapted in to the United States. Under respondeat superior the employer is liable for the injuries caused by an employee who is working within the scope of his employment relationship (Law encyclopedia: Respondeat superior, 2010, para.4).

The Trial Court Ruling

Due to the medical malpractice committed by Dr. Phan, Vivone registered case against Broadloawns the hospital where Dr. Phan worked at the time of this medical error. Vivone claimed against the institution taking some of the theories in support of his side. One theory is Respondeat Superior which means the responsibility of an employer for the mistakes committed by his employee. The common-law doctrine of respondeat superior was established in seventeenth-century England to define the legal liability of an employer for the actions of an employee (Respondeat superior, 2005, para.1). The second theory in which his claim is grounded is the borrowed servant doctrine which means the liability of an employer for the actions done by his borrowed employee. The common law principle that the employer of a borrowed employee, rather than the employees regular employer, is liable for the employees actions that occur while the employee is under the control of the temporary employer (Borrowed servant doctrine (or borrowed servant role), 2010, para.1). The third theory on which his claim is based is the vicarious liability which proposes about the liability of a person for an injury occurred by the mistake of another person who has legal relationship with him. The tort doctrine that imposes responsibility upon one person for the failure of another, with whom the person has a special relationship (such as Parent and Child, employer and employee, or owner of vehicle and driver), to exercise such care as a reasonably prudent person would use under similar circumstances (Vicarious liability, 2008, para.1)

On the basis of these theories, Vivone claimed against the hospital and submitted before the jury for the verdict after having an extensive discussion on the causation of the case. Finally, the jury found that the fault is with Dr. Phan. Since there is an employee and employer relationship in the case of Dr. Phan and Broadlawns, the verdict was against Broadlawns. Dr. Phan was an employee in the Broadlawns hospital. The jury judged against the institution $160000 as a compensation for the medical error.

The Appellate Court Ruling

After the verdict of trial court, Broadlawns approached the appellate court highlighting some of the claims. The institution is not liable for the mistakes of Dr. Phan and the court should not have allowed the testimony of two doctors who were the supervisors of Dr. Phan while he was working in the hospital. Failure of Vivone to prove the causal connection between his conduct and injury, the special verdict form was not proper were the four claims put forward by the Broadlawn Hospital in order to avoid the verdict of the trail court. Even though the hospital moved with these claims, the district court did not allow their post trial motions. But now the hospital is moving with some of the appeals. The appeal includes the correction of errors at law and the second appeal is that judgment is not withstanding the verdict proposing that it is to be taken into consideration where there is substantial evidence to back his claim.

The impact of Ruling to the Health Care Administrators and Workers in the US

The Ruling of the above mentioned case will impact the health care administrators and workers in many ways. The way U.S. law now works in most places, organizations are strictly liable for crimes committed by employees who are doing their jobs (More enforcement, less justice, 2010, para.3). The effective compliance program and the quality of health care is defendant in case of respondeant superior. The health care organization is responsible for the violation of any health care malpractices and it must provide the required penalty.

The health care administrators take the responsibility of the guilts committed by their workers. As an impact of this ruling, they will take the preventive measures to reduce the guilts committed by their employees. The institution will always maintain the quality of its health care by appointing well qualified health employees. The administrators will monitor the hiring health professionals. They will appoint the hired employees only after verifying the quality of their work and their motivation. The quality of the health care will be totally improved. The administrators will improve the effectiveness of the quality circle in order not to happen any further violations.

In one way, the organization will take the responsibility of the individual failure of its workers. But, it can take some actions against the worker based on the institutional laws and procedure. If the violation is severe the administrators can dismiss its employee. Therefore, the employee will also try to improve their quality of health care. The workers will always provide a better health care by updating the knowledge in their specialization.

The specialization of the employees will also increase. The health care institution is a developing industry. The employee will always try to update their knowledge in deep in a specialized area. Various health care services are provided with a multidisciplinary perspective; here the administrative of the institution will always try to monitor the multidisciplinary team effective in their quality. Sometime, a small negligence may result in the total effectiveness of the institution.

A Major Controversy in the US Health Care

There is a constant debate in the United States health care system in relation to the criminal prosecution for the medical error and for the fraudulent billing in the organization. The question is whether the health care organization leaders should be held personally for fraudulent billing that occurs within their organizations. Errors in billing is the biggest problem in the medical sector and some of the ways in which billing can be occurred are such as repeating the billing, an increase in the length of the stay in the hospital, improper calculation of the charges according to the type of room and the mistakes occurring in the key strokes. Even the simplest medical procedure can cost tens of thousands of dollars. One error could add several thousand dollars to an already hefty bill (Hospital billing error and fraud, n.d, para.2). As far as it is concerned, the health care organization leaders should be subjected to a criminal prosecution for improper billing of Medicare and Medicaid. Because the organization leader is the sole authority in the organization and most of the malpractices are occurred with their knowing. Even though it is a minute mistake in the billing, the money receiving out of this malpractice is enormous. The organization leader can stop such kind of malpractices from their organization if they have will. But no organization takes any step to stop such acts and moreover they encourage such malpractices. In order to eradicate this type of trends from the organizations, the organization leaders must be subject for criminal prosecution for improper billing.

Reference List

Borrowed servant doctrine (or borrowed servant role). (2010). Your Dictionary.Com. Web.

Hospital billing error and fraud. (n.d.). Fraud Guides. Web.

Law encyclopedia: Respondeat superior. (2010). Answers.Com. Web.

More enforcement, less justice. (2010). The FCPA Blog. Web.

Respondeat superior. (2005). The Free Dictionary. Web.

Vicarious liability. (2008). The Free Dictionary. Web.

Introduction

Closing the Gap initiative of the Australian government focuses on reducing the life expectancy and health gap among Indigenous Australians, the Aboriginal, and Torres Strait Islander people, to achieve health equality. Initially started as a social justice campaign, the initiative now presents a national strategy with a range of different socioeconomic targets. In addition to targets in the area of population health and wellbeing, the initiative also aims to improve issues with social determinants of health and provide more education and employment opportunities for First Nation people. The strategy also focuses on improving housing conditions and protecting the spiritual and economic connection of Aboriginal and Torres Strait Islander people with their land and waters. Taking a closer look at the strategy defines registered nurse practitioners role in improving First Nation peoples health by raising awareness about health disparity, developing cultural competence, and implementing cultural safety practices.

Indigenous Health and Wellbeing

Firstly, understanding the reasons behind health disparity for First Nation Peoples is required to develop an appreciation of the initiative in novice registered nurse practitioners. The main concerns which became the basis for the development of the initiative were high death rates and low life expectancy index among the Aboriginal and Torres Strait Islander people. Furthermore, it was determined that in most cases, the leading cause of death in the Australian Indigenous population was a chronic disease, such as diabetes, heart disease, kidney disease, and cancer (Australian Institute of Health and Welfare, 2022). While preventing mortality outcomes in patients affected by chronic diseases is possible with appropriate health resources, in this case addressing the issue required a complex approach to eliminating socioeconomic barriers to access to health services.

Next, the condition of a patient affected by the chronic disease is highly dependent on socioeconomic factors because they determine the patients social and emotional wellbeing. As a part of the governmental assimilation program, which wrongly assumed that improving the lives of First Nations people was possible through integration into white society, many Indigenous Australians were forcefully removed from their families. The Indigenous children forcefully removed from their families during that period are commonly referred to as the Stolen Generations. Emotional wellbeing is strongly associated with positive family relationships and support from family members. Considering that there are nearly thirty thousand Stolen Generations survivors, a significant portion of Indigenous Australians may experience mental issues from their inability to feel a sense of belonging and loss of cultural identity (Australian Institute of Health and Welfare, 2022). Therefore, the previous experience of unsuccessful policy draws attention to the issue of choosing culturally safe practices in addressing health disparities.

In addition, the disadvantage can persist through generations, resulting in poor emotional wellbeing in Stolen Generations descendants. Lastly, suicide and self-harm also present a significant part of mortality cases among Indigenous Australians. It is estimated that suicide rates are two times higher among Indigenous Australians than non-Indigenous Australians, and the difference is more apparent among younger people (Australian Institute of Health and Welfare, 2022). The issue signals a lack of activities in the healthcare system focused on support of the populations mental health. Therefore, addressing the issue and shifting the focus to more accessible mental health treatment options will require additional efforts from the healthcare system.

Furthermore, the equality in the health of First Nation people is affected by low education and employment opportunities for the population in remote areas, poor housing conditions, and the inability to engage in healthy behavior activities. Employment and education are closely connected with the health status of Australian Indigenous people. Insufficient employment opportunities have a negative effect on individuals quality of life by limiting their access to oral and hearing health services. According to the Australian Institute of Health and Welfare (2022), ear infections such as otitis media can often result in hearing loss in children if they are not examined and treated in time. Furthermore, hearing impairment can affect childrens academic progress, reducing their educational opportunities. Next, a significant portion of Aboriginal and Torres Strait Islander people experience hearing and vision problems from a lack of proper care and timely inspection (Australian Institute of Health and Welfare, 2022). Hearing and vision problems furthermore reduce the quality of life of the population by limiting their possible actions.

Thus, exploring the health disparity experienced by First Nation Peoples demonstrates the importance of the Closing the Gap initiative. Furthermore, the registered nursing practitioners knowledge of First Nation peoples health needs is essential for understating the role of cultural competence and cultural safety in the healthcare system. Registered nursing practitioners have access to regular direct communication with patients; therefore, they must use the interactions to increase the populations awareness of the topic. Moreover, students transitioning to registered nursing partitioners must develop the necessary cultural competence to ensure their ability to participate in the initiative by using culturally safe practices.

Cultural Competency and Cultural Safety

Next, considering the theme of cultural competency and cultural safety, both aspects are acknowledged as necessary in eliminating inequities in ethnic health. However, some experts perceive cultural safety as a more practical approach to cultural competency and prioritize it over cultural competency in professional requirements. The difference between cultural safety and cultural competency is mainly explained by the healthcare professionals willingness to challenge his own culture and cultural system. According to Curtis et al. (2019), the issue of ethnic health inequality also involves institutionalized racism, implicit bias, and unfair distribution of resources acknowledged as social determinants of health. Therefore, prioritizing cultural competency in addressing the needs of the Indigenous population is less likely to contribute to the overall system change than cultural safety policies. Thus, in the context of contributing to the Closing the Gap initiative, healthcare professionals cultural competence is less efficient than implementing cultural safety practices.

The definition of the concept of cultural safety can vary across different countries, but it always emphasizes the power dynamic in ethnic health inequality. In particular, the concept prioritizes patients rights and eliminates the power imbalance between the patient and the healthcare provider. Thus, the cultural safety approach rejects the idea of learning the cultural customs of an ethnic group because it emphasizes the power of healthcare providers over patients. Instead, cultural safety focuses on transforming the existing healthcare system to be more accessible for indigenous populations. According to Curtis et al. (2019), cultural safety shifts the focus from changing the patients culture to changing the culture of the clinical environment. Therefore, registered nursing professionals have more opportunities to contribute to the Closing the Gap initiative by utilizing cultural safety practices.

Next, while individual-level implementation of culturally safe practices in healthcare professionals is limited to their abilities and influence, the positive impact of cultural safety is evident when applied at the organizational level. According to Curtis et al. (2019), implementing culturally safe practices in healthcare organizations results in more transparent relationships between healthcare practitioners and patients, increased patient involvement, and higher patient safety. Furthermore, evidence of cultural safe practices efficiency also includes the elimination of biases, stereotypes, and prejudice in healthcare professionals, which increases the quality of services (Curtis et al., 2019). On the other hand, while cultural competency attempts to achieve similar outcomes, it risks oversimplifying the understanding of culture to the point of cultural essentialism, which will eventually result in lowered quality of care.

Lastly, considering the role of students transitioning to novice registered nurse practitioners in the initiative, several individual-level strategies are recommended to address the issue of health disparity for First Nation Peoples. Firstly, even though cultural competence presents a more common requirement for healthcare professionals, their activity should not be limited to the approach utilized in the cultural competence concept. Thus, all nurse practitioners should employ a wider understanding of their role in addressing ethnic health inequity by implementing cultural safety practices. Next, all healthcare professionals must implement cultural safety on individual and organizational levels and change the power dynamics between patients and healthcare providers by respecting patients rights. Lastly, novice registered nurse practitioners must develop appropriate skills to address the existing bias and stereotypes in the healthcare system and make each patient feel equal to the healthcare provider.

Conclusion

In conclusion, this essay explored the issue of ethnic health inequalities through the prism of the novice registered nurse practitioners role. The essay explained the major health concerns of Aboriginal and Torres Strait Islander people and described how the Australian government plans to address them through the Closing the Gap initiative. Gaining knowledge about health disparity for First Nation Peoples is very important for novice registered nurse practitioners because it allows them to understand the issue and raise the publics awareness of the problem. The essay also explored the differences between cultural competence and cultural safety and explained how cultural safety is more important for healthcare professionals because it utilizes a more comprehensive approach with an emphasis on decolonization. Lastly, the essay provided several individual-level cultural safety strategies to address ethnic health disparity, which can be implemented in novice registered nurse practitioners activities.

References

Australian Institute of Health and Welfare. (2022). Indigenous health and wellbeing.

Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S. J., & Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International Journal for Equity in Health, 18, 1-17.

The second dimension of PEN-3 model, the Educational Diagnosis of Health Behavior, has been evolved from three different models of health education. The models which are involved in the creation of the second dimension of PEN-3 model are

1. Health Belief Model,
2. Theory of Reasoned Action and
3. the PRECEDE framework.

The second dimension of PEN-3 model consists of factors like perceptions, enablers and nurturers.

While perceptions represent the knowledge, attitudes, values and beliefs which play a large role in the motivation of the individuals, enablers are social, systematic or structural influences, which have the effect of enhancing the health beliefs and practices. Sometimes enablers may also create new barriers in the process of maintaining or changing the health beliefs and practices. Enablers like available resources, accessibility, and referrals, in connection with the health beliefs and practices largely influence the health beliefs and practices in a community. The skills and types of service available within the community to achieve the ends of the educational diagnosis can also be considered as enablers.

The second dimension of PEN-3 model is also subject to the cultural appropriateness of the health beliefs, which forms the third and important dimension of the PEN-3 model. There are three factors involved in the third dimension of the model. They are:

1. positive,
2. negative and
3. existential.

Positive enablers may result in an individual, family or community is accustomed to health practices contributing to improved health status. It is essential that these enablers must be encouraged to develop good health among the communities and individuals. Such positive enablers resulting in good health practices are necessary to empower individuals, families and neighborhoods towards better and healthy living (Mississippi State University, 2001). An example in this direction is the creation of more primary health centers where free consultation on the ways to avoid obesity and improving the health consciousness are provided to the individuals susceptible to diabetes and heart diseases due to obesity. This is a positive enabler, which needs encouragement.

On the contrary, negative enablers would lead the individuals, families and communities to follow health practices that are harmful to keeping good health. Such resource and skills lead to unnecessary consequences in terms of affecting good health and potential loss of earning capacity of the adults. One example in this case may be cited is the proliferation of fast food outlets offering junk foods, which may increase the incidence of getting obese among the people. There must be programs evolved to educate the people the bad effects of having fast food items frequently from these outlets.

Existential perceptions are unique to particular communities, which are also having no harmful consequences. There is the need only to study such beliefs and practices as to their effect on the health of the individuals, families and neighborhoods. Efforts may be taken to improve upon these beliefs and practices so that they become beneficial to the individuals and families.

It is imperative that the health educators concentrate on both the positive and negative enablers to keep the pace of empowerment of individuals in any health program. This will have the advantage of having a higher level of sensitivity when the planners (Missisipi State University, 2001) select the most culturally appropriate health education interventions.

Thus, the PEN-3 model provides an opportunity to promote the notion of multiple truths by allowing examining cultures and behaviors. This process starts with identifying the positives and existential enablers, which represent unique cultural beliefs and practices before embarking upon the negative enablers. This encourages intervention and theorizing of positive values in preference to changing the negative values in the communities and neighborhoods (Airhihenbuwa, 2007).

References

Airhihenbuwa, C. O. (2007). On Being Comfortable With Being Uncomfortable: Centering an Africanist Vision in Our Gateway to Global Health. Web.

MissisipiStateUniversity. (2001). Health Education Models:HEALTH EDUCATION PLANNING MODELS  A REVIEW OF THE LITERATURE  PART II. Web.

Statement of the Phenomenon of Interest

The article clearly indicates, even from the title that it aims to investigate how pressure ulcers and their treatment affects the quality of life of patients. It also gives credence to the viewpoints of the patients themselves as they are the best authority on the issue since they are the ones directly affected by it. Hence, a qualitative format is called for, using interview data as the basis of analysis. Regarding philosophic underpinnings, the researchers have done a thorough job reviewing the literature for each of the concepts of pressure ulcers and quality of life.

Purpose

Having given the justifications of the study, the researchers went on to reasonably explain the purpose of conducting the research. It emphasizes its significance to nursing with the implications that practitioners need to be more aware of the effects of pressure ulcers on patient care, as it is mostly the nurses who are concerned with checking up on the status of the sores and changing the dressing and of course helping patients manage the ulcers with or without nursing care.

Method

The methodology used is appropriate for the purpose of the research, as it provided the relevant themes and subthemes intended to fill the meat of the data. The interviews were free-flowing, although the researchers tried to stay within the themes to meet the information they set out in their goals. Patients suffering from pressure ulcers indeed were the best people to report their subjective experiences with the illness in terms of how it affects their quality of life. For this reason, the qualitative method of inquiry was most appropriate. Any other information yielded from the interviews may just be a bonus.

Qualitative research uses a naturalistic approach in search of truth. It seeks to understand phenomena in observed in specific settings. In contrast, quantitative methods are, in general, supported by the positivists paradigm, which characterizes that the world is made up of observable and measurable facts. Positivists assume that a fixed measurable reality exists external to people (Glesne, 1999). On the other hand, qualitative methods are generally supported by the interpretive (also referred to as constructivist) who portrays the world in which reality is socially constructed, complex, and ever-changing.

Strauss and Corbin, (1990) argue that qualitative research is any kind of research that unearths data that is not arrived at by quantitative procedures. If quantitative researchers look for causal determination, prediction, and generalization of findings, qualitative researchers look for clarification and understanding to similar situations. Therefore, it can follow that varied results come out of qualitative analysis and quantitative inquiry.

Straus and Corbin (1990) claim that qualitative methods can be used to better understand any phenomenon about which little is yet known. They can also be used to find new insights or alternative explanations on things about which much is already known, or to gain deeper information regarding those that may be difficult to be explained quantitatively, or where the researcher has determined that quantitative measures do not adequately describe or interpret a specific phenomenon.

Sampling

Purposive sampling was used. All 23 subjects were recommended by clinical research nurses from medical, elderly care, orthopaedic and vascular surgery wards in four NHS hospitals. They reflected the core characteristics of the study population as indicated by Patton (1990). All ethical considerations were given to the participants who came to the research fully knowing what to expect and signing a written consent of their participation. They were aware that the study was to benefit them because it was designed to understand their experiences of developing a pressure ulcer and their experiences of pressure ulcer care and treatments. This was their chance to express themselves and to maybe make a difference for others who are suffering from the same predicament.

Data Collection

This qualitative study thoroughly brought out the experiences of the subjects interviewed. The demographics of each subject were considered and charted down in case they would affect the results. The interviews were done by two people who were not the researchers themselves to add to the objectivity of the data. The interviews were recorded and the data were coded according to the themes/subthemes established in the beginning. It was noted in the article that the methodology used was approved by the Multi-centre Research Ethics Committee. It was likewise endorsed by the Local Research Ethics Committees as well as the research governance and management departments of the participating centers. This fact alone is enough evidence that the safety, protection and human rights of the subjects were assured. The subjects are not obligated to continue with their participation if they, in any way, feel discomfort in the way things are going. They can quit anytime they feel like it. The data gathered may be more than what is necessary for the study. Thus, the researchers know which ones to use in order to meet the objectives of the study.

Data Analysis

The researchers ran the process of analysis of data clearly to the readers. It justified each step as in using external interviewers to maintain the objectivity and credence of the interviews. The themes and subthemes were distinctly enumerated at the beginning of the data-gathering stage in an attempt to predict which ones may come out. True enough, the data met the objectives of the study, as the subjects shared their experiences with pressure ulcers.

Readers will have no difficulty understanding the data analysis and its link to the findings of the study. It also states a waiver that although it may not be generalizable to the entire population, there is still value for certain groups of patients and settings (Lincoln & Guba, 1985).

The data suggests that the participants were fully aware of their experiences with pressure ulcers, as they were able to recount not only their experiences but also some probable causes for them. Hence it can be said that the data was credible because it reflected the truth based on the participants own experiences, as told by them first-hand. In terms of auditability, readers benefit from the clear flow of the writing of the study as they do not get side-tracked by other extraneous factors. The researchers were meticulous in reporting the process every step of the way that readers are kept organized in the flow of the unraveling of information.

This studys findings, no matter the limitations it has reported, can be applied to other study settings related to nursing care. It thoroughly investigates the participants views on the existence of pressure ulcers and how it affects their quality of life, and it clearly points out logical causes for both. Readers, especially nurses, can take home a lot of wisdom from reading the article as it points out a lot of loopholes many practitioners fall into in the delivery of quality service to their patients. Hearing the patients perspectives makes practitioners evaluate their own practice and motivates them to further hone their nursing care skills. The strategies used for analysis are effective, as it presents patient views with regards to various themes and concerns effectively. The purpose of the study was clearly met.

Findings

The context in which the findings were presented was clearly defined. Patients suffering from pressure ulcers shared consistent views on their predicament, with some variations in perspectives that would now depend on the participants personality and background. Since the participants own words were used, and not totally edited by the researchers, the readers have free access to the participants genuine experiences and take for themselves the learning they need from the findings.

The findings were consistent with the researchers conceptualizations of the data, as presented in their aims for the study namely to explore the following questions in hospital inpatient settings:

• How do people with pressure ulcers rate their health and quality of life?
• What are patients experiences of developing a pressure ulcer?
• What are patients experiences of pressure area care and treatment? (Spilsbury, Nelson, Cullum, Iglesias, Nixon & Mason, 2007, p. 495)

The data derived from the interviews met the aforementioned aims and generally, the participants were able to consistently discuss the themes set forth. Apart from bewailing their experiences with the pressure ulcers, the majority identified the causes for it; some blamed themselves for coming up with the ulcers (improper hygiene, neglect of health, etc.); some blamed the ulcer itself and vented their anger on its existence and some complained of poor nursing care (neglect of changing dressings, insensitive treatment of patient).

The researchers were diligent enough to spell out what is already known about the issue of pressure ulcers as such:

• Pressure ulcers are a significant health problem.
• Nursing staff have a major role in the prevention, treatment, management and care of pressure ulcers.
• There is limited research on the impact of pressure ulcers and their treatment on quality of life.

They were also able to contribute additional information to the field with this study:

• Pressure ulcers have a physical, social, emotional and mental impact on patients.
• Pressure ulcers can be essential in patients progress from illness to full recovery, and may be perceived to increase hospital stays, and result in ongoing treatments.
• Pressure ulcers cause much pain, discomfort and distress that is not always recognized or adequately treated by nursing staff. (Spilsbury, Nelson, Cullum, Iglesias, Nixon & Mason, 2007, p. 502)

In itself, this study asserts its significance to the nursing field. It provides a lot of information valuable to practitioners in carrying out their duties and responsibilities to their patients.

Conclusions, Implications, and Recommendations

The article wraps up the study very well in a succinct conclusion that covers all the learnings derived from the research project. It clearly communicates to the readers the significance of proper nursing care to provide a high quality of life for patients in general. For this particular study on pressure ulcers, the researchers specified that management of dressings of the pressure ulcers, providing information to patients and family members (in particular about realistic time expectations for healing), undertaking preventative interventions regarding the ulcers and understanding the importance of comfort and positioning for patients. In addition, healthcare professionals need to respond to patients criticisms of their lack of involvement, or poor standards in the treatment, management and care of pressure ulcers (Spilsbury, Nelson, Cullum, Iglesias, Nixon & Mason, 2007, p. 502-503). Being conscientious in the implementation of their duties is essential to the nursing profession. A study by Jensen and Lidell (2009) yielded findings that nurses considered that their conscience worked for them in three ways: as a driving force, as a restricting factor and as a source of sensitivity. The participants of this study perceived that their conscience is an asset that guided them in how they deal with their patients and their families and in their efforts to provide high-quality care.

Practically, it is also recommended that using support surfaces, repositioning the patient, optimizing nutritional status, and moisturizing sacral skin are appropriate strategies to prevent pressure ulcers (Reddy, Gill & Rochon, 2006. p. 974). This conclusion was arrived at from the study findings based on the participants reports themselves. It serves not only as a conclusion but also as reminder for nursing practitioners to be more sensitive and diligent in their practice. Bailey (2006) enumerates three things that nurses should take into consideration when ensuring a good quality of life for patients namely: pain and suffering, body functioning and autonomy. An efficient and sensitive nurse discerns well when she can give life-saving treatments which are applicable to her patients. With pressure ulcers, she needs to consider the degree of discomfort the patient experiences, if any, the body functioning of the patient, or if he has some organ failure, and of course, how independent the patient can move around with the least possible discomfort. Of course, a nurse should secure consent from the patient before administering nursing care. Aveyard (2005) did a study that evidenced that most nurses do not obtain permission from patients before providing care and refusals were ignored. The participants of the study did not know how to deal with the situation of proceeding with care when the patient was unable to give consent. Such a dilemma should be discussed in training nurses so a harmonious professional relationship with patients can be established. Patients may be helpless, but they do deserve to keep their dignity intact (Wainwright & Gallagher, 2008).

Nurses have the moral responsibility to ensure that their patients receive utmost care which includes teaching patients the ability to manage the disease on a daily basis. Educating patients on self-management is very effective in the recovery or at least the ease of pain of patients that health care professionals are advocated to include it in the routine care of individuals with chronic disease (Redman, 2005).

Although the study has covered much ground on the topic of pressure sores and its effect on patients quality of life, the researchers recommend future studies on its long-term effects on patients along with its treatment and prevention, specifically the costs it will entail for the patients, both monetary and non-monetary. The researchers foresee great challenges in these future research prospects.

References

1. Aveyard, H. (2005) Informed Consent Prior to Nursing Care Procedures, Nursing Ethics: An International Journal for Health Care Professionals, Vol. 12, Issue 1.
2. Bailey, S. (2006) Decision Making in Acute Care: A Practical Framework Supporting the Best Interests Principle., Nursing Ethics: An International Journal for Health Care Professionals, 13(3)
3. Buss, I. C., Halfens, R. J., Abu-Saad, H.. Kok, G. (2004) Pressure ulcer prevention in nursing homes: views and beliefs of enrolled nurses and other health care workers.,Journal of Clinical Nursing, Vol. 13 Issue 6
4. Degenholtz, H. B., Rosen, J., Castle, N., Mittal, V., Liu, D. (2008) The Association Between Changes in Health Status and Nursing Home Resident Quality of Life, Gerontologist, Vol. 48 Issue 5
5. Dharmarajan, T. S. & Ahmed, S. (2003) The growing problem of pressure ulcers. Postgraduate Medicine, Vol. 113 Issue 5,
6. Glesne, C. (1999) Becoming Qualitative Researcher: An Introduction 2^nd Ed. Longman, An imprint of Addison Wesley Longman, Inc.
7. Jensen, A. & Lidell, E. (2009) The Influence of Conscience in Nursing. Nursing Ethics: An International Journal for Health Care Professionals, Vol.16, Issue 1.
8. Lincoln Y.S. & Guba E.G. (1985) Naturalistic Inquiry. Sage, Beverley Hills, CA.
9. Levine, J. M.,Totolos, E. A.(1994) Quality-oriented approach to pressure ulcer management in a nursing facility. Gerontologist, Vol. 34 Issue 3
10. Patton M.Q. (1990) Qualitative Evaluation and Research Methods (2nd ed.). Sage, Newbury Park, CA.
11. Reddy, M., Gill, S. S. Rochon, P. A.(2006) Preventing Pressure Ulcers: A Systematic Review. JAMA: Journal of the American Medical Association, Vol. 296 Issue 8.
12. Redman, B. K. (2005) The Ethics of Self-Management Preparation for Chronic Illness, Nursing Ethics: An International Journal for Health Care Professionals, Vol. 12, Issue 4.
13. Schnelle, J. (2004) Determining the Relationship Between Staffing and Quality. Gerontologist, Vol. 44 Issue 1
14. Spilsbury K., Nelson A., Cullum N. , Iglesias C. , Nixon J. & Mason S., (2007) Pressure Ulcers And Their Treatment And Effects On Quality Of Life: Hospital Inpatient Perspectives. Journal Of Advanced Nursing 57(5), 494504
15. Strauss, A. & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. London: Sage.
16. Wainwright, P. & Gallagher, A. (2008)On Different Types of Dignity in Nursing Care: A Critique of Nordenfelt, Nursing Philosophy: An International Journal for Healthcare Professionals, Vol. 9, Issue 1.
17. Zeller, J. L.(2006) Pressure Ulcers, Journal of the American Medical Association, Vol. 296 Issue 8

Background

This paper explores the use of theoretical or conceptual framework in nursing research. McEwen and Will (2019) define theoretical framework as the concepts that give rise to the research problem. The framework enables researchers to evaluate the underlying assumptions critically by connecting the research problem to the existing knowledge. The researcher articulates the theoretical assumptions, thereby justifying the conduct of the study. The framework also enables researchers to identify the bounds of these generalizations by specifying the main variables that influence the phenomenon of interest. Therefore, identifying an accurate theoretical framework enhances the quality of a research by highlighting the meaning, nature, and challenges related to the research phenomenon.

Researchers use a six-step procedure when developing a reliable theoretical framework. Firstly, the researchers evaluate the research problem as the basis for constructing this framework. The research problem is a specific issue or gap in knowledge or practice that the study aims to address. Secondly, using brainstorming and other methods of generating ideas, the researchers must identify the variables that influence the variables of interest. Thirdly, the study must review related literature to identify the underlying assumptions and associations between the variables. Fourthly, they must group the variables into independent and dependent categories. Fifthly, the researcher should review the key social theories to determine the key variables of interest. Lastly, the researcher must discuss the relevance of the theorys assumptions to the study. The successful execution of these steps limits the scope of the research to focus on the specific variables that are most critical to the study.

Theory in Research

The Use of Theory in the Study of Social Systems

Theory in research offers a conceptual basis for investigating relationships within social systems. It enables researchers to understand, analyze, and develop methods of investigating variables in a relationship (Gray & Grove, 2020). In addition, theory in research facilitates the interpretation and coding of new research data, defining the research problem, and developing new methods of evaluating solutions to the research problems. Moreover, effective application of theory in research helps researchers in responding to new problems that have no pre-determined solutions. Besides, theory in research provides a means of discerning facts within the volumes of existing knowledge and enables the researcher to select the important facts. Therefore, researchers depend on established theory to develop a comprehensive framework of realizing the study objectives.

Use of Theories in the Study of the Research Question

Researchers are confronted by several factors that affect the identified research question. These factors vary in their level of importance to the study. While a few exhibit statistical significance, others do not have much connection the theory despite their perceived relationship. In addition, some factors often have in interactive effects, which might not be decipherable by a casual glance. Researchers rely on theory to identify the most important factors, potential interactions, and the means of collecting reliable datasets using existing methods. In addition, theory provides a basis for guiding and informing researchers in undertaking further studies and improving professional practice.

Using Theories in the Nursing Studies

The use of theory is particularly relevant in nursing research. The theories explicitly define nursing and determine the role of nursing professionals in healthcare settings. In addition, theories justify the nursing interventions conducting in the course of healthcare and provide the required knowledge base needed to act and respond appropriately in healthcare situations. Moreover, they provide nursing researchers and professionals with a sense of identity. In Corinthians 6:17, it is said that he that is joined unto the Lord is one spirit (KJV). In the case of nursing research, this identity helps the professionals and researchers acknowledge and understand their unique contribution to the patients wellbeing. Furthermore, the theories help nursing researchers to reflect on the underlying assumptions and their impact within diverse healthcare settings. Additionally, researchers apply theories to understand the limits to their research and to provide directions for future studies. Lastly, theories enable researchers to ascribe new meanings to old data, thereby enabling the profession to adapt to the changing healthcare environment. Therefore, theory plays a critical role in nursing research.

Theory as a Conceptual Framework

Researchers incorporate theories in the research by using theory to drive the entire process. The researchers fit the research problem into an existing theoretical framework to guide and enrich the quality of the findings (McEwen & Wills, 2019). McEwen and Willis examine the use of nursing theories in one study by DeSanto-Madeya, which explored the patients adaptation to spinal cord injury. DeSanto-Madeyas study is an effective guide to the application of theory as a conceptual framework in research.

Study Variables

The dependent variables included the emotional, physical, functional, and social components of adaptation after spinal cord injury. The study examined these variables after 1, 3, and 8 years after the patients suffered a spinal cord injury (Fawcett & DeSanto-Madeya, 2013). In contrast, the independent variables included social and educational support extended to the patients by their families.

Conceptual Definitions

The study adapted the Roy Adaptation Models (RAM) concepts to evaluate the level of patients adaptation over time. This model defines a person as a bio-psycho-social being that interacts constantly with a changing environment. As a result, patients must rely on innate and learned behaviors to survive. The study defined the patients family as the adaptive system that is in constant interaction with a variable focal stimulus (time since injury), and the contextual stimuli (the degree of injury as well as variables that enhance or inhibit the patients adaptation. These conceptual definitions restricted the researchers focus to only the relevant variables identified under the Roy Adaptation Model.

Instruments

DeSanto-Madeyas study used two main instruments to collect data and evaluate the level of patients adaptation. The study used an interview guide developed by the researcher to determine the level of patients adaptation. In addition, the study examined the data sheet containing the medical history of the patients. This data was sufficient to make reliable inferences on the sample.

Findings

The study interpreted the findings based on RAMs concepts. DeSanto-Madeya finds that patients have a moderate level of adaptation to the spinal cord injury irrespective of the duration after injury (2013). The study further finds that the patients adaptation to spinal code injury can be enhanced through provision of continuous social and educational support to both the patients and their families. These findings affirm the biblical worldview that being there for people in need strengthens their will to live and boosts their quality of life (King James Bible, 2020).

Relationship of Findings to Framework

The researcher interpreted the findings based on RAMs model. DeSanto-Madeya developed an adaptation score to describe the patients and families level of adjustment after the injury. This adaptation score aligned with the RAM, which describes patients as products of their environment. The findings also implied the existence of a cause-and-effect relationship between nursing or other healthcare interventions and the patients wellbeing as indicated by the different adaptation scores based on the patients level of social and emotional wellbeing.

Implication for Nursing Practice

The study finds that supportive family relationships enable victims of spinal cord injury to adapt easily to their environment. In addition, the study notes that depression often occurs among patients with spinal cord injury and their families. Moreover, the study finds that refocusing of values boosts the patients level of adaptation. These findings imply that nursing practitioners should consider patients with spinal cord injuries in the context of their families.

Recommendations for Further Researcher

The study recommended the conduct of additional inquiry using a larger sample. A larger sample reduces the margin of errors in the dataset. In addition, a larger sample size reduces the effect of outliers in the dataset. For these reasons, DeSanto-Madeya recommends the replication of this study using a larger sample to determine if the Roy Adaptation Model could be generalized to the new sample.

Nursing and Non-Nursing Theories

Nursing research should rely on both nursing and non-nursing theories for two reasons. Firstly, other non-nursing disciplines have more advanced theoretical frameworks that could enhance the quality of inquiry and findings from these studies. Secondly, the use of non-nursing theories in nursing research is an appreciation of the integrated nature of the nursing profession. Therefore, both nursing and non-nursing theories should be applied in nursing research.

References

Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3^rd Ed.). Davis.

Gray, J. R., & Grove, S. K. (2020). The practice of nursing research: Appraisal, synthesis, and generation of evidence. Elsevier Health Sciences.

King James Bible. (2020). King James Bible Online. Web.

McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing. Wolters Kluwer.