Treating addiction is a complex process that necessitates the use of creative approaches. The departure from standard treatment programs is especially important when the patients are children and adolescents struggling with substance abuse. Unlike adults, this population is extremely vulnerable to inappropriate choice of interventions. Two activities represent examples of creative psychotherapy when working with underage addicts songwriting in music therapy and clown roleplaying in drama therapy.
The most effective type of structured activity for the music therapy program is songwriting. The survey by Johnson and Heiderscheit (2018) has ascertained that songwriting is an intervention frequently used by music therapists when working with adolescents. Johnson and Heiderscheit (2018) explain that engaging in the communication and socialization skills needed to create a song this activity releases negative feelings. As a result, adolescents channel their energy into creativity instead of suppressing their addiction issues.
The most effective type of structured activity for the drama therapy program is clown roleplaying. The study by Gordon et al. (2018) has established that clown roleplaying is an effective intervention applied to manage mental health issues of children and adolescents, including addiction issues. Gordon et al. (2018) argue that clown roleplaying works by normalizing paradox for mental health patients, which contributes to rehabilitation. In essence, addicts recover by learning to manage ambivalence in structured clown play sessions.
In conclusion, both clown roleplaying and songwriting are appropriate activities for adolescents and children struggling with substance abuse because they channel their energy into creativity. Drama and music therapy provide creative ways for addicts to express themselves, which is a substantial part of healing from mental health issues. Not only does incorporating such activities contribute to the rehabilitation and recovery of underage patients, but it may also help adult addicts as well.
References
Gordon, J., Shenar, Y., & Pendzik, S. (2018). Clown therapy: A drama therapy approach to addiction and beyond. The Arts in Psychotherapy, 57, 88-94.
Johnson, K., & Heiderscheit, A. (2018). A survey of music therapy methods on adolescent inpatient mental health units. Journal of Music Therapy, 55(4), 463-488.
The assessment and management of pain have not only been a controversial topic within the fields of clinical and nursing but have also been dogged by challenges. The particular reasons behind this scenario are not hard to discern. Palliative care presents numerous challenges to the nursing fraternity given the complexity posed by the different types of medical complications. The ability to carry out pain assessment and management determines to large extent the capacity to deal with the effects and symptoms of the disease.
It must be pointed out that unless clinicians and nurses are equipped with skills and tools to assess pain, they may be deprived of the capacity to maintain the pain on patients.
Acute pain is often as lethal as an epidemic. The preceding events and factors that cause it are mostly unpleasant and the fact is it is more widespread than anticipated. Causes of pain consist of serious accidents such as fire or car accidents, physical assaults such as rape as attempted rape, and diseases that affect the natural functioning of the body. Victims of these conditions at times believe that there is no solution but the management of pain involves a proper appreciation of ones status, developing a trusting relationship with ones therapist, understanding ones diagnosis, and stabilizing ones self at the expense of uncovering the unpleasant memories (Davis, Weissman, & Arnold, 2004).
One must come to the reality that to manage pain, there is the need to understand that the patient is saving his/her life and thus concerted effort must be put to dilute the adverse effects of this pain. This explorative essay seeks to discuss the aspects of pain assessment and pain management. Towards this end, critical enablers and barriers to effective pain assessment and management of pain in a client with an eventually fatal condition will be dissected. In addition to the above, effective approaches to pain management will also form part of this essay, and a strong conclusion is given based on the discussion within this essay.
Overview of pain
Beck (2005) and Hanks Nugent, Higgs, and Busch (2004) define pain as a sensation that everyone perceives after an injury has occurred to the body. Most forms of the pains that are perceived by people have theoretical origins from the organic illnesses of the body. Several kinds of literature have provided varying degrees on the analysis of aspects of pain. However, one fact remains clear; the intensity of pain perceived by an individual depends on several factors that are directly related to the levels of injury.
In addition to the above, there are different types of pain. For example, organic pain draws its origin from the psychological nature of human beings. According to Given, Given, Rahbar, Jeon, McCorkle, Cimprich, Galecki, Kozachik, Brady, Fisher-Malloy, Courtney, and Bowie (2004), pain signals that are transmitted along with neuronal system different than other signals in the nervous system by their ability to sustain the strength of quality and magnitude.
The concept of pain is understood to arise from the damage caused to tissue which releases chemicals that stimulate pain receptors in the affected parts of the body (Boswell & Cole, 2006). The message is transmitted to the brain through the nerve endings that eventually give a sensation of pain to an individual. Two common types of pain include fast and slow types of pain. The major difference between the two types of pain depends on the time it takes for the pain sensation to be felt. According to Spiegel and Classen (2000), fast pain develops quickly after an injury such as the one that occurs after a needle injection or knife cut while slow pain develops over a long period and is usually a continuous sensation of pain
Pain assessment
Effective assessment of pain requires nurses to answer the important question to effectively carry out a thorough process on pain demographics and arrive at a valid conclusion (Modonesi, Scarpi, Maltoni, Derni, Fabbri, Martini, Sansoni and
Amadori, 2005). The knowledge of the type of pain is critical in the process of pain assessment. The types of pain that will be taken into consideration during pain assessment include nociceptive pain, neuropathic pain, psychogenic pain, and mixed category pain.
The symptoms of pain are clustered under three headings; Intrusive recollection of the trauma, avoidance of stimuli associated with the trauma, and disordered arousal (Scott & Stradling, 2006). Every individual has got different levels of nature, intensity, and levels of pain and thus an appropriate assessment would be important in recommending the kind of treatment to be administered. There is no simple cause and effect relationship between the event and subsequent psychological symptoms in that if a group of people undergoes a similar pain process, each persons experience of that event will be unique and probably very different from that of other members of the group (CREST, 2003).
Greenstein and Breitbart (2000) also buttress this point by demonstrating that pain therapy always is individualized to meet the specific concerns and needs of each unique patient based upon careful interview and questionnaire assessments at the beginning of (and during) treatment. The greatest challenge in assessing the responses of the pain comes about as a result of the constantly overlapping and interrelated signs and symptoms of trauma and those of the other related medical conditions (Montagnini, Lodhi & Born, 2003).
Feldman and Periyakoil (2006) demonstrate that for example, problems with concentration and sleep need careful, differential diagnosis to be distinguished from symptoms of anxiety and depression not directly connected to a traumatic experience and the diagnosis is further compounded when pain-related symptoms occur simultaneously with other psychiatric disorders.
These demonstrate the fact that thorough and continuous assessments must be carried out to accurately determine the intensity and levels of pain. In addition to this, overreliance on the conventional and standardized set assessment criteria may lead to a lack of proper identification of critical factors of the disease assessment such as the level of development. Such misjudgments may translate to wrong referrals or delays in the right interventions.
Lunney, Lynn, Foley, Lipson, and Guralnik (2003) elucidated further the purpose of the assessment (whether clinical, research, or forensic) will direct the use of different measures and interview methods. This step must also take into account the cause of the pain behavior in that there are several reasons for pain. Last, good communication etiquette with the client such as direct eye contact, open-minded discussions, and a display of relaxed position and atmosphere would add to the building of trust and quality relationship.
Pain Management
Pain is often characterized by an anxiety disorder that develops in response to a traumatic experience and is characterized by core features of re-experiencing, avoidance behavior, numbing of responsitivity, and hyperarousal (Vasterling & Brewin, 2005). Human beings may try to use their natural ability to avoid the uncovering of unpleasant past life experiences but the underlying truth is that victims of acute pain must seek viable and meaningful counseling and consultative sessions to cope with the effects of this condition.
Once thought of only in psychological terms, pain has emerged as the model of mental disorder for studying the effect of the environment on the human biological system, especially the brain (Kato, Kawata, & Pitman, 2006). Symptoms associated with pain include; re-experiencing the event in varying sensory forms (flashbacks), avoiding reminders associated with the trauma, and chronic hyperarousal in the Autonomic Nervous System (ANS) (Kissane, Clarke and Street, 2001).
The management of pain must focus on the last symptom since those who suffer from this condition demonstrate such behaviors that include increased heartbeat, cold sweating, rapid breathing, and hyper jumpiness. While such symptoms are commonly understood to be psychological problems, some or all of them may well be related to the physical effects of extreme stress on the brain (Bremner, 2008). Such abnormal behaviors deprive these people of the ability to have normal sleep.
Exposure to long periods of traumatic pain experiences can have serious adverse effects on ones life. It is prudent that management of pain begins early at the normal stress response. This will lessen the amount of time and prevent the client from long periods of suffering. The consultation process towards achieving effective pain therapy is a long process that is composed of effective approaches to pain management.
Approaches to Pain Management
Making contact with the consultee
This is the first consultative step in managing pain related to palliative care in the management of pain caused by medical complications such as PTSD. Experiencing trauma is an essential part of a human being; history is written in blood (Van Der Kolk, McFarlane, & Weisaeth, 2006). The counselor must not only strive to develop a relationship with the client but must proceed to develop full trust.
This will create an atmosphere of the sharing and exchange of information between the two parties. Pain disrupts the functioning of those afflicted by it, interfering with the ability to meet their daily needs and perform the most basic tasks and thus victims have the tendency to withdraw (Smith, Gomm & Dickens, 2003). There is therefore the need to tactfully engage the client into a long trustworthy relationship that is geared towards achieving the objective. In fact, victims of acute pain can become extremely restricted, fearing to be together with others or go out of their homes (Clarke & Kissane, 2002).
They demonstrate high levels of fear, panic, and the tendency to flashback, actions that lead to constant self-isolation. The counselor must make the client feel comfortable and at ease in his/ her presence to reduce loneliness and develop a feeling of appreciation. Such are the benefits of developing a quality relationship with the client and constitute the first meaningful step in the administration of therapy.
Developing the quality relationship between the counselor and the client involves the ability to let the client understand the duty to lead a normal life free of trauma lies in his own hands especially when dealing with psychological pain. This relationship should seek to enable the client to consider the counselor as a role model. To take this trust to a further level, the counselor must be able to demonstrate that he/she is capable of effectively counseling a traumatic individual affected by constant pain.
This can be done by relevant and available examples that the client can be able to see. Such will act as proof to the client that the counselor is capable of handling his/her condition. Due to the sensitivity of the matter, the counselor can win the trust of the client by adhering to high levels of confidentiality. Clients can never feel safe if their medical conditions are not kept confidential.
Defining the Plan and Goal Setting
How people react to pain is influenced by a whole range of factors including the nature, severity, and meaning of the traumatic event, and factors in the individual such as his or her personality, previous history, experience, support, and subsequent experience (OBrien, 1998). Scott, Stradling, and Dryden (1995) elucidate this fact further by stating that cognitive-behavioral counseling takes note of the everyday observation that people respond differently to the same situation. After the process of a thorough assessment, goals, and objectives of the treatment actions are set so that they remain achievable. In a pain therapy administration of a patient with acute pain, there is a need to first understand the position of the client and appreciate the possible causes of pain.
In defining the plan and goal setting, there are fundamental questions that must be answered. Are the set goals in line and relevant with the cause of the pain? Are the plans coherent, relevant, and workable? In the determination of a workable plan, the objectives of the treatment can be achieved. This plan must take into consideration the duration required for the treatment, monitoring, and evaluation strategies and techniques of its proper implementation. In the planning process, the goals for the retrieval of the unpleasant pain memories must be well explained to make the client understand the role of these retrievals in achieving the counseling objectives.
To emerge with deeper understanding insights, we must learn to appreciate that every plan must be variable to events causing the pain (Hobfoll, & De Vries, 1995). Pain treatment typically begins with a detailed evaluation and development of a pain therapy plan that meets the unique needs of the patient (Hogan & Patertson, 2006). In settings with a plan and goals that are focused on the exploration of the deep root causes of the trauma, the counseling and treatment sessions become effective and effortless. These goals become achievable within a limited period. Hwang, Chang, Fairclough, Cogswell, and Kasimis (2003) expound that the goal of trauma-focused exploration is to enable the patient to gain a realistic sense of self-esteem and self-confidence in dealing with pain
Interventions and Strategies
Counselors are better equipped with relevant and effective interventions and strategies that seek to fulfill the goals and laid down plans of the treatment. Is there evidence in support of the fact that early intervention is effective? (Institute of Medicine of National Academies, 2009). By having the knowledge of intensity, type and cause of the pain, the next question a consultant must appropriately answer is how easy or difficult the intervention or strategy will be accomplish (Bercovitch & White, 2004) This constitutes the important elements of the amount of work involved and the time this work will be successfully completed.
The interventions and strategies must also be in line and relevant to the type kind of pain under consideration. A good therapist must be very flexible, interventions and strategies must be flexible too and the overall decision to uncover unpleasant memories must remain relevant with the situations of a client.
Implementing the strategies constitutes the next step in this procedure. This process must encompass the elements of recovery and will eventually determine the next path to take. It then defines the term recovery and determine the level at which the development of quality relationship with the client, the treatment plans and counseling. In case of a partial or full recovery, is there the need for the treatment to proceed and what benefits would such a decision be to the client (Movsas, Chang, Tunkel, Shah, Ryan & Millis, 2003).
The evaluation of the results of all the actions taken to ascertain whether the desired results have been achieved must be done. This is done through the measurement of the levels of withdrawal, anger, feelings of loneliness and the ability to mix freely with others. This step must demonstrate that barriers to effective healing process have been overcome.
Historical and basic differences such as in cultural values and the impact of stigma have all been left aside by the application of practical strategies. Furthermore, peer self help can be used to evaluate the effectiveness of the consultation process. This involves the use of other individuals who have gone through the similar experience and have recorded positive improvements in their lives. This class of people can act as role models or yardsticks for the measurement of the ability to improve. Peer self-help, peer advocacy, warm lines , and other supports help establish a sense of safety; trust, and sense of community- one is not alone (Hogan & Patertson, 2006).
The consultation termination forms the last step in the consultation process. A final review of the overall results of the consultation process will then determine whether this stage has been finally arrived at. Evidence must support that the consultation process has been effective and its impacts must be easily observed. The need for further re-examination for any relevant symptoms must be undertaken. The quality relationship between the consultant and the consultee comes to an end and the consultee can then embark on journey of normal life. Consultation window must still remain open for a chance to share and exchange ideas on the development of the consultee in efforts to fit in to new life.
Conclusion
There have been tremendous and positive efforts to deal with the adverse effects of pain but further efforts must still be put to shorten the gap that exists between research and practice so that best practices in handling this condition are implemented. Counselors and therapists must lead the pack in making efforts to reduce the pain victims undergo. It is worth appreciating and noting that the amount of psychological distress these individuals undergo is great and as such pain is recognized more than it is today as a significant heath problem.
In addition to the above, correct and consistent compilation of epidemiological data on the cases of pain would help avail the statistics of this condition, reveal the chief root causes and thus adequately provide the knowledge needed for its proper handling. Further training and increase in the number of qualified therapists would make their services readily available and thus prevent most of these cases rather than seeking a long term cure interventions. Lastly, counselors, institutions and therapists must institute clear and workable policies, plans, strategies to effectively minimize the effects of pain.
References
Beck. J.S. (2005). Cognitive therapy: Basics and beyond. New York (NY): Guilford Press.
Bercovitch, M. and White, A. (2004). Transcutaneous electrical nerve stimulation (TENS). New York (NY): Oxford University Press.
Boswell, M.B. and Cole, B.E. (2006). Weiners pain management: A practical guide for clinicians. New York (NY): Taylor and Francis.
Bremner, J.D. (2008).The Invisible Epidemic: Post-Traumatic Stress Disorder, Memory and the Brain. Web.
Clarke, D.M. and Kissane, D.W. (2002). Demoralization: Its phenomenology and importance. Austr N Z J Psychiatry. Vol.36 no. 6: 73342.
CREST (2003). The Management Post Traumatic Stress Disorder in Adults. Web.
Davis, M.P., Weissman, D.E. and Arnold, R.M. (2004). Opioid dose titration for severe cancer pain: A systematic evidence-based review. J Palliat Med. Vol.7 no. 3:46268.
Feldman, D.B. and Periyakoil, V.S. (2006). Posttraumatic stress disorder at the end of life. J Palliat Med. Vol 9. No. 1:21318.
Given. C., Given. B., Rahbar, M. Jeon., S. McCorkle, R. Cimprich, B. Galecki, A. Kozachik, S. Brady, A. Fisher-Malloy, M.J. Courtney, K. and Bowie, E. (2004). Effect of cognitive behavioral intervention on reducing symptom severity during chemotherapy. J Clin Oncol. Vol 22. No 3: 50716.
Greenstein, M. and Breitbart, W. (2000). Cancer and the experience of meaning: A group psychotherapy program for people with cancer. Am J Psychother. Vol. 54 no. 4:486500.
Hanks , G.W., Nugent, M., Higgs, C.M. and Busch, M.A. (2004). OTFC Multicentre Study Group. Oral transmucosal fentanyl citrate in the management of breakthrough pain in cancer: An open, multicenter, dose-titration and long-term use study. Palliat Med. Vol.18. no. 8:698704.
Hobfoll, S.E. and De Vries, M.W. (1995). Extreme stress and communities: impact and intervention. New York: Springer.
Hwang, S.S., Chang, V.T., Fairclough, D.L., Cogswell, J. and Kasimis, B. (2003). Longitudinal quality of life in advanced cancerpatients: Pilot study results from the VA medical cancer center. J Pain Symptom Manage. Vol.25 no. 3:22535.
Kato, N, Kawata, M and Pitman, P.K. (2006). PTSD: Brain Mechanisms and Clinical Implications. Washington: Springer.
Kissane, D.W., Clarke, D.M., and Street, A.F. (2001). Demoralization syndrome A relevant psychiatric diagnosis for palliative care. J Palliat Care. Vol.17. no.1: 1221.
Lunney, J.R., Lynn, J., Foley, D.J., Lipson, S. and Guralnik, J.M. (2003). Patterns of functional decline at the end of life. JAMA. Vol.289. no. 18:238792.
Modonesi, C., Scarpi, E., Maltoni, M., Derni, S., Fabbri, L., Martini, F., Sansoni, E. and Amadori, D. (2005). Impact of palliative care unit admission on symptom control evaluated by the Edmonton Symptom Assessment System. J Pain Symptom Manage. Vol.30. no. 4:36773.
Montagnini, M., Lodhi, M., and Born, W. (2003). The utilization of physical therapy in a palliative care unit. J Palliat Med. Vol 6. No. 1:1117.
Movsas S.B., Chang, V.T., Tunkel, R.S., Shah, V.V., Ryan, L.S, and Millis, S.R. (2003). Rehabilitation needs of an inpatient medical Oncology unit. Arch Phys Med Rehabil. Vol 84 no. 11: 164246.
OBrien, S.L. (1998). Traumatic Events and Mental Health. London: Cambridge University press.
Scott, M.J. and Stradling, S.G. (2006). Counseling For Post-Traumatic Stress Disorder. New York: Sage.
Smith, E.M., Gomm, S.A. and Dickens, C.M. (2003). Assessing the independent contribution to quality of life from anxiety and depression in patients with advanced cancer. Palliat Med. Vol.17. no 6:50913.
Spiegel. D. and Classen, C. (2000). Group therapy for cancer patients: A research-based handbook of psychosocial care. New York (NY): Basic Books.
Van Der Kolk, B.A, McFarlance, A.C and Weisaeth, L (2006). Traumatic Stress: the effect of overwhelming experience on mind, body and soul. London: Guilford press.
Vasterling, J. and Brewin, C. (2005). Neuropsychology of PTSD: Biological, Cognitive and Clinical perspectives. London: Guilford press.
Medical imaging refers to the systems and practices used to produce images of parts of the human body for medical purposes with the aim of disclosing, diagnosing, or studying a particular disease. It entails the study of ordinary body anatomy and functioning. Procedures involved in medical imaging are usually understood as pathology. Several medical imaging techniques exist, and this paper will focus on UltraSonography, Magnetic Resonance Imaging (MRI) and plain radiography. Ultra Sonography is an imaging technique that is based on ultra sound and is used for envisaging subcutaneous body parts especially joints and muscles. Frequencies used in this imaging technique range from two to eighteen MHzs 1
Magnetic Resonance Imaging is a therapeutic imaging procedure used in radiology to envisage internal body parts that are detailed. It utilizes nuclear magnetic resonance to picture nuclei of molecules in the human body. It offers exceptional comparisons between distinct body tissues, and this makes MRI to be tremendously constructive in medical imaging. Ionizing radiation is absent in MRI.
Plain Radiography entails the creation of two-dimensional descriptions of the parts of the human body via x-ray radiations. Well-trained health experts specialising in the use of radiographic machines usually perform this radiography. It is the key stone of the contemporary medical imaging and is used to view almost all parts and organs of the human body.
The most crucial sections of medical centers and infirmaries are found in the medical imaging sector. This is where examinations on imaging are carried out. Joints are found where any two bones convene. They allow the skeleton to move since, in their absence, it would be impossible for human beings to move.
Synovial joints have a fluid known as the synovial fluid. These are the main joints in the body, and the fluid permits the joints to move about liberally and reduce friction. Synovial joints are the majority in the human body and include pivot, ellipsoidal, hinge, saddle, ball and socket joint and finally the gliding joint. Ball and socket joint usually moves in all ways and is supported by the ligaments. An example is the joints found in the shoulders. This joint consists of muscles, bones, ligaments and many fibers. Shoulders concentrate on military actions and allow for freedom in movement. Joints in the shoulders must be movable enough for the broad range of arm and hand activities. The joints also make the shoulder firm enough to allow for activities such as lifting and pulling2.
It is difficult to determine the exact pathological crisis with a single imaging modality due to the intricacy of the shoulder joints. The information available on soft tissues is also insufficient if passed through plane radiography, though it provides constructive details about the bone. Ultra Sonography (US) and Ultrasound are some of the imaging techniques, which are accurate, economical, and valuable. Several limitations have also been discovered in these two methods.
Plane tomography is similar to computed tomography although it does not offer specific information on the diminutive body parts especially the soft tissues. This can be overwhelmed by the induction of a contrast medium, exactly inside the joint. The most effective and accurate imaging modality for detecting pathological issues in the shoulder joint is the Magnetic Resonance Imaging (MRI). This imaging modality is, however, not recommended in patients with serious contradictions. Research shows that MRI is the best compared to Ultra Sonography (US). Efficiency of this MRI was tested in a different study, and the results showed that it is not a sufficient tool especially for patients with an excruciating shoulder. This is because it does not appropriately envisage the pathological variations in the patients shoulders3.
A different study shows that MRI is of limited use in the identification of arthritis of the joints. This study also asserts that plain radiography would be effective to develop a diagnosis and treatment plan for ordinary shoulder difficulties. This entails the complete description and physical inspection of the shoulder 4.The paramount imaging modality that is useful, can offer sufficient information, and fulfils the needs of the patient in the shoulder joints has, therefore, not yet been established. This paper will aim at determining which of these two imaging techniques for the shoulder joint (MRI and US) is the best.
Methods of bibliography Compilation
A bibliography of shoulder imaging was first compiled with relevant articles found in electronic journal database and other medical websites. Information on shoulder imaging was first obtained from distinct databases. Results obtained were skimmed and scanned. More research was done by reading relevant materials on the shoulder and imaging modalities. This included abstract reading and use of the word web to identify some useful books on the research topic as well as some useful medical sites with detailed information on shoulder imaging. All relevant references were finally fixed in the bibliography section4.
Selection of the five Most Important References
The presence of a large number of references permitted abstracts of the selected articles to be read through to identify the most useful ones providing clear ideas to the next step of the research topic. Recent articles conveying most aspects of the research topic were selected.
Experience gained during the process
Gathering large amounts of information was not easy and involved lots of effort to achieve the projects aim. During the research process, I gained wide knowledge on shoulder imaging. I also learnt how to obtain the relevant research sources and skim quickly through the abstracts to get an overall view of the research topic.
Significant five articles
This section outlines the most prestigious five articles. The order in which the articles are presented does not relate to their order of importance.
Imaging of the painful shoulder
King, Leonard J., and Jeremiah C. Healy. 1999. Imaging of the painful shoulder. Manual Therapy 4 (1):11-18.
Article summary
The author in the first part of this article gives an overview of five distinct imaging modalities of the shoulder during pain. He states some of the common pathologies of this joint and identifies the four most common parts of the shoulder exposed to this pathology. In addition, the author identifies the radiological techniques used to demonstrate this pathology. He asserts that conventional radiography is tremendously crucial in showing any bone abnormalities although it does not provide useful information when it comes to the soft tissues. He provides the criteria used to carry out an ultrasound examination of the shoulder and mentions its advantages over other examinations. He further talks of the usefulness of Arthography when used together with a CT-scan. In the modalities final section, the author concludes by stating that MRI technology is the best technique used in demonstrating the shoulder joint and all its constituents5.
According to the author, this technique offers high-quality imagery.
In the second part of this article, the author mentions four different shoulder pathologies, the first one being Impingement Syndrome. This is caused by the trap of the supraspinatus tendon, subachromial-subdeltoidbursa and biceps tendon located between the humeral head and the coraco-acromial arch. According to the author, acromion plays a dominant role in this situation, and there are some different causes of this syndrome. The author makes a comparison between plain radiographs, ultrasound, and MRI. He concludes that MRI and Ultrasound are better compared to plain radiograph. The second shoulder pathology according to the author is Rotator cuff tears, which might be caused by different etiologies. The author provides many studies that have dealt with this pathology and gives the results of using MRI and US to diagnose it. He further adds that both MRI and Ultrasound would provide useful information about it. The third pathological syndrome of the shoulder mentioned in this article is Biceps tenosynovitis Both MRI and ultrasound have the ability to display this pathology. The last pathological problem of the shoulder joint stated in this article is Instability.
At the end of the article, the author proves that many MRI studies have occurred and have demonstrated this disorder compared to the other imaging modalities. He concludes the article by claiming that MRI is the best imaging modality used to demonstrate shoulder joint complications.
Article significance
This article is of utmost importance due to the useful information it provides on shoulder pathology. It gives a comparison between different imaging modalities based on previous studies and ends by suggesting the best modality, which can show the shoulder in different cases of pathology. This research is focused on shoulder imaging and this article states that MRI and Ultrasound are the best imaging modalities compared to plain radiography and CT. The large number of references in this article is quite significant.
Magnetic resonance imaging or arthrography for shoulder problems: a randomised study
Blanchard, T. K., P. W. Bearcroft, A. Maibaum, B. L. Hazelman, S. Sharma, and A. K. Dixon. 1999. Magnetic resonance imaging or arthrography for shoulder Problems: a randomized study. The European Journal of Radiology 30 (1):5-10.
Article summary
This article concentrates on a study assessing the attitude of medical scientists towards Arthrography and MRI as imaging modalities of the shoulder. The study took one year to be complete and involved 51 patients who were referred to a rheumatology clinic to diagnose the rotator cuff problems in their shoulders6.
The clinicians according to this article split this group into two, 29 for MRI investigation, and 24 for arthrography. MRI investigations were held under 0.5 T or 1.5 T machines while arthrography was done through conventional methods. After necessary examinations, the patients were sent back to the
referred clinic to continue their treatment or to be followed up in the future. The researchers used questionnaires, which were sent together with the imaging reports to evaluate patient satisfaction towards MRI and arthrography.
Compared to the primary diagnosis, which had been done in the centers, MRI and arthrography results were similar to the presaging diagnosis. The article discusses the impact of these two imaging modalities. It confirms that clinicians diagnostic confidence when using MRI is more beneficial than arthrography.
According to the authors, Ultra Sound results are not accurate since Ultra Sound depends on the operator skills. According to them, MRI changes the treatment managements of some patients making them more vulnerable to surgery to solve their shoulder joint problems. This is different from arthrography, which shows the same result to the pre-imaging diagnosis. The authors in this article highlight the advantages of MRI and its ability to give a clear view of the examined organ.
They also show the importance of Arthrography in identifying some pathological problems of the shoulder joint though it lacks technological advancements as compared to MRI. They conclude their article by stating that arthrography can play a very pivotal role in demonstrating a full thickness rotator cuff tendon and getting a better visualization.
Article significance
This article has been found significant in this research topic due to its useful information on two imaging methods of the shoulder, that is, MRI and arthrography. The authors of this article concentrate on this two techniques due to their capabilities in diagnosing problems of the shoulder joint. The article at some point talks of the importance of arthrography due to its dependence on the contrast media, which is usually injected inside the joint. However, this article still proposes that MRI is the best imaging modality since it gives a wide range of multi-planner images by using technology that reflects on the clinicians decisions. This supports the hypothesis of this project that MRI is the best method for shoulder imaging.
Magnetic Resonance Imaging and Sonography of the Shoulder: Assessment of Patient contentment
Middleton, William D., 1, William T. Payne, 1, Sharlene A. Teefey, 1, Charles F. Hildebolt, 1, David A. Rubin, 1, Ken Yamaguchi, and 2. 2004. Sonography and MRI of the Shoulder: Comparison of Patient Satisfaction. Am. J. Roentgenol 138 (5):1449-1452.
Article summary
The main purpose of the study in this article is to determine the imaging modality preferred by patients with shoulder complications. The article determines whether such patients prefer ultrasound or MRI. These two imaging modalities are used to evaluate shoulder pain complications though with varying technological degrees. This study involved a hundred and thirty patients, and was conducted between the period December 1998 and April 2001. The patients were subjected to both imaging modalities after which they were requested to fill out a Satisfactory Survey form. Ultrasound examinations were first performed followed by MRI.
During ultrasound exam, the arm of every patient was moved in many directions to visualize the whole shoulder girdle components like rotator cuff and tendons. In MRI exams, the shoulders were examined via the use of different imaging planes. Six patients were, however, excluded from the study because they got 12 contraindications towards MRI7.
In this survey, researchers concentrated on whether the modality exam would cause or seize pain to the shoulder. In patients where this caused pain, then the patients were asked to grade the level of the pain and how long it took it to end. They were also asked whether they would do the test again and which imaging modality among the two they would prefer. Thirty-nine patients who were examined through ultrasound reported strong pain in the shoulder with nineteen patients reporting that the pain was during the exam period. For MRI exam, thirty-two patients reported pain or discomfort during the exam.
Overall, patients reported that MRI exam took exceedingly long time compared to ultrasound examination. Most patients were excited about the ultrasound investigation. Seven patients reported that they were not happy with MRI exams with most of them reporting that they were satisfied with it. The article concludes by asserting that most patients prefer ultrasound exams rather than MRI in shoulder examination.
Article significance
This article was found significant in this study. It provides the results of a study conducted on patients with shoulder complications, which is the main point of this research project. The study conducted in this article is tremendously significant to this research topic since it allows for patient opinion, which is indispensable in determining the best imaging modality. The study could have, however, provided better results if patient number was high due to accuracy and rationality. The study shows that MRI and ultrasound are the best imaging modalities dealing with shoulder joint.
Comparison of shoulder ultrasound and MR imaging in diagnosing full thickness rotator cuff tears
Cheng-Yen Changa, c, Su-Fang Wanga, Hong-Jen Chioua,c, Hsiao-Li Mab,c, and Ying- Chou Suna, Hong-Dar Wua,c. 2002. Comparison of shoulder ultrasound and MR imaging in diagnosing full-thickness rotator cuff tears journal of clinical imaging 26 (1):50-54.
Article summary
This article provides the results of a study conducted between July 1996 to October 2000. Four hundred and twenty-two patients were used to evaluate diagnosis ability by using Ultrasound and MRI to demonstrate full-thickness rotator cuff tears. Researchers divided the patients into two groups according to time. It was optional for the patients to undergo surgery to proof the diagnosis. During Ultrasound investigation, the arm of every patient was moved in different directions while performing different imaging planes like vertical and oblique. MRI investigations were done using 1.5 T MRI systems. Experienced radiologists did reports in the musculoskeletal system. There was a different diagnosis criterion for both groups during ultrasound exams. A 5- year experienced technician performed first group diagnosis while a 10-year experienced radiologist performed diagnosis for the second group8.
This was done to help in evaluating the findings. The results of this study show that the full thickness rotator cuff tears in some patients cannot be detected by using Ultrasound or MRI. Surgical action showed tears for some patients, which have not been detected in both modalities.
According to this article, both ultrasound and MRI have many advantages for patients. These include the fact that both are non-radioactive, non-evasive to patients and offer multi-planar shoulder images. Ultrasound examination is, however, more economic, time saving, and fast compared to MRI which is highly operator-dependent, more expensive and slow. Authors in this article emphasize on the fact that Ultrasound investigates full-thickness rotator cuff tears depending on the operator experience. They add that Ultrasound exam can be considered as the imaging modality of choice for screening especially in the presence of an expert. MRI, on the other hand, is the second option for clinicians planning to perform shoulder examinations after rotator cuff tear is diagnosed by Ultra Sound. Authors in this article conclude by straining the fact that in circumstances where an expert in ultrasound is unavailable, then MRI should be performed to show full-thickness rotator cuff tears due to its high technology.
Article significance
This article was considered significant in this research topic since it provides useful information about the ability of both Ultrasound and MRI imaging modalities in demonstrating shoulder complications. It presents a comparison on the ability of both imaging modalities and conditions required to have perfect and clear investigation results. In addition, the article stresses the point that MRI is the best imaging modality in depicting shoulder problems. It, however, gives some disadvantages of this modality compared to ultrasound, which is accepted, by most patients. This article thus provides further knowledge about MRIs and ultrasound capabilities in showing problems of the shoulder girdle.
The efficiency of analytic imaging techniques for the examination of soft tissue and articular complications of the elbow and shoulder
Shahabpour, M., M. Kichouh, E. Laridon, J. L. Gielen, and J. De Mey. 2008. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. The European Journal of Radiology 65 (2):194-200.
Article summary
This article is a brief summary of literature reviews from many medical sources and evaluates the capability of different imaging modalities in identifying certain pathological problems in the shoulder and elbow. This article is divided into two sections, and my interest based on the research topic is on the shoulder section. Many articles as well as previous studies concentrate on the shoulder joint. According to the article, occult fractures, articular structures and soft tissues of the shoulder, including tendons, ligaments, muscles, and capsulolabral structures can be perfectly demonstrated by MRI modality. There is an outstanding example in this study article, which shows the problem of full-thickness rotator cuff tears and the ability of normal MRI investigation to show it.
Ten of the studies in this article show that most clinicians prefer using conventional MRI pulse sequences as opposed to fat-suppressed MRI. Literature review explained that MR arthrography is accurate in showing the problems of the shoulder especially during contrast medium injection to the joint. Ultrasound investigations studies formed part of the literature and provided useful information about this modality and its ability to show shoulder problems. The article states that CT scan investigation that follows arthrography is useful to show rotator cuff tears and is strongly used for patients who have contraindications toward MRI9.
Ultrasound, according to this article, is an accurate imaging modality to demonstrate rotator cuff tears though it requires the presence of an experienced operator. In case of shoulder instability, the article emphasizes on two imaging modalities with MR arthrography being the best method. The article further asserts that with the presence of any contraindication toward MRI machine, CT arthrography is useful and gives remarkably satisfactory results. In terms of conventional radiography, the article states that a special radiographic position for the shoulder should be incorporated to show a full view of the joint. The article concludes by saying that MRI and Ultrasound could be used to detect rotator cuff tears and MR arthrography as well as CT arthrography could detect labrum tears.
Article significance
This article is one of the best five articles that was considered beneficial to the research topic. It is extremely useful for this research topic since it deals with many studies involving the shoulder and elbow joint. The largest part of this study focuses on the shoulder, and the article provides supportive information to add to the researchers knowledge. This is reflected in the research project. However, the quality of the study conducted in this article would have been more accurate if more previous studies were included. It is, however, well equipped with enough details on the shoulder joint, which is highly required in this research.
Bibliography
Blanchard, T. K., P. W. Bear croft, A. Maibaum, B. L. Hazelman, S. Sharma, and A. K. Dixon. 1999. Magnetic resonance imaging or arthrography for shoulder problems: a randomized study. European Journal of Radiology 30 (1):5-10.
Cheng-Yen Changa, c, Su-Fang Wanga,c,*, Hong-Jen Chioua,c, Hsiao-Li Mab,c,, and c Ying- Chou Suna, Hong-Dar Wua,c. 2002. Comparison of shoulder ultrasound and MR imaging in diagnosing full-thickness rotator cuff tears. journal of clinical imaging 26 (1):50-54.
King, Leonard J., and Jeremiah C. Healy. 1999. Imaging of the painful shoulder. Manual Therapy 4 (1):11-18.
Levine, Harry. 2010. Medical Imaging. Westport: Roundhouse Publishers.
Middleton, William D., 1, William T. Payne, 1, Sharlene A. Tee fey, 1, Charles F. Hilde bolt, 1, David A. Rubin, 1, Ken Yamaguchi. 2004. Sonography and MRI of the Shoulder: Comparison of Patient Satisfaction. Am. J. Roentgen 138 (5):1449-1452.
Shahabpour, M., M. Kichouh, E. Laridon, J. L. Gielen, and J. De Mey. 2008. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. European Journal of Radiology 65 (2):194-200.
Footnotes
Levine, Harry. 2010. Medical Imaging. Westport: Roundhouse Publishers.
Levine, Harry. 2010. Medical Imaging. Westport: Roundhouse Publishers.
Blanchard, T. K., P. W. Bear croft, A. Maibaum, B. L. Hazelman, S. Sharma, and A. K. Dixon. 1999. Magnetic resonance imaging or arthrography for shoulder problems: a randomized study. European Journal of Radiology 30 (1):5-10.
King, Leonard J., and Jeremiah C. Healy. 1999. Imaging of the painful shoulder. Manual Therapy 4 (1):11-18.
King, Leonard J., and Jeremiah C. Healy. 1999. Imaging of the painful shoulder. Manual Therapy 4 (1):11-18.
Blanchard, T. K., P. W. Bear croft, A. Maibaum, B. L. Hazelman, S. Sharma, and A. K. Dixon. 1999. Magnetic resonance imaging or arthrography for shoulder problems: a randomized study. European Journal of Radiology 30 (1):5-10.
Middleton, William D., 1, William T. Payne, 1, Sharlene A. Tee fey, 1, Charles F. Hilde bolt, 1, David A. Rubin, 1, Ken Yamaguchi. 2004. Sonography and MRI of the Shoulder: Comparison of Patient Satisfaction.
Cheng-Yen Changa, c, Su-Fang Wanga, Hong-Jen Chioua,c, Hsiao-Li Mab,c, and Ying- Chou Suna, Hong-Dar Wua,c. 2002. Comparison of shoulder ultrasound and MR imaging in diagnosing full-thickness rotator cuff tears journal of clinical imaging 26 (1):50-54.
Shahabpour, M., M. Kichouh, E. Laridon, J. L. Gielen, and J. De Mey. 2008. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. European Journal of Radiology 65 (2):194-200.
Considerably, the primary rationale for nursing regulation is to ensure that clients receive safe and quality services from healthcare practitioners. The primary responsibilities of the nurse managers are controlling the financial and human resources and sustaining a secure surrounding for the patients. In addition, they maintain quality of care and standards and ensure functional correlation with the staff members. Due to their high levels of competency and work knowledge, the nurse managers supervise the unlicensed and registered nurses in a medical facility to ensure they deliver outstanding care to the clients. Nurse managers must observe ethical principles, including integrity, beneficence, privacy, justice, independence, and nonmaleficence when handling patients to make reputable decisions and not destroy the companys image (Gunawan et al., 2018). However, due to the increasingly varied needs in healthcare centers, nurse managers must understand the corporate, nursing, and clinical components to ensure the effective delivery of quality care services. It is essential to discuss healthcare policies, regulatory agencies, and health policies that may impact the decision-making of the interviewed nurse manager, Mr. Wells.
The Role of the Nurse Manager
During his nursing career, Mr. Wells has elaborate nursing experience as he has worked in seven hospitals and tutored novice nurses. He reports having engaged in multiple functionalities, including setting work schedules, supervising subordinates in clinical settings or medical centers, and making personal, budgetary, and management decisions. Mr. Wells agrees with Warshawsky and Cramer (2019) that nurse managers must execute federal and state regulatory guidelines for victim security and educate subordinates regarding the transformation of laws and how they affect care delivery. Notably, Mr. Wells indicated that he counsels patients at their houses and operates multiple community programs and home-based grounded initiatives.
Mr. Wells ensures all the nursing resources, such as surgical tools, are available and provides adequate working conditions for the staff to deliver enhanced victim care. Mr. Wells coordinates bi-weekly meetings with the subordinates to ensure special allocation of duties, mainly during work shifts, to enable service delivery to patients without negligence. Nurse managers must apply emerging nursing methodologies to care delivery and showcase leadership skills as they work with diverse people (Warshawsky & Cramer, 2019). Mr. Wells acknowledges that he recruits and trains nurses, maintains the medical centers records, and treats and diagnoses clients. He reported that enhancing staff working conditions and delivering quality care to patients escalates contentment levels, thus maintaining organizational reputation.
Summary of Interview Database
Mr. Wells acknowledges that being a nurse manager requires extensive work knowledge and personality, embracing federal regulations, and making crucial decisions. During the interview, Mr. Wells extensively shared the roles of a nurse manager and pinpointed core external elements impacting decision-making, including regulatory agencies and health policies. He acknowledged that nurse managers must observe ethical principles such as integrity and justice and be decisive and resourceful, as other healthcare practitioners depend on their proficiency to deliver quality patient care. Mr. Wells admitted that one should be willing to learn from coworkers and engage all the stakeholders to implement multiple duties effectively. During the interview, Mr. Wells openly and transparently answered 20 queries related to external components impacting the nurse managers decision-making. He highly cooperated with the interviewer during the discussion by not disrupting him.
Furthermore, since the questions were divided into subsections, additional questions were asked so that Mr. Wells could clarify his answers regarding the external factors affecting the nurse managers decision-making. Even though some queries were challenging, Mr. Wells requested reframing to enable him to reflect and provide detailed responses. However, contrasted to other external elements, he admitted that regulatory requirements have significantly affected his capability to make reputable decisions in the healthcare facility. Mr. Wells had extensive knowledge of how healthcare policies, regulatory agencies, and health policies influence nurse managers decision-making.
Viewpoints Concerning External Factors
Health Policy
To a great extent, health policy is a set of overarching guidelines and objectives that dictate the accessibility and delivery of care. The nurse managers help shape health policies by proposing new approaches grounded on the demands encountered in nursing practice, assessing available principles, and identifying missing elements, inefficiencies, and opportunities to enhance the affordability and delivery of care. Healthcare practitioners must meet with lobbyists, administrators, and policymakers to offer clinical insight into policy recommendations (Efendi et al., 2019). Mr. Wells acknowledged that the health policy issue substantially impacted his decision-making. Mr. Wells relied on his education and knowledge to apply effective policies in diverse areas to enhance primary care among patients.
Healthcare Financing
Health financing is a primary function of the healthcare system that ensures progress toward universal health coverage by enhancing monetary protection and improving service delivery. Most medical facilities do not receive an adequate budgetary allocation from the government, hindering them from developing and improving the quality of service. The primary functions of healthcare financing include the purchase of interventions, resource pooling, and revenue generation (Rostampour & Nosratnejad, 2020). Mr. Wells admitted that even though he makes decisions regarding allocating monetary resources, the available budget does not meet all demands. For example, Mr. Wells indicated that he faces challenges when making choices regarding introducing new care methods or improving hospital research and development, which require additional costs. However, nurse managers must work with health policy stakeholders and engage investors and sponsors to ensure quality care is provided in hospitals.
Regulatory Requirements
Most healthcare facilities face the obstacle of having a shortage of healthcare workforce. Nurse managers must observe local, state, and federal health prerequisites and standards to minimize negligence and medical errors (Warshawsky & Cramer, 2019). However, the existence of laws deters healthcare practitioners from making crucial decisions, as they must manifest sympathy while complying with specific regulations. Mr. Wells admitted that a registered nurse was on sick leave one day, and he authorized a novice nurse to offer injections and prescribe some medications to the patient. Even though the administrative and statutory laws prohibit such actions, Mr. Wells knew that deviating from the norm would ensure that the victim receives the much-needed care. Nevertheless, Mr. Wells acknowledged that the availability of agency regulations might deter the development and implementation of care programs and nursing initiatives even though they help make decisions that reduce intentional repercussions to the clients.
Conclusion
By contrasting Mr. Wells responses and the available past studies, it is evident that nurse managers decisions are highly impacted by external factors, including regulatory, health policy, and financing prerequisite concerns. Mr. Wells effectively and elaborately answered all the questions, offering insights into how external elements impact quality care delivery. The nurse managers perform diverse duties, such as sustaining a secure surrounding for the patients, controlling the financial and human resources, and ensuring functional relationships with the subordinates.
In healthcare, when working with patients, assessment entails the methodical gathering of pertinent data. It is used to address two categories of practical issues: distinguishing between common issues or momentary troubles and clinically relevant psychiatric problems and categorizing and treating those who have been diagnosed with disorders. Clinical evaluations typically start with a particular concern, issue, or difficulty and most often involve DSM-5 assessments (American Psychiatric Association, n.d.). Among the most apparent challenges when it comes to the assessment of children and adolescents at-risk for mental illness is a lack of attention to risk factors and comorbidity. Therefore, when assessing children for mental health issues, a healthcare professional must have an awareness of social, individual, and family risk factors and comorbidity.
Risk Factors
Among the steps to evaluating the patients condition is to consider risk factors since many symptoms of mental health disorders might be the result of external and internal factors. Individual, familial, and social instances are most frequently used to distinguish between various risk factor categories. Individual risk factors in children and adolescents involve variables including heredity, physiological functions, gender, attitude, and character (Parritz & Troy, 2017). Family risk factors are those that are connected to the childs caregiving climate and include parental traits (Parritz & Troy, 2017). These involve the involvement of psychiatric disorders or strict, punitive parenting practices, in addition to family traits involving ongoing disputes between parents, an absence of oversight, or unusual disharmony among family members (Parritz & Troy, 2017). Finally, social risk factors are those that are connected to a childs broader context, such as classmates, schools, community, and socioeconomic group, as well as racial and cultural features (Parritz & Troy, 2017). For instance, when it comes to peers and schools, healthcare professionals must focus on academic excellence and assistance, extracurricular activities, and peer dynamics, including bullying, exclusion, and harmful influence (Parritz & Troy, 2017). In terms of socioeconomic considerations, they are particularly worried about the ways that poverty jeopardizes the well-being of children.
Protective Factors
As for protective factors, they must be considered along with the risk factors. Parents who have substance abuse issues or who have mental illnesses, contribute to child mistreatment and abuse, and provide insufficient control are risk factors in relationships. Parental engagement is an illustration of a protective factor in this situation (SAMHSA, 2019). Then, risk factors in communities involve localized poverty and violence. The presence of faith-based services and after-school programs might be considered protective factors in this case (SAMHSA, 2019). Lastly, risk factors in society might include discrimination, a lack of economic opportunities, and regulations and practices that support drug use (SAMHSA, 2019). Hate crime legislation or alcohol availability restrictions are examples of protective factors in this situation.
Resilience Factors
Resilience factors are those elements that help children and adolescents maintain psychological and physiological health despite high risks. Active coping, mental flexibility, and social protection all contribute to resilience in some way (Walker, 2019). Active coping is the capacity to use psychological as well as behavioral tools to deal with trauma or pressures, which is a continuously acquired skill (Walker, 2019). Together with active coping, mental flexibility contributes to the growth and maintenance of resiliences capacity to tolerate adversity. Social protection is the final component that affects the structure and operation of resilience (Walker, 2019). As it enables the child to respond positively when faced with difficulties or dangers, the social context in which the person lives has a significant influence on resilience.
Comorbidity and Its Role in Diagnosis
Finally, the coexistence of two or more illnesses in one person is referred to as comorbidity within classifications or groupings of disorders. In this case, a child may be coping with any two conditions (Parritz & Troy, 2017). This means that healthcare professionals must search for two ailments that are commonly noticed together instead of two different conditions. Comorbidity can happen for a number of causes (Parritz & Troy, 2017). Not all children will fit neatly into clearly defined categories because every classification promotes group commonalities over individual differences (Parritz & Troy, 2017). These childrens clinical profiles may combine symptoms from many diseases.
Medical professionals must choose which categorization area best fits the clinical presentation after assessing the severity, regularity, persistence, and pattern of issues in a developmental context. The role of comorbidity in diagnosis is crucial since an expert must take into account several factors. This involves understanding whether a childs clinical manifestations represent a single instance of disease, an unusual or mixed-symptom case, or a mixture of comorbid disorders while selecting the appropriate group (Parritz & Troy, 2017). While using the DSM-5 categorization, therapists may need to choose between two mutually incompatible categories of psychopathology.
Conclusion
Hence, a healthcare provider must be aware of societal, individual, and familial risk factors as well as comorbidity while evaluating children for mental health concerns. Risk factors are taken into account as one of the phases in evaluating the patients state since many symptoms of mental health problems may be brought on by both internal and external sources. Most typically, cases from the individual, family, and societal realms are employed to differentiate across different risk factor groups. Protective factors must be taken into account with risk factors. Children and adolescents who are exposed to high risks can retain their physical and psychological health due to resilience characteristics. Lastly, within categories or groups of disorders, the coexistence of two or more illnesses in one person is referred to as comorbidity.
A cath lab nurse is a medical professional who works with cardiac care doctors in providing care before, during, and after the operation. As a cath lab procedure nurse, most responsibilities are observing and assisting in invasive operations such as right heart catheterization and coronary angioplasties.
Discussion
There is a demand for attention to detail, efficient communication, rationalization, and stress management. As procedures become more demanding, physically and emotionally taxing, personnel can develop stress which escalates into anxiety and burnout, causing depression and fatigue among patients. The PICOT question for this scenario is: for cath lab procedure nurses and cardiac patients (P), what is the impact of nurse-led interventions against the distress experienced before, during, and after operations (I) when aiming to reduce these adverse effects (O) as compared to not intervening (C)?
Stress management is hard for all cath lab nurses serving in an environment with an ever-increasing workload. The pressure on cardiac care settings to deliver is present due to the shortage of personnel which directly impacts patient outcomes (Gillingham et al., 2020). With burnout and distress, nurses cant deliver quality care services (Rubin et al., 2021). It considers the possibility that cath lab procedure nurses need to learn stress-coping techniques, which could translate into better patient satisfaction rates. The evaluation of documents used follows a strategy utilizing a database search with keywords to identify relevant articles (Melnyk & Fineout-Overholt, 2018). For instance, this case utilized a systematic search on the National Library of Medicine database to identify peer-reviewed articles focused on stress in cardiac care affecting patients and nurses.
Through the National Center for Biotechnology Information (NCBI) database, a search to identify relevant literature focused on the key terms cardiac nurses AND cardiac patients AND stress AND nursing interventions. The limiters selected were peer-reviewed journal research articles published within the last five years in English. A total of 33 articles were identified. Upon title review, twenty-two were excluded related to relevance, leaving eleven articles remaining. The abstracts for the remaining articles were reviewed, and four were excluded due to relevance.
Conclusion
The remaining seven articles were examined to answer the clinical question; for cath lab procedure nurses and cardiac patients (P), what is the impact of nurse-led interventions against the distress experienced before, during, and after operations (I) when aiming to reduce these adverse effects (O) as compared to not intervening (C)?
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA; Lippincott Williams & Wilkins.
Clinical nutrition is the scientific study of the relationship between nutrients and a healthy body. The field deals with ingestion, digestion, absorption, transportation, storage, and removal of waste products by the body. Apart from these, a doctor of chiropractic would be interested in the environmental factors that affect the quality of food and how these factors affect health. For instance, there has been a controversy over the safety of eating genetically modified food. This mandates a clinical nutritionist to research to find out the effects of any of these foods. Nutrients can be described as the substances that the body requires for growth and development. There are more than forty-seven known nutrients. They are divided into two categories. The first one is the macronutrients that include fats, proteins, and carbohydrates that are broken down to provide the body with energy. In the second category are the micronutrients, which include minerals and vitamins that aid the body in utilizing macronutrients (Gibney, Elia, Nutrition Society (Great Britain), and Ljungqvist 7).
This paper explores the importance of the study of clinical nutrition. Nutrition study was pioneered by scientists way back in the 18th century and by the 20th century, they had discovered that some diseases like rickets and beriberi were related to lack of certain nutrients in the diet. This led to the setting of the recommended minimum amount of everyday nutrients that a person was to take to avert these diseases. The modern study of clinical nutrition has come up with dietary reference intake (RDIs) that sets the daily nutrients required by the body to ensure optimal health and reduce the risks of chronic sickness (Gropper, Smith, and Groff 27). Clinical nutrition has become so significant that it has now been included in conventional medical treatment, majorly because many diseases are now associated with eating habits.
A patient who has been diagnosed and found to be diabetic is usually referred to a clinical nutritionist. Who seeks to understand the patients lifestyle, family history, and medical background. The nutritionist then suggests the kind of foods to be avoided and recommends the ones to be taken. For instance, one may be advised to cut on carbohydrates and sugars intake; one should eat at regular intervals foods like yams, peas, and fruits (Insel, Ross, McMahon, and Bernstein 99). Diseases such as cancer, diabetes, and heart ailments have been linked to poor eating habits. For instance, a clinical nutritionist would recommend a reduction in the intake of saturated fats and cholesterol. Instead, one should take whole grain and fish. Fish is known to contain omega 3- fatty acids, which can prevent heart diseases by ensuring proper heart rhythm. Also, nutrients found in dry beans, peas, and grain products may reduce the risk of a heart attack.
The study of clinical nutrition has revealed very important outcomes. For example, it has been discovered that eating foods rich in carotenoids may trim down the chances of contracting cataracts. It has also been noted that a pregnant woman taking small quantities of fish, may prevent premature birth. Moreover, flavonoids found in foods like onions, broccoli, carrots, apples, and citrus fruits, may help in preventing cancer. In addition, vitamin E from vegetables reduces chest pains and lowers the risk of stroke in patients who have been found to suffer from atherosclerosis. Other nutritional studies have shown that kale and spinach diets provide the body with lutein nutrients that may prevent colon cancer (Rolfes, Pinna, and Whitney 213).
In conclusion, as outlined here, clinical nutrition is vital in the treatment of both acute and chronic diseases. People suffering from diseases like liver disorders, obesity, AIDS, metabolic disorders, cancer, among many others, require a special diet that will provide the body with the required nutrients. The management of these diseases requires the input of a chiropractic doctor or a nutritionist to recommend the foods to be taken (Heatley and Green 67).
Works Cited
Gibney, Michael J. Marinos Elia, Nutrition Society (Great Britain), and Olle Ljungqvist. Clinical Nutrition. Iowa: Blackwell, 2005. Print.
Gropper, Sareen S, Jack L. Smith, and James L. Groff. Advanced nutrition and human metabolism. Belmont, CA: Wadsworth, 2008. Print.
Heatley Richard, J. Hilary Green. Consensus in Clinical Nutrition. Great Britain: Cambridge university press, 1994. Print.
Insel, Paul, Don Ross, Kimberley McMahon, and Melissa Bernstein. Nutrition. London: Jones and Bartlett, 2010. Print.
Rolfes Sharon Rady, Kathryn Pinna, and Ellie Whitney.Understanding Normal and Clinical Nutrition. Belmont, CA: Wadsworth, 2008. Print.
Paper-based records have been in existence for centuries and their gradual replacement by computer-based records has been underway for the past 20 years. These forms of electronic records are known as Electronic Health Records (EHR) and are the future of medical records (CMS Office of Public Affairs, 2010). Though it is expensive form of record-keeping, EHR holds major advantages over paper records. It is for this reason that we have decided to incorporate EHR into our system due to the vast advantages that we will derive from the system. The move will be in line with the US Department of Health Services mission of ensuring that health providers switch to electronic records to store clients health information.
Advantages of EMR
EMRs can make a patients health information available when and where it is needed it is not locked away in one office or another.
EMRs can bring a patients total health information together in one place, and always be current clinicians need not worry about not knowing the drugs or treatments prescribed by another provider, so care is better coordinated.
EMRs can support better follow-up information for patients for example, after a clinical visit or hospital stay, instructions and information for the patient can be effortlessly provided, and reminders for other follow-up care can be sent easily or even automatically to the patient.
EMRs can improve patient and provider convenience patients can have their prescriptions ordered and ready even before they leave the providers office.
EMRs can support better follow-up information for patients for example, after a clinical visit or hospital stay, instructions and information for the patient can be effortlessly provided, and reminders for other follow-up care can be sent easily or even automatically to the patient.
EMRs can improve safety through their capacity to assist personnel in decision-making.
EMRs can improve privacy and security with proper training and effective policies, electronic records can be more secure than paper.
EMR Security and Privacy
EMRs are vulnerable to security breaches just as all forms of electronic data are. Anyone with appropriate login can access EMRs, besides, a person can steal login details over an unprotected network and have access to health records. It is common knowledge that the privacy of information reduces with an increase in the number of people who access it, this implies we will ensure that we have enough security measures to protect our clients information.
One point that we need to stress, however, is that even though EMRs may not be 100% secure, neither is paper (Thede, 2010). In fact, in our EMR system, we have created a program that will ensure the security of medical records, we have also put in place contingency plans in case the present program fails. Our security plans comply with the Health Insurance Portability and Accountability Act (HIPAA) requirements (CMS Office of Public Affairs, 2010).
Our system has a login feature that will only allow persons with the correct username and password to access a clients health information. Each employee will have distinct login details and this will make it easy to trace persons who have accessed what records, as well as what part of the record was viewed. After use, an employee must log off when they leave a computer (or the system logs off for you). In addition, the system secures the information with multiple backups to protect the most important information. This makes our EMR system more secure than paper (as a person cannot be traced) and complies with the HIPAA specifications. Though previous studies have shown that privacy concerns outweigh the benefits of EMRs, we have installed ample security features in recognition of our customers privacy as a constitutional right (Bright, 2007).
Use of EMR to Improve Care
The EMR that we have developed has an easy-to-use interface and medical personnel will find its applicability in several instances. For example, personnel will be able to view a patients medical history record at a glance and determine what the patient could be suffering from. Medical personnel can use various methods to check for trends such as re-infections or an error in previous treatments patients medical records. These methods include graphs, curves, and analytic tools that incorporate parameters such as BMI and age. The system can also predict when a medical condition will recur next, and even the most effective treatment alternatives.
Implementation Team
Due to the intricate nature of the EMR system, we have come up with an implementation team to ensure a smooth transition from paper to electronic records. The implementation shall consist of seven people as outlined below:
EMR Implementation Officer (EIO)
I will head the EMR implementation team and will hold the position of the EMR Implementation Officer (EIO). My immediate assistant will make daily reports to me on the progress of the implementation process. I am a super-user and will be available to assist in any stage of the implementation process as I have received enough training regarding the EMR.
Assistant Implementation Officer (AIO)
The AIO will be answerable to the EIO and will communicate with the trainers regularly to identify any hurdles in the implementation process and come up with solutions regarding the same in consultation with other stakeholders.
EMR Training Officer (ETO)
The ETO will head the training program and will engage medical personnel on a personal level. He will command a team of four experts in training our employees on the technical aspects of the EMR. The ETO is a serving member of the Centers for Medicare and Medicaid Services (CMS) under the US Department of Health Services.
Trainers
We have four implementation officers who are all experts in the application of electronic records in healthcare. All officers have been trained by the CMS and have participated in previous training regarding EMRs in other health institutions. Each of the four implementation officers is a specialist on different parts of the EMR and will be answerable to the ETO.
References
Bright, B. (2007). Benefits of Electronic Health Records Seen as Outweighing Privacy Risks. Web.
CMS Office of Public Affairs. (2010). Electronic Health Records at a Glance. Web.
Smaltz, D. and Eta B. (2007). The Executives Guide to Electronic Health Records. Chicago: Health Administration Press.
Thede, L. (2010.) Informatics: Electronic Health Records: A Boon or Privacy Nightmare? OJIN: The Online Journal of Issues in Nursing Vol. 15 No. 2.
The article gathers and relies on information collected by the National Healthcare and Nutritional Examination Survey (NHANES). The above-mentioned program was generally of studies coded to apprise haleness and nutritional conditions of the American population. The NHANES program was launched and approved by the National Center for Healthcare Statistics research and review board which specializes in epidemiological studies and health science research (Ogden et al., 2020). This was part of research by public healthcare surveillance after the realization that a big number of the population is under the threat of obesity-related consequences. The program was narrowed down to focus on individuals of Hispanic origin in comparison to other races in American society. The anlysis will focus on the essential aspects of the article including data type, methodology, research design and hypothese for the model to give insight on the reserchers view about the topic.
Available Data
The survey involved a cross-sectional analysis of the United States civilian nutrition where people of all age groups participated with consent; for the minors, permission from their guardians was prioritized. As mentioned earlier, it is crucial to consider the source of the data, if it is reliable, and whether or not the research board has the responsibility of provision of and strictly observing guidelines for ethical research practices. This document will forcuse on analyzing the reliability of the aticle as well as the information it has gathered.
Type of Data
The article provides valuable information about the trends in obesity prevalence by race and Hispanic origin. The level of measurement of the data used in the piece is nominal, as the data is classified into different categories according to race and Hispanic origin. The above-mentioned information category is estimated to generate radical results when configuring statistical ratios and percentages in the human population. Since the method relies on establishing a relationship between variables, the correct use of correlation coefficients is key (Islam & Rizwan, 2020). At first, the survey recorded an attendance rate of approximately 80% but the response rates eventually decreased barely recording the 50% mark since the year 2000 (Ogden et al., 2020). To efficiently record captured information, it had to have specific definitions. For infants, their scale was termed as a weight for length at or above the 97.7th percentile, for the period between childhood and teenage, it was body mass index (Ogden et al., 2020). Obesity and severe fatness among adults were characterized by a body mass index above the 40 mark.
Some of the assumptions that can be made from the data used in the article include, the prevalence of plumbness is higher among people of certain races and Hispanic origins than others. From the piece of work, research indicates that young ones of age 2-5 of non-Hispanic origin had increased overweight conditions between the years 2000-2005. For children of age 6-11, obesity rates increased to 19.3% with neither of the American races being severely affected (Ogden et al., 2020). Among the mature males, the Spaniards were the only race to record high weight disorders averaging at 43% after increasing from 27.5% (Ogden et al., 2020). However, despite these records, on aggregate, it can be assumed that the prevalence of plumbness has increased over time.
There are a variety of statistics that can be calculated from the data in the article. As illustrated above, they include the percentages of people in each racial and Hispanic origin group who are obese, the prevalence of obesity in each group from 1999 to 2016, and the percentage increases in fatness in each group from 1999 to 2016. Overall, the quality of the data used in the Ogden et al., 2020 piece is quite high. The data comes from the NHANES, which is a large, nationally representative dataset. The column is careful to note that the data is subject to certain limitations such as potential misclassification and missing data. This indicates that the authors are aware of the limitations of the data, and have taken steps to ensure that the data is as accurate as possible.
Study Design
The data from the column indicates that a bio-statistical study was conducted to determine trends in bulkiness prevalence by race and Hispanic origin. The writer sought to investigate the hypothesis that racial and ethnic disparities in plumbness prevalence have increased over time. The authors used a descriptive study design to analyze the data from the NHANES survey. The study design is used to describe the characteristics of a population in terms of trends, frequencies, and correlations. The program is unique because of its strict guidelines in terms of the schedule and obligations of the research (Siedlecki, 2020). The columnist used descriptive statistics such as mean, median, and standard deviation to summarize the data and compare the results across racial and ethnic groups.
The analysist used the chi-square tests and logistic regression models to further explore the associations between stoutness prevalence and race/ethnicity. For instance, although a 2-year trend cycle was more accurate for evaluating the linear and quadratic trend, the researchers considered a change to a 4-year pole estimate to be more realistic (Ogden et al., 2020). Racial and ethical disparities in obese was the issue under observation according to information in the article. Forcusing the synopsis has its reference rase as the Spaniards, not much would have changed where the focus samples are general American population.
However, the emphatic setting of society influences the direction of the research; despite all the negativity, the survey generates rather convincing rational regarding race and obesity. In the expository configuration, quantitative methods are used when collecting quantifiable information before it is analyzed and described statistically (Mihas, 2019). Quantitative methods that showed the progress in weight matters across different age groups provide further proof that the design was applied in the survey. The ratio of length to weight among adults is relatively higher and it is practically easy to misinterpret weight for obesity. The research results managed to categorize obese and severely-obese adults with a body mass index of 30 and above or 40 and above.
Overall, the piece used a descriptive study design and descriptive and inferential statistics to investigate the trends in stoutness prevalence by race and Hispanic origin. The authors used chi-square tests and logistic regression models to test this hypothesis and found that there have been significant increases in overweight prevalence among certain racial and ethnic groups over time (Siedlecki, 2020). A statistical assessment of the survey indicates that a very little portion of the children population faced weight problems during the 1999-2018 period.
Research Statists
Considering the survey generated nominal data after a descriptive analysis, statistical variables were used in the analysis. As mentioned earlier, there was a general increase in the percentage of severe weight conditions among the American races, especially the Spaniard race which was under observation. Among Hispanics children below the age of 9 years faced no sloutness issues, however, from 1999 to 2018, adolescent children with cases of weight problems increased by approximately 5% to nearly 21% (Ogden et al., 2020). The surge in stoutness among teenagers was attributed to the growth of the non-Hispanic white population in the United States. Among Spaniards and whites, obesity levels increased to 43%, but among the blacks not much change was realized (Ogden et al., 2020). Americans needed to be aware of proper physical fitness and the benefits it provides. The author provides a comprehensive report about stoutness but does not recommend any initiatives regarding the issue.
Recommended Changes
The authors did an excellent job of analyzing the data and presenting the results. They used appropriate statistical methods to analyze the data. Furthermore, they discussed important limitations of the study, such as the fact that NHANES data do not include individuals who are homeless or in institutional care (Ogden et al., 2020). Overall, the authors did not make any major statistical errors in their analysis. However, there are a few areas where the authors could have made changes to improve the article.
The authors could have included more information about the differences between racial and ethnic groups in terms of other health outcomes, such as diabetes and hypertension. Finally, the authors could have included more information about potential interventions to reduce stoutness among different racial and ethnic groups. By providing information about potential interventions, the authors could have helped to provide readers with a better understanding of the steps that can be taken to reduce the prevalence of plumbness among different racial and ethnic groups. Although there are some areas where the authors could have made changes to improve the piece, there are no major statistical errors.
Use of Correct Data
Based on the information available in the column, the statistical information provided could be interpreted as credible. The description and analysis of the statistical values have been done correctly. All the necessary observations have been monitored, hence, the analysis being accurate and reliable. The data source has a justifiable background as well as a guaranteed vastness of research material and archives from which to reference its results. Besides the above-stated facts, the results generated from the study can also be computed through a different survey hence justifying the legitimacy of the information and the resulting data. As stated earlier, the author is aware of the shortcomings of his work, and as an effort towards making amends, there is a section describing their failures.
Data Resourcefuness and Efficiency
Overall, the authors had access to the correct data to answer the research question. The survey data allowed the authors to get a comprehensive picture of prevalence of heaviness among adults in the US. By comparing the prevalence of plumbness among different racial and ethnic groups, the authors were able to identify any disparities that exist in stoutness prevalence. However, there are a few issues with the data that should be noted.
The data only reflects adults aged 20 and up, which may not be representative of the entire population. The survey data is self-reported, which means there is potential for bias. Finally, the data only covers the last two decades, which may not be enough to make long-term conclusions about trends in stoutness prevalence. The article used the correct data to assess trends in obesity prevalence by race and Hispanic origin. However, there are a few limitations to the data that should be kept in mind when interpreting the findings. Despite these limitations, the data is still useful in understanding how different racial and ethnic groups fare in terms of overweight prevalence.
Statistical Accurecy
As expected of NJANES, the ultimate goal of any scientific survey is to generate radicle and reliable information as part of observing the ethical responsibility. The period of the project was relatively enough to generate reliable readings that when properly integrated with the right models would generate realistic statistical assumptions. The samples under observation were reliable in providing feedback hence the success of the survey. Most of what a researcher would be investigating is available, and the statistical terms and stipulations have been strictly utilized. The chances of the error have not been eliminated. As mentioned earlier, despite the study showing possibilities of biases, the statistical assumptions and the process of developing them are reliable hence overpowering the shortcomings.
Conclusion and Recommendations
Conclusively, the article provides reliable facts and figures in support of the argument that obesity is prevailing more among Americans with Spaniard origins. However,the author failed to capture some sections like for recomentations, readesr are left with a problem at hand withought gauidance on imminent solutions. Furthermore, other than collecting individuals reports, the survey could be more time-preserving by using the healthcare facility records on infection records that are highly related to stoutness. Cases of hypertension, type 2 diabetes, gallbladder disease, and coronary heart disease are part of the symptoms of weight issues. Collecting records from hospitals and then statistically interpreting them concerning geographical setting and age could also help to develop information regarding the matter of stoutness in the American population. During the Covid-19 infection, numerous young energetic individuals passed on overweight-related diseases (Kompaniyets et al., 2021). These support the article on a drastic increase in plumbness percentages among American citizens.
Federal: Centers for Medicare and Medicaid Services (CMS)
State: Dependent on state regulations
Acute care in the US government refers to the treatment of patients with severe or life-threatening medical conditions. This type of care is typically provided in a hospital setting, and may involve intensive medical interventions, such as surgery or mechanical ventilation. Acute care is regulated by both federal and state governments, with federal regulations set by the Centers for Medicare and Medicaid Services (CMS) and other agencies (Meacham, 2020). State regulations may vary by state, but often cover areas such as staffing requirements, patient rights, and quality of care standards. Medicare provides coverage for many acute care services, including hospitalizations, physician visits, and diagnostic tests.
Assisted Living Facilities
National: National Center for Assisted Living
State: Dependent on state regulations
Assisted living facilities are a form of residential care facility that assists with daily living chores such as bathing, dressing, and medication administration while encouraging independence and autonomy. The National Center for Assisted Living, as well as state rules, oversee assisted living facilities in the United States (Derlet, 2021). These policies may differ from one state to the next and may address issues like as staffing requirements, resident rights, and health and safety standards. Meals, housekeeping, transportation, and social activities are common services and amenities provided by assisted living homes. Medicaid may pay part of the costs of assisted living facilities, but eligibility rules and coverage vary by state.
Critical Access Hospital
Federal: CMS
State: Dependent on state regulations
Critical Access Hospitals (CAHs) are a type of hospital in the United States that delivers important healthcare services to rural communities that are underserved. The Centers for Medicare and Medicaid Services (CMS) regulates CAHs and the Health Resources and Services Administration (HRSA) funds them (HRSA). The purpose of these hospitals is to offer basic healthcare services to those who would otherwise be unable to get them due to geographic, economic, or other limitations. CAHs usually provide a limited variety of services, such as emergency treatment, outpatient care, and short-term inpatient care (Milakovich & Gordon, 2022). Medicare covers services offered by CAHs such as doctor visits, diagnostic testing, and hospitalizations.
Dialysis Care
Federal: CMS
State: Dependent on state regulations
Dialysis care in the US is regulated by the Centers for Medicare and Medicaid Services (CMS) at the federal level. Dialysis is a treatment for individuals with end-stage renal disease (ESRD) who are unable to adequately filter waste and excess fluid from their blood (Rice et al., 2021). Dialysis care is typically provided in an outpatient setting, such as a dialysis center, and may be performed by a registered nurse or a trained technician. Medicare provides coverage for dialysis care services, including dialysis treatments, medications, and equipment necessary for the treatment of ESRD.
Home Health Care
Federal: CMS
State: Dependent on state regulations
Home health care in the United States is a heavily regulated sector, controlled at the federal level by the Centers for Medicare and Medicaid Services (CMS) and with extra laws differing by state. This ensures uniform quality of care across the country while also allowing for flexibility to suit the particular demands of each state. Home health care services are offered in the individuals home, allowing them to stay in familiar settings while receiving the medical care they require. These services are intended to assist persons manage medical illnesses and keep their independence by providing not just the essential medical care but also emotional support and companionship.
Nursing care, physical therapy, occupational therapy, speech therapy, and medical social services are all examples of home health care services. These services are tailored to the individuals exact needs, ensuring that the appropriate care is provided at the appropriate time. Medicare covers home health care services in its entirety, including physician visits, skilled nursing care, therapy services, and medical equipment relevant to the medical condition. This coverage guarantees that people obtain the treatment they require without having to worry about the expense, enabling them to focus on their health and well-being.
Hospice Care
Federal: CMS
State: Dependent on state regulations
Hospice care is a type of end-of-life care that focuses on providing comfort and support to individuals who are terminally ill. Hospice care in the US is regulated by the Centers for Medicare and Medicaid Services (CMS) at the federal level, and regulations may also vary by state. Hospice care is typically provided in the individuals home or in a specialized hospice facility, and the goal is to manage symptoms and provide emotional and spiritual support to both the individual and their family members (Derlet, 2021). Hospice care services may include pain management, emotional support, spiritual care, and bereavement counseling. Medicare provides coverage for hospice care services, including physician visits, nursing care, medical equipment, and medications related to the terminal illness.
Rural Health Clinic
Federal: CMS
State: Dependent on state regulations
Rural Health Clinics in the US government are a type of outpatient medical facility that is located in a rural, medically underserved area. These clinics are regulated by the Centers for Medicare and Medicaid Services (CMS) and receive funding from the Health Resources and Services Administration (HRSA). The goal of these clinics is to provide primary care services to individuals who are unable to access care due to geographic, economic, or other barriers. The services provided by rural health clinics include preventive care, treatment for acute and chronic illnesses, and management of chronic conditions. Additionally, these clinics often provide access to dental and mental health services, as well as pharmacy services. Rural Health Clinics play an important role in improving the health outcomes of individuals living in rural areas of the United States.
Pediatric Care
Federal: CMS
State: Dependent on state regulations
There are several US government agencies that are involved in pediatric care, including the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA). These agencies work to promote and protect public health through research, education, and access to healthcare services for children. Additionally, the American Academy of Pediatrics (AAP) is a membership association that focuses on promoting the health and well-being of infants, children, and adolescents in the United States. Medicare also provides coverage for pediatric care services, including physician visits, diagnostic tests, and hospitalizations.
Skilled Nursing Facility
Federal: CMS
State: Department of Social Services
Skilled nursing facilities in the US are regulated by both federal and state governments. While the federal government does set regulations and standards for skilled nursing facilities through agencies such as the Centers for Medicare and Medicaid Services (CMS) and the Occupational Safety and Health Administration (OSHA), the states also have a hand in regulating these facilities. In fact, each state has the freedom to customize their regulations and standards to better reflect the specific needs of their population (Milakovich & Gordon, 2022). The American Association of Nurse Assessment Coordination is a national organization that provides resources and support for professionals working in skilled nursing facilities. As the aging population continues to grow in the US, the demand for skilled nursing facilities is expected to increase in tandem. Therefore, the role of organizations such as the American Association of Nurse Assessment Coordination in ensuring the quality of care provided in these facilities will become even more important in the years to come.
Veterans Health Administration
Federal: Department of Veterans Affairs
The Veterans Health Administration (VHA), established in 1930, is a government agency within the Department of Veterans Affairs (VA) that is responsible for providing healthcare services to eligible military veterans. The VHA operates a vast network of hospitals and clinics across the United States and offers a comprehensive range of healthcare services, including primary care, mental health care, and specialized care for conditions such as traumatic brain injury and post-traumatic stress disorder. In addition to these services, the VHA also provides services for elderly veterans, including nursing home care and home-based primary care. Furthermore, the VHA has been a leader in healthcare innovation, with initiatives such as telehealth services and electronic health records that aim to improve the quality of care and access to care for veterans. Overall, the VHA plays a critical role in ensuring that over 9 million veterans enrolled in the VA system have access to the healthcare services they need and deserve.
References
Derlet, R. W. (2021). Corporatizing American health care: How we lost our health care system. Johns Hopkins University Press.
Meacham, M. R. (2020). Longests health policymaking in the United States. (7th ed.). Health Administration Press.
Milakovich, M. E., & Gordon, G. J. (2022). Public administration in America. Cengage Learning.
Rice, T., Rosenau, P., Unruh, L. Y., & Barnes, A. J. (2021). Health systems in transition: USA. (2nd ed.). University of Toronto Press.
Showalter, S. (2020). The law of healthcare administration. (9th ed.). Health Administration Press.