Category: Health & Medicine

Introduction

The global health sector is expected to grow considerably in the next several decades due to changes in the age composition of a population. The aging population contributes to the increased need for healthcare services, which is why this field will be growing in terms of employment opportunities. In addition to individuals whose job duties are based on evaluating clients and providing medical care to them, the healthcare industry also needs highly qualified specialists able to plan, direct, and coordinate health services. As a result, healthcare managers play an essential role in the overall efficacy of a healthcare setting.

Currently, numerous people are extremely interested in healthcare, although they would prefer developing their administrative skills instead of providing direct patient care. In turn, these individuals are a perfect match for the position of a healthcare manager. On the one hand, this job position does not require taking direct responsibility for the health of patients. On the other hand, healthcare managers are required to determine the impact of health policy and laws on clinical institutions, as well as manage healthcare professionals in various capacities. Thus, to coordinate the highest quality care and ensure that patients are served to the fullest potential, each healthcare organization should have a healthcare manager.

The Role of the Healthcare Manager Based on Biblical Principles

Christian values have always played a crucial role in the area of healthcare, as they have been used to make the best decisions when it comes to the health and life of multiple patients. From the perspective of healthcare management and administration, Christs message of love and compassion was initially considered during the Middle Ages (English Standard Version Bible, 2001). It was the period when the first hospital institutions were operated. According to the Bible, God created the whole universe and two people to take care of it. As a result, the main message that should be understood is that humans are managers who are acting on Gods behalf. In other words, people are required to take responsibility for everything that God has placed under their control. In the context of healthcare, managers should take into account the principles of patience, forgiveness, and acceptance of others to serve their functions effectively.

Taking into account that healthcare managers fill leadership roles, they should be able to maintain a high level of communication in the team. Based on the information from the Bible, this goal can only be achieved if the principles of servanthood and conflict resolution are used. Moreover, it is important to keep God at the center by focusing on the spiritual needs of patients in the first place (Roohi et al., 2020). For instance, it can be done by implementing faith-based services that can assist patients through difficult times. At the same time, patients should have the opportunity to understand their health care decisions regularly. In this case, healthcare administrators should develop patient advocacy programs that are intended to increase the level of patients awareness when it comes to medical terminology and self-management of various conditions.

Clinical Laboratory Manager: Demand, Skills, Knowledge, and Abilities

Nowadays, laboratory results are tremendously important in the healthcare industry, as they are used to develop appropriate treatment plans for patients. To ensure that testing is performed accurately, numerous public and private clinical institutions hire clinical laboratory managers. At the first sight, their duties and duties of clinical laboratory technologists are similar, as they both perform, design, and oversee test procedures. However, the scope of the managers duties is much wider. For example, these individuals are also required to analyze requests for tests, assist with budgets, as well as ensure high levels of safety, quality, and accuracy of the received results (Croxatto & Greub, 2017). Furthermore, clinical laboratory managers handle the administrative side of running a lab. To offer technologists the opportunity to spend time only on testing, managers are required to buy supplies and manage patient data. Accordingly, these specialists should be able to combine business skills and healthcare knowledge at the same time.

Most frequently, many applicants are aiming to take this job position, as it is associated with considerable career growth. For instance, the career is expected to grow 18% in the next seven years, thereby producing over 70,000 job opportunities across the U.S. (Hanley et al., 2016). Such considerable growth can be explained by high salary potential. It depends on multiple factors, such as previous job experience, level of theoretical knowledge, location, and the healthcare facility, although the average salary of the clinical laboratory manager is around $103,000 per year (Hanley et al., 2016). Also, considering that people of this profession work in one of the fastest-growing areas of healthcare, they are expected to build their career way faster than representatives of other areas.

Simultaneously, to take the job position of clinical laboratory manager, it is essential to have at least a Bachelors degree in the areas of epidemiology, health services management, or environmental health and safety. However, in addition to education, the person aiming to take this job position should have job experience in related fields of healthcare. For instance, numerous individuals work as medical technologists or research assistants before applying for the position of clinical laboratory manager. In this case, it is essential to know the areas of microbiology, chemistry, statistics, and anatomy. At the same time, it is important to note that these specialists have the opportunity to work either in public or private institutions. In spite of the fact that the majority of people work in public hospitals, there is a huge demand for managers operating in private labs and hospitals.

In the context of skills and abilities, clinical laboratory managers should be knowledgeable in both medical technology and management. It is important for the person applying for this job position to know biological science, specimen procurement processes, principles of laboratory testing, as well as supervision methods and techniques. Taking into consideration that the majority of the time these specialists are required to communicate with various units, it is tremendously important to have well-developed communication and leadership skills. In terms of technical skills, it is crucial to be professional in budgeting, staff management, scheduling, supervision, case management, and quality assurance. In turn, the main soft skills required in this field of healthcare are collaboration, planning, and problem-solving.

The typical working day of a clinical laboratory manager is based on several significant parts. First, this person is required to determine if there were any issues from the previous shifts testing procedures. Second, it is necessary to check the quality of current tests. The next half of the day is usually dedicated to projecting meetings with other healthcare teams and assisting with budgets. Hence, both healthcare knowledge and management skills are required to successfully serve the functions of a clinical laboratory manager.

A Career Development Plan to Obtain the KSAs Needed

To obtain appropriate KSAs (knowledge, skills, abilities), it is essential to develop a comprehensive career development plan. This goal can be successfully achieved with the help of the SMART goal framework. This tool stands for Specific, Measurable, Achievable, Relevant, and Time-based. In other words, this approach is usually used to help guide goal setting from the perspective of employment. When it comes to the profession of a clinical laboratory manager, it is essential to develop a combination of multifaceted skills and abilities.

The main goal of this plan is to obtain a job as a clinical laboratory manager within three months after graduating with a Masters degree in health administration. This goal can be considered specific as it outlines the final goal that should be achieved in a specific period of time. Also, the success of this career purpose can be measured by the number of job offers that invite a potential employee to work in the position of clinical laboratory manager in a certain healthcare facility.

Moreover, considering that this goal is realistic and practically possible, it can also be regarded as achievable. Masters degree program provides appropriate theoretical information that is needed for the profession of a clinical laboratory manager, which is why the intention to apply for this position can be successfully achieved. Simultaneously, this goal is relevant and time-based, as the applicant sets a specific deadline that should be met in the field that has been studied for several years.

The Impact of a Successful Laboratory Manager

Employee engagement has always been a tremendously essential factor affecting the quality of work performed by the entire team. Based on the information from one of the research studies (Lippi & Da Rin, 2019), approximately 75% of people who voluntarily leave their jobs do it because of their managers. They are most frequently dissatisfied with the communication in the team, which means that laboratory managers should take responsibility for the whole working environment. To improve the quality of services provided by the team of laboratory workers, clinical managers are required to follow several important strategies. For instance, these specialists should have an open-door policy that is based on the idea that anyone can ask questions and voice concerns regardless of their job position. Furthermore, leaders should be open to reciprocal feedback and constructive criticism.

In addition, each clinical laboratory manager should pay a considerable amount of attention to team-building activities. For example, after-work pizza parties, cooking classes, and sports activities are expected to motivate medical staff to work together and develop their strengths. At the same time, some activities can boost teamwork among coworkers regularly. For example, conversations over coffee help improve both formal and informal communication among laboratory workers, which is why they should be allowed to take a break of 10-15 minutes every two hours (Carey et al., 2018). Finally, diverse issues should be identified and analyzed by laboratory managers to avoid potential cases of discrimination based on ethnic background, race, and sexual orientation. According to various research studies, the prevalence of workplace discrimination can reach up to 25%. Therefore, to reduce the magnitude of this problem in a certain working environment, leaders should develop effective communication.

Tips for Efficient Lab Management

Efficient laboratory management consists of several significant elements that should be considered by each clinical manager. First, it is crucial to have a high level of awareness of laboratory terms and techniques that are frequently used by highly skilled scientists or engineers in lab settings. Taking into account that clinical managers spend the majority of their working time in laboratories, they should be able to communicate with colleagues effectively. Second, it is essential to get acquainted with the laboratory staff personally to develop trusting relationships in the team. Furthermore, each manager should take appropriate measures to stay up-to-date and acquire new skills. With the rapid advancement in science and technology, numerous laboratory trends have changed. Therefore, to lead the team of qualified laboratory specialists, it is important to join professional training sessions regularly.

Planning is an integral part of management, which is why it should also be considered by professional laboratory managers. For example, it is recommended to develop a five-year plan for the laboratory. As a result, all team members could work towards the same goal, while the manager would be able to determine the progress achieved by the staff. In this plan, it is important to highlight steps that should be followed by each team member individually and the whole team. This type of strategy is predicted to encourage medical staff to develop new skills and improve their knowledge, whereas the healthcare facility can gain a better reputation on the market. This plan should include clear mission and vision statements that summarize the main goals of the teamwork, as well as the role of each team member in the process of achieving common goals.

Conclusion

The healthcare industry plays a crucial role in modern society, as it is strongly associated with the overall physical and mental health status of the global population. In turn, to obtain detailed information about the health of a patient, clinicians tend to rely on laboratory tests. Currently, these tests are used to identify changes in the health of the patient. Nowadays, almost any type of chemical component can be found in blood or urine. As a part of regular checkups, laboratory tests are beneficial for detecting chronic and acute diseases in the earliest stages. Accordingly, laboratory personnel takes a vast amount of responsibility for the health status of the patients.

However, to become a qualified clinical laboratory manager, it is important to gain appropriate skills, knowledge, and abilities. In addition to obtaining at least a bachelors degree, potential specialists are required to develop analytical, management, and communication skills. The overall goal of the laboratory manager is to oversee the operations that take place in laboratories to ensure that safety protocols are followed. Hence, having theoretical knowledge in the field of healthcare is not enough to serve the functions of these specialists. It is crucial to have working experience as a medical technologist or research assistant before applying for the position of clinical laboratory manager. Subsequently, the supervision of the work of clinical laboratory scientists and technicians requires a multifaceted skill set.

References

English Standard Version Bible. (2001). ESV Online. Web.

Carey, R., Bhattacharyya, S., Kehl, S., Matukas, L., Pentella, M., Salfinger, M., & Schuetz, A. (2018). Practical guidance for clinical microbiology laboratories: Implementing a quality management system in the medical microbiology laboratory.Clinical Microbiology Reviews, 31(3), 1-15. Web.

Croxatto, A., & Greub, G. (2017). Project management: importance for diagnostic laboratories.Clinical Microbiology and Infection, 23(7), 434-440. Web.

Hanley, T., Sowder, A. M., Palmer, C. A., & Weiss, R. L. (2016). Teaching laboratory management principles and practices through mentorship and graduated responsibility: The assistant medical Directorship.Academic Pathology, (15)3, 2374289516678972. Web.

Lippi, G., & Da Rin, G. (2019). Advantages and limitations of total laboratory automation: A personal overview.Clinical Chemistry and Laboratory Medicine (CCLM), 57(6), 802-811. Web.

Roohi, G., Mahmoodi, G., & Khoddam, H. (2020). Knowledge implementation in health care management: A qualitative study.BMC Health Services Research, 20(1), 1-20. Web.

Social Determinants of Health in America

The concept of social determinants of health (SDOH) has gained increasing attention in recent years as an essential factor influencing health outcomes and disparities in America. SDOH encompasses many interconnected factors, such as racism, violence, discrimination, job opportunities, physical activity opportunities, language, literacy, and environmental conditions like polluted water and air. These determinants shape an individuals access to healthcare services and the quality of care received and impact their exposure to various health risks. This essay aims to explore the multifaceted nature of SDOH in America. It will discuss the policies, laws, and initiatives implemented to improve health outcomes for underserved populations. Furthermore, the essay will examine the impact of healthcare costs on SDOH, with a focus on private insurance, Medicaid, and Medicare programs. Finally, the report will delve into the critical role managed care organizations play in addressing SDOH among underserved populations, highlighting the importance of their involvement in promoting health equity and overall well-being.

Understanding Social Determinants of Health

SDOHs are deeply entrenched in the distribution of resources, power, and opportunities within society. They are influenced by many interconnected factors, such as racism, violence, discrimination, job and physical activity opportunities, language, literacy, and environmental conditions like polluted water and air (Ogunwole & Golden, 2021). Other factors include access to healthy food, social support networks, and exposure to crime and neighborhood safety (Hill-Briggs et al., 2021; Lopez et al., 2022). These factors collectively significantly impact health outcomes, shaping peoples access to healthcare services and their quality of care. Additionally, they influence individuals exposure to various health risks. For instance, living in neighborhoods with limited access to grocery stores offering fresh products can lead to poor diet and increased prevalence of chronic diseases like diabetes and obesity (Hill-Briggs et al., 2021). Similarly, residing in areas with high levels of air pollution can exacerbate respiratory conditions. It can increase the risk of cardiovascular diseases (White-Williams et al., 2020). Tackling these complex factors is essential for enhancing overall health and diminishing societal health inequalities.

The influence of SDOH on health outcomes is extensively supported by research in the field. For instance, Hill-Briggs et al. (2021) found that social determinants such as socioeconomic status, race, and ethnicity significantly influence diabetes prevalence and outcomes. Similarly, White-Williams et al. (2020) highlighted the impact of social determinants on heart failure outcomes, emphasizing the need for a comprehensive approach to care that addresses these factors. Other studies have demonstrated the link between SDOH and mental health, with elements like neighborhood safety, social support, and access to resources crucial in determining mental health outcomes (Lopez et al., 2022). Additionally, Ogunwole and Golden (2021) explored the relationship between SDOH and maternal and child health, finding that factors such as education, income, and access to prenatal care significantly affect maternal and infant health outcomes. It is vital to recognize and address the complex aspects of SDOH to promote health equity. This approach contributes to the overall well-being of individuals and communities nationwide.

Addressing Social Determinants: Policies and Laws

In response to the growing recognition of the importance of SDOH in shaping health outcomes, various policies, and laws have been put in place to address the underlying factors and promote health equity. The Affordable Care Act (ACA) is a prime example of a policy that extends healthcare coverage to a broader population (Lopez et al., 2022). This expansion has been particularly beneficial for underserved Americans. It did so by broadening Medicaid and establishing health insurance marketplaces. This expansion has helped reduce the number of uninsured individuals and improved access to essential healthcare services.

Additionally, the ACA introduced provisions to address health disparities, such as requiring non-profit hospitals to conduct community health needs assessments and create plans to address identified needs (Hill-Briggs et al., 2021). Furthermore, the ACA has increased funding for community health centers, which provide primary care services in medically underserved areas, and established the Prevention and Public Health Fund, which supports initiatives targeting SDOH (Ogunwole & Golden, 2021). These efforts demonstrate a comprehensive approach to addressing SDOH and promoting health equity in the United States.

Some states have implemented policies targeting specific social determinants, such as housing and education. These policies aim to improve health outcomes. For example, New York States Medicaid Redesign Team has prioritized investments in supportive housing for high-need Medicaid beneficiaries, recognizing the critical role of stable housing in promoting health (Lopez et al., 2022). Efforts have been made to address environmental determinants of health, such as air and water pollution. The Environmental Protection Agency (EPA) has addressed pollution-related health risks by implementing regulations limiting pollutant emissions from industrial facilities (Hill-Briggs et al., 2021). They promote clean water resources, which is particularly beneficial for vulnerable populations. However, challenges remain in addressing the systemic racism, discrimination, and income inequality that continue to shape SDOH in America. Ongoing advocacy and policy changes are needed to dismantle these structural barriers and promote health equity.

The Cost of Healthcare and its Impact on SDOH

In the United States, the elevated cost of healthcare has consistently hindered access to essential care for numerous Americans. This issue is especially pronounced for individuals who lack sufficient insurance coverage. The implementation of the ACA has helped to some extent by expanding access to healthcare coverage, but challenges remain. For example, private insurance often comes with high premiums, deductibles, and copayments, which can deter individuals from seeking care or adhering to treatment recommendations (White-Williams et al., 2020). As a result, addressing the financial barriers to healthcare access remains crucial in pursuing health equity and improved health outcomes for all Americans.

In contrast, Medicaid and Medicare provide essential coverage for low-income and elderly populations, but they face challenges related to provider reimbursement rates and gaps in scope. For instance, low reimbursement rates in the Medicaid program may limit the availability of healthcare providers willing to accept Medicaid patients, affecting access to care for these individuals (Lopez et al., 2022). Moreover, some states have not expanded Medicaid under the ACA, leaving many low-income individuals without access to affordable healthcare coverage (Ogunwole & Golden, 2021). To overcome these challenges and ensure equitable healthcare access, ongoing efforts are needed to improve Medicaid and Medicare programs, focusing on addressing reimbursement issues and expanding coverage in all states.

Managed Care and Addressed SDOH in Underserved Populations

Managed care organizations (MCOs) are crucial in addressing SDOH among underserved populations. MCOs are responsible for delivering healthcare services to Medicaid and Medicare beneficiaries and are increasingly focused on addressing SDOH to improve health outcomes and reduce costs (White-Williams et al., 2020). MCOs can help address SDOH by implementing targeted interventions that address specific social determinants, such as housing, education, and employment opportunities. For example, MCOs can partner with community-based organizations to provide their members with supportive housing services, job training programs, or educational resources (Lopez et al., 2022). By addressing these factors, MCOs can help promote health equity and improve health outcomes for their beneficiaries.

In addition, MCOs can adopt value-based payment models that incentivize providers to focus on addressing SDOH and improving health outcomes. Through these models, providers receive rewards for offering high-quality, cost-effective care that meets patients needs. This approach addresses social determinants that impact health (White-Williams et al., 2020). Examples of such models include accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and bundled payment arrangements (Lopez et al., 2022). These innovative payment models encourage providers to collaborate and coordinate care, focusing on prevention, early intervention, and addressing the root causes of health disparities. This approach can aid in transitioning the focus of healthcare delivery from merely treating illnesses to promoting overall health and well-being. Simultaneously, it fosters a more equitable healthcare system.

Conclusion

Social determinants of health play a significant role in shaping health outcomes in America. Factors such as racism, violence, discrimination, job and physical activity opportunities, language, literacy, and environmental conditions contribute to health disparities and inequities. To address these challenges and promote health equity, it is essential to implement policies and laws that target the root causes of these disparities and recognize the role of managed care organizations in addressing SDOH among underserved populations. Efforts to expand access to healthcare coverage, invest in supportive housing, improve environmental regulations, and promote value-based payment models are critical in addressing SDOH and promoting health equity. Continued advocacy and policy changes are needed to dismantle structural barriers and ensure that all Americans have the opportunity to achieve their full health potential.

References

Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., Thornton, P., & Haire-Joshu, D. (2021). Social determinants of health and diabetes: A scientific review. Diabetes Care, 44(1), 258279. Web.

Lopez, K. N., Baker-Smith, C. M., Flores, G., Gurvitz, M., Karamlou, T., Gallegos, F. N., Pasquali, S. K., Patel, A., Peterson, J. L., Salemi, J. L., Yancy, C. W., & Peyvandi, S. (2022). Addressing social determinants of health and mitigating health disparities across the lifespan in congenital heart disease: A scientific statement from the American Heart Association. Journal of the American Heart Association, 11(8). Web.

Ogunwole, S. M., & Golden, S. H. (2021). Social determinants of health and structural InequitiesRoot causes of diabetes disparities. Diabetes Care, 44(1), 1113. Web.

White-Williams, C., Rossi, L., Bittner, V., Driscoll, A., Durant, R. W., Granger, B. B., Graven, L. J., Kitko, L., Newlin, K., & Shirey, M. R. (2020). Addressing social determinants of health in the care of patients with heart failure: A scientific statement from the American Heart Association. Circulation, 141(22). Web.

In current healthcare settings, nuclear medicine has become an important tool for aiding patients. Despite the dangers associated with the use of radioactive elements, through their application in diagnostics and treatment, it is possible to limit their harm and enhance their benefits. In particular, these types of tools are invaluable when working on treating various types of cancer. For example, lymphoma, as the type of cancer that affects the bodys blood system, usually requires the use of nuclear medicine. Before any treatment is administered, molecular imaging is used to determine the diagnosis and the severity of the disease. Compared to other types of imaging, it enables doctors and physicians to examine patients on the deepest of levels and detect the presence of cancer and other disturbances (Fact sheet: Molecular imaging and lymphoma, n.d.). From that point onward, nuclear medicine serves as a tool for healing or managing the patients condition. Both chemotherapy and radiation therapy are widely used. These methods utilize either medicine or energy beams that are capable of attacking the cancer cells or managing their spread. Naturally, even these types of treatment are not always effective, and the ability of doctors to use them hinges on the patients response. However, it is undeniable that the application of radioactive and nuclear elements gives individuals more opportunities to live fulfilling lives.

Throughout this course, I was able to learn about a number of different treatment and diagnostics methods, as well as understand the development of the medical sphere in the past decades. I think that this knowledge gave me a newfound appreciation for researchers and doctors that strove to improve the tools at their disposal and create approaches capable of fighting even chronic diseases. In terms of my own everyday life, this knowledge helps me understand that concepts like harm or benefit are not always black and white, and many things that are inherently dangerous can be used responsibly. This applies to both medicine and all other kinds of human activity.

Reference

Fact sheet: Molecular imaging and lymphoma. (n.d.). Society of Nuclear Medicine and Molecular Imaging (SNMMI). Web.

Patient

The patient, Sarah, is a 28-year-old African American woman with a past medical history of asthma and type 2 diabetes. She admits that she does not check her blood sugar level regularly and takes her medications when she remembers. Her chief complaint is a wound on her left foot got several days ago. No treatment or medical attention was made at once, and the patient used hydrogen peroxide to clean the damaged area. At this moment, a 4-cm lesion is observed, with 7-cm surrounding erythema extended.

Differentials

Sarah has several serious health conditions, including diabetes complications, foot wounds, fever, and breathing problems. The impact of diabetes on wound growth is not always easy to predict, and such differentials as abscess, osteomyelitis, and atherosclerosis. An abscess is possible because of the impossibility of the diabetic organism to deal with infections, characterized by fever, local pain, and drainage (Chang et al., 2018). The patient has some of the symptoms that cause discomfort. Osteomyelitis is a bone infection, the main symptoms of which are fever, redness, and pain, and the patient meets certain criteria in this case (Giurato et al., 2017). Atherosclerosis is common in diabetic patients as it is characterized by blood vessel damage and the inability to carry oxygen in the body (Poznyak et al., 2020). If it is observed in the lower extremities (LE), numbness and weakness are the symptoms. Sarah admits numbness in her right LE. Shortness of breath, cough and wheezing may be supplementary signs, and the patient reports on her breathing problems as well.

Breathing problems and high blood glucose levels could have such differentials as pulmonary edema, sepsis, and diabetic ketoacidosis. Fever and cough are the signs, the nature of which should be checked. She is a former smoker with uncontrolled diabetes and extremely high sugar in the blood, which may provoke excess fluid in the lungs and the inability to breathe freely. Besides, her asthma history plays a role in the impossibility to detect other symptoms at an early stage. Sepsis is the condition when the body is not able to respond to inflection. Diabetes weakens Sarahs immune system, which causes changes in mental status (her poor attention to medications), fever, and high blood pressure. Finally, diabetic ketoacidosis occurs when the body lacks insulin, and ketones are produced and influence the bloodstream. Confusion and hyperglycemia are the reasons to consider this differential in the analysis.

Current Medical Diagnosis

At this moment, the medical diagnosis can be given a fast growth of diabetic foot infection that leads to a foot ulcer. This condition is common among diabetic patients when poor or no blood sugar control occurs and causes hyperglycemia. Another critical risk factor is the neglect of taking medications regularly. Finally, no medical wound care and the absence of antibiotics to predict infections after skin damage contributes to the infection progress (Aliakbar et al., 2019). The diagnosis of diabetic foot infection cannot be ignored because delayed treatment may result in lower limb amputation.

Diagnostic Images

To check the condition of the patient and develop a further treatment plan, several diagnostic images are necessary. It is better to start with X-rays (anteroposterior and lateral views) to detect if there is any soft tissue gas or a foreign body that causes smelly drainage and pain (Aliakbar et al., 2019). Magnetic resonance imagining (MRI) helps to identify soft tissue and bone conditions based on gadolinium uptake (Giurato et al., 2017). In the majority of cases, X-rays are enough to detect the area and the quality of damage and identify the next treatment step.

Laboratory Work

Several laboratory tests are necessary to understand the reaction of the body to damage. The first step is to evaluate the wound and send its microbial culture (surface swab) for analysis to check the present infections (Chang et al., 2018). Blood tests should be done to count the number of leukocytes (a complete blood test) and detect the signs of anemia, and blood serum secretion show current glycemic control (Giurato et al., 2017). The fact that the patient has not eaten today contributes to obtaining accurate results.

Plan of Care

Healthcare workers choose different ways to help their patients and manage diabetic foot ulcers. To avoid amputation, it is required to follow pharmacological treatment, surgical debridement, and regular dressing changes (Aliakbar et al., 2019). Local wound care includes drainage of an abscess, surgical resection (if necessary), and dressing with saline or 2% iodine solution during the next three months (every five and then every ten days) (Aliakbar et al., 2019). Antibiotic treatment should help to reduce the spread of infection, but as the patient is allergic to penicillin, amoxicillin is better to replace with tetracycline or aminoglycoside. Regarding the fact of diabetes, close monitoring of blood levels is recommended.

Conclusion

In general, the treatment of foot ulcers in diabetic patients is characterized by several restrictions and precautionary measures. In addition to type 2 diabetes, Sarah is obese and has hypertension. She has to be educated about the importance of monitoring her blood sugar levels and taking metformin regularly to predict the development of infection and heart-related problems. If treatment does not lead to positive results within the next five days, X-rays are used to check the spread of infection, and amputation remains the only option to save the patients life.

References

Aliakbar, A. H., Alsaadi, M. A., & Barrak, A. A. Z. (2019). Evaluation of the surgical and pharmacological treatment of diabetic foot infection: A retrospective study. Open Access Macedonian Journal of Medical Sciences, 7(9), 1499-1504. Web.

Chang, J. W., Heo, W., Choi, M. S. S., & Lee, J. H. (2018). The appropriate management algorithm for diabetic foot: A single-center retrospective study over 12 years. Medicine, 97(27). Web.

Giurato, L., Meloni, M., Izzo, V., & Uccioli, L. (2017). Osteomyelitis in diabetic foot: A comprehensive overview. World journal of diabetes, 8(4), 135-142. Web.

Poznyak, A., Grechko, A. V., Poggio, P., Myasoedova, V. A., Alfieri, V., & Orekhov, A. N. (2020). The diabetes mellitus  Atherosclerosis connection: The role of lipid and glucose metabolism and chronic inflammation. International Journal of Molecular Sciences, 21(5). Web.

The main task of the nurse is to help the patient and his or her assistant to make the conditions of treatment of each person maximally comfortable. Motivational interviewing (MI) is a counseling approach that healthcare providers can utilize to facilitate patient behavior change to improve health and psychological support in general. After completing the Motivational Interviewing Self-Paced Module, it is evident that MI could be applied in nursing practice to promote patient self-efficacy and behavior change. One potential application of MI in nursing practice is managing chronic diseases such as diabetes, helping change behavior, and stopping smoking and other bad habits.

Chronic diseases such as diabetes can indeed become a serious human problem. Nurses can use motivational interviewing techniques to address the issues caused by the disease. In the first place, this concerns questions about the patients health, the solution of which can induce changes in lifestyle. STI can be a powerful tool in promoting healthy lifestyles, which will significantly improve the sense of self. According to Jacobs et al. (2021), MI is an effective intervention for improving self-management skills in patients with diabetes. By using reflective listening, the nurse could acknowledge the patients concerns and challenges while highlighting their strengths and past successes. In this way, trust can be built between the patient and the nurse, increasing the patients motivation for treatment.

Furthermore, MI can be used to address patient ambivalence towards behavior change. Motivational interviewing can be helpful in cases where the patient is aware of the negative consequences of their behavior. For example, a nurse can study its advantages and disadvantages, which will help determine the persons inner motivation and increase the chances of recovery (Jacobs et al., 2021). An example is when a patient has a genetic predisposition to diabetes but he or she does not change his or her diet for the better. The MI helps to raise awareness of the risks of inappropriate behavior and to take specific steps toward improving health. The specialist can push the person to realize the pros and cons of cooking healthy food, which can motivate the patient to change.

Motivational Interviewing (AI) can be helpful in motivating patients to fight their bad habits. Jacobs et al. (2021) note that IM successfully approaches smoking cessation. The nurse can learn about triggers and barriers to a patients failure to act in harmful ways to his or her health and help explore the inner motivation behind these actions. An excellent way to encourage patients to improve is to list the benefits of abandoning bad habits. This approach can encourage the patient to understand the positive aspects and increase the preparedness level for a healthier lifestyle. Although this strategy is rarely effective, it impacts patients and makes them think about their lifestyles.

In conclusion, Motivational Interviewing (MI) is a counseling approach that can be effectively utilized in nursing practice to promote patient self-efficacy and behavior change. By using reflective listening and acknowledging patient concerns, trust can be built between the nurse and patient, increasing the patients motivation for treatment. MI can also address patient ambivalence towards behavior change, particularly in chronic diseases such as diabetes and bad habits like smoking. By understanding the patients inner motivation and exploring the benefits of healthier lifestyles, nurses can help patients make positive changes toward better health and overall well-being. MI is a powerful tool that can help improve patient outcomes and promote healthy living

References

Jacobs, N. N., Calvo, L., Dieringer, A., Hall, A., & Danko, R. (2021). Motivational interviewing training: A case-based curriculum for preclinical medical students. MedEdPORTAL : The Journal of Teaching and Learning Resources, 17(1), 11104. Web.

Introduction

Testosterone is a hormone that is predominantly synthesized in the testes of males and, to a lesser extent, in females. It is essential in the development of male physical traits such as muscle mass, bone density, and body hair growth. Additionally, testosterone plays a vital role in preserving muscle mass and bone density, controlling sexual desire, and facilitating sperm production. Inadequate amounts of testosterone can lead to various health issues, such as decreased sexual desire, fatigue, lowered mood, and diminished muscle mass.

Main body

Hypogonadism, also referred to as testosterone deficiency, is a medical condition characterized by insufficient production of testosterone by the body. Several factors can contribute to the development of this condition, such as aging, obesity, certain medications, and genetic disorders (Bhasin & Ozimek, 2021). Understanding the causes, symptoms, and treatment options of this condition is crucial as it can have notable impacts on mens health. Aging is one of the most prevalent factors contributing to testosterone deficiency, whereby the natural decline in testosterone levels occurs in men as they grow older (Erenpreiss et al., 2020). The reduction in testosterone levels may commence as early as 30 years of age and persist throughout the lifespan. Approximately 30% of men over the age of 60 have low levels of testosterone. This decline in testosterone levels with aging, known as age-related hypogonadism or andropause, can result in a range of physical and psychological symptoms that can impact the quality of life and overall health.

The surplus body fat is another frequent factor leading to testosterone deficiency, whereby the elevated levels of estrogen triggered by excess adipose tissue can suppress testosterone synthesis (Khodamoradi et al., 2022). In men, a body mass index (BMI) exceeding 30 was associated with a 2.4-fold higher risk of having low testosterone levels compared to men whose BMI was below 25. Certain medications can also cause testosterone deficiency; for example, opioid painkillers and glucocorticoids (steroids used to treat inflammation) can both suppress testosterone production. Men taking opioid painkillers were twice as likely to have low testosterone levels as men not taking these medications.

The indications of testosterone deficiency may differ, depending on the extent of the condition. Typical symptoms comprise lowered sexual desire, tiredness, sadness, reduced muscle bulk, and impotence (Halpern & Brannigan, 2019). Severe testosterone deficiency in men may additionally result in hot flashes, decreased body hair growth, and diminished bone density (Peterson et al., 2018). Hormone replacement therapy (HRT) is a common approach to treating testosterone deficiency. HRT is available in various forms, such as injections, patches, gels, and pellets for administration. HRT can aid in alleviating symptoms like lowered sexual desire and tiredness, and it can also promote muscle bulk and bone strength. Despite its benefits, HRT is not entirely risk-free and may raise the chances of developing blood clots, stroke, and prostate cancer. Apart from HRT, making lifestyle modifications can also enhance testosterone levels. Weight loss can aid in lowering estrogen levels and boosting testosterone levels, for instance. Engaging in physical exercise, particularly weightlifting, can also elevate testosterone levels (Lunenfeld et al., 2021). Resistance training was associated with increased testosterone levels in both young and older men.

Conclusion

To summarize, testosterone deficiency can substantially impact mens health, and it may stem from several factors, such as aging, obesity, and specific medications. Indications of testosterone deficiency may encompass lowered sexual desire, tiredness, and diminished muscle bulk. Generally, the treatment for testosterone deficiency involves hormone replacement therapy, but making lifestyle adjustments such as shedding excess weight and engaging in physical activity can also enhance testosterone levels. Men experiencing indications of testosterone deficiency should consult their healthcare provider to identify the most suitable treatment option based on their specific requirements.

References

Bhasin, S., & Ozimek, N. (2021). Optimizing diagnostic accuracy and treatment decisions in men with testosterone deficiency. Endocrine Practice, 27(12), 1252-1259. Web.

Erenpreiss, J., Fodina, V., Pozarska, R., Zubkova, K., Dudorova, A., & Pozarskis, A. (2020). Prevalence of testosterone deficiency among aging men with and without morbidities. The Aging Male, 23(5), 901-905. Web.

Halpern, J. A., & Brannigan, R. E. (2019). Testosterone deficiency. Jama, 322(11), 1116-1116. Web.

Khodamoradi, K., Khosravizadeh, Z., Seetharam, D., Mallepalli, S., Farber, N., & Arora, H. (2022). The role of leptin and low testosterone in obesity. International journal of impotence research, 1-10. Web.

Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Corona, G., Arver, S., Kalinchenko, S.,& & Morgentaler, A. (2021). Recommendations on the diagnosis, treatment, and monitoring of testosterone deficiency in men. The Aging Male, 24(1), 119-138. Web.

Peterson, M. D., Belakovskiy, A., McGrath, R., & Yarrow, J. F. (2018). Testosterone deficiency, weakness, and multimorbidity in men. Scientific reports, 8(1), 5897. Web.

The organization witnessed several other competing needs that impacted and made tackling the primary care strain stressor difficult. The competing issues included poor risk assessment procedures and inadequate health promotion. Screening techniques and tolerance for risk evaluations are frequently employed in prevention and healthcare promotion activities to determine the success of the programs. In addition, they select and determine the health condition of individuals. The function these instruments play in the formation of efficacy, as well as the consequences that these instruments have, are unknown (Kilbourne et al., 2018). Screening procedures and health risk evaluation procedures have an impact because they represent medical hazards and personal medical conditions. Furthermore, they identify at-risk patients and suggest behavioral changes that these persons should adopt in order to enhance their wellness.

Unexpected risks hindered corporate initiatives substantially at the firm since it needed time to identify, evaluate, and establish operational strategies to detect, respond on, and track them. Delays occurred when threat assessment efforts took longer than intended, putting other tasks on the development timeline on the back burner. Patients deserve to recognize how much the medical facility is working to reduce any possible hazards and that the management has a proper plan. Individuals can be empowered to embrace better behaviors and minimize their chance of illness and impairment via medical promotion and health management initiatives (Shahid et al., 2019). They can decrease health inequities, enhance the quality of living, and increase the accessibility of medical and associated activities at the societal level. Lack of proper health promotion denied patients the chance to receive helpful information to help prevent acute symptomatic illnesses.

A critical element of healthcare is guaranteeing that patients leave a medical interaction pleased and meeting their expectations. Healthcare personnel may improve patient engagement by concentrating on treatment excellence and safety as elements of the healthcare system, as well as employing patient-centered nursing methods to increase patient happiness and access to treatment. State and local governments and their employees, facing higher out-of-pocket expenditures and premiums, continue to be concerned about increasing healthcare spending (Kilbourne et al., 2018). At the medical institution where I worked, there was a policy to lower healthcare expenditure. The policy influenced the primary care strain issue in the organization, thereby increasing the effects of the stressor.

Professionals in the medical industry must understand ethical challenges, make sound judgments, and implement actions depending on their beliefs while adhering to the rules that guide them. The policy of reducing healthcare spending was beneficial to the management and patients. Minimizing medical spending allowed the organizations leaders to save money that would be used in emergencies such as the outbreak of COVID-19 (Adams et al., 2019). However, the policy faced numerous challenges, particularly in promoting ethics in the institution. Due to lowering healthcare spending, there was a need to reduce the nursing workforce to meet the organizations expenditure. More remarkable patient fatality, additional nursing staff, quitting their jobs early, and reduced patient services as the institution was already overburdened with patients and lacked the resources to attend to them are ethical challenges the policy brings.

Humans live in an era where past technologies have achieved their pinnacle, and technological advances are poised to significantly influence modern lives. Software and hardware fundamentals are shifting in todays digital ecosystem. I would advise the organization to adopt a new approach to utilizing innovative health technologies. The institutions healthcare officials and professionals must strengthen their relationships with pharmaceutical producers and software program creation firms. This policy will encourage accuracy, thus solving the ethical issue of negligence. For example, some nurses misdiagnosed an illness, which resulted in the death of a patient. They may share knowledge and create various economic strategies and simulations to help new technologies be adopted more quickly in healthcare. Implementing this practice will solve the competing issue of poor risk assessment procedures, thus benefiting the organization in proper planning.

References

Adams, A., Hollingsworth, A., & Osman, A. (2019). The implementation of a cultural change toolkit to reduce nursing burnout and mitigate nurse turnover in the emergency department.Journal of Emergency Nursing, 45(4), 452-456. Web.

Kilbourne, A. M., Beck, K., Spaeth-Rublee, B., Ramanuj, P., OBrien, R. W., Tomoyasu, N., & Pincus, H. A. (2018). Measuring and improving the quality of mental health care: A global perspective.Official Journal of the World Psychiatry Association, 17(1), 30-38. Web.

Shahid, N., Rappon, T., & Berta, W. (2019). Applications of artificial neural networks in health care organizational decision-making: A scoping review.PLoS ONE, 14(2), 125-132. Web.

A patient who visited the clinic had specific concerns connected with their health state. The first patients concern was constant and growing headaches. Such a symptom can be a cause of tumor growth (Yatavelli & Bhusal, 2022). Another concern was blurred vision, probably caused by prolactinoma growth and its pressure on the optic nerve. The patient will need to go through MRI and get her endocrine system evaluation (Yatavelli & Bhusal, 2022). The woman also informed us about amenorrhea which may cause missed periods and ovulation failure. This concern is an urgent sign of Prolactinoma and must be treated with oral contraceptives (Yatavelli & Bhusal, 2022). Another concern stated by the patient is the loss of libido. It threatens infertility in the future due to the release of an impaired egg (Yatavelli & Bhusal, 2022). This symptom causes painful intercourse, which the woman notified.

A high level of prolactin is typical for Prolactinoma, so amenorrhea is not the only reason for dryness in the vagina. The patient is not pregnant currently but complains about active galactorrhea. Most probably, prolactin secrets and cause this symptom, stimulating milk production. The womans appearance shows that she also suffers from acne, which, as she stated, is untypically excessive. This concern must be caused by amenorrhea because the patient suffers acute symptoms connected with sex hormones. Eventually, osteoporosis is observed, as the woman notified us about a finger phalanx fracture from a minor injury. Bones density decreases as Prolactinoma progresses, and prolactins negative impact on bones rises (Yatavelli & Bhusal, 2022). The patients concerns were also connected with such symptoms as depression, fatigue, and anxiety. Prolactinoma co-secrets growth hormone, so this emotional state is common (Yatavelli & Bhusal, 2022). As a result, it is necessary to provide further physical examination and document progressing changes connected with the mentioned concerns and new ones.

References

Yatavelli, R.K.R. & Bhusal, K. (2022). Prolactinoma. National Library of Medicine. Web.

Nutrition is essential to human life because it provides resources and supports respiratory, cognitive, cardiovascular, motor, and other functions. Nutrition can positively and negatively affect health, so approaches to nutritional counseling and diet formulation have now been developed (FAO, 2022). In addition, ways to process foods and make them safer have been identified. This paper examines some aspects of nutrition that can directly affect health.

The GALIDRAA Approach to Counseling

The GALIDRAA approach is a particular way of interpersonal communication to organize nutrition. It is based on listening, defining, and discussing nutritional characteristics, allowing a specific culture to emerge. The approach is used as a counseling tool by which staff gathers information and then refers to health care organizations. They expand the idea of how therapeutic support for individuals with digestive problems should be conducted. Cunningham et al. (2019) points out that behavioral transformation is an essential outcome. The authors suggest being more responsible in implementing the GALIDRAA approach.

GALIDRAA consists of eight components: greet, ask, listen, identify, discuss, recommend, agree, and appoint. Each is a small step toward changing behavioral patterns and following healthier eating practices. Its use is more difficult for the lower and middle classes, but the effectiveness is almost uniform (Cunningham et al., 2019). It should be noted that the approach should be implemented as part of clinical programs for treatment and prevention. Its use significantly improves the condition of individuals exposed to unhealthy eating habits.

Food Processing Methods

There are simple and complex food processing methods, which have different effects on their condition. Table 1 shows the standard complex and simple processing methods used.

Table 1. Standard complex and simple processing methods

In general, food processing technologies focus on four primary areas. Now scientists concentrate on preservation, preventing spoilage and foodborne illnesses (Knorr and Watzke, 2019). In times of famine, pasteurization and the ability to preserve meals for long periods saved many lives. In addition, canning made trade possible and expanded the influence of the various producers of dried and preserved foods. Processing methods improved palatability through biological and chemical techniques: pesticide treatments, herbicides, and multiple operations to enhance seed germination (Amit et al., 2017). Improved growth and development conditions lengthen the shelf life of the finished product and, consequently, increase transportability (Knorr and Watzke, 2019). The focus of food processing is now shifted to completely removing harmful elements (such as polyunsaturated fatty acids or palm oil), which significantly improve the taste of the food. It becomes healthier and more satiating than the same meals but contains potentially harmful substances. The new food processing methods are shown in Table 1.

Table 2. New food processing technologies

Consequently, a variety of processing methods aim to improve the quality of food by removing harmful or potentially harmful elements from the product or its surface.

Food Adulteration

The method of food adulteration is a way of lowering the quality of a product by removing practical elements or adding harmful impurities. Usually, impurities are the elements of adulteration that significantly affect the products quality, appearance, taste, and shape. Although they are perceived as unnecessary and even harmful ingredients in the food, they allow it to retain its appearance and texture for a long time. In this case, the product does not meet standards because it loses its original qualities. One example of adulteration is the addition of meat meals to canned foods to lengthen shelf life and increase the final weight.

The Risk Factors for Non-Communicable Diseases

Non-communicable diseases (NCDs) are not transmitted from person to person. They have a long duration and are usually slow in progression. The four main types of NCDs are cardiovascular disease (such as heart attack and stroke), cancer, chronic respiratory disease (such as chronic obstructive pulmonary disease and asthma), and diabetes (Peters et al., 2019). These diseases develop gradually but have broadly the same background.

Many non-communicable diseases share common risk factors to which all population segments are vulnerable. These include excess body weight, smoking, blood sugar, and cholesterol levels. In addition, high blood pressure and psychoactive substance use are frequent predictors of the development of non-infectious chronic diseases. These dangerous behaviors lead to four metabolic/physiological changes that increase the risk of NCDs, such as high blood pressure, overweight/obesity, hyperglycemia, and hyperlipidemia.

Current research indicates that diet is one of the most critical factors leading to disease development or progression. It has been noted that diets for children that meet not only average caloric intake but contain foods without elevated levels of chemicals keep them from becoming diabetic (Budreviciute et al., 2020). Consequently, attention must be paid to nutrition because it helps to regulate the communication between all organs and systems of the body.

Neurological Disorders and MNT (Medical Nutrition Therapy)

The relationship between nutrition and other systems can be seen in the development of neurological disorders. They are diseases of the central and peripheral nervous system expressed by specific symptoms. These usually include headaches, behavioral and cognitive changes, and sleep and memory problems. They are very dangerous because they can cause irreparable damage to the nervous system, which makes it challenging for a person to recover. Their development is closely related to the function of the nervous system. It has been proved that the levels of produced digestive enzymes directly depend on the activity of the nerve centers and vice versa (Burgos et al., 2018). The food consumed irritates the walls of the stomach and intestines, sending signals to the brain. The brain perceives and processes it; a disturbance can occur when harmful or wrong signals are found.

Clinical nutrition or medical nutrition therapy (MNT) provides adequate nutrition to the person that targets critical elements of digestive-related health. It is a therapeutic approach to reducing the symptoms of specific conditions and preventing further health complications by following an individualized diet and nutrition plan (Burgos et al., 2018). MNT usually requires a consultation with a nutritionist, who uses clinical tests to determine the condition (such as the number of vitamins or blood sugar). Following the recommendations makes it possible to achieve better nutrition and, consequently, to influence the bodys condition.

The Stages of Food Safety

Food safety is ensured by measures designed to make meals as safe as possible for consumption. The strategies and actions should cover all stages of the food supply chain. They include environmental conditions, agricultural production, processing, marketing, and preparation of foods for consumption (FAO, 2022). The steps are essentially the same for the mass consumer and each individual. They consist of evaluation, purification, separation, cooking, and freezing to keep products safe for consumption.

The evaluation phase is necessary to determine the products condition and includes an inspection of the exterior and interior filling. Evaluation is needed to determine the products visual quality and pre-screen potentially tainted products within. The cleaning phase involves removing contaminants from food of any nature. Various machines are used for this purpose, which remove non-food particles (e.g., sifting grains or removing leaves from fruits) and cleans the surface of products (rinsing, parasite treatment). The separation stage is necessary to sift out precisely identified non-food products. It allows the distribution of products by size, caliber, and grade (FAO, 2022). Cooking helps to make many products (vegetable, fruits, meat) ready to eat (boiling, frying, stewing, steaming) and keep them that way for some time. The harmful components that die at high temperatures are removed from the products at this stage. Freezing is necessary to preserve the foods original form and reduce the risk of contamination.

Conclusion

It has been established that nutrition does affect a persons health. For example, the GALIDRAA approach allows for a competent conceptualization of nutrition, and MNT instructs and guides the individual along this path. New food technologies are used for food processing and simple methods to avoid adulteration. Non-communicable and neuralgic diseases are closely related to nutrition, so attention to indicators such as sugar and cholesterol levels is recommended. With the help of methods to improve the safety of products, it is possible to preserve their quality and valuable properties.

Reference List

Amit, S. K. et al. (2017) A review on mechanisms and commercial aspects of food preservation and processing, Agriculture & Food Security, 6(51).

Budreviciute, A. et al. (2020) Management and prevention strategies for non-communicable diseases (NCDs) and their risk factors, Frontiers in Public Health.

Burgos, R. et al. (2018) ESPEN guideline clinical nutrition in neurology, Clinical Nutrition, 37, pp. 354-396.

Cunningham, K. et al. (2019) From didactic to personalized health and nutrition counselling: A mixed-methods review of the GALIDRAA approach in Nepal, Maternal & Child Nutrition, 15(2).

FAO. (2022) Thinking about the future of food safety  A foresight report. Food and Agriculture Organization of the United Nations: Rome.

Knorr, D. and Watzke, H. (2019) Food processing at a crossroad, Frontiers in Nutrition.

Peters, R. et al. (2019) Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction, Therapeutic Advances in Chronic Disease, 10.

Modern society is interconnected with a variety of terms and rules. People create new norms and principles regularly to improve the social environment and gain better lives conditions. These norms are crucial for common benefits and values because they ensure welfare and safety for everyone. Social and moral aspects help to build a strong and healthy society where people are motivated to respect each others comfort

Professional and familial duties usually collide, resulting in conflicts between public and private life. My cousin works as a nurse in one of the local clinics. Her responsibilities involve frequent night shifts, which create stress and bad humor. It leads to a conflict in her family because her husband feels a lack of attention and constant pressure caused by aggressive arguments between them. Provision 5 of the Code of Ethics for Nurses states that personal health and well-being should be promoted (American Nurses Association [ANA], n.d.). The nurse uses moral values determined by utilitarianism, where she focuses on the ethical choice to serve the patients for the sake of goodness and positive outcomes for people (Scarre, 2020). These values are chosen because they enhance living conditions for society and increase the number of good deeds. The social contract would say to keep the rules because everyone wants to live in order and make life comfortable (Rachels, 2019). This statement is justified because it says that inappropriate duties implementation harms other peoples lives. The best action would be to maintain professional responsibilities and find a consensus with family members to avoid further disruptions.

Conclusively, knowing when to sacrifice your interests to serve society is crucial. People must learn to establish their lives, trying not to harm their closest ones and those around them. Citizens have to learn to live together in harmony and peace. Finding this balance leads to overall satisfaction and life condition improvement. The example of the nurses situation proves that keeping social and moral norms fosters societys strong and healthy existence.

References

American Nurses Association (n.d.). View the code of ethics for nurses. Web.

Rachels, J. (2019). The elements of moral philosophy (9^th ed.). McGraw-Hill Education.

Scarre, G. (2020). Utilitarianism. Routledge. Web.