When receiving a Bachelor of Science in Nursing, a registered nurse experiences the first practical steps in their professional area. Such a worker already understands multiple concepts and can undertake responsibilities connected with patient care. A registered nurse is aware of how to conduct medical research, promote health, and ensure safety and quality to keep the healthcare system functioning and meet the standards of treatment.
The nursing course aims to ensure evidence-based practice, safety, and consistent care. Leadership skill cultivation in a fast-developing and changing environment is one of the priorities in becoming a professional registered nurse. The content and assignments meet the course objectives by providing the students with knowledge on research, finding and applying them in nursing practice. This process results in enhanced patient care, a lower rate of hospitalization, improved nurse education, prevention of chronic diseases, and increased quality of life. Through assignments, I was able to meet the courses objectives by implementing a care plan based on state and federal guidelines.
I implement the weeks course concepts during patients treatment, which helps me to link the knowledge with practical application. Clinical research is a potential concept that can help prevent a patients health stagnation. Efficient ways of health improvement are ensured by answering specific questions. This concept application investigates medicine or treatments impact on a patients health. The concept of an evidence-based plan is applied to promote the quality, cost-efficiency, and effectiveness of the caregiving process. Applying this concept involves finding relevant evidence which helps to make decisions in nursing practice. For example, during Spinal manipulation therapy (SMT), evidence supports or contradicts the effectiveness of this therapy, helping to assess the potential outcomes. Another actual application is connected with PICOT question answering and the implementation of its results into nursing practice. SMT is used to reduce pain intensity, while the PICOT application proves the effectiveness of this therapy for chronic back pain.
When taking action in treating chronic low back pain using SMT, I faced challenges in coping with this disease. It was hard to find proper treatment, experienced frustration. Also, conflicts and limitations were found in different studies, which created difficulties in SMT undertaking. The challenges were also faced regarding course content connected with home health. It required specific quality measurement, as such events as accidents with injuries increased (Ellenbecker et al., 2008). I understood that my time of care length was limited, which created additional stress.
On the contrary to challenges, I gained success due to proper steps implementation. I identified the problem, which helped me focus on the core objective from the beginning of the treatment process. Using an evidence-based plan, I was able to assess the problem thoroughly. I succeeded in the overall care-providing process because the plan was constructed correctly. Successful treatment of the patient was ensured by the helpful information derived from clinical notes that I took from doctors. Through these implementation steps, quality of care and prevention of disease progression were guaranteed.
To become a successful registered nurse, an individual has to gain experience through practicing and providing good services in healthcare. Course concepts are crucial for this kind of professional activity because they ensure positive outcomes for patients. Clinical research, evidence-based plans, and PICOT questioning help to develop nursing skills and link the knowledge gained with practical work. As a result, special courses provide registered nurses with competency crucial for patients treatment and keeping high healthcare standards.
Reference
Ellenbecker, H., Samia, L., Kushman, M.J. & Alster, K. (2008). Chapter 13: Patient safety and
Health education plays a key role in health promotion, as it provides individuals with knowledge and skills to make healthy life choices and encourages them to take responsibility for their health and well-being. The nursing process is employed to create an effective, tailored health education program (Toney-Butler, 2022).
Discussion
This process involves assessment, diagnosis, planning, implementation, and evaluation (Sharma, 2021). During the assessment phase, the nurse assesses the individuals health needs and risk factors, as well as their knowledge and attitudes towards health. During the implementation stage, health education materials are delivered to the individual or group. The evaluation phase is utilized to assess the efficacy of the health education program and make necessary changes.
A contemporary issue that a family may experience today is food insecurity. Food insecurity is a growing problem both locally and globally, and it is defined as limited access to nutritionally adequate and safe foods or uncertain availability of food due to economic constraints (Kopparapu et al., 2020). This leads to health disparities, such as increased risk of malnutrition, and can have an especially profound impact on vulnerable populations, such as children and the elderly.
As a nurse, there are several steps that can be taken to address this issue as part of a health education plan. First, the nurse should assess the familys access to food and resources. It includes looking at available resources in the community, such as food banks and other hunger relief services. The nurse should also assess the familys level of knowledge about nutrition and dietary needs, as this is important for making informed decisions about food choices. Finally, the nurse can assist the family in achieving a healthy lifestyle by providing education on food safety and nutrition including the selection of nutritious foods, proper storage techniques, safe meal preparation, and the significance of meal planning (Kopparapu et al., 2020).
Conclusion
Furthermore, the nurse should consider referring the family to other healthcare professionals and community organizations such as nutritionists, dietitians, and food pantries for further support (Kopparapu et al., 2020). Through these efforts, the nurse can ensure the family has the appropriate information and resources for making informed decisions about food and nutrition.
References
Sharma, M. (2021). Theoretical foundations of health education and health promotion (4th ed.). Jones & Bartlett Learning.
This paper outlines the aspects of appraisal of nursing evidence. The paper uses a systematic review to outline these aspects. To effectively address the systematic review, the review has been structured into introduction, objective, research criteria and evaluation, methods of data collection, and the discussion of the findings. The main aim of this systematic review is to determine whether restraints are suitable for use on aggressive patients with dementia who are admitted to nursing homes. The systematic review on dementia and the restraints to be used will be addressed in PICO format, which will assist in determining the suitability of restraints in such situations.
Introduction
PICO components are useful in almost every clinical situation. PICO makes the practices that involve evidence-based medicine more efficient. The process of evidence-based medicine together with PICO involves a simple criterion. This paper describes the main components of PICO for a possible clinical condition of dementia and the best remedy for aggressive patients with dementia.
PICO
For patients with dementia in nursing homes at increased risk for falls; will restraints decrease falls as opposed to nonrestraints?
Discussion of Systematic Review for the PICO Components
Objective
The main objective of this systematic review was to collect and evaluate the information that relates to dementia and restraints by reviewing several kinds of literature.
Criteria and Search Strategy
The materials used for the review were academic journals obtained from various libraries. Even though many journals outlined the concepts of dementia and restraints, only those that were published between 2008 and 2012 were picked for the review. The journals were taken from American databases, especially the ones that specifically deal with nursing. The databases included MEDLINE, Cochrane Library, and Pubmed. After the search, the article Placing physical restraints on older people with dementia by Yamamoto and Aso was selected and used for the review.
Data Collection and Evaluation
The data that were used for the systematic review were exclusively obtained from the journal article. The information used in this review was scrutinized by an evaluation tool called Joanna Briggs Institute Qualitative Assessment and Review Instrument to ensure that it was valid and reliable. By using the tool and prior knowledge on the topic, the information obtained, which concerned dementia and restraints, was categorized by quality and reliability. The categories were used to construct the meta-synthesis for the review.
Synthesis of the Findings
Meta-Synthesis I: Patients with Dementia in Nursing Homes
Dementia is a condition that is caused by multiple changes in brain chemistry. Some of the changes are reversible while others are permanent. The most common symptoms of dementia include: neglecting personal safety, nutrition, and hygiene; feeling confused about time and people, and sometimes becoming lost about well-known places among others. The patients suffering from dementia lose their psychological abilities at different rates, which depend on the conditions in which they live.
Yamamoto and Aso (2009) in their journal article have conducted a study on patients suffering from dementia in Norwegian Nursing Homes. The study was conducted with a 12-month follow-up to ascertain the validity and reliability of the data. The main objective of the study was to investigate the natural course of neuropsychiatric symptoms in patients with dementia.
The data in this study was collected through structured interviews, which were followed by a 12-month follow-up. The patients who participated in the interview were drawn from 26 nursing homes. The information included in the review met the following criteria: it suggested the presence of neuropsychiatric symptoms and had follow-up frequencies (Yamamoto & Aso, 2009).
The study conducted by Yamamoto and Aso (2009) was effective and the data collected was valid and reliable about the objectives of the study. Out of the 1,163 participants, more than half had dementia. The study also found out that approximately 83% of the patients with dementia had neuropsychiatric symptoms. There was a persistent use of antipsychotics, psychotropic drugs, and antidepressants among patients with dementia (Yamamoto & Aso, 2009).
Meta-Synthesis II: Restraints
Although several people oppose the use of restraints on people suffering from dementia, the benefits of using them surpass the shortcomings. However, the decision to use restraints should be made by both the medical practitioners of the nursing home and the family members of the patient. There is a well-formulated policy that guides medical practices regarding the use of restraints. Restraints, as described by Yamamoto and Aso (2009) refer to the physical materials that are used to bar patients with dementia from movements that may hurt them or people around them (p. 193).
The main objective of the study that was conducted by Yamamoto and Aso (2009) was to investigate the coping nursing strategies used in general wards and the dilemma that the nurses face in restraining patients with dementia. The restraints are recommended in cases where the patients are perceived to be combative, aggressive and in cases where they are so confused that they can cause injury to themselves or the nursing staff. The patients family members who take their patients to nursing homes where they use restraints should consider the above points.
Yamamoto and Aso (2009) collected the required data directly from nurses working in general wards. There were about 272 participants in total from the general wards, where patients with dementia were taken care of. The authors used a questionnaire comprising 16 items to measure coping strategies. Any score between 1-4 points in the questionnaire would be considered as a better coping strategy. The factors that were difficult to interpret from the questionnaire were deleted to avoid obtaining unreliable information.
The contents included in the literature review were consistent and effective as they assisted to clear out the misconceptions that people normally have regarding the use of restraints. For instance, the results showed that restraints alone cannot keep patients safe and they are the only effective way of handling aggressive patients with dementia. The results also showed that excessive restraints can cause complications such as constipation, depression, and bone loss among others.
Meta-Synthesis III: Non Restraints
The restraining devices and techniques were used to restrict and restrain patients with dementia from movements that might lead to injuries. Therefore, the devices were meant to keep the patients from accidental injuries that were mostly caused by self-harm. The devices to an extent were used to keep the nursing staff from accidents that they could experience as a result of the aggressive patients. However, current studies such as the one conducted by Yamamoto and Aso (2009) prove that the patients are exposed to more dangers than benefits when they are restrained.
Yamamoto & Aso (2009) suggest that older people who suffer from dementia are at a higher risk of being restrained as compared to their younger counterparts. The study conducted the study proves that older patients with dementia face several psychological and physical problems when put on restraints. The study suggests that older patients should be put on non-restraining devices to avoid such problems. The method used to collect data for this study was purely a qualitative one. The data in the study was collected from other literature (Yamamoto & Aso, 2009).
Meta-Synthesis IV: Prevent Falls
Old people are generally susceptible to falls, which are worsened by psychological conditions such as dementia. Medical conditions such as cardiovascular and vision impairment may also contribute to the falls. The nurses who take care of patients with dementia find it difficult to prevent the old patients from falling. The restraints are used in cases where the patients fail to recognize the environmental hazards they are exposed to or forget to use their walking frames (Yamamoto & Aso, 2009).
The study conducted by Yamamoto and Aso (2009) suggested that falls are a common occurrence in old people with dementia and are known to cause disability and discomfort not only to them but also to the nursing staff. The authors collected the data for this study from an older man who was suffering from dementia and had experienced numerous falls, which gave rise to a hip fracture.
Yamamoto and Aso (2009) explain that many cases of falls can be prevented through restraints and other techniques. The techniques that can be used to prevent falls include putting bright lights in the rooms of the patients and ensuring that there are no trip hazards in the rooms. The nurses should also ensure old patients with dementia are reminded to walk with their walking frames whenever they feel like doing so.
Applying the Results to PICO Question in Clinical Situation
The clinical situation in the case study is beyond non-restraint mechanisms. The patient is so aggressive that he causes injuries to his own body owing to his funny behavior. The use of non-restraints in the patients case is even likely to expose the nursing staff to danger and as a result, other measures should be put in place to prevent the staff from such a risk (Yamamoto & Aso, 2009).
The behaviors observed in the 65-year-old patient warrants the use of restraints. The family of the patient should allow the nurses at the nursing home to keep the patient restrained. If the patient is restrained, he will be prevented from causing more injuries to himself, the staff members, and even the family. The benefits that the nursing home and the patient are likely to enjoy when he or she is restrained are superior to the shortcomings of the strategy (Yamamoto & Aso, 2009).
Conclusion
The clinical situation was about an observation made on a 65 year who had a wheelchair. The patient was suffering from dementia, a condition that seemed to have been worsened by agitation and restlessness of the patient. Her condition is in a very serious stage and therefore, requires the use of restraints. Non-restraints, in this case, are not adequate and cannot be relied upon in handling the patient. The information regarding the patients with dementia and the use of restraints to assist them was extracted from literature through a systematic review.
Reference
Yamamoto, M., & Aso, Y. (2009). Placing physical restraints on older people with dementia. Nursing Ethics, 16(2), 192-202.
In spite of the fact that steroids are usually viewed by the general public negatively, the topic of their usage is rather controversial and widely discussed among athletes, fitness professionals, and medical experts from different perspectives. It is important to draw attention to the fact that steroids are associated with legitimate medical uses and can be beneficial for individuals in certain circumstances. In this proposal, it is necessary to focus on both positive and negative aspects of using steroids and discuss various advantages they offer, such as treating medical conditions, enhancing recovery and athletes performance, as well as aiding muscle growth.
It is not a popular opinion, but it is possible to recommend using steroids in treating conditions and enhancing individuals recovery, focusing on athletes traumas and other peoples conditions. Steroids can be actively used as they have anti-inflammatory properties, which can help manage inflammation caused by autoimmune diseases, such as rheumatoid arthritis and lupus. They are also effective in coping with allergies, asthma, and eczema, providing relief from symptoms and improving patients quality of life (Christiansen, 2020). One should note that these substances can reduce inflammation, swelling, and pain, allowing individuals to recover more quickly and resume their normal activities. The accelerated healing provided by steroids can be particularly beneficial for athletes, enabling them to return to their sports sooner and with less downtime. Furthermore, steroids are used in the treatment of certain cancers and to prevent organ rejection in transplant patients.
On the one hand, steroids can promote the growth of new blood vessels, which is crucial in the healing of wounds and injuries. This increased blood flow can deliver more oxygen and nutrients to damaged tissues, further aiding the recovery process. On the other hand, the long-term use of steroids may lead to serious illnesses, such as heart failure, myocardial infarction, deterioration of liver function, as well as hormonal imbalances (Christiansen, 2020). These negative effects should also be taken into account by medical experts and consumers of steroids.
The use of anabolic steroids, which are known for their ability to promote muscle growth, is one of the most controversial topics in this area. These steroids can be used to increase protein synthesis and nitrogen retention, which results in a higher rate of muscle development. This effect can be advantageous for individuals with muscle-wasting conditions or those recovering from significant muscle loss due to illness or injury. When used under medical supervision, anabolic steroids can provide a means for people to regain their muscle mass and enjoy an improved quality of life. Furthermore, while the use of anabolic steroids for performance enhancement in competitive sports is banned, it is essential to recognize that these substances can improve an individuals athletic performance when used responsibly and under medical supervision (Christiansen, 2020). Steroids are unique substances that can increase individuals strength, power, and endurance, enabling athletes to train harder and recover faster.
While it is essential to acknowledge the potential risks and side effects associated with steroid use, it is also equally important to focus on the specific benefits they offer. One should note that steroids can be invaluable in treating various medical conditions, promoting individuals recovery, and improving athletes performance. When used responsibly and under medical supervision, steroids can be beneficial for the public, but it is crucial to foster a more informed understanding of steroids, their uses, side effects, disadvantages, and benefits to ensure that they can continue to be used for legitimate purposes and to help those who need them most.
Reference
Christiansen, A. V. (2020). Gym culture, identity and performance-enhancing drugs: Tracing a typology of steroid use. Taylor & Francis.
Domestic violence is a purposeful, emotional, or forceful coercion/action of one person over another person, carried out for a specific purpose, contrary to the victims consent, will, and interests. The main difference between domestic violence and other types of violence is between people in close or related relationships. The case study describes a situation where Jill, a young woman, is exposed to violence from her partner Austin. Upon having abdominal pain, Jill resorted to the hospital without telling the nurse she was punched by her boyfriend. This paper aims to analyze what tools a nurse could use to assess the patient and how Jills safety can be promoted.
Jill resorted to the hospital due to unbearable abdominal pain caused by Austins punch. Moreover, she did not tell her partner about her pregnancy, meaning he could damage the embryo. Nonetheless, Jill preferred to keep silent about domestic violence when speaking to a nurse. Therefore, a nurse should take action to identify the signs of interpersonal violence since these specialists are endowed with the role of a mandated reporter. When assessing the patient, a nurse must primarily conduct a body check because the victims tend to have scars and bruises. Upon identifying such signs, she could politely ask Jill to report the abuse, ensuring safety and confidentiality. It is also necessary to pay attention to the mental condition of a patient. The victims are regularly avoidant, stressed, and nervous, or they constantly hurry or look around to avoid being caught on something.
The other tool a nurse should implement is the indicator of violent behavior. It is also an assessment of verbal and nonverbal elements aimed at identifying five key STAMP components: staring and eye contact, tone and volume of voice, anxiety, mumbling, and pacing ( Violence risk assessment tools, 2020). If the number of these cues increases each time a patient sees a nurse, reporting it as soon as possible is indispensable.
Triage is another effective instrument directed at the identification of domestic violence. It incorporates five questions concerning the history of ones experience of abuse and allows one to establish the significant criteria for the presence of violence is avoidance in answers ( Violence risk assessment tools, 2020). The fact that Jill is pregnant only boosts the assessing activities because saving a life of a child is crucial as well. As a result, a nurse plays an essential role in the identification of interpersonal violence and may easily report it to avoid any harmful events.
In summary, abuse victims typically hide their partners wrongdoing so as not to get more harm from them. Otherwise, the offender apologizes, explains the reason for the cruelty, shifts the blame to the victim, sometimes denies what happened, or convinces the victim of exaggerating events. However, the situation does not alter, meaning that the abused need protection. In order to promote Jills health, it is pivotal to report the case. It will help to trace the family dynamics and identify further measures. Moreover, Jill needs to express her thoughts and feeling via I-message to her partner. In addition, seeking protection from local communities may benefit her in terms of ma maintaining her safety and isolating her from the wrongdoer. In general, Jill is recommended to take care of herself and a future child in a safe place to ensure total protection.
It is important to note that there is a complex and multifaceted relationship between premature birth and bioethics. The former is a significant ethical as well as medical challenge, which can be categorized into four key bioethical perspectives. Firstly, premature birth poses an ethical problem with respect to life-sustaining treatment and its continuation. Secondly, the issue concerns neonatal research and ethical limits known by the involved parties. Thirdly, informed consent is critical since all stakeholders need to be aware of both the costs and consequences of caring for a prematurely born patient. Fourthly, premature birth is an ethical dilemma because it can be resource intensive, which is why the decision-making needs to account for it.
The first aspect of ethics and premature birth is life-sustaining treatment since it is a complex issue, especially in neonatal intensive care settings. One of the most critical bioethical perspectives related to this issue concerns the decision-making process regarding the withholding or withdrawal of life-sustaining treatment. The research revealed that doctors who placed a greater emphasis on the importance of the quality of human life were more likely to choose to withhold or withdraw neonatal intensive care (Dagla et al., 2020). In other words, the decision to withhold or withdraw life-sustaining treatment is a critical ethical consideration. Thus, physicians must balance the value of quality of life against the potential harm of medical intervention. The ethical principle of beneficence requires that doctors act in the best interest of their patients, which is why this can be complicated by competing ethical principles, such as autonomy and justice. As a result, ethical awareness, as well as sensitivity, are crucial in navigating the continuation of the treatment.
The second aspect of the subject is the ethics of neonatal research. Evidence suggests that physicians with a high attitude score (indicative of value of quality-of-life) were more likely to limit, while those with a low score (indicative of value of sanctity-of-life) were more likely for continuation of intensive care (Chatziioannidis et al., 2020, p. 1). In other words, those who value the sanctity of life are more likely to continue intensive care. In addition, the level of education of physicians, their participation in research, religious beliefs, and their stance on the current legal framework were all factors that had an impact on their attitude score (Chatziioannidis et al., 2020, p. 1). Thus, physicians with a greater familiarity with the potential consequences of continued treatment are aware of the chances and the quality of life implications of their efforts. In other words, their expertise and leaning towards valuing quality-of-life is determined by their knowledge of data and evidence rather than religious convictions.
The third critical aspect of bioethics and premature birth involves informed consent. It is stated that nurturing a collective consciousness via dialogics and pragmatism is congenial to integrating objective evidence review and subjective moral-cultural sentiments, and is that rarest of ethical constructs, a means and an end (Kaempf & Moore, 2023, p. 1). Therefore, it is necessary to make judgments about the situation and decisions on how to proceed by being fully informed on what will be the future ramifications. Some late premature births might have no reduction in quality of life, but early ones can be detrimental, which is why a clear understanding is needed by all involved parties. All sides require pragmatism alongside dialogue to reach a mutual understanding, which means the sentiments, emotions, and feelings should not be completely dismissed as irrelevant. The most ethical method would be achieving a collective consciousness and awareness about the situation.
The fourth and final important aspect of the issue is about costs and the ethics of resource allocation. In accordance with the Shared Decision Making framework, if these empowered parents demand endless treatment that is considered futile by healthcare providers, the psychological costs to healthcare providers and the economic costs of treatment will be enormous (Akabayashi et al., 2022, p. 496). This can be categorized as the most ethically sound way to address such a sensitive dilemma. It not only promotes communication and informed consent but enables a greater degree of openness about the costs compared to outcomes. In other words, parents should not be put on a pedestal of decision-making because continued care affects the providers of care as well. They need to voice their concerns as loudly as the parents in order to ensure that a compromise is reached. Trying to be silent on matters of cost only creates a sense of distrust and false hope.
In conclusion, premature birth is a complex issue that poses significant bioethical challenges in terms of life-sustaining treatment, neonatal research, informed consent, and resource allocation. The decision to withhold or withdraw life-sustaining treatment is a critical ethical consideration, and physicians must balance the value of quality of life against the sanctity of life. In the case of the ethics of neonatal research, physicians need to have a greater familiarity with the potential consequences of continued treatment to be aware of the chances and quality of life implications of their efforts. When trying to achieve informed consent, a collective consciousness via dialogics and pragmatism is necessary to make judgments about the situation and decisions on how to proceed. The ethics of resource allocation is important as well, and the Shared Decision Making framework promotes communication and informed consent among all stakeholders.
Acne vulgaris is a skin disorder that is caused by the blockage or inflammation of hair follicles. The availability of sebum, dead skin cells, and bacteria block hair follicles, causing the skin to blemish and show different signs, including blackheads, pimples, cysts, and whiteheads. Acne vulgaris is also called common acne and occurs mainly during puberty because that is the period when hormones are highly released. In this case, the most affected people are teenagers around puberty. The condition primarily affects skin areas with more or populated sebaceous follicles and includes a persons back, face, and the upper part of the chest. Acne vulgaris is one of the significant common skin conditions in the US, and those with severe acne can experience permanent physical and mental mutilating.
Main body
The disordered physiological processes associated with acne vulgaris result from the inflammatory mediators released into the skin. Other factors include high production of sebum, follicular hyperkeratinization with follicle complexations, and cutibacterium acne. Sebum is an oil secreted by sebaceous glands to keep the skin moist, and when glands clog, they block follicle hair leading to pimples and cysts on the skin (Venes, 2017).
Follicular hyperkeratinization is when skin cells shade near the pores or the uppermost part of the hair follicle. Inflammatory responses are experienced before hyperkeratinization, and it happens when cytokines activate endothelial cells for regulation purposes. The increase in keratinocyte profanation and reduced desquamation leads to high sebum and keratin production. Mediators and receptors, including insulin-like growth factors and peroxisome, are involved in regulating sebaceous glans, which contribute to acne vulgaris.
A combination of different components, including hormones, bacteria, and oil, causes acne vulgaris. Sebum is highly produced by sebaceous glands, which combine with dead skin cells on the hair follicles, blocking sebums release from the pores and causing acne. The condition is experienced mostly during puberty, but as a person enters adulthood, acne vulgaris begins to disappear because the production of sebum has been reduced. The condition can prolong in women up to their 40s because of varying hormones during pregnancy or the menstrual cycle. Certain types of medications and cosmetics, including lotions, can affect the occurrence of acne vulgaris (Habeshian & Cohen, 2020).
Additionally, high humidity, sweating, and polycystic ovary syndrome affect the occurrence of the condition. Some of the medications that can facilitate the development of acne vulgaris include lithium, steroids, and iodides. Backpacks, shoulder pads, and under-wire bras can foster the disorder. Therefore, the degree of using these components affects the development of acne vulgaris, and minimizing their usage and exposure to sunlight can reduce the occurrence of the disorder in a person.
In the United States, acne vulgaris is the most common skin disorder that affects many people yearly.
Twenty percent of the affected people experience severe acne vulgaris, which has a permanent physical and mental impact on an individual. Different people experience different degrees of acne vulgaris, and persons of some races are impacted more than others. In the Mediterranean region, cystic acne is the most prevailing condition affecting Spain to Iran. In the United States, people of North America experience acne, and African Americans experience pomade acne, which is a type of acne vulgaris mainly affecting the forehead, and caused by hair styling products (Habeshian & Cohen, 2020). Males experience the condition more likely than females during adolescence, but women experience acne vulgaris more than men during adulthood. Additionally, the condition can be seen in newborns due to the influence of maternal hormones and the large production of adrenal glands.
Acne vulgaris can be treated in different ways, including topical agents, systematic antibiotics, hormonal agents, and isotretinoin. Topical agents are used according to the patients age, patient preference, condition severity, and affected parts. Combining different medications can help improve the patients condition. For instance, clindamycin and erythromycin can be combined with benzoyl peroxide to avoid patient bacterial resistance development (Cong et al., 2019). If tropical agents do not work effectively, moderate to severe acne can be treated using systematic antibiotics, including Minocin and Doxycycline. Time should be considered when prescribing these antibiotics. In females, combining hormonal agents with contraceptives can be used to treat inflammatory acne. For persons with severe acne vulgaris, oral isotretinoin, usually taken with meals, effectively treats severe acne, whereas other methods have shown no response.
Conclusion
In conclusion, acne vulgaris is a skin disorder that affects most Americans, and during adolescence, males experience it more than females. In women, the condition can be experienced up to the age of 40s. Acne vulgaris varies with place, sex, and age, with the North Americans experiencing it more than other regions in the US. Some components facilitating acne vulgaris include particular medication and cosmetics, high humidity, polycystic ovary syndrome, and sweating. Different medicines can be applied depending on the conditions severity, and oral isotretinoin is the most appropriate method of treatment where the drug is taken with meals. Therefore, minimizing the usage of the mentioned products can help reduce acne vulgaris.
References
Cong, T. X., Hao, D., Wen, X., Li, X. H., He, G., & Jiang, X. (2019). From pathogenesis of acne vulgaris to anti-acne agents. Archives of dermatological research, 311(5), 337349. Web.
Habeshian, K. A., & Cohen, B. A. (2020). Current issues in the treatment of acne vulgaris. Pediatrics, 145, 225230. Web.
Venes, D. (2017). Tabers cyclopedic medical dictionary. FA Davis.
Using the introduction of the term tracheostomy that will be the key term applied throughout the current paper, it is necessary to state that tracheostomy is defined as the insertion of a tube through the neck tissues, into the trachea, leaving the whole of the larynx intact (Feber, 2006, p. 186). There can be emergencies which demand tracheostomy or this can be an elective procedure as well under the circumstances demanding the anastomosis of the trachea. However, whether a tracheostomy is an emergency measure or a carefully prepared one, whether it will be permanent or temporary therapy, the ultimate goal of tracheostomy care remains the same: to ensure airway patency by keeping the tube free from mucus buildup (Lippincott Williams & Wilkins, 2007, p. 359). Besides, Frace (2010) mentions that the care of the patients with tracheostomies belongs to the most challenging and stressful nursing care situations (p. 58). Tracheostomy care training will enable the students to show less stress while providing care for patients with tracheostomy and it will reduce the risks connected with the procedure.
Aim of Teaching Tracheostomy Care
The main aims of teaching tracheostomy are the basic principles, characteristics, and stages of care of a patient with tracheostomy. Melat Ziegler (2005) mentions refusal to perform tracheostomy care related to dysfunctional anxiety (p. 33), and the teaching session aims to eliminate such possibility among the students. The process of tracheostomy care instruction demands the development of the skill of critical thinking as the students should be able to make rational and responsible decisions (Bradshaw & Lowenstein, 2007, p. 57). The process of tracheostomy care should be focused on the caregiver, as well as, on the treatment.
Teachers Objective
It is possible to define the main objectives an instructor should set during the teaching session on tracheostomy care. They can be briefly summarized as follows: to acquaint the students with two main techniques that are used to perform a tracheostomy: a surgical tracheostomy and a percutaneous dictational tracheostomy or PRT (Russel, 2005, p. 429). The students should get basic knowledge of the types of tubes for tracheostomy, the benefits of tracheostomy, and the processes of suctioning, cleaning of the inner tube, and the equipment required for and the procedure of changing a tube (Feber, 2006).
Teaching Strategies
Since nursing is the profession that deals with human life and its hazards directly, and tracheostomy care also has its specificity that has been described in the above sections, it is necessary to provide solid theoretical background for the process of planning tracheostomy care training. Nursing demands moving from cognitivism to constructivism that is more learner-focused (Bosher & Pharris, 2008, p. 186). Adherence to constructivism as the theory in the basis of training will provide students with the environment that will enable them to think critically, practice reflectively, cooperate in the groups of fellow students and get at and effectively use the information they are provided with to support their practical tasks (Young and Paterson, 2007, p. 6).
Kolbs model of experiential learning corresponds to a constructive theoretical base. As for the instrument used to measure the learning styles of nursing students, it will be the Kolb Learning Style Inventory that is reported to be the most commonly used one with nursing students (McGovern Billings & Halstead, 2005, p. 29). On defining the ratio of learning styles in the group of students, it is necessary to direct the instruction towards prevalent learning styles though those that constitute the minority should not be omitted. Thus, the types of activities during tracheostomy care instruction suitable for accommodators will be group work, discussion, open-ended problems, simulations, etc. (Nilson, 2010, p. 231). Divergers will benefit from discussion, interactive lectures, simulations, while convergence is successful when demonstrations, case studies, and simulations are used (Nilson, 2010, p. 232). Thus, the use of Kolbs learning styles accounts for the choice of the teaching techniques mentioned below because tracheostomy care instruction should be treated as a multidimensional teaching process and this fact accounts for the necessity of the application of several teaching techniques in complex or in natural succession as established by the instructor.
First of all, it is necessary to form a theoretical basis for the students. This can be best achieved with the help of the application of a traditional teaching method, a lecture. The main peculiarities of the lecture about tracheostomy and tracheostomy care should be a clear and logical plan, the support of the lecture with schemes and other kinds of visual aids, the best choice will be to provide the students with concise notes about the flow of the lecture (Carpen, 2005, p. 4). The flow of the lecture should be logical, with a smooth but clear transition to the succeeding items. The manner of the presentation should be accessible; it is not necessary and even not desirable to overload the lecture with terminology, though the introduction of the necessary terminology is essential. Though the students perform a passive role during a lecture, the lecture can be modified so that a student could become an active participant in the instructional process during a lecture. An instructor should encourage students feedback, students should ask questions in the course of the lecture.
Besides a lecture, it is advisable to use the teaching strategies that would focus on active learning and critical thinking of the students. It can be the discussion of the material that has been delivered in the lecture. In the case of tracheostomy care, the discussion can be built around the benefits of tracheostomy or patient assessment.
The analysis of a case study can be a perfect strategy to use during the instruction of students on tracheostomy care as it can be valuable for applying concepts from lecture to clinical practice (Young & Paterson, 2007, p. 288). British Journal of Nursing (1999) offers a perfect case study involving a nurse who did not follow init guidelines concerning tracheostomy care. Also, it is possible to build the discussion based on one-minute web-based videos that reinforce the management of the tracheostomy emergencies (Tanner, 2006, p. 483).
Moving from the most passive to the active teaching and learning strategies, it is necessary to mention the use of a simulation lab that provides an opportunity to practice the management of spontaneous decannulation, and to demonstrate skills in cannulation (Tanner, 2006, p. 483).
Learning Outcomes
Learning outcomes should demonstrate a sufficient theoretical basis of the students knowledge and their acquisition of practical skills necessary for adequate provision of tracheostomy care. They should demonstrate that skills connected with the processes of suctioning, cleaning of the inner tube, and changing of the tube.
Evaluation Strategies
Since the tracheostomy care instruction is directed in two basic ways: theoretical one and practical one, it is necessary to evaluate the students knowledge in both spheres. The assessment of theoretical competence can be performed based on oral or written examination according to the choice of the examiner. It is possible to check theoretical knowledge with the help of the analysis of the case studies as it has been done during the process of instruction.
However, there is the necessity of the assessment of the development of practical skills of tracheostomy care. Students can be assessed in the simulation lab where they received the instruction and practical training. They should demonstrate their skills of suctioning, cleaning the inner tube, and changing the tube.
Conclusion
In conclusion, special attention of an instructor teaching a tracheostomy care course is caused by significant risk factors associated with caring for a patient that has been given or should be given a tracheostomy (tube obstruction, misplacement), as their possible consequences may result in respiratory and cardiac arrest threatening the patients health (Russel, 2005). It is necessary to provide the students with an adequate understanding of the basic principles, characteristics, and stages of care of a patient with tracheostomy. Since a solid theoretical ground is needed for the planning of tracheostomy care instruction, constructivism has been chosen as a suitable educational theory and the choice of the teaching techniques is made based on Kolbs learning styles. By the end of the tracheostomy care course, students should be able to demonstrate sufficient theoretical knowledge and adequate practical skills of care of a patient with a tracheostomy.
Reference List
Arorra, A., Hettige, R., Ifeacho, S., & Narula, A. (2008). Driving standards in tracheostomy care: a preliminary communication of the St Marys ENT-led multi disciplinary team approach. Clin. Otolaryngology, 33, 596-599.
Bradshaw, M.J., & Lowenstein A.J. (2007). Innovative Teaching Strategies in Nursing and Related Health Professions. London: Jones & Bartlett Publishers.
Carpen, H. (2005). Tracheostomy Care Guidelines. ICU Liason CNC.
Feber, T. (2006). Traheostomy care for community nurses: basic principles. Journal of Community Nursing, 11(5), 186-193.
Frace, M.A. (2010). Tracheostomy care on the medical-surgical unit. MEDSURGING Nursing, 19(1), 58-61.
Intensive care sister who did not follow unit guidelines. (1999). British Journal of Nursing, unpaged.
Lewis, T., & Oliver G. (2005). Improving tracheostomy care for ward patients. Nursing Standard, 19(19), 33-27.
Lippincott Williams & Wilkins. (2007). Best Practices: Evidence-based Nursing Procedures. Ambler, PA: Lippincott Williams & Wilkins.
McGovern Billings, D., and Halstead J.A. (2005). Teaching in Nursing: A Guide for Faculty. St. Louise, MO: Elsevier Health Sciences.
Healthcare is continuously changing at a fast and growing pace. Healthcare leaders and managers are trying to keep up as they sharpen their leadership competencies to remain effective in their organizations. The knowledge and skills health care leaders are required to have to meet their day-to-day responsibilities are very high. Leaders that are strong and efficient possess certain characteristics that are extremely important in the workplace to achieve their goals, as well as meet political, social, and environmental goals.
UnitedHealthcare is an organization in the healthcare industry that has leaders who are navigating the constant political, social, and environmental changes within their organization.
To understand how UnitedHealthcare (UHC) responds to change and its influence on decision-making, an interview was conducted with Dr. Srinivas Merugu, MD. Dr. Merugu is the Senior Medical Director for UnitedHealthcares Community and State Plan.
Dr. Merugu oversees the medical and clinical operations on the state level and has been with UHC for over 6-years. Dr. Merugu brings 25 years of experience in the medical field to his role at UHC. However, his passion is helping to carry out UHCs mission of helping people live healthier lives.
During the interview, Dr. Merugu was asked a series of questions that addressed a change in response to organizational, community, political, social, and global needs and how the organization monitors community wellness and anticipates community needs. The relationship between the purpose of the organization and specific drivers of change, and the effectiveness of traditional leadership models that are predominantly used throughout the organization just to highlight a few of the questions addressed. This paper will provide a synopsis and analysis of the interview while addressing how UHCs change leadership is essential to moving the organization towards positive outcomes.
Organizational Change in Response to Community, Political, Social, and Global Needs
The purpose of UHC is to help people live healthier lives and ensure that their health system works better for everyone. The organization holds a principle that individuals should access quality health services without straining financially.
Thus, by offering various insurance benefits, UHC ensures that society is in a better position than it previously was.
The organization is consequently changing to accommodate the emerging changes in the healthcare industry.
One of the major changes in the firm in 2022 is the introduction of Medicare plan advantage, which covers both parts A and B of Medicare in addition to other benefits. According to Oregon and Berson (2019), todays healthcare system is centered on investigating and meeting consumer needs. UHC also has a new prescription drug plan which, together with other benefits, offers personalized consumer experiences. According to Dr. Merugu, various changes are implemented in the company to ensure expanded access to health plans with distinguished value created in a simple and affordable design. The organization also plans to expand its Medicare consumers to reach 94% of the Medicare beneficiaries. The plan is to maintain the countrys largest Medicare advantage by targeting 3.1 million people in 276 counties accessing standard plans ( Medicare advantage, 2022). UHC will attract potential consumers with its affordable plans.
Amongst the needs driving change in UHC is the desire to be different in the healthcare industry. Dr. Merugu mentions that with tremendous changes in the industry, healthcare is becoming expensive every day. The firm is then forced to offer quality services at an affordable price while still maintaining the competitive space in the sector. High expectations from the consumers and policymakers are also driving needs in the company. Thus, UHC makes multiple changes to match these expectations to ensure operating stability. The nature of change in the organization is to qualify life events. The changes are designed to meet the emerging trends of needs to sustain human existence. The changes have global effects that alter both the enterprise and the lives of the community.
Change Leadership: Challenge the Status Quo
The challenges of the healthcare status quo are based on politics and economics. Dr. Merugu state that the healthcare status quo is made up of the increasing price of health services. The policymakers in the political areas basing their claims on striking cost of living are making it impossible for insurance companies such as UHC to offer cheaper health services. Todays healthcare status quo entails overpricing, fragmentation, and overtreatment (Vogenberg, 2019). Health services are highly-priced as low-quality unnecessary care is offered to meet the prices. The increasing cost of living and medical reforms are high contributors to this status.
UHC operates on transformative change leadership concepts and practices to cause a change in the social system and individuals. As a leading health insurance company, UHC operates around its mission to offer quality services with reduced financial hardships. The organization creates and maintains a changing environment whereby the management is always ready for positive change. Some of the concepts and practices include integrity, compassion, performance, innovations, and relationships ( Our vision for empowering health, 2022). UHC practices integrity is offering services that meet customer needs at the right prices. It also shows compassion to its consumers by offering additional benefits to standard insurance plans and other services. The organization encourages maximum performance, innovative projects, and positive relationships to meet its purpose.
UHC employs a thought leadership strategy to drive changes in the organization. According to Dr. Merugu, the firm considers itself a leader in the industry, and as innovators, they see themselves as leaders. Through the thought strategy, the healthcare company demonstrates its expertise in the insurance field. Some of the expected outcomes of this strategy include competitive advantage through product differentiation, boosted sales, higher profitability, reinforced brand, and personal satisfaction. The actual outcomes attained by the UHC are above the average levels of these factors.
How the Organization Monitors Community Wellness and Anticipates Community Needs
As an insurance company that offers Medicare and Medicaid services privately, UHC measures community wellness through various factors. Some of the factors include health disparities amongst the targeted population, the number of insured people in the community, mortality rate, trending diseases, and elderly population needs ( Health and wellness, 2022). The desired health outcomes for UHC upon cross-checking the level of wellness are an equal distribution of health services to all consumers and an increased number of insured people. Other outcomes include reduced mortality rate due to insurance coverage of trendy diseases and extended life expectancy for the elderly.
About the question of how UHC collects its data, Dr. Merugu provided that the claims are major sources of data. External sources are HEDIS and American Health Rankings, which offer countrywide surveys and reviews regarding the general healthcare industry. To determine community needs, UHC does individual surveys among their organization members to collect their opinions ( Health and wellness, 2022). The organization also analyzes the community through social determinants of health to find their needs. Partnerships with local people also help in learning more about gaps in societal health. For further means, UHC collaborates with HRSA and FQHC to determine societys needs.
Analyze the Relationship between the Purpose of the Organization and Specific Drivers of Change
The specific change drivers, such as the prescription of drugs, taxes, and outpatient services, do not reinforce the purpose of UHC. The three specific drivers lead to an increase in the cost of premiums between 2013 and 2018. According to UnitedHealth Group (2019), the medical drivers of change recorded an increase of 5.5% price between 2013 and 2018. The hike in health costs was prompted by the annual growth of outpatient services which grew by 8%, and prescription drugs by 7% (UnitedHealth Group, 2019). Increased federal and ACA health insurance tax significantly drove up the premiums costs. As provided by ACA, tax on health insurance increased by 20% from 2017 to 2018 (UnitedHealth Group, 2019. Oreg and Berson (2019) also affirm that the increased cost of living hikes taxes and the general cost of healthcare. The change in the cost of premiums, therefore, prevents UHC from its purpose of offering quality services without people straining financially.
The Effectiveness of Traditional Leadership Models within the Organization
UHC practices integrated psychological and situational or contingency leadership models to drive change. These two models are applied in the organization because they allow the leaders to be ready for emerging changes ( Our vision for empowering health, 2022). The models also allow the leaders to be thoughtful and e creative to effectively drive change. Integrated psychological models integrate thinking into the four models including trait-based, behavioral ideals, situational, and functional leadership models. Combining the different models and adding critical thinking enables the leaders to develop the best change strategy. The situational model allows leaders to deal with situations as they arise during their operations (Garfield et al., 2019). In the application of this model, leadership is not permanent but changes with incoming changes in the organization.
The traditional leadership models applied by UHC as an insurance company are appropriate. The healthcare industry is vastly changing as influenced by various factors, including evolving consumer needs, technology, the economy, and politics (Garfield et al., 2019). Practicing leadership models that allow leaders to act upon changes and think critically before implementing them is essential. The global healthcare service competition also requires an organization to have strategic models to deal with changes (Garfield et al., 2019). Furthermore, the models are effectively applied in the firm because they bring outstanding results. The application of these models could, however, be made differently by leaning more on the situational or contingency model. This model seeks to mold leaders to whom the current event needs. In handling the specific drivers of change between 2013 and 2018, the organization could act according to the situation. That way, while increasing the price of premiums, the firm should have added other expected benefits for the customers.
Conclusion
UnitedHealthcare organization has strong leadership and the ability to monitor community needs to deliver change. The firm is vigilant to the emerging changes caused by political, organizational, community, social, and global needs. The organization leaders through thought strategy act to rectify the healthcare status quo by putting quality and product differentiation before prices. Various leadership models are applied to effect the changes based on the communitys needs. UHC works closely with other healthcare service rendering and monitoring firms to improve their services and meet customer needs.
References
Garfield, Z. H., Hubbard, R. L., & Hagen, E. H. (2019). Evolutionary models of leadership. Human Nature, 30(1), 23-58. Web.
Health and wellness. (2022). UnitedHealthcare. Web.
Medicare advantage (Part C) plans. (2022). UnitedHealthcare. Web.
Nursing theories have a significant influence on nursing practice as they allow not only set the goals and extract the theoretical value but define the outcomes and retrieve practical use. Two types of theories can be identified within the framework of nursing: Grand theories and Middle Range theories. Researchers state that Grand theories are more complex used to explain the broadest issues within the discipline and are not subjected to testing and amendments (McEwen & Wills, 2014).
Meanwhile, Middle theories lie in between abstract theories and concise ones and represent more specific ideas and concepts, and can be empirically tested (Alligood, 2013). The purpose of this paper is to investigate and compare The Neuman Systems Model and Bradens Self-help theory. Neumans Grand theory represents a systemic approach towards relieving stress and the human necessity of protection. In contrast, Bradens Middle theory describes the facets that have a negative and positive effect on ones quality of life.
Background of the Theories
Betty Neuman is a pioneer in the field of nursing, specifically in the sphere of mental health investigations, since the 1960s. She created her model, which was developed over time, and published it in 1972, and since then, her model was widely used in nursing colleges not only in the United States but also across the world. The concept of her theory is aimed towards the systemic approach to stress relief and the human need for protection.
According to McEwen and Wills (2014), Neuman believed that the causes of stress could be identified and remedied through nursing interventions (p.150). She highlighted the dynamic balance that is crucial for humans and used a method of intervention as a way of prevention. Neumans model is considered perspective as it is abstract, universal, and have a wide range of appliance for any human of a different culture.
Carrie Jo Braden is a professor at the School of Nursing in Texas, famous for her publications about the five-stage Self-Help Model. This theory concerns the promotion of independent functioning, self-reliance, improvement of the psychosocial wellbeing of a patient with the help of nursing intervention (Chuang, Lin, & Gau, 2010). The method is based on the research that deals with learning how to learn to respond to chronic illness and understand the dynamics of the reaction learned. Nevertheless, there is a need to perceive the dynamics of this learned response because sometimes it depends on a personal trial. A learned response presumes a procedure of daily facing manageable adversities by retaining control over the problems. Comprehending the process of self-responding implies the introduction of nursing interventions to increase the efficacy of learning for a person with chronic illness. Therefore, enhancing self-behavior by the intrusion of disruptive forces increases the life quality.
Philosophical Underpinnings
Betty Neuman underpinned the theories and concepts derived from different disciplines to develop her approach. She preferred to extract the ideas from the theories of many other researchers. For instance, Neuman borrowed the wholeness of systems referring to Cornu and Chardin. Also, she referred to Lazarus on general systems theory, Skye on stress theory, and Bertalanfy and Lazlo on public systems theory (McEwen & Wills, 2014).
Carrie Jo Braden relied on the theories contrastive to her Self-Help Model. Her theory emerged from a couple of learned helplessness theories belonging to Seligman and Balta, Rosenbaums learned resourcefulness theory, and the method of personal disposition proposed by Miller and Magon (Chuang et al., 2010). She also applied background variables such as age, gender, ethnicity, education, and income that could influence the skill of developing self-response.
Major Assumptions, Concepts, and Relationships
Neuman followed the concepts of the metaparadigm, though managed to introduce additional concepts to her model. There are some major concepts of her theory that she presented: a human is a client/client system, as a composite of variables& physiological, psychological, sociocultural, developmental, and spiritual (Neuman & Fawcett, 2009, p. 16). Her ring structure was presented as a basic structure of protective concentric rings, for retention attainment or maintenance of system stability and integrity& (Neuman & Fawcett, 2009, p. 16).
The environment presented a structure of such rings and was divided into three parts: created, internal, and external environments that affect a humans perception of stressors. Health presupposes stability, which can be ruined by several stressors. The nursing concern is to adequately assess the environmental conditions and stressors that affect wellness instability and assist the client in maintaining optimal wellness (McEwen & Wills, 2014). Therefore, numerous concepts are comprising Neumans System Model.
Another primary concept introduced by Neuman is an open system that represents a flow of input and output that are interactional processes of organized complexity. The next idea is a basic structure that is the unique individual characteristic underlying the basic system of energy resources. Client variables that belong to the different processes and network within human nature. She also defined a flexible line of defense as A protective, accordion-like mechanism that surrounds and protects the normal line of defense from invasion by stressors (McEwen & Wills, 2014, p.151). Moreover, Neuman added healthy life of defense that is a level of health considered normal for an individual and for determining deviant wellness features. The other concept is the line of resistance, which activates when the stressors penetrate the normal line.
The five variables (sociocultural, physiologic, physiologic, spiritual, and developmental) that Neuman defined function to maintain the systems stability. The model is based on the clients reaction to stress as it maintains boundaries to protect client stability (Neuman & Fawcett, 2009). Her model described a three-step program: nursing analysis, nursing goals, and nursing outcomes. The first step is a nursing analysis that represents an adequate collecting database from the client that assists in making a diagnosis. The second step, nursing goals, concerns appropriate prevention as a strategy of intervention. Also, this step presupposes purposeful negotiation with the client. Finally, the nursing outcomes, that assume the evaluation of nursing goals and changes prescribed. The nurse tries to link variables, the client, his health, and the environment.
There is a need to mention the assumptions of Neumans System Model. The first assumption is that Each client system is unique, a composite of factors and characteristics within a given range of responses (McEwen & Wills, 2014, p.153). According to Alligood (2013), the other primary supposition concerns stressors and how they are different. Three lines work altogether to sustain the health of a client. Therefore, when a client or systems flexible line is broken, the stressors also ruin the normal line. Also, the client represents a dynamic system consisting of interdependent variables that are also interrelated with the environment.
Bradens Self-Help theory also includes some of the significant concepts belonging to the Middle Range nursing theories. Usually, such approaches consist of two or more of the specific interrelated concepts and address the phenomena describing the metaparadigm at one end and particular actions at the other. The first concept in Bradens model is disease characteristics, which is the degree of the illnesss effect on a patients behavior. The second concept is background characteristics that include gender, age, origin, and all the inducements that influenced current behavior. Monitoring is another aspect that represents the measurement of illness provided by professionals.
The severity of illness is a level of causation inflicted by the disease; dependency represents the level of reliance on other people while performing daily activities. Uncertainty is the next concept implying incapacity to identify the meaning of illness events; enabling skills is a level of self-reliance, problem-solving; self-help is defined by a degree of adult behavior. The last concept is life quality that denotes the level of satisfaction of the present situation.
The relationships in this five-stage model are represented in the following way. Stage I shows the severity of illness that is a stimulus for learning. At Stage II, uncertainty and dependency occur due to the increase of severity of illness: therefore, the levels of uncertainty and dependence also rise. Uncertainty can arise when there are symptoms not related to the disease emerge, whereas dependency appears when one perceives the severity of illness and ends up relying on others. At stage III, the concept of enabling skills appears as an agent between negative aspects and maintaining life quality. Skills enabling is usually is undermined by previous thoughts but is essential for problem-solving and learning personal strengths to sustain ones life. The last two stages include desirable life quality and preferable outputs of self-help. It denotes that one must realize what essential in life for maintaining the life level that they want.
The first assumption concerns perceiving the severity of illness, leading to uncertainty and limitations. Another primary assumption of Bradens theory supposes that adversities can be overcome by enabling skills and learned resourcefulness. These skills represent sets of behavior, affects, and cognition that interacts with the environment. Also, self-help is about maintaining relationships with friends, family, colleagues at any place that leads to satisfaction, which is a fundamental pursuit of health care.
Clinical Application
Neumans theory is widely used among nursing professionals worldwide. This model is applied to many areas of medicine, including surgery, mental health, womens health, gerontology. Many graduate students find Neuman System Model relevant to their practice. Because of its utility and popularity as a model, it has been monitored by a group called the Neuman Systems Model Trustees Group, Inc. (McEwen & Wills, 2014, p.153).
According to Chuang et al. (2010), The Braden Self-Help Model has previously been applied to patients with rheumatoid arthritis, chronic pain, breast cancer, heart failure, and HIV or AIDS (p.207). This model is also used among sociologists and health scholars investigating the relationship between healthcare and psychological factors and believe that patients with chronic illness should focus on enabling abilities to lead a safe life.
Application to Nursing Practice
According to McEwen and Wills (2014), The Neuman Systems Model has extended nursing science as a needs and causality-focused framework (p.154). It means that this model is appealing to the nurses who view their patients as coherent individuals reacting to stressors. Neumans model is useful as a base that sees prevention as intervention, and because it focuses on maintaining system stability. Also, the model helps to identify stressors and eliminate them. Though the theory is not testable fully, some aspects of it are tested, so it is widely used as a conceptual framework within the nursing practice (McEwen & Wills, 2014).
Bradens theory appeals to the nurses who interfere intending to help the patient to face the severity of illness, overcome dependency and uncertainty, and develop skills for understanding the importance of treatment. This approach provides care with nonmedical treatment, allowing to alleviate the symptoms and learn to self-respond. The model proves to be testable as many works were dedicated to testing this approach.
Application to My Practice
I perceive the Neuman Systems Model as multi-applicable in nursing practice. When a patient is admitted to the hospital because of stressful disorders such as anxiety, sexual, sleeping, or an eating disorder, the nurse can assist him by intervening as well. Firstly, the nurse should identify the environment of the stressors that can be psychological, physiological, socio-cultural, and spiritual. After that, the assessment is carried out, and the nurse decides what sort of intervention to practice. By setting the goals, the nurse esteems presumable outcomes, centers on a clients needs and activities, and starts the prevention as an intervention. There are three types of prevention I can use in my practice that eventually lead to re-adaptation and recovering patients health.
My perception of the Braden Self-Help model is directed towards treating patients with chronic illnesses or cancer. A nurse should be able to measure the severity of a clients pain, level of uncertainty, and dependency. The nurse intervention should be slight as the goal of treatment concerns the patients understanding and learning self-response. The clients ability to comprehend the opportunity of better life quality enables them to control everyday activities. So, the nurse must intervene mostly with nonmedical means but with psychological means that enable the patients skills. I can learn the pattern of such interventions for providing psychological help.
Parsimony
The Model developed by Neuman is complex because the concepts and functions it suggests can be used in multiple ways. Therefore, the model is a bit confusing and cannot be called parsimonious. Though some diagrams prove to be efficient in understanding. The definitions are concise, and the assumptions are well developed.
Bradens perspective is not as complex as the abovementioned theory as it constitutes clear concepts.
Conclusion
Comparing the Neuman Systems Model and Braden Self-Help model, it is necessary to state that they are unlikely to be compared. The Grand Neumans perspective is more complex and comprises some abstract concepts that are hard to comprehend. This theory implies treating patients affected by stressors with prevention as a way of intervention. The Middle Bradens methods include more concrete concepts and guided towards enabling skills of the patients suffering from chronic illnesses to qualify for better life circumstances.
References
Alligood, M. R. (2013). Nursing theory-e-book: Utilization & application. Elsevier Health Sciences.
Chuang, T.-H., Lin, K.-C., & Gau, M.-L. (2010). Validation of the Braden self-help model in women with systemic lupus erythematosus. Journal of Nursing Research, 18(3), 206214.
McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Neuman, B., & Fawcett, J. (2009). The Neuman systems model (5th ed.). Upper Saddle River, NJ: Pearson Education, Inc.