Category: Health & Medicine

Background Information

The patient is a 16-year-old female who lives with her mother, an elder brother (aged 22), and a younger sister who is 10. She is seeking treatment to address emotional discord and impulsivity. Her parents note the following concerns: absentmindedness, suspected hyperactivity, memory problems, and learning difficulties.

Chief Complaint

The main presenting problem entails emotional discord and poor impulse control that has persisted for the last five months. She also displays attention deficit and signs of hyperactivity. Additionally, the subjective data obtained through the parent interview indicate that the client grapples with attachment and self-esteem. She also struggles with interpersonal relationships at school.

Mental Status Exam

The assessment results (objective data) indicate an absence of impairment. However, the patient exhibits symptoms of psychomotor agitation, intense anger, distraction, and dramatic behavior. The clients current mental status data are shown below.

• Physical appearance: Appropriate
• Dress: Appropriate
• Psychomotor activity: Signs of exaggerated agitation/restlessness
• Insight: Low
• Judgment: Fair
• Affect: Appropriate
• Mood: Intense anger
• Orientation: Oriented x3, i.e., responsiveness and knowledge of person, place, and time (Pierce, Kaczor, & Thompson, 2014, p. 15).
• Memory: Intact
• Attention: Easily distracted
• Thought Content: Age appropriate
• Perception: Average
• The Flow of Thought: Average
• Interview Behavior: Overdramatic
• Speech: Normal

Social Information

In childhood, the social environment is a significant predictor of a childs wellbeing. According to Pierce et al. (2014), adverse experiences, including maltreatment in early years, are associated with low health outcomes and psychological problems later in life. Therefore, screening is essential to determine the childs social needs and address them.

For this case, the client, her parents, and siblings live in a suburban family house. The primary caregiver is the mother. The father visits only for a few days monthly owing to a demanding career. The mother drinks and has a history of substance abuse. The family owns a pet (a dog). The client is in the sixth grade, and she is an average student. She struggles with memory problems and learning difficulties that are reflected in her poor grades.

She also grapples with interpersonal relationships with her parents, siblings, and a small circle of friends. She describes her bond with family members as warm. She is an active church member (Catholic). The client reports that her problems started when the family moved to a new neighborhood. She feels misplaced at her new school. She denies ever using drugs, smoking, or drinking. The client considers her family to be very supportive.

Medical and Mental Health History

Medical History

The client has no significant medical conditions. Based on subjective data (parent interview), she had no reported complications at birth. She achieved the main developmental milestones at the appropriate age, except speech. She was diagnosed with dyslexia at the age of three. Her visual and hearing acuities are normal. She is not under any prescription drugs for major conditions. However, she experiences occasional migraines for which she takes aspirin.

She has no history of hospitalization nor any drug allergies. The initial interview session also revealed that the client has some learning difficulties. For example, she was enrolled in the literacy remediation program for the last three years to improve her reading skills. Further, according to the mother, she experienced delayed speech for which she received speech-language therapy. She repeated pre-primary because she was not prepared for grade 1.

Mental Health History

The client has a family history of poor impulse control. Her mother struggled with depressed moods as a child. The client first used therapy services at school when aged three years because of the inability to control impulses and maintain focus in class. However, after a few weeks, she refused to engage. According to the mother, she exhibits verbal and physical aggression and undesirable behaviors, such as dishonesty and theft. The client has not been diagnosed with a mental condition requiring hospitalization. She often makes suicidal pronouncements, but there is no reported attempt. However, at one time, she engaged in self-cutting.

Diagnosis

From the objective and subjective data above, two DSM 5 diagnoses can be made for the client. The first one is the adjustment disorder with a disturbance of conduct (F43.24) because of emotional or behavioral symptoms related to exposure to specific stressors happening within three months (American Psychiatric Association [APA], 2013, p. 8). The second diagnosis is the unspecified bipolar and related disorder (F31.9). Based on the DSM-5, this diagnostic category manifests as a bipolar-like presentation but does not meet the full criteria for bipolar disorders (APA, 2013). The clients symptoms informed the two diagnoses.

Adjustment disorder with a disturbance of conduct requires two fundamental criteria: exaggerated distress with overreactions to a stressor significant functional impairment linked to the stimulus (APA, 2013). In the present case, the client identifies the relocation of the family to a new home, forcing her to change school, as the source of her problems. Therefore, moving is a possible stressor. However, its severity is low, and thus, does not warrant a posttraumatic stress disorder diagnosis. The DSM 5 further stipulates that to diagnose adjustment disorder, the distress must not result from preexisting psychiatric conditions or bereavement (APA, 2013). From the information obtained, the client has no history of mental illness nor has she lost a loved one recently.

Patient responses to stressors vary among individuals. Anxiety and fear are the most frequent symptoms. However, other people may experience a loss of interest in social activities, low mood, and aggression (Severus & Bauer, 2013). Therefore, the clients anger and irritability represent her reactions to the moving of her family and the enrollment in a new school. Further, her attachment problems (emotional discord) and low self-esteem can be as a result of a loss of interest in social activities and relationships. The mild severity of the stressors informed the diagnosis of adjustment disorder.

The unspecified bipolar and related disorder is detected when the symptoms are insufficient to make a definitive diagnosis. According to the APA (2013), the criteria for inclusion entail short episodes of mania, depression, and hypomania and presence of bipolar symptoms that are linked to substance use or neurological conditions. The clients manic/hypomanic features (absentmindedness, hyperactivity, and impulsivity) indicate an unspecified bipolar and related disorder.

She also has a history of dyslexia and delayed speech, which are childhood disorders of the nervous system. Since the client denies drug, alcohol, and tobacco use, her symptoms may not be attributed to substance abuse but a neurological basis. The DSM-5 criteria incorporate the nature (manic, depressive, or both) and severity of the episodes into the diagnosis of the unspecified bipolar and related disorder (Kaltenboeck, Winkler, & Kasper, 2016). Further, the mental status exam indicates that the client displays exaggerated agitation, intense anger, and distraction, which may be responses to environmental stressors identified above.

References

American Psychiatric Association [APA]. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.

Kaltenboeck, A., Winkler, D., & Kasper, S. (2016). Bipolar and related disorders in DSM-5 and ICD-10. CNS Spectrum, 21(4), 318-323. Web.

Pierce, M. C., Kaczor, K., & Thompson, R. (2014). Bringing back the social history. Pediatric Clinics of North America, 61(5), 889-906. Web.

Severus, E., & Bauer, M. (2013). Diagnosing bipolar disorders in DSM-5. International Journal of Bipolar Disorders, 1, 14-16. Web.

In The long search for the pain gene article Wager observes the current academic research on lasting physical pain and the various states of pain among individuals. Chronic pain affects a considerable number of people, with as many as one in five individuals experiencing some form of it. Outside the immediate negative consequences, untreated chronic pain can also lead to the overuse or abuse of painkillers, such as the ongoing opioid crisis. The article focuses on the theory of a pain gene as the answer to recurring and unique experiences of pain among individuals (Wager, 2018). The specific work cites a study beginning in 1966 with a focus on personal experiences of people suffering from man-on-fire syndrome (Wager, 2018). Complexity is inherent to such a study, and the main gene responsible for pain factors can be observed through the molecular, pharmacological, and electrophysiological lens. In fact, certain genes can be allocated to physical features through extensive studies of regularities among large sample sizes.

This article is relevant to my current study primarily due to the complex biochemical understanding of nerves. The SCN9A is a gene that is responsible for the encoding of a complex molecule called Nav1.7 that functions as a sodium channel. It acts as the foundation of the primary functions of the nervous system (Bennett et al., 2019). As such, when an electrical current passes through the channels, ions move toward the neurons thereby creating a nerve impulse. This article effectively communicates some of the central ideas of my current study, which involves regular nerve operations and pain alleviation. In my opinion, the most important conclusion from the article is the ability to alter such relay stations can lead to pain reduction without damage to any brain processes. The understanding of this process is vital to observing any medical treatments that aim to target the patients pain symptoms as a result of nerve functions.

References

Bennett, D., Clark, A. J., Huang, J., Waxman, S. G., & Dib-Hajj, S. D. (2019). The role of voltage-gated sodium channels in pain signaling. Physiology Review, 99(1), 1079 1151. Web.

Wager, T. (2019). The long search for the pain gene. Nature. Web.

Computer science in nursing is a combination of the study of nursing with analytical sciences to effectively gather data and increase the effectiveness of nursing practice. The impact of nursing informatics cannot be overestimated, and it has helped to stimulate the use of technologies such as EMR and computerized supplier order entry in healthcare. Therefore, it is important to note in which areas computer science is used in nursing and why it is important.

I underestimated the impact of computer science on nursing. Previously, I thought that computer science is little used in nursing and concerns only the accounting of patient data. The field of public health informatics best matches my aspirations in practice. Nurses in the field of public health informatics are skilled in developing, designing and controlling health information networks, thereby ameliorating the overall health of the people. (American Nurses Association, 2022). These are highly qualified specialists with a very specific focus. In the context of ongoing reforms in healthcare, the functions and organizational forms of nurses activities are changing. With the development of medical science, the need for innovative approaches to the quality of patient care is increasing. The concepts of the information technology course are used in the therapeutic and preventive process in hospitals and advisory and educational work with the population. My self-ranking did not fully reflect these areas; therefore, I need to pay more attention to studying computer science in nursing practice.

In conclusion, the use of innovative technologies in the daily practice of a nurse makes her work more professional, comfortable, ensures the safety and convenience of performing basic professional duties. Moreover, it reduces labor costs, allows you to quickly and efficiently ensure the implementation of the therapeutic and diagnostic process, which justifies the need for the introduction of new technologies in the practice of nursing staff.

Reference

American Nurses Association (2022). Nursing informatics: Scope and standards of practice. Nursing Standards.

Introduction

Maintaining a healthy lifestyle is essential in todays world, where people are leading sedentary lives. Exercising regularly is one of the most effective ways to achieve this. A gym is a popular place where people go to do workouts and reap the results of such activities. Scientists have been interested in the effects of physical activity for a long time, focusing on how the gym can contribute to physical and mental changes. The gym is important because it not only helps reduce stress and other neurological conditions but improves body functions, reducing weight and improving other activities, which in turn can boost self-confidence.

Improved Physical Health

First, going to the gym is optimal for individuals to achieve better physical health. In terms of the benefits of exercise, regular gym-goers can expect to maintain a healthy weight and reduce the risk of chronic diseases such as diabetes, heart disease, and stroke. Research by Landi and colleagues (2018) emphasizes that regular exercise has been proven to boost physical fitness by reducing abdomen fat accumulation and weight management, improving lipid lipoprotein profile, and strengthening glucose tolerance and insulin levels. Additionally, it helps lower arterial pressure, enhance autonomic tonality, decrease inflammatory processes, reduce blood coagulation, enhance blood flow to the coronary arteries, and amplify cardiovascular output (Landi et al., 2018). However, it was noticed that exercise also strengthens the immune system, improves lung function, and helps to maintain healthy bones, muscles, and joints (Landi et al., 2018). Most chronic illnesses whose treatment has benefitted from exercise have been demonstrated to be closely related to systemic inflammation, as revealed by raised circulating levels of inflammatory markers, including C-reactive protein (Landi et al., 2018). Therefore, there are countless positive physical effects that the gym has on people.

On the contrary, physical inactivity is a significant contributor to muscle atrophy, stiffness, and functional decline. These factors contribute to increased feelings of fatigue and wasting of the muscles (Landi et al., 2018). The best method for preventing sarcopenia is thought to be physical exercise since it is so successful at reversing the loss of muscle mass and function that comes with aging. Physical activity on a regular basis has several positive effects on both young and old individuals health. In fact, the World Health Organization advises that individuals of all ages engage in as much physical exercise as they can, along with at least two hours per week of moderate-intensity activity or more than one hour per week of vigorous-intensity activity (Landi et al., 2018). By increasing physical activity by two times, one may reap additional benefits. Even at lower activity levels than those advised, there is a lower chance of adverse health effects.

Mental Health Benefits

In addition to its many benefits, regular exercise also has a significant impact on ones mental health. Exercise has a variety of positive effects on mental health. For instance, physical exercise is viewed as a noninvasive treatment for drug addiction, Alzheimers and Parkinsons disease, depression, stress, and other neurological conditions that affect the brain (Ruegsegger & Booth, 2018). Skeletal muscle secretions have been connected to the control of depression (Ruegsegger & Booth, 2018). The 2014 study by Agudelo and colleagues demonstrated the impact of exercise training in human and mouse models. According to Agudelo and colleagues, physical activity results in significant increases in chemicals whose action safeguards stress-induced rises in depressive episodes in the brain (cited in Ruegsegger & Booth, 2018). Thus, workouts can positively influence cognitive and neurological functions in peoples bodies.

However, exercise can take many forms and does not necessarily have to take place within the confines of a gym. For example, going for a jog outside, practicing yoga, or even taking a dance class can all provide mental health benefits. Exercise releases endorphins that result in a feeling of happiness which can be one explanation for its mental health benefits (Ruegsegger & Booth, 2018). In such a case, exercise can help individuals sleep better, which can also contribute to improved mental health. Therefore, it is important to find an exercise routine that works for each individual and make exercise a regular part of ones routine to reap the mental health advantages that workouts can provide.

Increased Self-Confidence

As seen, workouts and physical activity are recognized for enhancing wellness through avoiding illnesses, improving physical capabilities, reducing depression, and fostering happiness. Scientists have focused on subjective and psychological health, highlighting the role of exercise in leading a happy life, which has raised curiosity concerning the connection between physical exercise and contentment. When seeing the results of activity and its influence on mental and physical health, it is assumed that there is an additional influence on the perception of self. Aside from impacting the mental state, reducing stress levels, and improving sleep quality, self-confidence can be another benefit. In this scenario, the mentioned improvements can lead to better productivity and more positive interpersonal relationships. By taking care of ones physical and mental health through regular exercise, individuals can achieve greater happiness and fulfillment in life.

Exercise and physical activity are known to promote contentment and quality of life and being connected in terms of ones physical self-concept and identity. The study of Kim and Ahn (2021) focuses on the results of regular physical activities. The findings show that university students physical self-concept, ego, and mental health improved after working out for six weeks (Kim & Ahn, 2021). These findings are significant because they proved the causation of the powerful connection that links exercise engagement to physical self-concept, self-esteem, and mental well-being. The current study, therefore, points in the direction of youth who are at an essential stage for the establishment of healthy habits that may be sustained during life (Kim & Ahn, 2021). It is helpful to strive for a shift in their physical self-concept to create a happy and healthy life via exercise programs.

Conclusion

Hence, the gym is crucial because it not only aids in reducing stress and other neurological diseases but also enhances bodily functions, reduces weight, and improves other activities, all of which can increase self-confidence. Going to the gym is an essential aspect of maintaining a healthy lifestyle. The benefits of going to the gym are numerous, including improved physical health, mental health benefits, and increased self-confidence. Among the physical health improvements are weight, muscle, and cardiovascular activity. Mental changes can be seen through the elimination of stress, depression, and other neurological and cognitive conditions. Moreover, regular physical activity leads to a better perception of self, nurturing better self-confidence. Therefore, it is recommended that individuals should incorporate exercise into their daily routine to achieve a healthy and happy lifestyle.

References

Kim, I., & Ahn, J. (2021). The effect of changes in physical self-concept through participation in exercise on changes in self-esteem and mental well-being. International Journal of Environmental Research and Public Health, 18(10), 1-13. Web.

Landi, F., Calvani, R., Picca, A., Tosato, M., Martone, A. M., DAngelo, E.,& & Marzetti, E. (2018). Impact of habitual physical activity and type of exercise on physical performance across ages in community-living people. PLoS One, 13(1), 1-11. Web.

Ruegsegger, G. N., & Booth, F. W. (2018). Health benefits of exercise. Cold Spring Harbor Perspectives in Medicine, 8(7), 1-13. Web.

Introduction

Malaria is an anthroponotic protozoan disease with a transmissible mechanism of transmission. It is characterized by a cyclic course: a change of febrile attacks and interictal states, splenohepatomegaly, anemia. Diagnosis is made on the basis of clinical data, epidemiological data and laboratory results. The characteristic clinical symptoms are typical febrile paroxysms with tremendous chills, a rapid increase in body temperature to high numbers, followed by profuse sweat.

Currently, there are certain difficulties in the treatment and therapy of malaria. It is very expensive and does not always prove its effectiveness. Moreover, outbreaks of drug-resistant malaria are currently being observed in some countries in Africa.

Vaccine

Moreover, outbreaks of drug-resistant malaria are currently being observed in some countries in Africa. Regular monitoring of drug efficacy is required to develop treatment strategies for malaria-endemic countries and to detect and control drug resistance in a timely manner.

In developing countries, about 500 million cases of infection are recorded annually. About 435 thousand people, mostly children, die from malaria every year. Thus, the development of a drug that can defeat the epidemic is urgent for scientists. Pyrazole-urea compounds may be effective antimalarials because they competitively inhibit a key protein-protein interaction between MTIP and MyoA (Kortagere et al., 2010). Vaccines would be useful in the fight against malaria, but they are even worse than drugs. The main problem is the life cycle of plasmodia(Ashley & Phyo, 2018). For each stage of the parasite, the immune system has to pick up a new weapon. In addition, Plasmodium has other tricks to bypass host defenses, and is much more complex than the viruses that most effective vaccines work against.

References

Ashley, E. A., & Phyo, A. P. (2018). Drugs in development for malaria. Drugs, 78(9), 861-879.

Kortagere, S., Welsh, W. J., Morrisey, J. M., Daly, T., Ejigiri, I., Sinnis, P., Vaidya, A.B. & Bergman, L. W. (2010). Structure-based design of novel small-molecule inhibitors of Plasmodium falciparum. Journal of Chemical Information and Modeling, 50(5), 840-849.

Introduction

The heart is arguably the most important organ in human physiology. Its structure and functionality are amazing, to say the least. Through many years of study, scholars and researchers have relentlessly sought out to understand these two aspects of the human heart. As such, this paper shall set out to explore the main functions of the heart about an article published in the magazine USA today, titled How the heart works  descriptions of the various parts of the heart, their functions, and how they work together  Brief Article.

Literature review

According to the article, the heart is described as an energetic muscular organ located between the lungs that continuously pumps blood throughout the body via the circulatory system. The heart receives the deoxygenated blood from the body and pumps it to the lungs where the waste (Co2) is removed and gets oxygenated. It is then passed back to the heart where it is discharged to the body yet again.

The human heart is made up of four chambers and several valves which regulate and monitor blood flow within the body. The chambers include; the right atria, right ventricle, left atria and left ventricle. They are strategically located and serve as the pumps through which the blood flows into and out of the heart. Additionally, they are supported by four valves that control the inflow and outflow of the blood towards specific directions by opening and closing systematically. These valves have a set of leaflets that are forced open by the pressure exerted by the blood in motion and are designed specifically to allow a single direction of blood flow.

The heart plays a pivotal role in the circulatory system. Without it, other organs would fail due to a lack of oxygen and other nutrients that are transported throughout the body by the blood. Therefore, the full functionality of the heart is indeed crucial to our survival and existence. The article states that the deoxygenated blood from the veins is received into the heart by the right atrium. This blood is often dark red due to the high amounts of Co2 accumulated from the various tissues and cells within the body. Soon after the atrium fills up, an electrical signal is released causing the heat to beat. In this process, the atria contracts, pushing the blood down to the right ventricle. When this chamber contracts, the venous blood is pumped via the pulmonary valve into the pulmonary artery which directs it into the lungs for the purification process.

In the lungs, the venous blood is cleansed of its Co2 and at the same time gets oxygenated. After this process, it leaves the lungs and flows into the left atrium. At this stage, it is bright red due to a lack of Co2 and a high presence of oxygen. The contraction of the atria forces the blood down to the left ventricle through the mitral valve after which it is pumped to the aorta. The aorta is responsible for the distribution of the blood to the various body tissues.

The article further asserts that for the heart to function accordingly, these four chambers must coordinate efficiently. The contraction of these chambers is triggered by an electrical signal generated by specialized cells within the right atrium known as the sinoatrial node (SA). This is the natural pacemaker that causes the heart to beat through a series of evenly and timely spaced electrical discharges. However, emotional and hormonal factors may lead to an increase of these discharges, therefore, leading to a faster or slower heartbeat.

The electrical impulses move gradually from the right atria through the other chambers and in the process cause the systematic contraction and relaxation of the heart which allows the blood flow. Without such a mechanism, there may arise various complications which may have devastating effects on our health and lives.

Conclusion

This article has provided a very informative and elaborate discussion on the functions of the heart. Conclusively, it is clear that the heart is a very important part of our bodies and functionality, from the article review, the various parts have been highlighted and their functions and contributions discussed. It is therefore crucial that each person take ample precautionary measures to ensure that their heart is at maximum health at all times in order o avoid the dangers that may befall them due to health negligence.

Works cited

USA Today. How the heart works  descriptions of the various parts of the heart, their functions, and how they work together  Brief Article. Society for the Advancement of Education, 1997. Web.

At this stage of societys development, the healthcare sector has one of the most critical roles. This contributes to the development of the opinion that employees in this field of human activity are the most valuable. However, recently, a significant decline in efficiency has been increasingly noted in medical organizations due to the emergence of such problems as nurses resilience, burnout, and metabolic syndrome. The occurrence of these problems occurs for several reasons, including a high level of complexity and stress. These problems may be the result of more and more medical professionals leaving their workplace, which is a severe negative result for healthcare providers. Therefore, within the framework of this research work, a study was conducted of literary sources that considered issues such as resilience, burnout, and metabolic syndrome among medical professionals such as nurses. It is noted that many scientists are engaged in the study of this topic, and there are works studying the mentioned problems both separately and in interrelationships with each other. Further, many sources note that burnout is one of the most relevant and common issues faced by medical professionals. The main factors that influence its appearance are stress due to the care of patients with poor health outcomes, the complexity of quick decision-making, and a long working day. Another study drew a parallel between burnout and resilience of hospital and clinic workers. Similarly, a correlation was made between burnout and metabolic syndrome. To improve the situation with these problems, it was proposed that organizations study these phenomena in detail to form strategies to minimize them. Henceforth, this scientific work makes a valuable contribution to the study of problems related to the work of nurses.

Quality improvement initiatives are critical in ensuring that patients receive the best care possible. One of the most common initiatives is the reduction of readmissions in nursing homes. In order to achieve this goal, nursing homes can implement various strategies. Among the options is to provide more comprehensive discharge planning, which includes a thorough assessment of the patients needs and the development of a personalized care plan. Additionally, nursing homes can improve communication between staff members and increase the frequency of follow-up appointments with patients after they have been discharged. Therefore, quality improvement initiatives in nursing homes must be based on reducing readmission rates, with the purpose of it being a substantial reduction of facility costs and an increase in patient satisfaction.

First, it is necessary to accentuate the fact of the detrimental impact and frequency of readmissions. At an estimated cost of more than $28 billion, one in five Medicare patients who are released from the hospital obtains post-acute treatment in a skilled nursing institution (Burke et al., 2022). A readmission is related to a tripled death rate within six months, and nearly one-quarter of patients who are admitted to nursing homes are readmitted to the clinic within 30 days (Burke et al., 2022). As a result, many nursing homes and healthcare institutions strive to incorporate initiatives that would protect vulnerable populations and decrease the rate of hospital readmissions.

As can be seen from the discussion, the target population for the quality improvement initiative is the elderly residents of nursing homes. These individuals are often frail and have multiple chronic conditions (McHugh et al., 2021). As a result, they are at high risk of readmission to the hospital. By implementing the quality improvement initiative by reducing readmissions through comprehensive discharge planning and communication between the staff and patients, nursing homes can improve the quality of care provided to these vulnerable patients.

The benefits of the quality improvement initiative are numerous. Firstly, it can reduce the number of hospital readmissions, which can be stressful and disruptive for patients and their families. Secondly, it can improve the quality of care provided to patients, resulting in better health outcomes. Thirdly, by a decrease in the requirement for hospitalization it might reduce healthcare expenses. Finally, it will be possible to increase patient satisfaction by providing better care and reducing the need for hospitalization. Overall, discharge planning and proper communication can significantly change the trajectory of care and be preventive tools if used properly.

The implementation of the quality improvement initiative requires interprofessional collaboration. In the given situation, it is quite challenging to implement the initiative without the collaboration of all stakeholders. Nurses, physicians, social workers, and other healthcare professionals must work together to develop an effective plan that would holistically address the physical and psychological needs of each patient. The nursing home administrator must additionally be involved in the process to ensure that the initiative aligns with the goals of the facility. Collaboration with external stakeholders, such as hospitals and community organizations, may also be necessary.

However, what additionally requires analysis is the cost of incorporating the plan. The cost of implementing the quality improvement initiative must be justified. In the given situation, when focusing on such steps as improving communication between the patients and staff, follow-up interactions, and discharge planning, the costs will involve many factors. Among the costs associated with the initiative will be staff time, training, equipment, and supplies. While it is necessary to incorporate software for proper discharge planning, it will additionally be necessary to provide training with an expert and ensure the maintenance and setup of the programs. However, the cost of readmissions to the hospital is often much higher than the cost of implementing the initiative. Annually, fines of up to $528 million were assessed to approximately 79% of American health institutions (Ye et al., 2022). Therefore, by reducing the number of readmissions, nursing homes can save money in the long run.

Finally, the quality improvement initiative must be evaluated to determine its effectiveness. The evaluation should be based on measurable outcomes, such as the number of readmissions, patient satisfaction, and healthcare costs (McHugh et al., 2021). If any of the metrics will decrease, such a result will indicate that the facility is at risk and it requires further improvement. On the opposite, if readmissions decrease, patient satisfaction is significantly improved, and costs are reduced, the facility will need to sustain the new approaches. The results of the evaluation should be used to make any necessary adjustments to the initiative to ensure that it continues to be effective.

Hence, reducing readmission rates is the foundation for all quality improvement programs in nursing homes since it lowers facility expenses and boosts patient satisfaction. The reduction of readmissions in nursing homes is a critical quality improvement initiative. The senior residents of nursing homes are the target population, and the advantages include better patient outcomes, lower healthcare costs, and increased patient satisfaction. Interprofessional collaboration is necessary for the effective implementation of the initiative, and the cost must be justified. The evaluation of the initiative should be based on measurable outcomes to ensure its effectiveness.

References

Burke, R. E., Xu, Y., & Rose, L. (2022). Skilled nursing facility performance and readmission rates under value-based purchasing. JAMA Network Open, 5(2), 1-13. Web.

McHugh, J. P., Shield, R. R., Gadbois, E. A., Winblad, U., Mor, V., & Tyler, D. A. (2021). Readmission reduction strategies for patients discharged to skilled nursing facilities: A case study from 2 hospital systems in 1 city. Journal of nursing care quality, 36(1), 9198. Web.

Ye, Z., TemkinGreener, H., Mukamel, D. B., Li, Y., Dumyati, G. K., & Intrator, O. (2022). Hospitals serving nursing home residents disproportionately penalized under hospital readmissions reduction program. Journal of the American Geriatrics Society, 70(9), 2530-2541. Web.

How to treat depression in suicidal patients is a difficult question. Contemporary nursing models of mental health care emphasize the importance of personhood in mental health disorders, including depression. The movie The Hours presents a unique example of how depressed, suicidal women should not be treated. The Tidal Model exemplifies a new philosophy of mental health nursing, which embraces the concepts of caring, nurses curiosity, and patients personhood.

The Tidal Model of care holds a promise to improve mental health and emotional outcomes in depressed individuals and reduce the scope of their suicidal attempts. The purpose of this paper is to review and reconsider a Major Depression case through the lens of the Tidal Model of nursing. The movie The Hours and the character of Virginia Woolf will serve the basic units of analysis.

Depression: Signs, Symptoms, and The Hours

The complexity of signs and symptoms makes depression diagnosis extremely problematic. According to the World Health Organization (2010), depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. Depression affects at least 19 million of Americans and their families and is rightly considered as one of the major causes of disability (Nosek, 2008). According to the DSM-IV manual, the main signs and symptoms of depression include

1. depressed mood every day and most of the day;
2. diminished interest in all or almost all activities and significant changes in weight and appetite;
3. sleep problems, psychomotor retardation or agitation every or almost every day;
4. the feeling of self-worthlessness, fatigue, impaired ability to concentrate and take decisions, on a daily basis; and
5. suicidal ideation and recurrent thoughts, obsessions, about death (American Psychiatric Association, 2000).

In the movie The Hours, Nicole Kidmans character Virginia Woolf displays all symptoms of a Major Depressive episode.

Virginia Woolf constantly finds herself in a depressed mood. She feels hopeless and is disinterested in most things and activities. She is sad and lost. The sense of pleasure is unknown to her; she suffers from insomnia and does not seem to care of what is happening in her life. Mrs. Woolfs maids complain that she never knows what she wants; she cannot take decisions or changes them every minute (Daldry, 2002). The signs of psychomotor retardation, especially slowed movements and reduced speech are too obvious to ignore. Woolf is in a constant search for something she cannot define. As a result, she hardly has a chance to achieve her purpose.

The feelings of satisfaction and joy are unfamiliar to her. She lacks energy, and her sense of guilt is enormous. In the final letter to her husband, Virginia Woolf writes: I know that I am spoiling your life, that without me you could work. [&] I cant go on spoiling your life any longer (Daldry, 2002). Woolf had two suicidal attempts. She constantly thinks about death. Her symptoms have lasted for more than two consecutive weeks. Mrs. Woolf feels tired, disinterested in her life, worthless and guilty, and, as a result, exemplifies a serious case of the Major Depression episode (Bernstein, 2006).

Key Dimensions of the Tidal Model

The Tidal Model of mental health nursing signifies a new stage in the evolution of nursing philosophy. The three critical dimensions of the Tidal Model include world, self, and others (Pandey, 2007). World is the domain where people develop and communicate their stories (Pandey, 2007). Depressed individuals want their personal experiences explored and validated by people, and nurses must be able to re-evaluate the persons story in context and reveal its hidden meanings (Pandey, 2007). In case of Virginia Woolf, doctors are indifferent toward her personality and ideas about life. They cannot define the meaningful events that could have affected her mental health disorder.

Self is the second dimension of the Tidal Model  the domain where people want to feel secure (Pandey, 2007). It should be noted that patients ideas of security may (or most frequently) differ from those of other people, including their family members.

The issue of personal security becomes particularly sensitive, whenever the risks of suicide are involved. Virginia misses and wants to come back to London, but her husband insists that she stays in Richmond, to protect herself from the major troubles of life. His state is understandable: his sense of responsibility for a suicidal spouse and his helplessness in the face of Victorias illness are necessarily the results of living with a depressed, suicidal family member (Nosek, 2008). He is blinded by this responsibility and loses the touch with the emotional needs of his wife.

Eventually, it is through others that depressed suicidal patients can obtain quality care and support. Others is essentially about the complexity of the relationships with nursing practitioners, family members, friends, and significant others (Pandey, 2007). Virginia Woolf is fated to spend her life in isolation and cannot meet her social needs. She wants but cannot be regarded as a part of her family (Ahlstrom, Skarsater & Danielson, 2009).

She cannot go to London, nor can she interact with other people beyond her husband, maids, and sister. Once, Virginia Woolf exclaims that even psychiatric patients have the right to express and have their wants satisfied (Daldry, 2002). The absence of a comprehensive treatment strategy, the lack of family support, and failure to accept the voice and language of the patient lead to the tragic consequences. Virginia Woolf drowns herself, and her suicide marks the ultimate failure of the therapy that had to improve her health.

Three Commitments of the Tidal Model

The first three commitments of the Tidal Model include

1. value the voice,
2. respect the language, and
3. develop genuine curiosity (Buchanan-Barker & Barker, 2008, p.95).

These three commitments could have helped all characters of The Hours to cure their emotional ills. The first commitment is about listening to the patients story and accepting its language (Buchanan-Barker & Barker, 2006). A practitioner must demonstrate an ability to listen carefully to the patient and record the patients history in his (her) own words (Buchanan-Barker & Barker, 2008). Virginia Woolf has a unique writing talent, and can easily find words and expressions describing her emotional state and its possible causes. She is able to provide an insight into the mystery of her illness, and the main task of the nurse would be to record her story the way she presents it, to ensure that her voice and uniqueness are retained.

Respect to language as the second commitment of the Tidal Model logically follows from the first one: nurses must value patients natural language (Buchanan-Barker & Barker, 2006). The story of the patients life, written and transcribed in his (her) terms and expressions, is the best measure of respect and attention on the side of the nurse. Medical professionals must avoid using excessive medical terminology but, instead should convey simple thoughts and meanings (Buchanan-Barker & Barker, 2006). The picture of Woolfs diagnosis is increasingly complicated, and this is one of the key mistakes. The lack of genuine curiosity does not let the doctors and family members improve Virginias emotional state.

Genuine curiosity, the third dimension of the Tidal Model, produces significant effects on how patients tell the story of their lives (Buchanan-Barker & Barker, 2006). In case of Virginia Woolf, doctors fail to identify and discuss the meaningful events affecting her state. She is treated as a usual object of medical investigation. Medical professionals believe that depression is similar to other physiological disorders, which require nothing but medication and isolation from the tensions of life. As a result, her family develops coercive strategies of coping with the illness, but these strategies do not benefit Virginia Woolfs health outcomes (Ahlstrom, Skarsater & Danielson, 2009).

It is due to unresponsiveness from her family and doctors that Virginia Woolf fails to relieve the burden of her emotional problems. The story of Virginia Woolfs illness teaches a good lesson to nursing professionals in mental health facilities. The story of Virginia Woolfs illness suggests that the Tidal Model of care could have helped the famous writer to meet her social and emotional needs.

Conclusion

The Tidal Model of nursing marks a new stage in the evolution of nursing philosophies and embraces the concepts of care, curiosity, and patients personhood. Virginia Woolf displays all signs and symptoms of the Major Depression episode: she is disinterested in her life, experiences guilt and the sense of self-worthlessness, and constantly thinks about death. The story of her illness presents a unique example of how depressed, suicidal women should not be treated.

Medical professionals have no curiosity about her life and experiences that could have affected her state. Virginia Woolfs suicide is a rebellion against her emotional confinement and failure to cure her mental health ills. The Tidal Model of care holds a promise to improve emotional outcomes in depressed individuals and reduce the scope of their suicidal attempts.

References

Ahlstrom, B.H., Skarsater, I. & Danielson, E. (2009). Living with major depression: Experiences from families perspectives. Scandinavian Journal of Caring Sciences, 23, 309-316.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. New York: American Psychiatric Pub.

Bernstein, K.S. (2006). Clinical assessment and management of depression. MedSURG Nursing, 15(6), 333-342.

Buchanan-Barker, P. & Barker, P. (2006). Ten commitments: A value base for mental health recovery. Journal of Psychosocial Nursing, 44(9), 29-33.

Buchanan-Barker, P. & Barker, P.J. (2008). The tidal commitments: Extending the value base of mental health recovery. Journal of Psychiatric and Mental Health Nursing, 15, 93-100.

Daldry, S. (2002). The Hours. United States: Paramount.

Nosek, C.L. (2008). Managing a depressed and suicidal loved one at home: Impact on the family. Journal of Psychosocial Nursing & Mental Health Services, 46(5), 36-44.

Padey, R. (2007). Nursing and midwifery education. Mittal Publications.

World Health Organization. (2010). Depression: What is depression? World Health Organization. Web.

In medicine, nursing practice often refers both to science and to art. Science in terms of evidence-based practice, is where the practitioners combine their comprehension of health sciences, diseases, and illnesses. Art is in terms of the practitioners ability to incorporate or adapt to individual situations and patients while thinking about enhancing patient outcomes (Hansson and Froding, 2021). However, the two concepts in nursing are often at odds mainly due to the understanding that the best evidence is not a size-fit experience. Practical clinical judgment entails integrating a nurses accumulated educational background and knowledge wealth from patient experiences.

Combining clinical expertise requires combining evidence-based practice, allowing patients to choose their treatment plans. Moreover, in the absence of options, patients have difficulty making choices. On the other hand, incorporating patient preferences might result in making decisions based on personal beliefs and priorities, cultural and spiritual values, and quality life-related thoughts (Brown, 2018). While practitioners comprehend they must incorporate patient preferences in decision-making, often this fails due to literacy, time constraints, race, gender, past knowledge, and sociocultural influence barriers. An example of patient preference-clinical expertise conflict is holism vs. patient-physician privacy. First, holism entails a holistic understanding of the patients needs, where physicians incorporate their comprehension of the patients in treating them (Brown, 2018). Moreover, it considers life issues, emotional needs, and the patients whole person, which is achieved through the patient narrative.

The holism conflict in patient preference and clinical expertise becomes evident when asked for their lifes narrative. The failure to comprehend the narrative encourages patients to reveal sensitive private information like extra-marital affairs, psychological issues, and family conflict (Hansson and Froding, 2021). Often, the conflict arises when patients fail to realize the extent of information in their treatment plan. When encouraged to conversate about such sensitive matters, patients mistakenly presume every piece of information is medically relevant. Arguably, its the right of patients not to share sensitive information if it does not improve their treatment plan (Brown, 2018). Therefore, the ethical conflict associated with holism manifests when on the one hand, patient narrative usefulness results in a better understanding of the patients health circumstance. On the other hand, the conflict associated with the realization soliciting this information will infringe the patients privacy.

One way to handle this conflict is first to define a holistic approach to the patient bringing them on board with the requirements of the approach in treatment. Once patients understand the significance of patient narrative in their treatment, they become familiar with what the provided information will do in how they are treated. It is essential to point out that this awareness will enable patients to share content to help in their treatment and avoid sharing unnecessary sensitive information. The other way the conflict can be handled is by minimizing the possibility of unethical privacy intrusion. Some patients have been known to develop a distressing experience that potentially declines how they attain their therapeutic goals (Hansson and Froding, 2021). When patients work not based on presumption but knowledge, they comprehend the extent to which they are expected to reveal their information. Through such an understanding, patients are better positioned to evaluate the information they divulge while at the same time, they are comprehending their role in minimizing the risks associated with the sharing of sensitive information.

References

Brown R. (2018). Resisting moralization in health promotion. Ethical Theory and Moral Practice: An International Forum, 21(4), 9971011. Web.

Hansson, S. O., & Froding, B. (2021). Ethical conflicts in patient-centered care.Clinical Ethics, 16, 2, 55-66. Web.

Lachal, J., Revah-Levy, A., Orri, M., & Moro, M. R. (2017). Meta-synthesis: An original method to synthesize qualitative literature in psychiatry. Frontiers in psychiatry, 8, 269. Web.

Leary, H., & Walker, A. (2018). Meta-analysis and meta-synthesis methodologies: Rigorously piecing together research.Technological Trends, 62(5), 525-534. Web.

Lee Y. H. (2018). An overview of meta-analysis for clinicians. The Korean Journal of Internal Medicine, 33(2), 277283. Web.

Moeyaert, M. (2019). Quantitative synthesis of research evidence: Multilevel meta-analysis.Behavioral Disorders, 44(4), 241-256. Web.