The article by Kendzor et al. (2014) aims at establishing the relationship of anxiety and depression to behavior management and glycemic control among Mexican Americans residing close to the U. S.-Mexico border. The study adopted a cross-sectional approach, and certain confounding covariates were included to supplement the findings (p. 176). The results showed that depression and anxiety had a negative influence on the behavioral management of diabetes due to higher BMI and waist circumference, in addition to lower activity levels (p. 176). There were positive correlations between anxiety and glycated hemoglobin (HbA1c), and between depression and fasting glucose. The second article by Khattab, Khader, Al-Khawaldeh & Ajlouni (2010) is related to that by Kendzor et al.; it adopts a cross-sectional approach and seeks to identify factors associated with poor glycemic control among Jordanian type 2 diabetes patients. The study showed poor adherence to self-care management practices and prolonged diabetes were associated with poor glycemic controls (Khattab, Khader, Al-Khawaldeh & Ajlouni, 2010, p. 84).
I checked for the accuracy and reliability of the articles by comparing tools used and preselected variables, to the objectives of the study. The variables are commensurate with what the study seeks to achieve, and the indicators are well defined. According to Kendzor et al. (2014, p. 176), BMI, waist circumference and physical activity are ideal indicators of behavioral management, while fasting glucose and glycated hemoglobin indicate glycemic control. The tools used to assess the pre-selected variables were used correctly. For example, the Center for Epidemiological Studies Depression (CES-D) questionnaire was used to assess depressive symptoms while the Zung Self-rating Anxiety Scale was used to assess anxiety (Kendzor et al., 2014, p. 176). Also, well-trained nurses used standardized Sphygmomanometers EN 1060 to measure blood pressure (Khattab, Khader, Al-Khawaldeh & Ajlouni, 2010, p. 85).
Besides, sampling affects the reliability and accuracy of results. The samples used in both articles were heterogeneous about socioeconomic status and demographic characteristics. Also, the sample sizes used were large enough; hence, the chances of reproducibility are also high. I checked the manner of recruiting the samples, and these are scientifically accepted. However, there is a flaw in the second article by Khattab, Khader, Al-Khawaldeh & Ajlouni (2010); the sampling interval was three, not ten. Therefore, systematic random sampling should have involved numbers one to three, and not one to ten. Also, the study by Kendzor et al. (2014) did not specify the type of diabetes, and this could affect the reliability of results.
To ensure that the articles I downloaded were peer-reviewed, I refined the results within selected databases to refereed or peer-reviewed journals. I used the MEDLINE database to access the article by Kendzor et al. (2014) and later used the Ulrich web to verify this. I used this web to check if the article by Khattab, Khader, Al-Khawaldeh & Ajlouni (2010) was peer-reviewed. I entered the name of the journal containing the downloaded article into the search bar at Ulrich web, and a list of entries with similar names to the journal showed up, but the particular journal I was searching for was top on the list. I narrowed the results to peer-reviewed/refereed and a modified version of the initial list appeared. The journal I was searching for an appeared top on the list.
Peer-reviewed articles are written by experts in the respective fields and have gone through a subsequent evaluation to check for validity and reliability of results. The re-evaluation is conducted by a panel of experts in the specific field of the research article to check for article quality. This panel does not know the authors of the article; hence, no bias. These articles provide scientific evidence that is credible and highly valued in the world of research; it is irrefutable unless by a similar peer-reviewed article. A peer-reviewed article contains factual information that can be integrated into actual practice, and it is the basis for evidence-based health care.
References
Kendzor, D. E., Chen, M., Reininger, B. M., Businelle, M.S., Stewart, D. W., Fisher- Hoch, S. P., & McCormick, J. B. (2014). The association of depression and anxiety with glycemic control among Mexican Americans with diabetes living near the U. S.-Mexico border. BMC Public Health, 14, 176. Web.
Khattab, M., Khader, Y. S., Al-Khawaldeh, A., & Ajlouni, K. (2010). Factors associated with poor glycemic control among patients with Type 2 diabetes. Journal of Diabetes and Its Complications, 24, 84-89.
Quality assurance programs serve different roles in healthcare settings. They ensure that health services are cost-effective, responsive to public needs, and of high quality so that the safety of patients is enhanced (Donabedian, 2002). I believe that patients value the safety of health services more than the cost or their response to public needs. Many patients evaluate the quality of health services based on the level of safety during treatment and the potential to improve wellbeing after treatment (Spath, 2009).
Patient safety encompasses practices that prevent medical errors and that utilize medical knowledge to improve patients wellbeing (Donabedian, 2002). Many people value safety more than other benefits related to quality assurance because of the reduction of the risk of adverse events or outcomes during treatment and the recovery process. Avoidance of errors during evaluation, diagnosis, and treatment is critical to the improvement of patient safety (Spath, 2009).
I think that many patients are ready to embrace the high costs of health services if the risk of succumbing to medical errors is minimal. High-quality health care processes improve patient safety and as a result, lead to positive health outcomes. It is possible to have quality care and cost-effective programs in place by encouraging collaboration between the government and stakeholders in the private sector.
Fragmentation and high costs of health care are two main reasons why many health care facilities lack quality care and cost-effective programs. More collaboration would improve patient safety and the quality of health services. Working together with organizations such as Centers for Medicare & Medicaid Services (CMS) and the American Healthcare Association would lower the costs of health care and improve collaboration between the government and the health care sector. CMS has implemented several programs and initiatives that promote the delivery of quality medical care at low costs. Therefore, utilizing government programs and collaborating with government agencies is critical in ensuring that health care facilities have both quality assurance and cost-effective programs.
Utilization Review
Utilization review (UR) is a provision in health care that protects patients from inappropriate medical care through the evaluation of patient care (Spector, 2004). Health care providers review patient care based on aspects such as necessity, quality of care, length of hospital stay, and quality of decisions. The main functions of UR include enhancement of medical judgment, improvement of patient care, and achievement of better treatment outcomes (Spector, 2004).
UR can be included under the practice of medicine because its outcomes can directly affect the health of patients (Kongstvedt, 2001). For example, if a health care provider makes the wrong decision, the health of the patient is compromised. Also, physicians are obligated to provide quality and safe care to the patient at all times. UR is a critical component of quality and safe patient care.
Therefore, UR is part of the practice of medicine. In that regard, it should be limited to those medical professionals licensed to practice medicine because they possess the knowledge and skills necessary to avoid the poor judgment that could lead to negative health outcomes (Kongstvedt, 2001).
I think that a qualified and licensed medical professional should head the utilization review program. A licensed professional possesses the knowledge and skills necessary to provide quality medical care to a recommended degree of skill and judgment. Also, licensed professionals have been tested and proven qualified to handle patients and make decisions that promote positive health outcomes. Finally, qualified professionals have sufficient medical experience to make the right judgments regarding patient care.
References
Donabedian, A. (2002). An introduction to quality assurance in health care. New York, NY: Oxford University Press.
Kongstvedt, P. R. (2001). The managed health care handbook. New York, NY: Jones & Bartlett Learning.
Spath, P. (2009). Introduction to healthcare quality management. New York, NY: Health Administration.
Spector, R. A. (2004). Utilization review and managed health care liability. Southern Medical Journal 97(3), 34-38.
In the majority of clinical settings, diagnosis, prognosis, and plan of care for an individual patient are vague and, therefore, should be expressed in terms of probability. Any research, including clinical, is influenced by randomness. Thus, clinicians should rely on observation based on solid scientific principles, including ways to reduce bias and evaluate the role of chance.
The main type of study in the described case is a cohort study. A cohort study is an observational research in which a sampled group of people, initially united by a common feature (cohort), is observed for some time, and the outcomes in those exposed and not exposed to the intervention or other factors are compared. As described in the case, the researchers have been investigating risk factors for sudden cardiac death in a group of men and women between the ages of 35 and 70.
The time period for the study was 20 years, which highlights one of the main disadvantages of the cohort study, which is a high duration of the observation. As part of the study, participants were to provide data on demographic and behavioral characteristics yearly; they also needed to undergo testing for cardiac function and provide blood samples to assess lipid profiles and other biomarkers. With regard to clinical issues, the described research was represented by the incidence study, and the main method of assessment, in this case, was the registration of new cases during a certain period of time (DePoy and Gitlin 315).
Although cohort studies are scientifically more preferable, this approach is not always applicable to practice since such a method of research requires considerable amounts of time, effort, and money.
However, in order to assess the association between the new biomarker (inflammation) and its linkage to sudden cardiac death, the nested case-control study shall be considered (Keogh and Cox 163). The nested case-control study is a method of selection of the control group according to the case, while the control group in each case is an independent sample of the original population. The probability of inclusion in the group of control depends on the time during which the factor has been affecting the person in this study. This approach to study design is a form of iatric investigation, and it is frequently utilized to designate the reason for the ailment, especially in the detection of bursts of contagious sicknesses or in the studies of rare illnesses.
This type of study design is also applicable to the described research because if medical investigators need a relatively quick and easy way to learn the etiology of the new disease, they can compare the two groups of people in a rapid manner. Those who are already diseased (case) and those who were in similar conditions but did not have the disease (control) would represent the two different groups.
In a study of the new biomarkers, researchers will use the data collected in the past in order to verify the link between the specific results obtained and the suspected risk factor (Kumar 98). To check the specific cause, they will need to formulate a scientific hypothesis about how to relate the new biomarkers and the cases of sudden cardiac deaths. Then they will be able to assimilate the frequency of the trigger in the first group and the periodicity with which this cause appeared in the second group. If the risk factor occurrence dominates in the first group, it will evidence that this is the cause of the incidents.
In addition, according to the research description, one risk factor will be analyzed, in this regard, it can be argued that this type of study design is the most suitable one. This type of study is applicable to the current research because not much time will be needed for its furnishing, while the scientists will need to analyze the events that have already happened rather than wait until the new occurrences appear.
In addition, all the required information will be at the researchers disposal, and it would allow determining the association between the new biomarker and sudden cardiac death in a rapid way. The fast processing times imply that the case-control study is particularly useful when the research takes a long period of time due to a long investigation of the cause and the outcome (Rothman 44). Another positive aspect of this study is that it does not require a large number of individuals to get statistically crucial evidence.
However, it is worth noting that despite the fact that such a study enables checking the validity of the hypothesis of the link between the cause and the result, this type of study design is inferior to others in defining the causal link, and its strength between the risk factor and concrete results (Weiss and Koepsell 421). Therefore, the researchers are likely to use this method of research to gain an early understanding of the link to be able to conduct further research using other techniques that would be more profound and holistic in nature.
Apart from that, conducting such a study would not be as informative in nature as a prospective study type, and the researchers will need to question the reliability of the source data. However, the determination of the biomarkers will enable diminishing the subjectivity of the results. In fact, a retrospective study, in principle, cannot definitively prove the link between the phenomena and the outcome; it will only reveal a certain degree of probability of this occurrence to indicate the possibility of such a connection.
However, there are many issues that can be solved by the nested case-control study, for instance, whether a causal relationship is meaningful, or whether there is a responsivity to the hypothesis proposed by the researchers. However, the sample of the described research is within a certain range, and for that reason, it would not represent a sample of the full population; therefore, it would reduce the accuracy of the results (Hulley et al. 104). Nevertheless, no information was provided on the further course of an investigation; subsequently, it is difficult to define which study design can be applied further.
In conclusion, the main research is concerned with the cohort study design, while the hypothesis regarding the relation of sudden cardiac death and inflammation can be investigated by nested case-control studies. With the help of this study design, it would be possible to connect cases with complications such as inflammation. Further, it is a convenient type of study design while, even if testing the biomarker is expensive, the measurement will not have to be extensive. Nevertheless, some complications and limitations (deaths, dropouts) may hinder the research, and the result will not be comprehensive enough.
Works Cited
DePoy, Elizabeth, and Laura Gitlin. Introduction to Research, New York: Elsevier, 2013. Print.
Hulley, Stephen, Steven Cummings, Warren Browner, Deborah Grady and Thomas Newman. Designing Clinical Research, Philadelphia: Lippincott Williams & Wilkins, 2013. Print.
Keogh, Ruth, and DR. Cox. Case-Control Studies, Cambridge: Cambridge University Press, 2014. Print.
Kumar, Ranjit. Research Methodology, Thousand Oaks: SAGE, 2014. Print.
Rothman, Kenneth. Epidemiology, Oxford: Oxford University Press, 2012. Print.
Weiss, Noel, and Thomas Koepsell. Epidemiologic Methods, Oxford: Oxford University Press, 2014. Print.
Public health is a paramount issue in the United States. It has been increasingly difficult to juggle this significant problem with all the other issues that are circulating our country. One of the key problems with public health law is that there is a constant tug of war between the two main political parties throughout each governmental branch. Therefore, a legislature that would have an actual impact is usually in the throes of a deadlock, never to be passed. However, in terms of the protection of our populous, there have been some laws that serve as jumping-off points until the polarization of the political parties throughout the governing branches subsides.
One law, in particular, that is just is the Order for Medical Examination and Specimen Collection. This law, which is from the database of the CDC or Center for Disease Control, is focused on the protection of the surrounding inhabitants of a certain state. In this certain example, we focus on New Hampshire. The Attorney General passed this law in 2003. As part of this medical examination, you will be required to produce such specimens as are determined by medical personnel to be necessary to determine the presence of a communicable disease. (CDC).
Now I find this to be an effective law for the most part, although there are various negative aspects about it as well. Firstly, it is not a dictatorial movement by our government. In many states, laws are passed that act as commands that force individuals, their partners and spouses, and even their children to get vaccines. Often these treatments cause terrible side effects. Recently in Florida, two teens from the same family came down with serious vaccine injuries from Gardasil vaccinations. Thats not unusual. (Fassa, 2010, p. 1).
If there is no acceptance and action in regard to this legislature, people can be persecuted by the law. The weakness in this law is that these citizens have not contracted the actual disease and it seems as if the government is attempting to control their every move.
The way the aforementioned law differs from this type of legislature is that when an individual is recognized as having and portraying symptoms that are related to a disease that could have disastrous consequences, they must submit to testing for the betterment of those around them. One could argue that the laws that are passed that require certain vaccines act in the same way, but it is a hasty and commanding requirement that goes against much of the freedom promised in our Constitution. We must uphold the ideals of our forefathers in every situation because the United States must be consistent with its values.
The law that was described prior does a fantastic job of giving the United States citizens freedom but allows for the protection of our population. Human rights are extremely significant as a whole, but when dealing with the safety of an abundant population, those rights may have to be sacrificed for their safety. This legislature balances both of these priorities effectively. Granted, as previously stated, this law has flaws. There is an issue of profiling, although unfortunate occurs daily. There are different groups of people that have been stereotypically tied down to disease for years, and sadly many believe this typecasting to be true, which is it is not.
On the positive side, when in comparison to a dictatorial law that would in effect command-specific groups to get vaccines, we can see that the Order for Medical Examination and Specimen Collection in its true form does not promote prejudice, whereas the demand for a vaccine does. When a government instructs specific individuals to get medical treatment, suspicions arise and due to ignorance stereotypes are given. The Order for Medical Examination and Specimen Collection was created for the protection of populations, and at its core promotes freedom of the individual.
The findings by Robert Wood Johnson Foundation (2012), after conducting a study stated that most doctors, over 85% of the sample, indicated that it is crucial for doctors to be able not only the medical aspects of a patient but also the social needs. It was the wish of the doctors that to fully treat the patient, they are able the social requirements of the patient. Doctors felt the need to be in a position to eliminate social challenges that affect their patients, some of the factors include proper transportation, proper nutrition, and house assistance. The doctors felt they should be able to offer social prescriptions just the same way they offer medical prescriptions. The doctors felt they need the ability to be able to connect the patients with these resources (Ardishanson, 2012).
The survey was instrumental in providing information that doctors need the power to address the social needs of the patients but this is not possible as the current health care system is not in a capacity to offer this. Food, housing, and proper heat are some important basic social needs that have a direct effect on the true healing of a patient. Just like drugs for an illness, these social needs play the same role. Many primary care physicians are not well trained to address the social needs of their patients.
Many physicians have no time to address the social needs of the patients. An example of a challenge is an asthma infection in children. The problem will return due to the poor living conditions in their house. This may be caused by the growth of molds in their house or the presence of insecticides that have been sprayed in the surrounding. Doctors need to sensitize policymakers in the community on the need of addressing the social needs of the patient (Downie, 2012). There is a need for changes in the health care system in the United States; this will enable health care to address the costs necessary to connect the patient with the responsible provider of the social service.
References
Ardishanson (2012). Webinar> Health Cares Blind Side Webinar Integrating Patients Social Needs Into Health Care Delivery. CBSCLOOP. Web.
Downie, C. (2012). Register for Health Cares Blind Side Webinar with Rebecca Onie. Health Leads. Web.
Robert Wood Johnson Foundation (2012). Webinar: How Can We Address Health Cares Blind Side? New Public Health. Web.
Nursing is a profession in the health care department responsible for taking care of patients and ensuring their comfort while in the hospital vicinity. Nurses perform duties such as feeding the patients, administering drugs, and ensuring they have a conducive environment for recuperation. Their greatest responsibility is with the inpatients, but they also work with the outpatients in cases where they are required to measure their blood pressure levels, body temperature, and other such elements. One of the issues affecting the nursing environment in the health care system is the nurse-patient ratio. This refers to the number of patients allocated to one nurse, about the type of diagnoses.
Body
An effective nursing environment requires that the nurse should have enough time with the patient so that he/ she can attend to all their needs. This however is not the case, owing to the increasing number of patients in hospitals today. The lifestyles most people have adopted promote poor health habits hence increasing cases of diseases. A good example is the rising cases of different kinds of cancers. In the earlier years, this condition was unheard of and the few cases were mostly found in the elderly. This has however changed since cancer is the condition that most people are living with now. This means that chemotherapy has become famous and requires that more nurses be deployed in these areas, which is not the case. Therefore, the few who are there are being overworked hence being less productive.
Patients suffering from such conditions which in most cases are considered terminal require special attention since most of them suffer from stigmatization. They need counseling and this can only be possible if the nurse-patient ratio allows the nurse sufficient time. Besides these cases, many other traumatized patients in the hospital need special attention. These include patients who have gone through domestic violence, fatal accidents, and other traumatizing events such as infernos. If not given proper psychological attention, most of these patients normally end up with suicidal or developmental problems. This explains the importance of having enough nursing staff that will have sufficient time with the patients, understand their needs and be able to attend to them without causing more emotional pain.
Having a small number of nurses in a healthcare facility translates to more hours of work. This means that nurses will be forced to spend more time at work especially when there are emergency cases. This also reduces their productivity hence making them ineffective and the result of it all is unsatisfied patients. Lack of rest normally translates to fatigue which mostly causes emotional imbalance, and this explains why some nurses treat their patients harshly. Nurses are expected to be sober since in most cases they are dealing with people who are not stable emotionally. Patients can be annoying for example when they refuse to take medicine or food necessary for their recovery. It, therefore, requires an emotionally stable person to deal with them since the most important goal is for them to get well and go home.
Conclusion
In conclusion, therefore, health care facilities should increase the number of nursing staff to improve the services being offered to the patients. They could be having all the facilities they need but offer poor services owing to less motivated staff. Staff motivation in this case narrows down to enough resting time which translates to having enough staff within the facility. Patients undergoing special treatments such as chemotherapy should be assigned a specific nurse who will be able to attend to them at whatever time they need the attention. This can only happen if the supply of nurses exceeds the demand.
The Memorial Hermann Health care system in Texas has a history that extends 100 years even though its outlook today took shape in 1990s when Memorial and Hermann systems merged. The memorial hospital was started by the Rev. Dennis Pevoto when he purchased an 18-bed sanitarium in a downtown neighborhood in Houston with an aim of establishing a hospital for all regardless of religion, ability to pay and race. Rev. Pevoto was then the superintendent of the then Baptist Sanatorium and worked hard to see the growth of the hospital and its mission.
The Hermann hospital, on the other hand, started in 1914 when George H. Hermann left his $2.4 million fortune for the building and maintenance of a hospital meant to benefit the poor and sick. It began operation in 1925, and the people who began this hospital believed that medical services should be made accessible to everyone. The hospital focused n saving lives, giving people a chance to face illness with courage (McManis Consulting, 2011).
After the merger of the two hospital systems, the Memorial Hermann has become the largest non-profit healthcare system in Texas. The organization serves the larger Houston community through its 11 hospitals, 7 Cancer treatment centers, 3 heart and vascular institute, 27 sports medicine and rehab centers. The Texas medical center has also grown to become the biggest medical center around the globe world. The mission of this health care system still remains to provide quality healthcare services to all people in Southeast Texas (Burke Center, 2009). A SWOT analysis into the health care system will evaluate its strengths, weaknesses, threats and opportunities.
SWOT analysis
Strengths
One of the greatest strength of Memorial Hermann is location. The organization has many hospitals, clinics, and service outlets in the Houston Metropolitan area, which are found, in 129 locations and with 21,000 employees (Burke Center, 2009).
Has the greatest market share of the hospital inpatient in Texas with 34% of the market. It has 11 hospitals with the largest one being MHH Texas Medical Center with 860 beds, eight suburban hospitals, 3 hearts and vascular institutes, a rehabilitation hospital and research institute, a childrens hospital, 8 comprehensive cancer centers and a Neuroscience institute (McManis Consulting, 2011).
After the Merger of the two hospital systems, the strategy focused on building market share and financial strength. The focus has shifted now to working in an environment where service providers are more accountable and risk for performance which is more responsive by becoming more integrated and working on the quality and cost of services (Burke Center, 2009). This strategy borrows from other industries such as commercial aviation and US Navy submarines especially in instituting patient safety.
An environment of transparency and just culture in the organization where people can speak of what is going on without being victimized or penalized is strength in the organization. According to the one of the directors, Charles Stoke, employees can say what they think is being done wrong and proactive actions taken to improve the situation (Rodak, 2012). This culture is also built through intensive training and other tools.
Weaknesses
In an environment where the financial incentives are changing towards more uninsured people, the hospital does not have the right number of beds, physicians, operating rooms and other facilities for this change to a new prototype of payment. The current fee-for-service system and the distribution of facilities will be too expensive for this change. The systems payer mix for 2010 included 39% private health plans, 34% Medicare, 15% Medicaid and 9% uninsured (McManis Consulting, 2011).
The organization also faces transformational challenges facing multihospital system due to a fragmented private practice medical staff
Opportunities
The population of the state continues to grow and especially in the Houston metropolitan area where population stood at 5.9 million in 2009 and is projected to reach 6.6 million by 2014. More than one-third of this population is Hispanic which is among the main target market for the healthcare system due to their economic status. Also, the population of Houston is younger than the national average with only 8.6% of it being over 65 years of age, which compares with the nations 13%. More than one third of this population is also uninsured or self pay and is growing quickly (McManis Consulting, 2011).
The Organization can also have opportunities in the healthcare reforms that are moving from fee-for-service to the fixed price environment. Through consultation with a financial consulting firm, Wellspring, the organization is re-engineering its financial strategy geared towards consolidating services (Rodak, 2012).
Threats
There is a highly competitive market for hospitals and healthcare system in Houston. The area has 4,000 bed-capacities over what is needed now, this is according to McManis Consulting (2011), and there are many acute-care hospitals in the area. The Memorial Hermann system in most days has about 1000 vacant beds in its 2,920-bed capacity.
The market place for health care in Houston is also highly fragmented in regard to physicians whose majority is in small, independent practices and the majority of them also voice strong feelings against physicians being employees of health care systems (Burke Center, 2009).
Texas State prohibits corporate practice of medicine, the Legislations which significantly influences the relations between physicians and health systems (Burke Center, 2009).
Reference List
Burke Center. (2009). Working together to improve lives: Local planning and network development 2009-2010. USA: Burke Center.
McManis Consulting. (2011). ACO case study: Memorial Hermann, Houston, Texas. USA: McManis Consulting.
Heritage Assessment has brought cross-cultural interactions whereby different cultures are mixture together. This therefore means that geographical boundaries are no longer a limit to different cultures. There are however certain features of culture for example relationships and religion that can barely be worn down by global communications. Much concern has however been raised throughout the entire world over personalized health care awareness.
It is essential that every organizational cultural setting have maximum effects on management and governance of issues related to health care. The fact that the public have become conscious towards encouraging sound health and prevention of various diseases have led to creation of methods and techniques that ease the work of health care professionals towards understanding the kind of patient whom they are taking care of. Heritage Assessment tool is one of the techniques that is being used to recover the traits of a patient before administering any sort of medical help (Edelman & Mandle, 2010).
Heritage is distinctive to human being just like fingerprints. This is because different cultures have got exceptional features that they do not share with other communities. Heritage is the parameter used mainly in identifying the ethics, way of life and the religious background of particular people in a specific geographical boundary. Traditional health schemes used in restoring, improving and maintaining of human health stand out to be a distinctive culture.
The concepts employed include the physical, mental and spiritual beliefs of an individual. It is not easy to outline the way in which health matters are being handled based on specifications of cultural heritage. This paper mainly addresses the usefulness of applying heritage assessment in evaluating the needs of whole person. It also compares the differences in health traditions between Middle Eastern communitys culture, Nigerian culture and Indian culture addressing mainly their health maintenance, protection and restoration.
Many peoples attitudes and opinions concerning health care providers have greatly changed after apprehending policies set by national health care. Heritage Assessment tool is being used by health care providers to identify with the client position regarding his/her beliefs and cultures. Actually it is the best way in which they can be able to fully understand the person they want to treat before taking any form of medical actions. Given that the ultimate aim of most health care providers is to alleviate diseases and assuage suffering in the best effective way possible, it is therefore practical for health care experts to fully understand the procedure that will make the patient comfortable.
In health care profession, understanding of cross-cultural value plays a vital role for the health care providers (Spector, 2000). A conscious understanding of cross-cultural setting will help the health care providers in administering health care to their patients in a comfortable way as possible. Heritage Assessment tool can enable them understand this and it will also ensure that all the measures of intervention used are in the boundaries of recipient cultures since that is the only way which will make them comfortable.
Heritage Assessment tool can also be used to differentiate diverse traditions and heritage of diverse cultures. Being an Indian and having an Indian background, practices, traditional beliefs and customs, I have various health beliefs and some are specific based on the region I come from. Indian people are well known for fair treatment and endurance of guests despite their economic status, religious beliefs and race. Elderly Indians have a belief that health and wealth are things related to the human mind, soul and body. Many Indians may not seek medications when it comes to mental health as compared to other diseases and some may wait until their condition is critical to seek for medical help. Most Indians believe in traditional medicine such as Homeopathy, Acupuncture, Naturopathy, Acupressure, Ayurveda, Unani, Homeopathy, and Siddha (Probst 2011).
Despite other Indians believing in Western medication, there are some who still prefer herbal medication to accelerate their healing process. Indians have a diverse and unique culture. Today, most Indians concentrate more on preventing diseases than cure. They emphasize more on health restoration, protection and maintenance using vaccinations, health screenings and physical examinations. The Indian public health providers are looking for a way to improve and offer the best health services to the communities. Sanitation and hygiene has been a major concern for the Indian government whereby they aim at improving water and food provisions in schools and also in public sectors such as hospitals.
The Indian government is also promoting health by offering health education to the public. Screening tests are being done in Indian to detect some diseases such as diabetes and hypertension. India as a nation is well equipped with modern health facilities both in private and public health care centers. Indians are also encouraged to seek medical diagnosis and counseling. These are some of the ways in which the country is helping in restoring, protecting and maintaining Indians health.
Indians are people who are modest and that is the reason why they prefer to have healthcare providers who are of the same sex (Hoffman 2006). Nigerians however have different health beliefs and traditions. Nigerians believe that spiritual, mental and physical qualities cannot be isolated from human health. They believe that having a sound health means that you are in agreement with the universe since life is a process. Nigerians believe that inborn diseases are as a result of dirty food, rain, heat and cold air.
They believe that demons and evil spirits are responsible for making people sick hence they seek opinions mainly from traditional healers whom they believe have the power to realize the evil spirits and demons. Nigerians have health policy set by the government with the main goal of attaining maximum health care to all the citizens (Spector, 2000). One of the ways in which Nigerians help in restoring, protecting and maintain the public health is by educating the public and holding campaigns against non-communicable and communicable disease. Nigerian government has also joined hands with World Health Organization to ensure that all the health services and promotions become successful.
The Middle Eastern communities however do have different beliefs and traditions from that of Indians and Nigerians. Arabs world is full of Muslims who mainly believe that superstitions of evil eye can cause diseases to the people. This is why you find that most people who come from Arab world put on incensed perfumes and bracelets to protect them from the evil eye. However, these customs and believes are vanishing as a result of rise in educational level among the Arab population.
The Arabs mainly emphasize on sound health maintenance through proper food nutrition and hygiene. Today, most Arabs will seek medical help after seeing the symptoms for the disease. The Arab community is fully aware of health promotion and prevention and that is why their government is offering free medical care in clinics and hospitals. Screening methods and immunizations are some of the ways people use to promote health strategies to prevent and detect illnesses.
In conclusion, this paper has mainly addressed the usefulness of applying heritage assessment in evaluating the needs of whole person. It also compares the differences in health traditions between Middle Eastern communitys culture, Nigerian culture and Indian culture addressing mainly their health maintenance, protection and restoration.
References
Edelman, K & Mandle, B. (2010). Benefits of Heritage Assessment tool. Penguin. Penguin Publishers.
Hoffman, B. (2006). Art and cultural heritage: law, policy, and practice. Cambridge: Cambridge University Press.
Probst, P. (2011). Osogbo and the Art of Heritage: Monuments, Deities, and Money. Indiana: Indiana University Press.
SPECTOR. (2000). CulturalCare: Guide to heritage assessment and health traditions (5th ed.).New York: Pearson Education/PH College.
I live in Florida State near a phosphate fertilizer manufacturing company. Lately, there have been complaints from local farmers that their cattles teeth are browning. Local veterinary doctors have suggested that the disease is coming as a result of the over ingestion of fluoride by the cows. Some local scientists have established that the problem did not exist in previous years and it might be coming from poor effluent disposal from the fertilizer company.
Delegates representing the local people were dispatched to the factory directors to enquire how they manage their wastes but no clear explanation was given. There is fear among the members of the community that the problem might be escalated to their health especially pregnant mothers and children below the age of two years.
As Brown and Gunter (2000) note, Fluorine is a major by-product emitted by fertilizer factories specializing in the production of phosphate fertilizers. It can be emitted into the air and thus contaminate the air animals including human beings breathe. Studies have established that this leads to serious health complications like stillbirths, cancer, lungs complications and miscarriages (Gunter, 2004). Children below the age of two years succumb to death if exposed to the dangerous gas for more than six months.
Bryson (1998), adds that wastes can also be released as liquid effluent which later percolates to the soil and water channels and poisons it. One in the soil, vegetables absorb it and pass it to human beings and animals when ingested. Animals are particularly affected because they feed directly from the poisoned grass. Milk from the cows is also contaminated and can affect a number of people in the neighborhood.
Short-term effects have already been identified. A report by the local dispensary indicates that there have been a growing number of patients complaining about breathing problems. Stomachaches complaints has also shot up and local doctors are now fearing that the cause might be coming from the nearby factory. The long-term effects of fluoride emissions are serious and locals are living with fear for their health.
The solution to the problem
The solution to the health issue is to write a letter to the director of the US Environmental Protection Agency in Florida. His office has the powers to order a detailed and comprehensive laboratory experiment to prove or disapprove the presence of the killer chemical. It would not make a lot of sense to write to the state secretary of health since they work from the recommendations of the agency. The US Environmental Protection Agency also has sophisticated laboratory equipment to test such chemicals (Bryson, 1998).
Letter to director US Environmental Protection Agency in Florida
Jeremiah Leopard
New Port
The Director US Environmental Protection Agency, Florida
Tallahassee.
Dear sir/Madam,
Re: Attention to Save the Lives of People in Northern Florida
I am writing to ask that your office hinder to the cries of the people in northern Florida State. After carefully analyzing the chain of command that will change the situation in my community, I realized that your office was the most suitable for the task.
As you are aware, there is a big fertilizer company located near the port in northern Florida. of late, there has been numerous complaints by the locals of frequent ailments suspected by local medics to be a s a result of poor waste management by the factory. We did anything we could to convince the local office to conduct adequate research but our efforts were not successful. The people are expecting help from your office since I understand the state ministry of health works from your recommendations. Kindly consider this request to prevent a major calamity to the people of Florida and America as a whole.
Yours faithfully.
References
Brown, P. Gunter, J, (2000), Knowledge, Citizens and Organizations: An Overview of Environments, Diseases, and Social Conflict. Massachusetts, Massachusetts university press.
Bryson, C. (1998) The Donora Fluoride Fog: A Secret History of Americas Worst Air Pollution Disaster. New York, John Wiley and sons.
Gunter, K, (2004), Illness and the Environment: A Reader in Contested Medicine. NewYork: New York University Press.
Health is a fundamental component of national sociopolitical systems of different countries worldwide. Consequently, politicians make attractive promises during election times concerning the plans they have in place for their national health care systems. Unfortunately, their promises are usually based on false assumptions that they know what is best for their health care systems. Health is also a major issue of the emerging international political system led by United Nations whose World Health organization (WHO) agency manages global health affairs in member countries. World Health Organization defines health system as the organization of people, institutions and resources (both financial and non financial) whose purpose is to offer health care services to meet the health needs of target populations (Sharma & Atri 2010, p.386; Johnson & Stoskorpf 2010, p.3). It is important to note that health according to WHO refers to a state of complete physical, mental and social wellbeing of an individual or group of individuals and not absence of an undesirable physical condition that requires medication as most people assumes (Johnson & Stoskorpf 2010, p.3).
Health care system like any other constructed human system is complicated and requires qualified staff, finances, information, supplies, transport, communication and general management and direction (Johnson & Stoskorpf 2010, p.3). Health care systems operate within unique social, cultural, economic and political environments. There are as many health systems as the number of countries in the world which differs considerably in size, form and scale. Consequently, health systems have organizations, procedures and results that differ considerably from one country to another (Johnson & Stoskorpf 2010, p.3). The purpose of this essay is to establish similarities and differences between Saudi Arabias and Romanias healthcare systems.
Similarities and differences between Saudi Arabia and Romania health care systems in the light of major national factors
Saudi Arabia is a Muslim Kingdom located in West Asia. It is the home of Islam and its population is entirely of Sunni. Saudi Arabia is a perfect example of a country where Islamic system of law or Sharia is sternly followed. Saudi Arabias economy is mainly dependent on oil which accounts for over 85% of sales abroad (Shoult 2006 , p.19).Currently, the country is pursuing policies of economic diversification and is striving to raise the role of the private sector at a time when the rate of unemployment is recognized at four percent. Shoult argues that since Saudi Arabia boasts a quarter of the worlds oil reserves, the Kingdom is expected to hold on to its position as the worlds largest oil producer for the near future. Crude oil represents approximately 40% of Saudi Arabias GDP. Shoult (2006 ,P.19) notes that every year about 75-90% of Saudi export revenue is drawn from exports of crude oil, natural gas and refined products Shoult (2006,P.20).
Politically the country has been facing new political challenges particularly since the Sep 9/11 terrorist attacks on United States. Pressure has been put on the government to get rid of the Islamic Charities, amend school national curriculum, and enhance popular or civic participation especially with respect to the social status and role of women in the society Shoult 2006, p.19). Shoult (2006, P.21) explains that private sector players and foreign investors have to be conventional to the governments Saudiization programme intended at making employment opportunities for its rapidly increasing population.
It is important to note that the government and religion in Saudi Arabia have immense influence on virtually every aspect of Saudis day to day life. For instance Campagna (2006) argues that independent reporting on politics continues to be almost absent in Saudi Press even though print media from time to time pass judgment on the performance of low-level government departments and public institutions. However, critical reporting of the royal family, friendly foreign governments, widespread corruption, oil revenue distribution and local and regional divisions are highly limited Campagna (2006). For instance, Campagna (2006) argues that even though majority of newspapers in Saudi Arabia are owned by private investors the state remarkably influences what is disseminated and approves appointment of senior media officials like editors-in-chief. Consequently, there is no opposition journalism in Saudi Arabia. In a nut shell, the contexts in which human systems including health systems as well as business systems operates are to a large extent shaped by the intensive religio-political nature of Saudi Arabias society.
According to WHO and World Organization of National Colleges, Academies and Academic Associations of General Practitioners Saudi Arabia has a health care system in which the government is at the centre stage of health care services provision through a number of agencies (2008, p.136).Like other private sectors in different industries, private health sector is also growing (WHO et al 2008, p.136). Oxford Business Group (2008,p.186) observes that has recognized that privatization is important in ensuring that a health care service of high quality is available, accessible and affordable by majority in the long term. However, Oxford Business Group (2008, p.186) opines that even though the process of privatization will take long, as the government seeks to trim down its participation in the sector opportunities for private venture and investment in the health care market in the wider Gulf Cooperation Council (GCC) will prove attractive. In Saudi Arabia the duty of the Ministry of Health is to provide an all-inclusive preventive, curative and rehabilitative health care. The ministry also shoulders the responsibility of taking care of the heath human resources in a ways that will inspires up to standard performance WHO et al (2008, p.136).The Ministry of Health gets approximately 10 % of government total expenditure. According to WHO et al (2008, p.136) Saudi Arabias total spending on health is 77% which comes from the government and 23% from private sources.
According to Oxford Business Group (2008,p.186)pressures of Saudis population that is growing at a fast rate and Saudi Arabias increasing affluence are combining to put greater strains on Saudi health care system which is largely funded by the state. For example, over the next 10 years Saudis population is anticipated to grow by about 30% from 23m to around 30m consequently bringing about an increasing demands on the provision of health care services Oxford Business Group (2008, p.186).Even though wealth will bring about greater longevity, it will not reduce the need for health care if available statistics in the developed countries is anything to go by (Oxford Business Group 2008, p.186).Trend of a raising life expectancy is in fact expected to increase the strain up on resources in Saudi Arabia as demand for expensive treatments increases (Oxford Business Group 2008,p.186). For example, a report by (Oxford Business Group 2008, p.186) points out that diseases attributed to affluence and developed societies Such as cancer, diabetes and heart diseases are already rampant in Saudi Arabia and that in near future this trend is likely to continue. Furthermore, as a more learned and educated population becomes aware of the different treatments available more demands will be placed on the kingdoms healthcare system (Oxford Business Group, p.186).
Romania is ruled on the basis of multi-party democratic system and of separation of powers between the legislature, executive and the judiciary (Shen 1997, p.16; Nunberg, Bar bone & Derlien 1999, p.94). The country is a parliamentary democracy with executive powers vested in the Prime Minister (Shen 1997, p.16). The president is chosen through a popular vote for a maximum of two terms (Shen 1997, p.16). Romania is one of Eastern European countries that fell under the iron fist of the Communist rule (Shen 1997, p.16; Nunberg et al 1999, p.94) observes that during the 42 years when Romania was under Communist rule the country underwent extensive social changes and cultural transformation. He however argues that the countrys deep-rooted cultural values like strong religious beliefs and a enthusiasm for learning continued relatively intact while under the totalitarian state. Shen argues that despite the transitional social unrest that has been common in former Communist states that have been undergoing liberalization, Romania has succeeded in instituting a functional and democratic government (Shen 1997, p.16; Nunberg et al 1999, p.94; Tanchev et al 2008, p. 24).
Romania had a GDP of approximately $254 billion and a GDP per capita of $11,860 for the year 2010 (World Bank, 2008). After the fall of the Communist rule in 1989 the country underwent a decade of economic instability and decline brought in part by an obsolete industrial base and a lack of structural reorganization Shen (1997, p.16). Karatnycky et al (2009, p.310) argues that even though there are indications of an economic recovery and stabilization, Romania still has a long way to go.
According to Marshall Cavendish Corporation (2009, p.1573) after the collapse of Communism, Romanias health care system had many challenges to deal with including inequality between rural and urban health care services and a slow transition from a highly nationalized health care system to a decentralized and localized system Schubert, Hegelich and Bazant (2009, p.67). Even though Romania has high-quality health staff, the systems outdated equipment and extensive corruption has hindered positive progress (Cleaf 2007, p.4). While in Saudi Arabia the government gives health care main concern in planning and budgeting Romanian politicians have pushed health care to the bottom of the priority list (Oxford Business Group 2008, p.165). In addition, recurrent ministerial change around and turnovers has caused considerable delays and instabilities in the development agenda of the health care system. While in Saudi Arabia Ministry of Health budget accounts for 10% of the countrys expenditure, Romanian health budget account for less than 5% of the countrys GDP. For instance, in 2008 health budget accounted for 4.5% of the countrys expenditure which was a 27% increase from that of year 2007 (Oxford Business Group 2008, p.165).
While there are concerted efforts by the government in Saudi Arabia to create a bigger room for privatization of the health sector, there is a lack of commitment on part of the Romanian government with respect to defining the role of the private health sector in the economy. Private health sector in Romania has progressed slowly compared to Saudi Arabias that is currently developing at a renowned pace in environments that are increasingly becoming conducive to private domestic and foreign direct investment. In Saudi Arabia preventive care has been part and parcel of the health care system and is even envisaged in the mission statement of Ministry of Health while in Romania preventive care is a relatively recent part of the current health care strategy. The two countries however are currently facing similar challenges including lack of enough beds and doctors per head and both requires significant investment if these bottlenecks are to be conquered (Oxford Business Group 2008, p.165).
Although there is an evident physical upgrade that is taking place in Romania, there is a basic challenge of shortage of human resources supply to the system because medical professionals continue to leave Romania to work in other countries where there are attractive salaries Oxford Business Group (2008, p.165).On the other hand, cases of brain drain in Saudi Arabia are relatively fewer. In fact, Saudi Arabia is one of the oil rich Asian economies that are importing highly skilled manpower from developing countries because of its attractive salaries in virtually all industries. While in Saudi Arabia there are cases of a rise in diseases associated with affluence and developed societies like diabetes and cancer, case studies show that a considerable number of Romanian families from certain communities are often affected by poverty diseases (Fleck & Rughinis 2009, p.108).In some communities lack of drinking water, congested housing and low incomes all increase health risks for many people.
There is disparity in access to health care services in both Saudi Arabia and Romania between rural and urban areas and between various social groups. Urban families in Saudi Arabia and Romania can easily access health services compared to those living in rural Romania and nomadic communities in Saudi Arabia. In the two countries one of the main challenge facing the health care system is inequalities between rural and urban health care (Marshall Cavendish Corporation 2009, p.1573; Oxford Business Group 2010, p.285). In Romania, apart from the unequal access to health services experienced between the urban and rural areas some social groups do not access services equally with other privileged groups. For instance, Chew-Graham, Baldwin and Burns (2008, p.168) argue that special health needs of the mentally ill has not always been recognized and respected by the general services in Romania. These scholars further add that stigma is still a big stumbling block in guaranteeing access to good care for the mentally sick patients in Romania.
Major external influences impacting on delivery of health services in Saudi Arabia and Romania
Provision of health services is influenced by a combination of internal and external factors in virtually all countries all over the world. While internal factors are more critical in determining how health services are provided to target populations, external factors impacts significantly on delivery of health services. In Romania for instance impacts of liberalization spearheaded by Western countries that followed collapse of Communist rule in that country cannot be underestimated. For example, Bara et al (2003, p.38) argue that numerous changes have taken place in Romanian health care system due to shift from a centrally planned, state system to a more decentralized health insurance system with private elements. Even though privatization has been slow, Romanian citizens have alternative sources of health care services apart from the state controlled hospitals and clinics Jones (2006, p. 143). In Saudi Arabia privatization is increasingly gaining ground in the health care sector a move that has attracted foreign investors whose ventures influences provision of health services in that country (Voinea &Pamfilie, 2011).
Apart from privatization which is attracting external investors who end up influencing provision of health services in these two countries, international resolutions made by global and regional health organizations like EU and WHO which the two countries ratify inevitably impacts up on health care service provision especially with regard to children and the less privileged in the society (United Nations General Assembly 2006, p.76).In Saudi Arabia even though majority of the doctors and health workers are local a considerable number are trained outside their country. Also there is a high number of foreign health professionals from other countries who are attracted by financial rewards in Saudi Arabia. This trend which is a product of globalization forms one of the major external influences up on Saudi health system. In Romania a major external influence on her health systems has been implementation of an integrated management system in conjunction with WHO. The HIV/AIDS scourge put strains up on health systems of all nations in the world including Saudi Arabia and Romania. The number of patients seeking medication tends to rise where prevalence of HIV/AIDS is high as a result of opportunistic diseases. Furthermore health professionals and workers get infected and affected by the deadly virus thereby blocking their urgently needed services United Nations (2006, p.769).
Conclusion
Both Saudi Arabia and Romania have healthcare systems that are complicated and comprehensive even though they have evolved and progressed differently. These differences can best be explained by their diverse national conditions like politics, economy and demographics and different histories. However, the two health systems are undergoing significant changes such as privatization of the health sector which will inevitably impact on delivery of health services in the two countries.
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