Category: Nursing

Introduction

Australia is a very big country. The population is very high in city areas, but the population is very spread out in rural Australia. There are many villages and towns which are many hundreds of miles away from bigger cities and towns. The population of these rural towns is very small. Some may have only a few hundred people and some may have only a thousand or two thousand. Due to this, health is a very big problem in those places. It is not possible to have a good hospital with all facilities in such areas. The purpose of this paper is to study rural health care in a remote place in Queensland. The report is prepared as the writer is applying for a job in a rural area as said in the next section.

Background of the study

The study will be referencing a lady called Mary. She has type two diabetes and only now has to know that she is terminal, that she may die soon. Her father is Italian and her mother is a local aboriginal person. She has five children and lives in a very small town, i.e. 25 km from a small town with only 2500 persons. Only one 10 bed hospital is there. The nearest tertiary hospital is 500 km far. She had to be admitted to a tertiary hospital because the local hospital has no facility to manage her type 2 diabetes. In the local hospital only one doctor, one registered nurse and one enrolled nurse. The latest news is that Mary is dying because of advanced disease and she knows about it. She had been told about diet, medication, exercise, and other things by experts when in a tertiary hospital.

Primary health care initiatives in rural areas

Primary health care in rural areas and urban areas is very important. It is more important in rural areas because if one falls sick to serious diseases there is no facility for proper treatment in rural areas. Primary health care is defined as socially appropriate, universally accessible, scientifically sound first level care provided by a suitably trained workforce supported by integrated referral systems and in a way that gives priority to those most in need, maximizes community and individual self-reliance and participation and involves collaboration with other sectors. It includes health promotion, illness prevention, care of the sick, advocacy, and community development. (Sibthorpe, Glasgow, and Wells 2005).

This is a very detailed definition and self-explaining. A perfect rural primary health care plan will include all factors said in the above definition. But it is seen that all these facilities are not available for Mary in a local hospital. She has only one doctor, one registered nurse, and one enrolled nurse for help. She also has availability of some medication like insulin injection which she has to take daily. She learned and is doing this on her own.

Qualification for enrolled nurse

The writer of this report is an enrolled nurse (EN) at the local hospital for Mary. A registered nurse/cannot medicate Mary alone. The EN has to follow instructions from the registered nurse and sometimes the doctor. So, EN is under the direct control of the registered nurse. But EN is held responsible for own actions and so has to be careful in carrying out orders of superiors. A registered nurse is fully qualified with a degree or masters degree in nursing.

Practicing even without supervision is allowable for such qualified nurses. The EN is much lower qualified. Enrolled nurses in Australia are primarily educated through advanced certificate or associated diploma level courses in colleges of technical and further education, of which the duration is less than three years. (Enrolled nurse 2008). If not a native English speaker EN should also pass recognized language proficiency tests like IELTS. So this writer is only qualified to assist the registered nurse in helping Mary.

For preventing Marys admission to a tertiary hospital, the following things should be done. once diabetes is detected which is possible in a local hospital, it is the education of disease that is important. Mary should be taught that diabetes especially types 2 be fatal. She is educated that treatment is difficult in a rural area so diet and exercise are very crucial. Taking insulin tablets is also very important. Checking glucose levels every day is also important.

This is what might prevent Mary from her disease from getting serious. Moreover, Queensland people have more chance of getting type 2 diabetes because of race, genetic factors, diet, lifestyle, etc. they are also less educated, especially aborigines, and will not usually take disease control and prevention factors seriously. These are also steps to be taken for all diseases, that is educating people for control and more importantly prevention. Steps like informing people of the dangers of smoking, obesity should be taken.

According to John Menadue (former head of the following organizations in Australia: Department of Immigration and Ethnic Affairs, Centre for Policy Development, Quantas, etc) the countrys health policy should have focused more on wellness-centered treatment along with illness-centered treatment. He is correct in saying that a change be made and a wellness model be developed for the country. A model on wellness and illness will be given later in the paper. The shift should be made from hospitals and disease to more focus on primary health and wellness. The community should also be involved very much in these activities. These points are taken from a speech by the person to the CS & H Industry Skills Conference on 7 June 2005.

Changes

Recently many changes have taken place in primary and rural health care due to initiatives from the government and also not for profit organizations. From 1992 a Rural Health Education Foundation has been set up by a not for profit organization. It provides accredited education services to general practitioners and other health professionals working in rural and remote Australia. (Rural health educational foundation 2008). It focuses on providing latest education, information and news to all people (doctors, nurses etc) in health care in remote rural areas. The biggest facility is the satellite and internet linking facility.

Through this, experts from various fields educate the latest news and trends to professionals in rural areas. It also receives inputs from these rural areas. Another initiative is the Australian Primary Care Collaboratives Program (APCCP) and The Australian Primary Health Care Research Institute (APHCRI) set up by the government. According to the website of the former, their aims are to improve clinical health outcomes, reduce lifestyle risk factors, maintain health for chronic and complex conditions and improve access to Australian general practice. The latter organization is aimed at increasing research in primary health care.

It wants to place the research habit inside the primary health care sector and the general practice sectors in the country. But the greatest service for health education and for treatment for rural areas is the world famous Royal Flying Doctor Service dedicated to give health care and treatment to rural areas throughout the country. They also visit the town where Mary stays in case of emergencies or if some special treatment is needed. This is also a non-government, not for profit organization. It could be said that if the formation of all these organizations existed when Mary first had this diabetes, she will not need to be admitted to tertiary hospital. Maybe her life itself be saved through proper care and disease management.

Wellness and illness models

A wellness model released by the National Wellness Institute based in the United States. (Hetller).

They give six dimensions to wellness. Physical refers to optimum physical activity (exercise, yoga, aerobics etc) to maintain and better health. Spiritual refers to the spiritual mind of the person which can be better by activities like meditation etc. Intellectual refers to harnessing creativity and talents. Social means how the person has a healthy social life which is important for good health. Emotional health can be increased with inputs from spouse, family, friends, community etc. Occupational means doing a job that a person enjoys which will be in tune with his talent, education etc. It also means learning to enjoy the job. A combination of all these things is a sure way to wellness.

The most well known illness model is developed by John Rolland called Family Systems Illness Model. (Mengel, Holleman and Fields 2002).

The innermost circle is about personal understanding of disease, like type, if any disability may come or death may come. Next the understanding of the family of the situation comes in outer circle. Third in the outermost circle comes their belief systems and culture that should be used to understand and manage the situation. (Mengel, Holleman and Fields 2002).

Role of enrolled nurse

The qualification needed and responsibility of enrolled nurses already been mentioned in earlier section. This includes patient care, giving medications, injections and all other duties required by a nurse and only under the supervision of the registered nurse. But there are other things an enrolled nurse can do. This is by mainly giving primary education to the community. This is also practical because people number in communities like Mary stays is very small.

Each day a few houses can be visited and careful explanation can be given to the inmates of the houses. This can be done only with the authority of the registered nurse. Maybe the doctor and the registered nurse can also do this and the EN can go to help them. In such communities education levels will be low. Aborigines will also be poor and may not have internet in homes. Far off places may also be cut off from technology even if money is there.

So educating community about health is the most important thing that an EN can do. EN cannot give medications or injections without okay from registered nurse. So services mentioned above are one way to help people. All this should be done with reference to Mary. A visit to her house (25 kms away) should be done two times a week. This is now more important since she is terminal now. Her family should also be prepared to take care of her and also understand and come to terms with the serious condition of her.

Job opportunities

It can be seen that there will a plenty of job in rural areas for nurses. This is because only serious service minded nurses be willing to work in remote areas. They will be away from their own families and friends. They will also have not too much recreation facilities to enjoy after duty hours. The writer will apply for job because service is a passion. Moreover, people will be close in small communities. The friends can be close and also people will also help and assist each other more than city areas. There are many ways in which to apply for job in rural areas. There are many classified in print and on the internet that asks for EN to work in rural community.

The pay may be lesser than what is given in cities. There are also government jobs and advertisements for rural enrolled nurses. With so much demand there would be no problem in getting a nursing job in rural areas.

Education and preparation

The education qualification for enrolled nurses is already given in earlier sections. Preparation is a lot for such posts. As mentioned earlier, life will be lonely in case a lot of friends are needed by the person applying for the job. Basic facilities for living will be very little available. The climate will be a problem without air conditioning and heating. Even electricity might be a problem Because of size, the community may be far off from the family of the nurse. Travel facilities will be basic mainly only by road or small airplanes. The health of the nurse himself is also risk if he himself gets sick. This is a possibility if the disease treated is contagious.

So, apart from education qualification, the EN has to mentally prepare for handling the job efficiently. The nurse will also have to work with different cultures and races and give equal treatment to all. Moreover service minded persons will prefer such jobs more than money minded people. The writer feels that as a nurse, service is the most important thing. Hence the writer is well qualified to work in such an area.

Support services

Support services of the organizations mentioned earlier can be used. Also the internet which is available in most communities (at least few connections will be there) is also a very useful tool. Using private radio and HAM is also very useful. This can be used to ask for assistance and also to learn how other rural health professionals manage their duties and responsibilities.

Conclusion

The health care situation in rural Australia with special reference to Queensland and terminally ill Mary has been done. it can be seen that the recent developments in rural health in the country may prevent Marys present condition, if only applied much earlier in her life. But situation is now improving and the story of Mary may not be repeated. High technical facilities will never come in rural areas. Hence education and prevention is the key for health improvement in rural areas and many steps being now done. to make it possible. This will make life healthier in rural Australia.

Bibliography

Enrolled nurse. (2008). ASA Group: Australian Nursing Council. Web.

HETLLER, Bill. Six dimensional model of wellness. National Wellness Institute. Web.

MENGEL, Mark B., HOLLEMAN, Warren and FIELDS, Scott A. (2002). Managing Chronic Illness. Fundamentals of Clinical Practice. P.286. Web.

Rural health educational foundation. (2008). Rural Health Educational Foundation. Web.

SIBTHORPE, Beverly., GLASGOW, Nicholas J., and WELLS, Robert W. (2005). Sustainability of reforms is the key to progress. The Medical Journal of Australia: Questioning the sustainability of primary health care innovation. Web.

Nursing

I have recently completed a Bachelorss Degree in nursing and I am currently looking for suitable long-term employment. I am a hardworking person with a great personality benchmarked by excellent interpersonal skills which have helped me score great successes in the past. While at college I held several practical exposures at different hospitals, which I received favorable comments from staff and the management.

I have only recently moved to this area. Your institution was brought to my attention by one of my instructors at college, who said that you are currently hiring additional staff due to an increase in patient numbers. Your record of providing quality and timely services to patients makes me desire to be part of your team.

If there is a suitable vacancy for me, please let me know. I will be grateful to speak to you at any time. I am enthusiastic about exploring opportunities with your institution and I look forward to meeting you.

Nutrition and Oral Hydration: Resuming Postoperative Diet

The first diet doctors usually prescribe after an operation is a clear liquid diet. It is fat-free and based on water and juices. A soft diet corresponds to the next stage in recovery and contains limited solid foods. Eventually, a patient can gradually transition to a regular diet. Nurses assist patients on bed rest in preparing meals.

Performing Eye Irrigation

A medical professional should perform eye irrigation on a lying client. First, it is necessary to apply anesthetic eye drops, cover the clients neck and shoulders, and place a kidney dish next to the face. The next step involves slowly pouring the irrigation liquid onto the front eye surface. Finally, the client should move the eye in all directions.

Communicating with a Client Who is Hearing Impaired

When communicating with a client with hearing loss, it is important to face them, talk slowly, but naturally and avoid compound sentences. Ideally, there should not be any visual or audible distractions. Finally, it is useful to position oneself closer to the clients better hearing ear.

Reduction of Risk Potential

Anchoring with Tape an Indwelling Urinary Catheter

After choosing the appropriate sight for application, the nurse should apply three inches of tape directly to the skin. The next step is to wrap some tape around the tube and attach it to the previous tape. This way, the tape securing the catheter can be removed without directly pulling the clients skin.

Priority Action for a Non-functioning Urinary Catheter

When the urine is not draining through the catheter, it is crucial to check if the client has abdominal pain or discomfort. It is also necessary to ensure that the positioning of the catheter is correct, and the tubing has no kinks. If a blockage is causing a malfunction, a medical professional should replace the catheter with a new one.

Physiological Adaptation

Maintaining a Self-Suction Drainage Evacuator

After the evacuator installment, nurses should regularly empty the half-full drain and measure the exudate volume (Perry, Potter, and Ostendorf 2019). Moreover, they should remove drainage and debris from the tubing. It is also crucial to frequently clean the insertion site.

References

Perry, Anne Griffin, Patricia A. Potter, and Wendy Ostendorf. 2019. Nursing Interventions & Clinical Skills E-Book. 7th ed. St. Louis, Mo: Mosby. Web.

The roles and responsibilities of a registered nurse when delegating nursing care

A registered nurse obtains a license from the Australian State or Territory

Nurses Act or Health Professionals Act to practice in Australia. (ANMC, 2005). Of superior competence and reliability, she practices alone and interdependently. Accountability and responsibility makes her the right person to delegate nursing care to lesser qualified nurses under her supervision. Evidence-based nursing care is provided to individuals of all ages and cultures. Promotion and maintenance of health, preventive care, rehabilitation needs and palliative care are managed by registered nurses. Goals and health outcomes are achieved with the collaboration of the multidisciplinary health team. The registered nurse becomes indispensable to the health care system with her knowledge about and capacity to respond to individuals different in ethnicity, cultures, spirituality, socio-economic factors and beliefs about illnesses (ANMC, 2005). Leadership qualities set her apart from other staff in coordinating and ensuring the best possible health outcomes. Her competencies lie in her profession where she functions much in compliance with the relevant legislations and safe-guarding human rights. Critical thinking, self-analysis and experience assist in evolving a thoroughly competent and reliable professional. Her contributions to the developing health care requirements and her ability to contribute to the multidisciplinary team through the development of relationships are commendable. However her competence is questioned due to the dire shortage of professional nurses (Jones, 2002). Severe stress is experienced by the registered nurses due to the workload and heavy responsibilities. The agency nurses who are enrolled increase the responsibility of the remaining staff. Inability to use their high efficiency and expertise in patient care could also disillusion qualified nurses and cause them to leave the profession (Duffield et al, 2008).

Adhering close to the legal requirements for medications, she knows exactly which medicines can be prescribed by her and which need the prescription of a doctor. Nursing interventions can have legal implications and she demonstrates her awareness in her calculated actions. Upkeeping confidentiality is another of her pre-occupations. Recognised standards of practice are maintained by her. Patients should be protected from harm and on no account is she ready to compromise on their care. She is familiar with alternative strategies for interventions and looks out for behavior which can be bad for the patients health. Unsafe practices are condemned by her. Greater autonomy raises the accountability of nurses and education should be focused on improving the liability attitudes; it should essentially be an attitude-oriented education (Kim et al, 2007).

Ensuring that her personal values or beliefs do not interfere with her practice, she is able to understand the cultural or ethnic differences among her patients; cultural competence is essential for any professional who desires to be efficient in her calling (Ethnic Communities Council of Victoria, 2006). Complying with their cross cultural behaviour, she adapts to their requirements in values, beliefs and biases. Innovative changes in practice, organizational policies and other current knowledge are always known to the nurse and further enhance her competence. Upholding the dignity of her office, she accepts the dignity of others with grace, promoting and protecting their interests under her care. Keeping up with research evidence, she uses her new knowledge in keeping her practice safe and effective. Professional development results from her sharing information with her colleagues and higher-ups. She prioritises her workload according to the urgency of requirement and responds suitably to emergencies.

Recognising the limitations of enrolled nurses and unlicensed care workers, she shares her work cautiously. Aware about the scope and extent of delegation to these lesser qualified personnel, she takes care not to load them with responsibilities that cannot be accounted for by them. However she knows that delegation and supervision of other personnel who cannot take responsibility for some of their actions in providing care is necessary due to the shortage of registered nurses. If she feels concerned about some delegation, she can raise her doubts at the right forum. Enrolled nurses and unlicensed carers are safe in her hands. Delegating caring jobs or interventions according to the qualifications or capabilities of the person to whom she is delegating a job, she then supervises the work being done, teaching the carer or enrolled nurse as required. She abides by the legislation and organizational policies which allow the delegation. Effective and timely supervision would be entailed in the monitoring of the delegated job being done. Techniques, direct and indirect, would be employed by her to coach or mentor the delegated carer. Documenting the work delegated, she provides support to the carer ensuring optimal nursing care to the patient. Accreditation is another powerful manner of controlling the quality of any profession (Cherry and Jacob, 1999)

What the responsibilities of the registered nurse in the scenario were when considered delegating medication administration responsibilities to the enrolled nurse

Highly developed and advanced collaborative and team building skills are required of the nurse leader envisioned for 2020 (Huston, 2008). This is not evident in Tonys behaviour. He has not confirmed the performance level of the enrolled nurse, crossed the borders of his responsibilities and forgotten his duties by the ANMC standards for a moment and compromised his delegation powers. He is actually allowed to delegate the jobs that can be competently done by the delegated enrolled nurse. Only those aspects of care may be delegated as can be permissible based on the role, functions, capabilities and learning needs (ANMC, 2005). He has to teach the delegate and assess competence (Queensland Nursing Council, 2005). Clinically focused supervision must be made of the job delegated. Client outcome has to be monitored and evaluated. Tony has experienced one or more of the effects attributed to busyness by succumbing to his weakness of delegating a job he should have done himself: missed opportunities, compromised safety, emotional and physical strain, sacrifice of personal time, incomplete nursing care and inability to find resources (Thompson et al, 2008). The enrolled nurse feigns ignorance about the procedure. Tony does not pay attention to her appeal and insists that she do it away from his supervision. Though he claims that he is accountable and responsible for whatever the enrolled nurse does in replacing the syringe driver, the job would be done away from his eyes and may be done wrongly too. Legislation and organizational policies do not allow Tonys action (ANMC, 2005). Tony has to remember the ethics of responsible nursing before delegating a job (Daly et al, 2006). The consequentialist theory states that an action cannot be merely right or wrong morally; it has to be judged by its consequences (Daly et al, 2006).

Legally, morphine comes under the Health Regulation Act of 1976 where the drug is only given to a registered nurse with the relevant Drug Therapy Protocol endorsement (Queensland Nursing Council, 2009). Possession, administration and supply of the controlled drugs under the DTP can be only be done after obtaining an authorization from a higher authority like the Queensland Nursing Council which established the Nursing Act of 1992 (Queensland Nursing Council, 2009). Moreover only a qualified competent registered nurse with the DTP can administer morphine, not an enrolled nurse who is delegated. Tony made the mistake of just demonstrating the method of changing the syringe driver without actually making her do it at any time (ANMC, 2005).

The enrolled nurse has the right to complain to a responsible supervisor or manager of the unsafe practice that she has been delegated (ANMC, 2002). She has understood that her action may not be ethical and she cannot be accountable or responsible for the job delegated. Knowing that her profession has ethical, legal and professional responsibilities like any other and she is as responsible for providing safe, effective and optimal health outcomes as anyone else in the health care system, she can also refuse to do the job (ANMC, 2002). Tony is liable to be proceeded against for his unethical and unprofessional conduct.

References

Australian Nursing and Midwifery Council, (2005). Web.

Australian Nursing and Midwifery Council, (2002). Web.

Cherry, B and Jacob, S.R. (1999)  Contemporary Nursing: Issues, Trends and Management, Mosby Publication, St. Louis, Missouri (1999).

Daly et al, (2006), Contexts of Nursing Churchill Livingstone, Elsevier.

Duffield, C. (2008). Nursing work and the use of nursing time. Journal of Clinical Nursing. 17(24):3269-3274, 2008. Blackwell Publishing.

Ethnic Communities Council of Victoria, (2006). Cultural Competence Guidelines And Protocols The Australian Government.

Huston, C. (2008). Preparing nurse leaders for 2020. Journal of Nursing Management. 16(8):905-911, 2008, Blackwell Publishing.

Jones, L. (2002).  Nurses Quit Australian Hospitals in Record Numbers.

Kim, K-K et al, (2007). Perception of legal liability by registered nurses in Korea. Nursing Education Today, Vol. 27(6), p. 617-626.

Thompson, D. et al. (2008). The relationship between busyness and research utilization: it is about time. Journal of Clinical Nursing. 17(4):539-548, 2008, Blackwell Publishing.

Queensland Nursing Council, (2009). Web.

Queensland Nursing Council, (2005). Web.

The national and civil wars have a pervasive effect on the common life of Somali people, which tormented them to an extent. The majority of people are migrated to America, Middle East, and European countries. Civil war leads to their dreadful situation. Under the warlords, the Somali people lead a suffocated life. A large number of people went to the USA for better life and security. The majority of people in Somalia are staunch believers of Islamism. They admit the only god Allah. They strictly follow five-time prayers a day. The Minnesotans believe in God and Satan. They also believe in fate.

New political changes and social reformations made some changes in the life of the Somali people. These social reforms were helpful for the emergence of a new family system. The influence of western culture especially America is visible in Somalia. It also has been affected their communication process. Their social values are similar to Americans. They keep the values like independence, friendship, Cooperation, and individualism.

According to them, family is the center for personal development and personal security. They develop a healthy family system and they protect the family loyalties extremely. In recent decades Somalis give more importance to education.

Without racial discrimination and nationalism, the people follow a strict and systematized education culture. Abigail F. Castle and Susie Kuratas comment makes it clear when they rightly put it as: In addition to the normal stressors involved in going to a new school, a refugee must also deal with learning a new language and a new culture. Here it is clear that there is a gradual development in communication pattern. (Journey Into the Somali CultureBy Abigail F. Castel & Susie Kurata).

This led the people into a status of literacy. The established pattern of emotional or behavioral responses affects the educational and developmental performances of people. The emergence of the all-University Consortium on children, Youth, and Families at the University of Minnesota made drastic changes in the field of the communication pattern. It includes educational institutions, social service organizations, individual groups, private companies, mass media, religious organizations, and higher education representatives.

One of the most important and notable developments in the field of communication is the Consortiums Electronic Clearinghouse (CEC) It is an easy way to communicate with people. It paved the way for drastic development in communication. The working of CEC connected with internet, Anyway this electronic world lead the whole nation into the world of knowledge. Even though a large number of Somali students studying in American schools, most Somali children who are 16 years old or younger have not received any formal schooling. It really shows the pathetic state of Somalis in the modern world. In each year number of young professionals are created, a large number of people reaches the teaching profession. It provides the chance to spreading knowledge about Somalia into the world.

Both verbal and nonverbal communications are a vital part of communication. Autism (disability to communicate) is a lifelong phenomenon or a developmental disability that prevents the natural growth of verbal and nonverbal communication. It was mainly caused by their inability to communicate socially, educationally, and culturally. In Somalia, the region provides a rare chance for social interactions and leisure activities. At the time of the spreading of educational institutions, a gradual change happens in the field of verbal communication. The emergence of television and other visual media communication has been brought some changes in the social and cultural life of Somali.

The Somalis follow a traditional healing system that takes away the nursing practices of the modern world. Firstly the traditional healing emerged as a religious practice.  Although historically, the phenomenon of spiritual healing emerged as a religious practice, within the context of specific religious traditions and has traditionally been ascribed only to mystics, saints and holy persons, in modern times a variety of spiritual healing practices unconnected with traditional religion have entered mainstream professional healthcare. ( Healing at the Borderland of Medicine and Religion: Regulating Potential Abuse of Authority by Spiritual Healers, by Michael H. Cohen © 2002 Journal of Law and Religion, Inc..

The older men of their community were aware of many treatments and they did the roles of traditional doctors. They could even treat some kind of infectious diseases, hunch-back, facial droop, and broken bones. They also believe in spirits and thought that spirits reside in human beings. Fever, headache, dizziness, and weakness, etc are the result of the spirits temper. For the healing, they suggest the reading of the Koran, special provisions, and burning incense. Somalis are generally superstitious and they believe in the evil eye. They dont like the praising of others because they strongly believe that it will bring an evil eye and will ultimately lead to the ruin of the person praised. The mothers dont like even the doctors commenting about their babies weight and fear that it is harmful to their babies.

Most of the Somali women do not depend on hospitals for delivery and generally, it takes place in the home itself. They know the treatments regarding the new mother and the baby. They give enough coaching to their children about neatness from a very young age itself. Circumcision was common in men and women of Somalia before age five. It is connected with their religious belief and regarded as a ritual of passage that is necessary for marriage.

It is considered as part of their hygiene. Male circumcision may be performed by a traditional doctor or by a medical doctor or nurse in a hospital. Female circumcision is usually performed by female family members but is also available in some hospitals. The most common procedure in Somalia for female circumcision, known as infibulations, involves the removal and suturing of most genital tissue, leaving a posterior opening. They depend on hospitals very rarely for these kinds of treatments and to an extent the nursing aid was unnecessary for them. Moreover, their religious belief often hindered them from depending on the hospitals. They preached many superstitious beliefs that curtailed their contact with Western medicine. But some of the Somalis living in cities were taken to hospitals affected with diarrhea, fever, and vomiting. Patients were distributed with antibiotics from the hospitals and oral medication is insisted to children affected with cold.

Somalis in modern times keep a fascination for learning and their interests in studies are increasing day by day. Now they are very much interested in university education and

A great number of Somalis living in Victoria today hold passionate beliefs about the right to universal education and the value of a University qualification. (p. 3). It is a welcome attitude found in the Somalis, which may foster their interest in the nursing field in the coming future. The attitude of the Somalis to religion, education, social life, etc has been subjected to slight changes in modern times. But even now they hesitate to come to the forefront of society as well as into the nursing field. Their traditional healing system and their diffidence to hospitals for pregnancy etc are the withdrawing factors of nursing practices in Somalia.

Minnesota nursing schools are not reaching the level of quality institutions. So the state offers new opportunities like online nursing CCNE (commission on collegiate nursing education. These institutions offer better chances for common people. The nursing shortage creates plenty of opportunities for current nurses and potential nurses. It leads to a gradual increasing the demand for home nurses and specialized people for nursing disabled people.

Racial and political factors create problems to the smooth running of healthcare activities today the majority of people say that a number of diseases are emerging among the children in the Minnesota region. A collaborative program promoted four major universities in Minnesota state named; DNP (Doctor of Nursing Practice). This offers advanced clinical, organizational, economic, and leadership knowledge to the students, it promotes evidence-based practice through professional leadership. Childhood obesity was an illness that needs treatment. The attack of chronic diseases also is a barrier to prevention methods.

Lack of patient motivation, effective prevention methods, and the absence of supporting services are the dominating problems in this region. The following comments make clear the above mentioning points: However, several important barriers interfere with treatment efforts and will need to be addressed. There is also a need for increased training opportunities related to obesity prevention and treatment. The results of this study provide directions and priorities for training, education, and advocacy efforts. Health organizations also point out that the influence of behavioral management strategies and guidance in parenting techniques are affecting the health care assessment.

Lack of transportation facilities and absence of modern preventive methods and equipment etc are also the withdrawing factors of the health care activities and nursing practices in Somali. To conclude it is inferred that the impacts of nursing practices in Somali and Minnesota are not so higher. The people of Somali are religious and they are incapable of retaliating against the superstitious beliefs that are deep-rooted in them. Though they live in a post-modern era, they preach old customs and traditions and are sticking to their own methods of treatment. The modern methods of treatment are to an extent exile to them and very often they are forced to depend on it.

But to their wonder, the organizations promoting home nursing- for disabled persons- are mushrooming in modern Minnesota. It also is helping in increasing the social value of Somali women and wins them wealth and acclaim. The main barriers of the nursing practices in the Somali region are; illiteracy, lack and proper awareness in modern medical equipment, cultural and social backwardness, religious ethics, etc. It is impossible for an illiterate person to handle the role of a nurse properly. Moreover, he should be well versed in handling the medical equipment. The religion and society of Somali always prevent them from being fully involved in nursing practices.

Works cited

(Journey Into the Somali Culture, By Abigail F. Castel & Susie Kurata. Web.

(AVETRA 2008: Somali students in VET- some factors influencing pathways, Maree Keating and Bonnie Simons, Equity Research Centre, Page- 3. Web.

(Voices of the Somali Community  Concepts of Health Care and Medicine). Web.

(Management of Child and Adolescent Obesity: Attitudes, Barriers, Skills, and Training Needs among Health Care Professionals, Pediatrics Vol. 110 No. 2002. Web.

(A Phenomenological Case Study of a Somali Immigrant Woman, By Nura Dualeh. Arizona Education Review 2003/04. Web.

(Healing at the Borderland of Medicine and Religion: Regulating Potential Abuse of Authority by Spiritual Healers, By Michael H. Cohen © 2002. Web.

Understanding continuum and coordination of care

Care coordination has various meanings depending on whose scholar is describing it. However, the basic understanding is that it refers to the appropriate delivery of healthcare services through the organization of several participants, including patients, their families, nurses, physicians, and other medical professionals (Swan et al., 2019). There are three perspectives of care coordination, including the patient or family perspective, healthcare professionals perspective, and system representatives perspective. The patient or family perspective ensures that preferences and needs are met, especially during transitions. Professionals perspective deals with gaps that may arise in information sharing, teamwork, unreasonable effort levels, and poor outcomes (Swan et al., 2019). System representative is the deliberate integration of information, staff, and other resources to prevent care fragmentation.

Continuum of care involves delivering patient-centered services as the medical condition fluctuates, even across the patients lifetime (Swan et al., 2019). Ongoing healthcare services depend on the medical history and current situation of the patient.

Care coordination ring

The care coordination ring shows the primary goal at the center, aided by the perspectives. The continuous blue line represents closing of gaps achieved through care coordination while the colored circles are potential participants.

Care in nursing homes

Nursing homes should not be confused with residential care or assisted living services. They provide both residential and nursing care around the clock for people who do not need hospitalization but require more care than can be given at home. The care can be short or long term depending on the patients needs, such as severe learning and physical disabilities or terminal illnesses. These centers provide high level of care and hence they hire RNs, licensed practical nurses, and nurse aides to ensure all levels of care are professionally offered. In addition, there is a RN on the site around the clock to provide expert level support to other professional caregivers.

This presentation is directed to Phoenix Mountain Nursing Center.

Phoenix Mountain Nursing Center

Phoenix Mountain Nursing Center (PMNC) is based in Arizona and provides short and long term care to even Medicaid and Medicare beneficiaries. PMNC received below average reviews from government inspection in the cycle ended 2020 and has paid two fines in the last three years (Phoenix Mountain Nursing Center (PMNC), 2021). The inspectors findings show that the center does not have an infection control and prevention program, fails to test all its staff and residents for coronavirus, and does not conduct accurate assessments of the residents. Additionally, the center does not meet the patients needs in the first 48 hours upon admission and some residents did not receive enough fluids or food for good health (PMNC, 2021). It also failed to offer appropriate care and treatment to meet residents goals, orders, or preferences. Another problem was identified in the drug store, where labelling and storage did not follow professional standards. Therefore, PMNC will greatly benefit from the presentation as nurses will learn how to improve in those areas by applying the code of ethics and health policies.

Code of ethics: provision 3

Provision 3 of the nursing Code of Ethics is applicable in facilitating improvement of the situation at PMNC to ensure care coordination. All existing nurses must adhere to the Provisions guidelines to protect the rights of their residents. Care coordination and continuum of care is failing due to various problems among nurses. The nurses must embrace ongoing learning to prevent implementing outdated practices, such as those identified in labeling and storing drugs and medical supplies (Olson & Stokes, 2016). The nursing manager at PMNC to ensure that all the personnel in the facility are constantly trained on emerging knowledge.

Continuum of care is disrupted when residents do not receive treatment for 48 hours. Nurses must adhere to Provision 3 requirements by taking legal action to remedy the situation (Olson & Stokes, 2016). By using established mechanisms within the nursing home, nurses must protect the profession, public, and residents by reporting all questionable behavior that prevents care coordination.

Code of ethics: provision 6

Continuum of care is only possible when care is carefully coordinated in the nursing home. Provision 6 directs nurses and nursing executives to choose the right over wrong in care planning and decisions. PMNC must use policies to create an enabling environment for virtuous nurses. To close gaps in the care coordination ring, nurses must support each others ability to fulfill their ethical obligations (Olson & Stokes, 2016). If nurses are not treated fairly and equally, continuum of care will not be achieved as part of them might abscond or boycott their duties. Coordination and continuum of care might also be lost during organizational change if collective action and interdisciplinary efforts are not included in the process.

Affordable care act (ACA)

The ACA ensures coordination and continuum of care by including most citizens into insurance plans. PMNC participates in Medicare and Medicaid, which requires the center to adhere to the law while providing services to residents. For example, residents with preexisting conditions require follow up and must be accepted under their insurance plans (Ritter et al., 2021). PMNC must conduct assessment and other check up routines without extra cost to the residents as they are part of the preventive services. The essential health benefits most applicable to PMNC include rehabilitative care, chronic disease management, and emergency services.

Health Insurance Portability and Accountability Act (HIPaA)

The HIPAA seeks to regulate how digital health information is collected, stored, and shared across hospitals and other healthcare facilities. Specifically, it sets national standards by preempting state laws on the accessibility, portability, and renewal of patient data (Peregrin, 2021). Therefore, PMNC can achieve continuum of care by accessing residents health information from previous providers and renewing the data where necessary to continue with new care plans. However, the center must uphold existing standards on data integrity and privacy. Care coordination might require all nursing levels to gain access to residents data, raising potential privacy and confidentiality pitfalls (Peregrin, 2021). Proper training of personnel on data laws will ensure coordination and continuum of care without attracting lawsuits.

Senate bill 1373

The SB1373 was passed into law in 2021 to ensure that residents receive first aid, basic life support, and emergency care services at the nursing home. The regulations seeks to ensure that continuum of care is achieved and that residents are not deprived of medical care at any instance. In the absence of this rule, nursing homes would wait for ambulatory dispatch to attend the patient, increasing the risk for negative outcome. PMNC must ensure that there are no policies contradicting this requirement, first aid and emergency care personnel are always on the site, and residents medical data concerning advance directives are readily available to facilitate decision making. Care coordination will require closing of gaps in knowledge on emergency services, basic life support, and first aid.

Conclusion

PMNC must improve care coordination and continuum to improve its services to residents by applying the Code of Ethics, adhering to ACA and HIPAA, or other state and local policies. The Code of Ethics will guide nurses at all levels and the center management to create suitable environment, work groups, and policies to enhance coordination and continuum of care. HIPAA will also facilitate by enabling PMNC to access medical history of residents to ensure smooth transitioning and continued care.

References

Olson, L. L., & Stokes, F. (2016). The ANA code of ethics for nurses with interpretive statements: Resource for nursing regulation. Journal of Nursing Regulation, 7(2), 9-20. Web.

Peregrin, T. (2021). Managing HIPAA Compliance Includes Legal and Ethical Considerations. Journal of the Academy of Nutrition and Dietetics, 121(2), 327-329. Web.

Phoenix Mountain Nursing Center. (2021). U.S. News. Web.

Ritter, A. Z., Freed, S., & Coe, N. B. (2021). Younger Individuals Increase Their Use of Nursing Homes Following ACA Medicaid Expansion. Journal of the American Medical Directors Association. Web.

Swan, B. A., Haas, S., & Jessie, A. T. (2019). Care coordination: Roles of registered nurses across the care continuum. Nursing Economics, 37(6), 317-323. Web.

Safety is one of the major factors affecting patient outcomes. It is an important part of effective and cost-efficient healthcare (Hood, 2014, p. 489). However, the research indicates that there is a gap between the current safety standards and the general state of the healthcare system. The issue continues to affect the patients and requires a serious discussion. It is important to properly educate the professionals on the importance of safety and closely monitor the state of the affairs.

Safety and Ultimate Patient Outcomes

Patient safety means reducing the patients exposure to hazards and reducing the risk of harm during the treatment. It is an important part of the nursing practice and a significant contributor to the positive patient outcomes. The research indicates two major issues connected to the safety violations: Medication errors and nosocomial infections are among the leading threats to patient safety, although many of these events could be prevented (Tella et al., 2014, p. 7). Both of these problems severely affect the ultimate patient outcomes. The medication errors can have an undesired effect on the patient, prolong the necessary treatment and negatively affect the health prognosis. They present a major public health burden. The issue is compounded by the fact that the causes are hard to identify since some of the accidents occur due to production errors, rather than the nursing mistakes. The infections have the potential to actually worsen the state of a person, leading to readmissions and complications. They can have an unconvertible effect on the condition of the patient. Both issues are extremely widespread. The IOM reports indicate that safety violations cost Medicare more than 90$ million a year. That figure demonstrates the scale of the problem. AACN aims to address the safety competence of nurses more thoroughly, but the results of the program are not tangible yet.

Safety and Nursing Professional

Poor compliance with the safety standards does not exclusively affect the patients. While they are subjected to the most adverse effects of such mistakes, the nursing workers themselves suffer tangible consequences. Safety violations increase the risks of cross contaminations by exposing the nurses to more cases of infection. That puts the well-being of the medical workers at risk and by proxy decreases the efficiency of the healthcare system as a whole. The professional status of a nurse might also be put at risk if the patient seeks to press the charges after suffering from an unsafe practice. Even if the nurse is proven innocent, the negative publicity might put them under severe peer pressure and even force them to retire. Moreover, the patients who have suffered from a poor safety protocol have to seek help again, thus, increasing the workload of the medical personnel. All of these factors underline the need for a proper safety education that will allow the nursing workers to avoid costly mistakes.

Conclusion

It is clear that proper safety procedures not only allow for positive outcomes in patients but also increase the overall efficiency of the healthcare system. However, the research indicates that the current nursing education does not cover the subject of safety sufficiently (Tella et al., 2014, p. 12). Without the proper knowledge on the subject, the nurses are not able to perform their duties efficiently and put the wellbeing of the patients, as well as their own, at risk.

References

Hood, L. J. (2014). Leddy & Peppers conceptual bases of professional nursing (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Tella, S., Liukka, M., Jamookeeah, D., Smith, N., Partanen, P., & Turunen, H. (2014). What do nursing students learn about patient safety? An integrative literature review. Journal of Nursing Education,53(1), 7-13.

Promoting health and preventing disease are two of the core objectives of the nursing practice. To attain them, adequate approaches to the organization and performance of care practices should be implemented, and it is possible to say that Penders health promotion model (HPM) can successfully guide practitioners in selecting the right and highly effective methods allowing them to reach the best possible outcomes. According to Heydari and Khorashadizadeh (2014), the HPM is developed by Pender based on the principles of social cognitive theory, and it comprises three types of factors affecting health-related behaviors: individual features, behavior-specific cognitions and emotions, and immediate circumstances influencing behaviors. The model demonstrates how these factors impact individuals behaviors and engagement in self-care, in particular. Considering this, the purpose of the present paper is to demonstrate how nurses can choose and design patient care strategies based on the major assumptions of the HPM and how they can implement the main model characteristics in order to perform the roles of educators, healthcare providers, and advocates in a more efficient and effective way.

Model Characteristics and Their Application to Nursing Roles

Conclusion

As the results of the HPM review demonstrate, nurses can implement many of its characteristics and principles in order to improve the quality of care and interactions with patients. Overall, the selected model can be applied primarily to such nursing roles as educator, patient advocate, and care provider. It is suggested that a practicing nurse should aim to learn more about individual features of patients and environmental factors that may affect their health-related beliefs, as well as actual health outcomes. It means that, as a healthcare provider, a practitioner should utilize the patient-centered care approach and strive to develop trustful relationships with individuals. Secondly, a nurse must apply the knowledge about an individual patient to build effective education strategies and motivate them to lead healthier lifestyles and adhere to prescribed interventions. Lastly, as an advocate, a nurse should promote the well-being of individuals and communities by researching existing detrimental environmental factors, developing campaigns and policies targeting those problems. In this way, a practitioner will be able to make a significant contribution to the advancement of the profession and the improvement of patients quality of life.

References

Cohn, M. A., Pietrucha, M. E., Saslow, L. R., Hult, J. R., & Moskowitz, J. T. (2014). An online positive affect skills intervention reduces depression in adults with type 2 diabetes. The Journal of Positive Psychology, 9(6), 523-534.

Coyne I. (2015). Families and health-care professionals perspectives and expectations of family-centred care: Hidden expectations and unclear roles. Health Expectations, 18(5), 796-808.

Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses viewpoint: A qualitative study. Journal of Medical Ethics and History of Medicine, 9, 5.

Hardcastle, S. J., Hancox, J., Hattar, A., Maxwell-Smith, C., Thøgersen-Ntoumani, C., & Hagger, M. S. (2015). Motivating the unmotivated: How can health behavior be changed in those unwilling to change? Frontiers in Psychology, 6, 835.

Heydari, A., & Khorashadizadeh, F. (2014). Penders health promotion model in medical research. Journal of the Pakistan Medical Association, 64(9), 1067-1074.

Iwelunmor, J., Newsome, V., & Airhihenbuwa, C. O. (2014). Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions. Ethnicity & Health, 19(1), 20-46.

Kamran, A., Azadbakht, L., Sharifirad, G., Mahaki, B., & Mohebi, S. (2015). The relationship between blood pressure and the structures of Penders health promotion model in rural hypertensive patients. Journal of Education and Health Promotion, 4, 29.

Petiprin, A. (2016). Health promotion model. Web.

Varming, A. R., Hansen, U. M., Andrésdóttir, G., Husted, G. R., & Willaing, I. (2015). Empowerment, motivation, and medical adherence (EMMA): The feasibility of a program for patient-centered consultations to support medication adherence and blood glucose control in adults with type 2 diabetes. Patient Preference and Adherence, 9, 1243-1253.

Journey North provides a great experience of living and working in a northern community. Although the nursing station there resembles any other in the country, the working conditions can be described as extremely tough. The nurses are expected to withstand an enormous amount of stress and be ready to rely on themselves when it comes to providing the initial help that is needed before the transportation of a patient. Therefore, it is of major importance to learn all the features of the workplace in order to provide locals with high-quality services duly. Myocardial infarction can be one of the most complicated cases that a nurse working in the north can encounter. Thus, Journey North has created presentations, quizzes, and a video as a part of a dedicated scenario.

In the scenario, a forty-year-old male comes to the station and complains of chest pain, nausea, vomiting, sweating, pain radiating to the jaw, and shortness of breath. The EKG monitor strip indicates that there is a risk of a heart attack. Therefore, it is of major importance to correlate the symptoms and signs with the EKG findings. The nurse is then expected to obtain a 12 lead EKG and compare the results with the previous tracing if there is any. New changes should be immediately detected, recorded, and taken into consideration. The nurse should then check for Q-waves, the elevation of ST-segment, and an inversion of T-wave, all of which point to myocardial infarction. Nevertheless, it is important to keep in mind that myocardial infarction in women does not always show the Q-waves on EKG (Journey North, 2020). Moreover, in this case, it is better to rely on nondiagnostic, reversible ST-segment elevations, or any T-wave abnormalities.

The nurse should then apply oxygen at 6 liters per minute and ensure that the O₂ saturation is kept at 97-98%. Bed rest with the head elevated is then needed (unless hypotensive). Moreover, the nurse should assist the patient and seek to reduce the anxiety level. The nurse is also expected to draw blood or cardiac enzymes. After that, the nurse should send the EKG strip to the physician on call and contact him/her in order to find the best client management solutions and requirements for medevac (Journey North, 2020). After reaching a common decision, the nurse is expected to administer sublingual nitroglycerin 0.4 mg spray prn in case systolic blood pressure exceeds 100 mm Hg. The patient should then be given uncoated acetylsalicylic acid, 162-325 mg stat PO chewed, if he/she is not allergic to it. If nitrates do not relieve pain, the nurse should administer analgesia morphine and repeat the dose if directed by a physician. All the necessary arrangements for medevac should then be made. While doing so, it is important to continue monitoring heart and lung sounds to detect any signs of heart failure.

The experience provided by Journey North should be considered a truly valuable source of inspiration, as it brightly and accurately creates the atmosphere that future nurses can evaluate in order to make a weighed decision. Thus, nurses that are ready to take the challenge learn the basics of providing proper assistance prior to contacting physicians. This is crucial when a patient shows signs of severe conditions such as myocardial infarction. Nurses are expected to act immediately and courageously by taking full responsibility, as there is no time to wait for any kind of assistance in the tough conditions of the north. The myocardial infarction scenario is a useful dedicated source of information that is valuable to anyone in the nursing profession, as it provides the full guideline on how to rescue a patient almost singlehandedly.

Reference

Journey North: A virtual experience. (n.d.). Red River College of Applied Arts, Science & Technology. 2020. Web.

Introduction

The establishment of a nursing philosophy plays a crucial role in nursing practice and career growth. Even though all nurses study the same principles, theories, and regulations, each person shares specific beliefs and attitudes toward the environment, which provokes the promotion of unique approaches to care and treatment. The author of four nursing meta paradigms, Fawcett, admits that today, the awareness of paradigms contributes to an intellectual recognition of nursing fundamentals and the reduction of burnout (as cited in Deliktas et al., 2019). In addition, such external factors as interactions with patients and colleagues and classroom experience define the skills of nurses. Finally, many nursing theories reflect the way of how care is offered. A personal nursing philosophy is an opportunity to combine theoretical and practical aspects, consider individual interests and beliefs, and understand the uniqueness of nursing practice through the prism of the existing concepts. In this paper, the evaluation of meta paradigms and the theory of human caring by Jean Watson will be developed to prove the importance of holistic care, communication, and research in nursing practice.

Personal Philosophy and Nursing Metaparadigms

To introduce a strong and effective nursing philosophy that corresponds to my personal beliefs and knowledge, I should think about what nursing means to me and how I understand the concepts in nursing meta paradigms. There are four well-known categories, including person, health, environment, and nursing, with specific characteristics and purposes (Branch et al., 2016). The human factor refers to people in a particular society or culture (Deliktas et al., 2019). My nursing philosophy reveals a person as an individual (and a family) who needs care, support, and information to comprehend what happens around. The environment paradigm covers social, economic, and other factors that influence human health (Deliktas et al., 2019). I believe that an understanding of the internal and external factors promotes effective treatment and healing. Therefore, patients and their families must be satisfied with the environment they receive with nursing care. Human experiences, knowledge, and relationships with other people determine the environment quality.

The concepts of health and nursing services as the two basic elements in my nursing philosophy. Human health cannot be improved from one perspective only to uphold successful treatment. It has to be physical and mental wellbeing with appropriate social functioning. A healthy person means a happy and physically sustainable individual. In addition to professional recommendations developed by doctors, the role of nurses cannot be ignored. Therefore, nursing is a meta paradigm that sets the tone for my philosophy. Communication with patients, provision of information, prevention of diseases, and restoration of health are the responsibilities of nurses who take care of patients and their families. To complete such goals, a nurse should enhance critical thinking, decision-making, and research skills. It is important to turn dry facts and treatment plans that are clear for the medical staff into meaningful information and knowledge for patients with limited or poor healthcare experience. In general, my position is not simple, but if each aspect of nursing care is discussed from the four meta paradigms, positive health results can be achieved.

Nursing Theory and Personal Beliefs

Regarding the nature of my nursing philosophy and the expected duties of nurses in patient care, I investigate several current theories. There are many strong approaches offered by Nightingale, Henderson, or Johnson, and all of them are correct in their visions of nursing, health, and patients. However, I realize that the position introduced by Jean Watson about the importance of human caring is the most compatible with my beliefs and feelings.

Technological progress, clinical trials, and cultural variety result in the necessity to re-examine health and nursing knowledge all the time. According to Watson (as cited in Pajnkihar et al., 2017), caring must be based on practice and research. Her theory articulates that caring should be separated from curing because the latter focuses on healing disease, and the former includes the enhancement of the mind, body, and soul (Branch et al., 2016). Ten creative factors are the core components of Watsons theory, including hope, humanism, help, sensibility, problem-solving, teaching, emotion expression, needs, environment, and spirituality (Pajnkihar et al., 2017). Almost all these issues are observed in my philosophy, including the importance of research and education, helping patients and their families, and correct expression of needs and emotions. As well as Watson, I believe that care (not just treatment and healing) is necessary for patients. Many people take are responsible for health improvement (doctors), emotional support (family), and progressive techniques (researchers). Nurses have to find a balance between these parties and make sure wellbeing is promoted.

Conclusion

The introduction and discussion of a personal nursing theory is not just an academic or professional obligation of future nurses. It is a good chance for people to realize if they are ready for the chosen profession and if they make a correct decision. If some problems or concerns occur in formulating thoughts about nursing, it means that a person does not have enough knowledge and confidence to become a good nurse. In this paper, I was able to compare my beliefs and thoughts with other successful theorists and nurses, and the fact that I discovered similarities makes me think that I am on the right track.

References

Branch, C., Deak, H., Hiner, C., & Holzwart, T. (2016). Four nursing metaparadigms. IU South Bend Undergraduate Research Journal, 16, 123-132.

Deliktas, A., Korukcu, O., Aydin, R., & Kabukcuoglu, K. (2019). Nursing students perceptions of nursing metaparadigms: A phenomenological study. The Journal of Nursing Research, 27(5).

Pajnkihar, M., `tiglic, G., & Vrbnjak, D. (2017). The concept of Watsons carative factors in nursing and their (dis) harmony with patient satisfaction. PeerJ, 5.