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Advocacy Paper

Advocacy Paper



Author Note

Advocacy Paper


Often, in the healthcare profession, physicians, nurses and healthcare workers are often faced with issues that put more than one lives at risk. While at times, they have advanced directives from the patients themselves to inform them of the best course of action, things become easier for them to follow. On the other hand, having their family members around also gives medical professionals a source to seek guidance when faced with medical decisions that are accompanied by severe implications. The job of a healthcare professional is not easy. However, this job becomes especially difficult when a patient is brought into the hospital.

The patient is young and an organ donor, who was involved in a deadly car accident moments before being brought to the hospital. She was seen to immediately at the hospital and was classified brain-dead within the hour. Given that she was a registered organ donor, she was to be kept in the present state until arrangements were made across the state to hospitals where doctors sought organs for their terminally ill patients. While the situation seems simple enough, there was one aspect that changed the rules for the healthcare professionals assigned to her case. The woman was 21 weeks pregnant. She was braindead and an organ donor, with a healthy baby that continued to develop unharmed within her body ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"HUqZzVBY","properties":{"formattedCitation":"(Gop\\uc0\\u269{}evi\\uc0\\u263{} et al., 2017)","plainCitation":"(Gopčević et al., 2017)","noteIndex":0},"citationItems":[{"id":576,"uris":["http://zotero.org/users/local/5VyEEXyp/items/3AMF4K9I"],"uri":["http://zotero.org/users/local/5VyEEXyp/items/3AMF4K9I"],"itemData":{"id":576,"type":"article-journal","title":"Ethical and medical management of a pregnant woman with brain stem death resulting in delivery of a healthy child and organ donation","container-title":"International journal of obstetric anesthesia","page":"82-86","volume":"32","author":[{"family":"Gopčević","given":"A."},{"family":"Rode","given":"B."},{"family":"Vučić","given":"M."},{"family":"Horvat","given":"A."},{"family":"Širanović","given":"M."},{"family":"Gavranović","given":"Ž"},{"family":"Košec","given":"V."},{"family":"Košec","given":"A."}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Gopčević et al., 2017).


Matters such as this, where patients, who are registered organ donors, are proclaimed brain-dead upon arrival can make a healthcare facility delve deeper into the ethics of the situations. The situation, already precarious, is made even worse since the patient is a 21weeks pregnant. With the complete absence of a medical proxy or even an advanced directive, someone has to take responsibility regarding the patient and choosing the right course of action for her if and how her situation will be treated. While it is the physician’s job to decide the right course of medical treatment for her, it is the nurse that would decide, ideally, serving as the patient’s advocate and choosing the course that would in the best interests of the baby.

Bioethics is great regard in this help. It emphasizes on situations in which a patient is left in a vulnerable state, where a dedicated set of goals need to be pursued and achieved and dilemmas to be solved ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"HpBxK8M8","properties":{"formattedCitation":"(Hofmann & Magelssen, 2018)","plainCitation":"(Hofmann & Magelssen, 2018)","noteIndex":0},"citationItems":[{"id":577,"uris":["http://zotero.org/users/local/5VyEEXyp/items/T7GIXGIA"],"uri":["http://zotero.org/users/local/5VyEEXyp/items/T7GIXGIA"],"itemData":{"id":577,"type":"article-journal","title":"In pursuit of goodness in bioethics: analysis of an exemplary article","container-title":"BMC medical ethics","page":"60","volume":"19","issue":"1","author":[{"family":"Hofmann","given":"Bjørn"},{"family":"Magelssen","given":"Morten"}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hofmann & Magelssen, 2018). In this instance, bioethics is an ideal means to come up with a viable solution for the patient. Thus, to come to an organized and optimized solution bioethical decision-making process is used by healthcare providers. This aims to work with and align the bioethics of the situation with evidence-based practices and person-centered care.

The bioethical decision-making process comprises four steps. Each step in the process has a very different goal. However, one thing common among them all is a complementary focus on goals and ethics of the matter ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"cH6SnCgp","properties":{"formattedCitation":"(Forte, Kawai, & Cohen, 2018)","plainCitation":"(Forte, Kawai, & Cohen, 2018)","noteIndex":0},"citationItems":[{"id":573,"uris":["http://zotero.org/users/local/5VyEEXyp/items/G6XRBBAZ"],"uri":["http://zotero.org/users/local/5VyEEXyp/items/G6XRBBAZ"],"itemData":{"id":573,"type":"article-journal","title":"A bioethical framework to guide the decision-making process in the care of seriously ill patients","container-title":"BMC Medical Ethics","volume":"19","source":"PubMed Central","abstract":"Background\nOne of the biggest challenges of practicing medicine in the age of informational technology is how to conciliate the overwhelming amount of medical-scientific information with the multiple patients’ values of modern pluralistic societies. To organize and optimize the the Decision-Making Process (DMP) of seriously ill patient care, we present a framework to be used by Healthcare Providers. The objective is to align Bioethics, Evidence-based Practice and Person-centered Care.\n\nMain body\nThe framework divides the DMP into four steps, each with a different but complementary focus, goal and ethical principle. Step 1 focuses exclusively on the disease, having accuracy is its ethical principle. It aims at an accurate and probabilistic estimation of prognosis, absolute risk reduction, relative risk reduction and treatments’ burdens. Step 2 focuses on the person, using empathic communication to learn about patient values and what suffering means for the patient. Emphasis is given to learning and active listening, not taking action. Thus, instead beneficence, we trust comprehension and understanding with the suffering of others and respect for others as autonomous moral agents as the ethical principles of Step 2. Step 3 focuses on the healthcare team, having the ethics of situational awareness guiding this step. The goal is, through effective teamwork, to contextualize and link rates and probabilities related to the disease to the learned patient’s values, presenting a summary of which treatments the team considers as acceptable, recommended, potentially inappropriate and futile. Finally, Step 4 focuses on provider-patient relationship, seeking shared Goals of Care (GOC), for the best and worst scenario. Through an ethics of deliberation, it aims for a consensus that could ensure that the patient’s values will be respected as well as a scientifically acceptable medical practice will be provided. In summary: accuracy, comprehension, understanding, situational awareness and deliberation would be the ethical principles guiding each step.\n\nConclusion\nHopefully, by highlighting and naming the different perspectives of knowledge needed in clinical practice, this framework will be valuable as a practical and educational tool, guiding modern medical professionals through the many challenges of providing high quality person-centered care that is both ethical and evidence based.","URL":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6102884/","DOI":"10.1186/s12910-018-0317-y","ISSN":"1472-6939","note":"PMID: 30126394\nPMCID: PMC6102884","journalAbbreviation":"BMC Med Ethics","author":[{"family":"Forte","given":"Daniel Neves"},{"family":"Kawai","given":"Fernando"},{"family":"Cohen","given":"Cláudio"}],"issued":{"date-parts":[["2018",8,20]]},"accessed":{"date-parts":[["2019",8,19]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Forte, Kawai, & Cohen, 2018). The first step deals with the ethics of accuracy. It discusses the accurate diagnosis, the prognosis and the success and failure of possible treatments. Here, evidence-based practices along with sound scientific reasoning are key to ensure that the ethics of accuracy are being followed. In the present case, there are three factors that need consideration in this regard. Firstly, the doctors and the nurses need to determine the right course of action with the patient especially in terms of her pregnancy. They need to look at what the law says regarding organ donation from a pregnant brain-dead patient and proceed with caution from that point forward. It is true that the patient is brain-dead, but the focus should be on saving her child on a priority basis, rather than harvesting her organs for donation. At an early stage of gestation, such as 21 weeks, the fetus only has a 1% chance of survival. At this point, the viability of fetus until maturity is a huge dilemma.

Literature shows that between 1982 and 2010, around 30 cases of brain-dead pregnant patients were reported, with more than 17 babies successfully delivered. While the odds here, may not be in the favor of the child, delivering the fetus is the best resort at this point. Thus, the second step in the bioethical decision-making process brings the very ethics of comprehension into question. It brings in the values held by the patient with regard to suffering and the insistence of medical staff to adhere to the patient’s values and judgment. However, since the patient cannot speak for herself, the priority would be given to the fetus to ensure the delivery of a viable fetus that can grow into a healthy child.

The third step of the bioethical decision-making process is the ethics of situation awareness. Here, a multidisciplinary team including obstetricians, anesthesiologists, neurologists, and neurosurgeons was assembled. They will aim to assess the situation and seek to understand the best course of action for the patient. The ideal result, in the present situation, would be to subject the patient to therapeutic interventions. This way, the body will able to keep up it's normal functioning, protecting both the baby and the organs needed for transplant. The multidisciplinary team would work together in perfect tandem, using evidence-based and patient-centered practices to ensure that the patient is being looked after in the best way possible.

Finally, the fourth and last step of the bioethical decision-making process is called the ethics of deliberation, where the patient-provider relationship is subjected to intense scrutiny. Here the rapport between the patient and the provider is crucial to establish a certain set of goals for patient care. These values need to be respected for the sole reason that the patient wants it. These needs would always be respected, and it is the duty of the care provider to find scientifically acceptable practices to deliver ideal care. Given that the patient cannot make a decision for herself, a registered nurse could serve as a proxy for the patient and look out for her just as she would look out for herself if the situations were reversed. She needs to ensure that the fetus is delivered as a healthy baby and is able to continue its life as such. Furthermore, the nurse would also need to keep the people on the receiving end of an organ transplant from the patient. Thus, she would need to find the best course of action to address both concerns.


Being a healthcare professional is a challenging job. But, being a registered nurse is more challenging when compared to a physician or a healthcare worker. While it is the doctor’s that diagnose the patients and often advise the right course of action with their healthcare treatment, it is nurses that execute their wishes. They often establish and share a unique bond with the patients, and patients look to them for guidance when faced with decisions that can positively or negatively change the lives of such patients. In the present case, the patient lacked a family member to serve as a medical proxy to take decisions, and with the lack of an advanced directive, it fell to the registered nurse to serve as the patients advocate and make decisions for her that were in the best interest of the child, and that is exactly what she did. Using the bioethical decision-making model, the nurse was able to get to a viable solution that could potential save the patient’s baby and also ensure that the baby has a long and decent life.


ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Forte, D. N., Kawai, F., & Cohen, C. (2018). A bioethical framework to guide the decision-making process in the care of seriously ill patients. BMC Medical Ethics, 19. https://doi.org/10.1186/s12910-018-0317-y

Gopčević, A., Rode, B., Vučić, M., Horvat, A., Širanović, M., Gavranović, Ž., … Košec, A. (2017). Ethical and medical management of a pregnant woman with brain stem death resulting in delivery of a healthy child and organ donation. International Journal of Obstetric Anesthesia, 32, 82–86.

Hofmann, B., & Magelssen, M. (2018). In pursuit of goodness in bioethics: Analysis of an exemplary article. BMC Medical Ethics, 19(1), 60.

Subject: Healthcare and Nursing

Pages: 4 Words: 1200

Advocacy Summary

Advocacy Letter

[Institutional Affiliation(s)]

Author Note

[Include any grant/funding information and a complete correspondence address.]

Advocacy Letter

Dear Mr. Rubin Diaz Jr.,

My name is Mervis Henry and I am from Bronx, New York. I am writing to letter to tell you about the prevalence of Asthma in my community so that effective steps are taken from your side. I would like to suggest a policy that might contribute to alleviating the prevalence of Asthma in my community.

"It is a severe problem that continues to recur", Dr. Hal Strelnick stated, "and it would be worth any attempt to concentrate on it and find better and more practical solutions." ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Vl0DesAw","properties":{"formattedCitation":"(\\uc0\\u8220{}State Senate Passes Bill to Study High Asthma Rates in The Bronx,\\uc0\\u8221{} n.d.)","plainCitation":"(“State Senate Passes Bill to Study High Asthma Rates in The Bronx,” n.d.)","noteIndex":0},"citationItems":[{"id":"70NiILNo/u2PUBhGN","uris":["http://zotero.org/users/local/LGdpQbDd/items/SGP93Y6D"],"uri":["http://zotero.org/users/local/LGdpQbDd/items/SGP93Y6D"],"itemData":{"id":173,"type":"webpage","title":"State Senate Passes Bill to Study High Asthma Rates in The Bronx","container-title":"DNAinfo New York","abstract":"The bill now moves to the state Assembly, where its sponsor is Assemblyman Luis Sepúlveda.","URL":"https://www.dnainfo.com/new-york/20140618/mott-haven/state-senate-passes-bill-study-high-asthma-rates-bronx","accessed":{"date-parts":[["2019",12,2]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“State Senate Passes Bill to Study High Asthma Rates in The Bronx,” n.d.). The Bronx is the state's weakest constituency with some of the state's worst clinical outcomes. According to the U.S. Census, Ethnic minorities are over-represented in impoverished communities i.e. African Americans and Hispanics contribute to 43 percent and 54 percent of the community of the Bronx, respectively ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"bLqRNdhc","properties":{"formattedCitation":"(theejbm, 2015a)","plainCitation":"(theejbm, 2015a)","noteIndex":0},"citationItems":[{"id":"70NiILNo/J7SvG94n","uris":["http://zotero.org/users/local/LGdpQbDd/items/377LHPK9"],"uri":["http://zotero.org/users/local/LGdpQbDd/items/377LHPK9"],"itemData":{"id":174,"type":"post-weblog","title":"Health Disparities and Environmental Justice in the Bronx","abstract":"by Danielle Pasquel The direct link between socioeconomic status and human health has been well established in the field of public health. Poor communities face an array of distinct economic and so…","URL":"https://theejbm.wordpress.com/2015/03/23/health-disparities-and-environmental-justice-in-the-bronx/","language":"en","author":[{"literal":"theejbm"}],"issued":{"date-parts":[["2015",3,23]]},"accessed":{"date-parts":[["2019",12,2]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (theejbm, 2015a). Several public safety and toxicological reports have recorded the impact of environmental conditions on local inhabitant’s wellbeing, including exposure to waste disposal facilities, air, and water pollution, high-quality food supply, and exposure to wide space areas ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"KZnBTChi","properties":{"formattedCitation":"(theejbm, 2015a)","plainCitation":"(theejbm, 2015a)","noteIndex":0},"citationItems":[{"id":"70NiILNo/J7SvG94n","uris":["http://zotero.org/users/local/LGdpQbDd/items/377LHPK9"],"uri":["http://zotero.org/users/local/LGdpQbDd/items/377LHPK9"],"itemData":{"id":174,"type":"post-weblog","title":"Health Disparities and Environmental Justice in the Bronx","abstract":"by Danielle Pasquel The direct link between socioeconomic status and human health has been well established in the field of public health. Poor communities face an array of distinct economic and so…","URL":"https://theejbm.wordpress.com/2015/03/23/health-disparities-and-environmental-justice-in-the-bronx/","language":"en","author":[{"literal":"theejbm"}],"issued":{"date-parts":[["2015",3,23]]},"accessed":{"date-parts":[["2019",12,2]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (theejbm, 2015a). For decades, Asthma has been known as a gruesome and expanding outbreak, with asthma-related hospital admission and mortality rates outstripping the rest of the state systematically ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BD1v1mJl","properties":{"formattedCitation":"(\\uc0\\u8220{}Fighting Pediatric Asthma With a Personal Touch in the Bronx,\\uc0\\u8221{} 2019)","plainCitation":"(“Fighting Pediatric Asthma With a Personal Touch in the Bronx,” 2019)","noteIndex":0},"citationItems":[{"id":"70NiILNo/d2zN1JIS","uris":["http://zotero.org/users/local/LGdpQbDd/items/KNI3N4GZ"],"uri":["http://zotero.org/users/local/LGdpQbDd/items/KNI3N4GZ"],"itemData":{"id":175,"type":"post-weblog","title":"Fighting Pediatric Asthma With a Personal Touch in the Bronx","container-title":"Norwood News","abstract":"The program aims to close racial health disparities by offering personalized services to children hospitalized or treated for asthma in the Bronx.","URL":"https://www.norwoodnews.org/id=29211&story=fighting-pediatric-asthma-with-a-personal-touch-in-the-bronx/","language":"en-US","issued":{"date-parts":[["2019",7,31]]},"accessed":{"date-parts":[["2019",12,2]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Fighting Pediatric Asthma With a Personal Touch in the Bronx,” 2019). The Bronx had a maximum asthma mortality rate of 43.5 of 1 million in New York City between the years 2009 and 2011 as stated by the New York State Asthma Surveillance Summary Report ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Jt5qPXah","properties":{"formattedCitation":"(theejbm, 2015a)","plainCitation":"(theejbm, 2015a)","noteIndex":0},"citationItems":[{"id":"70NiILNo/J7SvG94n","uris":["http://zotero.org/users/local/LGdpQbDd/items/377LHPK9"],"uri":["http://zotero.org/users/local/LGdpQbDd/items/377LHPK9"],"itemData":{"id":174,"type":"post-weblog","title":"Health Disparities and Environmental Justice in the Bronx","abstract":"by Danielle Pasquel The direct link between socioeconomic status and human health has been well established in the field of public health. Poor communities face an array of distinct economic and so…","URL":"https://theejbm.wordpress.com/2015/03/23/health-disparities-and-environmental-justice-in-the-bronx/","language":"en","author":[{"literal":"theejbm"}],"issued":{"date-parts":[["2015",3,23]]},"accessed":{"date-parts":[["2019",12,2]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (theejbm, 2015a). It contributes to six times that of a New York City. The gravity of a problem can be recognized from the fact that New York Senate has recently introduced a legislation and ordered the New York State Department of Health to examine and develop an intervention plan to tackle the shockingly high prevalence of asthma ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Wi85hnIr","properties":{"formattedCitation":"(\\uc0\\u8220{}State Senate Passes Bill to Study High Asthma Rates in The Bronx,\\uc0\\u8221{} n.d.)","plainCitation":"(“State Senate Passes Bill to Study High Asthma Rates in The Bronx,” n.d.)","noteIndex":0},"citationItems":[{"id":"70NiILNo/u2PUBhGN","uris":["http://zotero.org/users/local/LGdpQbDd/items/SGP93Y6D"],"uri":["http://zotero.org/users/local/LGdpQbDd/items/SGP93Y6D"],"itemData":{"id":173,"type":"webpage","title":"State Senate Passes Bill to Study High Asthma Rates in The Bronx","container-title":"DNAinfo New York","abstract":"The bill now moves to the state Assembly, where its sponsor is Assemblyman Luis Sepúlveda.","URL":"https://www.dnainfo.com/new-york/20140618/mott-haven/state-senate-passes-bill-study-high-asthma-rates-bronx","accessed":{"date-parts":[["2019",12,2]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“State Senate Passes Bill to Study High Asthma Rates in The Bronx,” n.d.). I hope, all these facts are enough to make you comprehend the magnitude of this problem.

Strategy, implementation, and assessment of government-level asthma mitigation programs would increase the probability of sustained high-quality systematic management of asthma. Government health organizations are accountable for government citizen’s health and hence are key contributors in the prevention of asthma. I would like to suggest a policy here that will help mitigate the challenge of Asthma Prevalence. As already established, a high prevalence of asthma is related to the Bronx exposure to the various kinds of wastes, air and water pollution. The intervention plans in the Asthma mitigation Programs must focus on the removal of hazardous waste from the Bronx. Governmental high-quality surveillance programs should identify areas exposed to the risk of pollution mainly industrial areas. The best approach would be to involve state and private environmental agencies that are prone to encountering such challenges. The National Center for Environmental Health (NCEH) can assist in developing asthma initiatives via numerous practical opportunities, technical support and fund allocation to such organizations ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"dEC5zPwL","properties":{"formattedCitation":"(\\uc0\\u8220{}Reducing the Rising Rates of Asthma,\\uc0\\u8221{} n.d.)","plainCitation":"(“Reducing the Rising Rates of Asthma,” n.d.)","noteIndex":0},"citationItems":[{"id":"70NiILNo/M0BlVKq5","uris":["http://zotero.org/users/local/LGdpQbDd/items/6K6AIZYS"],"uri":["http://zotero.org/users/local/LGdpQbDd/items/6K6AIZYS"],"itemData":{"id":177,"type":"webpage","title":"Reducing the Rising Rates of Asthma","URL":"https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/14/11/30/reducing-the-rising-rates-of-asthma","accessed":{"date-parts":[["2019",12,2]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Reducing the Rising Rates of Asthma,” n.d.).

Secondly, as the racial disparities are prevailing in the Bronx, the prevalence of asthma is likely to be caused by that ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1AzPBvXI","properties":{"formattedCitation":"(theejbm, 2015b)","plainCitation":"(theejbm, 2015b)","noteIndex":0},"citationItems":[{"id":506,"uris":["http://zotero.org/users/local/CKNkWnK9/items/36CLLVR4"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/36CLLVR4"],"itemData":{"id":506,"type":"post-weblog","abstract":"by Danielle Pasquel The direct link between socioeconomic status and human health has been well established in the field of public health. Poor communities face an array of distinct economic and so…","language":"en","title":"Health Disparities and Environmental Justice in the Bronx","URL":"https://theejbm.wordpress.com/2015/03/23/health-disparities-and-environmental-justice-in-the-bronx/","author":[{"literal":"theejbm"}],"accessed":{"date-parts":[["2019",12,11]]},"issued":{"date-parts":[["2015",3,23]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (theejbm, 2015b). The policy aiming at reducing racial disparities in t Bronx should be developed with the sole purpose of ensuring that children and adults in the community are provided with personalized services without any discrimination like the rest. The hospitalizations in the regular and in the emergency department should be independent of any extreme social groups or governmental organizations. The policy will also aim to coordinate the main services between community health worker stations and hospitals of the Bronx. The children or any individuals who are seen becoming a victim of such discrimination should be immediately identified and provided with the significant treatment programs. The policy will reduce the prevalence rate as more individuals will be hospitalized and provided with health care services without any discrimination.

Now that I have given effective solutions to a problem, I urge you to take operative steps to alleviate this health problem in my country. Your position demands you to bring all influential agencies on common ground to overcome this challenge by developing sound policies that not only focus on eliminating the risk of waste and air pollution but also keep surveillance on the effective areas to control the severity of a problem.

Thank you for giving you precious time. I hope my letter would be taken into consideration. I look forward to hearing from you.


Mervis Henry


ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Fighting Pediatric Asthma With a Personal Touch in the Bronx. (2019, July 31). Retrieved December 2, 2019, from Norwood News website: https://www.norwoodnews.org/id=29211&story=fighting-pediatric-asthma-with-a-personal-touch-in-the-bronx/

Reducing the Rising Rates of Asthma. (n.d.). Retrieved December 2, 2019, from https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/14/11/30/reducing-the-rising-rates-of-asthma

State Senate Passes Bill to Study High Asthma Rates in The Bronx. (n.d.). Retrieved December 2, 2019, from DNAinfo New York website: https://www.dnainfo.com/new-york/20140618/mott-haven/state-senate-passes-bill-study-high-asthma-rates-bronx

theejbm. (2015a, March 23). Health Disparities and Environmental Justice in the Bronx. Retrieved December 2, 2019, from https://theejbm.wordpress.com/2015/03/23/health-disparities-and-environmental-justice-in-the-bronx/

theejbm. (2015b, March 23). Health Disparities and Environmental Justice in the Bronx. Retrieved December 11, 2019, from https://theejbm.wordpress.com/2015/03/23/health-disparities-and-environmental-justice-in-the-bronx/

Subject: Healthcare and Nursing

Pages: 3 Words: 900

Advocacy Through Legislation

Advocacy Through Legislation

Identify a problem or concern in your state, community, or organization that has the capacity to be advocated through legislation. Research the issue and complete the sections below. For each topic that requires the listing of criteria, a minimum of two criteria should be identified and discussed. Add more rows as is appropriate for the topic/proposal.


In no more than 250 words, describe the problem, who is affected, and the current ramifications. Explain the consequences if the issue continues.

Florida has been allocating the lowest capita to the mental health of its insured and uninsured population. According to statistics, 61.7 percent adults are suffering from mental illness and this population did not get any kind of treatment in Florida ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"N9jhzmOO","properties":{"formattedCitation":"(Apostolopoulos et al., 2016)","plainCitation":"(Apostolopoulos et al., 2016)","noteIndex":0},"citationItems":[{"id":1760,"uris":["http://zotero.org/users/local/F0XOCTdk/items/962BPNU2"],"uri":["http://zotero.org/users/local/F0XOCTdk/items/962BPNU2"],"itemData":{"id":1760,"type":"article-journal","title":"Work strain, social isolation and mental health of long-haul truckers","container-title":"Occupational Therapy in Mental Health","page":"50-69","volume":"32","issue":"1","author":[{"family":"Apostolopoulos","given":"Yorghos"},{"family":"Sönmez","given":"Sevil"},{"family":"Hege","given":"Adam"},{"family":"Lemke","given":"Michael"}],"issued":{"date-parts":[["2016"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Apostolopoulos et al., 2016). Whereas, according to the State of Mental Health in America. Florida is considered to be on 44th ranking. Suffering from issues including depression, anxiety, and other personality disorders are the considerations of mental health. The most affected population is said to be adults, and this may hinder the overall development of the state. If this is not controlled, then this will result in higher rates of health issues and increased mortality rate.

Idea for Addressing Solution

In no more than 250 words, outline your idea for addressing the issue and explain why legislation is the best course for advocacy. 70

The reason behind highlighting this issue is that, the adult population is more vulnerable towards mental health issues. These issues when not tackled, will increase unrest in the whole society; moreover, most of the population will not be able to contribute in the development. Legislation can be a best course for advocacy because it is the state, which allocates the resources, and the budget ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"7r7gQtAQ","properties":{"formattedCitation":"(Lake & Turner, 2017)","plainCitation":"(Lake & Turner, 2017)","noteIndex":0},"citationItems":[{"id":1757,"uris":["http://zotero.org/users/local/F0XOCTdk/items/9D756LYH"],"uri":["http://zotero.org/users/local/F0XOCTdk/items/9D756LYH"],"itemData":{"id":1757,"type":"article-journal","title":"Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care","container-title":"The Permanente Journal","volume":"21","source":"PubMed Central","abstract":"Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally., This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics.","URL":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593510/","DOI":"10.7812/TPP/17-024","ISSN":"1552-5767","note":"PMID: 28898197\nPMCID: PMC5593510","journalAbbreviation":"Perm J","author":[{"family":"Lake","given":"James"},{"family":"Turner","given":"Mason Spain"}],"issued":{"date-parts":[["2017",8,11]]},"accessed":{"date-parts":[["2020",1,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Lake & Turner, 2017). More budget for mental health will contribute in the advanced treatment facilities in the mental health care institutions.

Research the Issue

Perform research and compile information for your idea. Present substantive evidence-based findings that support your idea for addressing the problem (studies, research, and reports). Include any similar legislation introduced or passed in other states.

Evidence 1

Based on the studies and research it can be said that there is a need for improvement in the mental health care provisions.

Evidence 2

Relating the mental issue with the vulnerable population, the studies show that adult population is more vulnerable towards mental health issues in Florida.

Stakeholder Support

Discuss the stakeholders who would support the proposed idea and explain why they would be in support

Stakeholder(s) Supporting 1

State institutions may be one of the stakeholders for the reason of allocation of budget and other resources for the citizens.

Stakeholder(s) Supporting 2

Community members can be a support because awareness can be created from the basics with the inclusion of them.

Stakeholder Opposition

Discuss the stakeholders who would oppose the proposed idea. Explain why they would be in opposition and how you would prepare to debate or converse about these considerations.

Stakeholder(s) Opposed 1

Health institutions because of over burden in the services.

Stakeholder(s) Opposed 2

Financial institutions because of lack of budget.

Financial Incentives/Costs

In no more than 250 words, summarize the financial impact for the issue and the idea (added costs, cost savings, increased revenue, etc.). Provided support.

Increased revenue will contribute in making improvements in the mental health issues. Health sector is the source through which financial support can be utilized.

Legislature: Information Needed and Process for Proposal

Discuss the how to advocate for your proposal using legislation. Include the following:

Provide the name and complete contact information for the legislator.


Describe the steps for how you would present this to your legislator.

Creating links and community meetings will be the initial step, and then a proposal will help convey the concerns to the legislator.

Outline the process if your legislator chooses to introduce your idea as a bill to congress.

Modifying the proposal with the help of peers will be done and this will be presented to the congress through the legislator.

Christian Principles and Nursing Advocacy

In no more than 250 words, discuss how principles of a Christian worldview lend support to legislative advocacy in health care without bias. Be specific as to how these principles help advocate for inclusiveness and positive health outcomes for all populations, including those more vulnerable, without regard to gender, sexual orientation, culture, race, religion/belief, etc.

The principles of Christians can be a source to lend support to the legislation by promoting charity healthcare clinics. This includes all the segments of the society and community to be a part in the health sector, this will encourage positive outcomes in the health sector. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"lxaWJIVD","properties":{"formattedCitation":"(Cuellar De la Cruz & Robinson, 2017)","plainCitation":"(Cuellar De la Cruz & Robinson, 2017)","noteIndex":0},"citationItems":[{"id":1754,"uris":["http://zotero.org/users/local/F0XOCTdk/items/W42GATNL"],"uri":["http://zotero.org/users/local/F0XOCTdk/items/W42GATNL"],"itemData":{"id":1754,"type":"article-journal","title":"Answering the call to accessible quality health care for all using a new model of local community not-for-profit charity clinics: A return to Christ-centered care of the past","container-title":"The Linacre Quarterly","page":"44-56","volume":"84","issue":"1","source":"PubMed Central","abstract":"This article uses studies and organizational trends to understand available solutions to the lack of quality health care access, especially for the poor and needy of local U.S. communities. The U.S. healthcare system seems to be moving toward the World Health Organization's recommendation for universal health coverage for healthcare sustainability. Healthcare trends and offered solutions are varied. Christian healthcare traditionally implements works of mercy guided by a Christian ethos embracing the teachings of human dignity, solidarity, the common good, and subsidiarity. Culture of Life Ministries is one of many new sustainable U.S. healthcare models which implements Christ-centered health care to meet the need of quality and accessible health care for the local community. Culture of Life Ministries employs a model of charity care through volunteerism. Volunteer workers not only improve but also transform the local healthcare system into a personal healing ministry of the highest quality for every person., Summary: The lack of access to quality health care is a common problem in the U.S. despite various solutions offered through legislative and socioeconomic works: universal healthcare models, insurance models, and other business models. U.S. health care would be best transformed by returning to the implementation of a traditional system founded on the Christian principles of human dignity, solidarity, subsidiarity, and the common good. Culture of Life Ministries is an example of such a local ministry in Texas, which has found success in practically applying these Christ-centered, healthcare principles into an emerging not-for-profit, economically sustainable, healthcare model.","URL":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5375650/","DOI":"10.1080/00243639.2016.1274631","ISSN":"0024-3639","note":"PMID: 28392598\nPMCID: PMC5375650","shortTitle":"Answering the call to accessible quality health care for all using a new model of local community not-for-profit charity clinics","journalAbbreviation":"Linacre Q","author":[{"family":"Cuellar De la Cruz","given":"Yuri"},{"family":"Robinson","given":"Stephen"}],"issued":{"date-parts":[["2017",2]]},"accessed":{"date-parts":[["2020",1,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Cuellar De la Cruz & Robinson, 2017).


ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Apostolopoulos, Y., Sönmez, S., Hege, A., & Lemke, M. (2016). Work strain, social isolation and mental health of long-haul truckers. Occupational Therapy in Mental Health, 32(1), 50–69.

Cuellar De la Cruz, Y., & Robinson, S. (2017). Answering the call to accessible quality health care for all using a new model of local community not-for-profit charity clinics: A return to Christ-centered care of the past. The Linacre Quarterly, 84(1), 44–56. https://doi.org/10.1080/00243639.2016.1274631

Lake, J., & Turner, M. S. (2017). Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care. The Permanente Journal, 21. https://doi.org/10.7812/TPP/17-024

Subject: Healthcare and Nursing

Pages: 1 Words: 300

Advocating For Social Justice

Advocating for Social Justice

Student’s Name:

Institution Affiliation:




What does social justice mean to you?

Social justice is an idea that is associated with equality, freedom as well as society’s common good. Many people believe social justice has lost its meaning and this is why it has become a buzz word for activists as well as campaigners (Drevdahl, 2001). However, to me, there is more to social justice than thinking about what it's not. Social justice to me is the possibility of accessing quality healthcare for every individual. Social justice is consistent, everyday activities that aim at making things accessible for all people.

Is social justice the same as socialized medicine or even communism?

Socialized medicine, communism as well as social justice are entirely different ideologies that many people tend to confuse. For starters, social justice is majorly about the ownership and accountability by the people for advocating equality (Stanhope, 2015). Socialized medicine, on the other hand, focuses on government-owned and controlled healthcare system where services as well goods are offered and catered by the government thus promoting equal access. Communism is a political system whereby the government is responsible for owning and distributing resources regardless of their contribution to promote equality.

The notion of social justice is fairness so that everyone can achieve a certain level of health and wellness. After all, the Constitution guarantees everyone the right to pursue happiness. Is the health care system fair?

The healthcare system cannot be termed as fair as many people are still not accessing healthcare despite it being a basic need. The stakeholders overseeing the system have become too hungry to a point of focusing more on the profits rather than the service being offered. Citizens are still not being able to access quality healthcare and for some, they cannot access healthcare at all (Wendt, 2009).

If you could wave a magic wand and fix the health care system, what is the first thing you would notice indicating that it had changed? Or, in your opinion, do you think it needs to be changed at all.

For starters, the government should make healthcare free. I believe by doing this, many people from all corners of the nation despite their social class will access proper healthcare. Secondly, the government should initiate policies that govern all healthcare system regardless of private or public. This will help ensure the services being offered are appropriate and up to standard. Lastly, people should learn to put their trust in the government as there is no way we can heal the ailing and expect to uplift our healthcare system if we the people distrust our government.


Drevdahl, D., Kneipp, S. M., Canales, M. K., & Dorcy, K. S. (2001). Reinvesting in social justice: A capital idea for public health nursing?. Advances in Nursing Science, 24(2), 19-31.

Stanhope, M., & Lancaster, J. (2015). Public health nursing: Population-centered health care in the community. Elsevier Health Sciences.

Wendt, C., Frisina, L., & Rothgang, H. (2009). Healthcare system types: a conceptual framework for comparison. Social Policy & Administration, 43(1), 70-90.

Subject: Healthcare and Nursing

Pages: 1 Words: 300

Affordable Care Act

Affordable Care Act


School or Institution Name (University at Place or Town, State)

Affordable Care Act

Affordable care act was implemented in 210 and is also known as Obamacare. The act created a minimum level of coverage for insured Americans for their wellness and healthcare benefits. It has brought many benefits to the workforce. Aging of the labor force in American institutions has increased the complexity of health care needs. Escalating healthcare costs has caused concerns among employers for chronic diseases ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"nWx5pF57","properties":{"formattedCitation":"(Anderko, 2012)","plainCitation":"(Anderko, 2012)","noteIndex":0},"citationItems":[{"id":73,"uris":["http://zotero.org/users/local/Ugrd7iAF/items/GIYUNA9G"],"uri":["http://zotero.org/users/local/Ugrd7iAF/items/GIYUNA9G"],"itemData":{"id":73,"type":"article-journal","title":"Promoting Prevention Through the Affordable Care Act: Workplace Wellness","container-title":"Preventing Chronic Disease","volume":"9","source":"www.cdc.gov","URL":"https://www.cdc.gov/pcd/issues/2012/12_0092.htm","DOI":"10.5888/pcd9.120092.","ISSN":"1545-1151","shortTitle":"Promoting Prevention Through the Affordable Care Act","journalAbbreviation":"Prev Chronic Dis","language":"eng","author":[{"family":"Anderko","given":"Laura"}],"issued":{"date-parts":[["2012"]]},"accessed":{"date-parts":[["2019",2,13]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Anderko, 2012). The inclusion of workplace wellness funding in the affordable care act has increased potential for healthcare programs in organizations. Socially supported structures of wellness programs in organizations will improve the declining health of the aging demographic.

With the implementation of the affordable care act, the subsidies have made it less expensive to purchase health insurance. It is a positive change to spend eighty percent of the premium value of insurance policies on healthcare. The act has made it difficult for insurance companies to cancel the insurance benefits any time in the future if there is a mistake in the application process. They cannot deny they cannot deny the coverage as well based on the maturity of the plan. Americans under 138 percent of the poverty level having no insurance coverage will also enjoy the benefits of the reforms package in states expanding their program for medical aid.

On the other hand, the act has increased trouble for people having private plans because many private plans have been canceled due to noncompliance with the act. Holders of such plans will have to purchase new plans approved under the act ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"x0BhbjGd","properties":{"formattedCitation":"(Anderko, 2012)","plainCitation":"(Anderko, 2012)","noteIndex":0},"citationItems":[{"id":73,"uris":["http://zotero.org/users/local/Ugrd7iAF/items/GIYUNA9G"],"uri":["http://zotero.org/users/local/Ugrd7iAF/items/GIYUNA9G"],"itemData":{"id":73,"type":"article-journal","title":"Promoting Prevention Through the Affordable Care Act: Workplace Wellness","container-title":"Preventing Chronic Disease","volume":"9","source":"www.cdc.gov","URL":"https://www.cdc.gov/pcd/issues/2012/12_0092.htm","DOI":"10.5888/pcd9.120092.","ISSN":"1545-1151","shortTitle":"Promoting Prevention Through the Affordable Care Act","journalAbbreviation":"Prev Chronic Dis","language":"eng","author":[{"family":"Anderko","given":"Laura"}],"issued":{"date-parts":[["2012"]]},"accessed":{"date-parts":[["2019",2,13]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Anderko, 2012). Many companies have to abandon sponsored plans and reduce their networks to cut the costs to make their plans according to the affordable care act. Despite the negative effects of the act it proved to be more positive than negative. It has provided people with greater relaxation in healthcare benefits.


ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Anderko, L. (2012). Promoting Prevention Through the Affordable Care Act: Workplace Wellness. Preventing Chronic Disease, 9. https://doi.org/10.5888/pcd9.120092.

Subject: Healthcare and Nursing

Pages: 1 Words: 300

Agape Hospice Rotation

Title page

Agape hospice rotation

Hospice care is crucial for the people who are in the last stage of terminal illness, and it focuses on enhancing the quality of life. Hospice programs are home-based generally, but sometimes services are also provided away from home. The patients who are diagnosed with fatal illness and demand quality care for comforting themselves are qualifiers of hospice care. These patients demand compassionate care rather than prolonged lives. The focus of hospice care is on promoting dignity and reducing discomfort at the end of life CITATION Deb15 \l 1033 (Stoewen, 2015). Hospice will be an integral part for patient care who are suffering from advanced illness. It will focus on maximizing the quality of life patients life who are undergoing chronic pain by adopting pain management strategies. The goal is to provide relief by minimizing the intensity of pain. The program will focus on choosing between the pharmacological and treatments for care management. Specific goals will be established to implement effective treatment plans. The goals of the program cover the physical, mental and spiritual aspects CITATION Sis09 \l 1033 (Roy, 2009).

The minimum criteria for the staffing of nurses is graduation, apart from that the experience and professional skills will be considered. A nurse should earn a degree in nursing. A nurse needs hospice and palliative care exams for certification after two years of experience in hospice settings. The diseases that are prevalent among hospice patient population include cancer, heart diseases, lung diseases, and dementia. The prevalence of cancer is around 40% among hospice population in America. The prevalence of dementia is 14.8%, heart disease is 14.7% and lung disease is 9.3%. The pre-servicing and in-servicing training stresses improving the competency of nurses and social workers. The nursing staff is provided with training about treating patients with care. The role of nurse is to give sufficient care by utilizing different models of care. The training provides guidance on emotional channels that involve information assessment, learning, judgments, and emotion. Nurses assess the behavioral factors that affect adaptive ability and takes steps for encouraging adaptability among patients CITATION Sis09 \l 1033 (Roy, 2009).

I encountered with a cancer patient in hospice settings. My role as a nurse was to take care of the patient and provide medications according to physician's instructions. I had to provide palliative care to the dying patient, so I used Acetaminophen for controlling fever and pain. Antidepressants were also administered for assisting a patient in overcoming social anxiety disorder. Selective serotonin inhibitors had an effective role in lessening anxiety. Another patient that I encountered in hospice care was suffering from Parkinson's disease. When the pain was more severe and the patient wanted to relax I gave him Anticholinergic. The medication helped the patient to overcome his breathing problem, removed movement disorders and improved blurred vision CITATION Deb15 \l 1033 (Stoewen, 2015).

The most interesting part of my experience was to provide them comfort. Compassion and positive attitude helped me to establish an effective relationship with the patients. As patients in hospice care are going through severe pain the most challenging part was to cope with their moods. Most of the time patients despised me when I had to give medicine. At that time patients were restless so I had to be calm. I learned from the rotation that patients in hospice settings need care and compassion. The nurse must be able to understand their needs by assessing their verbal and non-verbal complaints. I learned that in hospice care nurses must be empathic with the patients because it promotes dignity and self-respect.


Stoewen, D. L. (2015). Health and wellness . Can Vet Journal, 56 (9), 983–984.

Roy, S. C. (2009). Nursing Theories: A Framework for Professional Practices . Nursing Outlook, 18, 42- 45.

Subject: Healthcare and Nursing

Pages: 2 Words: 600

Aging Bias

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Aging Bias

Paul Rose

Southern Illinois University Edwardsville

Author Note

Ageism is a prejudice, discrimination and stereotyping against people on the basis of their age. Ageism is an insidious and widespread practice that creates a harmful effect on older peoples health. Ageism is an everyday challenge for older people. Restricted from social service overlooked for employment, ageism marginalizes and stereotyped aged people in their community. Unlike sexism and racism, ageism is not countered widely and have a negative impact on the wellbeing and health of older people. Ageism in nursing is usually represented ambiguously within a profession of nursing and difficult to grasp. Ageism affects the shift time and staffing pattern. Nursing practice is usually associated with physicality and youth, although often without full evidence to support myth and perception. Nursing emphasizes physical work and youth in many health care settings. Studies have shown that ageism is particularly problematic in nursing practice. Older nurses usually leave practice setting which results in a risk of a shortage of nurses. Studies have shown that older nurses have been stereotyped as out of touch, angry and pushed to retirement. Unlike individual and social construction of ethnicity and race, ageism presents both threats and opportunities to identity and self. Ageism may elicit outright fear and worry thus triggering disparagement and hostility among older nurses. Negative ageism also intersects with sexism and racism leaving elder nurses so-called minority groups making them vulnerable to societal assault.

Despite professional and social demographics, ageism manifests as interpersonal and social discrimination based on advancing age. The most common impact of ageism on nursing practice is a negative judgment and violent and hurtful actions against others on the perception of advanced age. Sometime ageism is also associated with physical and psychological abuse of older people. Ageism is commonly misunderstood by health care professionals and nurses. Nurses tend to take care of older people as their duty. Most of the practice environment is linked with physicality and youth. Ageism in nursing diminishes patient care quality, worsens the shortage of nurses and also damages mentoring relationships. This is due to the long-standing biases among supervisors and administrators as well as the tension between young and older nurses. An evidence-based approach is a self-care management education plan that should be carried out in a community setting. Self-care education programs can improve key aspects of both communicable and non-communicable disease management like patient-provider communication and medication compliance.

Ageism is a discrimination or stereotyping against people or groups based on their age. It may be a cause due to system. The term was quoted by Robert Neil Butler and the intention was to describe the discrimination against adults and older people in the community. The discrimination against older people is considered as violence against them. For example, biases have been observed in the celebration of birthday parties of old people with black balloons and to pass racial and age related comments against them. Older people are usually ignored in hospitals and they have to wait for hours for the treatment. They have been victim of the social and communal discrimination in the societies and communities. Healthcare providers have been observed to be violent and overreact them such as shouting in the facilities while providing them healthcare facilities. They are the first victim of the sexual violence and misbehavior among the societies.

Through evidence-based environmental adaptation, communication technique and meaningful life enrichment program ageism can be addressed. Awareness should be created among nurses regarding how to combat the negative impact of ageism in nursing. Different workshops and conferences should be conducted to remove the stereotype that is associated with age aim. Evidence-based campaigns should be carried out to adopt a positive attitude towards the older workforce and to increase awareness. The main goal of these community education programs should be to change the behavior and attitude of people toward ageism. The main purpose of a community education plan is to develop the capacity of individuals through their actions to improve the quality of life of older people. This will be a coordinated and comprehensive plan for providing recreational, cultural and social services to aged people in the community. The educational partnership between the public and private sectors will be developed for the cooperative use of all available resources to reduce the stigma associated with ageism.

The main audience for this community education program will be nurses, fresh graduates, and health care professionals. Nurse leaders have the authority to develop the management and workplace strategies and to shape new practices among their clinical nurses. A community-based education plan will be developed by creating a more flexible tradition and interpretations in nursing including mentorship, staffing model and shift design. Simple interventions such as educating nurses will have proved to be very effective in changing the belief and attitudes that result in improved nursing care.


Table 1

Correlations Among and Descriptive Statistics For Key Study Variables


M (SD)





Relig.Dist. Intol.Sex1.53 (.50).07-.09 .02 .14 .06Age31.88 (10.29) .08 .19 .20 .01Income2.60 (1.57).04-.14-.09Educ.3.44 (1.06) -.29-.06Relig.1.21 (.30) -.19Dist. Intol.3.75 (1.19)

Notes. Ns range from 107 to 109 due to occasional missing data. For sex, 0 male, 1 female. Educ. education. Dist. Intol. distress intolerance. Relig. religiosity.


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Subject: Healthcare and Nursing

Pages: 3 Words: 900



Your Name (First M. Last)

School or Institution Name (University at Place or Town, State)

Service Agency Identification

Aid for friends is an organization founded by Rita Ungaro with an aim to alleviate the issue of hunger, poverty and isolation of the old home bound population that lives in Philadelphia. This agency has huge number of volunteers that that visit the clients as friends and provide them home cooked meals free of charge. These volunteers also spare some time and talk to clients on each visit. Other than food older citizens have other unmet needs that threaten their existence, i.e. disabled need caregivers, they need essential home items like toasters, ovens and human affection especially on important occasions like birthdays and Christmas. Aid for friends addresses all these needs.

Population served through this program consists of older citizens who are in dire need of help due to their poverty, loneliness, disability and age. According to statistics 13,000 older citizens need help in preparing their meals; 73% from this number lives all alone and 40% can’t even leave their homes. Volunteers at AFF prepare around 300,000 dinner meals in their homes, 58,000 soups and 42,000 breakfasts to serve the need of 17,000 homes. 30% of the served population is below age 60 and 28% is above the age 85.

Rita Ungaro founder of AFF always had a kind heart for those in need. She used to serve food to the poor from her own pocket but soon she realized that serving meals by herself is not solution to this problem and she need help at larger scale to cater the needs of older poor generation. She started to talk about of this problem at public forums. In 1974 she with help of YWAC started AFF.

I have always felt helpless when I look at the poverty situation in my country. This poor population live in horrible circumstances, specially the old people. After living amazing lives in youth, many of these people live in circumstances when they don’ even have food or anyone to talk with. When I heard about this organization, I knew that I have to join it as volunteer as this is the only way for me to help such people in my small capacity. I was extremely touched by the mission of AFF and the way they practically reach a huge number of population.

Student action and reflection page

Part 2 – Action -STUDENT

I joined this organization as volunteer. I was told by the management that they want volunteers in distribution, funds collection and preparation units. I joined distribution team and preparation unit. My main task was to help my team in packaging food according to listed requirements. My team mostly consisted of new volunteers. My performance impressed the supervisor and he made me team leader. This was a unique experience that gave me sense of purpose and achievement. After two weeks I was assigned client friend that lived few blocks away from my home. Client was a 73 year old man, who was living alone and had leg problem. I used to deliver him food daily.

Part 3 – Reflection/Commitment –STUDENT

My role in this activity made me realize that life is not just about living in your own bubble but it is about helping others. This experience was life changing. This has taught me to take responsibility for my actions and to take decisions as team lead, which was a new experience for me. Now I feel more confident about decision making. Knowing that someone is depended on me has helped me to overcome my punctuality problem.

My client was old man who used to feel huge difficulty doing house chores as his leg was hurt from an accident. In theory, my duty was just to deliver him food and do conversation. But in spirit it was more than that. I was taught to show them compassion and ask him if he needs help with anything else. I often used to help him doing his other chores that were not exactly part of my duty description, like putting his weekly medicines in medicine box, organizing his room and side tables, making him coffee etc.

AFF can get huge benefit, if local citizens, especially nurses and healthcare practitioners, join the organization. Affiliation of such volunteers can bring huge quality factor in the services as many clients need special medical attention and these needs are not fully fulfilled due to lack of funding. Local government organizations should consider giving funds to this organization as it will help organization expand its service unit.

I plan to always stay associated with this organization as volunteer. I think my qualification as nurse is really helpful for those in need of medical assistance. My medical knowledge can help clients understand their issues better. Earning money should not be the only purpose of life, as citizen and nurse I should help needy for free to make world better place for everyone to live.


Subject: Healthcare and Nursing

Pages: 2 Words: 600

Alcoholics Anonymous Or Narcotics Anonymous Meetings And Al-Anon Meetings

Alcoholics Anonymous or Narcotics Anonymous Meetings and Al-Anon Meetings


[Institutional Affiliation(s)]

Meeting Date

Author Note

[Include any grant/funding information and a complete correspondence address.]

Alcoholics Anonymous or Narcotics Anonymous Meetings and Al-Anon Meetings


Alcoholics Anonymous (AA) are therapeutic programs for the individual suffering from Alcohol Use Disorder (AUD) (Stone, Conteh, & Francis, 2017). They are designed to help alcoholics achieve sobriety. Al-Anon meetings are conducted for support and assistance of parents, spouses, siblings, friends, and other relatives of alcoholics, even if the alcoholics do not acknowledge the drinking problem and ask for help. The programs are based on the recommended Twelve Steps of Alcoholics Anonymous.

The AA and Al-anon groups are established on a spiritual and non-religious philosophical basis. I noted that members of both groups, gain understanding from being part of an interactive group as compared to the one-on-one support sessions — the essential group dynamics involved in both groups the strong sense of togetherness and harmony.

Both meetings followed almost similar formats. The meetings started with the opening statement and serenity prayers. Anyone who has a related announcement is encouraged to speak. We went around the room, and everyone introduced themselves as they pleased. I introduced myself as a SHU nursing student. Next, everyone shared their stories about what they used to be and how they are doing now. Throughout the meetings, no crosstalk or hurtful remarks were allowed. Everyone got a chance to share as much as they liked.


I realized that the basic principles of nursing were diligently incorporated in the meetings. Every member of the group was treated with dignity and humanity. Moreover, group leaders were vigilant about the risks of abusive comments or violence from members.

           Before attending these meetings, I perceived these meetings as dull and tedious therapy sessions. However, I was personally impressed by the power of motivation and courage that helps people transform and adopt a better lifestyle. In both meetings, for everyone in the room, including me, it was a good experience. Everyone shared their burden and felt motivated by the end of the meeting. Attendance and active participation in such meetings is fundamental for recovery.


It gives a feeling to the members that they are not alone, and together they will overcome the hurdles. It gives people a platform to share their experience and hope to solve their common problems.


If I had joined these meetings other than educational purposes, it would have helped me to regain power and control over my problems.


After critically analyzing the effects of the meeting, I concluded that these programs are based on cognitive behavioral therapy and are effective tools in facilitating recovery. The experience of other people who share their stories tells a person how they can resist alcohol and drugs, ways they can cope with obstacles in life with the use of alcohol. In addition to this, it encourages participants to develop an attitude to resist relapse and in the case of Al-anon meetings, how to help others recover.


ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Stone, D., Conteh, J., & Francis, J. (2017). Therapeutic Factors and Psychological Concepts in Alcoholics Anonymous. Journal of Counselor Practice, 8, 120–135. https://doi.org/10.22229/nav074629

Subject: Healthcare and Nursing

Pages: 1 Words: 300


History of Alcohol Use Disorder




Alcoholism, also called alcoholic disorder is defined as the inability to control the consumption of alcohol because of both, emotional as well as physical dependence on alcohol. Generally, the use of alcohol is defined in terms of using alcohol that is associated with problems caused by the adverse effect of alcohol, or something having alcohol, injurious to health. Binge drinking, defined as a dinking pattern in which a male is having five or more than five drinks in the time span of two hours or a female is found to be having at least four drinks within the same time span. There are several terrifying health concerns associated with Binge drinking, taking into account that people are taking the initiative to overcome this impact. Medication-assisted therapy is one of the options that is used to treat opioid disorder, considering that there are very few people who know that alcoholism can be treated or somewhat reduced with the help of therapy or counseling, as compared to self-initiatives actions of overcoming addiction. Therefore, the purpose of this paper is to evaluate the patient's diagnosis with alcohol use disorder. It will describe the demographics and background of the patient, as well as the disease process, sign, and symptoms, treatment options and pharmacology.

Case History on Alcohol Use Disorder


BB is a 64 years old male, Indian American male with history of alcohol use disorder. BB was brought into the emergency room by emergency medical services. Patient was hospitalized at Jamaica Medical Center for his erratic behavior due to alcohol use and depression. Patient has no past psychiatric hospitalizations. No history of MH treatment. No history of suicide or self-harm. No history of violence or arrests. No legal issues. No history of trauma. Migrated to the USA 40 years ago, he lives with wife and family in a private house.

BB has two sons aged 28 and 30 years, his highest level of education is high school. He identifies himself as a businessman and stated that he runs a liquor business with his wife and children. According to BB, the business is not as profitable as it used to be years ago when the business was established, and he decided to close the business. Currently, he is unemployed, he expressed emotions about his fear and anxiety and depression due to his inability to support his family financially. BB was diagnosed with Alcohol Use Disorder when she was 45. BB developed thoughts of hopelessness, worthlessness, which led to suicidal ideations.

This led to two inpatient psychiatric hospitalizations, where he overdoses both times on medications. On this first admission, BB was started on PO Antabuse, Ativan and referred to rehabilitation and detoxification program. He reports stopping the medication and discontinues his rehabilitation program after three months of feeling sober. The second hospitalization was six months ago, which may have been caused due to another episode of binge drinking. During the second admission, BB shared that he has tried to reduce his habit of consuming alcohol before getting ended in a residential treatment option. He shared that he was unable to continue his attempts for more than 30 days and he just tried to "white knuckle” his way. Also, BB has shared some major withdrawal symptoms such as excessive sweating and shivering as two of the major hurdles in sustained sobriety.

Before getting admitted to the residential treatment, BB has attended some Alcoholics Anonymous meetings that he never found as effective and supporting him in sustained sobriety. BB has also reported that he had full 120 days of assistance from alcohol when he was undergoing treatment in a residential treatment facility. BB was referred to a psychiatrist and psychotherapist and started to see the psychiatrist once a month and psychotherapist twice in a week. The therapy sessions according to BB paved the way for recovery by increasing more adherence to abstinence support and medications, collaborated by education and referral of the supporting groups.

He expresses frustration for relapsing two weeks ago and is disappointed in the way his family views his alcohol abuse. He feels as though his family does not respect him anymore due to his alcohol abuse and is motivated to quit on his own. BB denies any history of blackouts, seizures, diabetes, and hypercholesterolemia.

As per the data collected from the CDC, alcoholism is one of the disorders that plays a central role in causing disability in the United States of America. According to the same report, about 62% of the adults who were older than 18 years were suffering from alcoholism, making up 15.1 million people. It also included 9.8 million men and about 5.3 million women, making up 84% of the adult men and 4.3% of the adult women. every year, it is calculated that 88,000 people making up 62000 men and 26000 women die because of alcohol-related diseases. it is highlighted that, as per information collected in 2014, alcohol abuse or alcohol-related aspects as the third major cause of death in the United States of America. There were about 9,967 deaths because of alcohol-driven impacts. Different studies have highlighted that alcoholism majorly contributes to cardiovascular problems along with atrial fibrational, hypertension and different types of strokes, particularly hemorrhagic.

BB is a good historian, well-groomed in clean casual clothing and he was healthy in appearance much like dishevel African American man. He is quick enough to respond to person, place situation or the time, also with better communication skills accompanied by angry and irritable mood swings. Some major signs in BB are, BP, 130/88 (in sitting position and of the left arm), HR is 104, RR is 22 and Temperature is 98.8 Fahrenheit. His facial gestures are glassy with bilaterally constricted pupils, highly reaction to lights round in shape with the red sclera and teary eyes. He has normal ears with a normal ear canal and an adequately functioning tympanic membrane. He has a running nose with no erythema of the nostrils with a normal septum, BB has a dry oral mucous membrane with a poor dentation and has his back tooth missing. The heart rate of BB is regular with mild tachycardia recorded as 104. He has bilateral extremities with different tattoos and a fresh mark of a needle in the antecubital areas. He has space in the lower extremities. His bilateral hand tremors with extended arm, noting there is no edema observed on the upper as well as lower extremities. He has bilateral feet with cracking, dry and peeling skin, where BB usually itch at times. He maintains eye contact most of the time during interview, he was articulate, and the thought process was clear and concise. BB reports that his father was alcoholic, Also, his son who is 30 years has also been treated with alcoholism in the past. According to him, alcohol abuse or addiction runs in the family, but he feels that he has observed a change in his drinking habit because he takes his medication regularly. This disease contributed to a lack of concentration and coordination in his liquor business, reduces productivity, which in turn impacts business goals and objectives. His addiction to alcohol led to the downfall of his liquor business which he operated for 25 years. He admits to drinking7 to 10 bottles of alcohol daily, and sometimes throw upon himself.

Patient reports that when there are negative feelings or thoughts, he listens to soft music and sometimes takes a long walk.

Counseling is done for substance abuse and its impact on patient's health. Patient was advised against the mixing of substance use with any prescription/over the counter herbal medications. He was educated on the illness, and signs and symptoms of withdrawal and how to contact his providers or the emergency room if it is after hours. BB was given information about support groups such as Alcoholics Anonymous (AA) and other programs are helpful for the patient.


According to BB, he has endorsed multiple diagnostic criteria in his initial process of assessment. As per his memory, within the time span of last year, he has consumed more alcohol as compared to the past. Also, he found difficulty in reducing his total alcohol consumption and because of this habit of alcohol consumption, he has restrained from his friends and family members. BB also had strong cravings for alcohol which resulted in lack of attention in the recreational activities. He also quoted that he kept on drinking alcohol, despite knowing that alcohol can cast a negative impact on diabetes. Also, he has developed a strong tolerance towards alcoholism, with an ability to drink one gallon each day which as one liter in the past years, BB has also experienced severe symptoms of withdrawal from the last few months such as sweating, mood disturbance and shaking.

According to BB medical records, he was diagnosed with alcoholism at the age of 25. Alcoholism is a chronic, relapsing disease that affects millions of Americans of all ages and is more common among men (American Psychiatric Association, 2018). Various factors contribute to alcohol use disorder, they include genetics, environment, trauma, mental illness, and peer pressure (APA, 2018). BB said that his parents were addicted to alcohol and other drugs, and he had some belief that this caused him to be addicted to alcohol. He stated that his older brother had pancreatitis and dementia, he died two years ago. BB also shares that he has faced a lack of communication and companionship with his friend because of alcoholism, taking into account that he was not able to reciprocate. BB shares that he was conscious about making new friends because he was fearful of being let down by his friends because of drinking.

Diagnosis: DSM-5 Diagnosis

Diagnostic and Statistical Manual of Mental Disorders highlights a criterion that must be met by the individual who is diagnosed with AUD. Under DSM-5, anyone who is meeting any two of the criteria out of 11 during the time span of 1 year, he would be eligible for receiving a diagnosis of AUD. Meeting criteria defined the severity of AUD, either to be mild, server or moderate. In order to assess, if someone has AUD, there are some questions that must be asked, calculating information from the past year

There were times when either there was a complete withdrawal or more urge to drink as compared to the normal routine?

Once you feel that you should drink then you wanted to give up drinking or you were tired of it but were not able to?

You have spent a lot of time drinking or trying to overcome the after effects of drinking?

You had strong cravings for drinking?

You came to know that the urge or craving of drinking interfered with familial responsibilities or alcoholism has caused some school problems or issues related to employment.

You continued to drink, knowing that it can cause trouble with the friends or family members?

The urge of drinking was so strong that you tried to cut back from all the actions that were somehow imported or interesting to you in the past. It also includes your recreational activities?

You have been caught in a situation where drinking or the after-effects of drinking has caused to some life risks such as while driving, using any machine or swimming. It may also include a situation in which you are drunk and you are walking in a dangerous area or you are having unsafe sex?

You were in a situation where you continued to drink, knowing that it will make you anxious or depressed or it can add to your health problem? It also includes a situation of having a memory blackout?

You want to drink more and more as compared to your drinking schedule to get the effect that you want? Or you found that the number of drinks is less to cast an effect on you?

You found that when the effect of alcohol was wearing off, you were facing the withdrawal symptoms. These symptoms are irritability, restlessness, trouble in sleeping, nausea or excessive sweating. Also, you seem to sense things that were not part of reality?

In the time of remission, BB meets all the diagnostic criterion, applied to alcoholism. it is highlighted that the proponent of disease model hypothesized that continuous exposure to substance abuse is driven by some neurological hangs that are the product of some chemical interaction between the brain of an individual and the substance that is consumed. There are some additions in the disease model, in recent past, such as genetics, social and environmental factors. (Volkow, et al. 2016). BB also shared that he faced some interpersonal difficulties since the time of elementary education. He highlighted his assumptions of not being normal by the time he was nine years old.

According to Erikson, children who are 9 years old are found to be struggling with industry vs inferiority. one of the key features of this developmental stage is developing trust in others as well as being industrial, referring to self-confidence. Erikson also proposed that the children who feel inferior about themselves, or who are unable to develop self-confidence are unable to manage their life activities, considering themselves as not normal. As per BB's report, there is a possibility that he did not develop self-confidence in developmental stage and it was influencing his social connection, leading to an inferiority complex. He also added that he has always longed for a strong social network. The integration of data from BB’s report as well as assessment from the conceptual framework proposed by the disease model and Erikson inferred the significance of interpersonal support that can be used for BB’s ongoing support.

In a nutshell, it can be said that BB found himself different from other who are 9 years old. This assumption of difference kept him at a distance from everyone around, posing hurdles in development leading to inferiority. His concept of being inferior was the reason that he started drinking. A fall in business life added to his inferiority giving him more reason for drinking and isolation.

The adherence to Treatment Plan based on contextual conceptualization, the treatment schedule of BB emphasized increased social support to align with a growing sense of being industrious. There are some overarching goals associated with the guide such as permeant withdrawal from alcohol parallel to the time span of treatment as measured in the self-report by client.

There are some interventions that will be used for the achievement of health goals, such as induction of physical health schedule that can help to know how substance abuse by Kevin has impacted his physical health. The collaboration of Kevin’s physical health with that of mental health. Also, this will include an evaluation for the pharmacotherapy to be summed up in synchronization with the physicians and medical compliance management. This will be addressed in the form of weekly counseling sessions. These goals will also include increasing Kevin’s social support. Some cognitive-behavioral anxiety management techniques will also be used such as though banning, mindfulness as well as deep breathing.

Ideally, the goal will be quoted in the SMART formula. Also, the interpersonal approach will be used for empathizing with the counselor’s use of immediacy that can help Kevin get social feedback. Kevin will also be motivated to participate in weekly interpersonal process groups that will incorporate interpersonal feedback and social contact (Teyber & Teyber, 2011). An increase in Kevin’s sense of industry with the help of social support and participation in manual work will also be emphasized. Kevin will also be proposed with a set of social assessment along with career assessments so that Kevin can develop career interest. Also, some career counseling strategies will be used to help Kevin in developing the skills that can help him return to professional life.


There are three medicines the rea approved and will be used to treat AUD.

Disulfiram: this medicine can cause unpleasant symptoms such as skin flushing and nausea after drinking. These feelings can help to abstain from alcohol.

Naltrexone: It blocks the receptors that can help to feel good when drinking alcohol. This medicine is also capable of reducing cravings for alcohol, which can help overcome drinking.

Acamprosate: This drug helps to prevent alcohol driving. This medicine works on different brain systems with an aim to reduce cravings right after quit drinking.

Referrals and consultation

PCP for a physical exam

Follow up

Patient will attend Alcohol detoxification Program daily from M-F, will meet with NP for medication management minimum of once weekly but will be checked on for symptom management daily. Alcohol detoxification program is limited to six weeks but can be of shorter duration if it is determined that a lower level of care is appropriate. Upon finishing the Partial Program, the next level of care will be determined, and referrals made.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed.). Arlington, VA: American Psychiatric Publishing

Kukla, M., Bell, M., & Lysaker, P. (2018). A randomized controlled trial examining a cognitive behavioral therapy intervention enhanced with cognitive remediation to improve work and neurocognition outcomes among persons with schizophrenia spectrum disorders.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences, clinical psychiatry. Philadelphia: Lippincott Williams & Wilkins

Stahl, S. M. (2013). Stahl' s essential psychopharmacology: Neuroscientific basis and practical applications (4 ed.). New York: Cambridge University Press.

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016) Neurobiological Advances from the Brain Disease Model of Addiction. The New England Journal of Medicine, 374(4), 363-371. doi: 10.1056/NEJMra1511480.

Subject: Healthcare and Nursing

Pages: 7 Words: 2100

Allocating Public Health Resources

Allocating public health resources

Allocating public health resources

As mentioned in the Family Smoking Prevention and Tobacco Control Act of 1971, the state must enforce measures to promote the ban on tobacco ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"EG7fGo6S","properties":{"formattedCitation":"(Koh & Sebelius, 2010)","plainCitation":"(Koh & Sebelius, 2010)","noteIndex":0},"citationItems":[{"id":2113,"uris":["http://zotero.org/users/local/s8f0QVnP/items/JTHGCFDX"],"uri":["http://zotero.org/users/local/s8f0QVnP/items/JTHGCFDX"],"itemData":{"id":2113,"type":"article-journal","title":"Promoting prevention through the affordable care act","container-title":"New England Journal of Medicine","page":"1296–1299","volume":"363","issue":"14","source":"Google Scholar","author":[{"family":"Koh","given":"Howard K."},{"family":"Sebelius","given":"Kathleen G."}],"issued":{"date-parts":[["2010"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Koh & Sebelius, 2010). Seeing the situation, I will exert my energy on moving toward the upstream and will search for the causes of why people are ending in the river. As the history of American healthcare suggest that measures taken to avert the outburst of diseases are far more effective than curing people from such diseases. During the treatment, people normally lose the fight against disease, similar is the case in this situation. I might end up losing my own energies if I start taking the injured people out of the stream.

Yokoe argues that it is an obvious fact that in healthcare preventive measures should be focused more, compared to allocating resources for the treatment and recovery ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"eTmLWG87","properties":{"formattedCitation":"(Septimus, Weinstein, Perl, Goldmann, & Yokoe, 2014)","plainCitation":"(Septimus, Weinstein, Perl, Goldmann, & Yokoe, 2014)","noteIndex":0},"citationItems":[{"id":2115,"uris":["http://zotero.org/users/local/s8f0QVnP/items/MTP2KVGK"],"uri":["http://zotero.org/users/local/s8f0QVnP/items/MTP2KVGK"],"itemData":{"id":2115,"type":"article-journal","title":"Approaches for preventing healthcare-associated infections: go long or go wide?","container-title":"Infection Control & Hospital Epidemiology","page":"797–801","volume":"35","issue":"7","source":"Google Scholar","title-short":"Approaches for preventing healthcare-associated infections","author":[{"family":"Septimus","given":"Edward"},{"family":"Weinstein","given":"Robert A."},{"family":"Perl","given":"Trish M."},{"family":"Goldmann","given":"Donald A."},{"family":"Yokoe","given":"Deborah S."}],"issued":{"date-parts":[["2014"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Septimus, Weinstein, Perl, Goldmann, & Yokoe, 2014). As in the situation presented in the case, the only resource available is an individual, therefore his energies must be employed toward preventing the cause of people falling in the stream. This resource allocation will be much beneficial, in contrast to, if his energies are utilized in taking people out of the stream.

The health care literature suggest that resource allocation remains prudent if it is resulting in limiting the causes of disease eruption. The health care measures taken in American history are suggestive of the fact that policy formulation serves the purpose, rather treating ailments. The formative years of American health care system concerted upon blocking health-related infectious sources. We also witness prioritizing prevention in the world we live in. The strict scrutiny of food items at the airports or various entry ports is suggestive of the fact that preventive measures prove more substantial than treatment measures. These are the reason I believe, more resources should be allocated to preventive measures.


ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Koh, H. K., & Sebelius, K. G. (2010). Promoting prevention through the affordable care act. New England Journal of Medicine, 363(14), 1296–1299.

Septimus, E., Weinstein, R. A., Perl, T. M., Goldmann, D. A., & Yokoe, D. S. (2014). Approaches for preventing healthcare-associated infections: Go long or go wide? Infection Control & Hospital Epidemiology, 35(7), 797–801.

Subject: Healthcare and Nursing

Pages: 1 Words: 300

Alternative Therapies For Anxity

Alternative Therapies for Anxiety

[Name of the Student:]

[Name of the Institution:]

Alternative Therapies for Anxiety


Anxiety is the condition of uneasiness, nervousness, or worry about something such that a person is uncertain about its outcome. It is normal to experience anxiety at times in life. However, an anxiety disorder is said to happen when a person begins to experience feelings of worry and fear frequently in day-to-day situations (Levitt, 2015). That implies the patient experiences feelings of anxiety repeatedly, and these feelings become extremely tense within no time. The patient suffers from considerable disturbance in managing everyday activities, finds difficult to come over the feeling of anxiety, and remains uncertain of how long they will last. Common signs and symptoms of anxiety disorders are: to feel nervous or tense, expect some danger without reason, have an increased heart rate, breathe with unusual fast pace, have problems related to gastrointestinal tract, be unable to focus on a subject, and have trouble in sleeping.

The anxiety disorders are of various types and caused by several reasons. A person’s life experiences can cause anxiety disorders if the person is likely to acquire this disorder already. Some distressing incidents observed in life can leave a long-lasting disturbing effects on the mind of such a person. These effects can appear in the form of anxiety disorder sometime later in the person's life. However, the medical causes of anxiety disorders have also been reported besides those caused by observing or experiencing trauma. The medical causes associated with anxiety disorders include cardiovascular disease; diabetes; respiratory disorders; withdrawal from drug, alcohol, or relaxing pills; side-effects of using certain medicines, or thyroid problems (Bandelow & Michaelis, 2015). Further, anxiety disorders can also be caused due to certain medical conditions of the patient.

Alternative Therapies for Treating Anxiety

Alternative therapies for treating anxiety disorders might be natural remedies, psychotherapy, and medications. The doctor might suggest any of these alternative therapies based on the condition of the patient. The natural remedies for anxiety disorders include exercise daily, yoga, meditation, group discussions, travelling, writing, sports, and many others (Stonerock, et. al., 2015). Psychotherapy involves having counselling sessions periodically with a therapist so that the symptoms of anxiety can be reduced. Psychotherapists mostly apply cognitive behavioural therapy to teach the patient-specific skills for coping with the disorder. The patient is required to confront the disturbing situations intentionally to overcome the feeling of anxiety. Among the medications used in treating anxiety disorders are some anti-depressants, anti-anxiety medications, sedatives, etc (Er, 2015). The doctor can also suggest certain changes in the lifestyle such as keeping oneself physically active, refraining from alcoholic products, omitting drugs, quitting smoking, relaxing therapies, and trying to have a proper sleep.

Music Therapy: Literature Reviews

Music therapy is used to treat patients of anxiety disorders by addressing their cognitive, emotional, or social needs. The therapist may use various activities to fulfil the purpose, asking the patient to listen to certain melodies, playing a musical instrument, writing songs, or indulging in music composition depending upon the background of patients (Bidabadi & Mehryar, 2015). Researchers have studied the music therapy used in the treatment of anxiety disorders. While using the music therapy for reducing anxiety, the therapist uses music as the main tool to interact with the patient. Music therapy has proved to be effective in treating anxiety especially in children and young people. Listening to music improves the mood of the patient and provides relief by relaxing the muscles of the body. The therapists have successfully used music therapy for treating patients with symptoms of stress, cancer, mental disorders, cardiovascular diseases, and others. It might be perceived usually that medicine has more curative effects on the patient with anxiety than the music therapy. However, some researches describe that music has more relaxing effects on the patient than that of medicine.

According to a research conducted to find out the potential therapeutic benefits of music therapy for the critically ill, patients accommodated in intensive care units acquire stress and anxiety, especially those kept under mechanical ventilation. Anxiety created in this scenario can result in delayed recovery of patients (Mofredj, et. al., 2016). It was suggested that music therapy can be a reliable way of treating this problem. Music therapy can decrease stress, abate anxiety caused by mechanical ventilation, and create a relaxation response without using any medication. As a result, the patient will find an ease in ventilation due to decreased cardiac workload and increased oxygen consumption. The findings of the research also indicated, that music has a positive effect on the sleep quality. It reduces the patient’s suffering by decreasing the sedative exposure. This leads to an expedited ventilator weaning process and faster delivery.

A research was conducted to find out the role of music therapy in generalized anxiety disorders. The study presented results of pilot interventions with patients retained under clinical control. The research deployed music therapy to decrease the symptoms of this disorder. This study entailed seven patients, and the researchers programmed twelve sessions for the group, each session lasting for 2 hours (Gutiérrez & Camarena, 2015). The results revealed that music therapy was effective to alleviate levels of anxiety and depression.

A research was conducted to establish the fact whether the music therapy has a positive effect in reducing anxiety and depression in patients of Alzheimer’s or not. The study evaluated the effectiveness of implementing a short protocol of music therapy to alleviate anxiety and bring improvement in the emotional quotient of the patients suffering from Alzheimer's disease. The study proceeded with a group of 25 patients who underwent music therapy session that lasted for one hour. The test procedure comprises an analysis of a patient's saliva to measure the level of cortisol therein. It was completed using the immunoassay technique. Further, a questionnaire was filled out to quantify anxiety levels (de la Rubia Ortí et al., 2017). The results verified that using this therapy decreases the stress level as well as depression and anxiety in the patients. The research identified that there is a direct relation between the variation of these variables and that of the cortisol. The music therapy used as a short protocol can prove to be an alternative medicine to improve the emotional variables in patients of Alzheimer’s.

Another important research measured the effects of music therapy to reduce stress and anxiety in patients having a spinal cord injury. To conduct the study, forty patients experiencing anxiety and depression with a spinal cord injury were selected for the control group. After admitting these patients, they were given music therapy once a day, one hour one time for four weeks, besides continuing the psychological nursing procedures. The patients were checked against Hamilton’s anxiety scale and depression scale scores respectively. The recordings showed that music therapy can reduce anxiety and depression in the patients with spinal cord injuries significantly, and expedite the recovery process.

Research Statement, Method, and Results

Radiation therapy is linked with increased possibilities of higher stress levels. The research statement for the study was “to evaluate the effectiveness of music therapy in reducing anxiety and distress in patients who are newly diagnosed head and neck or breast cancer during simulation for radiation therapy.” The study aimed at identifying patients’ baseline levels of anxiety disorders before undergoing the simulation procedure. It also aimed at examining the impact of music therapy in reducing the levels of anxiety and discomfort of patients during the therapy. The study was conducted by simulating with and without the use of music therapy. The anxiety inventory questionnaire as well as distress thermometer were used to calculate the measurements. Patients had a conversation with a music therapist and their choice of music was given priority. The patients with no music therapy did not need taking a consultancy session with the music therapist. They also did not hear any music during the simulation for radiation therapy. After the simulation, all patients repeated the selected anxiety questionnaire and the symptoms distress thermometer (Rossetti et al., 2017).

The results established that music therapy lowered the patients’ anxiety and distress significantly. The results were obtained by using music therapy during the simulation procedure for radiation therapy based on the STAI-S questionnaire and symptoms distress therapy. The study concluded that music therapy-induced during simulation can be used as an effective intervention to reduce the anxiety and stress (Bian, Jiang, & Fan, 2015). It is most probable that continued research conducted on the role of music therapy in treating anxiety, stress, and depression will yield sound principles and more established results on the subject.


Anxiety disorders can be acquired through traumas or hereditary factors. Natural remedies, psychotherapy, cognitive behavioural therapy, alternative medications, and music therapy can be used to reduce anxiety. Several researches conducted to establish the fact that music therapy when administered systematically would significantly reduce anxiety, stress, and depression. Music has a relaxing effect on the mind and muscles of the body. It relieves tension, removes worries of patients, and help in more effective recovery from the disease. It is a very appropriate tool to keep the patients relaxed during the clinical procedures that cause anxiety and stress.

Works Cited

Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327.

Bian, M., Jiang, J., & Fan, D. (2015). Effect of music therapy on anxiety and depression in patients with spinal cord injury. Modern Clinical Nursing, (7), 47-49,50.

Bidabadi, S. S., & Mehryar, A. (2015). Music therapy as an adjunct to standard treatment for obsessive compulsive disorder and co-morbid anxiety and depression: A randomized clinical trial. Journal of Affective Disorders, 184, 13–17.

de la Rubia Ortí, J. E., García-Pardo, M. P., Iranzo, C. C., Madrigal, J. J. C., Castillo, S. S., Rochina, M. J., & Gascó, V. J. P. (2017). Does Music Therapy Improve Anxiety and Depression in Alzheimer’s Patients? The Journal of Alternative and Complementary Medicine, 24(1), 33–36. https://doi.org/10.1089/acm.2016.0346

Er, I. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician, 91(9), 617–624.

Gutiérrez, E. O. F., & Camarena, V. A. T. (2015). Music therapy in generalized anxiety disorder. The Arts in Psychotherapy, 44, 19–24. https://doi.org/10.1016/j.aip.2015.02.003

Levitt, E. E. (2015). The psychology of anxiety. Routledge.

Mofredj, A., Alaya, S., Tassaioust, K., Bahloul, H., & Mrabet, A. (2016). Music therapy, a review of the potential therapeutic benefits for the critically ill. Journal of Critical Care, 35, 195–199. https://doi.org/10.1016/j.jcrc.2016.05.021

Rossetti, A., Chadha, M., Torres, B. N., Lee, J. K., Hylton, D., Loewy, J. V., & Harrison, L. B. (2017). The Impact of Music Therapy on Anxiety in Cancer Patients Undergoing Simulation for Radiation Therapy. International Journal of Radiation Oncology*Biology*Physics, 99(1), 103–110. https://doi.org/10.1016/j.ijrobp.2017.05.003

Stonerock, G. L., Hoffman, B. M., Smith, P. J., & Blumenthal, J. A. (2015). Exercise as a treatment for anxiety: Systematic review and analysis. Annals of Behavioral Medicine, 49(4), 542–556.

Subject: Healthcare and Nursing

Pages: 5 Words: 1500

AMA Journal Of Ethics Case

AMA Journal of Ethics Case

[Name of the Writer]

[Name of the Institution]

The case study chosen from the AMA Journal of Ethics Case is “How should clinical ethics consultants support parents’ decision making?” The issue raised in this article is the misinterpretation of the role of ethics consultant in the shared decision making. It has also been mentioned that how there is a gap in the clinical setting for the utilization of the patient decision aids ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"8roNmfmk","properties":{"formattedCitation":"\\super 1\\nosupersub{}","plainCitation":"1","noteIndex":0},"citationItems":[{"id":424,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/66A62YKV"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/66A62YKV"],"itemData":{"id":424,"type":"article-journal","title":"How Should Clinical Ethics Consultants Support Parents’ Decision Making?","container-title":"AMA Journal of Ethics","page":"831-837","volume":"21","issue":"10","source":"journalofethics.ama-assn.org","abstract":"Clinical ethics consultants (CECs) frequently provide guidance to parents feeling grief and uncertainty. In response to a case in which a CEC works with parents making end-of-life decisions for their child","DOI":"10.1001/amajethics.2019.831.","ISSN":"2376-6980","author":[{"family":"Feder","given":"Katherine J."},{"family":"Firn","given":"Janice I."}],"issued":{"date-parts":[["2019",10,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} 1. However, decision making in the end of life cases is a tougher choice as parents still want to provide that is best for their child. Their logical thinking capabilities are clouded by emotions and stress. On the other hand, ethics consultants are emotionally less connected with the patient and decisions made by him would have no bias and thorough assessment of short term long term effects of any clinical decision. The decisions made by the consultants should be consulted before finalizing based on the cultural values and noms of the patient and their family.

Nurses have a significant role in establishing relationships with the patients and their families, community and other populations and service providers in a multi cultural diverse health care setting. The relationship of patient and nurse is primarily the exchange of information which is important for shared decision making. However, the expectations of the patient’s family is hard to meet. The ethical consultants and nurses need to discuss the case together and then come to any conclusion that can be shared with the patients or other involved stakeholders ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"mtrZjbjU","properties":{"formattedCitation":"\\super 2\\nosupersub{}","plainCitation":"2","noteIndex":0},"citationItems":[{"id":421,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/US2WUFEA"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/US2WUFEA"],"itemData":{"id":421,"type":"article-journal","title":"Shared Decision-Making for Nursing Practice: An Integrative Review","container-title":"The Open Nursing Journal","page":"1-14","volume":"12","source":"PubMed Central","abstract":"Background:\nShared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice.\n\nObjective:\nTo understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings.\n\nMethods:\nAn integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings.\n\nResults:\nFifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making.\n\nConclusion:\nA comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.","DOI":"10.2174/1874434601812010001","ISSN":"1874-4346","note":"PMID: 29456779\nPMCID: PMC5806202","title-short":"Shared Decision-Making for Nursing Practice","journalAbbreviation":"Open Nurs J","author":[{"family":"Truglio-Londrigan","given":"Marie"},{"family":"Slyer","given":"Jason T."}],"issued":{"date-parts":[["2018",1,22]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} 2. Nurses along with these consultants have to look for the greater good and that might even go against the wishes of the parents. Yet, majority of the work is entirely based on learning the ethically defensible decisions.

The possible solution in order to over the particular issue is to consider the process of shared decisions making and other legal and ethical values. The implementation of such practices where all the related health care professional in making a combined decision should be made mandatory. The patient’s autonomy should be given its due consideration along with measuring parent’s views. The ethial consultant should present the positive and negative implications of many choices that are available in any cases. The assessment of the greater good and societal pressure can also prove affective in making decisions. There is also a need for the consultants to include all the members and their opinion in order to make an informed decision without any element of biasness. In a healthcare setting, a single patien is basically the center of attention and their norms, values and culture should be given respect. As nurses spend majority of their time with their patients, patients are more comfortable sharing their thoughts and having discussions with the nurses realted to any ethically based decision.

This case provides insight for further research and assessment for the role of ethical consultants and the degree to which their involvement should be considerd appropriate. The same kinds of decisions made by the consultants might not be interpreted by different parents as the same. The process of making ethical decsions for the consultants and health care providers is limited due to the cultural barriers. They need to respect and give due importance to the values of any patient belonging from different society, religion or geographical location. They also need to get culturally intelligent education and learn the ethical and legal differences among different cultures ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"zaasWZVj","properties":{"formattedCitation":"\\super 3\\nosupersub{}","plainCitation":"3","noteIndex":0},"citationItems":[{"id":427,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/6F4SDKQM"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/6F4SDKQM"],"itemData":{"id":427,"type":"book","title":"Legal and Ethical Issues for Health Professionals","publisher":"Jones & Bartlett Learning","publisher-place":"Burlington, MA","number-of-pages":"530","edition":"4 edition","source":"Amazon","event-place":"Burlington, MA","abstract":"Legal and Ethical Issues for Health Professionals, Fourth Edition is included in the 2015 edition of the essential collection of Doody†s Core Titles.Legal and Ethical Issues for Health Professionals, Fourth Edition is a concise and practical guide to legal and ethical dilemmas facing healthcare professionals in the real world today. Thoroughly updated and featuring new case studies, this dynamic text will help students to better understand the issues they will face on the job and the implications in the legal arena. With contemporary topics, real world examples, and accessible language, this comprehensive text offers students an applied perspective and the opportunity to develop critical thinking skills. Legal and Ethical Issues for Health Professionals provides an effective transition from the classroom to the reality of a clinical environment.New to the Fourth Edition• Features new case studies pulled from the news and how they pertain to healthcare ethics• Reviews the Affordable Care Act/ObamacareInstructor Resources: Lecture Outlines in PowerPoint format, Instructor†s Manual, Sample Syllabus, and a Test BankStudent Resources: Each new print copy includes Navigate 2 Advantage Access that unlocks a comprehensive and interactive eBook, student practice activities and assessments, a full suite of instructor resources, and learning analytics reporting tools.","ISBN":"978-1-284-03679-4","language":"English","author":[{"family":"Pozgar","given":"George D."}],"issued":{"date-parts":[["2014",12,17]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} 3. The role of ethics consultants is quite challenging in a culturally diverse health care setting and its responsibilities and should be clearly known to the patients and their families.

End Notes

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY 1. Feder KJ, Firn JI. How Should Clinical Ethics Consultants Support Parents’ Decision Making? AMA J Ethics. 2019;21(10):831-837. doi:10.1001/amajethics.2019.831.

2. Truglio-Londrigan M, Slyer JT. Shared Decision-Making for Nursing Practice: An Integrative Review. Open Nurs J. 2018;12:1-14. doi:10.2174/1874434601812010001

3. Pozgar GD. Legal and Ethical Issues for Health Professionals. 4 edition. Burlington, MA: Jones & Bartlett Learning; 2014.

Subject: Healthcare and Nursing

Pages: 2 Words: 600


Research Paper

[Name of the Writer]

[Name of the Institution]

America may be too dependent on physician graduates from foreign countries


The United States is a country of immigrants. It is significant to note that spirit and virtually brought by the immigrants have added to the texture of American life. The stance of diversity has created a mosaic of challenges and complexity for those who are using healthcare facilities. It is assumed that International Medical Graduates (IMGs) has brought a profound wealth of knowledge of the disease that is not actually found in the practical and theoretical frameworks of the native land. Side by side there is a diverse exposure of transcultural and transnational attitude that empowers catering to the desires of patients. It is significant to note that foreign graduates have incorporated the stance of “belief systems” of cultures from different parts of the world, taking into account that belief system has an impact on the health and treatment of disease. There are certain complications as well, taking into account that the Healthcare System of America is threatened by the stance of foreign programs. Such paradigms include biased perception in terms of students, staff, patients and physicians. There is a gap in the platform of communication skills, taking into account that communication channels are distorted and hampered because of the foreign students. The relationship between patient and doctor is deteriorated because there is a lack of understanding. It is also asserted that foreign students have inferred professional and social acculturation. These baselines refer to an interactive approach that, there could be a lack of positivity and understanding in terms of the general population. It is significant to note that, America may be too dependent on physician graduates from foreign countries, taking into account that there are several pons and cons associated with it.


Different countries invite “foreign medical graduates” so that positive statistics in demographics in health care can be maintained. In order to address the above-mentioned issues, the American government has relied on a surprising and increasing extent of the medical graduated from foreign land; most of the specialists are the citizens of other countries. It would not be wrong to say that the quarter of medical specialists in the United States are foreign medical graduates. More than 40 per cent of the primary healthcare workers is trained in other countries and then moved to America for practical implications. About half of this forty per cent is concerned with the caring of the older people. (Motala, et, al. 2019). Another population is interceded in providing Medicaid, adhering to their geographical associations. In accordance with the study of Health Affairs 2018, it has been brought into insight that the patients who are suffering from myocardial infarction and congestive heart failure are assumed and reported to have low mortality rate when they are treated by the doctors who are foreign medical graduates.

Another study by BMJ has inferred that the patients who were treated by the foreign medical specialists also have low mortality rate although they seemed to be sicker in general, with no specific disorder. (Dayratna, et, al. 2019). Another study by “Annals of Internal Medicine” has highlighted that among 80,000 or more than this physician in the country are foreign students, making up to 18% of the total medical staff. It is asserted that more than 15% of the full professors and the practitioners in the medical schools in the United States behold a different educational background as compared to the occupational demographics (Schühle, et, al. 2018). Many of these professors and other attendants belong to Western Europe, Latin America, Asia, the Middle East and the Caribbean. A study by Dhruv Khullar, a physician at New York Presbyterian has inferred that the diversity of the American medicine and the conventional stance of ideas conversation and thoughts has been the reason of one of the competitiveness as a global leader on innovation and Biomedical research.” (Ranasinghe, et, al. 2015).

It is significant to note that there are several other countries other than the united states that are relying on foreign medical specialist in order to address the needs of the patient. In accordance with the data collected from Organization for Economic Cooperation and Development, it has been highlighted that about 58% of the physicians who are serving in USA are foreign medical graduates, 40% doctors in New Zealand and the same ratio of medical graduates in Ireland are trained outside their countries. In 2015, OECD asserted that the United States has more than 213,000 foreign-trained doctors and none of the countries has this much ratio. According to an article that was published in the "The Upshot”, it has been brought into insight that many people think, the healthcare system of the United States has a lot of problems. There are different approaches associated with the problems, taking into account that people think there is a lack of doctors, available ratio of doctors is not fulfilling the required healthcare outcomes.

It is also brought into insight that the healthcare system of America is facing crucial issues in terms of “patient caring approaches”, asserting that there are a number of diseases that are left unaddressed. The healthcare education system has not imparted versatility in accordance with the requirements. (Jimenez-Gomez, et, al. 2019). Many of the researchers believe that having a great ratio of immigrants, America is facing a major issue associated with catering to the needs of the patient taking into account that the doctors are failed to interact with the patients, a major role is played by the interference of cultural association and the belief system that is associated with disease. It is also lamented that communication is also one of the gaps that need to be addressed in order to ensure quality health. An analysis of the ratio of doctors asserts that there are several pros and cons associated with foreign medical graduates. (Ahmed, et, al. 2018)

Pros of foreign medical graduates

Acceptance rates are comparatively higher than average

It is significant to note that there are a lot of people who have a dream of becoming a doctor and there is a lack of "academic excellence" and "financial crisis". There are a lot of people who are a victim of these circumstances, taking into account that the United States of America is acting as homage for the students. It is a two-way process in which countries are exchanging students in order to get medical education and serve the country. The reality of this fact can be traced in George Washington School of Medicine who is accepting a ratio of 3.6 applications, acting as a representative of an active future of medical specialists. Ross University School of Medicine and the Caribbean Island of Dominica is also acting as a source of educational development. This avenue of exchanged education can act as a tribute to the increasing ratio of medical specialists, adhering to the fact that it is posing strong incentives for students. It would not be wrong to say that this stance of exchanged education not only facilitates students, but it is also a great tool to empower the healthcare baseline of the country as well. (Duvivier, et, al. 2019). Healthcare needs are acting as a home to the implication of creative strategies that can impart a greater success to foreign health systems. Such aspects could be any of social, political and moral paradigms, taking into account that there are a lot of people who are having sheer psychological and moral associations with diseases. In this case, foreign medical graduates are one of the greatest incentives and approaches towards adequate and better health in the United States, mitigating all social and ethical barriers in the passage of good health.

Addressing shortage of doctors

It is asserted that the United States of America is having a sheer shortage of doctors in the last few years taking into account the increase in population and a systematic approach towards the maintenance of healthcare. According to Monavvari, (2015), research has highlighted that America will be facing a shortage of 120.000 physicians by 2030. This data has been collected by the Association of American medical colleges. It is significant to note that the foreign medical specialists have maintained the number of “shortages”. (Monavvari, et, al. 2015). It is important to note that foreign medical graduate makes up about a quarter of the entire medical system in United States and foreign doctors are acting as a cure to the continuous decline in the ratio of doctors. Research has highlighted that many of the foreign doctors try to approach the deprived public and it is an ultimate way of fulfilling the desires of the patients. Many of the foreign medical graduates try to practice their education in the rural and the deprived areas, taking into account that it not only increases their exposure to the patients, but it is also an action that facilitates general public as well.

Foreign medical specialists are always available in the hour of need, taking into account that they are seen in lots of highlighted scenarios. The availability of foreign medical graduates in hospitals has empowered healthcare system by taking radical steps in order to adjust and cater to any emergency situation. (Ranasinghe, et, al. 2015). In the subject issue, American Association of Medical Colleges has highlighted that the stance of shortage of doctors is expected to grow with each year. Side by side it is an increasing flow because there are a lot of doctors who have moved to urban areas and other countries leaving empty seats in rural and unpopulated localities. As the population is estimate to grow with an expected ratio of 11% by 2030, asserting that the number of people greater than 65 years of age will make half of the population and this number is more vulnerable to diseases. So, foreign medical graduates are a great option to overcome future devastations and provide basic needs. (Pinsky, et, al. 2017).

Social Paradigms

Foreign medical specialists are one of the major factors to address social paradigms. It is significant to note that foreign medical specialist belongs to different areas and, America itself has a major section of people who are migrated from other countries. According to the research by American Association of medical colleges, it has been brought into highlight that foreign medical students are a positive approach to incorporate health resources that can impact long term health goals because foreign medical graduates are better at understanding people who belong to their race and religion. Social paradigms refer to a number of other aspects such as cultural, moral and religious approaches. (Schühle, et, al. 2018).

Cultural aspects

Foreign medical graduates are one of the major tools to cater to "cultural aspects” of immigrants because culture act as an identity and it is hard for immigrants to compromise their identity. There are several cultures that are using self-formulated medical strategies to address their issues and this stance is posing a serious threat to the overall healthcare baseline of a country. Research by “Upshot” has highlighted that there are many people who have certain traditional remedies towards specific disease and people practice such actions with great punctuality, taking into account that those remedies are doing more harm than good. (Armstrong, et, al. 2017). There are several cases that are reported in the context of unsafe and unusual practices that had more severe reactions than expected. Foreign medical graduates are representatives that can motivate people to shun their cultural actions and adopt healthy and safe practices. If such suggestions are passed by any of the local doctors, the patient will take it like a lunatic quote or a for-granted discourse but the same conversation with same cultural representative doctor will have a better influence and more appealing effect. (Dayratna, et, al. 2019).

Moral Aspect

Moral aspects play a major role in healthcare system. As morals are directed by cultural and religious sources so it would not be wrong to say that moral aspects are the amalgamation of both religious and cultural practices. In accordance with the benefits of foreign medical graduates, it can be asserted that they are good at making people realise the difference between good and evil. It is significant to note that patients are more influenced with the one who has the same religious or cultural approach, taking into account that a foreign medical graduate will demonstrate better understanding. (Ahmed, et, al. 2018). It is also significant to note that history is full of cases where hybrid identities and tilted beliefs have made a sheer loss. It can be found that those case studies not only act as a tool to analyse the importance of moral and spiritual understanding, but it is also a stance that can allow the medical graduate to better understand what is required of them. Many people have racist beliefs and they think that White people are not their will wishers. An intellectual and interactive approach can act as a major tool to let the patients understand the difference between right and wrong. (Armstrong, et, al. 2017)

Religious Approaches

Religion is one of the prime factors that have played a significant role in regarding or disregarding the attitude and identities of people. Although there are certain areas at which, religion contrast with the scientific approach and it is the point of conflict that compromise the life of a number of people. It is important to note that Monavarri’s research has brought into consideration several cases in which religious approach is misunderstood by people and it is an ultimate threat to the life of an innocent being. (Monavvari, et, al. 2015).Usually, parents make unethical choices adhering to the misunderstood beliefs and it paves the way for social destruction. Many of the foreign medical graduates have different religious backgrounds and they can act as major tools for highlighting the facts and figures both valid and invalid that should be practiced in terms of medical framework. It is important to note that foreign medical graduates try to convince patients in terms of their best interest by adhering to the religious beliefs. Religious identity of the foreign medical graduate acts as a reinforcement of better healthcare standards by convincing patients to opt for healthy activities and suitable medications. (Duvivier, et, al. 2019).

Source of innovation

Foreign education is always different, taking into account the variation in methodologies, modules and the approaches towards understanding. It is important to note that the foreign medical graduates when migrating to the United States bring with them all the novelties they have learned throughout their course. It allows a great modification and change in the actual stance of traditional medical approaches. Research has proven that foreign medical graduates incorporate certain novel technologies and techniques that are not only unique but they are a source of great benefit for the general public. It is asserted that the foreign medical graduate empowers healthcare system by incorporating the positivity of innovation and negating the risk attitudes. In a nutshell, it is assumed that the inclusion of foreign medical graduate is a source of upgrading the present scenario, taking into account the reflection students have brought with them by learning in a well-equipped environment. (Monavvari, et, al. 2015).

Adhering to “better than”

Comparison is one of the approaches that facilitate and treats patients. Having a lot of options is one of the approaches that strengthen patient-doctor relationship. In accordance with the learning attributes and academic outcomes of foreign medical graduates, there is an evident option of “better and choice". A patient, as well as a doctor, has an option to choose one strategy or tool that can facilitate patient at first end. Foreign medical graduates bring several novel and unique things that may be more appealing to the patient and it allows them to be satisfied with the treatment they are given and environment they are provided. Moreover, foreign medical graduates allow people to incorporate their will as well, in the last few centuries there is a greater approach of using foreign medicines and doses that are bound to core standards of patient-oriented outcomes. (Ranasinghe, et, al. 2015).

Incorporation of better understanding

Racism is one of the dilemmas that United States has failed to address and it is a serious threat to the economy and demographics of country. In accordance with the research by Pinsky, (2017), it has been highlighted that doctors belonging to a different race and religion are one of the major attractors for people. It is a common observation that people try to approach that doctor who has some kind of similarity with the patient because it is a mode of satisfaction for them. People believe those doctors with same cultural or religious backgrounds more as compared to others. There is a comparatively stronger bond of interaction between patient and doctor; it is a greater approach towards fast understanding. It is one of the solutions to ever prevailing "communication barriers", taking into account that there is less comprehensibility. (Pinsky, et, al. 2017).

Eradication of mocked traditions

There are a lot of people who are a victim of traditions that are unacceptable and highly remote in terms of contemporary times. Foreign medical graduates are eradicating the lineage of stereotypes associated with medicine and diagnosis. It is assertive that even in the present time, there are a lot of people who think herbal medicine and self-medication is an approach towards adequate health. In reality, it is a sheer and apparent drift from the scientific code of conduct, taking into account that people are becoming a victim of severe issues that were not known before. (Jimenez-Gomez, et, al. 2019).

Sustenance of core medical values with the economy

It is significant to note that foreign medical graduates are one of the factors that can empower the economy because they are playing a major role in the support of the national economy. It is significant to note that foreign medical graduates are becoming a major source of adhering to core medical values. These core medical values refer to honesty, convenience, sustainability and adhering to the standardised values of mechanics and science. Other spectrum highlights that the sustenance of core values of medical are also empowering economy. The use of certain machinery and scientific approach has allowed people to empower and enhance medical standards by adhering to those paradigms that are benefitting for both state as well as people. (Duvivier, et, al. 2019).

Cons of foreign medical graduates

There are several cons associated with foreign medical graduates as well. These cons have different approaches to medical and healthcare paradigms.

Concerns regarding professionalism

Professionalism is treated as one of the major baselines in each profession. It is significant to note that the ratio of foreign medical graduates is no doubt great support for the people and state side by side, it is a stance of “lack of professionalism”. It is evident that each of the countries has a different approach towards working. When foreign graduates are brought into the realms of another country, their skills are either praised or criticised. In case of United States, when student migrates, they are exposed to an entirely new framework of healthcare system and the context of “advanced medical approach”, such students are termed as inexperienced and unskilled. It is also important, not all the countries have a standardised educational system. The medical graduates from such institutions distort the actual working timeline of hospitals because they are failed to cater to their job requirements. Research has highlighted that there is a ratio of 4% professional associated with foreign medical graduates that are working in the United States but they are equally unskilled and untrained, acting as a serious threat to the life of patients. (Ahmed, et, al. 2018).

Distorted doctor-patient relationship

As foreign medical graduates belong to a different nationality, they have a different approach towards life and diseases. Usually, a disease is a result of a certain environmental conditions, bound to specific realms. A doctor brought up in that locality will have the same vision towards the diseases. According to Schuhle, (2018), it has been highlighted that foreign medical graduates are one of the reasons for the distorted patient-doctor relationship. Although such graduates are much understandable for the people having similar identity at the same time, they are the stance of unhealthy relationship with patient. There are several cases reported to assert that a patient has been treated with an unsuitable dose and approach leading to unfavourable results. It is also highlighted that the teaching approach also plays a significant role in maintaining the relationship between patient and a doctor, usually prescribed medicines and treatments are not adequate in terms of geographical circumstances. (Schühle, et, al. 2018).

The significance of adopted and enforced

The analysis of the foreign medical specialist has paved the way for “clash between enforced and adopted skills”. When a medical graduate is forced into another place, there is an evident stance of adopted circumstances because a doctor takes time in adjusting to the requirements of a particular realm. This difference of ideology is a serious threat to the analysis of the healthcare system, taking into account that adopted strategies take a comparatively long time to be brought into practice as compared to the enforced approaches. There are a lot of cases in which doctors are facing serious issues in using the machinery and applying the basic strategies for patient management because of the difference in their learning and exposed environment. The stretch between adopted and enforced is highlighted because it is not only a difference of approach but a clash of ideologies because not all the graduates are easily adapted to the exposed scenarios, till then they are a threat to the country. (Motala, et, al. 2019).

Ethical concerns

It is said, “Every picture has two faces”. The same tool of analysis can be applied to medical sciences in terms of foreign graduate. At a stance where foreign graduates are catering to the concerns and issues of the racist and discrimination people, on the same baseline they are themselves becoming the mode of discrimination. It has been observed that doctors are becoming biased and racist, taking into account that not all the patients are treated with equal attention and support. Foreign doctors try to accommodate their race and identity first. This scenario is acting as a serious threat for the people who are living in rural areas and other areas where foreign medical graduates are employed for community reforms. (Pinsky, et, al. 2017).

Communication barriers

Among the major challenges and threats, foreign medical graduates are posing to the United States; one of the major barriers is communication barriers. Although it is asserted that English is a global language and it is the means of communication, still there are a lot of foreign graduates who are not good at English. It is significant to note that communication barriers are a serious threat because it mitigates understanding that leads to several other gaps. It can even threaten the life of a patient, compromising the stance of the normal and balanced life. It is important to note that communication ability is something that goes beyond the realms of speaking and writing English. It also includes an approach towards street language, idioms and the use of specific terminologies. (Schühle, et, al. 2018).

Non-verbal communication plays an equally important role in it. Taking into account that body language is more sophisticated yet powerful and attractive rather than the medium that obstructs and facilitates the relationship that exists between the patient and a doctor. It is inferred that there are a number of healthcare institutions where less questioning is preferred while there are institutions in which adequate and detailed questioning is necessary to know the cause of problem. The same scenario is implied on the patients as well, many of the patients think that more questioning from doctor means they are more concerned and careful about their health while many patients think that more questioning shows the inability of the doctor to cater to the concerns of the patient.

Health Standards

Health standards play a major role when it comes to the threats that are posed by the employment and recruiting of foreign medical graduates. A difference in the type of education adheres to the difference of standards as well. It is inferred that the medical graduates who belong to other area or location have a different approach towards the health needs of the patients and standards of health. In a number of approaches, it is the consent of the patient that is the main focus of the doctor while in other cases; “saving life” is the catch line of patients. It is critical to think about the devastation this change of priority can impart. (Motala, et, al. 2019).

Lack of comprehension

Comprehension is one of the characteristics that play a significant role in the analysis of the facts and figures that can strengthen or distorts the relationship between a patient and a doctor. It is assertive that “foreignness” is an apparent word that strengthens the bonds of segregation for the natives. It would not be wrong to say that comprehension is an abstraction that is acting as a stance of assumed and expected results. Research has highlighted that the lack of comprehension between the patient and doctor is creating a range of issues in terms of long term goals, taking into account that patient does not get the subject of doctors and doctors are unable to understand the patient wants to say. (Jimenez-Gomez, et, al. 2019).

Settlement challenges

It is asserted that the feeling of “being new and foreign” is an approach that hampers and impact the professional attitude of a doctor. In a simplified form, it is the complications of personal life that distract doctors and tilt them to unprofessional attitude. It is important to note that foreign students face a number of challenges in terms of residence, settlement and access towards insurances and legitimized policies. Although it is not an apparent factor still it is one of the background factors that play a major role in shaping the attitude of doctors towards patients. Research has highlighted that the performance of a doctor is linked with the background factors that are acting as a tool to highlight or mitigate passion and courage. (Duvivier, et, al. 2019).


In accordance with an analytical view towards migration and recruitment of foreign medical graduates, it has been highlighted that America is too dependent on the physician graduates from foreign countries, stressing that they are doing more harm than good. Although foreign graduates are empowering economy and technology along with cultural stability it is also cutting off the staunch backbone of "trust in doctors" and "positive relationship between patients and doctors". People are becoming resistant and reluctant taking into account that the impact of destruction is more prominent in terms of lack of adequate education, lack of skill, communication barrier, biases and racism. Moreover, the gap in understanding is compromising lives of people, saviours are assumed to be warriors because they are trying to cater to identity rather than the necessity of patient. In a nutshell, a large number of foreign graduates are a threat because they are hampering the code of set standards by compromising health, taking into account that healthy America will address the shortage of doctors and economic gaols itself. In a nutshell, the approach towards foreign medical graduates should be treated as a choice not as a compulsion because anything that has long term distractions should be mitigated.


Ahmed, A. A., Hwang, W. T., Thomas Jr, C. R., & Deville Jr, C. (2018). International medical graduates in the US physician workforce and graduate medical education: current and historical trends. Journal of graduate medical education, 10(2), 214-218.

Armstrong, K., Anderson, M. E., Carethers, J. M., Loscalzo, J., Parmacek, M. S., Wachter, R. M., & Zeidel, M. L. (2017). International exchange and American medicine. New England Journal of Medicine, 376(19), e40.

Dayratna, K., Larkin Jr, P. J., & O'Shea, J. (2019). Reforming American Medical Licensure. Harv. JL & Pub. Poly, 42, 253.

Duvivier, R. J., Wiley, E., & Boulet, J. R. (2019). Supply, distribution and characteristics of international medical graduates in family medicine in the United States: a cross-sectional study. BMC family practice, 20(1), 47.

Jimenez-Gomez, A., Moreira, D. C., & Leon-Astudillo, C. (2019). International Medical Graduates in Pediatrics: Should I Stay or Should I Go?. JAMA Pediatrics, 173(3), 217-218.

Monavvari, A. A., Peters, C., & Feldman, P. (2015). International medical graduates: Past, present, and future. Canadian Family Physician, 61(3), 205-208.

Motala, M. I., & Van Wyk, J. M. (2019). Experiences of foreign medical graduates (FMGs), international medical graduates (IMGs) and overseas trained graduates (OTGs) on entering developing or middle-income countries like South Africa: a scoping review. Human resources for health, 17(1), 7.

Pinsky, W. W. (2017). The importance of international medical graduates in the United States. Annals of internal medicine, 166(11), 840-841.

Ranasinghe, P. D. (2015). International medical graduates in the US physician workforce. J Am Osteopath Assoc, 115(4), 236-241.

Schühle, J. (2018). State-of-the-art or the art of medicine? Transnational mobility and perceptions of multiple biomedicines among Nigerian physicians in the US. Global public health, 13(3), 298-309.

Subject: Healthcare and Nursing

Pages: 15 Words: 4500

An Action Plan For Young Adults With Genital Herpes Infection Simplex Type 2 (HSV-2).

An Action Plan for Young Adults with Genital Herpes Infection Simplex Type 2 (HSV-2)

[Author Name(s), First M. Last, Omit Titles and Degrees]

[Institutional Affiliation(s)]

Author Note

An Action Plan for Young Adults with Genital Herpes Infection Simplex Type 2 (HSV-2)

Action Plan 1

Preventive Measures for HVS-2

As always, prevention is better than cure. With young adults being more at risk of contracting Genital Herpes (HVS-2), it is vital that they are made aware of the preventive measure they can take ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1aUqEhHO","properties":{"formattedCitation":"(Hover & Bertke, 2017)","plainCitation":"(Hover & Bertke, 2017)","noteIndex":0},"citationItems":[{"id":504,"uris":["http://zotero.org/users/local/0omESN17/items/VF4PRUJF"],"uri":["http://zotero.org/users/local/0omESN17/items/VF4PRUJF"],"itemData":{"id":504,"type":"article-journal","title":"Herpes simplex virus 1 and 2 educational assessment of young adults in rural southwest Virginia","container-title":"PloS one","page":"e0179969","volume":"12","issue":"6","author":[{"family":"Hover","given":"Shantal S."},{"family":"Bertke","given":"Andrea S."}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hover & Bertke, 2017). In this regard, safe sex is one of the primary means of prevention. Furthermore, if you have contracted genital herpes, the best thing for you is to practice complete sexual abstinence until the virus has gone dormant. Since there is no vaccination that can prevent HVS-2 that can cure it, practicing safe sex, or even no sex at times is the best bet. Additionally, using condoms is also another effective measure of preventing the transmission of HVS-2. It lessens the direct skin on skin contact and reduces transmission up to 96% ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"NJkO9NOJ","properties":{"formattedCitation":"(Hirschler, Hope, & Myers, 2015)","plainCitation":"(Hirschler, Hope, & Myers, 2015)","noteIndex":0},"citationItems":[{"id":505,"uris":["http://zotero.org/users/local/0omESN17/items/USJ9BVJW"],"uri":["http://zotero.org/users/local/0omESN17/items/USJ9BVJW"],"itemData":{"id":505,"type":"article-journal","title":"College students’ perceptions of and experiences with human papillomavirus and herpes: Implications for college sexual health education","container-title":"American Journal of Sexuality Education","page":"298-315","volume":"10","issue":"4","author":[{"family":"Hirschler","given":"Christopher"},{"family":"Hope","given":"Andrea"},{"family":"Myers","given":"Jaime L."}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hirschler, Hope, & Myers, 2015).

Action Plan 2

Sexual Health Education about HVS-2

Sexually active young adults are at a higher risk of contracting HVS-2 as compared to adults. This is because of their behavioral, as well as biological differences. According to ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"g5W27n5H","properties":{"formattedCitation":"(Hover & Bertke, 2017)","plainCitation":"(Hover & Bertke, 2017)","dontUpdate":true,"noteIndex":0},"citationItems":[{"id":504,"uris":["http://zotero.org/users/local/0omESN17/items/VF4PRUJF"],"uri":["http://zotero.org/users/local/0omESN17/items/VF4PRUJF"],"itemData":{"id":504,"type":"article-journal","title":"Herpes simplex virus 1 and 2 educational assessment of young adults in rural southwest Virginia","container-title":"PloS one","page":"e0179969","volume":"12","issue":"6","author":[{"family":"Hover","given":"Shantal S."},{"family":"Bertke","given":"Andrea S."}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} Hover & Bertke (2017), a majority of young adults i.e. 65.1% had received little to no sex education. Among this group, only 14% of individuals had any information regarding herpes and the means of its spread. Thus, apart from ensuring that they are aware of the impacts of HSV-2, it is also important that they are given the resources to discuss their issues with a healthcare professional. Additionally, they should also have access to the means that can ensure their sexual health, since most HSV-2 remain asymptotic.

Action Plan 3

Removing Stigma from HVS-2

The mere notion of contracting STIs has the psychosocial effect of isolating a person, all because of the stigma society has attached to it. According to an estimate, most young adults obtained information on the subject through school sexual education classes. This is followed by the internet and their peers. Few individuals admitted to having sought help from a healthcare professional ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"PnU0LDg1","properties":{"formattedCitation":"(Hirschler et al., 2015; Hover & Bertke, 2017)","plainCitation":"(Hirschler et al., 2015; Hover & Bertke, 2017)","noteIndex":0},"citationItems":[{"id":505,"uris":["http://zotero.org/users/local/0omESN17/items/USJ9BVJW"],"uri":["http://zotero.org/users/local/0omESN17/items/USJ9BVJW"],"itemData":{"id":505,"type":"article-journal","title":"College students’ perceptions of and experiences with human papillomavirus and herpes: Implications for college sexual health education","container-title":"American Journal of Sexuality Education","page":"298-315","volume":"10","issue":"4","author":[{"family":"Hirschler","given":"Christopher"},{"family":"Hope","given":"Andrea"},{"family":"Myers","given":"Jaime L."}],"issued":{"date-parts":[["2015"]]}}},{"id":504,"uris":["http://zotero.org/users/local/0omESN17/items/VF4PRUJF"],"uri":["http://zotero.org/users/local/0omESN17/items/VF4PRUJF"],"itemData":{"id":504,"type":"article-journal","title":"Herpes simplex virus 1 and 2 educational assessment of young adults in rural southwest Virginia","container-title":"PloS one","page":"e0179969","volume":"12","issue":"6","author":[{"family":"Hover","given":"Shantal S."},{"family":"Bertke","given":"Andrea S."}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hirschler et al., 2015; Hover & Bertke, 2017). Thus, in order to remove the stigma associated with the disease, it is important that young adults and adolescents, especially those that are sexually active, is to educate them on the subject. Being familiar with a subject lessens the amount of shame associated with it, which ultimately lifts the stigma attached to it.


ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Hirschler, C., Hope, A., & Myers, J. L. (2015). College students’ perceptions of and experiences with human papillomavirus and herpes: Implications for college sexual health education. American Journal of Sexuality Education, 10(4), 298–315.

Hover, S. S., & Bertke, A. S. (2017). Herpes simplex virus 1 and 2 educational assessment of young adults in rural southwest Virginia. PloS One, 12(6), e0179969.

Subject: Healthcare and Nursing

Pages: 1 Words: 300

An Epidemic In The Community

An Epidemic in the Community

Your Name (First M. Last)

School or Institution Name (University at Place or Town, State)

An Epidemic in the Community

In this case, given for the discussion Debbie being a BSN health nurse should figure out the actual cause of TB and take all the necessary measures to protect the community from this disease through educating. She also needs to figure out the ways to treat the patients of tuberculosis. In the given scenario, she needs to implement Epidemiologic Triangle concept model that revolves around the concept that disease or agent reaches the patient under specific circumstances. In this case, the affected are Hispanic immigrants from lower-wage class ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"MYidmklQ","properties":{"formattedCitation":"(\\uc0\\u8220{}Data & Statistics | TB | CDC,\\uc0\\u8221{} 2019)","plainCitation":"(“Data & Statistics | TB | CDC,” 2019)","noteIndex":0},"citationItems":[{"id":1307,"uris":["http://zotero.org/users/local/KZl8ZL3A/items/DCCD6V2N"],"uri":["http://zotero.org/users/local/KZl8ZL3A/items/DCCD6V2N"],"itemData":{"id":1307,"type":"webpage","title":"Data & Statistics | TB | CDC","abstract":"Home page for TB Data and Statistics. Provided by the Centers for Disease Control and Prevention (CDC)","URL":"https://www.cdc.gov/tb/statistics/default.htm","language":"en-us","issued":{"date-parts":[["2019",2,21]]},"accessed":{"date-parts":[["2019",3,5]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Data & Statistics | TB | CDC,” 2019).

According to the research present online, a region of Mexico has higher rates of TB in comparison to the various areas of the United States. All the affected people are in serious need of treatment, but at the same time as a nurse, other members of the community should be saved from this disease.

This requires Debbie to take primary prevention to stop the development of the disease among the healthy members of the community. This requires her to educate them about the vaccination and the precautionary measures regarding hygiene and sanitation. She should also create awareness about environmental factors like the introduction of ultraviolet lights and ventilation in community places like hospitals, nursing homes, old houses, etc. The secondary measure that she should take is to identify people who have chances of developing a disease and those who don’t have it. She should encourage people to take TST test and QFT-G test to find out who has this disease in in-active state and those who have this disease in the non-active state. Those who have don’t have active TB should be given medications like Isoniazid and Rifampin while those who have active TB should be given medicines ethambutol, pyrazinamide, rifampin, and isoniazid. All these measures will help the community deal with the issue and will prevent the disease from further spread ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"gTSxhdeH","properties":{"formattedCitation":"(Stanhope & Lancaster, 2014)","plainCitation":"(Stanhope & Lancaster, 2014)","noteIndex":0},"citationItems":[{"id":1311,"uris":["http://zotero.org/users/local/KZl8ZL3A/items/GLC4VT4Q"],"uri":["http://zotero.org/users/local/KZl8ZL3A/items/GLC4VT4Q"],"itemData":{"id":1311,"type":"book","title":"Foundations of Nursing in the Community - E-Book: Community-Oriented Practice","publisher":"Elsevier Health Sciences","number-of-pages":"726","source":"Google Books","abstract":"With concise, focused coverage of community health nursing, Foundations of Nursing in the Community: Community-Oriented Practice, 4th Edition provides essential information for community practice — from nursing roles and care settings to vulnerable population groups. The book uses a practical, community-oriented approach and places an emphasis on health promotion and disease prevention. Practical application of concepts is highlighted throughout the text in case studies, critical thinking activities, QSEN competencies, and Healthy People 2020 objectives. Evidence-Based Practice boxes highlight current research findings, their application to practice, and how community/public health nurses can apply the study results.Levels of Prevention boxes identify specific nursing interventions at the primary, secondary, and tertiary levels, to reinforce the concept of prevention as it pertains to community and public health care.Focus on health promotion throughout the text emphasizes initiatives, strategies, and interventions that promote the health of the community.Clinical Application scenarios offer realistic situations with questions and answers to help you apply chapter concepts to practice in the community.Case Studies provide client scenarios within the community/public health setting to help you develop assessment and critical thinking skills.What Would You Do? boxes present problem-solving challenges that encourage both independent and collaborative thinking required in community settings.How To boxes offer specific instructions on nursing interventions. NEW! QSEN boxes illustrate how quality and safety goals, competencies, objectives, knowledge, skills, and attitudes can be applied in nursing practice in the community.NEW! Feature box on Linking Content to Practice highlights how chapter content is applied in the role of public/community health nursing.NEW! Healthy People 2020 objectives in every chapter address the health priorities and emerging health issues expected in the next decade.","ISBN":"978-0-323-10096-0","shortTitle":"Foundations of Nursing in the Community - E-Book","language":"en","author":[{"family":"Stanhope","given":"Marcia"},{"family":"Lancaster","given":"Jeanette"}],"issued":{"date-parts":[["2014",4,11]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Stanhope & Lancaster, 2014).

Poor populations are at high risk of getting infected by diseases like TB, as these have low-income levels and don't have access to health facilities. Developing and underdeveloped populations have high-risk TB while developed countries take preventive measures at the primary level to keep the spread of disease. Also, the ratio of TB in high-income population is less in comparison to high-income areas ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"jig418hw","properties":{"formattedCitation":"(Zu\\uc0\\u241{}iga, Mu\\uc0\\u241{}oz, Johnson, & Garcia, 2014)","plainCitation":"(Zuñiga, Muñoz, Johnson, & Garcia, 2014)","noteIndex":0},"citationItems":[{"id":1309,"uris":["http://zotero.org/users/local/KZl8ZL3A/items/KPYXVU7Q"],"uri":["http://zotero.org/users/local/KZl8ZL3A/items/KPYXVU7Q"],"itemData":{"id":1309,"type":"article-journal","title":"Tuberculosis treatment for Mexican Americans living on the U.S.-Mexico border","container-title":"Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing","page":"253-262","volume":"46","issue":"4","source":"PubMed","abstract":"PURPOSE: This study produced a rich description of the lived experiences of tuberculosis (TB) treatment among Mexican Americans living in the Lower Rio Grande Valley (LRGV) of Texas.\nDESIGN: This qualitative study used phenomenological methodology, guided by Merleau-Ponty's philosophical framework, particularly his theories on mind-body influence, fabric of relationships, importance of culture, and equilibrium. A purposive sample was recruited through TB clinics in four south Texas border counties: Hidalgo, Cameron, Starr, and Willacy, which make up the LRGV. Interviews from 18 participants-5 women and 13 men-were conducted in the participant's preferred language. Interviews were analyzed for common themes as described by Cohen Kahn and Steeves.\nFINDINGS: The majority of interviews were conducted in Spanish. Five themes were discovered: (a) day-to-day life during Directly Observed Therapy treatment, (b) signs and symptoms, (c) familismo, (d) living on the border, and (e) stigma.\nCONCLUSIONS: TB treatment can create a high level of patient burden. The participants in TB treatment in the LRGV on the Texas-Mexico border reported a high level of stigma. Due to this stigma, patients struggled to find a balance between exposure to stigma and the support from family that buoyed them through treatment.\nCLINICAL RELEVANCE: The findings support the importance of addressing stigma and the resulting sense of isolation in patients being treated for TB, perhaps through bolstering support from family and healthcare providers, which is relevant for public health professionals working in regions with high rates of TB.","DOI":"10.1111/jnu.12071","ISSN":"1547-5069","note":"PMID: 24597900","journalAbbreviation":"J Nurs Scholarsh","language":"eng","author":[{"family":"Zuñiga","given":"Julie Ann"},{"family":"Muñoz","given":"Silvia E."},{"family":"Johnson","given":"Mary Zuñiga"},{"family":"Garcia","given":"Alexandra"}],"issued":{"date-parts":[["2014",7]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Zuñiga, Muñoz, Johnson, & Garcia, 2014).

In my community Hampton Road, the Tb case rate low as <2.8. These communities can't be compared in the epidemic of TB as Road Hampton has many TB care facilities and the majority of the population has access to the healthcare facilities. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Wpu4yI94","properties":{"formattedCitation":"(\\uc0\\u8220{}Data & Statistics | TB | CDC,\\uc0\\u8221{} 2019)","plainCitation":"(“Data & Statistics | TB | CDC,” 2019)","noteIndex":0},"citationItems":[{"id":1307,"uris":["http://zotero.org/users/local/KZl8ZL3A/items/DCCD6V2N"],"uri":["http://zotero.org/users/local/KZl8ZL3A/items/DCCD6V2N"],"itemData":{"id":1307,"type":"webpage","title":"Data & Statistics | TB | CDC","abstract":"Home page for TB Data and Statistics. Provided by the Centers for Disease Control and Prevention (CDC)","URL":"https://www.cdc.gov/tb/statistics/default.htm","language":"en-us","issued":{"date-parts":[["2019",2,21]]},"accessed":{"date-parts":[["2019",3,5]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Data & Statistics | TB | CDC,” 2019)


ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Data & Statistics | TB | CDC. (2019, February 21). Retrieved March 5, 2019, from https://www.cdc.gov/tb/statistics/default.htm

Stanhope, M., & Lancaster, J. (2014). Foundations of Nursing in the Community - E-Book: Community-Oriented Practice. Elsevier Health Sciences.

Zuñiga, J. A., Muñoz, S. E., Johnson, M. Z., & Garcia, A. (2014). Tuberculosis treatment for Mexican Americans living on the U.S.-Mexico border. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 46(4), 253–262. https://doi.org/10.1111/jnu.12071

Subject: Healthcare and Nursing

Pages: 1 Words: 300

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