Reply Hollie
Case study:
Health disparities a 32-year-old African American woman may experience related to her pregnancy, such as the risk for preterm labor and the high rate of infant mortality in low-income women.
This is a timely topic as this year the CDC pointed out that the risk of black* women dying in pregnancy is three to four times that of white women (CDC, 2019). ACOG (2015) discusses the consistent and prevalent disparities in obstetrics and gynecology. Healthcare access is one of the documented issues. ACOG reminds us that the United States is the only country that has a market driven health care system rather than the view that healthcare is a right that every citizen should have (ACOG, 2015). In 2013, 59% of black women lived in areas where Medicaid was not going to be expanded (ACOG, 2015). Also documented is the biases and stereotyping from a provider point of view (ACOG, 2015). Demographic and social biases have been shown to influence clinican’s decisions regarding contraception and pre-natal care (ACOG, 2015). Could the mistrust of many black women with the healthcare system have anything to do with forced sterilization in the past? (ACOG, 2015).
These disparities are nothing new. In 2011, Cox, Zhang, Zotti, and Graham discussed racial disparities and unfavorable birth outcomes. The study referenced that fact that black women consistency received less than adequate pre-natal care from providers. In addition black women had a greater chance of premature babies, babies with low birth weight, and babies who die in childbirth (Cox, Zhang, Zotti, & Graham, 2011). We have the power, as Nurse Practitioners to encourage and provider early and consistent pre-natal care free of bias and judgment. With consistent care, we can assist with nutritional and psychosocial counseling as well as assisting with modifiable risk factors such as alcohol, drug use, or cigarette smoking in pregnancy (Cox, Zhang, Zotti, & Graham, 2011).
*I am African Canadian so prefer to use the word black rather than African American
References
American College of Obstetrics and Gynecology (ACOG). (2015). Women’s Health Care Physicians. Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Racial-and-Ethnic-Disparities-in-Obstetrics-and-Gynecology
Centers for Disease Control (CDC). (2019). Pregnancy-Related Deaths | CDC. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm
Cox, R. G., Zhang, L., Zotti, M. E., & Graham, J. (2011). Prenatal care utilization in mississippi: Racial disparities and implications for unfavorable birth outcomes.Maternal and Child Health Journal, 15(7), 931-42. doi:http://dx.doi.org/10.1007/s10995-009-0542-6
Reply Gina
Given the United States’ climate of racial inequality and health disparities, our patient, which is an African American woman is more likely to be exposed to stress and complications such as preterm labor, preeclampsia, depression, fetal demise or fetal growth restriction during the pregnancy. A healthy environment, financial stability, healthcare, education, and social community context are essential during pregnancy (Mohamed et al., 2014). In this case study, the patient is a 32-years-old, African American single mother, has three children from previous relationships, is financially unstable, overweight, with preexisting conditions such as hypertension and at risk for gestational diabetes. She has two jobs that probably does not offer benefits or insurance coverage. The patient is more likely to experience hypertensive disorders of pregnancy that may be attributable to pre-pregnancy hypertension. Her BMI is already elevated, which may lead to complications, including preterm birth, fetal death, macrosomia, gestational diabetes, and cesarean delivery.
According to Mohamed et al. (2014), women of color are less likely to have access to vital reproductive health services including screening for sexually transmitted infections and cervical cancer, family planning; and abortion, when compared with non-Hispanic white women. Although socioeconomic status is considered the main leading factor in health disparities, factors at the patient, practitioner, and health care system levels contribute to existing and evolving disparities in women’s health outcomes (Mohamed et al., 2014). In this case, I would inquire on factors that contributed to her delay in OB care and lack of follow-up visits. What determined the patient to have all this gap in care? Was it the lack of financial resources or other factors such as domestic violence? Based on the screening results, the patient should be screened for domestic violence and guided in the process of care based on her needs and beliefs.
Unfortunately, African American women receive lower-quality health care related to inequities in income, housing, education and job opportunities, which results in higher risk for mortality across the life span for this population (Bryant, 2010). This contributes to racial disparities in pregnancy-related risk factors such as hypertension, anemia, gestational diabetes, and obesity and other conditions such as heart disease, HIV, AIDS, and cancer (Bryant, 2010).
Stress has been linked to one of the most common and consequential pregnancy complications, preterm birth. Studies showed that infants of African American mothers are more likely to be born preterm than infants of white mothers (Mohamed et al., 2014). But, why is preterm birth rate higher in African-Americans?
Women of color are 49 percent more likely than whites to deliver prematurely, and black infants are twice as likely as white babies to die before their first birthday (Mohamed et al., 2014). In this case, the stress, financial instability, lack of nutritional food, and comorbidities may put in jeopardy the patient and infant’s life. Although the Affordable Care Act (ACA) created historical advances in health insurance coverage, millions still go without health insurance each year, many of the people of color (Mohamed et al., 2014).
Low-income, lack of financial resources, maternal pre-pregnancy weight, exposure to stress, and maternal health status prior to pregnancy may lead to fetal growth restriction. Research showed that African American women are more likely to experience fetal growth restriction (FGR), a significant contributor to neonatal morbidity and mortality, than are women of other races and ethnicities (Bryant, 2010). The patient has to be enrolled in public programs such as the Special Supplemental Food Program for Women, Infants, and Children, to avoid food insecurity during pregnancy that may have a beneficial effect on FGR risk among women (Bryant, 2010).
According to Bryant (2010), there are multiple disparities in obstetrical outcomes between women of different race or ethnicities. The author suggests that stress induced by racial and gender discrimination plays a significant role in maternal and infant mortality. According to Kliff (2018), infants in the United States have a 76 percent higher risk of death compared with infants in other wealthy nations and African American women experience the most elevated rates of maternal and infant death. This inequity in health status can be reduced by properly addressing the social determinants of health and advocating for a system of more culturally and linguistically appropriate care for all. (Kliff, 2018).
In this case, it will be our responsibility as health care providers to encourage that all care is patient-centered, culturally appropriate, and listens to women’s needs. This new visit at the office represents a good opportunity for screening and education of the patient in a culturally sensitive manner about steps she can take to prevent disease conditions and any negative birth outcomes.
References
Bryant, A. S., Worjoloh, A., Caughey, A. B., & Washington, A. E. (2010). Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. American journal of obstetrics and gynecology, 202(4), 335-43.
Center for Reproductive Rights (2018). Addressing Disparities in Reproductive and Sexual Health Care in the U.S. Retrieved from https://www.reproductiverights.org/node/861
Mohamed, S. A., Thota, C., Browne, P. C., Diamond, M. P., & Al-Hendy, A. (2014). Why is Preterm Birth Stubbornly Higher in African-Americans? Obstetrics & gynecology international journal, 1(3), 00019.
Sarah Kliff (2018), American kids are 70 percent more likely to die before adulthood than kids in other rich countries, Retrieved from https://www.vox.com/health-care/2018/1/8/16863656/childhood-mortality-united-states.
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Db Womens 19158813
/in Uncategorized /by developerIt is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format (6th Ed.)
Select ONE of the questions listed below and create a substantive initial post. Please post the question number you chose in the title of your post. (i.e. Question 2 Postpartum check)
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Db Womens Health 2 Apa References 2 Replies
/in Uncategorized /by developerReply Hollie
Case study:
Health disparities a 32-year-old African American woman may experience related to her pregnancy, such as the risk for preterm labor and the high rate of infant mortality in low-income women.
This is a timely topic as this year the CDC pointed out that the risk of black* women dying in pregnancy is three to four times that of white women (CDC, 2019). ACOG (2015) discusses the consistent and prevalent disparities in obstetrics and gynecology. Healthcare access is one of the documented issues. ACOG reminds us that the United States is the only country that has a market driven health care system rather than the view that healthcare is a right that every citizen should have (ACOG, 2015). In 2013, 59% of black women lived in areas where Medicaid was not going to be expanded (ACOG, 2015). Also documented is the biases and stereotyping from a provider point of view (ACOG, 2015). Demographic and social biases have been shown to influence clinican’s decisions regarding contraception and pre-natal care (ACOG, 2015). Could the mistrust of many black women with the healthcare system have anything to do with forced sterilization in the past? (ACOG, 2015).
These disparities are nothing new. In 2011, Cox, Zhang, Zotti, and Graham discussed racial disparities and unfavorable birth outcomes. The study referenced that fact that black women consistency received less than adequate pre-natal care from providers. In addition black women had a greater chance of premature babies, babies with low birth weight, and babies who die in childbirth (Cox, Zhang, Zotti, & Graham, 2011). We have the power, as Nurse Practitioners to encourage and provider early and consistent pre-natal care free of bias and judgment. With consistent care, we can assist with nutritional and psychosocial counseling as well as assisting with modifiable risk factors such as alcohol, drug use, or cigarette smoking in pregnancy (Cox, Zhang, Zotti, & Graham, 2011).
*I am African Canadian so prefer to use the word black rather than African American
References
American College of Obstetrics and Gynecology (ACOG). (2015). Women’s Health Care Physicians. Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Racial-and-Ethnic-Disparities-in-Obstetrics-and-Gynecology
Centers for Disease Control (CDC). (2019). Pregnancy-Related Deaths | CDC. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm
Cox, R. G., Zhang, L., Zotti, M. E., & Graham, J. (2011). Prenatal care utilization in mississippi: Racial disparities and implications for unfavorable birth outcomes.Maternal and Child Health Journal, 15(7), 931-42. doi:http://dx.doi.org/10.1007/s10995-009-0542-6
Reply Gina
Given the United States’ climate of racial inequality and health disparities, our patient, which is an African American woman is more likely to be exposed to stress and complications such as preterm labor, preeclampsia, depression, fetal demise or fetal growth restriction during the pregnancy. A healthy environment, financial stability, healthcare, education, and social community context are essential during pregnancy (Mohamed et al., 2014). In this case study, the patient is a 32-years-old, African American single mother, has three children from previous relationships, is financially unstable, overweight, with preexisting conditions such as hypertension and at risk for gestational diabetes. She has two jobs that probably does not offer benefits or insurance coverage. The patient is more likely to experience hypertensive disorders of pregnancy that may be attributable to pre-pregnancy hypertension. Her BMI is already elevated, which may lead to complications, including preterm birth, fetal death, macrosomia, gestational diabetes, and cesarean delivery.
According to Mohamed et al. (2014), women of color are less likely to have access to vital reproductive health services including screening for sexually transmitted infections and cervical cancer, family planning; and abortion, when compared with non-Hispanic white women. Although socioeconomic status is considered the main leading factor in health disparities, factors at the patient, practitioner, and health care system levels contribute to existing and evolving disparities in women’s health outcomes (Mohamed et al., 2014). In this case, I would inquire on factors that contributed to her delay in OB care and lack of follow-up visits. What determined the patient to have all this gap in care? Was it the lack of financial resources or other factors such as domestic violence? Based on the screening results, the patient should be screened for domestic violence and guided in the process of care based on her needs and beliefs.
Unfortunately, African American women receive lower-quality health care related to inequities in income, housing, education and job opportunities, which results in higher risk for mortality across the life span for this population (Bryant, 2010). This contributes to racial disparities in pregnancy-related risk factors such as hypertension, anemia, gestational diabetes, and obesity and other conditions such as heart disease, HIV, AIDS, and cancer (Bryant, 2010).
Stress has been linked to one of the most common and consequential pregnancy complications, preterm birth. Studies showed that infants of African American mothers are more likely to be born preterm than infants of white mothers (Mohamed et al., 2014). But, why is preterm birth rate higher in African-Americans?
Women of color are 49 percent more likely than whites to deliver prematurely, and black infants are twice as likely as white babies to die before their first birthday (Mohamed et al., 2014). In this case, the stress, financial instability, lack of nutritional food, and comorbidities may put in jeopardy the patient and infant’s life. Although the Affordable Care Act (ACA) created historical advances in health insurance coverage, millions still go without health insurance each year, many of the people of color (Mohamed et al., 2014).
Low-income, lack of financial resources, maternal pre-pregnancy weight, exposure to stress, and maternal health status prior to pregnancy may lead to fetal growth restriction. Research showed that African American women are more likely to experience fetal growth restriction (FGR), a significant contributor to neonatal morbidity and mortality, than are women of other races and ethnicities (Bryant, 2010). The patient has to be enrolled in public programs such as the Special Supplemental Food Program for Women, Infants, and Children, to avoid food insecurity during pregnancy that may have a beneficial effect on FGR risk among women (Bryant, 2010).
According to Bryant (2010), there are multiple disparities in obstetrical outcomes between women of different race or ethnicities. The author suggests that stress induced by racial and gender discrimination plays a significant role in maternal and infant mortality. According to Kliff (2018), infants in the United States have a 76 percent higher risk of death compared with infants in other wealthy nations and African American women experience the most elevated rates of maternal and infant death. This inequity in health status can be reduced by properly addressing the social determinants of health and advocating for a system of more culturally and linguistically appropriate care for all. (Kliff, 2018).
In this case, it will be our responsibility as health care providers to encourage that all care is patient-centered, culturally appropriate, and listens to women’s needs. This new visit at the office represents a good opportunity for screening and education of the patient in a culturally sensitive manner about steps she can take to prevent disease conditions and any negative birth outcomes.
References
Bryant, A. S., Worjoloh, A., Caughey, A. B., & Washington, A. E. (2010). Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. American journal of obstetrics and gynecology, 202(4), 335-43.
Center for Reproductive Rights (2018). Addressing Disparities in Reproductive and Sexual Health Care in the U.S. Retrieved from https://www.reproductiverights.org/node/861
Mohamed, S. A., Thota, C., Browne, P. C., Diamond, M. P., & Al-Hendy, A. (2014). Why is Preterm Birth Stubbornly Higher in African-Americans? Obstetrics & gynecology international journal, 1(3), 00019.
Sarah Kliff (2018), American kids are 70 percent more likely to die before adulthood than kids in other rich countries, Retrieved from https://www.vox.com/health-care/2018/1/8/16863656/childhood-mortality-united-states.
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Db1 19033773
/in Uncategorized /by developerA new director decides to reorganize the department you work in.This reorganization comes about without input from the employees and many of the nurses that you oversee are feeling resentful of the change. AS a nurse leader, identify factors that may lead to conflict and ways you can manage them. 1 page.
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Db1 19045707
/in Uncategorized /by developerTYPE – Reflective Practitioner
Students are expected to:
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Db1 19090191
/in Uncategorized /by developernit 1 – Advanced Nur
Unit 1 Discussion – Advanced
It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format (6th Ed.).
Advanced Nursing Practice Situation
Scenario: Today is a busy day at the community health center since yesterday was a holiday. I am seeing walk-ins, and my three examination rooms are full. I hope I will be able to see more than 20 patients today—the expectation of ‘management’—and will be rewarded with a productivity bonus. My next patient is John, a 42-y.o. man I have known for several years. He is accompanied as usual by his wife Mary. Today, John is complaining of lower extremity swelling and pain in most of his joints. He is worried about losing his job as a truck driver, because he is having difficulty climbing in and out of his truck. He is afraid that he may have lupus, because all of his siblings and his mom have this disorder. He also requests a refill on his antidepressant, which doesn’t seem to be working as well as it did a month ago. While reviewing his chart, I notice that John has gained weight—he now weighs over 300 lbs. In reviewing his medications, I see that the antidepressant he is taking may be contributing to his weight gain. John’s physical examination is unremarkable. His heart rate is regular without murmur or irregularity, and his lung sounds are without wheezes or crackle. Since John is a large man, all of his joints areas are large, but they are all symmetrical, with good range of motion and only mild palpation tenderness in his wrists. His ankles are large but without erythema or other skin discoloration or disruption, and his pedal pulses are strong and equal bilaterally.
I ponder how to manage this visit. Do I take the time to investigate John’s depression more thoroughly, wondering about his 11 y.o. daughter, who at his last visit was on chemotherapy for a neuroblastoma? Should we discuss the pros and cons of different antidepressants? Should we discuss the possibility of a gastric bypass again, even though I know the thought of anesthesia terrifies him? Do we again discuss the importance of a healthy diet and increased exercise, giving consideration to his joint pain? I am torn between what I feel this patient deserves and the call of the clock. Would it be unreasonable to order the necessary lab tests to investigate the possibility of lupus, hypothyroidism, or some other disorder and postpone these time-consuming discussions until his next visit?If I am expedient with this visit, the other patients waiting also will be grateful. Maintaining a caring practice in an economically driven discipline requires skill and grounding in those values that are essential for quality patient care. In the context of the caring theory and analysis of the Advanced Practice Nursing Situation above, let’s discuss this situation using “multiple ways of knowing.”
Questions for this week’s Postings:
Please be sure to validate your opinions and ideas with citations and references in APA format.
Estimated time to complete: 1 hour
Search entries or author Filter replies by unreadUnread Collapse replies Expand replies Subscribe ReplyReply to Unit 1 Discussion – Advanced Nursing Practice Situation
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Db1 19090193
/in Uncategorized /by developerEvaluating Patients
Instructions
It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format (6th Ed.).
Classroom Participation
Students are expected to initially address the discussion question by Wednesday of each week. Participation in the discussion forums is expected with a minimum total of three (3) substantive postings (this includes your initial posting and posting to two peers) on three (3) different days per week. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.
All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion you will not receive these points, you may however post to your peers for partial credit following the guidelines above. Due to the nature of this type of assignment and the need for timely responses for initial posts and posting to peers, the Make-Up Coursework Policy (effective July 2017) does not apply to Discussion Board Participation.
Discussion Prompt [Due Wednesday]
Case study:
Bana is a 24-year-old Muslim woman who was recently relocated to the United States as a refugee from Syria, along with her husband and three young children. She arrives at your office today for a physical with her children and a case manager. Her English is limited, and she relies on her case manager to explain the details of her situation, although the case manager does not speak Arabic and thus cannot interpret for her.
In interviewing Bana with the help of the case manager, you learn that her husband is currently looking for a job and that she works at night cleaning office buildings. Her last menstrual period was about 8 weeks ago, and she has been experiencing nausea and vomiting in the mornings recently. A pregnancy test proves positive, and you provide some prenatal education to the client.
During the physical, you notice recent bruises around her throat. She is embarrassed by them and indicates that she was assaulted in Syria before flying to the United States several weeks ago. On questioning further about the assault, Bana appears not to understand and looks at her case manager for help.
Online discussions are intended to be thoughtful exchanges among students that focus on the weekly readings and translating theory to practice. Initial postings are expected to be completed by Wednesday of each week. Response posts are due by Sunday of each week. Minimum expectations are to complete the initial posting and provide a substantive response to the initial posting of one other classmate who posted to a different question. Students earn points weekly for posts which meet (or exceed) minimum posting requirements. Points are deducted daily for late initial posts. Late response posts will not be accepted.
Estimated time to complete: 3 hours
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Db2 18982865
/in Uncategorized /by developerwhat are Gordon’s focus areas of functional health? How do nurses utilize those functional health patterns across the lifespan? How do they impact the nursing diagnosis?
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Db2 19033783
/in Uncategorized /by developerPersonal affiliation and networking are important for nursing leaders. Why are theses important? How will they benefit you in the your career future? Identify two affiliations or situation in which you have network for the health of a population or your community. 1 page
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Db2 19045721
/in Uncategorized /by developerStudents are expected to:
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Db2 19053961
/in Uncategorized /by developerU5D2
TYPE – Scholar Practitioner
1A. Using the National Center for Complimentary and Integrated Health (NCCIH) at https://nccih.nih.gov/, provide research about a complementary therapy. Provide a summary overview of the therapy. What evidence is there about providing care for patients of all cultures. Discuss how you would work with a patient to integrate the therapy into his/her care plan.
1B. Using transcultural care concepts, provide evidence based practice guidelines that illustrate how linguistic challenges interfere with culturally competent care. What are the safety concerns for APNP providers?
Students are expected to:
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