1-A.G

Childhood asthma is a frequent clinical occurrence associated with respiratory impairments and airway inflammation, which requires immediate treatment and long-term care. The discussed disorder can considerably worsen overall health conditions, reduce the quality of life, and increase the risk of life-threatening implications. The provided asthma-associated case study can be beneficial for reviewing short-term and long-term treatment options efficient for treating the given patient. Furthermore, one’s potential education can be ultimately useful for achieving sufficient treatment outcomes as well as organizing appropriate preventive and therapeutic actions.  

   The provided clinical case exemplifies moderate persistent asthma that requires immediate intervention. It is evident that short-acting beta2-adrenergic agonists (SABA), systemic and inhaled corticosteroids, as well as anti-inflammatory medications, can provide quick symptomatic relief by reducing such aberrations as wheezing and bronchoconstriction present in the reviewed patient, normalizing respiration, and improving overall health. Furthermore, such drugs as inhaled steroids, leukotriene modifiers, nedocromil, cromolyn sodium, and methylxanthine can assist in providing long-term asthma control, stabilizing respiratory functions, and preventing possible asthma exacerbations and inappropriate lung growth in children (Woo & Robinson, 2015). It is estimated that a combination of SABAs and inhaled corticosteroids is useful for managing acute asthmatic exacerbations and maintaining normal respiratory functions (Arcangelo & Peterson, 2013). The beta2-adrenergic agonists like albuterol and levalbuterol are capable of exerting “their bronchodilatory effects through β2 adrenoceptors (β2ARs) located on airway smooth muscle (ASM) cells” and providing significant airway relaxation by activating the aforementioned receptors, whereas the steroid medications are efficient in decreasing airway inflammation and airway hyperresponsiveness by lessening the number of circulating inflammatory mast cells and eosinophils in the respiratory tract (Billington, Penn, & Hall, 2017, p. 23). Furthermore, the use of inhaled corticosteroids can be also beneficial for relieving airway obstruction, normalizing respiratory functions, asthma control, and minimizing the risk of asthmatic exacerbations. 

   Patient education is important for achieving sufficient treatment outcomes. Patients, as well as their caregivers, have to be aware that adherence to the prescribed treatment regimen and recommendations, reporting adverse effects, and regular physical evaluation along with cooperative communication with a physician can assist in stabilizing the patient’s condition and preventing asthma progression. Therefore, asthma is a severe acute or chronic respiratory abnormality that requires competent treatment and care. It is estimated that inhaled SABA, as well as inhaled and systemic corticosteroids, are efficient for achieving short-term therapy goals, whereas leukotriene modifiers, methylxanthines, and anti-inflammatory agents demonstrate normal heir efficacy in providing long-term asthma control and maintaining normal respiratory functioning. Lastly, a patient’s teaching is a critical component of successful medication. 

2-michael V.

The short-term option for this child diagnosed with asthma will be bronchodilators to quickly relieve his symptoms by opening swollen airways that are limiting breathing (Saglani, Fleming, Sonnappa, & Bush, 2019).  Long-term options include Inhaled corticosteroids, Leukotriene modifiers, Long-acting beta agonists, and Combination inhalers. Corticosteroids are the first line of treatment for severe acute asthma, because of the inflammatory process.  Steroids control airway inflammation through a number of mechanisms, such as reducing the number and activation of lymphocytes, eosinophils, mast cells, and macrophages; suppressing the production of cytokines, tumor necrosis factor-α, granulocyte-macrophage colony-stimulating factor, adhesion molecules, and inducible enzymes, including nitric oxide synthase and cyclooxygenase-2.  The step-up approach involves beginning with low-dose treatment and increasing intensity at subsequent visits if control is not achieved (Bateman et al., 2019). When selecting the medication and dosage, the provider must take into account the risk to the patient, severity of disease, and potential for impairment.

The goal of asthma treatment is to decrease symptoms and reduce airway inflammation and hyperreactivity.  Healthcare provider should develop written asthma action plan with the patient and his mother for self-management, so they know how to recognize the severity of its symptoms (peak flow) and what to do (Bateman et al., 2019).  Patient should be educated on ways to control exposures to allergens.  An allergy test will be a good plan to identify the patient’s allergy (Bateman et al., 2019).  The patient may need a referral to a pulmonologist if symptoms are uncontrolled with the current regiment.  Pulmonary function testing may be necessary in this child’s case.

References

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 Could you provide me with a specific example of a time when you used the DIKW process and the outcome? Thanks. 

 

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 Reply amanda

Question #2

       There are so many health indicators and concerns for a teen or woman who is a victim of sexual exploitation.  “In a systematic review of the impact of IPV on sexual health, IPV was consistently associated with sexual risk taking, inconsistent condom use, partner non-monogamy, unplanned pregnancies, induced abortions, sexually transmitted infections and sexual dysfunction”(Chamberlin & Levenson, 2011)  These are just some of the physical health concerns they may have.  There are so many emotional concerns that would be linked to sexual exploitation also.   Post-traumatic stress disorder (PTSD), including flashbacks, nightmares, severe anxiety, and uncontrollable thoughts, Depression, including prolonged sadness, feelings of hopelessness, unexplained crying, weight loss or gain, loss of energy or interest in activities previously enjoyed”(Joyful Heart Foundation, 2019). 

      Georgia specifically has a state wide domestic violence hotline. “Educational videos on temporary protective orders were distributed to Nurse Mangers in all 159 Georgia Counties and 19 Health Districts to utilize in trainings and seminars.  The tapes, obtained from the Georgia Commission on Family Violence, were designed to increase the nurses’ knowledge of services available to victims of domestic and sexual assault, and to enable them to direct these women to alternatives that can help reduce their exposure to violence.  Designed and developed a tri-fold pocket card (in English (Links to an external site.)Links to an external site. and Spanish (Links to an external site.)Links to an external site.), in collaboration with the Georgia Coalition Against Domestic Violence (GCADV),  that contains information on the signs of domestic violence, safety plans, options available to survivors of domestic violence, and a list community organizations that work with survivors of domestic violence”(DPH, 2018).

      In my county specifically I know there is an organization called Community Welcome House, Inc.  This organization helps domestic violence victims.  It provides, “Emergency housing sanctuary in the time of crisis Residents receive assistance with medical care, child care, counseling, financial assistance, vocational training, employment and permanent housing”(Domesticshelters.org, 2019). 

Chamberlin, Linda & Levenson, Rebecca. (2011). Guidelines for Addressing Intimate Partner Violence Reproductive and Sexual Coercion For Obstetric, Gynecologic, Reproductive Health Care Settings. American College of Obstetrics and Gynecology. Retrieved on March 17, 2019 from https://www.acog.org/-/media/Departments/Violence-Against-Women/Guidelines-for-Addressing-Intimate-Partner-Violence.pdf?dmc=1&ts=20190317T1155502488

Joyful Heart Foundation. (2019). Effects of Sexual Assault and Rape.  Retrieved on March 17, 2019 from http://www.joyfulheartfoundation.org/learn/sexual-assault-rape/effects-sexual-assault-and-rape

Department of Public Health. (2018). Violence against Women Prevention. Retrieved on March 17, 2019 from https://dph.georgia.gov/violence-against-women-prevention

Domestic Shelters, (2019). Retrieved on March 17, 2019 from https://www.domesticshelters.org/help/ga/newnan/30263/community-welcome-house

 Reply hollie 

Question 1—Domestic Violence

 Domestic violence can come in many shapes and forms. In some cases, physical injury can occur, while in other cases psychological abuse, deprivation, intimidation or other types of harm can occur (ACOG, 2012). The American College of Obstetricians and Gynecologists (ACOG) recognizes that routine visits and prenatal visits are an ideal time to assess for domestic violence (ACOG, 2012). Assessing for domestic violence can be done by using simple screening questions. These questions should not be asked in front of the abuser or other individuals. ACOG (2012) recommends using a framing statement and confidentiality statement before asking any questions. The framing statement lets the patient know that questions are being asked because relationships play a large role in health and the confidentiality statement lets the patient know that what she states today will not be told to anyone else unless reporting is required (ACOG, 2012).  

Risk Factors

 Two risk factors for domestic violence include: low education levels and drug and/or alcohol abuse (Huecker & Smock, 2018). Studies have shown that there is an inverse relationship between education levels and rates of domestic violence (Huecker & Smock, 2018). Men are more likely to perpetrate violence if they have low education and women are more likely to experience intimate partner violence (IPV) if they have a low education level (WHO, 2017). Alcohol and drug use are also risk factors for IPV. Alcohol and drug abuse is associated with an increase in the incidence of domestic violence, likely due to the inability of an impaired person to control violent impulses (Huecker & Smock, 2018).

Clinical Signs

 Obtaining a history, screening for IPV, and performing a physical exam can help point to IPV. Huecker and Smock (2018) state the most common injuries involved in IPV are on the head, neck, and face. Defensive injuries may also be present on the forearms (Huecker & Smock, 2018). A full physical exam should also evaluate the skin in areas covered by clothing (Huecker & Smock, 2018). Sexual abuse may be harder to identify physically, depending on the nature of the abuse (Huecker & Smock, 2018). Psychological complaints may include: anxiety, depression, and fatigue (Huecker & Smock, 2018). The patient may also have vague complaints, such as chronic pain, headaches, or chest pain (Huecker & Smock, 2018).

References

ACOG. (2012). Intimate Partner Violence. The American College of Obstetricians and Gynecologists, 518(1), 1-6. Retrieved from https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co518.pdf?dmc=1&ts=20190318T0127216097

Huecker, M., & Smock, W. (2018). Domestic violence. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK499891/

WHO. (2017). Violence against women. Retrieved from https://www.who.int/news-room/fact-sheets/detail/violence-against-women

 

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Political actions in the healthcare sector are important to the LGBTQ community as the engagement of the nurses in political actions help improve their well-being. The nurses can actively participate in elections to put up to power the leaders they want or to bring down the leaders who do not fully satisfy their needs. The nurses can therefore engage in policy making by ensuring that manifesto of the leaders elected include the various policies they need. The nurses can ensure that the leaders being elected have the potential to listen to the various proposals of the nurses on the grounds of ensuring protection for the LGBTQ community (Amann, 2017). This will facilitate the incorporation of the recommendations of nurses in the policies. 

The nurses can stand to be elected as leaders into political position which is the most important as it pertains to LGBTQ and in all the patients. The nurses can act best in that position as they leaders can be able to implement the needed policies that will improve the healthcare sector. A nurse chairing a political position will have adequate knowledge on how policies will work in the healthcare sector and how LGBTQ community could be protected. The political position will facilitate the enhancement of the health care services for all the patients regardless of the category (Groenwald andEldridge, 2019). The political action will facilitate the improvement of the LGBTQ as awareness to the public reducing the stigma associated with them due to non-acceptance in the society.  

The nurses can also obtain training and be involved in city councils and committees where they can raise issues of concern within the industry. Participating in these trainings on political issues will facilitate the enhancement of the needed knowledge to the community on the LGBTQ. The participation in the committees will facilitate the enlighteningof the society on the healthcare delivery for all the patients (Kung and Rudner Lugo, 2015). The involvement will generate an opportunity for nurses to protect the LGBTQ from being denied some services and priorities.  

References 

Amann, C. A. (2017). Undergraduate Health Policy Education: Impacting the Future of Nursing. Groenwald, S. L., & Eldridge, C. (2019, August). Politics, power, and predictability of nursing care. In Nursing forum. 

Kung, Y. M., & Rudner Lugo, N. (2015). Political advocacy and practice barriers: A survey of Florida APRNs. Journal of the American Association of Nurse Practitioners, 27(3), 145-151. 

Role of Nurses in Influencing Policy Making
 Nurses as Political Actors

Nurses should see themselves as practitioners with the opportunity and obligation to impact current and future delivery systems of health care to be successful. The practice of nursing is based on human health science and caring psychology. This works from a context that holistically respects all people and aims to encourage and advance the health of people throughout their lives and throughout all levels of society (Lesbian, Gay, Bisexual, and Transgender Health, n.d).

A large number of the leading nursing associations encourage nurses to take part in the formulating of policies actively. For instance, the American Association of Colleges of Nursing underlines the job of nursing in strategy. It distinguishes, in its “Fundamentals” reports, the standard arrangement inclusion that ought to be tended to in instructive projects at the baccalaureate, master’s, and doctoral degrees of expert nursing. The National League for Nursing and the American Nurses Association additionally anticipate that medical caretakers should address the approach as a component of their expert job. Politically, nurses can play a significant role in influencing policies that influences the lives of lesbian, gay, bisexual, and transgender individuals (LGBT) (Burke, 2016). They include individuals from different ethnic and socioeconomic backgrounds, yet society has treated them as lesser beings. Nurses can influence policymaking concerning these groups in the following ways.

Lobbying political leaders; Through unique knowledge of their constituents ‘ needs, city and county officials have the power to implement policies and programs that protect LGBTQ people, improve community engagement, and open opportunities (Burke, 2016). Nursing leaders can, therefore, lobby political leaders to pass policies that favor LGBT.

Involvement in campaign groups; Many of these LGBT individuals face discrimination due to current policies in place. Nurses can join in their campaign and together fight for their rights. Sometimes, demonstrations are the only voice that the government hears and responds to.

Volunteer to engage in conferences or activities related to strategy. Prepare a fact sheet and help prepare a document to educate policymakers. Inform stakeholders regarding events that provide incentives for policymakers to tackle.

Conclusively, there is a need for changes to be effected on policies relating to LGBT rights to ensure they feel safe in society. As such, nurses should politically intervene with members of LGBT. They have the potential to have a profound global impact on politics. Nevertheless, it is nurses ‘ ethical and professional duty to intervene in policies they deem to be affecting their patients, LGBT notwithstanding.

References
Burke Sheila A. (2016). Influence through policy: Nurses have a unique role.Retrieved 29 October 2019, from https://www.reflectionsonnursingleadership.org/commentary/more-commentary/Vol42_2_nurses-have-a-unique-role
Lesbian, Gay, Bisexual, and Transgender Health. (n.d). Retrieved 29 October 2019, from  https://www.cdc.gov/lgbthealth/

 

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Provide a 3-4 sentence reply to the below discussion question answer in apa format with in-text citations and references

Answer: In last weeks discussion question, I had mentioned that the culture of the institution can be a barrier, and in addition to this,the lack of leadership support, education and time can compound the problem. It takes support from management as well as from fellow personnel (nurses, ancillary staff) to initiate, promote and maintain EBP in an organization. According to Polit & Beck, (2018),”Although many organizations support the idea of EBP in theory, they do not always provide the necessary supports in terms of staff release time and provisions of resources”. There are ways to address this particular barrier:

Organizing a staff meeting and explaining the value of implementing the EBP method

Explanations (posters on walls in break room, bathrooms,pamphlets) on how this new EBP method will bring quality care to the patient or improve a system within the organization helps staff become more receptive to new information.The staff has to see EBP as valuable and feasible.

Schedule monthly forums or meetings, enlist the aid of different staff members(on a rotation basis) and make them accountable to finish the task (making it count towards the annual evaluation). At my organization, extra duty tasks are included as favorable in the yearly evaluation. The incentive is pay increases, bonuses, time off awards.

Encourage online research. In the hospital that I work at there is a library (in the basement) but it is underutilized by everyone.Keep the staff informed as to when the library is open and provide administrative time off the floor for continued education, (Jennifer, 2017).  

Original Question: Consider an obstacle or barrier to the implementation of evidence-based practice you identified in last week’s discussion. What are two ways to address this problem?

 

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