Nursing: Politics, Policy, and Health Care Explained

Nursing: Politics, Policy, and Health Care Explained

Health Care Policy and Politics Explained

Criteria Ratings Pts
1. identifies limits of the health care market
2. addresses federalist system of government to fragmented health care delivery
3. identifies political nature of policy alternatives
4. addresses primary care provider dominance to corporate interests
5. Adequately identifies greater stature of nurses and other health care professional in health polic

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The Development of African American Culture

The Development of African American Culture

Running head: DEPENDENT PERSONALITY DISORDER Dependent Personality DisordeR Roxana Tejera Institutional

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Affiliation 1 DEPEDENT PERSONALITTY DISORDER 2 Abstract Dependent personality disorder is a condition where an individual has an excessive need for approval and guidance. The history of the disorder dates back to 1945. There are two primary categories of causal factors for DPD: (1) genetic factors; and (2) social and cultural factors. The principal symptoms for DPD include difficulty making decisions, inability to initiate things on your own, and need to be with and around people among others. DPD has five sub-types namely accommodative dependent disorder, selfless dependent disorder, disquieted dependent disorder, immature dependent disorder, accommodating, and ineffectual dependent disorder. This disorder can be prevented by rewarding independence during childhood. Unfortunately, it is not possible to prevent hereditary causes. Treating DPD is mainly through psychotherapy interventions for both short-term and long-term goals. To overcome this disorder, there is need for the person to accept that he or she needs help as well as have a willingness to go through counseling. DEPEDENT PERSONALITTY DISORDER 3 Dependent Personality Disorder Definition Dependent personality disorder (DPD) refers to a situation where an individual has an excessive and persuasive need to have someone taking care of him or her. The primary characteristics of this disorder include clinging behavior, submissiveness, and excessive fears of being alone. Hence, a person suffering from DPD can be defined as one who finds it difficult to initiate and do things on the own so that they have to rely on the affirmation and direction of “significant and powerful” others. These people exude low levels of confidence in their abilities and intelligence. They tend to belittle their achievements as long as others have not approved them. They are also prone to self-doubting and being pessimistic. As a result of feeling unable to function without guidance from others, these people go to great extents to establish and maintain the dependent relationships. History of DPD The history of DPD dates back to Abraham’s and Freud’s descriptions of oral dependency in 1927 (Andrasik 2006). However, by that time, the dependency was yet to acquire the status of a disorder. Abraham and Freud described the dependency as an oral character. In 1945, the condition appeared for the first time as a disorder in a Ware Department Technical Bulletin. Seven years later, in 1952, the disorder featured in the first edition of the Diagnostic and Statistical Manual (Andrasik 2006). At this time, clinicians referred to it as a subtype of passive-aggressive personality disorder. DEPEDENT PERSONALITTY DISORDER 4 Causes The development of dependent disorder is a result of multiple factors. Genetic factors have been found as one of the contributors to DPD (Reichborn-Kjennerud 2010). In a research involving 2794 Norwegian twins, Gjerde et al. (2012) revealed that the probability of inheriting a dependent disorder is 0.66 as compared to 0.64 in the case of avoidant personality disorder. According to these findings, children of parents with DPD face a considerable risk of inheriting the disorder as compared to those whose parents do not have the condition. Over-involvement of primary caretakers is the other established factor responsible for the development of DPD. In childhood, caretakers may cultivate dependence in the child by rewarding loyalty and punishing any attempt the child makes towards attaining independence. A child who has never been rewarded for exercising independence may never attempt it even if it would be appreciated. Similarly, a child who grows up in a home where a significant other has a dependent disorder may develop the condition as well. Children learn through observation and imitation. As such, if a child notes that his or her mother, father, an elder sibling or another close relative heavily relies on the approval of others to do anything, he or she may grow up knowing that is the way things are done. Sociological and psychological theories agree that children are born as blank slates. At the point of birth, children do not know what to do, when, or how. Society informs them everything about behavior. In other words, the behaviors people carry through life, including extreme dependence, is passed over to them by the society. The social learning theory expounds on how children learn. According to this theory, human beings, including children, learn from one another through observation, imitation, and DEPEDENT PERSONALITTY DISORDER 5 modeling. Framed differently, children like adults, pay attention to what the behavioral patterns of significant others. The second phase of behavior formation is trying to remember what one observed. The third stage involves reproducing the behavior. Thus, according to social learning theory, every behavior is learned from those close to the individual. Moreover, there are cultures that celebrate dependency. In most societies, asking for help is seen as being friendly and sociable. In tune with this view, people tend to keep asking for guidance and help. As these people grow and become members of a global culture, they are not able to let go the lessons inculcated in them. Unfortunately, there is no scientific formulae of knowing how the various contribute to the development of DPD. Symptoms According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), there are several ways of identifying DPD. One of the most pronounced symptoms of DPD is that these individuals have difficulties making common decisions (Hales et al. 2011). Typically, people suffering from this disorder need excessive reassurance before they settle on even simple decisions such as what time to eat or what clothing to wear. Another symptom very similar to this is that these people tend to transfer their responsibilities to others (Hales et al. 2011). As a functioning of feeling incapable of assuming autonomy, they allow others to handle things on their behalf. People with this disorder tend to depend on parents to decide on who to marry or spouse on where to live. At times, these people will also need excessive guidance on who to be friends with. Also, people with the dependent disorder are overly agreeable. They do whatever they can to avoid disagreements. To them, disagreeing is a far too risky involvement as it can destroy DEPEDENT PERSONALITTY DISORDER 6 dependent relationships. They are afraid of disagreements not because they are cowardly but because they do not want to lose a source of approval and guidance (Hales et al. 2011). In the same vein, these people are very quick to seek new relationships when an existing one ends. For example, in the case of divorce, these people will most likely get married again in the shortest time possible. They do all they can to be in a relationship that will provide the same support the previous one provided. Equally important, these people feel helpless when alone. Because of the feeling that they are not able to care for themselves, they tend to suffer from high degrees of anxiety when left alone (Hales et al. 2011). In response, these people prefer being around people, even if they have little interest in them. Lastly but not least, people with DPD have difficulty with starting anything. They see themselves as inept to accomplish any task. Even worse, they are not able to sustain tasks. Thus, if you assign them to do something, they need you to provide support all through. In the end, you prefer doing the task rather than assigning it to them. Different Types There are five main types of dependent personality disorder (DPD) namely disquieted, selfless, immature, accommodating, and ineffectual. The section below discusses each of these subtypes in brief. The Ineffectual Dependent Disorder People suffering from this type show a combination of schizoid and dependent patterns. The major symptoms of this disorder are that the person is not interested social relationships (Cavaiola & Lavender 2000). They tend to prefer solitary activities. However, in stark contrast, DEPEDENT PERSONALITTY DISORDER 7 people with this disorder understand and empathize with the emotions of others. Another distinguishing feature of this type is that the individuals have no drive to act on their own. The Disquieted Dependent Disorder People with this disorder are highly vulnerable to separation anxiety. At the same time, they are very cautious not to lose support. A notable distinguishing characteristic of people with this disorder is that they at times express their fear of losing supportive relationships (Cavaiola & Lavender 2000). They tend to have outbursts of anger when their needs for safety and security are not met. The Selfless Dependent Disorder For this disorder, total identification and idealization are the principal themes. These people tend to forfeit their own self-identities as they merge with others. Ironically, their loss of self-identity seems fulfilling. Besides the loss of self-identity, people with the selfless dependent disorder are highly prone to experience depression when their relationship face difficulties (Cavaiola & Lavender 2000). The Immature Dependent Disorder As the term suggests, people with this disorder are overly attached to childlike activities and children. They have zero interest in spending with adults and assuming adult responsibilities. Instead, they prefer engaging in childhood activities and derive satisfaction from relating with children (Cavaiola & Lavender 2000). The Accommodating Dependent Disorder DEPEDENT PERSONALITTY DISORDER 8 This disorder shares most symptoms with the histrionic personality disorder. People with this type are very agreeable, submissive, benevolent, and neighborly (Cavaiola & Lavender 2000). Also, these people seek to become the centers of attention. As such, they tend to exhibit self-dramatizing behaviors. Prevention To understand how to prevent DPD, it is important to divide the causal factors into two: (1) genetic factors: and (2) social and cultural factors. For the genetic factors, preventing DPD is virtually impossible. Hence, the only way of preventing the development of DPD is by addressing social and cultural factors. In this tune, one way of preventing DPD is by teaching caretakers on how to help children learn independence. At times, caretakers are too protective. They do not provide space for children to experiment and explore on their own. Essentially, caretakers should encourage children to be independent. They should reward any effort towards attaining independence. Another way of preventing DPD is by living independently. As mentioned elsewhere, children learn through imitation. Hence, significant others must ensure that they provide a good example of an independent life to children. In this light, parents and elder siblings should show children that they can decide on their own, and feel confident about their decisions even if nobody approves them. Treatment Plans for Short-Term and Long-Term Goals For both short-term and long-term goals, psychotherapy is the primary method of treating DPD. However, depending on the nature of the goals, short-term or long-term, different types of psychotherapy are used. For short-term goals, assertiveness training and cognitive-behavioral DEPEDENT PERSONALITTY DISORDER 9 therapy (CBT) are the most common treatments. Training in assertiveness helps build selfconfidence. CBT helps develop new perspectives and attitudes concerning others. For long-term goals, psychodynamic psychotherapy is the best intervention. Suggestions on How to Overcome the Disorder The first and probably the most important suggestion for people seeking to overcome the disorder is to accept that they need help. Unfortunately, most people suffering from DPD never seek help, they only seek help when symptoms become unmanageable. While this also helps, it is at times too late. That said, it is very important to accept that you need help. Denial never helps. Secondly, one needs to seek professional help. While it is good to seek help from friends and relatives, it is much better to approach professionals in psychotherapy. The importance of seeking professional help cannot be overstated. Thirdly, success from psychotherapy requires commitment and discipline on the part of the patient. Therefore, anyone willing to overcome DPD must have a positive attitude and mindset. One must not approach psychotherapy like it is punishment. There is need for willingness on the part of the patient. Parenting Skills to Help the Individuals One skill that parents need to help children with DPD is praising them for efforts. In the case of children with DPD, one of the greatest issues to deal with is to help them improve their confidence levels. Praising children helps boost their confidence levels. On top of verbal commendation, parents can also have a journal where they write the good things their children do. They can then allow the children to read through the journals occasionally. This will also DEPEDENT PERSONALITTY DISORDER 10 help people prone or already suffering from DPD to appreciate themselves and develop positive self-esteem. Setting rules and being strict on them is another skill parents to help individuals with DPD. It is not true that being passive results in better behavior. Inability to set and enforce rules makes it possible for dependent individuals to keep asking for support and direction, even in handling simple things. Parents need to define what areas their children can seek help. Most importantly, these rules should be revised over time as the child advances in age. Adults relying on their parents to decide on who to marry or where to live evidence that these parents encouraged that kind of excessive dependency. Parents must ensure that their children learn how to assume responsibilities. Another equally important skill for parents with individuals having DPD is how to argue and solve conflicts. From time to time, these parents need to pick moderate conflicts with these individuals. By so doing, these people will learn that disagreeing is normal in life and it does not mean the relationship is over. Evidence-based Therapies for DPD Cognitive-behavioral therapy (CBT) the most recognized and effective evidence-based interventions for DPD. Ideally, CBT seeks to address self-defeating thought processes and patterns. This kind of therapy helps deconstruct inflexible patterns hindering the person from embracing healthier behavior. Matusiewicz and colleagues conducted research on the available empirical support for CBT as an intervention for DPD in the years between 1980 and 2009 (Matusiewicz et al. 2010). This investigation observed that CBT is the most effective evidencebased intervention for DPD. DEPEDENT PERSONALITTY DISORDER 11 Psychodynamic therapy is the other most popular evidence-based intervention for DPD. Psychodynamic therapy also referred to as insight-oriented therapy aims at unconscious processes in the mind. This approach is based on the assertion that thought patterns, both conscious and unconscious, shape behavior. What people go through in life define their behavior patterns. What a child experiences during his or her early years shows up later in life. Studies investigating the effect of psychodynamic therapy on personality disorders including DPD have pointed that the approach has positive results. Research conducted by McMain and Alberta maintains this position (McMain & Alberta 2007). DEPEDENT PERSONALITTY DISORDER 12 Conclusion While every person needs people, excessive dependence on others is a disorder. As such, it is important to know the boundaries. For those who have found themselves in the situation that they cannot care for themselves and are always in constant need for support should not lose hope. DPD can be treated. For parents, it is important to note that children learn through imitation. Thus, it is important to provide to them good examples, which in this case is independence. During childhood, caretakers should reward independence without discouraging dependence. Most importantly, there parental skills that can be helpful for people living with individuals suffering from DPD. Some of these skills include praising the individual for effort, showing them that conflict is normal in life, and setting boundaries on areas the person is allowed to seek guidance or not. While these skills can help prevent the development of DHD, they may be of little importance if the person has lived with the condition for a long time. For this reason, it is advisable to seek professional help. In treating DPD, cognitive behavioral therapy and psychodynamic therapy are some of the most effective evidence-based interventions. The government should develop programs to help prevent the development of DPD. For example, the government can design programs to teach every parent on how children learn. With this understanding on how children learn, parents would know what skills to employ and how to conduct themselves in the presence of children. DPD is not just a social problem. It is also an economic problem. People with DPD have difficulties initiating anything meaning that their innovation and creativity levels are very low. DEPEDENT PERSONALITTY DISORDER 13 References Andrasik, F. (2006). Comprehensive Handbook of Personality and Psychopathology Volume 2. Hoboken: John Wiley & Sons. Cavaiola, A. A., & Lavender, N. J. (2000). Toxic coworkers: How to deal with dysfunctional people on the job. Oakland, Calif: New Harbinger Publications. Gjerde, L. C., Czajkowski, N., Røysamb, E., Ørstavik, R. E., Knudsen, G. P., Østby, K., Torgersen, S., Myers, J., Kendler, K. S., & Reichborn-Kjennerud, T. (2012). The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire. Acta Psychiatrica Scandinavica, 126(6), 448–457. http://doi.org/10.1111/j.1600-0447.2012.01862.x Hales, R. E., Yudofsky, S. C., Gabbard, G. O., & American Psychiatric Publishing. (2011). Essentials of psychiatry. Arlington, VA: American Psychiatric Pub. Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders. The Psychiatric Clinics of North America, 33(3), 657–685. http://doi.org/10.1016/j.psc.2010.04.007 McMain, S., & Alberta, E. (2007). Advances in psychotherapy of personality disorders: A research update. Current Psychiatry Reports, 9 (1), 46-52. Reichborn-Kjennerud, T. (2010). The genetic epidemiology of personality disorders. Dialogues in Clinical Neuroscience, 12(1), 103–114. Running head: DEPENDENT PERSONALITY DISORDER Dependent Personality DisordeR Roxana Tejera Institutional Affiliation 1 DEPEDENT PERSONALITTY DISORDER 2 Abstract Dependent personality disorder is a condition where an individual has an excessive need for approval and guidance. The history of the disorder dates back to 1945. There are two primary categories of causal factors for DPD: (1) genetic factors; and (2) social and cultural factors. The principal symptoms for DPD include difficulty making decisions, inability to initiate things on your own, and need to be with and around people among others. DPD has five sub-types namely accommodative dependent disorder, selfless dependent disorder, disquieted dependent disorder, immature dependent disorder, accommodating, and ineffectual dependent disorder. This disorder can be prevented by rewarding independence during childhood. Unfortunately, it is not possible to prevent hereditary causes. Treating DPD is mainly through psychotherapy interventions for both short-term and long-term goals. To overcome this disorder, there is need for the person to accept that he or she needs help as well as have a willingness to go through counseling. DEPEDENT PERSONALITTY DISORDER 3 Dependent Personality Disorder Definition Dependent personality disorder (DPD) refers to a situation where an individual has an excessive and persuasive need to have someone taking care of him or her. The primary characteristics of this disorder include clinging behavior, submissiveness, and excessive fears of being alone. Hence, a person suffering from DPD can be defined as one who finds it difficult to initiate and do things on the own so that they have to rely on the affirmation and direction of “significant and powerful” others. These people exude low levels of confidence in their abilities and intelligence. They tend to belittle their achievements as long as others have not approved them. They are also prone to self-doubting and being pessimistic. As a result of feeling unable to function without guidance from others, these people go to great extents to establish and maintain the dependent relationships. History of DPD The history of DPD dates back to Abraham’s and Freud’s descriptions of oral dependency in 1927 (Andrasik 2006). However, by that time, the dependency was yet to acquire the status of a disorder. Abraham and Freud described the dependency as an oral character. In 1945, the condition appeared for the first time as a disorder in a Ware Department Technical Bulletin. Seven years later, in 1952, the disorder featured in the first edition of the Diagnostic and Statistical Manual (Andrasik 2006). At this time, clinicians referred to it as a subtype of passive-aggressive personality disorder. DEPEDENT PERSONALITTY DISORDER 4 Causes The development of dependent disorder is a result of multiple factors. Genetic factors have been found as one of the contributors to DPD (Reichborn-Kjennerud 2010). In a research involving 2794 Norwegian twins, Gjerde et al. (2012) revealed that the probability of inheriting a dependent disorder is 0.66 as compared to 0.64 in the case of avoidant personality disorder. According to these findings, children of parents with DPD face a considerable risk of inheriting the disorder as compared to those whose parents do not have the condition. Over-involvement of primary caretakers is the other established factor responsible for the development of DPD. In childhood, caretakers may cultivate dependence in the child by rewarding loyalty and punishing any attempt the child makes towards attaining independence. A child who has never been rewarded for exercising independence may never attempt it even if it would be appreciated. Similarly, a child who grows up in a home where a significant other has a dependent disorder may develop the condition as well. Children learn through observation and imitation. As such, if a child notes that his or her mother, father, an elder sibling or another close relative heavily relies on the approval of others to do anything, he or she may grow up knowing that is the way things are done. Sociological and psychological theories agree that children are born as blank slates. At the point of birth, children do not know what to do, when, or how. Society informs them everything about behavior. In other words, the behaviors people carry through life, including extreme dependence, is passed over to them by the society. The social learning theory expounds on how children learn. According to this theory, human beings, including children, learn from one another through observation, imitation, and DEPEDENT PERSONALITTY DISORDER 5 modeling. Framed differently, children like adults, pay attention to what the behavioral patterns of significant others. The second phase of behavior formation is trying to remember what one observed. The third stage involves reproducing the behavior. Thus, according to social learning theory, every behavior is learned from those close to the individual. Moreover, there are cultures that celebrate dependency. In most societies, asking for help is seen as being friendly and sociable. In tune with this view, people tend to keep asking for guidance and help. As these people grow and become members of a global culture, they are not able to let go the lessons inculcated in them. Unfortunately, there is no scientific formulae of knowing how the various contribute to the development of DPD. Symptoms According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), there are several ways of identifying DPD. One of the most pronounced symptoms of DPD is that these individuals have difficulties making common decisions (Hales et al. 2011). Typically, people suffering from this disorder need excessive reassurance before they settle on even simple decisions such as what time to eat or what clothing to wear. Another symptom very similar to this is that these people tend to transfer their responsibilities to others (Hales et al. 2011). As a functioning of feeling incapable of assuming autonomy, they allow others to handle things on their behalf. People with this disorder tend to depend on parents to decide on who to marry or spouse on where to live. At times, these people will also need excessive guidance on who to be friends with. Also, people with the dependent disorder are overly agreeable. They do whatever they can to avoid disagreements. To them, disagreeing is a far too risky involvement as it can destroy DEPEDENT PERSONALITTY DISORDER 6 dependent relationships. They are afraid of disagreements not because they are cowardly but because they do not want to lose a source of approval and guidance (Hales et al. 2011). In the same vein, these people are very quick to seek new relationships when an existing one ends. For example, in the case of divorce, these people will most likely get married again in the shortest time possible. They do all they can to be in a relationship that will provide the same support the previous one provided. Equally important, these people feel helpless when alone. Because of the feeling that they are not able to care for themselves, they tend to suffer from high degrees of anxiety when left alone (Hales et al. 2011). In response, these people prefer being around people, even if they have little interest in them. Lastly but not least, people with DPD have difficulty with starting anything. They see themselves as inept to accomplish any task. Even worse, they are not able to sustain tasks. Thus, if you assign them to do something, they need you to provide support all through. In the end, you prefer doing the task rather than assigning it to them. Different Types There are five main types of dependent personality disorder (DPD) namely disquieted, selfless, immature, accommodating, and ineffectual. The section below discusses each of these subtypes in brief. The Ineffectual Dependent Disorder People suffering from this type show a combination of schizoid and dependent patterns. The major symptoms of this disorder are that the person is not interested social relationships (Cavaiola & Lavender 2000). They tend to prefer solitary activities. However, in stark contrast, DEPEDENT PERSONALITTY DISORDER 7 people with this disorder understand and empathize with the emotions of others. Another distinguishing feature of this type is that the individuals have no drive to act on their own. The Disquieted Dependent Disorder People with this disorder are highly vulnerable to separation anxiety. At the same time, they are very cautious not to lose support. A notable distinguishing characteristic of people with this disorder is that they at times express their fear of losing supportive relationships (Cavaiola & Lavender 2000). They tend to have outbursts of anger when their needs for safety and security are not met. The Selfless Dependent Disorder For this disorder, total identification and idealization are the principal themes. These people tend to forfeit their own self-identities as they merge with others. Ironically, their loss of self-identity seems fulfilling. Besides the loss of self-identity, people with the selfless dependent disorder are highly prone to experience depression when their relationship face difficulties (Cavaiola & Lavender 2000). The Immature Dependent Disorder As the term suggests, people with this disorder are overly attached to childlike activities and children. They have zero interest in spending with adults and assuming adult responsibilities. Instead, they prefer engaging in childhood activities and derive satisfaction from relating with children (Cavaiola & Lavender 2000). The Accommodating Dependent Disorder DEPEDENT PERSONALITTY DISORDER 8 This disorder shares most symptoms with the histrionic personality disorder. People with this type are very agreeable, submissive, benevolent, and neighborly (Cavaiola & Lavender 2000). Also, these people seek to become the centers of attention. As such, they tend to exhibit self-dramatizing behaviors. Prevention To understand how to prevent DPD, it is important to divide the causal factors into two: (1) genetic factors: and (2) social and cultural factors. For the genetic factors, preventing DPD is virtually impossible. Hence, the only way of preventing the development of DPD is by addressing social and cultural factors. In this tune, one way of preventing DPD is by teaching caretakers on how to help children learn independence. At times, caretakers are too protective. They do not provide space for children to experiment and explore on their own. Essentially, caretakers should encourage children to be independent. They should reward any effort towards attaining independence. Another way of preventing DPD is by living independently. As mentioned elsewhere, children learn through imitation. Hence, significant others must ensure that they provide a good example of an independent life to children. In this light, parents and elder siblings should show children that they can decide on their own, and feel confident about their decisions even if nobody approves them. Treatment Plans for Short-Term and Long-Term Goals For both short-term and long-term goals, psychotherapy is the primary method of treating DPD. However, depending on the nature of the goals, short-term or long-term, different types of psychotherapy are used. For short-term goals, assertiveness training and cognitive-behavioral DEPEDENT PERSONALITTY DISORDER 9 therapy (CBT) are the most common treatments. Training in assertiveness helps build selfconfidence. CBT helps develop new perspectives and attitudes concerning others. For long-term goals, psychodynamic psychotherapy is the best intervention. Suggestions on How to Overcome the Disorder The first and probably the most important suggestion for people seeking to overcome the disorder is to accept that they need help. Unfortunately, most people suffering from DPD never seek help, they only seek help when symptoms become unmanageable. While this also helps, it is at times too late. That said, it is very important to accept that you need help. Denial never helps. Secondly, one needs to seek professional help. While it is good to seek help from friends and relatives, it is much better to approach professionals in psychotherapy. The importance of seeking professional help cannot be overstated. Thirdly, success from psychotherapy requires commitment and discipline on the part of the patient. Therefore, anyone willing to overcome DPD must have a positive attitude and mindset. One must not approach psychotherapy like it is punishment. There is need for willingness on the part of the patient. Parenting Skills to Help the Individuals One skill that parents need to help children with DPD is praising them for efforts. In the case of children with DPD, one of the greatest issues to deal with is to help them improve their confidence levels. Praising children helps boost their confidence levels. On top of verbal commendation, parents can also have a journal where they write the good things their children do. They can then allow the children to read through the journals occasionally. This will also DEPEDENT PERSONALITTY DISORDER 10 help people prone or already suffering from DPD to appreciate themselves and develop positive self-esteem. Setting rules and being strict on them is another skill parents to help individuals with DPD. It is not true that being passive results in better behavior. Inability to set and enforce rules makes it possible for dependent individuals to keep asking for support and direction, even in handling simple things. Parents need to define what areas their children can seek help. Most importantly, these rules should be revised over time as the child advances in age. Adults relying on their parents to decide on who to marry or where to live evidence that these parents encouraged that kind of excessive dependency. Parents must ensure that their children learn how to assume responsibilities. Another equally important skill for parents with individuals having DPD is how to argue and solve conflicts. From time to time, these parents need to pick moderate conflicts with these individuals. By so doing, these people will learn that disagreeing is normal in life and it does not mean the relationship is over. Evidence-based Therapies for DPD Cognitive-behavioral therapy (CBT) the most recognized and effective evidence-based interventions for DPD. Ideally, CBT seeks to address self-defeating thought processes and patterns. This kind of therapy helps deconstruct inflexible patterns hindering the person from embracing healthier behavior. Matusiewicz and colleagues conducted research on the available empirical support for CBT as an intervention for DPD in the years between 1980 and 2009 (Matusiewicz et al. 2010). This investigation observed that CBT is the most effective evidencebased intervention for DPD. DEPEDENT PERSONALITTY DISORDER 11 Psychodynamic therapy is the other most popular evidence-based intervention for DPD. Psychodynamic therapy also referred to as insight-oriented therapy aims at unconscious processes in the mind. This approach is based on the assertion that thought patterns, both conscious and unconscious, shape behavior. What people go through in life define their behavior patterns. What a child experiences during his or her early years shows up later in life. Studies investigating the effect of psychodynamic therapy on personality disorders including DPD have pointed that the approach has positive results. Research conducted by McMain and Alberta maintains this position (McMain & Alberta 2007). DEPEDENT PERSONALITTY DISORDER 12 Conclusion While every person needs people, excessive dependence on others is a disorder. As such, it is important to know the boundaries. For those who have found themselves in the situation that they cannot care for themselves and are always in constant need for support should not lose hope. DPD can be treated. For parents, it is important to note that children learn through imitation. Thus, it is important to provide to them good examples, which in this case is independence. During childhood, caretakers should reward independence without discouraging dependence. Most importantly, there parental skills that can be helpful for people living with individuals suffering from DPD. Some of these skills include praising the individual for effort, showing them that conflict is normal in life, and setting boundaries on areas the person is allowed to seek guidance or not. While these skills can help prevent the development of DHD, they may be of little importance if the person has lived with the condition for a long time. For this reason, it is advisable to seek professional help. In treating DPD, cognitive behavioral therapy and psychodynamic therapy are some of the most effective evidence-based interventions. The government should develop programs to help prevent the development of DPD. For example, the government can design programs to teach every parent on how children learn. With this understanding on how children learn, parents would know what skills to employ and how to conduct themselves in the presence of children. DPD is not just a social problem. It is also an economic problem. People with DPD have difficulties initiating anything meaning that their innovation and creativity levels are very low. DEPEDENT PERSONALITTY DISORDER 13 References Andrasik, F. (2006). Comprehensive Handbook of Personality and Psychopathology Volume 2. Hoboken: John Wiley & Sons. Cavaiola, A. A., & Lavender, N. J. (2000). Toxic coworkers: How to deal with dysfunctional people on the job. Oakland, Calif: New Harbinger Publications. Gjerde, L. C., Czajkowski, N., Røysamb, E., Ørstavik, R. E., Knudsen, G. P., Østby, K., Torgersen, S., Myers, J., Kendler, K. S., & Reichborn-Kjennerud, T. (2012). The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire. Acta Psychiatrica Scandinavica, 126(6), 448–457. http://doi.org/10.1111/j.1600-0447.2012.01862.x Hales, R. E., Yudofsky, S. C., Gabbard, G. O., & American Psychiatric Publishing. (2011). Essentials of psychiatry. Arlington, VA: American Psychiatric Pub. Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders. The Psychiatric Clinics of North America, 33(3), 657–685. http://doi.org/10.1016/j.psc.2010.04.007 McMain, S., & Alberta, E. (2007). Advances in psychotherapy of personality disorders: A research update. Current Psychiatry Reports, 9 (1), 46-52. Reichborn-Kjennerud, T. (2010). The genetic epidemiology of personality disorders. Dialogues in Clinical Neuroscience, 12(1), 103–114. Running head: DEPENDENT PERSONALITY DISORDER Dependent Personality Disorder Name Institutional Affiliation 1 DEPEDENT PERSONALITTY DISORDER 2 Abstract Dependent personality disorder is a condition where an individual has an excessive need for approval and guidance. The history of the disorder dates back to 1945. There are two primary categories of causal factors for DPD: (1) genetic factors; and (2) social and cultural factors. The principal symptoms for DPD include difficulty making decisions, inability to initiate things on your own, and need to be with and around people among others. DPD has five sub-types namely accommodative dependent disorder, selfless dependent disorder, disquieted dependent disorder, immature dependent disorder, accommodating, and ineffectual dependent disorder. This disorder can be prevented by rewarding independence during childhood. Unfortunately, it is not possible to prevent hereditary causes. Treating DPD is mainly through psychotherapy interventions for both short-term and long-term goals. To overcome this disorder, there is need for the person to accept that he or she needs help as well as have a willingness to go through counseling. DEPEDENT PERSONALITTY DISORDER 3 Dependent Personality Disorder Definition Dependent personality disorder (DPD) refers to a situation where an individual has an excessive and persuasive need to have someone taking care of him or her. The primary characteristics of this disorder include clinging behavior, submissiveness, and excessive fears of being alone. Hence, a person suffering from DPD can be defined as one who finds it difficult to initiate and do things on the own so that they have to rely on the affirmation and direction of “significant and powerful” others. These people exude low levels of confidence in their abilities and intelligence. They tend to belittle their achievements as long as others have not approved them. They are also prone to self-doubting and being pessimistic. As a result of feeling unable to function without guidance from others, these people go to great extents to establish and maintain the dependent relationships. History of DPD The history of DPD dates back to Abraham’s and Freud’s descriptions of oral dependency in 1927 (Andrasik 2006). However, by that time, the dependency was yet to acquire the status of a disorder. Abraham and Freud described the dependency as an oral character. In 1945, the condition appeared for the first time as a disorder in a Ware Department Technical Bulletin. Seven years later, in 1952, the disorder featured in the first edition of the Diagnostic and Statistical Manual (Andrasik 2006). At this time, clinicians referred to it as a subtype of passive-aggressive personality disorder. DEPEDENT PERSONALITTY DISORDER 4 Causes The development of dependent disorder is a result of multiple factors. Genetic factors have been found as one of the contributors to DPD (Reichborn-Kjennerud 2010). In a research involving 2794 Norwegian twins, Gjerde et al. (2012) revealed that the probability of inheriting a dependent disorder is 0.66 as compared to 0.64 in the case of avoidant personality disorder. According to these findings, children of parents with DPD face a considerable risk of inheriting the disorder as compared to those whose parents do not have the condition. Over-involvement of primary caretakers is the other established factor responsible for the development of DPD. In childhood, caretakers may cultivate dependence in the child by rewarding loyalty and punishing any attempt the child makes towards attaining independence. A child who has never been rewarded for exercising independence may never attempt it even if it would be appreciated. Similarly, a child who grows up in a home where a significant other has a dependent disorder may develop the condition as well. Children learn through observation and imitation. As such, if a child notes that his or her mother, father, an elder sibling or another close relative heavily relies on the approval of others to do anything, he or she may grow up knowing that is the way things are done. Sociological and psychological theories agree that children are born as blank slates. At the point of birth, children do not know what to do, when, or how. Society informs them everything about behavior. In other words, the behaviors people carry through life, including extreme dependence, is passed over to them by the society. The social learning theory expounds on how children learn. According to this theory, human beings, including children, learn from one another through observation, imitation, and DEPEDENT PERSONALITTY DISORDER 5 modeling. Framed differently, children like adults, pay attention to what the behavioral patterns of significant others. The second phase of behavior formation is trying to remember what one observed. The third stage involves reproducing the behavior. Thus, according to social learning theory, every behavior is learned from those close to the individual. Moreover, there are cultures that celebrate dependency. In most societies, asking for help is seen as being friendly and sociable. In tune with this view, people tend to keep asking for guidance and help. As these people grow and become members of a global culture, they are not able to let go the lessons inculcated in them. Unfortunately, there is no scientific formulae of knowing how the various contribute to the development of DPD. Symptoms According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), there are several ways of identifying DPD. One of the most pronounced symptoms of DPD is that these individuals have difficulties making common decisions (Hales et al. 2011). Typically, people suffering from this disorder need excessive reassurance before they settle on even simple decisions such as what time to eat or what clothing to wear. Another symptom very similar to this is that these people tend to transfer their responsibilities to others (Hales et al. 2011). As a functioning of feeling incapable of assuming autonomy, they allow others to handle things on their behalf. People with this disorder tend to depend on parents to decide on who to marry or spouse on where to live. At times, these people will also need excessive guidance on who to be friends with. Also, people with the dependent disorder are overly agreeable. They do whatever they can to avoid disagreements. To them, disagreeing is a far too risky involvement as it can destroy DEPEDENT PERSONALITTY DISORDER 6 dependent relationships. They are afraid of disagreements not because they are cowardly but because they do not want to lose a source of approval and guidance (Hales et al. 2011). In the same vein, these people are very quick to seek new relationships when an existing one ends. For example, in the case of divorce, these people will most likely get married again in the shortest time possible. They do all they can to be in a relationship that will provide the same support the previous one provided. Equally important, these people feel helpless when alone. Because of the feeling that they are not able to care for themselves, they tend to suffer from high degrees of anxiety when left alone (Hales et al. 2011). In response, these people prefer being around people, even if they have little interest in them. Lastly but not least, people with DPD have difficulty with starting anything. They see themselves as inept to accomplish any task. Even worse, they are not able to sustain tasks. Thus, if you assign them to do something, they need you to provide support all through. In the end, you prefer doing the task rather than assigning it to them. Different Types There are five main types of dependent personality disorder (DPD) namely disquieted, selfless, immature, accommodating, and ineffectual. The section below discusses each of these subtypes in brief. The Ineffectual Dependent Disorder People suffering from this type show a combination of schizoid and dependent patterns. The major symptoms of this disorder are that the person is not interested social relationships (Cavaiola & Lavender 2000). They tend to prefer solitary activities. However, in stark contrast, DEPEDENT PERSONALITTY DISORDER 7 people with this disorder understand and empathize with the emotions of others. Another distinguishing feature of this type is that the individuals have no drive to act on their own. The Disquieted Dependent Disorder People with this disorder are highly vulnerable to separation anxiety. At the same time, they are very cautious not to lose support. A notable distinguishing characteristic of people with this disorder is that they at times express their fear of losing supportive relationships (Cavaiola & Lavender 2000). They tend to have outbursts of anger when their needs for safety and security are not met. The Selfless Dependent Disorder For this disorder, total identification and idealization are the principal themes. These people tend to forfeit their own self-identities as they merge with others. Ironically, their loss of self-identity seems fulfilling. Besides the loss of self-identity, people with the selfless dependent disorder are highly prone to experience depression when their relationship face difficulties (Cavaiola & Lavender 2000). The Immature Dependent Disorder As the term suggests, people with this disorder are overly attached to childlike activities and children. They have zero interest in spending with adults and assuming adult responsibilities. Instead, they prefer engaging in childhood activities and derive satisfaction from relating with children (Cavaiola & Lavender 2000). The Accommodating Dependent Disorder DEPEDENT PERSONALITTY DISORDER 8 This disorder shares most symptoms with the histrionic personality disorder. People with this type are very agreeable, submissive, benevolent, and neighborly (Cavaiola & Lavender 2000). Also, these people seek to become the centers of attention. As such, they tend to exhibit self-dramatizing behaviors. Prevention To understand how to prevent DPD, it is important to divide the causal factors into two: (1) genetic factors: and (2) social and cultural factors. For the genetic factors, preventing DPD is virtually impossible. Hence, the only way of preventing the development of DPD is by addressing social and cultural factors. In this tune, one way of preventing DPD is by teaching caretakers on how to help children learn independence. At times, caretakers are too protective. They do not provide space for children to experiment and explore on their own. Essentially, caretakers should encourage children to be independent. They should reward any effort towards attaining independence. Another way of preventing DPD is by living independently. As mentioned elsewhere, children learn through imitation. Hence, significant others must ensure that they provide a good example of an independent life to children. In this light, parents and elder siblings should show children that they can decide on their own, and feel confident about their decisions even if nobody approves them. Treatment Plans for Short-Term and Long-Term Goals For both short-term and long-term goals, psychotherapy is the primary method of treating DPD. However, depending on the nature of the goals, short-term or long-term, different types of psychotherapy are used. For short-term goals, assertiveness training and cognitive-behavioral DEPEDENT PERSONALITTY DISORDER 9 therapy (CBT) are the most common treatments. Training in assertiveness helps build selfconfidence. CBT helps develop new perspectives and attitudes concerning others. For long-term goals, psychodynamic psychotherapy is the best intervention. Suggestions on How to Overcome the Disorder The first and probably the most important suggestion for people seeking to overcome the disorder is to accept that they need help. Unfortunately, most people suffering from DPD never seek help, they only seek help when symptoms become unmanageable. While this also helps, it is at times too late. That said, it is very important to accept that you need help. Denial never helps. Secondly, one needs to seek professional help. While it is good to seek help from friends and relatives, it is much better to approach professionals in psychotherapy. The importance of seeking professional help cannot be overstated. Thirdly, success from psychotherapy requires commitment and discipline on the part of the patient. Therefore, anyone willing to overcome DPD must have a positive attitude and mindset. One must not approach psychotherapy like it is punishment. There is need for willingness on the part of the patient. Parenting Skills to Help the Individuals One skill that parents need to help children with DPD is praising them for efforts. In the case of children with DPD, one of the greatest issues to deal with is to help them improve their confidence levels. Praising children helps boost their confidence levels. On top of verbal commendation, parents can also have a journal where they write the good things their children do. They can then allow the children to read through the journals occasionally. This will also DEPEDENT PERSONALITTY DISORDER 10 help people prone or already suffering from DPD to appreciate themselves and develop positive self-esteem. Setting rules and being strict on them is another skill parents to help individuals with DPD. It is not true that being passive results in better behavior. Inability to set and enforce rules makes it possible for dependent individuals to keep asking for support and direction, even in handling simple things. Parents need to define what areas their children can seek help. Most importantly, these rules should be revised over time as the child advances in age. Adults relying on their parents to decide on who to marry or where to live evidence that these parents encouraged that kind of excessive dependency. Parents must ensure that their children learn how to assume responsibilities. Another equally important skill for parents with individuals having DPD is how to argue and solve conflicts. From time to time, these parents need to pick moderate conflicts with these individuals. By so doing, these people will learn that disagreeing is normal in life and it does not mean the relationship is over. Evidence-based Therapies for DPD Cognitive-behavioral therapy (CBT) the most recognized and effective evidence-based interventions for DPD. Ideally, CBT seeks to address self-defeating thought processes and patterns. This kind of therapy helps deconstruct inflexible patterns hindering the person from embracing healthier behavior. Matusiewicz and colleagues conducted research on the available empirical support for CBT as an intervention for DPD in the years between 1980 and 2009 (Matusiewicz et al. 2010). This investigation observed that CBT is the most effective evidencebased intervention for DPD. DEPEDENT PERSONALITTY DISORDER 11 Psychodynamic therapy is the other most popular evidence-based intervention for DPD. Psychodynamic therapy also referred to as insight-oriented therapy aims at unconscious processes in the mind. This approach is based on the assertion that thought patterns, both conscious and unconscious, shape behavior. What people go through in life define their behavior patterns. What a child experiences during his or her early years shows up later in life. Studies investigating the effect of psychodynamic therapy on personality disorders including DPD have pointed that the approach has positive results. Research conducted by McMain and Alberta maintains this position (McMain & Alberta 2007). DEPEDENT PERSONALITTY DISORDER 12 Conclusion While every person needs people, excessive dependence on others is a disorder. As such, it is important to know the boundaries. For those who have found themselves in the situation that they cannot care for themselves and are always in constant need for support should not lose hope. DPD can be treated. For parents, it is important to note that children learn through imitation. Thus, it is important to provide to them good examples, which in this case is independence. During childhood, caretakers should reward independence without discouraging dependence. Most importantly, there parental skills that can be helpful for people living with individuals suffering from DPD. Some of these skills include praising the individual for effort, showing them that conflict is normal in life, and setting boundaries on areas the person is allowed to seek guidance or not. While these skills can help prevent the development of DHD, they may be of little importance if the person has lived with the condition for a long time. For this reason, it is advisable to seek professional help. In treating DPD, cognitive behavioral therapy and psychodynamic therapy are some of the most effective evidence-based interventions. The government should develop programs to help prevent the development of DPD. For example, the government can design programs to teach every parent on how children learn. With this understanding on how children learn, parents would know what skills to employ and how to conduct themselves in the presence of children. DPD is not just a social problem. It is also an economic problem. People with DPD have difficulties initiating anything meaning that their innovation and creativity levels are very low. DEPEDENT PERSONALITTY DISORDER 13 References Andrasik, F. (2006). Comprehensive Handbook of Personality and Psychopathology Volume 2. Hoboken: John Wiley & Sons. Cavaiola, A. A., & Lavender, N. J. (2000). Toxic coworkers: How to deal with dysfunctional people on the job. Oakland, Calif: New Harbinger Publications. Gjerde, L. C., Czajkowski, N., Røysamb, E., Ørstavik, R. E., Knudsen, G. P., Østby, K., Torgersen, S., Myers, J., Kendler, K. S., & Reichborn-Kjennerud, T. (2012). The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire. Acta Psychiatrica Scandinavica, 126(6), 448–457. http://doi.org/10.1111/j.1600-0447.2012.01862.x Hales, R. E., Yudofsky, S. C., Gabbard, G. O., & American Psychiatric Publishing. (2011). Essentials of psychiatry. Arlington, VA: American Psychiatric Pub. Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders. The Psychiatric Clinics of North America, 33(3), 657–685. http://doi.org/10.1016/j.psc.2010.04.007 McMain, S., & Alberta, E. (2007). Advances in psychotherapy of personality disorders: A research update. Current Psychiatry Reports, 9 (1), 46-52. Reichborn-Kjennerud, T. (2010). The genetic epidemiology of personality disorders. Dialogues in Clinical Neuroscience, 12(1), 103–114.
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NRS490 GCU Shared medical appointments with RN Diabetic control

NRS490 GCU Shared medical appointments with RN Diabetic control

Running head: CAPSTONE PROJECT CHANGE PROPOSAL Capstone Project Change Proposal Gregory Catania RN

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Grand Canyon University NRS 490 1/20/19 CAPSTONE PROJECT CHANGE PROPOSAL 2 Shared Medical Appointments with Registered Nurse for Better AIC Control in Diabetes Background Diabetes described as a complex, chronic illness that requires tight glycemic control to prevent risk factors associated with Diabetes. There is evidence of tighter glycemic control helping reduce risks associated with diabetes like vascular damage and organs failure. The chronic hyperglycemia associated with long-term damage, dysfunctional organs and potential organs failure. Uncontrolled diabetes affects the eyes, kidneys, the heart, nerves, and blood vessels (American Diabetes Association, 2014: S83). The growing incidences of diabetes without a comparable level of care and glycemic control exposes individuals to the risk factors associated with diabetes. However, research on lifestyle interventions has demonstrated delayed onset of diabetes-related risks with people with impaired glucose tolerance (Chen, 2018: 13). This paper aims to validate the effect of consistent medical intervention exploring the mediating role of the registered nurse. The PICOT study shades light using empirical evidence. Problem Statement of PICOT Study Diabetes has persistent being a health concern globally despite improvement in treatment and growing knowledge in its management. The prevalence of non – communicable diseases is on the rise with 19 million mortality associated with cardiovascular diseases; diabetes is remaining a significant contributor (Vakili et al., 2015). Globally 1.7 billion people are overweight with a substantial 315 million being obese. The population with type 2 diabetes estimated at 250 million people and the number is projected to increase to 400 million by 2025 according to Marseglia et al. (2016). CAPSTONE PROJECT CHANGE PROPOSAL 3 PICOT Question: 1. An increased glucose level is independently related to an increased A1C level. Does reducing the A1C levels with specialized teaching from the nurse, practitioners, and dieticians help to control diabetes on adult patients? 2. Do shared medical appointments improve glycemic control through Registered Nurse Mediation? Population: The populations for the study are American adult patients diagnosed for type 2 diabetes, aging 40 to 60 years old. This population is heterogeneous concerning co-morbidities and general health status, which is essential to establishing the appropriate intervention. Intervention: The proposed intervention involves active Registered Nurses involvement in assisting patients with type 2 Diabetes keep appointments, observe strict adherence to medications, dietary and other recommendations. The nurse would help monitor record keeping with regard to fasting blood sugars, time of taking medication in the 12 weeks during the study. The study will note the essential parameters like blood sugar, weight, and other vital measurements at the beginning of the study and the end of the study. Comparison: To determine whether the intervention is successful; A1C levels would be measured before and after the changes in lifestyle and diet. Outcome: At the end of the study, it is expected that the A1C levels of adult diabetic patients that adhere to study recommendations would reduce. CAPSTONE PROJECT CHANGE PROPOSAL 4 Timeframe: The research proposed to take 12 weeks. PICOT Purpose Statement Control of type 2 diabetes for American newly diagnosed adult patients has been problematic (P) due to the poor lifestyle and diet, which leads to an increased glucose level. Specialized teaching from the nurse, practitioners, and dieticians is an effective strategy to make the patients live appropriately by eating the right food and doing exercises (I), which can enable them to control their A1C levels (C) and live the normal life (O) within 12 weeks (T). Education as regards to lifestyle modifications has been proved to be an effective intervention for controlling type 2 diabetes. Kuo et al. (2015) indicate that lifestyle interventions such as regular exercises and diet changes reduce the incidence of diabetes by 53 percent compared to the control group. People assigned to these interventions reported reduced A1C levels than the control group. In a similar study by Islam et al. (2014), changing the lifestyle plays a crucial role in reducing the glucose levels, which further minimizes the cases of diabetes by 27 percent. Hence, there is an essential relationship between increased glucose level and increased A1C level as well as the lifestyle change and reduced A1C levels, which leads to effective control of diabetes. Among patients with pre-diabetes, it is worth to control their diet and do regular exercises to help in a decrease of diabetes occurrence. Failure to prevent diabetes means increased mortality. It is, therefore, the responsibility of each person to ensure they are living a healthy life to lower the risk of diabetes. CAPSTONE PROJECT CHANGE PROPOSAL 5 Literature Review There is evidence of the efficacy of oral anti-glycemic agents in controlling diabetes. In the PICOT statement, do socioeconomic factors, biochemical characteristics and oral medications relate to the complications of diabetes? This question aims at investigating the clinical features of patients with type 2diabetes on oral drugs and determines the complications and risk factors in the patients. (Islam, 2014:7). Does uncontrolled diabetes affect cognitive function-a predisposition to dementia? This other research question aims at finding out the effect of uncontrolled diabetes on the risk of dementia. (Marseglia, 2016:1072) Is there a difference in cost between Nursing practitioners and primary care physicians? This research question aims at investigating if there is a difference in cost and level of care between Nursing practitioners and primary care physicians. It also consists of an explored eye examination, cholesterol, HbA1C, neuropathy, referrals, and costs between Nursing practitioners and Primary physicians (Kuo, 2015:1982). Does medication adherence have any effect on glycemic control among diabetic patients? This research question aims at looking at the quantitative study of medication in relevance to diabetic patients. (Almadhoun, 2018:3). The research questions relate closely with the aim of finding out more information and statistics about diabetes and the precautions that can be taken to prevent its development. My capstone project research question; does diabetes nursing visits and improving A1C levels to the required status over 12 weeks help control diabetes? This question aims at finding out if regular visits of the patients by nursing practitioners and improving their A1C levels will help control diabetes. CAPSTONE PROJECT CHANGE PROPOSAL 6 Theory of Planned Behavior The PICOT study is grounded in the theory of planned behavior advanced by Ajzen (1991). The approach has been used in many fields to explain behavior and intentions. The approach is relevant in the current study because there are aspects of patients desiring health that can be achieved through lifestyle modification, adhering to medication treatment protocols and exercising. The motivation to modifying lifestyle is triggered to avert risks associated with uncontrolled diabetes. Implementation plan The study will recruit 20 types 2 diabetic patients with uncontrolled diabetes, ten male and ten female between the ages of 40-60 years. The respondents’ vital data will be collected at the beginning of the intervention and monitored over twelve weeks and at the end of the study. The data will then be analyzed to determine the effect of registered nurses in facilitating adherence to treatment and lifestyle modifications by the study respondents as suggested by physicians, dieticians, and pharmacists. The intervention plan is a multi-dimensional and holistic to determine the mediating role of the registered nurse influence in diabetes control. Potential Barriers to the Intervention There are inherent limitations to the PICOT study; first, the respondents may drop-off during follow-up thus affecting the survey. Secondly, the study sample size may be too small to allow generalization. Thirdly, there is the possibility of data interference reducing reliability and validity of the study. Lastly, the follow-up period may be too short to experience a remarkable change in outcome. The limitations were overcome by the nurse taking leadership in communicating and creating professional relationships with the respondents. Calls were made in CAPSTONE PROJECT CHANGE PROPOSAL 7 advance to confirm clinic days, reminder respondents to take medication and adhere to the study protocol. Conclusion In conclusion, as evident in the article, there have been various research projects that offer factual support to the PICOT study. Research projects are relatable in a way that they aim at finding out the best applicable methods of controlling diabetes and AIC levels. There are reports and research findings that contribute to providing more information on the control and management of diabetes. These include; Effect of Uncontrolled Hyperglycemia on levels of Adhesion Molecules in Patient with Diabetic Mellitus Type 2 and the effects of health mentoring program in community-dwelling vulnerable elderly individuals with diabetes. The proposed PICOT study will illuminate the possible mediating role of the Registered Nurse in improving the treatment and management of type 2 Diabetes. The results from the PICOT study demonstrate that the part of the nurse is vital is achieving tighter glycemic control. All cases except one recorded a real reduction in AIC. CAPSTONE PROJECT CHANGE PROPOSAL 8 References Almadhoun, M.R (2018) Journal of Clinical and Experimental pharmacology 8 (3), pp.1-10 American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(Supplement 1), S81-S90. DOI:10.4172/2161-1459.1000250 Gong, Q., Zhang, P., Wang, J., Ma, J., An, Y., Chen, Y. & Chen, Y. (2018). Reducing Morbidity and Mortality in Type 2 Diabetes by Lifestyle Intervention: 30-Year Follow-Up of the Da Qing Diabetes Prevention Study. http://dx.doi.org/10.3233/JAD-160266 Islam, S.M.S., Alam, D.S., & Wahiduzzaman, M., Nielsen, L.W, Fresch, G., Ferrari, U, Seisoler, J, Rouf, H, M.A & Lechner, A. (2014). Clinical Characteristics and Complications of Patients with Type 2 Diabetes Attending an Urban Hospital in Bangladesh. Diabetes and Metabolic Syndrome: Clinical Research Reviews, 1-7 http://dx.doi.org/10.1016/j.dsx.2014.09.014 Kuo, Y., Goodwin, J.S. & Chen, N. Lwin, K.K., Baillargeon, J., & Raji, M.A. (2015). Diabetes Mellitus Care Providers by Nurse Practitioners versus Primary Care Physicians, Journal of American Geriatric Society. 63 (10), 1980-1988 Marseglia, A., Fratigioni, L., Laukka, E.J., Santoni, G., Pedersen, J., Backman, L. & Xu, W. (2016). Early Cognitive Deficits in Type 2 Diabetes A Population-Based Study. Journal of Alzheimer Disease. 53, 1069-1078 Ruszkowska-Giastek, B., Sollup, A., Wernik, T., Rupiecht, Z., Golalczkyk, K., Gadomska, G. & Rosc, D. (2015). Effect of Uncontrolled Hyperglycemia on levels of Adhesion Molecules in Patient with Diabetic Mellitus Type 2. Zhejiang University- Science (Biomedical and Biotechnology) 16 (5), 355-361 CAPSTONE PROJECT CHANGE PROPOSAL Vakili, S.T.T., Nezami, B.G., Shetty, A., Chetty, V.K. & Srinivasan, S. (2015). Association of High Dietary Saturated Fat Intake and Uncontrolled Diabetes with Constipation: Evidence from the National Health and Nutrition Examination Survey. Neurogastoral Motil, 27 (10), 1389-1397 Wol, S.K. (2018) Journal of Korean Academy of Nursing 48 92) 182-194 9 CAPSTONE PROJECT CHANGE PROPOSAL 10 Appendix Literature Evaluation Table Student Name: Gregory Catania RN Change Topic (2-3 sentences): Better Diabetic A1C control in outpatient adult clinic with specialized nursing visits that include education, lifestyle changes, medications and diet. Criteria Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article Article 1 Islam, S.M.S. et al. Journal of Diabetes & Metabolic Syndrome, Clinical Research & Reviews http://dx.doi.org/10.1016/j.ds x.2014.09.014 Article 2 Article 3 Article 4 Marseglia, A. et al. Journal of Alzheimer’s Disease Vol. 53, p.1069-1078 http://dx.doi.org/10 .3233/JAD-160266 Kuo, Y. et al. Almadhoun, M.R et al. Journal of Clinical and Experimental pharmacology 8 (3), p.1-10 Journal of American Geriatric Society (10), 1980-1988 https://doi.org/10.111 1/jgs.13662 DOI:10.4172/21611459.1000250 Article Title and Year Published Clinical Characteristics and Complications of Patients with Type 2 Diabetes Attending an Urban Hospital in Bangladesh (2014) Early Cognitive Deficits in Type 2 Diabetes A Population Based Study (2016) Diabetes Mellitus Care Providers by Nurse Practitioners versus Primary Care Physicians (2015) Research Questions (Qualitative)/Hypo thesis (Quantitative), and Purposes/Aim of Study To find out the relationship of social economic factors in T2D with complications of diabetes To explore biochemical characteristics in T2D and diabetic related complications To find out diabetic related complications among Pt taking oral medications and development of complications To find out if uncontrolled diabetes has an effect on cognitive function- a predisposition to dementia To explore differences in cost of care between Nursing practitioners compared with primary care physicians Study explored eye examination, cholesterol, HbA1C, neuropathy, referrals and costs between NP and Primary physicians. The study aim: to investigate if there is a difference in cost Study aim: To investigate the clinical features of patients with type 2 diabetes, Purpose of the study is to find out if diabetes contributes to risk of dementia (196) Study Aim: To Assessment of Medication Adherence and its association with glycemic control among type 2 diabetes mellitus patient in Gaza (2018) To find out if medication adherence has any effect on glycemic control among T2D patients Quantitative study CAPSTONE PROJECT CHANGE PROPOSAL 11 on oral medication and determine the complications and risk factors in the patients (515). find out the effect of uncontrolled diabetes on the risk of dementia Design (Type of Quantitative, or Type of Qualitative) Setting/Sample Study was a cross-sectional quantitative inquiry The study was a cross-sectional quantitative study Sample size 515 patient at outpatient setting. Sample size was 196 in a home for the elderly in Sweden Methods: Intervention/Instru ments Mixed method data collected through questionnaire, face to face interview, laboratory investigations ECG, eGFR, Blood pressure machine, observation during outpatient visit The collected data was analyzed using descriptive statistics, and inferential statistics. The analysis deployed used t-test, logic analysis and simple logic regression analysis Methods included observation, laboratory tests, cognitive functions tests Analysis was done using multivariate linear regression to estimate differences and multi-nominal logistic regression to examine association Statistical Logistic regression model The study revealed that even in the best clinical setting the control of diabetes was suboptimal. Average HBA1C was 8.3; hypertension 51%, 71% had uncontrolled T2D. Uncontrolled diabetes led to eye complications (68.9%), chronic kidney disease (21.3%), CVD (11.8%) and Neurological issues (2.5) from the study subjects. There is need to have consistent screening using HBA1C goal, reduce BP and addition of statins to treatment regimens to help The study reported that uncontrolled diabetes exposes patient to risk of dementia. There was no significant difference the two groups regarding costs except Nursing practitioners rarely performed eye examinations, there is risk of Nursing practitioners Rx wrong medications Control is diabetes is essential in reducing risks associated with diabetic There is need to have a treatment protocol that investigates eyes, HbAIC, CVD, Neurological Analysis Key Findings Recommendations and level of care between Nursing practitioners and primary care physicians Retrospective cohort study Evaluating data provided by Medicaid from beneficiary of primary care N=64,354 The data collected was coded and analyzed with regard to study variables Cross-sectional study T2D in Gaza attending diabetic clinic Sample size 148 Patients were followed through face to face questionnaire, laboratory examination to monitor progress Descriptive statistics and inferential statistics done. Regression analysis to determine influence of independent variables The study found out that majority of the patients did not comply with treatment instruction leading to 56.1% having poor control. Need to improve medical adherence to improve T2D glycemic control CAPSTONE PROJECT CHANGE PROPOSAL lower high cholesterol. Explanation of How the Article Supports EBP/Capstone Project The article recommends control of blood sugar as a means of reducing diabetic complications. PICOT study seeks to enhance the use of HBA1C as measure of controlling T2D through education, screening and patient management in diet & lifestyle change because drugs alone are insufficient. Criteria Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article Article 5 Ruszkowska-Giastek, B. et al. Zhejiang University- Science (Biomedical and Biotechnology) 12 complication. Diabetic control will delay cognitive problems in patient T2D Controlling diabetes help delay cognitive function impairment, nurses can help patients gain proper control through education, diet, exercise and medication Article 6 Vakili, S.T.T. et al. Neurogastoral Motil, 27 (10), 1389-1397 https://dx.doi.org/10. 1111%2Fnmo.12630 complications to improve primary care Nurses have a significant role in helping patient with T2D manage tighter glycemic control. Nurses can help patient and doctors achieve targeted HbAIC < 6.4 The article is important because adherence to drugs leads to better glycemic control Article 7 Article 8 Wol, S.K. et al. Journal of Korean Academy of Nursing 48 92) 182-194 https://doi.org/10.40 40/jkan.2018.48.2.1 82 Kostev, K. et al. Journal of Diabetes, science and technology https://doi.org/10. 1177/1932296817 710477 Prescription Patterns in Disease control in T2D Mellitus in Nursing home and Home care setting: Retrospective Analysis in Germany (2018) To determine the influence of treatment setting on diabetes control https://link.springer.co m/content/pdf/10.1631 %2Fjzus.B1400218.pdf Article Title and Year Published Effect of Uncontrolled Hyperglycemia on levels of Adhesion Molecules in Patient with Diabetic Mellitus Type 2 (2015) Association of High Dietary Saturated Fat Intake and Uncontrolled Diabetes with Constipation: Evidence from the National Health and Nutrition (2015). The effects of health mentoring program in community dwelling vulnerable elderly individuals with diabetes (2018) Research Questions (Qualitative)/Hyp othesis (Quantitative), and Purposes/Aim of Study To evaluate the concentration of soluble forms of vascular adhesion in patient with controlled and uncontrolled diabetes type 2 Cross-sectional Quantitative study Hypothesis there is no relationship between diabetes and constipation. To determine the influence of mentoring in the community on health treatment outcome in T2D CAPSTONE PROJECT CHANGE PROPOSAL Cross –sectional study, randomized, control, quantitative design Korea setup with elderly at risk of dementia, diabetes complications 96 at the start and 70 at study end. Follow up, laboratory analysis Quantitative longitudinal comparative study Descriptive Statistical and inferential statistics analysis Statistical analysis using Wilcoxon tests and Chi squared test to compare analyze results There is a significant relationship between diabetic patients and constipation compared to no diabetic subjects Mentoring is an effective strategy in monitoring the diabetic patients in the community There was no significant different between the two groups. The mean age at the nursing homes 80.7 years and those at home 74.8 years. Patients in any set up provided adequate education is offered treatment goals will be achieved. The article is vital because nurses attend to patient’s outpatient and inpatient nurses facilitate glycemic control. Design (Type of Quantitative, or Type of Qualitative) Setting/Sample The Study was a quantitative controlled randomized inquiry Examination Survey Poland sample size 62 with 35 diabetic, 27 diabetic uncontrolled and 25 healthy subjects Diabetic patients non- Hispanic 6207 subjects Methods: Intervention/Instr uments Laboratory analysis, urine, blood and kidney function tests Analysis Statistical analysis involved test for normality, ANOVA for variance and Pearson correlation analysis to test relationship among variables Control of diabetes delays vascular impairment Physical and laboratory examination, BMI, diet water intake Descriptive Statistics and inferential statistical analysis was deployed Key Findings 13 Recommendations Doctors need to ensure tight control of diabetes to prevent vascular complications and neuropathy Diet is instrumental in managing diabetes and ensuring HbAIC targets are reached for tighter glucose control. Mentoring need to be incorporated in management of T2D in the community Explanation of How the Article Supports EBP/Capstone Control of Diabetes delays diabetic related complication including vascular impairment, CVD and heart disease The article is important because diabetic control can help reduce constipation in T2D pts The nurses are important as treatment facilitators in the community with regard to education Germany comparing T2D in nursing homes and at home 9850 subjects /2 Analyzed, stored data between 2011 and 2015 CAPSTONE PROJECT CHANGE PROPOSAL 14 Table of Respondents Data No Respondents Name Gender Age 1 Ann P F 42 2 Peter T M 3 Jane H 4 HBAIC start HBAIC end Remarks 30.5 7.2 6.5 Positive 56 28.5 8.3 7.8 Positive F 57 25.8 6.9 6.3 positive Grace O F 43 30 9.1 7.7 Positive 5 Hilary C F 45 29 7.7 7.7 Neutral 6 Barrack K M 40 32.5 9.2 7.2 Positive 7 Giuliani M M 59 28 6.9 6.2 Positive 8 Yuri J M 60 27 7.9 6.5 Positive 9 Doris M F 40 26 6.6 6.0 Positive 10 Fleur H F 41 30 7.0 6.1 Positive 11 Timothy G M 55 19 6.7 6.2 Positive 12 George H M 46 24 7.5 6.9 Positive 13 Hannah Y F 48 31 8.2 7.1 Positive 14 Jacobs M M 49 27 7.8 6.9 Positive 15 Shah T F 58 30 9.5 8.2 Positive 16 Georgas H M 52 29.9 8.9 7.2 Positive 17 Petrobras G M 47 28 7.3 6.3 Positive 18 Eve T F 57 27 6.9 5.9 Positive 19 Harish P M 53 29.5 8.8 6.4 Positive 20 Shah M F 45 30 7.8 6.1 Positive Table: Capstone Change Variables BMI CAPSTONE PROJECT CHANGE PROPOSAL Key BMI 30 Obese 15
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African American and Amish cultura development

African American and Amish cultura development

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Amish Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview ▪ Came to the United States in 1693 for the same reason many other groups came to America—persecution and to practice their lifestyle as they so chose. ▪ No reference group in other parts of the world. ▪ Adapt to dominant society slowly and selectively Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Continued ▪ Mutuality and sharing rather than individual achievement and competition ▪ All speak English and are taught English in school, but most speak Deitsch and various dialects (Pennsylvania German) at home ▪ Healthcare providers by definition are outsiders Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Continued ▪ Majority of men work on farms or in carpentry ▪ If women work outside the home, they work in restaurants, sewing, and teach in their schools ▪ If they work far away from home, prefer to live with another Amish family. ▪ Shared finances are the norm. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Continued ▪ A few have telephones, including cell phones for business but do not let it ring in the house. ▪ Some are using communally shared computers because of the necessity of ordering online instead of mail order catalogues. ▪ A few may drive cars but only out of necessity for work and never on the Sabbath. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Continued ▪ Some illnesses and symptom expression do not have direct translations into English ▪ Highly contexted culture ▪ What is common knowledge regarding health matters to most are not to the Amish due to no TV, major newspapers, etc. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Continued ▪ New communities are being formed in the United States due to lack of land in immediate community ▪ New communities in Kentucky, Tennessee, and Belize, Central America Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Continued ▪ Demut—humility and demureness ▪ Gelassenheit—quiet acceptance, reassurance, and resignation ▪ Temporality is grounded into present time and guided by natural rhythms ▪ Seek health care from afar when needed Transcultural Health Care: A Culturally Competent Approach, 4th Edition Myths ▪ They do ride in cars and may even own a car out of necessity but severe restrictions as to when and where it can be driven. ▪ Do use the telephone but do not have them in the home. May be located in a neighborhood grocery or deli. ▪ Kerosene refrigerators and gas hot water heaters—no electricity—generators instead Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles ▪ Man is head of the family. ▪ Women are accorded high respect and status. In private they are partners, in public, women assume a retiring role. ▪ Freindschaft—three-generation families. Grandparents live in separate house or separate quarters of the home. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Alternative Lifestyles ▪ Singleness is not stigmatized ▪ Same-sex couple may live together out of necessity when away from home. ▪ Pregnancy before marriage is rare, couple encouraged to marry, or the child can be adopted. Abortion is unacceptable. ▪ Gays/Lesbians remain closeted and can cause concern for healthcare provider. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Genetic Diseases ▪ ▪ ▪ ▪ ▪ ▪ ▪ High rates because of a closed gene pool Ellis-van Creveld Syndrome Cartilage hair hypoplasia Pyruvate kinase anemia Hemophilia B Phenylketonuria Glucaric aciduria Transcultural Health Care: A Culturally Competent Approach, 4th Edition Genetic Diseases Continued ▪ Manic-depressive illness ▪ Bipolar effective disorders are higher than general population ▪ Low rates of alcoholism, drug/alcohol abuse Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ ▪ ▪ ▪ Mostly home-grown foods Local storage lockers Increasing trend for junk/snack food Diet is high in fat and carbohydrates leading to obesity, especially in women. ▪ Food has a significant social meaning during visiting. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Practices ▪ Children are a gift from God and large families are an asset usually ▪ Start families early to mid to late 20s ▪ Have lay-midwives but use allopathic practitioners if necessary ▪ Some women are interested in birth control—as are men, but rarely talked about Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Practices Continued ▪ Will attend live prenatal classes ▪ May use herbs, blue cohosh pills to enhance labor ▪ Grandmothers provide much assistance ▪ Older children help care for younger children Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Exceptionally rare to be in a long-term care facility ▪ If at all possible, prefer to die at home ▪ If family member is caring for the ill at home, neighbors may do the cooking and farm chores ▪ Do use visiting nurses and therapists when needed Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals Continued ▪ Visiting during illness and after death is an obligation ▪ Neighbors take care of family and friends coming from afar ▪ “Wakelike” sitting up all night is not uncommon ▪ Plain wooden coffin for burial Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals Continued ▪ Burial in home cemetery or in community church cemetery ▪ Death is a normal transition of life ▪ May present as stoic—although loss is keenly felt Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ No regional or national church ▪ Districts divided into 30 to 50 families or 200 to 300 people ▪ All religious leaders are male, volunteered, and untrained ▪ National committee may be used for some decisions affecting other communities Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality Continued ▪ Corporate worship is the norm with faith-related behavior, not individual wishes. ▪ Salvation is ultimately individual. ▪ If engaged in sinful activity, can rejoin the church after proper penitence. ▪ Church officials may be sought in healthcare matters. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ Healthcare decisions are ultimately an individual matter ▪ Want to have a decision in healthcare matters— just ask me/us ▪ Health promotion is a family/individual affair Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices ▪ Healthcare knowledge is passed among and between families by the women ▪ No health insurance but communities share and have the Amish Aid Society ▪ Some places give a discount because of cash payment ▪ Cost of procedures may be a deciding factor to have the procedure done Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices Continued ▪ ▪ ▪ ▪ Herbal treatments Self-medication Abwaarde—minister by being present Achtgewwe—helping others and is many times gender- and age-related Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices Continued ▪ Brauche or sympathy curing, laying on of warm hands, or powwowing and is similar to Native American practices ▪ Abnemme—failure to thrive and child is taken to a healer who may perform incantations ▪ Aagwachse or livergrown, grown together caused by jostling buggy rides Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices Continued ▪ Usually stoical with pain and physical discomfort ▪ “Physically or mentally different” are fully accepted into the community without stigma. ▪ Time off for illness is acceptable. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practitioners ▪ Braucher or traditional healer first and may be men or women ▪ Use reflexology and massage as well as herbal therapies ▪ Western healthcare practitioners, nurses, physicians, dentists are outsiders, but use them when needed and trusted Transcultural Health Care: A Culturally Competent Approach, 4th Edition African Americans Larry Purnell, PhD, RN, FAAN Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition African American ▪ Second largest “minority” group in the United States. ▪ Negro, black, Black American, person of color, and colored: Depends on the individual. ▪ African American does not necessarily mean you have black skin—it is a term to denote that the person has pride in both the African and American heritage Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition African American ▪ Much diversity among this group in terms of the variant cultural characteristics. ▪ Half live in the Southern United States with large numbers living in large cities in the North. ▪ Most came to the United States involuntarily with the slave trade from Africa. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Education and Occupation ▪ Great inequities in educational opportunities in the past, and this still continues in some areas of the United States with inferior schools and lack of economic and human resources. ▪ High drop-out rates from school due to pregnancy, socioeconomics, and family responsibilities. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Education and Occupation Continued ▪ Less well represented in managerial and professional occupations. ▪ High employment in “blue collar” positions and factories increase risks for cancer and poorer health status—steel and tire industries and other hazardous occupations. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communications ▪ Black English dialect where the “th” is pronounced like “de” = dese for these. ▪ Gullah, a Creole language spoken by African Americans who come from the Georgia Coast and South Carolina. A dialect originating from Africa and is really a combination of two other languages. ▪ Spoken in other places in the world. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communications Continued ▪ Highly verbal and expressive with family and trusted friends. ▪ Do not air your dirty laundry. ▪ Dynamic loud speech pattern may be perceived as aggression or anger. ▪ Touch easily among family and trusted friends. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communications Continued ▪ Expressive nonverbal communications. ▪ Comfortable with close physical distance between conversants. ▪ Direct eye contact can be seen as aggression, especially by elders and lower socioeconomic persons—can be a way of protection, especially in times past. ▪ Culture of “being in becoming” and relaxed with time and have a linear sense of time and are polychronic. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communications Continued ▪ ▪ ▪ ▪ More formal with names in the beginning. Use appropriate titles. Family name is highly respected. People respected by community may be called aunt, uncle, cousin, mother, etc. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family ▪ Traditionally matriarchal out of necessity during times of slavery. Now more egalitarian but great variation. ▪ Single parenting creates more matriarchal families. ▪ Gender roles are easily inter-changeable. ▪ Cooperative teamwork is valued and the “norm”. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Continued ▪ Value self-reliance and education. ▪ Families try to protect their children from street violence, but society prevails during teen years and attempts may be seen as futile. ▪ Employment at an early age is encouraged to develop self-survival and self-reliance skills— also help with chores. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Continued ▪ Many see the future as having limited opportunities if from the lower educational and socioeconomic levels. ▪ Value the Afrocentric Framework—although some do not know them by name. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Afrocentric Framework Nguzo Sabo ▪ ▪ ▪ ▪ ▪ ▪ ▪ Umojo—unity Kujichagula—self-determination Ujimaa—cooperative economics Ujima—collective work and responsibility Kuumba—creativity Nia—purpose Imani—faith Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Continued ▪ Elders, especially grandmothers, are respected. ▪ Not uncommon for grandparents to assist with and/or raise grandchildren. ▪ Extended family is important and cousins and nephews, etc. are considered nuclear family— so are “non-blood relatives”. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Continued ▪ Minimal to no stigma for single parenting. ▪ High HIV and AIDS occurrence due to IV drug use and sexual activity. ▪ Lesbians and gays accepted but not talked about for fear of increased stigma and rejection. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Different assessment techniques required to detect cyanosis, pallor, rashes, and jaundice. ▪ Overgrowth of connective tissue leading to keloids. ▪ Long bones are longer, bone density is greater than that of Asians, Hispanics, and EuropeanAmericans. ▪ Greater incidence of birthmarks. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology Continued ▪ Leading cause of death among males is homicide. ▪ Violence in inner city neighborhoods. ▪ High morbidity and mortality due to hypertension —renin-angiotensin syndrome. ▪ Cirrhosis and diabetes rates are also high. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology Continued ▪ Sickle cell anemia ▪ Glucose-6-phosphate-dehydrogenase deficiency ▪ Lactose deficiency ▪ Prostate cancer due to enzyme level detection ▪ Colon tumors are deeper within the colon Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology Continued ▪ ▪ ▪ ▪ ▪ ▪ Less responsive to beta-blockers More responsive to monotherapy Less responsive to mydriatic dilation High frequency for psychosis and low frequency for depression Higher doses of neuroleptics Higher incidence of side effects for psychotropics and tricyclics Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Symbol for health and wealth ▪ Accept food; otherwise you reject the person ▪ Food considered important for controlling high blood and low blood ▪ Soul food is high in fat and sodium with fatback used frequently Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition Continued ▪ Children introduced to solid food early ▪ Milk, vegetables, and meat are strength foods ▪ Diet frequently low in Vitamins A and C and iron ▪ High-carbohydrate diet leads to obesity ▪ Overweight is seen as positive Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Practices ▪ Oral contraceptives is the most common method of birth control ▪ Mother and grandmother are the primary advisors for pregnancy and childbearing practices ▪ Consume your craving during pregnancy or the baby will be marked Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Practices Continued ▪ Geophagia, eating non food substances, can lead to iron and potassium deficiency ▪ A few believe that a pregnant woman should not have her picture taken because it will capture the baby’s soul ▪ Do not take pictures while pregnant because it can cause a stillbirth Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Practices Continued ▪ After delivery avoid cold air and get plenty of rest ▪ Umbilicus may be wrapped or have a coin placed on it to prevent protruding outward— for some it is a means of protection from evil. Practice is rare but still occurs among some. Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Death does not end the connection between people, can communicate with the dead person’s spirit ▪ Some believe in voodoo death in that death or illness can come to a person through supernatural forces ▪ Voodoo is also known as root work, mojo, spell, fix, or black magic Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Body must be kept intact after death—I came into this world with all of my body parts and I intend to leave this world with all of my body parts ▪ Falling out due to extreme emotional response. However the person can still hear and understand ▪ Express grief openly and publicly with eulogies at funerals is common Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ The Black Church is the Black Community ▪ Religion is taken seriously; expect to receive a message in church ▪ Group singing and public testimonials ▪ Most are Baptist or Methodist although they belong to all religious groups including Nation of Islam and Seventh Day Adventist Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality Continued ▪ Use prayer for all situations ▪ Many believe in laying on of hands while praying—power of being able to heal ▪ May speak in tongues ▪ Inner strength comes from faith in God—it is “God’s Will” —fatalism Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices Health-Seeking Behaviors ▪ The world is a very hostile and dangerous place to live ▪ The individual is open to attack from external forces ▪ The individual is considered to be a helpless person who has no internal resources to combat such an attack and therefore needs outside assistance Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices ▪ May be suspicious of outsider healthcare professionals and therefore see a physician or nurse only when absolutely necessary ▪ Natural and unnatural illnesses ▪ May receive care from a “root doctor” simultaneously with biomedical practitioners Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices Continued ▪ Have a tendency to take medicine on an “asneeded” basis ▪ Barriers to health care include affordability, accessibility, acceptability, adaptability, and past discrimination ▪ Some believe “no pain, no illness” ▪ Able to enter the sick role with ease Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices Continued ▪ Illness brings the family together ▪ Low rates of organ donation due to lack of information, racism, religion, distrust, and fear of organ being taken prematurely ▪ Blood transfusion acceptable unless religion forbids it Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practitioners ▪ Folk practitioners can be grandmothers, respected women or elders in the community, church leaders, root doctors, or voodoo priests and priestesses, who remove hexes ▪ Some may prefer a care provider of the same gender Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practitioners Continued ▪ Folk practitioners are held in high esteem and used by all socioeconomic levels of African Americans ▪ Prefer Western healthcare providers who are known to the family or community ▪ Must establish trust to be effective in return visits Copyright © F.A. Davis Company Copyright ©2013 2008 F.A. Davis Company
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How does antibiotic resistance develop

How does antibiotic resistance develop

Antibiotics are one of the most highly utilized and important medication classes in medicine. Did you know that livestock animals such as cows, pigs, and chickens can receive antibiotics? Resistance to antibiotics is a growing concern, not only in humans but also in livestock animals. Antibiotic resistance occurs when bacteria change in such a way that the effectiveness of drugs is reduced.

research antibiotic resistance further and address the following:

  • How does antibiotic resistance develop?
  • What complications can occur from antibiotic resistance, both in humans and in livestock?
  • Should we decrease the use of antibiotics in humans and livestock animals?
  • give one reference from your book and use 2 other outside references. use APA format

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Coronary artery disease

Coronary artery disease

Coronary artery disease is a common type of heart disease and the leading cause of death among both men and women in the United States. In this assignment, you will explore this disease in more detail using the scenario below.

Scenario:
One of your aging relatives is sedentary and smokes cigarettes. Out of concern for his health, you decide to research more about this disease.

  1. Research this disease using a minimum of 2 sources. You can use your textbook for one of the sources. Choose the remaining source(s) from the GALE Virtual Reference Library provided on the Structure and Function of the Human Body library guide page.
  2. In a minimum of 2 pages (not counting the references page), address the following:
    • Explain how coronary artery disease develops in the human body.
    • Describe the ways that your relative can prevent the onset of this disease.
    • Explain what treatment options exist if steps to prevent the disease fail.
  3. Include a references page at the end of your document, formatted using the APA guidelines, that lists your research sources

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Tags: nursing anatomy

Philosophy of Nursing personal outlook

Philosophy of Nursing personal outlook

In 2 pages, describe your philosophy of nursing. give references apa

The definition of a philosophy is having a personal and specific outlook and approach you can use to make decisions and take action. Your philosophy of nursing should include your beliefs and attitudes about nursing, being a nurse, your approach to caring for others. It can also include your attitudes about working in healthcare facilities, working as part of a team, or even how you feel about people in general.

Save a copy of your philosophy as you will want to refer to it during your Program

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Cultural Competence in Nursing

Cultural Competence in Nursing

What are the methods a nurse can use to gather cultural information from patients? How does cultural competence relate to better patient care? Discuss the ways in which a nurse demonstrates cultural competency in nursing practice.

****please respond to the discussion above add citation and references 🙂 Thanks ******

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Topic4 DQ2

Topic4 DQ2

Discuss why nutrition is a central component in health promotion. What are some of the nutritional challenges for emerging populations? What roles do nutritional deficiency and nutritional excess play in disease?

*******please respond to the discussion above add citation and references 🙂 ************

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Research in nursing

Research in nursing

Robert Im going to post the whole work for the research class

9 discussion board

week 2,4,5 small paper

week 10 final paper

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