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Hollywood and various means of social media can skew the public’s view of nursing both negatively and positively. “With the widespread use of cell phones with cameras, candid pictures and video clips that are amusing to friends are not as amusing to human resource personnel hiring nurses, to nurse managers, or to a courtroom when an error with serious consequences brings the nurse’s professional judgment into question. It is important for the nurse to understand that whatever is posted can be seen by others as well as the intended person and is available to be seen forever. Removing a posting or a picture from a website does not make it unavailable because it remains retrievable” (Cherry & Jacob, 2017.)

It is important that we protect our patient’s privacy, by not posting pictures or even descriptions of patients we care for, even if in our eyes it would be impossible to identify the person being cared for.

On the other hand, through social media outlets, good practice and new guidelines can be shared widespread through the masses. “Nurses can use a variety of social media programs to advance their personal and professional goals. Nurses can access information for their workplace or personal lives, connect with colleagues, share information about best practices, and advance health through personal and professional means.” (Jackson, 2014.)

I believe that Hollywood, and the use of social media has the capacity to play a very valuable role in nursing, and can positively improve patient care when done judiciously especially in the workplace.

References:

Cherry, B., & Jacob, S. R. (2017). Contemporary nursing: Issues, trends, & management. St. Louis, Mo: Elsevier Mosby.

Jackson, J., Fraser, R., & Ash, P. (2014). Social Media and Nurses: Insights for Promoting Health for Individual and Professional Use. Online Journal Of Issues In Nursing, 19(3), 1-17. doi:10.3912/OJIN.Vol19No03Man02

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Many factors go into the process of discovering if a new procedure falls into one’s scope of nursing practice. The ANA develops a solid base for nurses to determine what is their scope of practice. In other words, can we do this new procedure that this physician has asked me to do? If so what process does it take to determine yes or no and how would we introduce it to our peers?

The ANA over views standards for nursing care. They outline the scope of nursing practice describing it as services that are deemed competent for a specific nurse to perform falling under the terms of their specific license.

The first step in the process would be determining who would be doing the procedure/task, would it be an RN or Advanced practice RN . In this case their licenses are different and are legally allowed and trained to participate in different skills and procedures. Next step would be determining what exactly the procedure entailed, as nurses we are allowed to do procedures that protect, promote and optimize health for our patients, and optimize their abilities. We are allowed to treat our patients specific to doctor’s orders. We are expected to perform procedures that will only promote health and prevent illness, where no harm will be done to the individual, family or community. We must then determine where and when the procedures/ skills will be done, in our scope we can practice wherever a patient is in need of care in any setting appropriate (clinic, hospital, at home, as a home health nurse, school etc) and whenever a patient is in need. ( American Nurses Association, 2018)

After going through this process we must decide what our specific health care license qualifies us for as nurses by the state we live in. We must know our states Nurse practice act. Then, determine the laws and rules created by the states regulatory bodies that are intended to protect the public. This is what we as nurses are allowed to follow and act on. The Nurse practice act is updated annually and it sets the standard for our nursing scope of practice by mandating the Board of registered nurses to set out the responsibilities we have as an RN. (State of California, 2018)

After going through the process of figuring out if this falls under my scope of practice I would introduce it by bringing it up in work meetings, trying to do in services on the floor for day and night shift. Getting my manager and assistant manager and upper management involved with the new procedure to pass along information on this new procedure.

References:

American Nurses Association. “Scope of Nursing Practice”. 2018 . Retrieved from : https://www.nursingworld.org/practice-policy/scope… of California. Board of Registered Nurses. “Nursing Practice Act”. 2018. Retrieved from http://www.rn.ca.gov/practice/npa.shtml

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Adolescence is a huge time of change in a young persons’ life, Hormones are fluctuating and they are trying to find their place in the social hierarchy. They can experience stress from a lot of different sources from relationships with friends and family members or other problems at school. Suicide is the third leading cause of death of ages 15 to 24 with approximately 5000 deaths yearly, 84% of them being male. (WebMD,2017) The attempt of suicide greatly outnumbers the total number of suicides because males usually pick a more violent method like shooting themselves. In 2012 teen, ages 15-24, suicides accounted for 10,9% of all suicides in the US. (WebMD, 2017) The nurse should look for warning signs and be ready to intervene where and when appropriate. All suicide attempts or talk should always be taken seriously.

Some risk factors are: depression or other mental health problems, previous suicide attempts, substance abuse and/or alcohol disorder, feeling social isolation, history of abuse or mistreatment, family history of suicide, impulsive or aggressive behaviors, financial or social loss, relationship loss, physical illness, feeling of hopelessness, difficult situations like abuse or bullying, lack of social support, lack of coping skills, being adopted, and easy access to methods/means of suicide.(CDC 2013, WebMD 2017)

Some warning signs to look for: talking about wanting to die or commit suicide, looking for a way to commit suicide such as looking online or buying a gun, talking about feeling hopeless or not having a reason to live, feeling trapped, talking about being a burden on others, increased use of drugs or alcohol, acting anxious or agitated, reckless behavior, sleeping to much or not sleeping at all, withdrawing or social isolation, extreme mood swings, or showing rage and talking about getting revenge. (Alaska.gov 2018)

Interesting that CBS news in 2013 had Alaska number one for suicides in the nation. There are many local, state, and national website/ helplines for suicide prevention. The Alaska.gov website has pages and pages of resources based on detection, prevention, and help after an attempt. Local in Ketchikan we have Gateway Community Mental Health, they also are the ones that are on call for the Emergency Room for mental health holds, and Community Connections. We must not forget about the school counselors, teachers, office staff and School nurse as support. State wide in Alaska, there is The Care line Alaska at 1-877-266-HELP or http://www.carelinealaska.com, Alaska Native Tribal Health Consortium Suicide and Suicide Attempt Prevention at www.anthc.org/chs/wp/injprev/suicide-and-suicide-attempt-prevention.cfm, or the Alaska statewide Suicide Prevention Council at http://hdss.alaska.gov/suicideprevention/Pages/default.aspx, and many more. At the national there are the Youth Suicide Prevention School Based Guide(pdf), National Suicide Prevention Lifeline at 1-800-273-TALK or on the Crisis Text line by texting talk to 741741.

Suicide is serious and an attempt can lead up to success that is not temporary, it is a permanent solution to a temporary problem. By us recognizing the problems in time we might be able to decrease the amount of suicides and suicide attempts. One person making a change for one person makes a world of change.

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While reading this scenario I became saddened, because this really does occur. The city I live in has a large Hmong population. One of several police officers in town is of Hmong decent and one of them was fired for domestic abuse/violence towards his wife. He tried to state it was within his culture to treat his wife in this manner; however, that didn’t work in his defense.

The Asian population is very diverse and many subcultures are present within the general Asian population. Some questions I would consider is, how acculturated is this patient? Is she a student? How long has she lived here? Where was she born? The answers to these questions will help the nursing professional during their assessment. The Asian population makes up 4.8% of the US population (Jarvis, 2016 p. 11). When assessing an individual of Asian descent, cultural considerations to keep in mind are: They respect medical authority, but don’t appear hurried, talk loud or fast and remember that although eye contact is viewed as respectful, constant eye contact can be interpreted as intimidating and they may break eye contact while talking. Also a very firm handshake can be viewed as aggression.

Intimate Partner Violence (IPV) formerly called Domestic Violence is the single greatest cause of injury to women 15 to 24 years of age (Cherry & Jacob, 2014 p.186) The Abuse Assessment Screen (AAS) is a questionnaire that asked six questions and if the patient answers “yes” for any of the questions, the interviewer is supposed to ask the patient if they can talk more about this topic. The questions address issues regarding: intimidation, physical, emotional, and sexual abuse (Jarvis, 2016 p. 106)

If abuse is questioned at my facility, we are to let our lead nurse know, call security, local law enforcement and chart in the patient’s EHR.

Reference:

Cherry, B., & Jacob, S. R. (2014). Contemporary Nursing Issues, Trends, & Management (6th ed., pp. 183-201). St.Louis, MO: Elsevier.

Jarvis, C. (2016). Physical Examination & Health Assessment (7th ed., pp. 11-115). St.Louis, MO: Elsevier

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Physical Health

The medical history focuses special attention on medication use and the risk for malnutrition, falling, incontinence, and immobility. The nurse examination seeks to identify specific diseases or conditions for which curative, restorative, palliative, or preventive treatment may be available. Special attention is directed towardvisual or hearing impairment, nutritional status, and conditions that may contribute to frailty and falling or difficulty in ambulation.

Mental Health

Cognitive, behavioral, and emotional statuses are evaluated, paying close attention to detecting dementia, delirium, and depression.

Social and Economic Status

The social support network includes the accessibility and capability of caregivers, the elderly person’s economic resources, and other bases of support such as cultural, ethnic, and spiritual resources. It also includes the individual’s own assessment of their quality of life.

Functional Status

Functional status is measured by the ability to accomplish basic activities of daily living (ADLs) and to participate in behavioral and social activities referred to as instrumental activities of daily living (IADLs). ADLs include bathing, dressing, toileting, transferring, continence, and feeding. IADLs require a higher level of cognition and judgment than physical activities and include preparation of meals, shopping, light housework, financial management, medication management, use of transportation, and use of the telephone.

Environmental Characteristics

Evaluating the patient’s physical environment regulates the safety of the living environment. It also assesses the patient’s availability and use to essential services, such as shopping, pharmacy, and transportation.

What special considerations should the nurse keep in mind while performing this assessment?

It might take a little more time to complete the assessment and need to make sure that we are doing it at an optimal time, They might tire easier and when they take and what medications that they are taking. We need to make sure that we have them use any assistive devices that they normally use such as glasses, hearing aids, pocket talkers, walkers, and provide written explanations if needed. Be prepared to use interpreters instead of family members for non-English speaking patients. Make sure that when testing for mobility to have a safe clear and enough room. Be respectful of their environment and their things as well as the need for pain relief.

Reference:

Jarvis, C., (2016), Physical Examination and Health Assessment, Seventh Edition, Elsevier., MO.

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Physical Health

The medical history focuses special attention on medication use and the risk for malnutrition, falling, incontinence, and immobility. The nurse examination seeks to identify specific diseases or conditions for which curative, restorative, palliative, or preventive treatment may be available. Special attention is directed towardvisual or hearing impairment, nutritional status, and conditions that may contribute to frailty and falling or difficulty in ambulation.

Mental Health

Cognitive, behavioral, and emotional statuses are evaluated, paying close attention to detecting dementia, delirium, and depression.

Social and Economic Status

The social support network includes the accessibility and capability of caregivers, the elderly person’s economic resources, and other bases of support such as cultural, ethnic, and spiritual resources. It also includes the individual’s own assessment of their quality of life.

Functional Status

Functional status is measured by the ability to accomplish basic activities of daily living (ADLs) and to participate in behavioral and social activities referred to as instrumental activities of daily living (IADLs). ADLs include bathing, dressing, toileting, transferring, continence, and feeding. IADLs require a higher level of cognition and judgment than physical activities and include preparation of meals, shopping, light housework, financial management, medication management, use of transportation, and use of the telephone.

Environmental Characteristics

Evaluating the patient’s physical environment regulates the safety of the living environment. It also assesses the patient’s availability and use to essential services, such as shopping, pharmacy, and transportation.

What special considerations should the nurse keep in mind while performing this assessment?

It might take a little more time to complete the assessment and need to make sure that we are doing it at an optimal time, They might tire easier and when they take and what medications that they are taking. We need to make sure that we have them use any assistive devices that they normally use such as glasses, hearing aids, pocket talkers, walkers, and provide written explanations if needed. Be prepared to use interpreters instead of family members for non-English speaking patients. Make sure that when testing for mobility to have a safe clear and enough room. Be respectful of their environment and their things as well as the need for pain relief.

Reference:

Jarvis, C., (2016), Physical Examination and Health Assessment, Seventh Edition, Elsevier., MO.

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Healthy People 2020 says, social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks (Healthy People 2020, n.d.). Social determinants also affect health care.

Many things contribute of the development of an illness but given the social determinants there may be an increase change in developing one. For example. People who are born into poverty are more likely to remain in poverty. People who live in poverty generally have less access to good nutrition, decent and reliable medical care, and may live in inadequate housing. Since they are not able to access healthy food and medical care they are more likely to not treat illnesses which can lead to more comorbidities.

Certain conditions must be met in order for a microbe or infectious disease to be spread from person to person. This process, called the chain of infection, can only occur when all six links in the chain are intact (Infection Prevention and Control Manual, n.d.).

Link 1 – Disease Microorganisms (Agent). The pathogens that cause a communicable disease.

Link 2 – Reservoir. The host (human, animal, environment) that allows the agent to live.

Link 3 – Mode of Escape. The route the infectious agent leaves the host.

Link 4 – Mode of Transportation. How the infection agent travels to a new host.

Link 5 – Mode of Entry. How the infectious agent enters the new host.

Link 6 – Susceptible Host. The future host of the infectious agent.

Yes, there are steps that the burse can take to break the communicable disease chain. The most simple and obvious step is hand hygiene. The nurse should take the practice to “wash in” and “wash out” when seeing every single patient. The nurse should also wash their hands occasionally throughout the shift using soap and water. Some diseases are resistant to hand sanitizers and require the use of actual soap. The nurse should also follow isolation precautions such as wearing gowns and gloves when entering the room of someone on contact isolation.

Infection Prevention and Control Manual. (n.d.). Retrieved from https://www.gov.nu.ca

Social Determinants of Health. (n.d.). Retrieved from https://www.healthypeople.gov/2020/topics-objectiv…

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“A vulnerable population is a group or groups that are more likely to develop health-related problems, have more difficulty accessing health care to address those health problems, and are more likely to experience a poor outcome or shorter life span because of those health conditions” (Maurer & Smith, 2012, p. 528). People at risk for poor health are not necessarily classified as vulnerable: vulnerable groups must have aggravating factors that place them at greater risk for undergoing poor health status than the rest of at-risk populations.

According to Healthy People 2020 (U.S. Department of Health and Human Services [USDHHS], 2010), groups particularly vulnerable to health risks include the poor, the homeless, the disabled, the severely mentally ill, the very young, and the very old.”

Examples of vulnerable populations in the United States include homeless people, and particularly homeless veterans and youths; and irregular migrants.

These people can often not advocate for themselves because of the precarity of the situation they live in. For instance, homeless people often lack both access to the knowledge and resources needed to defend their rights. Irregular migrants are arguably in an even more precarious situation since their lack of papers and fear of getting caught by authorities forces them to silence. It is thus very important to advocate on their behalf, making sure they have access to basic healthcare services and creating programs specifically targeting at their needs and characteristics. Community nurses are in a position to know the problems associated with specific service programs. They can advocate by becoming involved as members of special interest groups, testifying before governmental agencies, advocating changes from within their current employing agencies, and providing information to other community groups and organizations.

For instance, among the 1.6 million homeless people, at least 10% are veterans. They have particularly high rates of mental illness (45%) and substance abuse (70%), and many confront both issues, so it is particularly important to target those specific needs.

Some ethical issues that may arise is the need for cultural sensitivity and attention paid to different backgrounds and languages. This is especially true for migrants, many of whom have difficulty reading or speaking English. Thus quality care needs to include interpreter services and to be particularly sensitive to differences in cultural values and health care practices.

References :

Maurer, F. A., & Smith, C. M. (2012). Community/publi c health nursing practice: Health for families and populations (5th ed.). St. Louis,

MO: Saunders Elsevier. ISBN-13: 9781455707621

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The United States was trying to improve the health care system by passing the Affordable Care Act through legislation so they could provide healthcare to the rich and the poor person. According to Amadeo (2018), four reasons that we needed healthcare reform in the United States. The reasons included health care costs were increasing, improve the quality of life, lack insurance and decrease fraud. According to American Public Health Association, the Affordable Care Act (ACA) was needed because over 16% people did not have insurance in the US. The ACA has assisted more than twenty million people with health insurance coverage but over twenty nine million still need health insurance. We have a long way to go to improve health insurance for all the people. The ACA has assisted by reducing spending but health insurance is still high for some families. Even though the ACA has been available for the patients but our health outcomes are poor. The ACA has shifted its focus from treatment to prevention and maintenance. Many insurance companies encourage and have requisites to obtain insurance the member has to complete health surveys for prevention. Many people buy insurance from their work companies because health care is so expensive. Insurance companies charge the employer premiums and still charge the member monthly dues and co-payments. There is a charge of co-payment due to the member every time you see the primary care physician, consulting physicians, laboratory, radiology procedures, urgent care or emergency care for each member of your family.

The ACA will need time to improve the patient outcomes and make further progress because not many people like change. There are both positive and negatives to ACA. The areas that need improvement for the patients who are not employed have difficulty paying the out-of-pocket costs. Some patients have to pay thousands of dollars and are unable to pay if they need care. People who are illegally here are not able to obtain insurance. If the illegal patient comes to Emergency Department, as healthcare workers we cannot refuse care if they need assistance.

According to Institute of Medicine (IOM) (2018), nursing will be driving force of primary care and prevention to assist the patients. Nursing has the ability to collaborate with other disciplines to obtain positive outcomes for the patient. Nursing is the largest work force in America who will be primary people to assist the patients in prevention of diseases.

References:

Amadeo, K. (2018). Why reform health care. Why we need health care reform. Retrieved from https://www.thebalance.com/why-reform-health-care-3305749.

American Public Health Association (APHA). (2016). Why do we need the Affordable Care Act? Making progress on critical health system problems facing the United States. Retrieved from https://www.apha.org

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Primary Prevention is the planning and assessment of what the needs are in this location. The risk factor most important which is communicable diseases should be determined. Things to determine are vaccines needed and other protection for workers coming into the area of disaster. Overpopulation, depressed economics and environmental issues such as lack of sanitary water and poor waste management add to long term effects on the public health. Exacerbated by lack of shelter, malnutrition because of food shortages, and poor access to health care cause a dramatic increase in the rates of communicable diseases after a disaster. (Jafari, 2011).

Secondary preventions is the acute phase of the disaster. As was mentioned in the documentary “Hitting the ground running”, triaging, treating, and recovery. This stage involves all personnel being on high alert and high energy. Organization or an attempt to is the key to be most effective, yet that is not always attainable as mentioned in the documentary (GCU, 2010).

Tertiary prevention would be assessing long-term effects of the disaster as in the resources that should to be kept in place. The starting point should be need for a better emergency system and early warnings. Even though this area is so economically depressed, the need is great for all life sustaining resources to be reassessed by government agencies.

Pre-impact phase is where the three proposed interventions falls and would be most beneficial. Before the actual disaster takes place is the most important time for the disaster planning. This disaster planning activities has a critical influence on how the disaster will affect an area or region, community or state. In assessing of the probabilities and risks of occurrence of certain types of disasters the community can have much needed resources readily at hand. Planning can assist emergency responds providers in a disaster situation to be more effective (Maurer, 2013).

Red Cross is the agency to work with due to the organization’s quick response to all disasters. They provide long-term care to the communities as well as encompass all interventions. Red Cross addresses all interventions, with damage assessment, mass care, food provision, shelter provision, supply provision, health services, and family services. As well as providing disaster welfare inquiry service, a network to allow families inquiring on the welfare of their families during the search and recovery stages (Maurer, 2013).

References:

GCU. (2010). “Diary of Medical Mission Trip”. Retrieved from Grand Canyon University: http://lc.gcumedia.com/zwebassets/courseMaterialPa…