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Scopes of practice are “legislatively-defined spheres of activity within which various types of healthcare providers are authorized to practice.” (Yang, 2014). As a nurse, it is important for one to be aware of not only state requirements, but also the requirements of an employer to be practicing within our domain. It is in knowing and understanding our individual scope of practice that we can safely exercise our responsibility to accept only those roles or assignments for which we possess the knowledge, skills and competencies to perform (Koch, 2013). In my own practice, going from a medical-surgical setting to the emergency department, my scope of practice greatly changed. I relied on not only the Board of Nursing, but also my employer’s policy and procedure guideline when faced with a situation, where I could possibly practice “outside of my scope.” As Koch said, “ Be ‘nurse-smart’ and practice safely; know your scope of practice.” (2013).

Koch, G. (2013). Understanding Scope of Practice 101. Oregon State Board Of Nursing Sentinel, 32(4), 6-7.

Yang, Y. T., & Meiners, M. R. (2014). Care Coordination and the Expansion of Nursing Scopes of Practice. Journal Of Law, Medicine & Ethics, 42(1), 93-103.

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Teenage pregnancy is a worldwide problem bearing serious social and medical implications relating to maternal and child health. Each year, approximately 900000 teenagers become pregnant in the United States, and despite decreasing rates, more than 4 in 10 adolescent girls have been pregnant at least once before 20 years of age. Also the incidence of STD has skyrocketed, and most new infections occur in people between 13 and 21 years of age (National Center for HIV/AIDS, 2010). Teens exhibit high behavioral risk for acquiring most STDs. Teenagers and young adults are more likely than other age groups to have multiple sex partners , to engage and unprotect sex and to choose older partner older than herself (for youngers woman’s) .We as a nurses always must assess sexuality . When discussing the topic of sexuality, take and open, frank, direct, and nonjudgmental approach. There are special risks to a baby when the mother is not fully mature. Because most teenagers are not physically, emotionally, or financially ready to carry and care for a child, their babies tend to have low birth weight and are predisposed to a variety of illnesses.

There are many precursors to adolescent pregnancy like:

Lack of knowledge about sex or contraception

Having sex at a young age

Being the victim of sexual abuse

Dating older guys

Poor parental supervision

Limited communication between parents and teen

Nurses can develop audiovisual aids (diagrams, pictures, Power Point presentations, and videos) to make sex education unforgettable. We must tech our teens that abstinence is a highly positive choice for both sexes until they are ready to deal with the responsibility of being sexually active. The emphasis must be that sexual health promotion is a lifestyle choice and that contraception is useless if not practice consistently. Use of condoms should be encourage for every sexual encounter.

Teen pregnancy prevention is a critical dimension of adolescent health, and strong, effective organizations are best positioned to make a positive impact on policies and programs which affect teens. For this reason, Advocates for Youth created the National Support Center for State Teen Pregnancy Organizations, designed to support and strengthen state organizations’ capacity to address adolescent pregnancy and sexually transmitted infections (STIs).

Reference:

Hunt, R. (2009). Introduction to community-based nursing (4th ed.). Philadelphia: Wolters Kluwer

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Some patients will die in a hospital or in a nursing home where they live, some are not home with family. If in a hospital it may be due to the patient being admitted for treatment but will end up on hospice or palliative care (NIA, 2017). Quite a few people live in a nursing home already and will end up on palliative care or hospice. Some people may choose not to have end-of-life care in home due to the stress that may be put on the family members providing care (NIA, 2017). But a big part in lack of communication and the patient not voicing their wishes to their health care providers (NIA, 2017). As a nurse when a patient is placed on palliative or hospice care we need to make sure we know and understand their wishes (Casarett, D., Harrold, J., Harris, P. S., Bender, L., Farrington, S., Smither, E., & … Teno, J). Where are they wanting to have their end of life care (Casarett, D., Harrold, J., Harris, P. S., Bender, L., Farrington, S., Smither, E., & … Teno, J).

Reference

Casarett, D., Harrold, J., Harris, P. S., Bender, L., Farrington, S., Smither, E., & … Teno, J. (2015). Does Continuous Hospice Care Help Patients Remain at Home? Journal of Pain and Symptom Management, (3), 297. doi:10.1016/j.jpainsymman.2015.04.007.

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Some patients will die in a hospital or in a nursing home where they live, some are not home with family. If in a hospital it may be due to the patient being admitted for treatment but will end up on hospice or palliative care (NIA, 2017). Quite a few people live in a nursing home already and will end up on palliative care or hospice. Some people may choose not to have end-of-life care in home due to the stress that may be put on the family members providing care (NIA, 2017). But a big part in lack of communication and the patient not voicing their wishes to their health care providers (NIA, 2017). As a nurse when a patient is placed on palliative or hospice care we need to make sure we know and understand their wishes (Casarett, D., Harrold, J., Harris, P. S., Bender, L., Farrington, S., Smither, E., & … Teno, J). Where are they wanting to have their end of life care (Casarett, D., Harrold, J., Harris, P. S., Bender, L., Farrington, S., Smither, E., & … Teno, J).

Reference

Casarett, D., Harrold, J., Harris, P. S., Bender, L., Farrington, S., Smither, E., & … Teno, J. (2015). Does Continuous Hospice Care Help Patients Remain at Home? Journal of Pain and Symptom Management, (3), 297. doi:10.1016/j.jpainsymman.2015.04.007.

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The global health issue that I would like to discuss is having clean drinking water and safe sanitation for people in the third world countries. When I go back home to India, we still have to boil the water because it is unsafe to drink. We have to buy bottle water and check the caps to make sure it has not been tampered with before buying it. Also, most of the poor people do not have safe sanitation areas. Many of middle-class Indian people is obtaining toilets but it is expensive and unaffordable to the poor people.

According to CDC (2015), across the world over 780 million people do not have access to drinking water supplies. An estimated 2.5 billion people in the world, lack access to adequate sanitation. Every year, diarrhea diseases kill over 801,000 young children all over the world. These children who have diarrheal diseases die are more than with AIDS, malaria, and measles combined. Diarrhea and other diseases are spread through unsafe water, inadequate sanitation, and insufficient hygiene practices. According to CDC (2015), diarrheal disease is the second leading cause of death among children under the age of five years old. Eighty-eight percent (88%) of deaths from diarrheal diseases stem from unsafe drinking water, inadequate sanitation, and poor hygiene.

According to Centers for Disease Control and Prevention (CDC) (2015), has a program called WASH. The program assists people in third world countries who have unsafe drinking water and reduce illnesses by providing and improving sanitation and hygiene. CDC’s global WASH program provides expertise and interventions aimed at saving lives and reducing illness by improving global access to healthy and safe water, adequate sanitation, and improved hygiene. The WASH program works on long-term prevention and control measures for improving health, reducing poverty, and improving socio-economic development. Also WASH program, responds to global emergencies and outbreaks of life-threatening illnesses. CDC’s global WASH program involves partnerships with US government agencies, Ministries of Health, non-governmental agencies, and various international agencies.

References:

Centers for Disease Control and Prevention (CDC). National Center for Emerging and Zoonotic Infectious Diseases. Division of foodborne, waterborne and environmental diseases. (2017). CDC and the safe water system. Retrieved from http://www.cdc.gov/ safewater/

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The community health nurse can apply the strategies of cultural competence in their practice by assessing and also accepting the cultural practices and beliefs of each patient. This means that the nurse should be respectful of patient’s cultural diversity as well as the cultural influences influencing their patients by examining how their beliefs impacts their health. It is important that all nurses have cultural awareness since this can improve patient’s outcome.

Cultural Preservation involves a nurse seen as preserving culture when they support the family of Muslim faith to cleanse the body of their deceased family member themselves (Al-Islam, n.d). A possible barrier may conflict between family members who are not accustomed to this tradition because they were born in America.

Cultural accommodation involves the use of practices that have not been proven to be harmful. Example include Acupuncture, a traditional form of Chinese medicine believed that illness occurs when the body’s natural flow of energy or chi is blocked. The insertion of tiny needles in specific points in the body releases the blockage and restores the flow of energy, thus relieving illness (Mayo Clinic, 2016). A possible barrier may be that the patient is still experiencing levels of pain that need further investigation and the patient does not want to see the doctor despite recommendation by the nurse.

Cultural re-patterning involves a nurse working with patients in order to convince them to abandon harmful cultural practices and beliefs. Many cultural practices believe that bedrest is important for healing. Teaching a patient that getting up and moving soon after surgery promotes healing and is an e.g. of repatterning. The barrier here is that many people have been taught and raised in a certain culture from birth. Resistance to change should always be anticipated and the nurse prepared to adjust care as needed

Cultural brokering finally involves mediating between groups or individuals that have different cultural beliefs in order to reach a consensus and effect changes.Many cultures do not make any decisions for health until the entire family is there to agree in the decision making. The Nurse may need to intervene if one family member wants to make decisions before the entire family arrives. A possible barrier may be time constraints. Decisions may need to be made before to the entire family arrives. The Community health nurse then may be able to do a group phone call with all family members.

References

Acupuncture. (n.d.). Retrieved from http://www.mayoclinic.org/tests-procedures/acupunc…

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The primary purpose of the Affordable Care Act (ACA), is to help more people receive better access to cost-effective, quality healthcare. The ACA reduces insurance premiums, offers prescription drug discounts, and prevents insurance companies from denying coverage to children under the age of 19 that may have pre-existing conditions (Cook, 2014). The ACA supports no charge evaluations to help keep Americans healthy. Services include: immunizations, assessment of blood pressure and cholesterol levels, as well as cancer screenings such as colonoscopies and mammograms; also included in the plan are prevention programs such as smoking cessation and obesity management (Cook, 2014). The goal is for all Americans to have access to reasonable-priced health insurance. To reduce costs, middle and low-income families receive tax credits, and the Medicaid program is expanded to cover more people in need (Cook, 2014).

With more people now having insurance coverage, the demand for quality providers has increased. The government has established multiple avenues for workforce development, such as scholarships and loan repayments; so that prospective providers are able to afford the necessary education required to serve the population (American Nurses Association, 2014).

For example, the purpose of Nursing Workforce Diversity Grants (NWD), is to develop an opportunity for people who are minorities or from disadvantaged backgrounds to enter the nursing workforce (American Nurses Association, 2014). Additionally, increasing the exposure to people of different backgrounds is one way also to foster cultural competence between the caregivers themselves, as well as toward their patients.

Nurses have a reputation as trusted sources of health information; this creates a valuable role when it comes to informing people of the benefits available to them, and how they can be accessed (Wakefield, 2013). For many Americans, it is their first time to have coverage; the ACA gives nurses a chance to improve our communities health by conveying the message of attainable, cost-effective care to the uninsured (Wakefield, 2013).

Reference

American Nurses Association. (2014). Health Care Transformation: the Affordable Care Act and More. Retrieved from https://www.nursingworld.org/~4afc9b/globalassets/…

Cook, C. (2014). Key Features of the Affordable Care Act (Obamacare). Retrieved from https://aclawlib.wordpress.com/2014/02/10/key-feat…

Wakefield, M. (2013). Nurses and the Affordable Care Act: A call to lead. Retrieved from

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When a disaster hits different cultures they still hold on to spirituality, beliefs and values. The help that is given will show great value and usually spirituality will be heightened during this time. People may question their faith based on the disaster that has been laid upon them. The volunteers and medical personal that approach these victims will need compassion, understanding and show dignity and respect with beliefs and as a human being (Varghese, 2010). Ethical and cultural awareness is needed to properly care and communicate. Nurses, providers and volunteers can listen and communicate and may even show support by prayer. Many times victims and even the help will question why this has happened and why is there not enough supplies. These are difficult questions and prayer and working together is important to move forward. Nurses can keep open communication and let people know what they can do and all the people that are helping their country. This will bring up the spirit when people know others will help. Nurses can stay positive and always try to encourage others to help each other.

Reference

Varghese, S. B. (2010, December 22). Cultural, ethical, and spiritual implications of natural disasters from the survivors’ perspective. In Critical care nursing clinics of North America . Retrieved August 14, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/?term=Cultural%2C+ethical%2C+and+spiritual+implications+of+natural+disasters+from+the+survivors’+persp

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Ethnography focus on collective experience of a community/phenomenology focuses on the individuals. Ethnography studies the culture behavior, attitudes and beliefs and the data are collected through interviews, observations and analysis of documents it can take longer period than phenomenology. Phenomenology studies individuals’ experiences often are referred to as lived experiences and the interviewers are the main methods of collections

The similarities are that both involve social aspects and true-life experiences, they both seek to explore a subject’s experience in the setting of the world in which the subject lives.

Difference Between Ethnography and Phenomenology | Definition, Features, Focus, Data Collection. (2017, February 17). Retrieved from http://pediaa.com/difference-between-ethnography-and-phenomenology/

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Sampling theory was developed to determine the most effective way to acquire a sample that accurately reflects the population under study. Key concepts of sampling theory include populations, target population, sampling on eligibility criteria accessible population, elements representatives’, sampling frames and sampling plans or methods. A sampling plan or method outlines strategies used to obtain a sample for a study, like a design, or sampling is not specific to a study. The plan is designed to increase representativeness and decrease systematic variation or bias. Its designed to increase representatives while at the same time decreasing systematic bias or variation.

Kukull, W. A., & Ganguli, M. (2012, June 05). Retrieved October 10, 2018, from