Health (Social Concern) Research Papers Example

Health (Social Concern) Research Papers Example

Research Paper
Under –age drinking is a major stigma in any colleges today mostly due to the social tenets that accompany college life and the facilitators around. This is a pertinent issue and this research paper focusses on evaluating the development of underage drinking, its causes, effects how people view it in the outside world and how it can be treated or controlled.
According to an American health education journal by Dodd, Virginia (201), ‘why underage College students drink in excess: qualitative research findings ‘, participants attach positive expectations to alcohol abuse and the negative consequence as disincentives. This has cultivated a culture of much more drinking characters in universities and campuses. This research has shown that males between the ages of 18-20 drink more than females and both develop much more drinking habits over time. Expectancies include:

Social lubricant
The norm of being accepted in social circles and societies in campus makes students vulnerable to alcoholism alcohol related conditions .This in way provides a bind and one seeks to prove a point by standing up to the ‘group’ philosophy thus creating a scourge of massive and blind alcohol uptake by teenagers in campus.

Peer influence
Peer influence is also noted as a strong trigger of the alcoholism in campus as a result of meeting peer expectations and the teenagers merely doing it in order to please their peers and seem to appear on the same foot and platform socially.

Rite of passage
Alcoholism also stems from a belief that is attached to a ‘rite of passage’ a sort of initiation into a certain age group or class differentiated from the rest of the people around. This is a culture very common in campuses thus the overly forward attachment to alcohol thus the subsequent alcohol related problems.

Social consequences
The behavioral patterns associated or exhibited by drunks in campus is an association may teenagers choose to distance themselves with in order to paint a picture of good character and thus avoiding bad publicity and ultimately reduced alcohol uptake.
According to a journal of addictions nursing (Taylor and Francis LTD)2011,a major problem with college students is binge drinking which leads to poor academic achievement and low self-fulfillment characterize by short term effects such as Alzheimer’s disease or short term memory loss and blackouts. This drinking stigma has been characterized also by rowdy behavior, violence cases, general vandalism and even violent sexual behavior with varied extent of contractual sexual diseases. Participants in this test showed impulsivity in stopping binge drinking with the perceived outcomes being majorly similar. This was done through the use of Prochaska and DiClemente’s Trans theoretical model which eventually provides results showing binge drinking alters inhibitory control and suggests impulsivity interferes with intentional behavioral change in people therefore influencing the design of future alcohol prevention programmes.
Harvard review of psychiatry (Taylor & Francis Ltd). Jul/Aug2012, Vol. 20 Issue 4, p189-200. 12p reveals that alcohol is usually introduced during the formative years of a person between the ages of 18-24years usually the campus aged population which is underlined by the legal drinking age in the united states of 21 years. Brains at this stage are less sensitive to alcohol sedation and more sensitive to alcohol related effects in memory. History of alcoholism underscores the drinking situation and facilitates the psychiatric conditions that occur due to underage excessive drinking. Abstinence from such improves one’s brain capacity as well minimizing disruptions ingrain development during such age in life. This also reduces negative behavioral aspects of people.
An article from the daily telegraph far from harmless reads that parents are the main suppliers of the children with alcohol between the ages of 12-15 therefore contributing immensely to underage and subsequent minors drinking even in campus. This article reads in part that binge drinking before the age of 14 increases the chances of becoming an alcoholic. This has prompted authorities in other countries such as the United Kingdom to introduce stiffer warnings such as those in cigarettes. A Mediterranean model in the article provides that supervised drinking inculcates responsible use of alcohol. It further adds that public campaigns on the dangers of alcohol abuse should be done to enable families’ counters such a stigma. This will aid in help solve such a state of societal issue which is as a result of our cultural values strongly connecting with sports and celebration.
This article provides for parents to be as well responsible for their children’s teenage alcohol abuse as it contributes to a social and medical problem
A psychiatric study on adult children of alcoholics: Drinking, psychiatric, and psychosocial status in the source article Behaviors, provides information on the risk that the family history realizes in teenage drinking which by extrapolation leads to campus underage drinking. This study analyzed paternal alcoholism impact on the offspring outcomes more particularly psychiatric & psychosocial status of offspring.
In some studies there’s a relationship between the family history and alcohol related problems among the offspring and in other studies there’s been failure to corroborate the ris between the family alcoholism history and the offspring alcohol related problems. This therefore enables risk to be determined of placing the children under risk of alcoholism stigma and deviant drinking outcomes according to the study.
The underage drinking has been characterized by number of thorough reports are published, so that this act can easily be monitored. This has resulted into health side effects and even the related deaths. The information are is acquired from the epidemiology research. This bad behavior is associated with a lot of economic, social, behavioral and even health problems in the young generation. More the specific the most parts damaged by this drinking binge is the brain and the liver of an individual carrying out the activity intensively.
When the young people get indulged in this behavior, they practice breakage of rules, precisely drinking while under the influence of alcohol, that can lead to the occurrence of road accidents. The youths that are under the influence as well end up participating in risky sexual behaviors like having unprotected sex. This may result into HIV /Aids transmission and related disease infection. The youth as well may indulge into the sexual activity with more than one partner therefore increasing the chances of infecting and spreading the sexually transmitted disease from one person to the other. Apart from the infections, the females stand a bad chance of getting unwanted pregnancies. During the influence of the drink, the youths are likely to get involved in violence. This could result into the physical fights and the assaults.
There is the existing and persistent binge drinking and the alcohol use disorder in the period of the adolescence. It’s likely to be reported seven times more past year illicit drug use than the adolescence drinkers who are non-binge. The binge drinking has lately been reported to cause most of the disorders in the adolescences health .Among the disorders are the lifelong pathological changes in the young brains and the neurocognitive disadvantage in the young abusers. The age onset of alcohol drinking really affects the future drinking patterns of an individual and the level of rates to which one is prone to be affected by the alcohol risk behaviors and the health related problems.

Thesis statement
Underage drinking has been and still is a scourge in our current society. We ought as a society to find measures which will be easily used in the current societal set up to fight and ward off the alcoholism culture that has brought a myriad of problems to teenagers in the United States. Campus alcoholic behavior is not to be tolerated as this impacts negatively on campus teenage students; however this has to be done in such a way so as to prevent triggering a whole range of protests from the opposes. This may be done in my view through peaceful campaigns on the dangers and consequences of early alcohol abuse, to internalize these issues in the society thus enabling proper decisions to be made both individually and collectively.
As noted from the various articles early alcoholism impact adversely on the immature minds of campus students and the children who are either victims of a family’s history in alcoholism or the activities that revolve the campus social circles .Early alcohol addiction especially at formative years of individuals results to major impacts over long periods of time some are outlined below:
There are a lot of development activities that continue to phase out in an adolescents life. This phases could lead to the new challenges. This challenges are new and therefore require quick adaptability and flexibility in the young minds. This challenges are majorly categorized in the physical, relational, and the social context of an individual. Every aspect of change affects individual mind in one way or another. The major changes and the transformations that occur are outlined below.
– There are increasing responsibility in an individual’s life, his future and behavior.
– Being less dependent and moving towards acquiring a more mature with the initial family of origin.
– Moving towards achieving a more mature relationship with the peers.
– There are increased privileges. For instance one acquires a driving license. This means he or she can own a vehicle if it’s affordable to him/ her.
– An adolescent begins to date and therefore can enjoy and explore romance and sexual relationships.
– Living individuals home and living on your own.
– Preparing to onset the adult roles and responsibilities.
Liver cirrhosis is a common disease due to alcohol addiction with many people losing their lives at very early stages of life
– The gastrointestinal tract mostly bleed. This is due to the corrosion of the walls of the intestine by the acidity resulting from the alcoholic drinks.
– Most of the brain calls are damaged as part of the brain is characterized by memory and the mental stability and speech is impaired, the cells become weaker for an individual under the influence to co-ordinate.
– The GI tract cancer may be as a result of the constant pumping of chemicals in the alcohol inside the gastrointestinal tract therefore becoming dangerous.
– Memory loss that is occasioned by the part of the brain that controls memory. The individuals cannot remember what took place after a drinking spree.
– Depression that occurs most frequently and normally characterized by alcoholics both as a cause and an underlined consequence as people tend to venture into their innate circles of despair and doom with no hope of positivity.
– There is always a high blood pressure that come up as a result of the rate of stimulation brought about by alcoholism. This increases the heart beat more than normal therefore causing the blood supply in the body. This is a threat to a healthy living.
– Pancreatitis; this may be due to the sugar levels contained in alcohol that overwork the pancreas in its role in regulating the blood sugar level therefore causing the swelling.
– Nerve damage as well results as an alcoholic tends to be less responsive to changes that the body normally respond to for instance pain which alcoholics tend to develop a tolerance to. This impairs normal body function and creates a problem in normal body functioning.
– The degenerative disease of the brain and the changes that occur in the mental status that causes characteristics such as mental confusion, coma, vision impairment or even amnesia.
As explained it manifests itself that alcoholism is a degrading factor in society especially if done irresponsibly. This therefore underscores the need for precautionary measures against alcoholism right from early stages in life as well as follow up measures to minimize the risk of having the youth and teenagers fall to such a scourge.

Sinuk, F., & Taylor, C. (2011). Journal of addiction nursing. Adolescent Brain Development and Underage Drinking in the United States, 20(4), 189-200. Retrieved December 21, 2014.
Glassman, D. (n.d.). Why under age college students rink so much. Qualitative Research Finding American Journal, (N2), 93-101.


Public Health Problem Research Paper Example

Public Health Problem Research Paper Example

Description and Analysis of Specific Public Health Problem
HIV/AIDS used to be a disease that was rendered incurable due to the fact that there was no treatment back then. In fact, it is notable that the diagnosis of HIV/AIDS ultimately served as a “death sentence” (Lopez, 2011), mainly because of the fact that the patient is left without any options to prolong his life. However, the development of HIV/AIDS treatment has now lead to the transition of HIV/AIDS from being an acute cureless disease to a chronic one that can be countered with specific medications. Such, of course, served as a welcome development to HIV/AIDS patients, who have also long suffered the debilitating effects of the disease on their immune system, which left them vulnerable to complications. Nevertheless, a slew of findings have shown that HIV/AIDS treatment has introduced complications among patients never before seen or even foreseen by healthcare practitioners. That, of course, leads to the question on whether it is proper to allow the continuous delegation of HIV/AIDS treatment to patients or initiate developments designed to attack said complications. Lopez (2011) promptly argued that new developments to treating HIV/AIDS must be introduced, given that many of the complications arising from HIV/AIDS treatments arise from specific lifestyle problems arising from society. Complications arising from HIV/AIDS treatments are a social problem, not least because of the impact of lifestyle problems, which affect society at large. Moreover, the continued prevalence of HIV/AIDS worldwide provides the findings of Lopez (2011) on HIV/AIDS patients in the United States (US) with great social significance, given that it casts doubts on the integrity of current healthcare practices with regard to HIV/AIDS treatment.
Initially regarded as an acute disease, HIV/AIDS has had no known treatment, leading patients to regard the diagnosis as a death sentence, with no chance of prolonging their lives. However, the introduction of new treatments for HIV/AIDS has made longer life expectancies for patients possible. HIV/AIDS treatments such as nucleoside reverse transcriptase inhibitors (NRTIs), non-NRTIs, and high active antiretroviral viral therapy (HAART) all provided new hope for HIV/AIDS patients, who now enjoy a high chance of possibility towards full recovery. Nevertheless, there is an understanding that complications, mostly in the form of lifestyle effects side effects, have since emerged among patients – a phenomenon never encountered before by healthcare practitioners. Lifestyle patterns among HIV/AIDS patients, including smoking and poor diet leading to diabetes, have aggravated their health conditions to extents incurable by current HIV/AIDS treatments. At the same time, HIV/AIDS treatments have been found to cause side effects on patients as well, such as myocardial infarction (MI) and cardiovascular disease (CVD). Since HIV/AIDS treatments are not exactly designed to counter complications, the compelling need to introduce new improvements have now emerged as a means to keep the integrity of healthcare practices on HIV/AIDS intact, to the full benefit of patients, specifically those in the US (Kirton, 2008; Lopez, 2011)
As a public health issue, one could not deny the importance of solving the problem of HIV/AIDS treatments with regard to complications. HIV/AIDS continues to threaten people worldwide and it may cause severe consequences to communities, from mismanagement of treatment delegation to discrimination of patients in certain everyday activities. Therefore, even if current HIV/AIDS treatments can prolong the life expectancies of people, the complications that have since emerged from patients now stand as a compelling issue in public health healthcare practitioners must seek to resolve (Lopez, 2011).
As consistently mentioned, the etiological factors for HIV/AIDS treatment complications include the aggravating effects of lifestyle practices of HIV/AIDS patients and side effects coming from current forms of HIV/AIDS treatments – NRTIs, NNRTIs and HAART. Smoking, a lifestyle problem of HIV/AIDS patients, can cause a slew of diseases that include leukemia, cancer, CVD and many others (Lifson et al., 2010). NRTIs, NNRTIs and HAART could lead to heart-related complications such as MI and CVD, given the inflammatory nature of HIV/AIDS. Also, NRTIs, NNRTIs and HAART could also cause diabetes due to insulin resistance and glucose level anomalies. Lifestyle effects, such as poor diet leading to obesity, are also found to have led to MI, CVD and diabetes among HIV/AIDS patients in the US (Formulary Staff, 2010; Kirton, 2011; Lopez, 2011).

Solving the Public Health Problem
It is also important for healthcare practitioners in the US to become more information towards patients with regard to detailing preventive measures against HIV/AIDS treatment complications. For one, it is crucial to tell patients to undergo specific therapies, such as lipid-lowering therapy, in order to mitigate MI and CVD. Healthcare practitioners must also monitor the state of obesity among HIV/AIDS patients in order to prevent instances of diabetes. The use of HIV/AIDS treatments from different classes not known to cause CVD must also be considered by healthcare professionals in order to enable HIV/AIDS patients to avoid HIV/AIDS treatment complications (Lopez, 2011).
Moreover, it is crucial for healthcare practitioners to prepare HIV/AIDS patients in the US with regard to new kinds of HIV/AIDS treatments. For new HIV/AIDS treatments to become more effective, healthcare practitioners should first make sure that HIV/AIDS patients are willing and knowledgeable to take those. For that, healthcare practitioners must teach HIV/AIDS patients to deal with possible complications both from the treatment and HIV/AIDS itself. It is also crucial to develop new programs designed to address HIV/AIDS treatment complications, which in turn could make sure that HIV/AIDS patients exert full compliance (Kirton, 2008; Lopez, 2011).

Public Health in the Future
As specified in the literature, it is highly important to curtail the negative effects of HIV/AIDS treatment complications, specifically among HIV/AIDS patients in the US. Given the fact that HIV/AIDS treatments have since led to lengthening the life expectancies of HIV/AIDS patients, it is also imperative to protect them against complications in order to prevent making their new lease in life an ordeal for them to endure. As a public health problem, HIV/AIDS treatment complications need to be countered efficiently through delegation of proper remedies, as stated earlier. Yet, as it stands, it is important to emphasize that prevention is, indeed, better than cure when it comes to dealing with HIV/AIDS treatment complications (Kirton, 2008). To prevent HIV/AIDS treatment complications from emerging, it is important for healthcare practitioners to impose strict regimens for HIV/AIDS patients undergoing treatments. The use of NRTIs, NNRTIS and HAART, provided those do not introduce side effects, must come with proper lifestyle practices such as the consumption of suitable dietary regimens and prevention of smoking. Healthcare practitioners must exercise greater authority to prevent activities that may just aggravate the health of HIV/AIDS patients. At the same time, it is also important for healthcare practitioners to monitor HIV/AIDS patients constantly while undergoing treatment until such time that they have recovered to the strongest extent (Lopez, 2011).
My personal experience with HIV/AIDS treatment complications comes from an acquaintance, who is currently an HIV/AIDS patient. While my acquaintance has contracted HIV/AIDS through unsanitary hospital equipment, his habit of smoking and poor diet has led him to suffer from complications. Even prior to contracting HIV/AIDS, my acquaintance has since been a heavy smoker and drinker, which is why it became really difficult for him to become an HIV/AIDS patient, given that he had a really hard time sacrificing what he has been used to doing. Therefore, for people like my acquaintance, I could really see why it is very important for them to get new kinds of treatment and other measures that could enable them to deal with HIV/AIDS treatment complications. Indeed, it is not all the time that contracting HIV/AIDS is due to circumstances that could have been prevented by the patient himself, such as in the case of sexual intercourse. Improper medical practices delegated by healthcare practitioners, which is understandably beyond the control of individuals, could cause HIV/AIDS and patients would, of course, be forced to stop whatever practices they are used to doing. Nevertheless, I am of the belief that with HIV/AIDS or not, avoiding unhealthy practices is something that healthcare practitioners must promote to protect public health.
In the future, I am of the opinion that healthcare practitioners in the US must maximize their capabilities to prevent HIV/AIDS treatment complications. From preventive measures to innovative practices that include the creation of new kinds of HIV/AIDS treatment, protecting the welfare of HIV/AIDS patients must serve as the primary goal. Understanding the causes of HIV/AIDS treatment complications serves as perhaps the first and most important step for healthcare practitioners and HIV/AIDS patients in the US alike. At the same time, keeping healthy at all times must serve as the primary goal of HIV/AIDS patients, given the gravity of their situation. HIV/AIDS patients in the US must also receive adequate assistance from healthcare practitioners, who in turn must exert competence in what they do so that they could ensure their smooth recovery. For healthcare practitioners specializing in producing HIV/AIDS treatments, they must make it a point to take into consideration the different kinds of complications that patients experience. In that way, healthcare practitioners would be able to introduce highly effective HIV/AIDS treatments. All of the foregoing recommendations must find bearing in future studies.

Formulary Staff. (2010). Some antiretroviral drugs used to treat HIV associated with an elevated risk of myocardial infarction. Formulary, 45(9), 292
Kirton, C. (2008). Managing long-term complications of HIV infection. Nursing 2008, 38(8), 44-49.
Kirton, C. (2011). HIV: The changing epidemic. Nursing 2011, 41(1), 36-43.
Lifson, A., Neuhaus, J., Arribas, J., van der Berg-Wolf, M., Labriola, A., and Read, T. (2010). Smoking-related health risks among persons with HIV in the strategies for management of antiretroviral therapy clinical trial. American Journal of Public Health, 100(10), 1896-1903.


Example Of Georgia: Family Nurse Practitioner Research Paper

Example Of Georgia: Family Nurse Practitioner Research Paper

[Institution Title]

An Overview: Family Nurse Practitioner
In every community, each individual has their respective parts to play. This part are identified as role. Role is defined as “the set of interconnected rights, beliefs, norms and behaviors as determined by the people in a given social condition” (MacMillan Online Dictionary, 2014). It is then acceptable to assume that roles are dictated by the society according to what it deemed appropriate and necessary for a specific individual based on social position or social status. In the case of the Nurse Practitioner, he or she too has a socially-determined role to play to the betterment of the community. However, before one can proceed towards enumerating the role of the nurse practitioner, it is best to know how this social position came to exist. It was sometime during the late 50’s, and early 60’s there has been a growing scarcity of physicians to address the growing needs of the people. In addition, given the dramatic increase in the opportunity for specialization in the field of medicine, majority of the physicians had been displaced from rendering primary care. This began a period when rural health centers have become isolated, and the health of the public had been compromised. The scarcity of the available primary care services has been intensified in 1965 with the launch of the Medicaid programs that awarded health coverage for women, children, disabled and the elderly from low-income family. To address the gap, doctors began training clinically-experienced nurses. These nurses were believed to be the solution to the growing demand for primary care. About the same year that Medicaid was launched was the time that the first training school for nurse practitioners were opened by Nurse Loretta Ford and Dr. Henry Silver (O’Brien, 2003). A nurse practitioner is a nurse practitioner who has the skills that are especially needed in the detection and management of acute self-limiting disorder (Sullivan-Marx, McGivern, Fairman, & Greenberg, 2010). This also includes the management of chronic but stable conditions. The FNP is also responsible in providing primary ambulatory care to individuals with the direction of a primary care physician (Doval Mezey & O’Neill McGivern, 1999).

Licensure vs. Certification
Licensure is commonly associated with activities that are considered otherwise forbidden with the proper expertise and specialization (Wilson, 2014). Thus, licensure awards the individual to privilege to perform the activity. A license is considered a mandatory requirement in the performance of an activity that is typically awarded by the government. The system of licensure limits or control the people’s entry to a given act or profession because of the necessary skills and expertise require of the profession. On the other hand, certification is only a declaration that one has successfully completed a course, passed an exam or met a particularly given requirement (Wilson, 2014). However, it is not a permission that allows an individual to act, but merely a statement of qualification or eligibility. An example of licensure is driving. Not everyone is allowed to drive because it needs the mastery of a particular skill. In addition, anyone caught driving without a license would be considered violating the law. This limits the people who engage into the act of driving like those who does not have the psychological and mental capacity to drive especially. Certification, on the other hand, can best be represented with a CPR certification. A CPR Certificate only means that the person was able to complete the necessary training for the course. However, that does not give the individual the right nor the privilege to practice medical and other health-related procedure or treatment.

Scope of Practice
A nurse practitioner’s scope of practice varies from state to state. In some states, they allow the nurse practitioner to practice their profession independently while on some states it needs to be collaborated with a physician or a supervisor. In the state of Georgia, the Georgia Registered Professional Nurse Act identifies all the provisions and specifications on the role, duties, requirements and specifications for nurses and nurse practitioners. In Title 410, chapter 12, Section 3 enumerates the rules for nurse practitioners. Specifically, in Article 3 Section 2(a) it states that the scope of practice for family nurse practitioners includes the advanced practice nursing care and medical services specific to the nurse practitioner respective specialty to individuals, families and groups, emphasizing health promotion and disease prevention as well as the diagnosis and management of acute and chronic diseases. The nurse practitioner collaborates as necessary with a variety of individuals to diagnose and manage clients’ health care problems (The State of Georgia, 2013). However, not inclusive to the role of the family nurse practitioner relates with the performing minor medical and surgical procedure without the supervision and collaboration of a licensed physician. Requirements for licensure as Family Nurse Practitioner includes the following: (a) evidence of current licensure as a registered professional nurse in Georgia; (b) a completed Board application with required fee; (c) official transcript which verifies graduation with a master’s or higher degree in nursing for the respective nurse practitioner specialty or a graduate level post–master’s certificate in an advanced practice registered nurse practitioner specialty and evidence of advanced pharmacology within the curriculum or as a separate course, advanced physical assessment, and pathophysiology and (d) verification of current national certification from the respective Board-recognized certifying organization (The State of Georgia, 2013). This is also specified under Article 3, Sections 3(a)-(d) of the Rules for Nurse Practitioners in the State of Georgia.

Health Care Policy and Legislature
The legislative process is a system by which the law is made. It involves the series of steps that a bill or a proposal typical undergoes a law (American Association of Critical-Care Nurses, 2014). On the other hand, a system by which the law is implemented, but is regulated as determined by its procedure and specifications is called the regulatory process.
An example of state policy in Georgia is the State Health Benefits Plan. According to the State Health Benefits Plan state employees including retirees, teachers and school system employees are covered by the health insurance properly accorded by the state of Georgia. The coverage of the benefit includes their dependents (Georgia Department of Community Health, 2014). The role of the Family Nurse Practitioners in this state program is to provide the residents with the information and ensure their full access to the rewards of the State Health Benefits Plan.

Prescriptive Authority and Other Challenges of the FNP Role
A family nurse practitioner’s role is often challenged. The challenge, usually, arise from their level of expertise and capabilities to execute and perform the roles that had, usually, been assigned to primary care physicians. In addition, other challenges also include the growing scarcity in the number of family nurse practitioner due to the high cost of pursuing specialization. At the same time, the necessary experience appropriated for a registered nurse to complete before they can progress to becoming a family nurse practitioner.
Family nurse practitioner is also being restricted in terms of execution and implementation of duties in the absence of a physician or a supervisor to collaborate with them. This prevents them from performing emergency medical procedure that could address the immediate care needed by the patient. On the other hand, as far as the Drug Enforcement Agency is concerned, a family nurse practitioner is limited to exercising their role. This is because their scope of duty is not included in this health institution as it believed that they did not possess the sufficient expertise and training in handling patient with drug addiction and drug abuse problems. The practice of electronic prescription furthers limits the role of a nurse practitioner because the prescription and dispensing of medication have not been electronic-based. This limits the scope of their duties while increasing the problems relating to mismanagement of drug administration because it is not adequately explained to the patient.

Given the knowledge and understanding of the role and the duties of a family nurse practitioner, it enables the public to know what activities and services that a family nurse practitioner is allowed to do. This also enables people to respect the authority of the family nurse practitioner. People now have the knowledge of the process that these professionals had to go through in order to earn their title and their license to perform their duties and responsibilities.

American Association of Critical-Care Nurses. (2014, October 7). Introduction to the Legislative and Regulatory Process. Retrieved from American Association of Critical-Care Nurses Website:
Doval Mezey, M., & O’Neill McGivern, D. (1999). Nurses, Nurse Practitioners: Evolution to Advanced Practice. New York: Springer Publishing Company.
Georgia Department of Community Health. (2014, October 14). State Health Benefit Plan Program. Retrieved from Georgia Department of Community Health Website:
MacMillan Online Dictionary . (2014, October 8). Role. Retrieved from MacMillan Online Dictionary Website:


Evolution Of Managed Health Care Research Paper Examples

Evolution Of Managed Health Care Research Paper Examples

Managed health care is a comprehensive term describing the system integrating delivery of health care services with resourcing and financing. It’s also an approach under which the healthcare services can be delivered with the best possible scarce resources allocation in order to optimize the patients’ outcomes (Navarro, Cahill). In a properly functioning managed care system, people get healthcare services that are appropriate and necessary, within set efficiency criteria, within defined timeframe, complying with the highest quality standards, and with “anticipated and measurable outcomes” (Linsley, Morton, 2014). Managed healthcare differs from so-called “liberal medical practice,” allowing physicians to choose methods of treatment, make decisions and bill for their services on their own (Deom, Agoritsas, et al., 2010).
There are several forms of managed care existing in the modern World, including various types of organizations as well as insurance options. The most common managed care organizations and components of managed healthcare are the following:
– health maintenance organizations (HMO), providing an extensive range of healthcare services on a prepayment basis;
– preferred provider organizations (PPO). This type of organizations consists of groups of hospitals, clinics, doctors who enter into contractual relations with an insurance company, employing company or other party to deliver health care to covered group of people;
– various service plans. For example, there are point-of-service plans. Under these plans the people can choose from PPO and HMO features. There are also self-insurance plans, where employers take the insurer’s responsibilities, and “indemnity or fee-for-service plans” (Tobin, 1997).
The main features of managed healthcare are the responsibility as well as accountability for quality healthcare of definite groups of people, along with acceptance of the financial risks coming from assuming the responsibility (Dorsey, 1995, p. 597).

Well-working continuum of managed care is ideally patient-centric (see figure 1).
Figure 1. Model of managed care. Source: Linsley P, Morton S. (2014) Managed care: a structured approach. Nursing Standard. 28, 19, 37-42.
Many researches state that managed healthcare emerged in 20th century. But the first U.S. healthcare program which can be associated with the managed care concept was launched in 1798 by a group of shipping companies and covered maritime workers (Liberman, Rotarius, 1999). The earliest managed healthcare plans of the beginning of the 20th century were episodic, isolated and often represented a form of employees benefit offered by some employers, for example, Western Clinic of Tacoma, WA, 1910; Blue Cross, 1930s; Greater New York health plans, 1944 (Navarro, Cahill). This period predecessing the World War II is known as a time of emergence of “proto-HMOs” (Fox, Kongstvedt, p.4) combining features of health care and insurance, delivering medical services on a prepaid basis.
Shortage of hospital facilities followed the World War II. The Hill-Burton Act, 1946, addressed this shortage and resulted in an expansion of healthcare facilities and much more easy access to healthcare services. The Stabilization Act, 1942, eliminating taxation on healthcare employee benefits, gave stimuli to health insurance penetration growth. McCarran-Ferguson Act, 1945, had withdrawn insurance institutions from supervision of federal authorities. Healthcare programs coverage of the employees grew from 10% before the War to 70% in 1955 (Fox, Kongstvedt, p.5). This time was also marked by emergence of major health maintenance organizations and plans (Health Insurance Plan of Greater New York, Kaiser-Permanente Medical Program, the Group Health Cooperative for Puget Sound and Minneapolis Group Health Plan).
The time between 1930s and 1960s was a time of coexisting and competing entrepreneurial medical practices and prepaid group practices, where doctor-patient financial relations were altered with arising the third party payers and management organizations. Under new circumstances within group-practice-based HMOs, the physicians were not able to sell unnecessary extra services to their patients to increase their earnings, because the clinical decisions were supervised, and payments were processed in a more organized way (Jackson, 2012).
In 1960-1970s, the role of healthcare maintenance organizations (HMO) in delivering and financing health care services was quite limited. In early 1960s, the President Kennedy and the Congress introduced some proposals that later became the basic elements of Medicare. In 1965, the Congress adopted two major healthcare programs – Medicare for elderly adults and also Medicaid for low-income groups of people (Fox, Kongstvedt, p.6). This combination of Medicaid, Medicare and private insurance resulted in sufficient increase in third-party-paid healthcare coverage. In 1970, only 33% of health care costs were paid on an individual basis, healthcare expenditures share in GDP increased to 7.4% (Fox, Kongstvedt).
Healthcare spending aceleration in 1970s (due to inflation, technology’s development, longer lifespans, etc.) led policymakers, employers and insurance companies to look for cost control strategies. Inorder to gain control over rising costs, policymakers and insurers shifted from traditional fee-for-service plans to managed care” (Saunier, 2011).
The HMO Act, passed in 1973, paved the way for the HMOS to “the employer-based insurance market” (Fox, Kongstvedt). Under this Act, all employers with headcount over 25 people, were obliged to provide two HMO programs, each belonging to one of the federally qualified types (“the dual-choice mandate”). The first type was open panel or network model; the second was group model (the closed panel). HMOs competed for inclusion in employer-based health care programs, and obtaining federal qualification was one of the methods to reach this profitable segment. Later, the federal qualification was cancelled. In 70s, health maintenance organizations focused on optimizing utilization and payment procedures. Group HMOs involved mostly salaried physicians (Fox, Kongstvedt) and controlled the length of stay, in-place medical procedures in order to eliminate unnecessary utilization. It was a time where hospitals start offering discount programs for HMOs re-directing clients flow to those facilities. New contractual payment schedules emerged (case rates, capitation, diem payments, etc.). HMO plans replaced the old, traditional healthcare plans.
The Tax Equity and Fiscal Responsibility Act, 1982, enabled HMOs to participate in Medicare programs. It increased the range of benefits offered under Medicare programs. Managed care “was an evolutionary step beyond indemnity insurance” (Navarro, Cahill), and the penetration of managed healthcare programs continued to increase over 1980s. Managed care movement facilitate communication in the healthcare market and promote health through offering prevention and wellness programs to the clients. According to Liberman (1999) managed care didn’t arise from the single initiative of policymakers, it “represents the market response.”
In early 1980s, there was also an evolution of PPOs – preferred provider organizations. This model enabled lower cost-sharing for people visiting a “preferred provider” (a provider entered the discount network) than those who decides to be served by another provider.
Another “step forward” in 1980s was spreading the special programs for managing of large cases (severe trauma, accidents, expensive conditions under chronic diseases, etc.), introducing well-managed coordination of various providers, a second opinion encouraging, etc. (Fox, Kongstvedt, p.9).
In general, HMOs put a significant competitive pressure on traditional healthcare service providers (Luft, 1991). Under Reagan’s presidentship and further, commercial HMOs almost replaced non-profit HMOs. According to Rodwin (2010, p.357), “for-profit HMO enrollment grew from 12% in 1981 to over 63% by 2000.” Besides commercialization, one of the dominant trends of that time is diversification of programs, including those emerged under the Employee Retirement Income Security Act. In 1990s, over 50% of employed population were covered by ERISA healthcare plans (Rodwin, 2010).
The period of 1985-2000 is characterized by growth, restructuring, consolidation and innovation. Growth in penetration of HMO and PPO, “maturation of external quality oversight activities” (Fox, Kongstvedt, 2007), introducing prominent performance management tools, more sophisticated approaches to costs management were the evidence of the managed care entering its palmy days.
Restructuring trends manifested in the emergence of hybrid products, combined HMO offerings including PPO and point-of-service components, etc. Consolidation of HMO ownership resulted in domination of oligopolies in the market. By 1986, “62% of HMOs and 73% of all enrollees were in national organizations” (Rodwin, 2010).
Emergence of computer technologies and their rising role in processing claims created the foundations for future virtual revolution (Fox, Kongstvedt, 2007). Besides technological innovation, attributing to information technology’s development, there were some organizational and processing innovations. Integrated delivery systems were the good example of that trend. Integrated systems were implemented in two different types of organizations – physician–hospital organizations and carve-out companies, uniting providers of specific groups of services.
Another trend in managed care is standardization and public management. In late 1990s and early 2000s, almost all the states issued a set of regulations concerning managed health care (Patient Protecting Laws, Patient’s Bill of Rights), defining standards and rules for covered hospital stay, disclosure of information, etc. Some of the provisions were controversial. The people could complain if their HMO denied in service provision, but each complaint was treated as a private case, without its projecting to an organizational or public level.
Under the President Bush administration, Medicare program was restructured into a program offering a fixed money contribution that covered people could use to purchase the medical benefits (Rodwin, 2010). During these years, penetration of managed care continued to grow. According to Duggan and Hayford (2013), the share of Medicaid beneficiaries enrolled in various forms of managed health care increased from 11 percent in 1991 to 71 percent in 2009. The growth pace of Medicare populations using managed are programs exceeded the total growth pace of Medicaid recipients (Ae-Sook, Jennings, 2012).
Employer-based segment in late 1990s-early 2000s was strong due to economy growth, low unemployment levels and stable corporate profits. But in 2004 the market size of managed care decreased due to anti-managed care political campaigns accompanying with worsening media image of managed healthcare programs (often referred as “he “managed care backlash”). The managed care institutions were accused in denying coverage of necessary services in order to maximize their profits and in limiting choice of healthcare providers.
In two years the market recovered again and reached the volume of around 80 million dollars in 2006 (Fox, Kongstvedt, 2007). The healthcare spending acceleration returned driven by the set of factors: richer employer’s benefits, growing number of outpatient treatments, rise in operating expences, population aging and the consequent increase in elderly population healthcare needs, necessity to meet rising customers’s expectations, etc.
The modern managed healthcare is highly dynamic. Over 200 million of Americans are covered with various managed care programs in different economy sectors (MCOL, 2012, see table 1) and receive their preventive, primary and also acute medical services (NCD) under these plans.

Source: MCOL Research (2012). Retrieved from

In the structure of managed care enrollment, preferred provider organizations dominate (see figure 2).
Figure 2. National Managed Care Enrollment 2012.
“The total enrollment exceeds the eligible population due to double counting of A) spouses and dependents who have dual coverage, and B) HDHP plans that are also classified as PPO, HMO or POS” (MCOL, 2012).
Source: MCOL Research (2012). Retrieved from
The figure above confirms the fact that majority of the U.S. people receive the healthcare services under the mixed models (PPO, HMO, POS, etc.) combining different financing structures (Jackson, 2012).
Modern managed care is a comprehensive system comprising tools for utilization management, network management, financial management and selective contracting (Deom, Agoritsas, Bovier, & Perneger, 2010) as well as built-in mechanisms for innovation based on internal and external learning. But patient-doctor relations continuity is gaining importance as the patients are willing to invest in maintaining this continuity in order to keep the trust and increase efficiency.
There are several modern trends in employer-based insurance, such as sharing financial responsibility with the recipients (employees), narrowing providers networks, emphasizing prevention and wellness efforts rather than primary care, increasing participation in state health care plans.
Affordable Care Act, passed in 2010, made the fundamentals for future change in managed health care, obliging companies with over 50 employees to guarantee affordable healthcare insurance plans. Starting from 2014, all people not eligible for public care programs should acquire health insurance (Keckley, Copeland & Scott, 2013).
According to William Fera (2013), the society is going through transition to the next generation of healthcare system, also known as the “Managed Care 2.0.” The successful shift assumes overcoming challenges in leadership, care management, cost control and managing quality of care.
In a managed care of new generation effective leadership and management structure playing important role, defining the strategic vision, partnership development framework, information sharing strategies, etc. New paradigm of managed care transforms an approach to manage the patients care towards more comprehensive design and architecture, involving various organizations and data networks. Cost management and quality management should be integrated in order to optimize the cost-quality balance and to improve the clinical outcomes. Managed care 2.0. gives a roadmap for service providers “to compete in the value-based system of health care that is quickly becoming a reality” (Fera, 2013).
The managed health care in the United States is a unique model, with deep roots in both market specific requirements and legislation trends, and this model tends to globalize nowadays. There are many drivers of managed care evolution and growth, including demographic challenges, macroeconomic trends, healthcare technologies evolution, information technology boom, customer requirements, regulatory trends and other forces. All these factors change the landscape of the U.S. managed healthcare along with increasing impact of global healthcare trends.

– Dorsey, J. (1995) Evolution of Managed Health Care. Bull N Y Acad Med., 1995 Winter; 72(2 Suppl), 595–603. Retrieved from
– Liberman, A. (1999). Managed Care Evolution – Where Did It Come from and Where
Is It Going? The Healthcare Manager, December 1999, 50-57. Retrieved from
– Rodwin, M. (2010). The Metamorphosis of Managed Care: Implications for Health Reform Internationally. Journal of law, medicine & ethics. June 1, 2010, 352-364. Retrieved from


Good Essay About Public Health Intervention For Obesity In Bowie, MD

Good Essay About Public Health Intervention For Obesity In Bowie, MD

It is estimated that 34.9% of adults and 17% of youth in the US are obese (Ogden, Carroll, Kit & Flegal, 2014). Compared to national data, the average obesity rate for Maryland is lower than the national average with the adult obesity rate of 26.7% and the low-income preschool obesity rate of 15.5% (, n.d.). Although the average statistics for Maryland indicate a lower prevalence of obesity, the data for Bowie, MD indicates that obesity in that city is still a significant problem with 30.7% of adults and 16.7% of low-income preschool children being obese (, n.d.). Therefore, a community-based intervention utilizing tertiary health prevention strategies is warranted to decrease the existing rate of obesity while an intervention utilizing primary and secondary health prevention strategies is warranted to maintain low obesity rates and prevent the growth of obesity rates in the future.

Current Health Interventions
In order to reduce obesity rates, the Maryland Department of Health and Mental Hygiene (2006) implemented the Nutrition and Physical Activity/Obesity Prevention Program (NPA/O). The strategy covers a variety of settings and populations, including the healthcare settings, school settings, business settings, and community settings. In community settings, the goal is to increase access to green spaces, increase access to healthy food options, and promote urban planning that encourages more physical activity; in business settings, the program aims to increase the number of healthy food options in supermarkets and the availability of healthy foods in workplaces; in community settings, the objectives include offering physical activity programs in community and promoting healthy choices through media; in healthcare settings, the aims are to implement patient education and screening procedures for measuring, treating, and preventing obesity (Maryland Department of Health and Mental Hygiene, 2006).
However, specific strategies, interventions, or results for the city of Bowie, MD are not reported. The Health Improvement Plan proposed for Prince George’s County, where the city of Bowie is located, indicates that obesity is a major problem in the county because the residents are more likely to be obese than residents from other counties within the state of Maryland (Creekmur & Preneta, 2012). The plan addresses only diverse priorities, such as controlling infectious disease, promoting mental health, or enhancing access to substance abuse treatments, while obesity is mentioned once under the objective that considers educating mothers about the benefits of breastfeeding in obesity prevention (Creekmur & Preneta, 2012). Because the issue of obesity has been addressed only at state-level, implementing a public health intervention in Bowie, MD is considered necessary to improve the population’s quality of life.

Recommended Interventions for Obesity
Nursing Diagnoses
According to the nutrition and physical activity profile for the state of Maryland reported by the Centers for Disease Control and Prevention (CDC, 2012), only 20.8% of adolescents were physically active every day for at least 20 minutes while 64-87.4% of them did not consume the recommended amounts of fruit and vegetables. Furthermore, 38.8% of schools in Maryland did not offer nutritious foods and beverages, and daily physical education classes were attended by 20% of adolescents (CDC, 2012). Adults reported higher physical activity levels than adolescents with 43% of adolescents reported working out, but only 28.7-36.9% of them reported eating the recommended amounts of fruit and vegetables. The appropriate nursing diagnoses for both populations are sedentary lifestyle and altered nutrition: more than body requirements.

Prevention Planning and Implementation
An intervention to address obesity needs to focus on improving physical activity levels and dietary habits among the entire population, but it should also address the needs of people who are identified as obese. Tertiary health promotion is required to help people with obesity to prevent immediate adverse events (i.e. joint disorders, cardiovascular risk factors, etc.) and long-term adverse events (i.e. type 2 diabetes, heart disease, etc.) associated with it (CDC, 2014). The goal of this intervention in healthcare settings is to improve the accessibility of patient education and counseling to all individuals with obesity.
Furthermore, healthcare settings should also implement secondary health promotion to identify individuals with risk factors for developing obesity. Screening programs need to be implemented in various healthcare facilities to measure obesity risk indicators, such as blood cholesterol. Individuals at risk for obesity will also receive patient education to help them understand how nutrition and physical activity affect their health.
In workplaces, interventions that address nutrition and physical activity issues simultaneously are the most effective interventions for reducing obesity rates (Katz et al., 2005). This intervention will support the development of workplace policies that provide workers with exercise breaks and healthy food choices in cafeterias. Employers will also be encouraged to provide their employees with various resources (e.g. nutrition guidelines, nutrition tracking software, etc.) to help them improve their dietary habits.
Finally, two interventions will take place in public schools. First, in order to increase the physical activity levels among adolescents, schools will make physical education classes mandatory and offer extracurricular physical activities to students (Sobush et al., 2009). Second, adequate food programs that offer healthy food choices and health education need to be introduced in school because the lack of those programs can contribute to increased obesity levels (Veugelers & Fitzgerald, 2005). Because a survey in the state of Maryland showed that 21.3% of students drink at least one artificially-sweetened beverage (CDC, 2012), the health education program should also aim to educate adolescents about the health benefits of choosing water over artificially-sweetened beverages (James, Thomas, Cavan, & Kerr, 2004).

Evaluation of Recommended Interventions
The main outcome measure for evaluating the intervention is the obesity rate among adults and adolescents. Other outcome measures that will be used to evaluate the effectiveness of the interventions include dietary habits and physical activity levels. Several measures will be taken to determine whether this intervention had an effect on those outcomes. First, it is expected that the number of adults who participate in moderate physical activity at least 300 minutes per week or intense physical activity at least 150 minutes per week. Second, it is expected that school-based interventions will increase the number of adolescents who engage in physical activity for at least 60 minutes every day. Third, it is expected that nutrition education and the availability of health food choices will improve the decisions people make regarding their dietary habits, so the program will be considered successful if it shows a reduction in fast food consumption, a reduction in the consumption of artificially-sweetened beverages, and an increase in the consumption of fruit and vegetables.

Although obesity has been identified as a significant issue in Prince George’s county and the city of Bowie, local policies and prevention programs have not addressed the issue in detail. Their efforts in public health interventions do not focus on obesity and lack measurable goals. This intervention focuses on improving the dietary habits and physical activity levels among the adult and adolescent populations through interventions in workplace and school settings, but it also considers delivering tertiary care to individuals already affected by obesity. The evaluations for this intervention will be conducted by measuring obesity rates, physical activity levels, and dietary habits among the citizens of Bowie, MD in order to determine the effectiveness of the intervention and identifies areas that warrant improvement.

Centers for Disease Control and Prevention. (2012, September). Maryland: State nutrition, physical activity, and obesity profile. Retrieved from stateprograms/fundedstates/pdf/maryland-state-profile.pdf
Centers for Disease Control and Prevention. (2014). Childhood obesity facts. Retrieved from
Creekmur, P. B. & Preneta, F. (2012). Prince George’s County health improvement plan 2011 to 2014: Blueprint for a healthier county. Retrieved from docs/LocalhealthPlanPrefinal.pdf
James, J., Thomas, P., Cavan, D., & Kerr, D. (2004). Preventing childhood obesity by reducing consumption of carbonated drinks: Cluster randomised controlled trial. British Medical Journal, 328(7450), 1237-1239.
Katz, D. L., O’Connell, M., Yeh, M. C., Nawaz, H., Njike, V., Anderson, L. M., & Dietz, W. (2005). Public health strategies for preventing and controlling overweight and obesity in school and worksite settings. Morbidity and Mortality Weekly Report, 58(RR07), 1-12. Retrieved from
Maryland Department of Health and Mental Hygiene. (2006, May). Maryland nutrition and physical activity plan 2006 – 2016. Retrieved from cdp/pdf/npaplan.pdf
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA, 311(8), 806-814.


Pain Transmission Report Examples

Pain Transmission Report Examples

Pain is an essential part of the body’s defense system which is perceived as an unpleasant feeling. Pain produces a quick warning to the central nervous system to start motor response as a minimization of harm. Lack of pain perception is dangerous can cause grave problems such as Auto-amputation, corneal scarring or self-mutilation. Researchers in the medical profession have distinguished between pain and what is known as nociception. Nociception occurs when signals get to the central nervous system as a result of the activation of nociceptors (Svokos & Goldstein, 2009). Nociceptors are special sensory receptors which relay information regarding tissue damage. Pain may be explained as the unpleasant feeling resulting from nociception. This paper provides material on the subject of pain, while focusing on nociception, endogenous opioids, pathophysiology of neuropathic pain, how it is experienced by individuals and the cultural perceptions of pain.

According to Svokos & Goldstein (2009), nociception is the process through which tissue damage is detected by specialized receptors known as nociceptors. Nociception is a term that is used by many to refer to pain. However, there is a difference. Nociception is only the transmission of tissue damage information to the brain with no reference to the development of emotional or other responses to the noxious stimulus. There are two types of nociceptive pain. The pain that emanates from the skin and inner tissues (muscles and joints) is known as somatic pain while pain that comes from internal organs is known as visceral pain. Somatic pain is localized and easy tom point out while visceral pain is not. Stimuli that may cause damage such as chemical, thermal or mechanical stimuli cause cutaneous pain by affecting primary afferent nociceptors. Nociceptors are found distributed in skin, connective tissue, muscles, viscera and blood vessels. They are pseudonipolar neurons found with the cell body which is located inside the dorsal root ganglion (DRG). Nociceptors have a cell body which contains a peripheral terminal (ending) and axon that elicit a response to stimuli and have a central branch which transmits information into the Central Nervous System (CNS). There are two main types of nociceptors which respond to various modalities from noxious stimuli. The largest of the nociceptors is known as C-fibers and is connected to unmyelinated axons. C-fibers conduct information at a slow pace and respond to noxious stimuli such as thermal, chemical or mechanical stimuli. Natural thermal, chemical or mechanical are transduced into electrical signals by proteins found in the membrane of nociceptors. These electrical impulses are transmitted along the central and peripheral nociceptor axon into the CNS. Analysis reveals that the transducer molecules activated by noxious stimuli include TRPV1 and TRPM8. TRPV1 responds to heat, reduction in pH as happens in the chemical capsaicin and inflammation. TRPM8 responds to noxious cold. These molecules are usually targeted in therapeutic interventions for clinical pain conditions.
The second type of nociceptor population comprises of thinly myelinated axons known as A-delta fibers. These nociceptors are responsible for faster transmission than unmyelinated C-fibers. They convey sharp and momentary pain rather than the slow and distributed pain which is associated with the C-fibers. Another category of nociceptors that has unique properties is known as the “silent” or “sleeping” nociceptors. This category is not responsive to noxious intensities of mechanical stimulus except when the intensity is extreme. It is hard to activate silent nociceptors within the normal noxious stimulus intensity range after tissues are injured; these nociceptors “wake up” due to the effect of endogenous chemical mediators that are associated with injury to tissues. This type of nociceptors is usually related to increased responsiveness to noxious and innocuous intensities.

The Central Nervous System
The nociceptor’s central branch ends inside the spinal cord dorsal horn. It has synaptic linkages with an intricate array of neurons which play different roles as nociceptive processors. Some interneurons are connected to motor neurons which generate withdrawal reflexes. The spinal cord output neurons transmit nociceptive messages to the thalamus and brainstem reticular formation.

Endogenous opioids
Opioid compounds as well as their receptors are found in the peripheral nervous system and CNS as well as in tissues (Koneru, Satyanarayana & Rizwan, 2009). Opioid systems take part in a variety of homeostatic functions and control of movement as well as in the processing of noxious impulses. Opioid analgesics have different effects which may be understood by reviewing the various types of opioid peptides.

Endogenous Opioid Peptides
There are different endogenous opioid Peptides which are produced in the body. These include endorphins, dynorphins, enkephalins and endomorphines. Each of these families of opioid peptides comes from a particular type of precursor protein and has a unique anatomical distribution. Endorphins are opioid polypeptide compounds which are produced in the pituitary gland and hypothalamus in vertebrates in the course of strenuous exercise, pain, excitement and orgasm. They have opiate-like characteristics because they can create analgesia and a feeling of well-being. They are “natural pain relievers” and can be found in more than 20 different points in the body such as in the nervous system, brain and the pituitary gland. The name “endorphin” implies a pharmacological process rather than a particular chemical formation. “Endorphin” is used for many proteins with opioid-like attributes. There are four types of endorphins namely alpha (α), beta (β), sigma (σ) and gamma (ɤ) (Koneru, Satyanarayana & Rizwan, 2009). The differences between the four endorphins are in the number and type of amino acids in their molecules. Each has between 16 and 31 in each molecule. During stress or pain, endorphins are released in the pituitary gland (Koneru, Satyanarayana & Rizwan, 2009).
According to Koneru, Satyanarayana & Rizwan (2009), enkephalins are pentapeptides which are involved in the regulation of nociception in the body. Two types of enkephalins exist. One is leu-enkephalins and the other is met-enkephalins. Met-enkephalins are a variety of naturally-occurring endogenous opioid peptide neurotransmitters which are found in the brains of humans and many animals. Leu enkephalins create pharmacological effects at the µ and δ opioid receptors. They select δ receptors more than µ receptors and have minimal effect to κ opioid receptors if any.
Dynorphins emerge from the prodynorphin precursor protein. Dynorphins are created in different regions of the brain like the hypothalamus, midbrain, hippocampus, pons, spinal cord and the medulla. Dynorphins have many physiological functions which are dependent on the site at which they are produced in the body. For example, those created in the magnocellular oxytocin neurons result in negative feedback inhibition of the secretion of oxytocin. Those created in the lateral hypothalamus’ arcuate nucleus result in appetite control. Dynorphins show their effects through the κ opioid receptors while acting as pain response modulators. They maintain homeostasis by controlling the appetite. There are two types of endomorphins. These are endomorphin-1 and endomorphin-2. Endomorphins have a very high specificity and affinity for µ opioid receptors. Endomorphin-1 is densely and widely distributed in the upper brainstem and the brain. It may regulate arousal or sedative behavior. On the other hand, endomorphin-2 is mostly found in the lower brainstem and the spinal cord. It plays a significant role in pain perception as well as in responses related to stress, reward, vigilance and arousal.
Opioid receptors fall into the categories κ, µ and δ. They are characterized by seven trans-membrane domains. They are found in high densities in CNS areas which are associated with the integration of information regarding pain. These areas of the CNS include medial thalamus, spinal cord, limbic system, hypothalamus and the brainstem. µ receptors have high morphine affinity. These are the main receptors that mediate the action of morphine and its congeners (Koneru, Satyanarayana & Rizwan, 2009). The endogenous ligands for the µ receptors are Endomorphins-1 and 2 which are located in the mammalian brain. There are two subtypes of receptors that exist: µ1 and µ2. µ1 has a greater morphine affinity. It mediates supraspinal analgesia and is blocked selectively by naloxone. µ2 has a lesser morphine affinity and mediates spinal analgesia, constipation and respiratory depression action. The κ receptor has a great affinity for Dynorphin A and ketocyclazocine. The δ receptor has a high leu/met Enkephalins affinity.

How normal pain is transmitted
Normal pain circuitry comprises of nociceptor activation response after a stimulus of pain is received. A depolarization wave is transmitted to the first order neurons. Sodium rushes in through sodium channels while potassium rushes out. The first-order neurons stop at the trigeminal nucleus of the brainstem or in the spinal cord dorsal horn. This is where the electrochemical signal causes the voltage-gated calcium channels to open in the pre-synaptic terminal. Calcium is the allowed in. In turn, calcium allows the excitatory neurotransmitter glutamate to be freed into the synapse. Glutamate then binds itself to NMDA receptors located on the second-order neurons. This causes depolarization. The neurons then cross into the spinal cord and travel up the hypothalamus (Svokos & Goldstein, 2009). Once in the hypothalamus, the neurons synapse with the third-order neurons. These then connect to the cerebral cortex and the limbic system. An inhibitory pathway prevents pain from being transmitted in the dorsal horn. The anti-nociceptive neurons move from the brain stem to the spinal cord where they Synapse at the dorsal-horn with short inter-neurons through the release of norepinephrine and serotonin. The synapse between the first- and the second-order neurons is modulated by the inter-neurons through the release of gamma amino-butyric acid (GABA), which is an inhibitory neurotransmitter. When pain ceases, it is as a result of the inhibition of the synapses between first-order and second-order neurons. On the other hand, enhancement of pain results when inhibitory synaptic connections are suppressed.

Pathophysiology of neuropathic pain
Neuropathic pain may be defined as the pain which is initiated by a dysfunction or primary lesion of the nervous system. Neuropathic pain comprises of “negative” symptoms (numbness and loss of senses) and “positive” symptoms (spontaneous pain, heightened sensation of pain and paresthesias) (Svokos & Goldstein, 2009).
Neuropathic pain is caused when the nervous system is damaged, injured or rendered dysfunctional. Neuropathic pain, unlike is the case for physiologic pain (nociceptive pain), is not self-limited. In addition, it is not treated easily. It is common in medical practice and is often a challenge to clinicians and patients alike. Neuropathic pain results in damage of either peripheral or CNS. The nerve fibers, once damaged, send the wrong signals to pain centers. Nerve fiber injury may result in a change in the function of nerves at the site where the injury has occurred or areas around the site of injury. Manifestations of neuropathic pain may include spontaneous pain, hyperalgesia and parasthesias. Neuropathic pain is associated with conditions which may be categorized in two main groups; pain as a result of CNS damage and pain as a result of peripheral nervous system damage (Svokos & Goldstein, 2009). Damage to the CNS is manifested in clinical conditions such as cortical strokes, syringe-myelia, neoplastic lesions, and trigeminal neuralgias. Peripheral nervous system damage is manifested through clinical conditions such as nerve compression, ischemic neuropathy, plexopathies and nerve root compression.

Pathophysiological processes involved in neuropathic pain
The mechanisms associated with neuropathic pain area not well understood. Animal studies have indicated that various mechanisms may be part of this process. However, it is important to understand that what may apply for animals does not necessarily have to apply for humans. First-order neurons can increase their firing if partially damaged, increasing the sodium channels. Enhanced depolarization on some sites along the fiber may cause ectopic discharges which in turn cause spontaneous pain as well as movement-related pain. Impairment of the inhibitory circuits may be done at the brainstem, dorsal horn or both. This allows impulses of pain to travel unimpeded (Svokos & Goldstein, 2009). Second-order and third-order neurons may create a memory of pain and be sensitized. One of the main challenges in the study of neuropathic pain is in being able to assess it. This challenge may be broken down into two components: (1) assessing the intensity, improvement and quality; and (2) diagnosing neuropathic pain with accuracy. Clinicians may use some diagnostic tools in the course of evaluating neuropathic pain. Nerve condition studies can be used to identify and quantify the degree of damage to the sensory (not nociceptive) pathways through monitoring of neurophysiological responses to stimuli of an electrical nature. Quantitative sensory measures the perception in response to stimuli of different intensities by the application of stimuli to the skin.

Inter-individual differences in pain sensitivity
The way people perceive pain differs from one person to the other. Individual pain perception differences have been the subject of inquiry in clinical practice for a long time. One individual may have an experience of pain that it totally different from another person experiencing the same pain stimulus (Coghill, 2012). Functional brain imaging techniques (fMRI) have been employed in analyzing the level of brain activity. This approach is used with the view to contributing to the creation of psychological/ psychophysical models that may be used to take pain treatment to an optimum. Understanding the differences in pain perception may be attributed to several factors such as environmental, genetic, ethnicity and gender, psychological, and cognitive variables (Coghill, 2012).
Genetic variables may be responsible for the differences in the level of pain perception between individuals. This is because the mechanisms that cause the differences in pain perceptions are dependent on a substrate which is partially determined by genetic factors. The study of twins gives insight into this matter. For example, 26-32% of the differences in heat pain between individuals are accounted for by genetics in twins. 21% in chemical pain and 60% of variability in cold noxious pain is genetically determined (Coghill, 2012). Interactions between sociological and genetic factors may also contribute to these differences in pain perception between individuals.
Ethnicity and gender have a genetic component and may cause these differences. Studies indicate that females are a bit more sensitive to thermal pain than males (approximately 8% difference). Females also withdraw their hand from cold noxious stimulus about 40% earlier than males. Ethnic differences also carry a substantial component of genetics which is manifested in differences in heat perception. For example, there are differences in which Southern Europeans, Northern Europeans, African Americans and Jews perceive pain. Asian-Americans have been proven to be more sensitive to pain than Hispanics or African Americans. Ethnic differences may also be experienced in a qualitative and not quantitative sense. Hispanic subjects tend to feel more of an itch upon the application of capsaicin to their skin while Asians and European Americans feel pain (Coghill, 2012). African Americans experience warmth with minimal pain.
Psychological factors can also contribute to how pain is experienced. There is diversity in internally maintained affective and cognitive information that can contribute to how pain is perceived. Such information may substantially alter how nociceptive information is interpreted.

Cultural influences on how pain is perceived
How people perceive pain and how they behave while in pain is greatly influenced by their sociocultural contexts (Calliste, 2003). Pain perception is made up of interactive, emotional and sensory components. The definition of pain can only be offered by the individual experiencing it. Patterns and meaning of pain across cultures has been a subject of constant inquiry. Studies show that there are differences in how people cope with pin across cultures. When American, African and Caucasian students were evaluated for coping styles for thermal pain, Africans gave the highest rating for unpleasantness (Calliste, 2003). Cutaneous pain perceptions were compared in African Americans and Caucasians where African Americans registered a higher rating for unpleasantness and gave lower tolerances (Calliste, 2003). Childbirth pain is also a major area for pain studies. In Kartchner & Callister (2003), mastering and overcoming childbirth pain was regarded as self-actualization. Women who were more religious seemed to have accepted that pain was inevitable and important in life. They depended on a higher power to enable them overcome childbirth pain. Hispanics and African Americans were noted to have the lowest tolerance for pain while people from Eastern countries have very high tolerances for pain (Calliste, 2003). Pain behavior is also different across cultures. In some cultures, people believe that pain is a personal experience and so they bear it privately. Some cultures verbalize pain more and this has been explained as the belief that pain is something bad which should be eliminated with speed.

Pain is an essential part of the body’s defense system which is perceived as an unpleasant feeling. Pain provides warning to the CNS to initiate motor responses in an effort to avoid further damage to tissue. Nociception is the process through which tissue damage is detected by specialized receptors known as nociceptors. There are different types of nociceptors which serve different purposes in pain perception. While the mechanisms for pain transmission and perception are similar for all people, people in different cultures perceive pain differently and behave differently in response to it (Calliste, 2003). There are also stark differences in how individuals experience pain, which may be explained in terms of genetics, ethnicity and psychological factors.

Calliste, L. C. (2003). Cultural Influences on Pain Perceptions and Behaviors. Home Health Care Management & Practice, 15(3), 207-211.
Coghill, R. C. (2012). Individual differences in the subjective experience of pain: New insights into mechanisms and models. Headache: The Journal of Head and Face Pain, 50(9), 1531-1535. Retrieved April 1, 2013, from
Kartchner, R., & Callister, L. C. (2003). Giving birth: The voices of Chinese women. Journal of Holistic Nursing.12(2), 12-45.
Koneru, A., Satyanarayana, S., & Rizwan, S. (2009). Endogenous Opioids: Their Physiological Role and Receptors. Global Journal of Pharmacology, 3(3),

Case Study On Pediatric

Case Study On Pediatric

Scenario of Paediatric Care within a Hospital Setting
Every day, children becomes ill or get involved in various types of accidents that require medical attention. Whether these children are taken to a paediatrician, specialist, clinic or a hospital setting, a nurse will tend to them. Therefore, a paediatric nurse plays a crucial role which is as imperative as that of a doctor. Paediatric nurses are known to provide essential information in regard to treatment, prevention of future illnesses and injuries in children, and helping the child and the family as well all through the illness or injury. In this paper, I will develop a scenario of paediatric care within a hospital setting for a child who has been having problems with her lymphatic system. In addition, I will expound on all aspects of paediatric care methodology such as the path physiology, weight and height of the child, diet, Head to Toe assessment that includes neurological assessment and physiological assessment among other vital diagnostic aspects in a paediatric care scenario.

SECTION ONE: The Paediatric Scenario
This case involves an 8 year old girl Known as Sherry who is suffering from Leukaemia and Alopecia. She lives at home with her both parents and two siblings. She is the second born and the only girl child in the family. For the past 3 months, sherry has been receiving chemotherapy. In addition she has a Central Venous Device (CVAD) that is normally taken care of by her parents and herself. Due to these health complications which led to her hospitalisations, Sherry has experienced a number absences from school. However, her parents have hired a tutor at home to keep her updated with her studies. The nurse diagnosed Sherry of Alopecia and has been hospitalised with a line of infections, esophagitis, stomatitis and bleeding which calls for the need of platelet replacement. Sherry has totally refused to see her friends although she accepts to talk with them frequently over the phone.

SECTION TWO: Aspects of the Paediatric Care
Upon admission to the local hospital’s paediatric unit, Sherry was recorded to be having a temperature of 38.8°C (101.8°F) that did not respond well as expected to the acetaminophen that she was taking every four hours for the last two days. The paediatric nurse conducted the Head to Toe health assessment that showed evidence of some white patches in her mouth, there was no apparent signs of distress in this child. Her lung sounds are very clear and regular, and her heartbeats are also recorded to being strong and regular. The lesions in Sherry’s mouth may be representing mucositis, an extremely painful condition which is attributed to the destruction of the oral flora by Chemotherapy (Hockenberry, Wilson & Wong, 2012, p.12). The weight and Height of Sherry is measured to being around the 50th percentile, which is the median height and weight of children of her age. She recorded a height of 3.9’ or 46.8 inches tall and a weight of 45 lbs.
In regard to Sherry’s psychological assessment, although the nurse had observed no signs of distress, she was concerned why she did not want to meet any of her friends. Her mother explained that it was largely because of the fact that she was very prone to infections, she feared to risk exposure and be hospitalized again. However, the nurse argued that, her level of growth and development would support that she might be facing psychological difficulties trying to adjust to her alopecia. A major source of belonging for young girls who may be about to join their teenage lives are mostly obsessed with their hair, therefore, her bald head after the chemotherapy was conducted played a key role in making her avoid interactions with her peers. In regard to the symptoms and diagnosis of the diseases facing Sherry, the detected CVAD line infection is mostly caused by pathogenic development of the proximal tip of the catheter which is nurtured by the fibrin formation that occurs at the site. Although tunnelled CAVD catheter are known to be having antibacterial filters to protect the line from any form of infection from the microorganism which may travelling down the catheter, the risk of line infections is very high with CVAD. These fibrins are responsible for providing the excellent media for bacterial growth. However, this can be prevented through proper flushing of CAVD and applying the positive pressure at the tip (proximal) of the catheter. In regard to the formulation of Sherry’s care plan, the nurse carried out other vital assessment procedures which includes: Urine Specific gravity, Hemoccult of stools, urine culture and sensitivity, chest x-ray, assessment of the venous access device (CVAD) for swelling and redness and also the oxygen saturation through the pulse oximetry.
The approach to medication or the rationale for the treatment that the caregiver decided to undertake on Sherry is based on the laboratory findings report which includes: Hematology; Hemoglobin 10.1g/dL, Hematocrit 25%, platelets count of 50,000/mm3 and a whiteblood cell count of 150/mm3. The treatment for the sharp pain that Sherry was experiencing associated with mucositis (stomatitis and esophagitis) was treated by administering morphine sulphate PCA (patient controlled analgesia) through continuous infusion. Proton pump inhibitors were also prescribed for every 4hours for 24 hours following chemotherapy. Lorazepam was also prescribed in the quest to counter nausea in accordance with the lab findings report. The length of hospitalisation for Sherry was a total of 72 hours where intensive follow up and close monitor of her progress was being evaluated. She was later released where she was expected to continue receiving schoolwork teaching from her tutor, but the parents were requested to be making regular visits with her to the hospital facility so as the paediatric nurse would be able to check on her she is fairing.
In matters pertaining to the diet of the patient, the parents are advised to add more fruits into sherry’s diet and also make her drink a lot of water. However, more they should be cautious about the lesions in Sherry’s mouth since she was complaining of difficulty in eating and drinking, especially hot foods and drinks. The nurse suggested that, only cool drinks should be offered to the girl, her hydration can be maintained through intravenous fluids till her pain is controlled. In regard to the general effect of hospitalisation on Sherry and her parents, it is noted that both parents are very dedicated and supportive of their daughter. They full understand the essence of staying with their child at the hospital during low moments in her life such as these ones. She does not feel alone in the hospital and therefore, being in this hospital facility does not appear to be causing any form of distress on her.

In conclusion, this scenario of a paediatric care within a hospital setting comprehensively explains the case of Sherry , a young girl who is suffering from pre-existing conditions which are; Leukaemia, Alopecia and CVAD. She is receiving specialised care from a nurse who plays the role of a physician and also a psychologist due to the adverse emotional effects which accompanied this young girl after undergoing a chemotherapy. In general, this is a scenario that seeks to explain how a paediatric nurse would handle a situation of a child facing such level of difficulty in her health. This case requires a nurse to be fully knowledgeable about the process of chemotherapy, growth and development as well as be able to clearly understand a patient’s personal situation, background and be able to familiarize themselves with the parent-child relationship.

Hockenberry, M. J., Wilson, D., & Wong, D. L. (2012). Wong’s essentials of pediatric
nursing. Mosby Incorporated.
Potts, N. L., & Mandleco, B. L. (2012). Pediatric nursing: Caring for children and their
families. Clifton Park, NY: Delmar Cengage Learning.


Research Paper On Family Health Assessment Using Gordon’s 11 Functional Health Patterns

Research Paper On Family Health Assessment Using Gordon’s 11 Functional Health Patterns

Family health assessment plays a vital role in the formulation of a suitable healthcare plan within a family setup. It aims at using a holistic approach to ensuring that the health of various individuals, communities and families remains client-centered. Since every family is unique in its own way, therefore, it is imperative to have a tool for evaluation that is appropriate for a target family by ensuring that health-related choices , perceptions and their general way of life of the family members has been put into consideration. In the context of family health assessment, the term family is simply meant to represent the biological parents and children living together. In this paper, I will discuss my analysis bases on Gordon’s 11 functional health patterns assessment. I will assess the family whose profile is as follows; The family has a father who is 46 years old, a mother (39years), four children two boys(10 and 16 years) and two girls who are 4 and 6 years old respectively. All the members of the family are in good health. However, the 10 year old son was diagnosed with ADHD when he was four years old and OCD when he was six years of age.

Pattern of Health Perception and Health Management
In a scale of 1-10, the family scores themselves 8 in regard to their health perception and general well-being. The family does not use any drugs, smoke nor drink alcohol. The father said that he has thalassemia minor, which is a genetic disorder which he inherited from his father. This genetic blood disorder also manifests itself on his 4year old daughter. The mother is in good health condition although she has a very minor gastroesphageal reflux disease (GERD). She says that she has been taking protonix on a daily basis. The two boys recorded no health conditions. In addition, this family engages themselves in various outdoor activities such as biking, swimming and camping although not very regularly.

Nutritional – Metabolic Pattern
The family strives to eat a healthy diet on a daily basis. This diet usually consist of low fat/sodium, consumption of whole bread and high fiber foods. The family takes juice in moderation and also drinks a lot of water. The father, who is also the main person in food preparation, ensures that his family eats healthy foods. According to Gordon’s 11, his framework refers to various factors that influences food intake, these includes family values, knowledge on preparation among other influences (Bomar, 2008, p.14). The father has proven to be a positive influence in regard to eating health foods. Generally, the family’s appetite is great and none of the members of the family has shown extreme changes on their skin, body weight, nail texture or hair color. However, the father’s body weight has been observed to be fluctuating since he lost his job.

Pattern of Elimination
In regard to the pattern of elimination, this aspect largely varies with every individual family. The father experiences regular bowel movements especially in the morning immediately after breakfast. The 5year old daughter and the mother suffer from constipation while the other three children are noted to experience one bowel movement every day. Their urine appearance is yellow in color and clear without sediments, no member of the family experiences pain during urination. The family uses laxatives rarely, particularly after a long car or plane trip.

Pattern of Activity and Exercise
This family does not indulge themselves in exercises on a daily basis but has an active lifestyle. All members of the family enjoy riding the bicycle, hiking, swimming and camping. Mostly, the parents prefer to exercises on an elliptical. Both boys enjoy playing soccer while the girls love dancing and playing piano. Other whole family activities include watching television, or playing video games although these are usually regulated. All these activities enable the family to build unity and trust.

Cognitive – Perceptual Pattern
There is no member of the family who was reported to be having any form of celebrovascular disorders, autoimmune disorders or ay degenerative neurologic disorders. The mother and her 10 years old son are both short-sighted while both girls are long-sighted. The father had undergone eye surgery about 8 years ago and thus leading him to wearing glasses. Apart from these eye disorders, there exist no other sensory disorders in the family.

Pattern of Sleep and Rest
The family seems to enjoy adequate sleep since the children have a specific routine for sleep. Normally, the children sleep for 9-10 hours every night while the parents sleep for 6-7 hours. Nonetheless, the mother’s sleeping pattern is largely affected when she works in the night shift in her nursing job.

Pattern of Self Perception and Self Concept
The 10 years old sold appears to be having a lot of problem expressing himself as a person. He expressed very important clues that portrayed disturbances in his self-esteem, identity confusion and showed signs of powerlessness. The young boy has been receiving regular treatment for his depression. The family considers itself able to adjust themselves effectively to various changes such as loss of income or employment.

Role – Relationship Pattern
The individual family members acknowledged the role of the mother to be that of the sole breadwinner after the father lost his job. The father’s role is that of a caregiver. Numerous issues especially those in regard to threat of change and loss ends up causing stress especially to the mother who is duly expected to combine both family chores and work.

Sexuality – Reproductive Pattern
The parents say that they have a sexually fulfilling relationship. The mother is reported to have carried 8 pregnancies and had 4 births. In addition, the family reports that the two older boys receive sex education with their school system of learning but it is also reinforced at home. The oldest boy has been taught the need for proper testicular self-examination. Additionally, the mother carries out breast-self examination on a regular basis.

Pattern of Coping and Stress Tolerance
The family says that they manage to cope with stress by applying a number of strategies that they claim took them years to learn. These stress management strategies includes spending time with close friends, family members or spending time away from each other for a while. The family seems to understand that stress is a necessary part of our lives.

Pattern of Values and Beliefs
The family reports that they are not staunch followers of any given religion but they believe in doing good and avoiding evil. They indicated that they value their family most. They are a very closely bonded family which does a lot of activities together.

The totality and holism of individual interactions with their environment provides the foundation for an effective family health assessment (Bomar, 2008, p.24). Using the Gordon framework, I have assessed that this family has no major health issues or obvious illnesses instead, they ensure proper health maintenance that helps them to stay healthy. In general, the family is health conscious.

Bomar, P. J. (2004). Promoting health in families: Applying family research and theory to
nursing practice. Philadelphia, Penns: Saunders.


Example Of Nursing: Mental Health Essay

Example Of Nursing: Mental Health Essay

Discussion on why mental health is a National Health Priority in Australia. (200 words)
Explanation as to how the ‘Determinants of Health’ need to be considered in relation to youth and young adults’ (15 -25 years) mental health as a health issue in Australia. (200 words)
.Discussion on primary, secondary and tertiary health promotion in relation to youth and young adults’ (15 to 25 years) mental health as a health issue in Australia (300 words).
Discussion of the involvement and roles of community nurse in health promotion that targets youth and young adults’ (15 to 25 years) mental health within a community setting in Australia. (300 words)

Mental health is a crucial public health issue in any nation. It is very costly on the nation health care and social services budget because these patients/clients need constant supervision either at home or in institutions. Besides, the medication needed to keep patients’/ clients stabled often contain serious side effects and are also costly. Hence, this document will review the mental health situation in Australia and how it is being addressed within the country.

Discussion on why mental health is a National Health Priority in Australia.
Mental health is a national health priority in Australia because according to statistics mental illness is very common since one in every five Australian experience some kind of mental disorder in a 12-month time span. Precisely, it has been predicted that 45% of Australians between the ages of 16-85 years will experience a mental illness at some time during their span. This incidence decreases with age. Associating factors include substance abuse. Australians between the ages of 18-24 are at the highest risk and account for 26 % of the total mental illness population in the country (Mental Illness Facts and Statistics, 2013).
Australians 75 years and older are affected at a rate of 5.9%. Importantly, mental health dysfunctions happen to be the third highest factor leading to disability. Already addressing disability has risen to a public health crisis within the country. For example, 27% of the average Australian’s age is lost to disability. Financially, social services have to undertake the responsibility of these individuals and their families when this occurs. Various forms of depression account for most of the absences from work over time among the Australian working. Therefore, based on this supporting evidence mental health in Australia presently is of highest priority. Human resources are a country’s greatest wealth. Once this aspect of the economy is affected as it is in Australia immediately measures must be taken to correct this irregularity for prosperity to be enhanced in the nation (Mental Illness Facts and Statistics, 2013).
Explanation as to how the ‘Determinants of Health’ need to be considered in relation to youth and young adults’ (15 -25 years) mental health as a health issue in Australia.
Determinants of health in any society are relative to the society’s culture and political administration. In the Australia mental health crisis particularly among 15 -25 age group considerations regarding accessibility to education; further education; employment opportunities; parental guidance; social activities; accessibly to available health care and social amenities within the society are areas which can be addressed in providing adequate interventions. According to reports from headspace; Australia has not provided its 15-25 age group population with life skills that would prevent mental illness through health promotion ventures such as education; early detection and intervention (head space, 2013).
This national youth mental health foundation contends that developing services, which are responsive and able to offer early intervention, is essential. The foundation cited delays in obtaining services as being responsible for the escalating mental health rates among youths in the country. Since government services are difficult to access these youth turn to friends and family members for help. Often they are not aware of services in their communities and the need tom intervene with appropriate care is aborted as youth take to the streets for help. Therefore, Public health administration must provide health screening; education; services to detect and treat early signs of mental illness among this high risk population (head space, 2013).
This is very urgent since mental health and substance abuse among 15-25 olds in Australia are synonymous. It would mean that the underlying determinant, which needs to evaluate are reasons for Australia youths abusing drugs that would create mental illness. Importantly, these two disorders account for approximately 60-70% of ill health among Australian youth. Precisely, they are the core of the labor force and human productive resource. Hence, Public health has a major role tom play by taking responsibility for the crisis and designing programs to address this issue (Australia government, 2013).
Discussion on primary, secondary and tertiary health promotion in relation to youth and young adults’ (15 to 25 years) mental health as a health issue in Australia
Australia government operating within the Australia Institute of Health and Welfare gathers data as a primary intervention strategy. While the data in itself does not provide primary care services it determines the nature and quality of primary care intervention communities containing high risk mental health clients will receive. Beverly Raphael (2000) on behalf of the commonwealth of Australia issued a population health model for the provision of mental health. The aim was to integrate mental and general health across life span (Raphael, 2000).
The primary health care model advanced Raphael (2000) indicates that it is a bridge acting to unite ‘existing parallel systems, primary medical care and public health’ (Raphael, 2000, p.18). However, while this model exists theoretically, there is very little evidence of its application in modern Australian mental health care system. A perusal of the Australia government mental health services website shows only data collection a preliminary primary intervention such, there seems to be no existing parallel systems within the present mental healthcare models used in Australia. The website merely states the problem without saying what systems are in place to deal with it from primary, secondary and tertiary levels (Australia government, 2013).
Raphael (2000) continues to advocate that secondary mental health is specialist care. They are expected to be provided by ‘psychiatrists, psychologists, mental health nurses, and specially trained social workers and occupational therapists’ (Raphael, 2000, p.18). Again there is no program in the Australia mental health care targeting youths specifically regarding this disorder. Distinctly, twenty-first century mental health youth disorder in Australia signals a substance abuse issue also. As such, it may be necessary to for Australia public health to develop a specialist substance abuse mental health youth project in adequately addressing the mental health since it a dual dysfunction superimposing on the other (Raphael, 2000).
At the tertiary level, mental health care moves into providing institutionalized services inclusive of housing even though specialist care may be lacking. Head space plays a very important role in providing services for youth through centers spreading across the nation. However, this allows only for 50% of clients; the remaining 50% go neglected lying on the streets and sometimes homeless (Rickwood, 2013).
Discussion of the involvement and roles of community nurse in health promotion that targets youth and young adults’ (15 to 25 years) mental health within a community setting in Australia.
There have been no specific programs by community health nurses in Australia targeting youth mental health issues. Maybe due to lack of funding public health approaches have been generalized. Headspace has always been more specific. Elsom, Happell and Manias (2008) conducted a survey regarding ‘expanded practice roles for community mental health nurses in Australia: confidence, critical factors for preparedness, and perceived barriers’ (Elsom, abstract, 2008).
Two hundred and ninety-six community mental health nurses employed in metropolitan and rural settings in Victoria, Australia were sampled. ‘Ninety-five percent agreed that extra educational preparation was necessary in relation to undertaking expanded practice roles successfully. Factors considered most strongly as barriers to expanded nursing practice included the medical profession, followed by fear of litigation, and government departments and policies’ (Elsom, abstract, 2008). This limitation exists while mental health nurses roles are expanding as consultants in secondary and tertiary level practices (McGorry, 2013).
In the meantime there exist issues pertaining to the supply, recruitment and retention of Australian mental health nurses. A task force summary analyzing the labor situation reported that mental health services are experiencing extreme difficulties maintain adequately experienced qualified nurses. As such, this creates greater pressure on public health in meeting apparent mental health needs depicted in the youth population substance abuse mental health crisis now facing the country (Piazza Consultants, 2003).

In highlighting the mental health youth crisis facing Australian youth that possible reasons for escalation of the crisis is adequate resources targeting this high risk population as well as available services to address this issue. Additionally, depletion in community health nurses intervention the problem is compounded. Hence, mental health is a National Health Priority in Australia, now.

Australia Government (2013). Mental Health. Retrieved on August 9th from, 2013
Elsom S, Happell B., & Manias E. (2008). Expanded practice roles for community mental health
nurses in Australia: confidence, critical factors for preparedness, and perceived barriers.
Issues Ment Health Nurs. 29 (7):767-8
Headspace (2013).With mental health being the single biggest health issue facing young
Australians, developing services which are able to offer early treatment is essential.
Retrieved on August 9th, 2013 from
Mental Illness Facts and Statistics (2013). Retrieved on August 9th from, 2013 from
McGorry P, Bates T., & Birchwood M. (2013). Designing youth mental health services for the
21st century: examples from Australia, Ireland and the UK. Br J Psychiatry Suppl.


Primary Prevention/Health Promotion Teaching Work Plan Research Paper Example

Primary Prevention/Health Promotion Teaching Work Plan Research Paper Example


These findings indicate that the average health conditions in South Orange Village Township are relatively better than those of the entire state. Nevertheless, there are inflated rates of obesity and diabetes in South Orange Township compared to the State averages. In respect of this finding, our group decided to design a Teaching Work Plan that would focus on primary prevention/health promotion, with a bid to enlighten the community on how they can prevent the cases of obesity and diabetes.

Primary prevention is the first level of health care activities, which are designed to prevent the occurrence of diseases and promote health.Primary prevention aims to support and promote good health, and eliminate or reduce factors that contribute to poor health. Preventive programmes have played a fundamental role in reducing rates of disease spread within our societies and across the world. The objectives of the CLC group Teaching Work Plan include:

Planning Before Teaching
The group has the following plans before the actual teaching work is carried out:
– Identifying/designing the most appropriate method of reaching as many of the community members as possible.
– Conducting public awareness campaigns before teaching work.
– Allocating time for the teaching activities.
– Apportionment of role among CLC group members.
– Preparation of teaching materials and other necessary facilities.
– Contacting the local administrative authorities for easier accessibility of the community.
– Securing means of transport for the group members.

Epidemiological Rationale for the topic
Our group has decided to focus on primary prevention measures for diseases such as obesity and diabetes, which were found to rate higher compared to the State averages.And with respect of this, the group shall teach the community about the causes, effects, and levels of obesity and diabetes in South Orange Township. This has been deemed important because the data by the has not been be accessed by a significant number of South Orange Community members. The group will also teach about the interrelationship between obesity and diabetes. In addition, the group will teach the community about the available primary prevention options that every household would find easier to practice, and importance of health promotion shall be emphasized.

Nursing Diagnosis
Nursing diagnosis shall be drawn from health promotion diagnosis perspective because these health conditions: diabetes and obesity, are attributed to poor feeding habits. From the finds, it could be concluded that there is general good health in South Orange Community because health issues have been well articulated.

Readiness for Learning
The group will assess the level of readiness for learning South Orange Community members by observing the level of participation among the community members. The community will be involved in discussion of the topic: their views will be collected and assessed to find out whether they match healthy living. Our group will also assess the degree of willingness by individuals to home health information given by the CLC group.

Learning Theory and Goals
The learning process will involve interaction between the CLC team and the community members. The group will lay out the guiding principles of interaction during the teaching work, where we shall take the guiding role, while the community members shall participate by contributing on the topic and seeking for clarifications. The goals for devising this method of interaction is to allow for participatory learning process; where the community members can feel comfortable to share information on health issues, and develop willingness to absorb new information. The key issues that will be discussed entail nutrition issues, with focus on developing healthy feeding patterns; this would help to reduce the rates of obesity and diabetes among the children and adults.The key goals of this work plan include:

Our group will devise teaching skills that would encourage interactive sessions with the community members. The group will incorporate question and answer sessions to allow room for making clarifications. Comments and recommendations from the community members will be welcomed for consideration in the policy making process.

Evaluation of Objectives, Goals, and Teacher
The group shall assess and ascertain whether the objectives and goals have been achieved by analyzing the responses by the community members about the call for health promotion. The teacher will be evaluated by observing the level of community participation induced by the teacher. Low level of community participation would indicate poor score for the teacher; information not well delivered to the community.

Barriers and Strategies to Overcome Barriers
The barriers that the CLC group would likely face in the community include difficulty in accessing the community members, insufficient time for teaching work, language barrier, bad weathers, and lack of willingness to participate by the community members. It was found out that in South Orange Township, the working population is very large; this would mean difficulty in assembling the community for teaching work because these people are so much involved in work. South Orange Village Township is fairly larger; therefore, much time would be needed to conduct a comprehensive health promotion education in the entire Village Township. The racial composition indicated that there is a mixture of people from different origins; this would create an element of language barrier, more so at the local level. South Orange is located at the boundary between humid continental and humid subtropical climate; this gives an impression that weather patterns would fluctuate at different times, thus affecting the smooth flow of the teaching process. In addition, certain individuals would not feel comfortable to participate in the health promotion education, especially the victims of the poor health conditions like the obese and diabetic persons, for fear of being ridiculed.
Therefore, the CLC group will organize the teaching activities both during the day and in the evening to cater for all. We will carry out health promotion/primary prevention education in areas of larger populations, and network to reach those who reside in areas of sparse population. This would allow for proper coverage of the Village Township. The group shall also assign interpreters to enable the dissemination of information to all and sundry. The teaching work will be conducted during good weather times to avoid hitches. The group will conduct public awareness campaign to enhance participation process. Members of the public will be informed about the education programme; they will be asked to feel free to participate in the programme, and emphasis will be laid on the importance the teaching programme.

Schulze , B. M., & Hu, B. F. (2005, April). PRIMARY PREVENTION OF DIABETES: What Can Be Done and How Much Can Be Prevented? Retrieved July 19, 2013, from
Buschman, H. (2011, August 15). How fat and obesity cause diabetes. Retrieved July 19, 2013, from