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For this case, the family comprises of five nuclear members and two extended family members. The nuclear family structure comprises of mother, father, 2 girls, and one boy. The extended family is made up of grandfather and grandmother. The nuclear family lives in a five-bedroomed house whereas the grandfather and grandmother live in a two-bedroomed house in the same compound as the nuclear family. The participants are all Caucasian with the eldest (grandfather) being 70 years old while the youngest person in this family is aged 12 years.
The family being studied belong to middle-class social status and lives in a neighborhood that is occupied by middle-class people, mostly Caucasians. The father in the nuclear family is a dentist while the mother is an early childhood teacher in a nearby private school. All the three children in the family attend the private school where their mother teaches. Both the grandfather and the grandmother are retired pensioners. Regarding spirituality, the family being studied attends church every Sunday at a nearby protestant church. The grandmother and the mother of the children are members of the church’s choir.
Also Read:
NRS 429 HEALTH PROMOTION IN MINORITY POPULATIONS SAMPLE PAPER
There are many notable health behaviors observed in this family. One of the health behaviors I noted immediately from the family is smoking tobacco. Both the grandfather and the father of the children are heavy smokers. However, no one else in the family uses tobacco apart from the two. Health behaviors are affected by collective actions (Fadlon, & Nielsen, 2019). Secondly, another notable health behavior in the family is obesity and overweight. Out of the seven family members, only two people, the boys and the mother are not overweight. Currently, no member of the family has become obese, however, if things continue as they are, then it is only a matter of time before obesity strikes.
In terms of mental health, all members of the family have stable mental health. There is no history of mental disorders. However, the father who is a dentist has a mild case of anxiety for which he gets medication. The first-born daughter also recently reported to her mother about being overly anxious. The girl is about to sit her final grade exams and is anxious about the results. The mother has scheduled for her to visit a doctor to control the anxiety. At this stage, it is impossible to conclude that the girl has anxiety problems. Apart from these mild cases of anxiety in the father and the first-born daughter, there is no history of mental illness in the family. All the family members especially the adults take physical exercises seriously. The grandmother and the grandfather run a few kilometers every day without fail. The mother and the father do physical exercises in the in-house gym before going to work.
One of the functional health patterns noted from the family is a strict diet of healthy foods. In my observation, I noticed each family member consuming at least 3 different varieties of fruits and vegetables each day. The family meals had high fiber content for example potatoes, pasta, bread, and rice. Additionally, the family consumed a lot of protein foods particularly beans, fish, meat, eggs, and pulses in moderate measure. Being a family where only two members out of seven are overweight, the family has taken to eating whole-food diets and low-carb foods.
Another functional health pattern in the family is regulated smoking and alcohol intake. Only two members of the family, grandfather and father, take alcohol and smoke tobacco. However, the two are not heavy smokers nor drinkers. This moderation in terms of alcohol intake and smoking is good but must be watched. Based on the moderate consumption of alcohol by the grandfather and the father, there is no immediate health risk surrounding these habits. However, care must be taken to reduce further intake of these substances. The daily exercises help to burn out the extra calories from the alcohol consumed.
The most critical barrier to health I noticed in the family being interviewed is the psychological barrier. The men in the family do not take any signs or symptoms seriously, even when they do, they do not seek medical attention as soon as possible because of the perception that it is unmanly to seek medication. The rest of the family indicated that the only reason they do not seek medication is due to fear. Some of them have a phobia for syringes, while others mentioned fear of the outcome as the major reason they do not seek medication sooner.
There were no barriers relating to financial, physical, language, or cultural. The family is in a good position financially and can afford treatment in some of the best healthcare facilities across the country. In terms of language, there are no language barriers that may hinder the family from seeking medication. Similarly, I did not observe any physical nor cultural barriers that would prevent them from seeking medical intervention if or when the need arises.
The theory of family systems is a human behavior theory that states that the interaction between family members influences each other’s behavior. In this approach, the family is perceived as a whole unit rather than individual people (Madisson et al., 2019). Taken in this context, from the family being interviewed, one can interpret that the behavior of a member has an impact on the behavior of the other family members (Erdem, & Safi, 2017). For example, if the children witness their father and grandfather smoking and drinking, they may pick up this behavior and perceive it as a normal thing.
It is critical to remember that a family is an emotional unit where individual members play specific roles and have to follow the set rules and regulations. Through these roles, clear patterns of behavior develop within the emotional unit. This factor means that depending on the relationship between family members, the behavior patterns can either build the family or lead to a dysfunctional family unit (Pratt, & Skelton, 2018). The family systems theory is important because even in family members that are disconnected, the family center/unit still holds a profound impact strong enough to influence the family’s actions and emotions. Based on this analogy, it means that individual behavior has an impact on the other members of the family (Alokozai et al., 2019). For the family being studied, whatever the route the family center chooses, the others are likely to act the same way. Positive actions by the center of the family lead to positive behavior by the rest of the family members. The reverse is also true.
The composition structure of any family has a profound impact on their behaviors and actions. Even though family members are made up of individuals with different personalities, the interaction between members of a family creates a degree of interdependence which affects the behavior of every family member. Each family member has a role bound within an emotional system where the behavior/actions of an individual member affect those of other members of the family. If the center of the family picks positive health habits, so will the rest of the family and vice versa.
Understanding family structure and style is essential to patient and family care. Conducting a family interview and needs assessment gathers information to identify strengths, as well as potential barriers to health. This information ultimately helps develop family-centered strategies for support and guidance.
This family health assessment is a two-part assignment. The information you gather in this initial assignment will be utilized for the second assignment in Topic 3.
Develop an interview questionnaire to be used in a family-focused functional assessment. The questionnaire must include three open-ended, family-focused questions to assess functional health patterns for each of the following:
Select a family, other than your own, and seek permission from the family to conduct an interview. Utilize the interview questions complied in your interview questionnaire to conduct a family-focused functional assessment. Document the responses as you conduct the interview.
Upon completion of the interview, write a 750-1,000-word paper. Analyze your assessment findings. Submit your questionnaire as an appendix with your assignment.
Include the following in your paper:
Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.
Objectives:
Discuss characteristics of successful students.
Assessment Description
Take a moment to explore your new classroom and introduce yourself to your fellow classmates. What are you excited about learning? What do you think will be most challenging?
Discuss why you have decided to complete your BSN at this time, and the concerns you have about completing your baccalaureate degree. Based on the readings in the course resources, what strategies can you implement to be a successful student?
Having two toddlers at home led me to the decision of staying home and caring for them at this time. So I couldn’t have come across a better timing even if I tried. Since I am at home with my babies, I decided to attain my bachelor’s degree. Don’t get me wrong, just cause I’m home does not mean I have free time, but I know if I don’t do it now, I never will. I also want to continue learning since I will not be putting my knowledge to good use with any patients at this time. So here I am now, ready and excited to continue my education.
Some concerns I have about completing this program are time management and writing papers. Without a doubt, I need to start planning my days and schedule time to complete my assignments. This is something that I have always wanted to do but never did time for it. I think that is the best way to be successful throughout my courses. As for writing papers, it has been a while since I did any, but I will try my best and learn from my mistakes as I go. I will also take advantage of the resources available to achieve a good grade in my course.
One strategy I will be implementing from 7 Habits of Highly Effective Nursing Student is becoming proactive. I tend to push until the end because of prioritizing care for my family. I will definitely be doing more delegating around my house. This will help me become more efficient at doing my assignments ahead of time. Therefore allowing enough time to ask questions if need be. This will be less stressful rather than waiting till the end.
List three examples of plagiarism and discuss how plagiarizing as a student affects the integrity of a baccalaureate degree, the public perception of the nursing profession, and evidence-based practice. Describe two things you will do to ensure academic integrity in your work.
According to the Plagiarism Tutorial, “Plagiarism is defined as the use of another person’s thoughts, ideas, words, quotations, or phrases without showing proper acknowledgement of where the information came from”. Three examples of plagiarism are using insufficient citations, copying another person’s work, or using their ideas as your own. I believe that plagiarism affects the integrity of the baccalaureate degree by devaluing the degree because institutions may think of the degree as easy to accomplish by just copying someone else’s work. Patients often look to nurses for guidance, knowledge and recommendations. If we as nurses do not take the time to really learn and understand medical material, how would we be able to teach and guide our patients?
Plagiarism also affects evidence-based practices, because if nurses practice what is considered best practice, but do not take the time to really examine, question and critically think about the outcomes, they may not catch flaws in the system in order to make improvements. It is important to always think and observe how the evidence- based practices are working for our current patients. Two things I will do to ensure academic integrity in my work will be to read and reread my work to make sure I cite and give credit to writings in which I’ve gathered information. I will continue to critically think and include my own thoughts and opinions on evidence based practices.
https://www.gcumedia.com/youtube/v2.1/?list=PLIP5_iaUyziU2URMjUIHGubHcy3GvGcLj
Define critical thinking and evidence-based practice. Discuss what critical thinking in nursing practice entails and explain why it is important. Discuss the role of critical thinking and evidence-based practice as they relate to patient outcomes.
As mentioned in Critical thinking: the development of an essential skill for nursing students journal, (2014) “Critical thinking according to Scriven and Paul is the mental active process and subtle perception, analysis, synthesis and evaluation of information collected or derived from observation, experience, reflection, reasoning or the communication leading to conviction for action”. Chapter 3 in Dynamics in Nursing Art & Science of Professional Practice defines evidence-based practice as, “the integration of clinical expertise, the most up-to-date research, and patient’s preferences to formulate and implement best practices for patient care”.
Critical thinking is a vital component of any health care professional’s job. The ability of a nurse to think critically is a fundamental aspect of nursing. It gathers all of the patient’s information and decides what will benefit their current medical situation. It allows a nurse to make the most suitable decisions for patients, resulting in the most favorable outcomes.
In order to provide the best care to our patients, it is essential to have the ability to critically think and use current evidence-based practice. Evidence-based practice is information research over time that has been demonstrated to be the most satisfactory patient outcome. The use injunction of critical thinking and evidence-based practice will support the development of effective nursing practices.
Dean, J. Dynamics in Nursing Art & Science of Professional Practice. Chapter 3 Practice and Competency Development. https://lc.gcumedia.com/nrs430v/dynamics-in-nursing-art-and-science-of-professional-practice/v1
Papathanasiou, I. V., Kleisiaris, C. F., Fradelos, E. C., Kakou, K., & Kourkouta, L. (2014). Critical thinking: the development of an essential skill for nursing students. Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH, 22(4), 283–286. https://doi.org/10.5455/aim.2014.22.283-286
Describe how the nursing profession is viewed by the general public. Discuss factors that influence the public’s perception of nursing? Describe ways to educate the general public on the professional nurse’s role and scope of nursing within a changing health care system.
The general public views the nursing profession as a profession of trust and respect, a profession where everyone in it is empathetic and noble. It is also perceived as an essential component in maintaining quality care for patients, especially in chronic illness.
One factor that influences the public’s perception of nursing is culture. For example, in the Chinese culture, the nursing profession is seen as a caregiver with a poor profession, but the most significant factor, especially nowadays, is the media. The media has portrayed the nursing profession as a problematic profession with no skills as a physician assistant.
Ways to educate the general public on the professional nurse’s role and scope of nursing within a changing health care system would be by using the media to portray an independent, knowledgeable, and skilled nurse. Reeducating or educating the new generation of physicians on the nurses’ role and how essential they are to run a smooth health care system. But overall, setting a good example for yourself by having work values and respect for all team members.
Berkowitz, B. (2019, December 16). Nurses in the Media. Columbia School of Nursing. Retrieved March 11, 2022, from https://www.nursing.columbia.edu/news/nurses-media
Ten Hoeve , Y., Jansen , G. J., & Roodbol , P. (n.d.). The nursing profession: Public … – wiley online library. Retrieved March 12, 2022, from https://onlinelibrary.wiley.com/doi/full/10.1111/jan.12177
The field of nursing has changed over time. In a 750?1,000 word paper, discuss nursing practice today by addressing the following:
You are required to cite a minimum of three sources to complete this assignment. Sources must be appropriate for the assignment and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Attachments
NRS-430V-CONHCPPhilosophy.docx
How has nursing practice evolved over time? Discuss the key leaders and historical events that have influenced the advancement of nursing, nursing education, and nursing roles that are now part of the contemporary nursing profession.
Example Topic 3 DQ 1 Amber Chavez
The Nursing Practice has evolved significantly over the years. I remember learning about Florence Nightingale during my first semester of nursing school. I thought it was amazing that a woman in the late 1830’s was called, by God, into service and had the ability to make such a huge impact on the profession and nursing as we know it to this day. According to Dynamics in Nursing, “at the time, British hospitals for soldiers did not employ female nurses, she was assigned to be the chief nurse of the hospital in Turkey” (Whitney, S.).
Something as simple as handwashing and keeping sanitary conditions, hugely impacted care and outcomes of soldiers. Technology has impacted nursing. Paper charts made it very difficult for healthcare teams to get on the same level because only one person could view the chart at a time. It would take longer for doctors to see labs. Medications that were not compatible were not easily flagged on a computer screen. IV poles could not monitor the flow of medication administration. Medicine will continue to evolve and in 10 years from now we will have unimaginable advances in healthcare.
Whitney, S. Dynamics in Nursing Art & Science of Professional Practice. Chapter 2. Retrieved from https://lc.gcumedia.com/nrs430v/dynamics-in-nursing-art-and-science-of-professional-practice/v1.1/#/chapter/2
Discuss the difference between a nursing conceptual model and a nursing theory.
Select a nursing theory and provide a concise summary of it. Provide an example in nursing practice where the nursing theory you selected would be effective in managing patient care.
In the article, “Using a conceptual model in nursing research-mitigating fatigue in cancer patients” it talks about how these two terms may be used interchangeably, however, a nursing theory will use part of a specific theory to use as the basis of the study. It includes statements where recommendations are made and it shows how the theory is proved or relevant, more so than a conceptual model would. A conceptual model would be considered more so of the organization for the framework of the actual research.
The nursing theory I would like to summarize is the Self-care theory by Dorothea E. Orem. This theory speaks of helping a patient preserve their autonomy when this becomes difficult after having a sickness or being affected by other life changing events. This is meant to help a patient continue having a good quality of life, stability and function on their own. I believe a good example would be with a patient that lost a limb. This patient would most likely want to initially depend on others to help with tasks because they are either scared or simply unfamiliar with what it would entail to live with, say, just one arm. Providing assistance and teaching these patients how to do these tasks one handed, how to get dressed, do self-care such as brushing their teeth or taking a shower, little things that will help them commence their independence are all effective.
Kim, H. S. P. R., & Kollak, I. P. R. (2005). Nursing theories : Conceptual and philosophical foundations, second edition. Springer Publishing Company. Retrieved from https://ebookcentral-proquest-com.lopes.idm.oclc.org/lib/gcu/reader.action?docID=291336
Mock, V., St Ours, C., Hall, S., Bositis, A., Tillery, M., Belcher, A., Krumm, S., & McCorkle, R. (2007). Using a conceptual model in nursing research–mitigating fatigue in cancer patients. Journal of advanced nursing, 58(5), 503–512. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505113/?viewType=Print&viewClass=Print
This is a Collaborative Learning Community (CLC) assignment.
This assignment is to be completed in a group, which will be assigned by your instructor. The presentation will be submitted and graded as a group assignment.
Nursing theories are tested and systematic ways to implement nursing practice. Select a nursing theory and its conceptual model. Prepare a 10?15 slide PowerPoint in which you describe the nursing theory and its conceptual model and demonstrate its application in nursing practice. Include the following:
You are required to cite a minimum of three sources to complete this assignment. Sources must be appropriate for the assignment and relevant to nursing practice.
Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Topic 4: Professional Accountability, Standards Of Practice, And Professional Development
Outline the process for the development of nursing standards of practice for your state, including discussion of the entities involved in developing the standards of practice and how the standards of practice influence the nursing process for your areas of specialty.
“Statement of Purpose
The Oklahoma Board of Nursing was established to safeguard the public health and welfare of the residents of Oklahoma by ensuring that any person who practices or offers to practice registered nursing, practical nursing, or advanced practice nursing in this state is competent to do so. The Board also ensures that any person who practices or offers to practice as an advanced unlicensed assistance person in this state is competent to do so. The Board accomplishes this purpose through the regulation of nursing licensure, unlicensed assistance certification, nursing practice and nursing education. The purpose, as defined in the Oklahoma Nursing Practice Act, supersedes the interests of any individual, the nursing profession or any special interest group.
General Functions of the Oklahoma Board of Nursing
Board Members
The Board is composed of eleven members appointed by the Governor – six are registered nurses, three are licensed practical nurses, and two are citizens of the State who represent the public. All members serve for a period of five years, with the Public Members serving co-terminously with the Governor. The officers of the Board are the President, Vice-President, and Secretary-Treasurer who are elected annually. “ (Oklahoma Board of Nursing)
Oklahoma Board of Nursing. (n.d.). Retrieved March 22, 2022, from https://nursing.ok.gov/about.html
Outline the concept of professional accountability as it pertains to nursing. Provide examples of how a nurse demonstrates professional accountability in clinical expertise, the nursing process, and evidence-based practice.
Review the Institute of Medicine’s 2010 report “The Future of Nursing: Leading Change, Advancing Health.” Write a 750?1,000 word paper discussing the influence of the IOM report on nursing practice. Include the following:
You are required to cite a minimum of three sources to complete this assignment. Sources must be appropriate for the assignment and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Professional Development of Nursing Professionals – Rubric
Collapse All Professional Development Of Nursing Professionals – RubricCollapse All
IOM Summary of Four Messages and Significance to Nursing Practice
40 points
Criteria Description
IOM Summary of Four Messages and Significance to Nursing Practice
40 points
Summary of the four messages outlined in the IOM report is clearly presented. A detailed explanation of why these are significant to nursing practice is presented. A strong understanding of the IOM report and its influence on nursing practice is demonstrated.
35.6 points
Summary of the four messages outlined in the IOM report is presented. Explanation of why these are significant to nursing practice is presented. Minor detail is needed for clarity.
31.6 points
Summary of the four messages outlined in the IOM report is presented. Explanation of why these are significant to nursing practice is generally presented. There are some inaccuracies. Some information or rationale is needed to fully support summary.
30 points
Summary of the four messages outlined in the IOM report is partially presented. Explanation of why these are significant to nursing practice is incomplete. There are significant inaccuracies.
0 points
Summary of the four messages outlined in the IOM report and explanation of why these are significant to nursing practice is omitted.
Influence of IOM on Education, Leadership, Benefits and Opportunities for BSN-Prepared Nurses
40 points
Criteria Description
Influence of IOM on Education, Leadership, Benefits and Opportunities for BSN-Prepared Nurses
40 points
The direct influence of the IOM report on nursing education and nursing leadership is thoroughly discussed. The benefits and opportunities for BSN-prepared nurses resulting from the IOM report are described in detail. Overall, an in-depth understanding of the IOM report and its influence on nursing is demonstrated.
35.6 points
The direct influence of the IOM report on nursing education and nursing leadership is discussed. The benefits and opportunities for BSN-prepared nurses resulting from the IOM report are described. Overall, an understanding of the IOM report and its influence on nursing is demonstrated.
31.6 points
The direct influence of the IOM report on nursing education and nursing leadership is summarized. Some benefits and opportunities for BSN-prepared nurses resulting from the IOM report are generally described. Overall, a general understanding of the IOM report and its influence on nursing is demonstrated.
30 points
The direct influence of the IOM report on nursing education and nursing leadership is partially presented. Some benefits and opportunities for BSN-prepared nurses resulting from the IOM report are summarized. There are inaccuracies.
0 points
The direct influence of the IOM report on nursing education, nursing leadership, and the benefits and opportunities for BSN-prepared nurses is not discussed.
Education and Role of the Nurse to Meet the Needs of an Aging and Diverse Population
40 points
Criteria Description
Importance of the Evolution of the Education and Role of the Nurse to Meet the Needs of an Aging and Diverse Population
40 points
A thorough explanation the importance of the evolution of the education and role of the nurse to meet the needs of an aging and diverse population is presented. The explanation demonstrates a clear understanding of the role of the nurse in meeting the needs of an aging and diverse population.
35.6 points
An explanation of the importance of the evolution of the education and role of the nurse to meet the needs of an aging and diverse population is presented. Some detail is needed for clarity.
31.6 points
A summary of the importance of the evolution of the education and role of the nurse to meet the needs of an aging and diverse population is presented. Some information is needed to fully support explanation.
30 points
A partial explanation the importance of the evolution of the education and role of the nurse to meet the needs of an aging and diverse population is presented. There major are inaccuracies.
0 points
The importance of the evolution of the education and role of the nurse to meet the needs of an aging and diverse population is not presented.
Significance of Professional Development, Lifelong Learning, in Relation to Diverse Populations
40 points
Criteria Description
Significance of Professional Development, Lifelong Learning, in Relation to Diverse Populations Across the Life Span and Health-Illness Continuum
40 points
The significance of professional development, or lifelong learning, and its relevance in caring for diverse populations across the life span and within the health-illness continuum is discussed in detail. The relevance of professional development in caring for diverse populations across the life span and within the health-illness continuum is demonstrated.
35.6 points
The significance of professional development, or lifelong learning, and its relevance in caring for diverse populations across the life span and within the health-illness continuum is discussed. Some detail is needed for clarity.
31.6 points
The significance of professional development, or lifelong learning, and its relevance in caring for diverse populations across the life span and within the health-illness continuum is summarized. Some rationale or evidence is needed for support.
30 points
The significance of professional development, or lifelong learning, and its relevance in caring for diverse populations across the life span and within the health-illness continuum is incomplete. There are major inaccuracies
0 points
The significance of professional development, or lifelong learning, and its relevance in caring for diverse populations across the life span and within the health-illness continuum is not discussed.
Effectiveness of Nurses Managing Patient Care Within an Evolving Health Care System
40 points
Criteria Description
Effectiveness of Nurses Managing Patient Care Within an Evolving Health Care System
40 points
A through discussion of how nurses can assist in effectively managing patient care within an evolving health care system is presented. The discussion offers compelling rationale and demonstrates insight into managing patient care within contemporary health care.
35.6 points
A discussion of how nurses can assist in effectively managing patient care within an evolving health care system is presented. Minor detail or rationale is needed.
31.6 points
A general discussion of how nurses can assist in effectively managing patient care within an evolving health care system is presented. Some rationale or evidence is needed for support.
30 points
A partial
The qualitative material is vast and occasionally overwhelming. Two methods that would aid in managing and organizing the data for a researcher are creating a clear identification system and coding. For example
Within the Shadow Health platform, complete the Focused Exam: Cough Results. The estimated average time to complete this assignment each time is 1 hour and 15 minutes. Please note, this is an average time. Some students may need longer.
This clinical experience is a focused exam. Students must score at the level of “Proficiency” in the Shadow Health Digital Clinical Experience. Students have three opportunities to complete this assignment and score at the Proficiency level. Upon completion, submit the lab pass through the assignment dropbox.
Each of you will be completing a Shadow Health Assessments each week. You will need to sign into the account, and please make sure you register under the correct date. You will get all your information under the Course Materials.
If you have problems signing in, you will need to call the Help Desk for them. Make sure you are reading the rubric for each Shadow Health assignment, because sometimes you will only have 1 try to pass, and other times you may only have 3, but with significant point reduction each try.
You do not need a PIN to sign in. Go to PATH, then Course Material. You will see: Shadow Health Digital Clinical Experience. Go there and follow the instructions. Thanks
Please upload all assignment completions under your assignment due area. Thanks
If Proficiency is not achieved on the first attempt, it is recommended that you review your answers with the correct answers on the Experience Overview page. Review the report by clicking on each tab to the left titled Transcript, Subjective Data Collection, Objective Data Collection, Documentation, and SBAR to compare your work. Reviewing this overview and the course resources may help you improve your score.
Please review the assignment in the Health Assessment Student Handbook in Shadow Health prior to beginning the assignment to become familiar with the expectations for successful completion. You are not required to submit this assignment to LopesWrite.
Scored Items
Not Scored
Finding: Established chief complaint
Finding: Reports cough (Found)
Pro Tip: Asking a patient broadly about their chief complaint allows them to answer in their own words and confirm information that you may have already received from another source.
Example Question: Do you have a cough?
Finding: Reports cough started 3 days ago (Found)
Pro Tip: Whenever you are assessing a symptom or a health condition, in this case the patient’s cough, inquiring about onset assesses the severity and the progression of the problem.
Example Question: How long have you had a cough?
Finding: Reports cough is wet (Available)
Pro Tip: The characteristics of a cough, such as whether it is dry or wet, can indicate key information about the type of illness the patient has.
Example Question: Is your cough a wet cough?
Finding: Reports clear sputum with cough (Available)
Pro Tip: The characteristics of a cough, such as whether it is productive, can indicate key information about the type of illness the patient has.
Example Question: Do you produce any phlegm or sputum with your cough?
Finding: Reports coughing every few minutes (Available)
Pro Tip: Establishing how frequently Danny coughs will illustrate how long he has been suffering these particular symptoms and might indicate possible triggers.
Example Question: How frequently are you coughing?
Finding: Reports coughs last a few seconds (Available)
Pro Tip: Establishing how long Danny’s coughs last will illustrate how long he has been suffering these particular symptoms and might indicate possible triggers.
Example Question: How long do your coughs last?
Finding: Reports cough is worse at night (Available)
Pro Tip: Establishing a timeline for Danny’s coughing will illustrate how long he has been suffering these particular symptoms and might indicate possible triggers.
Example Question: Is the cough worse at night?
Finding: Denies smoking (Available)
Pro Tip: Tobacco use puts the patient at risk for many medical conditions. Asking even young patients about whether they consume tobacco products helps you assess this risk factor.
Example Question: Do you smoke?
Finding: Reports being exposed to secondhand smoke through father (Available)
Pro Tip: Tobacco use puts the patient at risk for many medical conditions. Asking about whether a patient is exposed to secondhand smoke allows you to assess this risk factor.
Example Question: Are you ever around cigarette smoke?
Finding: Reports he doesn’t know what triggers the cough (Available)
Pro Tip: Asking about aggravating factors of Danny’s cough will allow you to determine potential causes and educate the patient on what to avoid.
Example Question: What makes your cough worse?
Finding: Reports cough is temporarily relieved by cough medicine (Found)
Pro Tip: Asking about how the patient has been managing their pain assesses their current condition and their approach to self-care. The results of their previous treatment may be helpful in your diagnosis and the development of their new treatment plan, as well as a good opportunity to educate the patient on effective self-care practices.
Example Question: Have you done anything to treat your cough?
Finding: Reports cough medicine was purple (Available)
Pro Tip: The type of cough medicine a patient takes, and how they take it, can impact its effectiveness. Following up on the cough medicine’s color may help you identify the type of medication it is.
Example Question: What color was the cough medicine?
Finding: Reports taking one spoonful of cough medicine (Available)
Pro Tip: The type of cough medicine a patient takes, and how they take it, can impact its effectiveness. Following up on the dose of cough medicine allows you to determine whether it is being taken correctly.
Example Question: How much medicine did you take?
Finding: Reports mother gave him the medicine (Found)
Pro Tip: Children should only take medication under the supervision of an adult who can assure it is taken as directed. You should ask younger patients whether the medicine was given to them and by whom.
Example Question: Who gave you the medicine for your cough?
Finding: Reports only took the medicine this morning (Found)
Pro Tip: The type of cough medicine a patient takes, and how they take it, can impact its effectiveness. Following up on the frequency Danny took cough medicine allows you to determine whether it is being taken correctly.
Example Question: How many times have you taken the cough medicine? Shadow Health: Focused Exam: Cough Results Danny Riviera
Finding: Denies home remedies (Available)
Pro Tip: Patients sometimes try non-medicinal home remedies to treat coughs, such as breathing steam, or drinking tea with honey. Not all home remedies are effective or advisable, so it’s important to find out what remedies the patient has tried.
Example Question: Have you tried any home remedies for your cough?
Finding: Denies taking medication (Available)
Pro Tip: Knowing a patient’s current medication regimen helps you determine if any future treatments will be safe and effective.
Example Question: Do you take any medications from a doctor?
Finding: Reports taking daily vitamin (Available)
Pro Tip: Some symptoms can occur as a result of a vitamin deficiency, and others as a result of vitamin excess. Vitamins can also interfere with some treatments, so it’s important to know what your patient is taking.
Example Question: Do you take vitamins?
Finding: Reports typical high activity level (Available)
Pro Tip: Establishing a patient’s typical activity level is an important baseline to help you determine how an illness is affecting his life.
Example Question: Are you usually active?
Finding: Reports activity level low since getting sick (Available)
Pro Tip: Establishing a patient’s activity level, and whether it has been impacted since becoming ill, is an important baseline to help you determine how an illness is affecting his life.
Example Question: Have you been less active since getting sick?
Finding: Reports still able to run or play (Available)
Pro Tip: Ability to remain active indicates that the patient’s breathing is not dangerously affected, and that the patient isn’t seriously fatigued.
Example Question: Are you able to keep up when you play with your classmates?
Finding: Reports focusing in class is difficult (Available)
Pro Tip: Mental lethargy and difficulty concentrating are common symptoms when a patient is sick.
Example Question: Are you able to focus in class?
Finding: Reports current runny nose (Found)
Pro Tip: Asking your patient if his nose is running will allow you to determine the symptoms he is experiencing and possible triggers.
Example Question: Do you currently have a runny nose?
Finding: Denies sneezing (Available)
Pro Tip: Asking your patient if he has been sneezing will allow you to determine the symptoms he is experiencing and possible triggers.
Example Question: Have you been sneezing?
Finding: Reports nasal discharge is clear (Available)
Pro Tip: The color of a patient’s nasal discharge can provide you key information as to the type of condition the patient has.
Example Question: What color is your snot?
Finding: Reports nasal discharge is thin (Available)
Pro Tip: The consistency of a patient’s nasal discharge can provide you key information as to the type of condition the patient has.
Example Question: What is the consistency of your nasal discharge?
Finding: Denies ear pain (Available)
Pro Tip: Ear pain is often coincident with coughs and sinus problems. Asking about them allows you to ascertain if Danny needs follow-up care for his ears.
Example Question: Do you have any ear pain?
Finding: Reports history of frequent ear infections (Available)
Pro Tip: Asking about Danny’s history of ear infections allows you to ascertain his risk for current and future ear infections.
Example Question: Have you ever had ear infections?
Finding: Denies ear discharge (Available)
Pro Tip: Asking Danny about ear discharge, which are often coincident with of ear infections, allows you to ascertain his risk for current and future ear infections.
Example Question: Do you have any ear discharge?
Finding: Denies hearing problems (Available)
Pro Tip: Simply talking with the patient assesses his hearing; however, some types of hearing loss are only apparent in specific settings such as noisy environments. Asking the patient about hearing problems identifies conditions that may not be readily apparent.
Example Question: Do you have any hearing problems? Shadow Health: Focused Exam: Cough Results Danny Riviera
Finding: Reports sore throat (Available)
Pro Tip: Sore throats are often coincident with coughs and sinus problems. Asking about them allows you to ascertain if Danny needs follow-up care for his throat.
Example Question: Is your throat sore?
Finding: Reports a little pain with swallowing (Available)
Pro Tip: Pain when swallowing helps you understand how severe the patient’s sore throat is.
Example Question: Does it hurt when you swallow?
Finding: Reports frequent runny noses (Available)
Pro Tip: Asking how often Danny experiences runny noses like the one he has now may help you determine the source of the problem.
Example Question: Do you get runny noses often?
Finding: Reports past frequent coughs (Available)
Pro Tip: A patient experiencing a cough should be asked about their history of coughs so you can determine whether their current condition fits into a recurring pattern.
Example Question: Do you have coughs very often?
Finding: Reports past pneumonia (Available)
Pro Tip: Pneumonia is a serious medical condition that can be life-threatening if not managed appropriately. Regardless of the patient’s presenting illness, it is critical to identify current medical conditions in order to treat the patient appropriately. Specific questions should be asked about previous medical problems, even if the patient doesn’t notice current symptoms.
Example Question: Have you had pneumonia?
Finding: Denies asthma diagnosis (Available)
Pro Tip: Asthma is a serious medical condition that can be life-threatening if not managed appropriately. Regardless of the patient’s presenting illness, it is critical to identify current medical conditions in order to treat the patient appropriately. Specific questions should be asked about previous medical problems, even if the patient doesn’t notice current symptoms.
Example Question: Do you have asthma?
Finding: Reports immunizations as current (Available)
Pro Tip: A health assessment should include an evaluation of the patient’s immunization status in order to identify diseases to which the patient is vulnerable.
Example Question: Do you have current immunizations?
Finding: Denies seasonal allergies (Available)
Pro Tip: Seasonal allergies can cause symptoms like runny nose, cough, and discomfort. Asking Danny if he has seasonal allergies can help you to ascertain possible triggers for symptoms.
Example Question: Do you have seasonal allergies?
Finding: Denies food allergies (Available)
Pro Tip: Knowing if your patient has food allergies is important and relevant medical history. Asking your patient about food allergies will allow you to most effectively treat him.
Example Question: Do you have food allergies?
Finding: Denies medication allergies (Available)
Pro Tip: Knowing if your patient has allergies to medicine is important and relevant medical history. Asking your patient about medicine allergies will allow you to most effectively treat him.
Example Question: Are you allergic to any medication?
Finding: Reports father has history of asthma (Available)
Pro Tip: Medical problems such as asthma that are present in a patient’s immediate family can represent increased risk factors to respiratory conditions such as the ones the patient currently has.
Example Question: Do you have a family history of asthma?
Finding: Denies family history of allergies (Available)
Pro Tip: Medical problems such as allergies that are present in a patient’s immediate family can represent increased risk factors to respiratory conditions such as the ones the patient currently has.
Example Question: Do you have a family history of allergies?
Finding: Denies chills (Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has chills will illustrate the way his symptoms manifest.
Example Question: Do you have chills?
Finding: Denies fever (Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has a fever will illustrate the way his symptoms manifest.
Example Question: Do you have a fever?
Finding: Reports feeling somewhat fatigued (Found)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has fatigue will illustrate the way his symptoms manifest.
Example Question: Do you have fatigue?
Finding: Denies night sweats (Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has night sweats will illustrate the way his symptoms manifest.
Example Question: Do you have night sweats?
Finding: Reports cough makes it difficult to sleep (Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has had difficulty sleeping will illustrate the way his symptoms manifest.
Example Question: Have you been sleeping okay?
Finding: Denies swelling (Available)
Pro Tip: Soliciting a shallow history of your patient’s symptoms will help you to most effectively treat him. Asking Danny if he has had swelling will illustrate the way his symptoms manifest.
Example Question: Have you noticed any swelling?
Finding: Reports frequent colds (Available)
Pro Tip: A patient such as Danny who is presenting with a cough and a runny nose may have a cold, so you should ask about his history of colds to determine whether this is part of a larger pattern.
Example Question: Do you have unusually frequent colds?
Finding: Denies headaches (Available)
Pro Tip: Headaches are a common complaint that can be caused by a variety of benign conditions. However, headaches can be an indicator of serious underlying neurological conditions such as cerebral hemorrhage, meningitis, or brain tumors. They may also be a symptom of sinus infection.
Example Question: Do you get headaches?
Finding: Denies nosebleeds (Available)
Pro Tip: When a patient presents with symptoms that are often seen with respiratory infections, you should ask about similar signs of respiratory infections such as nosebleeds.
Example Question: Do you have nosebleeds?
Finding: Denies vision difficulty (Available)
Pro Tip: Eye or vision problems can lower one’s ability to function and can be a major safety risk.
Example Question: Do you have any problems with your vision?
Finding: Denies dizziness (Available)
Pro Tip: Asking about dizziness helps you assess the risk for inner ear, neurological, or cardiovascular problems.
Example Question: Do you have any dizziness?
Finding: Denies watery eyes (Available)
Pro Tip: Whether a patient has watery eyes may help you indicate the type of sinus problem he is experiencing.
Example Question: Do you have watery eyes?
Finding: Denies eye redness (Available)
Pro Tip: Whether a patient has eye redness may help you indicate the type of sinus problem he is experiencing.
Example Question: Do you have eye redness?
Finding: Denies eye pain (Available)
Pro Tip: Eye pain can lower one’s ability to function and can be a major safety risk.
Example Question: Do you have any eye pain?
Finding: Denies sinus pain (Available)
Pro Tip: Patients with sinus problems such as a runny nose may be at greater risk for sinus pain.
Example Question: Do you have any sinus pain?
Finding: Denies chest tightness (Available)
Pro Tip: Chest pain may indicate cardiac conditions, muscular inflammation, gastric upset, or respiratory distress. If chest tightness is present, asking about its location, characteristics, and related factors helps to determine the cause of the discomfort.
Example Question: Do you have chest tightness?
Finding: Denies chest pain (Available)
Pro Tip: Chest pain may indicate cardiac conditions, muscular inflammation, gastric upset, or respiratory distress. If chest pain is present, asking about its location, characteristics, and related factors helps to determine the cause of the discomfort.
Example Question: Do you have any chest pain?
Also Read:
NRS-434VN Topic 1: The Health Assessment of Infants
NRS 434 Topic 2: Health Assessment of the Toddler, Preschool, and School-Aged Child
NRS 434 Patient Safety: Help Patients Understand
Nrs 434 Infant Assessment
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.
Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
Communication is so very important. There are multiple ways to communicate with me:
Qualitative data have been described as voluminous and sometimes overwhelming to the researcher. Discuss two strategies that would help a researcher manage and organize the data.
JANAE
In qualitative research, non-numerical data are gathered and analyzed
This NRS-445 Nursing Research and Evidence Based Practice Course is a writing-intensive course that promotes the use of research findings as a basis for improving clinical practice. Quantitative and qualitative research methodologies are analyzed with an emphasis on the critical review of research studies and their application to clinical practice. Students develop evidence-based practice recommendations from the critical analysis of available literature guided by a PICOT question. Prerequisite: HLT-362V.
The nursing practice involves addressing various healthcare issues and challenges that affect patient care, healthcare providers, and healthcare systems. Among these challenges are non-adherence to tuberculosis (TB) treatment and job stress experienced by nurses. Non-adherence to TB treatment is a significant global health concern. At the same time, job stress is a substantial issue in the nursing profession that can affect patient care quality and nurse well-being. This paper aims to synthesize and compare the findings of four recent research studies that explore factors influencing TB treatment adherence and coping strategies for job stress among nurses. The paper will critically appraise the studies to support evidence-based practice in addressing these healthcare challenges.
In patients diagnosed with tuberculosis (TB) and nurses experiencing job stress (P), what interventions (I) can be implemented to improve patient adherence to TB regimen and nurses’ well-being (O) within six months (T) considering individual and social vulnerabilities such as job stress, economic precariousness, stigma, medication side effects, and lack of knowledge compared to standard care alone or no intervention (C)?
The first article, a qualitative study, analyzed nurses’ coping process with job stress. The study utilized a grounded theory approach to identify four axial concepts and a core variable constituting the coping process (Eslami et al., 2017). The study discovered that the context-based nature of coping processes in nurses was crucial in reducing the adverse effects of coping.
In the second article, the role of mindfulness in reducing stress among healthcare providers was examined. The study aimed to investigate the association between the change in non-reactivity to inner experience after Mindfulness-Based Stress Reduction (MBSR) and the adjusted changes in perceived stress among healthcare providers (Benzo et al., 2018). The study’s findings revealed that non-reactivity to inner experience was an essential aspect of MBSR that was independently associated with a change in perceived stress in healthcare providers.
The third article is a qualitative study investigating patients’ perceptions of individual and social vulnerabilities affecting their adherence to tuberculosis treatment in a large municipality in northeastern Brazil (Da Silva et al., 2017). The study found that social exclusion, stigmatization, economic insecurity, and poor access to transportation were significant barriers to adherence.
The fourth study, conducted in Asmara, Eritrea, aimed to identify factors influencing patients’ adherence to tuberculosis treatment. The study involved focus groups, in-depth interviews with patients, and key informant interviews with healthcare providers (Gebreweld et al., 2018). The study identified several factors that worked against patients staying on their prescribed treatment. The four studies provide valuable insights into interventions that can be implemented to improve patient adherence to tuberculosis regimens and nurses’ well-being while considering individual and social vulnerabilities, which are of great significance to nursing.
The four articles provide valuable information that can be used to answer the PICOT question about interventions that can improve patient adherence to TB regimens and nurses’ well-being in the context of job stress and other individual and social vulnerabilities. The first article’s findings on the coping process of nurses with job stress can help develop interventions that address nurses’ coping strategies. The second article’s focus on mindfulness-based interventions can inform interventions aimed at reducing stress among healthcare providers. The study’s findings can help develop interventions that improve nurses’ well-being and reduce stress in the workplace.
The third article’s qualitative study on patients’ perceptions of individual and social vulnerabilities can help develop interventions that address these vulnerabilities and facilitate adherence to tuberculosis treatment. The fourth article’s focus on identifying factors influencing patient adherence to tuberculosis treatment can help develop interventions that address these factors. The findings of the four studies can be used to compare the effectiveness of the interventions against standard care alone or no intervention, as per the PICOT question.
While not all articles provide interventions that directly address the PICOT question, the insights provided by the studies can be used to develop interventions that improve patient adherence to TB regimen and nurses’ well-being in the context of job stress and other individual and social vulnerabilities. The interventions and comparison groups identified in the articles can be adapted and compared to standard care alone or with no intervention as per the PICOT question.
The first study used a qualitative grounded theory approach, while the second used a quantitative methodology. The third and fourth studies also used qualitative methods. However, the third used a qualitative descriptive cross-sectional study design, while the fourth used a combination of in-depth interviews, focus groups, and key informant interviews. One benefit of the grounded theory approach used in the first study is that it allows for developing a theory grounded in the data collected. However, a limitation is that the sample size may be small, which could limit the generalizability of the findings.
In the second study, a benefit of using a quantitative methodology is that it can provide objective, numerical data that can be analyzed statistically to make generalizations. However, a limitation is that it may need to capture the nuances and complexities of the phenomenon being studied (Bhandari, 2020). A benefit of the qualitative descriptive cross-sectional study design used in the third study is that it allows for an in-depth exploration of complex phenomena and provides rich, detailed data.
However, a limitation is that it may not be suitable for examining causal relationships. In the fourth study, a benefit of using a combination of in-depth interviews, focus groups, and key informant interviews is that it allows for a more comprehensive understanding of the phenomenon being studied from multiple perspectives. However, a limitation is that the small sample size may limit the generalizability of the findings to other settings beyond Asmara, Eritrea.
The first study focuses on nurses and their coping mechanisms for job stress. The study found that individual and extrinsic factors can affect coping processes and lead to stress reduction and occupational health issues. The second study looks at the effectiveness of mindfulness practices in reducing perceived stress among healthcare providers. Completing an MBSR program significantly reduced stress and improved overall quality of life. Non-reactivity and mindfulness of emotions were strongly associated with reduced perceived stress.
The third qualitative study explored the barriers and enabling factors to adherence in patients with chronic illnesses. The study identified social stigma, prejudice, and discrimination as significant barriers to adherence, medication side effects, work incapacity, malnutrition, and alcoholism. On the other hand, support from family members, health professionals, and faith and religiosity were enabling factors for adherence.
The fourth study investigates factors influencing adherence to tuberculosis treatment in Asmara, Eritrea. The study found various factors affecting adherence, including a lack of knowledge about the disease, transportation issues, loss of income, social factors, drug side effects, and extended treatment periods. These studies have implications for nursing practice. The studies indicate that nursing practice can benefit from incorporating coping mechanisms for job stress, mindfulness practices for self-care, addressing barriers to treatment adherence, and identifying enabling factors that support adherence.
Ethical considerations in research are vital to protect participants’ well-being, rights, and privacy. This includes obtaining informed consent, maintaining confidentiality, and minimizing risks (Bhandari, 2021). The four studies followed ethical guidelines by obtaining informed consent, ensuring anonymity, and providing debriefing and follow-up sessions. The research ethics committees also approved their projects, while participants were informed of their right to withdraw at any time.
The anticipated outcomes for the PICOT question revolve around improving patient adherence to tuberculosis treatment regimens and the well-being of nurses. Specifically, the desired outcomes include improved patient adherence, improved nurses’ well-being, and job satisfaction, reduced adverse effects of job stress on patient care, increased patient knowledge about the importance of adherence, increased social support for patients with tuberculosis, reduced stigma and social exclusion experienced by patients with tuberculosis, and reduced medication side effects and financial hardships for patients with tuberculosis.
The four studies selected provide insights into interventions that can be implemented to achieve these outcomes. The first two studies focus on improving nurses’ well-being and job satisfaction by understanding their coping processes and the effectiveness of mindfulness-based interventions. These interventions can positively impact patient care and adherence to tuberculosis treatment regimens by reducing the negative effects of job stress.
The third and fourth studies highlight the importance of patient perceptions of individual and social vulnerabilities that affect their adherence to treatment and the critical role of social support, education, and effective communication with healthcare providers in improving patient adherence to tuberculosis treatment regimens. Interventions to provide social support, reduce stigma and social exclusion, and address medication side effects and financial hardships can improve patient adherence to treatment and overall health outcomes.
The PICOT question is focused on interventions that can improve patient adherence to TB regimen and nurses’ well-being in the context of job stress and other individual and social vulnerabilities. The four research articles provide valuable insights into the coping processes of nurses, mindfulness-based interventions for reducing stress among healthcare providers, patients’ perceptions of individual and social vulnerabilities affecting adherence to tuberculosis treatment, and factors influencing patient adherence to tuberculosis treatment. These insights can be used to develop interventions that address these issues and improve patient adherence to TB regimens and nurses’ well-being.
Based on the information provided, a proposed evidence-based practice change is implementing a mindfulness-based stress reduction (MBSR) program for nurses working with tuberculosis patients. The program will address individual and social vulnerabilities affecting nurses’ well-being and patient adherence to treatment. The MBSR program includes mindfulness practices, such as body scans, sitting and walking meditation, and mindful breathing (Kriakous et al., 2021). The program will also include education on coping strategies, stress reduction techniques, and communication skills for effectively addressing patients’ concerns and needs.
The program will be evaluated by comparing the effectiveness of the program against standard care alone or no intervention in improving patient adherence to the TB regimen and nurses’ well-being within six months. The program will also be adapted and implemented in other healthcare settings to improve healthcare providers’ well-being and patient outcomes.
Nursing practice faces various healthcare challenges, including non-adherence to tuberculosis (TB) treatment and job stress experienced by nurses. This paper has reviewed four recent research studies that explore factors influencing TB treatment adherence and coping strategies for job stress among nurses. The findings of the studies provide valuable insights into interventions that can be implemented to improve patient adherence to TB regimens and nurses’ well-being while considering individual and social vulnerabilities.
Although the studies utilized different methodologies, they all contribute to evidence-based practice in addressing healthcare challenges. The paper’s insights can be used to develop interventions that improve patient adherence to TB regimen and nurses’ well-being in the context of job stress and other individual and social vulnerabilities.
Benzo, R. P., Anderson, P. M., Bronars, C., & Clark, M. (2018). Mindfulness for healthcare providers: The role of non-reactivity in reducing stress. EXPLORE, 14(6), 453–456. https://doi.org/10.1016/j.explore.2018.03.008
Bhandari, P. (2020, June 12). What is quantitative research? | definition, uses, and methods. Scribbr. https://www.scribbr.com/methodology/quantitative-research/
Bhandari, P. (2021, October 18). A guide to ethical considerations in research. Scribbr. https://www.scribbr.com/methodology/research-ethics/
Da Silva, R. D., de Luna, F. D. T., de Araújo, A. J., Camêlo, E. L. S., Bertolozzi, M. R., Hino, P., Lacerda, S. N. B., Fook, S. M. L., & de Figueiredo, T. M. R. M. (2017). Patients’ perception regarding the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment: A qualitative study. BMC Public Health, 17(1). https://doi.org/10.1186/s12889-017-4752-3
Eslami Akbar, R., Elahi, N., Mohammadi, E., & Fallahi Khoshknab, M. (2017). How do nurses cope with job stress? A study with grounded theory approach. Journal of Caring Sciences, 6(3), 199–211. https://doi.org/10.15171/jcs.2017.020
Gebreweld, F. H., Kifle, M. M., Gebremicheal, F. E., Simel, L. L., Gezae, M. M., Ghebreyesus, S. S., Mengsteab, Y. T., & Ward, N. G. (2018). Factors influencing adherence to tuberculosis treatment in Asmara, Eritrea: A qualitative study. Journal of Health, Population, and Nutrition, 37(1). https://doi.org/10.1186/s41043-017-0132-y
Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2021). The effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: A systematic review. Mindfulness, 12(1). https://doi.org/10.1007/s12671-020-01500-9
In this GCU NRS-450 Nursing Informatics Course, the focus is on the methods and technologies used to acquire, process, and analyze patient data, emphasizing information and communication technologies that support the documentation of care and effective communication among health team members at all system levels. Essentially, this course provides students with an understanding of the importance of professional and ethical standards pertaining to the regulation and security of health information.
McGonigle and Mastrian (2021) define nursing informatics as the nursing subspecialty that enables nurses to master data, information, know-how, and wisdom through subspecialties that combine nursing science with information and computer science (p.56). Information technology has changed nursing care and transformed healthcare practice by assisting care delivery, supplementing decision-making, and predicting future trends in care using data. Technology’s potential to improve patient safety and quality of care is enormous (Schoenbaum & Carroll, 2020).
However, technology keeps advancing, and better methods are being incorporated into practice. However, these technologies still require human interaction and human input to influence patient care. This proposal describes the role of a nurse informaticist, especially in an interdisciplinary team, explains the impact of full nurse engagement in technology, and finally suggests opportunities and predicts challenges that including a nurse informaticist in an interdisciplinary team creates.
Recent developments in healthcare, including the COVID-19 pandemic, opened our eyes to the need to harness the potential of technology in making healthcare efficient and meeting the needs of many patients remotely. Before this, the National League for Nursing, through their new vision, had urged nursing education programs to teach and prepare them for practice in the era of healthcare technologies (McBride & Tietze, 2022). However, the workload from clinician care needs and care efficiency needs can overwhelm the individual nurses, thus the need for interdisciplinary collaboration.
Nurse informaticists are specialists trained with scientific and artistic knowledge and skills in utilizing data science to influence care through communication, decision-making, and daily monitoring workflow in healthcare systems. Their role is crucial in an interdisciplinary team approach to care because they enable the interdisciplinary teams to work efficiently. Nurse informaticists can influence policymaking and implementation, technical capacity, and patient outcomes.
Nurse informaticists have played an essential role in selecting and implementing appropriate technologies to meet patient care needs in various hospitals. Enhancing technology usability by matching user needs and vendor software features is another way nurse informaticists have ensured that organizations get worth for their expenditures on technologies and that patients have received safe care by using appropriate, safe, and high-yield technologies.
Various institutions have implemented the informaticist role in the clinical and administrative care hierarchies. Nurse informaticists support other nurses, healthcare professionals, patients, and other stakeholders by enabling information structures, processes, and technologies. According to McBride and Tietze (2022), nurse informaticists have improved patient safety and reduced care-associated costs (P.10). The achievements of these outcomes have been possible through safe medication administration systems using technology, predicting patient care changes through the prediction of patterns of previous outcomes, and easy documentation, retrieval and access of patient records.
Nursing Education for the Healthcare Informatics (NEHI) developed a model in 2013 through which nurse informaticists interact with other providers and care processes to achieve desired outcomes. According to the NEHI model, nurse informaticists influence public policy formation and the healthcare delivery environment by improving point-of-care technology, patient safety and care quality, and data management (McGonigle & Mastrian, 2021). Therefore, these nurses bridge the clinical and technological care delivery to meet efficiency and safety needs. Nurse informaticists in an interdisciplinary team initiate communication and champion communication technologies to facilitate team activities.
Informaticists also ensure that the team gets access to a high-quality electronic source of health information that would influence evidence-based decision-making. More importantly, they safeguard the security and privacy of patients’ protected health information (PHI) (McGonigle & Mastrian, 2021). Nurse informaticists ensure that members of the interdisciplinary team use technologies and patient information in a well-coordinated manner so that interruptions and distractions do not breach care continuity and give more room for medical and medication errors. Nurse informaticists ensure that uniform technology use empowers members to maintain patient safety and meaningful use by developing protocols and procedures for using these technologies.
Engaging nurses in healthcare technology impacts patient care, workflow, and costs. Evidence-based practice is the current nursing care paradigm shift. Practice guidelines and decision-making require clinical evidence to improve patient safety and quality of care. Fully engaging nurses in health care technology will enable them to stay abreast of the current practice guidelines and information for decision-making. Healthcare technologies will enable nurses to access evidence-based information from online databases and also enable them to analyze future outcomes of practice using current and past data and information. Therefore, patient care outcomes result from safe and current evidence-based practices.
Protected health information (PHI) can be used to identify patients; inappropriate handling of this information can lead to a breach of patient privacy, confidentiality, and data security. As aforementioned, nurse informaticists enable communication between interdisciplinary team members to ensure successful care coordination. However, coordination requires collecting and sharing patient information that includes PHI.
Nurse informaticists ensure that this information is protected by implementing access controls such as ensuring secure communication in the team and regularly assessing and emulating system communication methods to ensure that PHI privacy and security are not breached (Lindley et al., 2020). In-service staff session updates ensure that nursing staff and other healthcare professionals’ knowledge and information skills are up-to-date with PHI privacy rules and guidelines (Park & Jeong, 2021). This increases professionalism that increases awareness levels.
Nurse engagement in healthcare technology improves workflow by enhancing care flexibility, improving care efficiency, and facilitating collaboration. Nurses can deliver care remotely to their patients by using technology. Additionally, they can deliver care in a shorter time when they use technology to care interventions and prevent errors. Finally, nurses’ full engagement in technology enables them to collaborate with other care professionals through effective communication.
As aforementioned, fully engaging nurses in healthcare technology improves car efficiency. Efficiency improvement reduces the work input required to achieve care outcomes. However, the costs of the initial implementation strategies will increase due to the costs of purchasing these technologies and training nurses on how to use them. When used efficiently and successfully, technologies could improve patient safety, costs, and quality outcomes.
Adding a nurse informaticist’s role would improve care efficiency by improving technology uptake and use among team members. This technology would enhance interdisciplinary collaboration to improve workflow and team outcomes, such as work efficiencies. Therefore, adding a nurse informaticist role would generally improve care delivery in the interdisciplinary approach. However, adding a nurse informaticist role would change the workflow in the healthcare organization because they would take up some roles of current work.
Role overlap can lead to conflicts that would deter successful collaboration. Therefore, team planning and nursing leadership would be required to ensure successful collaboration in the team. Team communication and regular monitoring of team outcomes would improve collaboration. Team decision-making could ensure that every member owns the outcomes of the team activities.
This proposal has analyzed the benefits and shortcomings of adding a nurse informaticist role into the organization’s workforce structure. These are the four key takeaways from the proposal about the nurse informaticist role. Nursing informatics is a field that combines nursing science with information and computer science to manage and communicate data, information, knowledge, and wisdom in nursing practice.
The role of the nurse informaticist is to support the use of technology in nursing practice and facilitate the integration of technology into the daily work of nurses and other healthcare providers. Fully engaging nurses in health care technology can positively impact patient care, including improved patient outcomes, reduced errors, and increased patient satisfaction. Adding a nurse informaticist role to an interdisciplinary team can bring both opportunities and challenges, including initial costs, changes to workflow, and resistance to change.
However, with careful planning and support, these challenges can be overcome, and the use of technology can ultimately lead to improved patient care and better patient outcomes. Nurse informaticists can play a crucial role in improving the usability and effectiveness of healthcare technology by matching user needs and vendor software features and by influencing the selection and implementation of appropriate technologies. This can ensure that this organization gets value for its investments in technology and that patients receive safe, high-quality care.
Lindley, L. C., Svynarenko, R., & Profant, T. L. (2020). Data infrastructure for sensitive data: Nursing’s role in the development of a secure research enclave. Computers, Informatics, Nursing: CIN, 38(9), 427–430. https://doi.org/10.1097/CIN.0000000000000677
McBride, S., & Tietze, M. (2022). Nursing informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism. Springer Publishing.
McGonigle, D., & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett.
Park, H.-K., & Jeong, Y.-W. (2021). Impact of nursing professionalism on the perception of patient privacy protection in nursing students: Mediating effect of nursing informatics competency. Healthcare (Basel, Switzerland), 9(10), 1364. https://doi.org/10.3390/healthcare9101364
Schoenbaum, A. E., & Carroll, W. M. (2020, September 30). Nursing Informatics Key Role in Defining Clinical Workflow, Increasing Efficiency and Improving Quality. HIMSS. https://www.himss.org/resources/nursing-informatics-key-role-defining-clinical-workflow-increasing-efficiency-and
The healthcare technology field is considerably dynamic, and technological advancement has made it change at a very high speed. Healthcare institutions continue to adapt healthcare technology from administrative and clinical information systems to promote healthcare service delivery, improve patient safety and outcomes, and reduce costs. Consequently, the need for healthcare informatics skills and knowledge in these institutions has increased. This proposal justifies the need for introducing a nurse informaticist role in the organization. The proposal will entail an exploration of nursing informatics, the nurse informaticist, the impact of full nurse engagement in healthcare technology, and the opportunities and challenges to the nurses and the Interprofessional team with the introduction of the new role.
According to the Health Information and Management Systems Society (HIMSS) (n.d.), nursing informatics is the science and practice specialty that combines computer, nursing and information technology sciences to enhance the management and communication of information, knowledge, and data in nursing practice. Nursing informatics is a subset of healthcare informatics as a field that integrates healthcare and information technology, which is specific to integrating information technology into nursing practice. The nursing informatics field mainly assists healthcare institutions in applying healthcare technology by bridging the technical and clinical perspectives gap to maintain patient safety and improve care.
The nurse informaticist is a specialist that works with the healthcare institution’s stakeholders across the care continuum to link nursing science and information technology. The specialist not only works with the nurses and the Information Technology specialists but also collaborates with other healthcare providers in the interprofessional team to promote patient safety and care outcomes while applying healthcare technology at the bedside and organizational levels. Strudwick et al. (2019) note that the nurse informaticist must have robust technical and nursing skills, alongside data analysis, leadership, project management and interpersonal skills to play the specialty role effectively.
Many healthcare organizations have adopted the nurse informaticist role following the advancement of healthcare technology and the increased need for nursing informatics expertise. These healthcare organizations enjoy the benefits of having this active role since it is easier for them to adapt new healthcare technology applications, devices and systems, implement related policies and analyze and manage healthcare data to inform practice. In addition, organizations with nurse informaticists have improved patient safety and care outcomes since the nurse informaticist’s main aim is to ensure patient safety while using healthcare technology. The organizations also have easier management processes and structures since the nurse informaticist works with the administrators to implement and use administrative information systems.
Nurse Informaticists interact with the rest of the nursing staff and other interprofessional team members by working with them daily. They collaborate with nursing staff to gain and develop feedback on using healthcare technology at the bedside level. The feedback is used to improve healthcare technology, thus improving the quality of patient care. According to Vos et al. (2020), nurse informaticists collaborate with physicians, pharmacists and other medical specialists in the interprofessional team to ensure that healthcare technology, such as electronic health records, are used appropriately to ensure optimum patient care quality. For example, the nurse informaticist works with the doctors to ensure that electronic patient files are accurate, thus avoiding related mistakes such as patient misidentification, which would negatively impact patient care quality. Effective collaboration of the nurse informaticist with other nursing staff and medical specialists in the interprofessional team is facilitated by constant communication, openness, and respect for each specialist’s contribution to the team.
Full engagement of nurses in healthcare technology begins with introducing the role of a nursing informaticist in the organization. The engagement positively impacts patient care by providing a platform whereby nurses can give feedback on the healthcare technology used in patient care at the bedside level. The feedback helps improve these technological applications, systems, and devices, thus providing potential for better patient care. HIMSS (n.d.) notes that nurses can utilize EHR, online portal systems, and patient monitoring devices through nursing informatics to facilitate care services, thus improving overall patient care.
Additionally, the nurse informaticist and other interdisciplinary team members are expected to manage patients’ protected health information by safeguarding privacy, security and confidentiality. According to Chen et al. (2019), managing patients’ protected information is the responsibility of every interdisciplinary team member, who are expected to maintain the set policies and safeguards of the institution. The interdisciplinary team and the nurse informaticist can use evidence-based practices to manage patients’ protected health information, including technical, physical, and administrative safeguards (Chen et al., 2019).
Technical safeguards include installing antitheft software, firewalls, and encryption of patient information. The physical safeguards include protecting the specific physical setting where technology stores the information, using access control locks and alarms. Administrative safeguards include developing institutional policies regarding the protection of patient information. Other practices include using strong passwords, biometric identification, and login out of computers to prevent unauthorized access to patient information (Healthit.gov, n.d.).
Nurse engagement in technology reduces the cost of care and increases the return on investment for the organization. The HIMSS (n.d.) notes that nurse informaticists have a deep understanding of medical economics. The understanding helps the nurse informaticist to advise the organizational administrators and stakeholders on the healthcare technology they should invest in to maximize return on investments and, at the same time, reduce the cost of care. In addition, engaging nurses in healthcare technology enables them to design processes that make workflow more efficient.
Adding the new nurse informaticist role in the institution will have different challenges and opportunities for nurses and the interprofessional team. The opportunities include having technical assistance provided by the nurse informaticist to the nurses and the interprofessional team at any time needed since the nurse informaticist has technical experience in healthcare technology. Additionally, the adoption and application of new healthcare technology will be made easier due to the prior training and guidance offered by the nurse informaticist.
However, their introduction of the nurse informaticist role may bring different challenges to the interprofessional team. According to Peltonen et al. (2019), the nurse informaticist may bring power and authority issues within the team, thus leading to a loss of respect among team members. For instance, the nurses and the nurse informaticist may have role, power, or expertise conflicts, posing a major challenge to the functionality of the interprofessional team. Differences in the understanding of different issues in nursing or technology may also complicate the interaction of the nurse informaticist and the interprofessional team.
Introducing the nurse informaticist role in the organization will benefit patient care quality, return on investments, workflow, and managing patients’ protected health information by increasing the efficiency of care services (Chen et al., 2019; Strudwick et al., 2019). The nurse informaticist will also play a major role in linking information technology knowledge and nursing practice. In addition, the new role will enhance nurses’ engagement in healthcare technology, positively impacting patient care and organizational performance. The nurse informaticist will also collaborate with nurses and the other members of the interdisciplinary team to promote care efficiency. Therefore, it is vital to introduce the nurse informaticist’s role in the organization.
Chen, Y., Ding, S., Xu, Z., Zheng, H., & Yang, S. (2019). Blockchain-based medical records secure storage and medical service framework. Journal of Medical Systems, 43, 1-9. https://doi.org/10.1007/s10916-018-1121-4
Peltonen, L. M., Nibber, R., Lewis, A., Block, L., Pruinelli, L., Topaz, M., Perezmitre, E. L., & Ronquillo, C. (2019). Emerging Professionals’ Observations of Opportunities and Challenges in Nursing Informatics. Nursing leadership (Toronto, Ont.), 32(2), 8–18. https://doi.org/10.12927/cjnl.2019.25965
Strudwick, G., Nagle, L., Kassam, I., Pahwa, M., & Sequeira, L. (2019). Informatics Competencies for Nurse Leaders: A Scoping Review. The Journal of Nursing Administration, 49(6), 323–330. https://doi.org/10.1097/NNA.0000000000000760
The Health Information and Management Systems Society. (n.d.) What is Nursing Informatics? Accessed 12th June 2023 from https://www.himss.org/resources/what-nursing-informatics
The Office of the National Coordinator for Health Information Technology (Healthit.gov). (n.d.). Guide to Privacy and Security of Health Information. Accessed 12th June 2023 https://www.healthit.gov/sites/default/files/pdf/privacy/onc_privacy_and_security_chapter4_v1_022112.pdf
Vos, J. F., Boonstra, A., Kooistra, A., Seelen, M., & van Offenbeek, M. (2020). The influence of electronic health record use on collaboration among medical specialties. BMC Health Services Research, 20(1), 1-11. https://doi.org/10.1186/s12913-020-05542-6
NRS-455: Pathophysiology Course builds upon the existing knowledge of the pathophysiological processes of disease as they affect patients across the life span, recognizing the nurse’s multidimensional role in health promotion and disease management and prevention, which include biological, environmental, social, psychological, and spiritual dimensions. Integration of nutritional and pharmacological concepts encourages critical thinking and application of nursing interventions. Prerequisite: NRS-420.
Bronchiolitis is a common lower respiratory tract infection primarily affecting infants and young children. It is characterized by inflammation of the small airways, leading to airway obstruction, mucus production, and respiratory distress. Bronchiolitis is particularly prevalent during winter and autumn, with sporadic occurrence witnessed throughout the year. It mainly affects children under 2, with the occurrence within the initial year of life at 11% to 15%, with a minimum of 5 hospitalizations in every 1000 children below two years old (O’Brien et al., 2019).
In Australia, an estimated 13,500 children are hospitalized annually due to bronchiolitis. This paper delves into a case study of Joe, a 21-month-old boy with bronchiolitis secondary to an RSV infection; the paper will also focus on the pathophysiology of bronchiolitis, outline the nursing assessments and management strategies for Joe, and address health promotion measures for Joe and his family upon discharge.
The pathophysiology of bronchiolitis is attributed primarily to the respiratory syncytial virus (RSV). However, various other viruses, including human rhinovirus, coronaviruses, human metapneumovirus, adenovirus, parainfluenza virus, and human bocavirus, have also been recognized over time (Justice & Le, 2022). These viruses infiltrate the respiratory epithelial cells, inducing inflammation and necrosis of the epithelial lining.
This inflammation causes small airway obstruction, increased mucus production, and decreased mucociliary clearance. As a result, airway resistance increases, leading to impaired airflow, hyperinflation, and respiratory distress. The combination of inflammation, mucus plugging, and airway narrowing results in decreased ventilation and poor oxygen exchange, leading to hypoxemia (Erickson et al., 2020).
Joe’s clinical presentation aligns with the progression of bronchiolitis. The increased respiratory rate of 57 breaths per minute compensates for maintaining oxygenation due to the narrowed airways. As highlighted by Ozdem?r and Songül Yalç?n (2021) in their study of “the role of body temperature on the respiratory rate in children with acute respiratory infections,” the elevated temperature of 39.5°C indicates the presence of infection and the body’s immune response.
The decreased % oxygen saturation of 90% suggests impaired oxygen exchange due to compromised airway function. The rapid heart rate of 148 beats per minute responds to the increased respiratory effort. At the same time, the elevated blood pressure of 105/70 mmHg may be related to the fever and respiratory distress. The prolonged capillary refill time reflects poor perfusion, likely due to increased respiratory effort and oxygen demand.
Joe’s restlessness, apathy, and disinterest in his environment are consistent with the general malaise associated with the illness. The increased work of breathing, intercostal retractions, and nasal flaring indicate significant respiratory distress as his body attempts to overcome the compromised airway function. Furthermore, Joe’s continued feeding difficulties can be attributed to his respiratory symptoms. The increased effort required for breathing may make it challenging for him to coordinate feeding, leading to poor intake and potentially contributing to his lethargy and dehydration.
The nursing assessment and management of a child with bronchiolitis involve a comprehensive approach to relieve symptoms, prevent complications, and promote recovery. The initial step in managing a child with bronchiolitis involves thoroughly assessing the child’s respiratory status. As Justice and Le (2022) highlight, the nurse should monitor the child’s respiratory rate, depth, and effort, looking for signs of increased work of breathing such as nasal flaring, intercostal and subcostal retractions, and use of accessory muscles. Auscultation of lung sounds is also critical in identifying wheezing, crackles, and decreased breath sounds indicative of airway obstruction and reduced ventilation.
In the given case study, Joe, a 21-month-old boy, has been admitted to the pediatric short-stay unit due to bronchiolitis from a respiratory syncytial virus (RSV) infection. A comprehensive assessment of the initial observations reveals potential nursing issues requiring timely and focused interventions. These issues include fever, tachypnea, increased work of breathing, oxygen desaturation, increased heart rate, elevated blood pressure, poor feeding, restlessness, lethargy, and signs of respiratory distress.
A range of nursing assessments needs to be undertaken to provide comprehensive nursing care for Joe. The primary assessments should focus on the child’s airway, breathing, circulation, and level of consciousness (ABC). These assessments are critical in identifying any immediate threats to Joe’s life (Peate & Brent, 2021). Given the signs of respiratory distress and decreased oxygen saturation, assessing his respiratory status is a priority. The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) framework can help guide the nursing assessment.
Starting with the airway assessment, the nurse should examine Joe’s airway for any obstruction or signs of distress. His intercostal retractions, nasal flaring, and increased work of breathing indicate compromised airway patency (Yadav et al., 2022). The breathing assessment shows that Joe’s respiratory rate of 57 breaths per minute, along with the intercostal retractions and nasal flaring, suggests respiratory distress. His oxygen saturation of 90% indicates poor gas exchange and the need for supplemental oxygen. The circulation assessment reveals a heart rate of 148 beats per minute and blood pressure of 105/70mmHg, which shows an increased cardiac workload likely due to fever and respiratory distress.
The disability assessment highlights Joe’s lethargy and poor feeding, indicating altered neurological status and dehydration. After the initial ABC assessment, other assessments are necessary to gather more information about Joe’s condition. His elevated temperature of 39.5°C indicates a fever that can exacerbate his distress. Addressing his poor feeding is crucial to ensure proper nutrition and hydration. Additionally, a general assessment of Joe’s appearance, responsiveness, and signs of discomfort is essential. His restlessness, apathy, and disinterest in the environment indicate his discomfort and distress (Nurseslabs, 2019). Capillary refill time of 2-3 seconds suggests adequate perfusion but needs ongoing monitoring.
Considering these assessments, it is crucial to tailor Joe’s nursing management to his specific needs. Given his respiratory distress and oxygen desaturation, providing supplemental oxygen as prescribed by the physician is essential to improve oxygenation and alleviate the work of breathing. According to a study by Brekke et al. (2020) on the value of vital signs in predicting clinical deterioration, early detection of changes in vital signs before clinical deterioration has been proven crucial in timely intervention. Close monitoring of vital signs, particularly heart rate, respiratory rate, oxygen saturation, and blood pressure, is necessary to track Joe’s response to interventions and identify any deterioration.
Family-centered care is crucial in pediatric nursing as it focuses on involving and supporting the entire family unit to ensure comprehensive and effective healthcare for the child. A scoping review by Kokorelias et al. (2019) found that family plays a vital role in ensuring the health and well-being of infants by providing essential care, emotional support, a safe environment, and the foundation for healthy development.
The relationships, experiences, and interactions within the family unit during this crucial stage of life can have a profound and lasting impact on the child’s well-being. In this case, involving Joe’s mother, Molly, in the care plan by explaining the interventions and rationale will help her understand the importance of interventions such as oxygen therapy, which can be unfamiliar and unsettling for parents.
Holistic health considerations consider all aspects of an individual’s well-being, recognizing that various interconnected factors influence health. This approach goes beyond addressing physical symptoms and encompasses emotional, mental, and social dimensions (Wopker et al., 2021). In the context of a child’s health, this means that nurses should not only focus on treating the child’s physical ailments but also pay attention to their emotional and psychosocial needs and those of their family. For Joe, reducing distress through comfort measures, such as creating a calm and soothing environment, may help decrease his anxiety. Additionally, ensuring Molly is well-informed and emotionally supported can positively impact her coping abilities and, consequently, Joe’s overall well-being.
Regular reassessments are essential in determining the effectiveness of interventions and identifying any changes in Joe’s condition. If there is an improvement in his oxygen saturation, respiratory rate, and general appearance, this could indicate a positive response to the interventions. However, escalating care to higher levels, such as the pediatric intensive care unit, would be necessary if his distress worsens.
After discharge, health promotion strategies should be implemented to support Joe and his family. Educating the family about proper hand hygiene, avoiding exposure to sick individuals, and maintaining a smoke-free environment can help prevent future infections. Demonstrating proper administration of medications and explaining their purposes is essential to ensure compliance. Referring the family to community support resources, such as local pediatric clinics, support groups, and online resources related to bronchiolitis and RSV infections, can provide ongoing assistance. Additionally, arranging a follow-up appointment with Joe’s primary care provider will facilitate ongoing recovery monitoring.
This paper has explored the multifaceted aspects of bronchiolitis through the lens of a case study involving Joe, a 21-month-old boy. The pathophysiology of bronchiolitis, predominantly linked to the respiratory syncytial virus, was examined, highlighting its impact on airway obstruction and compromised respiratory function. The nursing assessments and management strategies demonstrated a comprehensive approach to addressing Joe’s distressing symptoms and guiding his care. Family-centered care and holistic health considerations were emphasized in promoting Joe’s well-being and his mother’s understanding. Integrating health promotion measures post-discharge underscores the importance of preventative education and ongoing support for Joe’s recovery.
Atay, O., Pekcan, S., Gokturk, B., & Ozdemir, M. (2020). Risk factors and clinical determinants in bronchiolitis. Turkish Thoracic Journal. https://doi.org/10.5152/turkthoracj.2019.180168
Brekke, I. J., Puntervoll, L. H., Pedersen, P. B., Kellett, J., & Brabrand, M. (2020). The value of vital sign trends in predicting and monitoring clinical deterioration: A systematic review. PLoS One, 14(1). https://doi.org/10.1371/journal.pone.0210875
Erickson, E. N., Bhakta, R. T., & Mendez, M. D. (2020). Pediatric bronchiolitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519506/#:~:
Justice, N. A., & Le, J. K. (2022, July 29). Bronchiolitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441959/
Kokorelias, K. M., Gignac, M. A. M., Naglie, G., & Cameron, J. I. (2019). Towards a universal model of family-centered care: A scoping review. BMC Health Services Research, 19(1), 1–11. https://doi.org/10.1186/s12913-019-4394-5
Martin, P. (2023, April 30 – Updated). 7 Bronchiolitis & Respiratory Syncytial Virus (RSV) Nursing Care Plans. Nurseslabs. https://nurseslabs.com/bronchiolitis-nursing-care-plans/
O’Brien, S., Wilson, S., Gill, F. J., Cotterell, E., Borland, M. L., Oakley, E., & Dalziel, S. R. (2019). The management of children with bronchiolitis in the Australian hospital setting: Development of a clinical practice guideline. BMC Medical Research Methodology, 18(1). https://doi.org/10.1186/s12874-018-0478-x
Ozdem?r, B., & Songül Yalç?n, S. (2021). The role of body temperature on respiratory rate in children with acute respiratory infections. African Health Sciences, 21(2), 640–646. https://doi.org/10.4314/ahs.v21i2.20
Peate, I., & Brent, D. (2021). Using the ABCDE approach for all critically unwell patients. British Journal of Healthcare Assistants, 15(2), 84–89. https://doi.org/10.12968/bjha.2021.15.2.84
Wopker, P. M., Schwermer, M., Sommer, S., Längler, A., Fetz, K., Ostermann, T., & Zuzak, T. J. (2021). Expert consensus-based clinical recommendation for an integrative anthroposophic treatment of acute bronchitis in children: A Delphi survey. Complementary Therapies in Medicine, 60, 102736. https://doi.org/10.1016/j.ctim.2021.102736
Yadav, S., Lee, B., & Kamity, R. (2022, July 25). Neonatal respiratory distress syndrome. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560779/
The goal of NRS-460 Complex Disease Management Course is to integrate knowledge from pathophysiology, pharmacology, nursing theory, and current evidence-based practice to inform clinical judgment and to ensure safe, effective, and holistic care. It applies the nursing process to provide safe, quality care reflecting cultural humility across the life span. The course pays particular attention to interprofessional collaboration in the process of disease management and care coordination.
Heart disease is the leading cause of increased mortality rates, comorbidities, prolonged hospitalization, high rates of readmissions, compromised quality of life, and a steady increase in care costs. According to Roth et al. (2020), cardiovascular diseases like heart disease, stroke, and heart failure accounted for approximately 19.7 million deaths in 2019.
Similarly, the global trends for disability-adjusted life years (DALYs) and years of life lost doubled from 17.7 million to 34.4 million from 1990 to 2019. The modifiable and non-modifiable risk factors for heart disease include physical inactivity, smoking, unhealthy diet, obesity, poor stress management, family history of cardiovascular disease, age, and genetics.
When developing a care plan for people with heart disease, it is vital to address modifiable risk factors to prevent complications and improve disease management approaches. Therefore, this final care coordination plan focuses on issues facing people with heart disease, patient-centered interventions, ethical considerations for individualized care approaches, relevant health policy implications for coordinating care, and the priorities for the care coordination plan.
People with heart disease face various issues and challenges, including unfamiliarity with self-management interventions, limited access to timely care, and unawareness of early vital sign identification, reporting, and monitoring. Jaarsma et al. (2020) state that self-management approaches for heart disease entail pharmacologic and non-pharmacologic interventions like adherence to prescribed medications, engaging in physical activity, complying with healthy diet plans, and self-care monitoring competencies.
Patient-centered interventions for improving patients’ self-management competence include educating them on disease management activities, linking them to community resources, incorporating technology like telehealth to promote remote monitoring, and fostering effective communication. Equally, patients with heart disease can leverage community resources, including community-based health organizations, expert offices, and online databases like the American Heart Association (AHA) to improve self-management competencies.
Secondly, limited access to timely and convenient care exacerbates heart disease complications. According to White-Williams et al. (2020), poor social determinants of health, including poverty, low-level education attainment, health illiteracy, uninsurance, and infrastructure deficiencies, are the profound causes of limited access to quality and timely care for people with heart disease.
It is possible to address these issues by educating people about the causes, effects, and management approaches for heart disease, collaborating with local authorities to modify the environment, and providing infrastructures like accessible sidewalks, gymnasia, and other public opportunities for physical activity. Equally, it is possible to utilize community resources like recreational parks, community amenities for physical activity, and health institutions that provide information regarding heart disease management and prevention.
Thirdly, people with heart disease grapple with the challenge of unawareness of early vital sign detection, reporting, and management. According to Conn et al. (2019), in-home vital sign monitoring can transform the healthcare system by facilitating care transition from reactive to proactive and preventive care.
Improving individual awareness of vital sign monitoring and reporting is possible by strengthening the use of mHealth and telehealth technology to foster communication, educating people on how to use these technologies, and coordinating care with community-based organizations to ensure timely response in the case of deteriorating signs. In this sense, individuals with heart disease and other cardiovascular conditions can utilize community resources like healthcare institutions, expert offices, and free-access databases to gain insights into appropriate interventions for conducting vital sign monitoring.
Patient-centered interventions for improving heart disease management and control should rely massively upon ethical considerations. Tomaselli et al. (2020) contend that patient-centered care entails respecting patients’ demands, preferences, and principles. This care dimension results in patient empowerment and enhancement of individual decision-making competencies necessary for influencing care trajectories. According to Varkey (2021), healthcare professionals have an ethical obligation to benefit patients, prevent harm, ensure justice and fairness, and respect values, preferences, and decisions.
The four bioethical principles of beneficence, non-maleficence, autonomy, and justice enshrine these moral obligations by requiring healthcare professionals to provide care consistent with individual needs and interests. When designing and implementing patient-centered interventions to improve the health of people with heart disease, it is vital to involve them, understand their learning priorities, empower them to make decisions, and ensure that the subsequent approaches are consistent with established collective goals and objectives.
Developing a care coordination plan for managing heart disease and improving the health of people grappling with this disease is consistent with the Affordable Care Act (ACA) 2010 provision, which requires hospital and healthcare professionals to prevent avoidable readmissions. According to the Centers for Medicare and Medicaid Services [CMS] (2022), the Hospital Readmissions Reduction Program (HRRP) is a value-based program that encourages hospitals to improve communication and enhance care coordination to reduce avoidable readmissions perpetrated by various diseases, including acute myocardial infarction (AMI), Chronic Obstructive Pulmonary Disease (COPD). Further, this program enables CMS to track hospital readmission rates (HRRs) and determine benefits and penalties based on the organizational ability to reduce preventable readmissions.
In this sense, CMS can provide incentives for hospitals that reduce preventable readmissions to the acceptable benchmarks while reducing Medicare payments to institutions with high readmission rates. Gai & Pachamanova (2019), the HRRP program proposes various interventions for reducing preventable readmissions, including coaching patients on discharge instructions and self-management, improving care coordination and care setting transition planning, and performing medication reconciliation. These approaches align with the proposed patient-centered interventions for improving the health and wellness of people with heart disease.
Notably, it is essential to communicate the plan with patients and family members before enacting it. Equally, making changes consistent with patients’ feedback, external evidence, and contextual issues is vital. For example, patients with heart disease may fail to adhere to the requirement of 150 to 300 minutes of physical exercise per week due to the underlying complications associated with the disease. Therefore, altering the intervention schedule should be consistent with patients’ preferences, needs, and values.
Equally, the care coordinator should emphasize various priorities when discussing the plan with patients and family members and when making changes based on evidence-based practice. These priorities include improving patients’ health literacy, enhancing their self-management competencies, and bolstering their knowledge of appropriate technologies for care coordination and effective communication.
The learning sessions for improving the health and wellness of people with heart disease contain various topics, including practices of a healthy diet, recommended measures and length of physical exercise, smoking cessation approaches, and strategies for vital sign monitoring. These sessions align with the evidence from the current scholarly literature that supports the process of improving patients’ self-management competencies and enabling them to prevent disease progression by addressing modified risk factors for heart disease.
According to Podvorica et al. (2021), education sessions for people with heart disease should focus on increasing patients’ knowledge in improving modifiable factors like nutrition, physical activity, body mass index (BMI) monitoring, glycemia, and cholesterol. Undoubtedly, focusing on these themes is fundamental in improving self-management competencies, enhancing the quality of life, reducing readmissions, and minimizing eventual complications associated with heart disease.
Equally, the proposed patient-centered interventions for improving the health and wellness of people with heart disease are consistent with Healthy People 2030’s objectives. For instance, Healthy People 2030 aims to reduce cholesterol in adults to about 186.4 mg/dL by emphasizing physical activities and healthy weight management approaches (Healthy People 2030, n.d.). Other Healthy People 2030 objectives for heart disease include reducing the proportion of adults with high blood pressure, increasing aspirin use for secondary prevention of atherosclerotic cardiovascular disease, and enhancing control of high blood pressure in adults.
While heart disease is the leading cause of increased mortality rates, comorbidities, prolonged hospitalization, increased care costs, and compromised quality of life, implementing patient-centered interventions and ensuring care coordination can improve the health and wellness of people living with the disease. Examples of patient-centered approaches for addressing the disease include emphasizing physical activity sessions, educating patients on self-management interventions, linking patients to community resources, improving their health literacy, and coordinating with community-based organizations to foster communication, timely care delivery, information transfer, and consultations.
When implementing these approaches, it is vital to incorporate ethical considerations, align them with external evidence, and make changes consistent with patients’ preferences, needs, and values. Finally, it is crucial to uphold the Hospital Readmissions Reduction Program (HRRP) provisions and evaluate the Healthy People 2030 objectives to ensure consistency with the final care coordination plan.
Centers for Medicare and Medicaid Services. (2022). Hospital readmissions reduction program (HRRP). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program
Conn, N. J., Schwarz, K. Q., & Borkholder, D. A. (2019). In-Home cardiovascular monitoring system for heart failure: Comparative study. JMIR MHealth and UHealth, 7(1), e12419. https://doi.org/10.2196/12419
Gai, Y., & Pachamanova, D. (2019). Impact of the Medicare hospital readmissions reduction program on vulnerable populations. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4645-5
Healthy People 2030. (2020). Heart disease and stroke. https://health.gov/healthypeople/objectives-and-data/browse-objectives/heart-disease-and-stroke
Jaarsma, T., Hill, L., Bayes?Genis, A., La Rocca, H. B., Castiello, T., ?elutkien?, J., Marques?Sule, E., Plymen, C. M., Piper, S. E., Riegel, B., Rutten, F. H., Ben Gal, T., Bauersachs, J., Coats, A. J. S., Chioncel, O., Lopatin, Y., Lund, L. H., Lainscak, M., Moura, B., & Mullens, W. (2020). Self?care of heart failure patients: Practical management recommendations from the heart failure Association of the European Society of Cardiology. European Journal of Heart Failure, 23(1). https://doi.org/10.1002/ejhf.2008
Podvorica, E., Bekteshi, T., Oruqi, M., & Kalo, I. (2021). Education of the patients living with heart disease. Materia Socio Medica, 33(1), 10. https://doi.org/10.5455/msm.2021.33.10-15
Roth, G. A., Mensah, G. A., Johnson, C. O., Addolorato, G., Ammirati, E., Baddour, L. M., Barengo, N. C., Beaton, A. Z., Benjamin, E. J., Benziger, C. P., Bonny, A., Brauer, M., Brodmann, M., Cahill, T. J., Carapetis, J., Catapano, A. L., Chugh, S. S., Cooper, L. T., Coresh, J., & Criqui, M. (2020). Global burden of cardiovascular diseases and risk factors, 1990-2019: Update from the GBD 2019 study. Journal of the American College of Cardiology, 76(25), 2982–3021. https://doi.org/10.1016/j.jacc.2020.11.010
Tomaselli, G., Buttigieg, S. C., Rosano, A., Cassar, M., & Grima, G. (2020). Person-Centered care from a relational ethics perspective for the delivery of high quality and safe healthcare: A scoping review. Frontiers in Public Health, 8(44). https://doi.org/10.3389/fpubh.2020.00044
Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119
White-Williams, C., Rossi, L. P., Bittner, V. A., Driscoll, A., Durant, R. W., Granger, B. B., Graven, L. J., Kitko, L., Newlin, K., & Shirey, M. (2020). Addressing social determinants of health in the care of patients with heart failure: A scientific statement from the American Heart Association. Circulation, 141(22). https://doi.org/10.1161/cir.0000000000000767
NRS-465: Applied Evidence-Based Project and Practicum is the final course in the Rn to BSN Degree program program. This writing-intensive integrates the academic and practical knowledge students have acquired throughout the program’s curriculum. Students participate in planned clinical experiences that refine professional competencies at the baccalaureate level and enable them to integrate new knowledge and enhanced skills to advance nursing practice. Clinical practice hours are dedicated to learning objectives in leadership and community health.
The evidence-based project provides students an opportunity to identify a clinical nursing practice issue and propose a possible solution. Students, under the guidance of faculty and approved preceptors, identify and analyze a nurse practice issue, develop a change project, and propose an evidence-based solution that reflects synthesis and integration of course content and professional practice. The evidence-based project development is guided by the baccalaureate program learning outcomes. Clinical hours: 100. 50 hours in leadership and 50 hours in community health. Prerequisite: NRS-415, NRS-420, NRS-425, HLT-362V, NRS-445, PHI-413V, NRS-450, NRS-455, NRS-460.
This paper’s identified population is people addicted to alcohol and other substances. Despite the numerous efforts that different governmental and non-governmental institutions have implemented, the addiction problem still haunts many people. Addicted persons continuously abuse substances despite the adverse effects that are associated with them. There are apparent effects on a person’s social, mental, and physical well-being. Some addiction-related factors include personal preferences, environmental factors, and genetic predisposition (Nawi et al., 2021).
Addiction to substances can lead to psychological and physical symptoms such as withdrawal symptoms of discontinuation of abusing the substance. The different approaches to managing addiction include support groups and behavioral and pharmacological therapies. To prevent addiction, diverse populations need to be educated about the risks associated with the substances abused. It is also vital for healthcare givers to address the underlying mental health issues that may predispose these individuals to addiction.
In managing addiction, healthcare workers must address the addicts’ health, economic and cultural needs. This approach must be based on the best available evidence and prioritize the fact that addiction influences an individual’s health differently. When engaging patients, healthcare providers collaboratively develop individualized treatment plans considering the patient’s unique cultural, economic, and health circumstances. Involving patients in their care empowers them to make informed decisions concerning their treatment.
Patient involvement in care has been shown to reduce the healthcare costs associated with addiction. Engaging patients in self-care can lead to more adherence to treatment protocols, decreasing the rates of hospital admissions and the likelihood of relapsing (Abdisa et al., 2020). Cultural factors can influence their understanding of addiction and willingness to seek health care. The involvement of cultural factors in the plan of care can help healthcare professionals to come up with strategies that are appropriate and culturally sensitive for each individual.
Patient engagement is essential to help patients manage their health conditions. When patients are engaged in the plan of their care, they are more likely to comprehend their situation, adhere to treatment, and attain informed decision-making concerning their care. A study by Kuipers et al. (2019) notes that when healthcare workers involve patients in developing personalized care plans, they will likely consider their goals, needs, values, and preferences. Understanding the patient’s condition can help them achieve enhanced self-management, which may entail managing their symptoms and making necessary lifestyle adjustments to impact their health positively and adherence to treatment plans.
Involving patients in their care plan has been shown to help healthcare workers manage the conditions better, resulting in fewer complications and an overall improvement in the quality of life achieved by the patients. An improvement in the quality of life can help to achieve a reduction in the burden of disease observed. The patient’s satisfaction and care received at the health care organization can be increased when they are engaged in their care.
Client satisfaction in healthcare increases the chances that they are likely to utilize the services again, which can lead to improved outcomes concerning their health. Similarly, when patients are involved in managing their conditions, the healthcare givers can have a deeper understanding of their needs and come up with preferences and goals, which can be taken into account to improve the overall experience. In addition, they can be provided with individualized management plans that are likely to be successful when adhered to consistently.
Studies by Marzban et al. (2022) and Aboumatar et al. (2022) have indicated that interventions aimed at patient engagement, such as patient activation and decision-making involvement, are associated with improved health outcomes in patients with chronic health conditions. There are also reduced costs associated with healthcare and an overall improvement in patient satisfaction.
Another study by Kichloo et al. (2020) indicated that the utilization of telehealth and patient portals was associated with an enhancement in adherence to medication and an overall reduction in the number of hospitalizations. There was an overall increase in healthcare utilization in patients who utilize this technology. Similarly, remote healthcare coaching and promotion of self-management in persons who have an addiction were associated with enhanced health outcomes.
For people with an addiction, applying information and communication technology tools may significantly improve their health literacy. According to the Centers for Disease Control and Prevention (2022), health literacy refers to the ability of patients to access, comprehend, and utilize information and services and make informed decisions about their health. The improvement of health literacy in people with an addiction can help them manage their conditions and other resulting health-related issues.
Utilizing mobile health applications can also help improve consumer health literacy. This application helps with the need to access information and other resources to help them manage their challenges. They can help with medication adherence, have a range of support groups to choose from, and track their symptoms resulting from drug abuse.
Similarly, telehealth can help these individuals remotely access beneficial information, which can help reduce transportation and time constraints challenges (Gajarawala & Pelkowski, 2020). Individuals will likely face stigma or other barriers that hinder them from accessing quality health care and benefit from this approach.
The use of social media services can help this individual access other beneficial education resources and support groups where they can share their experiences with individuals suffering from the same condition. Healthcare givers can use electronic health records to help them enhance consumer health literacy for these individuals. The use of electronic health records can increase patients’ accessibility to their health information and help them communicate efficiently with their healthcare providers.
There are other mobile applications and telehealth features that can help to facilitate an improvement in patient care. Mobile applications enable patients to access health information remotely, access resources they need to manage their condition and get support from other individuals or organizations (Haleem et al., 2021). Some of the features these applications can offer include tracking symptoms, educational materials, and medication reminders to help them adhere to treatment.
Accessibility to remote healthcare services has also been enhanced through telehealth features. For instance, individuals living far away from healthcare facilities can use telehealth to remove transportation barriers. They can schedule video visits with their healthcare professionals and benefit from remote monitoring of their symptoms and accessibility to virtual support groups (Jin et al., 2020). Electronic health records facilitate communication between patients and healthcare providers and enable them to access their health information. Patient confidentiality can be promoted by using secure systems, which help promote coordination between different healthcare professionals as they allow easy information sharing.
It is crucial to promptly address the needs of those with an addiction so they can enjoy quality health outcomes and lead no more lives. The use of telehealth and other health applications cannot be overlooked. With such modalities, patients can access quality and reliable information that can help them make informed decisions about their health and adopt different lifestyle adjustments that can help them improve their lives.
Accessibility to healthcare workers remotely can enable addicts to share information in real-time and get feedback from healthcare givers (El-Sherif et al., 2022). Therefore, healthcare providers are encouraged to adopt such technology that can help them monitor their patients closely and ensure that collaboration among different healthcare workers is achieved to promote quality health outcomes. These modalities have also helped increase patient confidentiality by ensuring that only individuals can access patient information.
By considering ethics culture and inclusiveness, healthcare providers can ascertain that applying technology and managing different patient conditions respect their right to autonomy and enhance accessibility to equitable healthcare. Mobile healthcare applications provide tailored information to each individual and ensure addicts can access quality and reliable information (Kernebeck et al., 2020). For instance, providing information about a smoker’s different behavioral strategies to help them quit the habit will enable the individual to follow these guidelines and achieve the best outcomes.
Other individuals with visual impairments can also benefit from the use of mobile applications that have been designed to accommodate their disabilities. When telehealth is adopted, healthcare workers can promote culturally sensitive and ethical patient engagement, protecting their privacy and considering the right to autonomy. Before engaging in any intervention, patients are informed about the benefits and risks of engaging in that Intervention. Patients are likely to face stigmatization from different people protected through telehealth.
The engagement of patients in self-management is a vital component of delivering high-quality healthcare. The utilization of healthcare modalities such as electronic health records, telehealth, and mobile applications has been determined to increase the engagement of patients in their health care in an inclusive, culturally sensitive, and ethical manner. Recent literature has indicated that using these modalities can help reduce costs associated with health care, enhance patient satisfaction, and improve the health outcomes of these patients. All healthcare organizations are encouraged to adopt evidence-based technology that has been shown to promote individualized patient care.
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Nawi, M., Ismail, R., Ibrahim, F., Hassan, R., Manaf, A., Amit, N., Ibrahim, N., & Shafurdin, N. S. (2021). Risk and protective factors of drug abuse among adolescents: A systematic review. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-11906-2