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Intellectual Property in Electronic Health Records
Introduction
As a nurse, one comes into contact continually with issues of electronic health records. The Health Insurance Portability and Accountability Act is one of the Acts of the Federal Government that attempt to speak to the question of e-health records and classification of it as intellectual property. In this case, it is required that in the provision of cover for Americans, there is need to have a catalog of information kept by the health care providers which can be used in the offer of health covers (Hiller et al, 2011).
The HIPPA provides for mechanisms of protection of such information that is intellectual property by the privacy rule which demands that Personally Identifiable information ought not to be disclosed unless within the framework provided for under the Act (Bates, 2005).
Background
It is the case that such information may be used in the carrying out of research. However, there is no clear methodology of addressing intellectual property concerns in the information that is stored therein. Most certainly, the IP in the coming up with software that can store such information is squarely an entitlement of the software developer.
Where does this leave the information and the collector of information? This is a question that must be determined to inform agreements that organizations which offer IT services to the health care providers may have to craft in their Service Level Agreements. (Garde, 2007)
It cannot be avoided that this is an issue that deserves adequate attention because often, the patient will not know whether they have any rights regarding the information they give herein. This actually gives them impetus to lie about the information they give.
Even if they do not lie about the information they give, they may end up being a bit economical about the truth in the information they give. The growing need for enhancement and embrace technology in every area and the growing relevance of cloud storage means that the traditional ways of record keeping by health care providers is an idea of a bygone age. (Garde, 2007).
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It is a mundane principle of IP law that information gathering cannot amount to a situation where the gatherer is granted IP rights. This is because IP rights involve the exertion of mental capacities and the sweat of the brow cannot suffice for the abrogation of such rights by one such person. Ultimately, there is then a question that arises. Who then is entitled to such rights?
These information rights will inform how we handle such information and the procedures to be followed in the use or transfer of such information. The seriousness of the question of confidentiality and security of information is at the centre of electronic health records. In the event that this is not properly addressed, there is a real possibility that the policy on the creation of such records crumbles and the efficiency envisioned in such an instance fails in the main.
Findings
A priority, I perceive need to have a brief legislation on the IP rights regarding such scenarios. In such a case, there is need to properly brainstorm and see whether a law can be crafted to even sanction properly the actions of such persons who may handle such information, for instance nurses as they go about with their ordinary dealings.
It may then appear as though there shall be an overlap with the question of Confidentiality as already provided for in other pieces of legislation including HIPAA. However, this will be more specific and will spell out clearly the IP rights and offer a more comfortable pillow for the patient and users of such information will be under a more elaborate set of duties. (Zittrain, 2000)
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Procedure
There is an elaborate procedure for the making of laws. In this my case, I have already encountered the need by observation and from experience that there is no clear policy directive on such. There is also an alarming dearth of scholarly attention to such an area which has far reaching implications for research. A focus group discussion with members of the profession reveals that information may be abused without the knowledge of the proper owners of the said property which is actually a virtual violation of the fundamental right to dignity.
It is the case that information that is de-identified may be used for research with few qualms. However, this does not completely take away the need to have the proper owners of the information at the centre of such a procedure.
This procedure is made easier by the fact that a citizen like me may institute the procedure without being found to have lacked the requisite locus. As the law progresses, the question of locus is slowly being found to be merely procedural and cannot be allowed to supersede substantive societal needs and justice. As a matter of conjecture, this will need a bit of education of the stakeholders on the issues to which this law will speak to.
Only then will a critical mass be achieved because this is a fairly technical area that may not be fully appreciated by many. However, IP Law is an issue of concern to all policy makers because the traditional forms of property are slowly being phased out.
The presentation of such laws to both houses of congress, both of whom must ruminate over the proposals and determine whether or not they deserve parliamentary attention. (Mason, 2015) It is hoped that the idea shall not die at the committee stage, but shall sail through to help protect the rights of patients.
References
Bates, D., 2005. Physicians and ambulatory electronic health records.”. Health Affairs, 24(5), pp. 1180-1189..
Hiller, J., McMullen, M. S., Chumney, W. M., & Baumer, D. L. (2011). Privacy and security in the implementation of health information technology (electronic health records): US and EU compared. BUJ Sci. & Tech. L., 17, 1.
Zittrain, J., 2000. “What the publisher can teach the patient: intellectual property and privacy in an era of trusted privication.. Stanford Law Review, pp. 1201-1250.
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The National Health Service (NHS)
Introduction
The National Health Service (NHS) is identified as one of the best healthcare system. This is attributable to the National Health Service April 2013 health reforms; which aimed at improving care delivery with fewer resources. These reforms have made improvements in a number of areas in healthcare including funding of the system and patient satisfaction, making the NHS to be more efficient.
Patient choices have been extended to primary care, community care and in mental health services (NHS England, 2014). There has been increased transparency on patient outcomes and data. However, several studies have reported less positive information on National Health Service reforms. According to critics, the benefits and savings being reaped from the reforms is only short term, and that it is not sustainable.
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The progress of the reforms are somewhat disappointing towards establishing a sustainable integrative healthcare services which impeded the establishment of greater use of A&E alternatives, high level completion or greater capacity for outpatient care (Tian, et al., 2012).
For this reason, this article will explore how the NHS reforms introduced in April 2013 have brought changes in the healthcare services. The main reasons behind the introduction of these reforms will also be evaluated. This will facilitate the understanding of development of healthcare systems in the UK, and the State’s roles in changing of the system (Murray et al., 2014).
Additionally, the reasons for recent changes to National Health Service will be evaluated through the analysis of healthcare policies and political perspective in the contemporary health issues in the UK. This facilitates understanding of the various debates and concepts of health promotion, public health, and management of the health services. This paper is planned as follows (Trust Development Authority, 2014);
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Development of healthcare in the UK and Changing of the States roles
The healthcare system in the UK was established after World War II, and began its operations on 5th July 1948. The National Health Service was proposed in the UK parliament in 1942 in the Beveridge report on Social Insurance (BSI) and other health services allied. The NHS is a bequest of Aneurin Bevan, a previous mineworker who turn out to be the then Minister of Health. NHS was established under the doctrines of impartiality, universality and easy access and delivery of services. The principles were facilitated by a central funding from the government (Alexander, 2013).
In England, the health policy and healthcare is the accountability of the central government. In Scotland, Northern Ireland and Wales, the health care and health policy is the concern of the decentralized governments. In every of the United Kingdom nations, the National Health Service system has its unique structure as well as organization, but has a general organization structure.
Generally, the healthcare consists of two major categories, one section deals with strategy and policy management, whereas the other deals with actual clinical care and medical interventions, which is in turn subdivided into primary care ( General physicians, pharmacists, dentists etcetera), secondary care ( consists of hospice-centred care) and tertiary maintenance (expertise hospitals) (Woringer et al., 2015).
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Recently, the distinction amid the two sections has become less clear. This is attributable to the fact that the last few years have been guided by shifting balance of authority. The other phase and Walness reports have described the gradual changes within the NHS that has resulted into shift towards the local or devolved rather than the centralised decision making process.
The emphasis has been on identification of barriers to effective delivery of the primary and secondary care. This was reinforced by the previous government on 2008 in the strategy dubbed “NHS Next Stage Review: High Quality Care for all” (Cornock, 2016), and “Equity and excellence: Liberating the NHS” 2010 strategy that has remained focus of the current government (Cornock, 2016).
The government has remained supportive of the initial National Health Service principles but possibly through different mechanisms. Recent past, the United Kingdom`s government announced plans to develop strategies that will produce most radical changes in the NHS. The white paper proposed on July 12th, 2010 “Equity and excellence: Liberating the NHS” aimed at outlining strategies that creates a patient centred and more responsive NHS (Trust Development Authority, 2014).
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Reasons for reforming NHS
The NHS reforms introduced in April 2013 aimed at bringing positive change to the services. Learning from the past mistakes in UK and elsewhere, it was just right time to bring about the fundamental shift to reform the National Health Service. Previously, the UK politics and policy only established short-term political initiatives which were the main hindrances of long-term policy achievements and establishing a sustainable and transformational change. The previous government’s structural reforms were large-scale which acted as major distractions rather than facilitators (NHS England, 2014).
The NHS reforms ensured that such distractions are avoided in the future. Previously, the National Health Service reforms relied on external stimuli such as performance management, targets, quality inspection and regulation, choice and competition. These were too little to offer for improvement from within the health care. This called for a new settlement where the strategic role of a politician could be demarcated clearly. This helped minimize the frequent shift in directions which hindered transformational change (Trust Development Authority, 2014).
Unlike in the past, April 2013 National Health Service reforms did not dwell on bold strokes or politician big gestures, but rather engaged the primary care, secondary care and tertiary care providers. It focused mainly on healthcare staff improvements. The complementary approaches used by these reforms pursued national leadership in combination with devolution, competition and innovative standardization (NHS England, 2014).
The April 2013 reforms focused on transparency, devolution and performance in a systematic manner. The reforms ensured that the improvement in the NH was based on commitment instead of compliance by investing in staff improvement to empower them to achieve sustainable quality improvement. The reforms envisioned a high performing healthcare organization, which indicated continuity in leadership, organization stability and clear goals for improvement in delivery of healthcare services (Woringer et al., 2015).
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Underlying concepts of funding in healthcare
The overall organizational structure of NHS in the National Health Service fiscal support is obtained from taxation. Approximately, 60% of the funds are used for staff salary, whereas additional 20% is used for medical appliances such as drugs, buildings, training costs, and equipment. The principle founders of the NHS system were the NHS primary Care Trusts (PCTs).
They disburse funds to the commissioned healthcare providers such as the National Health Service trusts, General Providers and Private providers according to the agreed contract basis. In public healthcare medical cover, vast of the National Health Service services are free. This implies that UK citizens need not pay anything for doctor visits, nursing services and consumable charges such as medications and laboratory services (Iacobucci, 2015).
The Department of Health have the responsibility for direction of National Health Service, public health and social care and the delivery of care. This includes developing policies and strategic interventions and ensures that they secure healthcare resources. Previously, there are about 10 strategic Health authorities manages NHS at local level, and the PCTs control approximately eighty percent of the NHS budget to provide the commission services and governance, and to ensure resource availability within the public health.
The NHS trusts operate on basis of paying by results (NHS England, 2014). Examples of National Health Service trusts include the Mental Health, Acute care, Ambulance, Foundation Trust and Children’s Trust. The foundation Trusts was developed to increase financial obligations and are monitored by an independent body. These include the Care Quality Commission, National Audit Office, Audit commission, Medicines and Healthcare Products Regulatory Agency, British Medical association, and the National Institute for Health and Clinical Excellence (NICE) (Frisina Doetter & Götze, 2011).
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Evaluation of health policies as well as political thoughts in contemporary health issues
The government has embarked on widespread reform programme which aims at introducing substantial changes in the National Health Service structure and management, and to improve the quality of care delivery. For instance, a number of new changes in NHS was introduced by the April 1st NHS reforms in England. One of the main changes done by these reforms includes shifting of responsibilities that originally were in the Department of Health, to the politically independent entity- the National Health Service commissioning Board.
The reforms will also establish a health specific economic monitor whose aim is to guard the healthcare delivery from ‘anti-competitive practices. The reforms ensure that all NHS trusts are shifted to foundation trust status (Le Grand, 2013).
The reforms are expected to fill some gaps in the UK healthcare system. According to the April 2013 reforms, the government supports the idea of GP commissioning. This implies that the key decisions of patient’s treatment should be made by GP in partnership with the service user rather than the managerial organisations.
The Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs). Under the new reform, GPs are integrated in the consortium that controls commission’s services and budgets. However, the NHS commissioning Board is expected to reduce health inequalities so as to access healthcare (Edkins, Cairns & Hultman, 2014).
The government white paper calls for a healthcare system that moves away from the centrally-driven healthcare system to one which focuses on the patient outcomes and the quality of care delivered (Mead, 2013). This devolution of healthcare system implies the five main domains used to assess the effectiveness of the program success are realized.
These includes reduction of premature death, improving the life of people living with chronic diseases, helping people recover from preventable injuries, ensure people easily access better care services equitably and ensuring a safe environment and protecting people from harm (Mead, 2013).
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The reform has been highly criticized warning that the move is creeping towards privatisation of commissioners. The opponents argue that the profit oriented firms could oust GPs from their role of making decision on effective treatments due to the creeping privatisation of primary care.
According British Medical Association (BMA), the reforms would make the relationship between physician and patients will suffer irreparable damages, and the negative impacts will damage NHS irreversibly. According to the BMA, health and social care bill is incoherent, complex and unfit for its purpose. They argue that to sustain the implemented reforms will be difficult (Sussex, n.d.).
The privatisation of commissioning will cause massive effects on public health, as it will is likely to exacerbate health inequalities and loss of accountability. Most of the areas affected by the reforms are about the issue of how money is spent and who makes the decisions. This is because new organizations are being established and others being abolished. The legal responsibility for management of NHS budget will be shifted to new organisations. Local councils are also given higher mandate in matters that influence health services. The suggested performance reforms and finance performance is somewhat daunting (Milburn & Flowerday, 2012).
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For instance, on autonomy, many people believe that the policy landscape is clear. This implies that the NHS Trusts autonomy would be progressively replaced by the independent foundation trusts. According to Cornock (2016), the rising new relationship between commissioners and providers will help bring primary and secondary care closely, which will help merge the transformation and sustainability plans to sustain effective delivery of services (Triggle, 2014).
However, this would imply deterioration of performance and finance as the central control of healthcare budget is extended to include other aspects of healthcare such as operational management and workforce (Murray et al., 2014). As the issue of finance recedes, NHS is expected to invent new approach to sustain the earned autonomy for NHS providers. This is a challenge because the foundation trust model may fail to ultimately protect the local organizations autonomy. Therefore, to reinvent autonomy, the NHS governance and structure will need to be restructured (Woringer et al., 2015).
Conclusion
Despite the fact that the reforms were established to reduce health inequalities, the reforms issues are highly debateable. The government believed that the NHS reforms were the best approach to improve the public health. Clearly, many things as highlighted by BMA have been overlooked. In this context, the NHS needs to make more honest assessment of what can be achieved and ensure that the strategic plans designed are comprehensive and realized.
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References
Alexander, J. (2013). The Tavistock and Portman NHS Trust short course Holding the Baby and Toddler Mind: An individual family and community perspective April 2013. Infant Observation, 16(2), 200-204. http://dx.doi.org/10.1080/13698036.2013.818362
Edkins, R., Cairns, B., & Hultman, C. (2014). A Systematic Review of Advance Practice Providers in Acute Care. Annals of Plastic Surgery, 1. http://dx.doi.org/10.1097/sap.0000000000000106
Frisina Doetter, L., & Gatze, R. (2011). Health Care Policy for Better or for Worse? Examining NHS Reforms during Times of Economic Crisis versus Relative Stability. Social Policy & Administration, 45(4), 488-505. http://dx.doi.org/10.1111/j.1467-9515.2011.00786.x
Iacobucci, G. (2015). Privatisation of cancer and end of life care services in Staffordshire could threaten NHS providers, warn critics. BMJ, 350(mar19 9), h1557-h1557. http://dx.doi.org/10.1136/bmj.h1557
Le Grand, J. (2013). Will 1 April mark the beginning of the end of England’s NHS? No. BMJ, 346(mar26 4), f1975-f1975. http://dx.doi.org/10.1136/bmj.f1975
Mead, J. (2013). Orthopaedics – Allegation of obsolete procedure dismissed: Ecclestone v Medway NHS Foundation Trust (High Court, 12 April 2013 – Judge Reddihough). Clinical Risk, 19(3), 83-84. http://dx.doi.org/10.1177/1356262213497684
Milburn, S., & Flowerday, A. (2012). Delivering scalable Telehealth: What is Scale? With case studies from NHS providers, a perspective on the challenges, constraints and issues associated with scalability. Int J Integr Care, 12(4). http://dx.doi.org/10.5334/ijic.931
Sussex, J. (n.d.). How Fair? Competition between Independent and NHS Providers to Supply Non-Emergency Hospital Care to NHS Patients in England. SSRN Electronic Journal. http://dx.doi.org/10.2139/ssrn.2640148
Woringer, M., Cecil, E., Watt, H., Chang, K., Hamid, F., & Khunti, K. (2015). Community Providers of the NHS Health Check CVD Prevention Programme Target Younger and More Deprived People. Int J Integr Care, 15(5). http://dx.doi.org/10.5334/ijic.2185
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Sexually Transmitted Infections
This practicum is one of the most fascinating experiences in my clinical practice. Dealing with patients diagnosed with sexually transmitted infections (STIs) is challenging as most of the patient are hesitant to talk openly to a nurse or doctor about their experiences, which makes it challenging during clinical decision making processes (American Congress of Obstetricians and Gynaecologists, 2011).
Mrs. Kate (pseudo name) a 21 year old college student presented to the clinic with complaints of itchiness around her genitalia, sharp burning sensation during sexual intercourse and had noted whitish discharge that had foul smell. From the clinical manifestation, I gathered that the patient is suffering from an infection, which could be either sexually transmitted infections (STIs) or urinary tract infections (UTIs). There is a thin line that separated the two, which indicated the need for further laboratory test.
According to Centre for disease control and prevention (CDC), UTIs and STIs clinical manifestations are non-specific and are a common to problem for females. This highlights the likelihood of misdiagnosis. The common clinical manifestation for the urogenital diseases includes a burning sensation during urination, vaginal discharges and pelvic pain. However, in UTIs infection, vaginal discharge with awful smell is normally absent. The patient with urinary tract infection tends to have fever. A pelvic exam, urine culture and vaginal culture results indicate that the patient had yeast vaginal infection (CDC, 2013).
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One of the challenges experienced during this practicum was during sexual history assessment. Initially, the patient was hesitant to disclose the information because it is a taboo and also she believed that disclosing this information would victimize her. After reinforcing the issue of confidentiality, the patient became relaxed and disclosed the sensitive information.
The sexual history assessment was done using the general guide of the ‘5 Ps.’ This included the number of sex partners, the type of sexual activity, the rates of use of protection, and use of contraceptives. This helped me understand the patient literacy and perspectives about UTI (Schuiling and Likis, 2013).
The patients seemed somewhat distressed when I gave her the diagnosis results. However, she was cooperative all through the care plan. The patient was advised to have regular check up with the gynaecologists. This is because sexually transmitted infections (STIs) have short and long term impacts that can be life threatening. The short term impacts include emotional disturbances due to physical changes.
The long term effects include genital sores, inflammation, infertility issues and pelvic inflammatory reactions. Fortunately, genital yeast infections like other sexually transmitted infections (STIs) is manageable if diagnosed early and proper medication regimen is provided (CDC, 2013).
The patient had tried to manage the itchiness and pain using Tylenol (OTC) and vaginal cream, which yielded little success. The patient was given fluconazole 150 mg and Terconazole 80 mg both orally administered one suppository/day for at least 3 days. The medication ensured that the patient did not get recurrent infection. The patient was encouraged to observe hygiene and practice abstinence during the medication regimen. Other hygiene measures such as mutual monogamy, abstinence and avoid of douching practices.
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This practicum was very enlightening, especially on ways to practice cultural competency. I noticed that sexually transmitted infections (STIs) education focuses in specific information on signs and symptoms which seems to be the worst case scenarios and a taboo to most of the community.
The only down to earth guidance is abstinence and use of condom. If not handled with care, the interaction with the patient could affect patient psychosocial status. I have learnt a lot from this practicum and will use the knowledge to help other patients to identify risk factors and practice preventive measures (Schuiling and Likis, 2013).
References
American Congress of Obstetricians and Gynecologists. (2011). Guideline for adolescent health care (2nd ed.). Retrieved from http://www.acog.org
Centers for Disease Control and Prevention (CDC). (2013). Incidence, prevalence, and cost of sexually transmitted infections in the United States. Retrieved from http://stacks.cdc.gov/view/cdc/13174
Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.
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Amenorrhea Practicum Journal Entry
During this practicum, a 25 year old female presented to the healthcare facility with complains of severe cramp pain that occurs about one week before her menses, during the menstrual cycle and a week after the cycle ends. The patient complains that her menstrual cycles is irregular, and gets heavy periods with some clots. The patient reported to the clinic due to sharp pain that radiated from the chest. The patient had lived with this condition for 12 years. She has been managing the disease using alternative tradition medicines, which has not been effective.
Review of the system was conducted and laboratory tests were performed (urinalysis, urine culture, pregnancy test and wet prep). The differential diagnosis identified included amenorrhea, endometriosis, and ovarian cysts without explanation. Ovarian cysts were suspected due to presence of pelvic pain before the onset of period. However, this is not likely because the patient did not complain of fever and vomiting. Amenorrhea is suspected due to presence of pelvic pain. However, this is not likely as the key indicator of amenorrhea is absence of menses (Domino, Baldor, Golding, 2014).
To make a definitive diagnosis physical test was performed. Under the supervision of my preceptor, I conducted a pelvic exam. This included palpating pelvis areas to check abnormalities such as cysts and scars. The pelvic exam was negative. An ultrasound was requested to capture the image of the reproductive organs. The results indicated that the patient was suffering from endometriosis (American Congress of Obstetricians and Gynaecologists, 2011).
Treatment made included pain relive medication to help manage the painful cramps. The patient was also given Lo Loestrin Fe which has been found to be effective in management of pain. The increase and decrease of hormones during the menstrual cycle makes the endometrial implants to thicken.
Using this hormone therapy, it slows down the growth which prevents the implantation of the endometrial tissue. However, the patient was educated that although these medications manage the pain, they are not a permanent fix for this health complication. The symptoms can reoccur after stopping the treatment (CDC, 2013).
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The patient was also advised on ways to manage pain using home remedies. This includes the use of heating pad to relax the pelvic muscles, which helps in reducing pain. OTC non-steroidal anti-inflammatory drugs such as Motrin IB. The patient is advised to eat health and exercise regularly as it helps improve the pain (Buttaro et al., 2013).
During this practicum, I have learnt that issue of endometriosis is poorly understood in the society. This is probably because of the common myth of “etiquette menstruation” where the society believes that menstruation is a private affair and must not be discussed in public. Most of women conceal their suffering, which makes them to suffer in silence. As advanced nurse practitioner, it is our responsibility to raise awareness on endometriosis to encourage the affected persons to speak up, and seek medication early (CDC, 2013).
During the research, I also realized the common modalities between ovary cysts, amenorrhea and endometriosis. This includes the similarity in the clinical manifestation, test and diagnosis procedures and treatment. In these three reproductive systems disorders, they are clinically manifested by presence of pelvic pain before the onset and after menstrual cycle.
The test diagnosis of these disorders includes ultrasound, Pregnancy tests, urinalysis and urine culture. In management of the disease, most of them are managed using OTC pain killers, hormone therapy or invasive methods. Therefore, I need to research more on these reproductive disorders to ensure that I deliver effective care when serving the affected community (American Congress of Obstetricians and Gynecologists, 2011).
References
American Congress of Obstetricians and Gynecologists. (2011). Guideline for adolescent health care (2nd ed.). Retrieved from http://www.acog.org
Buttaro, T., Trybulski, J., Bailey, P., & Sandberg-Cook, J. (2013). Primary Care, 4th Edition. Philadelphia, PA: Lippincott Williams & Wilkins.
Centers for Disease Control and Prevention (CDC). (2013). Incidence, prevalence, and cost of sexually transmitted infections in the United States. Retrieved from http://stacks.cdc.gov/view/cdc/13174
Domino, F. J.; Baldor, R.A.; Golding, J (Ed.). (2014). The 5-minute clinical consult standard 2015 (23rd ed, Kindle Edition). Philadelphia, PA: Lippincott Williams & Wilkins.
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Life Cycle of the Female Menstrual Cycle
1. Discuss the initiation of puberty and the role that hormones play during this period in the adolescent’s life span.
The puberty and adolescence are one of the fascinating transitions in human growth and development. It is during this period that sexual maturity occurs. The initiation age of puberty is normally between 8 and 15 years, but it is mainly influenced by person’s genetic composition and the environmental factors. During this period, more sex hormones are secreted by the gonads.
The hormones are responsible for the major physical and biological changes including acceleration of growth in height and weight, development of secondary sexual characteristics such as thelarche, voice changes and growth of public. The period lasts for two to three years but ends when the individual sexual reproduction matures (American Congress of Obstetricians and Gynaecologists, 2011).
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2. Discuss the menstrual cycle and the phases involved in the menstrual cycle. What is the role of various hormones during each phase and what is the significance of each?
The two predominant hormones in menstrual cycles are oestrogen and progesterone which are secreted by the ovaries. During the first days of the cycle, the levels of oestrogen and progesterone hormones are low. In day five (Follicular phase), one egg in the ovary is selected. The suppressed levels of oestrogen cause the secretion of follicle stimulating hormones by the pituitary gland. This hormone facilitates the formation of follicle.
The follicle stimulates the secretion of oestrogen which promotes the formation of the endometrial wall. Day 6 to day 14, the oestrogen levels rise progressively as it prepares for ovulation process. The 14th day of the menstruation cycle is the ovulation day. It is this day that the egg breaks free from the follicle, and migrates to the fallopian tube (luteal cycle).
During this cycle, the corpus luteum develops as a result of release of Luteinizing hormone from the pituitary gland. This promotes the secretions of progesterone, which causes proliferation of endometrium for readiness of implantation. If no fertilization takes place, the levels of the progesterone and oestrogen decreases, and endometrium is shed off (the menstrual phase). This marks the beginning of the next cycle (Blakemore et al., 2010).
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3. Compare and contrast the hormones relevant during the menstrual cycle and menopause. What changes occur in the woman’s body as she prepares to enter menopause?
The main changes observed as women prepare for menopause is irregular menstruation cycle is controlled by various hormones. This stage also involves mood swings, vaginal dryness, hot flashes, changes in their sex drive, and insomnia. During menopause, the reproductive hormones levels become imbalanced which causes changes in menstruation cycle. The few ovarian follicles develop and its responsiveness to follicle stimulating hormone reduces.
Additionally, ovaries produce less estradiol, androgens and progesterone causing the production of follicle to stop. This is due to the low estrogen and progesterone levels, which makes the levels of the Follicle stimulating hormone and luteinizing hormone to remain high. This causes shortened and irregular menstruation cycles- the key indicators of onset of the menopause (Trickey, 2011). Eventually, these hormonal changes make menstruation to stop.
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4. Tanner staging during puberty has been used for decades. Tanner staging also estimates when to expect to see these changes in boys and girls. Yet it seems that girls and boys are “maturing faster” today than in previous decades. Do you believe this is a true statement?that adolescents are maturing at an earlier age? If so, what do you believe is the cause of this? If you disagree with this statement, give rationale for why.
Yes, today’s adolescent’s maturity occurs faster than the average age. This fact is attributable to improved health environmental factors. However, there is no exact cause for this because each child’s development and growth is unique and is influenced by various factors such as environmental toxins, socioeconomic status, physical activity and presence or presence of disease. Healthy children with healthy lifestyle mature at a faster rate as compared to the malnourished (Trickey, 2011).
References
American Congress of Obstetricians and Gynecologists. (2011). Guidelinesfor adolescent health care (2nd ed.). Retrieved from http://www.acog.org
Blakemore, S., Burnett, S., & Dahl, R. (2010). The role of puberty in the developing adolescent brain. Human Brain Mapping, 31(6), 926-933. http://dx.doi.org/10.1002/hbm.21052
Trickey, R. (2011). Women, hormones & the menstrual cycle. Fairfield, Vic.: Ruth Trickey/Trickey Enterprises (Victoria).
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Teenage Sexual Education
My project is on the provision of sexual education to teenagers. Teenagers that are sexually active are a matter of serious public concern. In the past years, several school-based programs have been designed for sole aim of holding up the initiation of sexual activity. Schools can play a central role in offering teenagers with a wide knowledge base that can aid them in molding their healthy lifestyle and coming up with informed decisions about their behavior (Shindel& Parish, 2013).
Detailed sexual education provides accurate information about gender identity, human sexuality, sexual health, reproduction and develops skills for communicating and relating to others in meaningful and satisfying ways. Additionally, it supports one’s ability to make sexual decisions with integrity and respect to other people.
Noddings (2015) reports that equal access to sexual education for teenagers of all cultures, races, gender identities, economic circumstances, and ethnicities are a matter of social justice. Young people who learn how to make respectful and intentional sexual decisions manage leading a healthy and safe lifestyle free from early teenage pregnancies, STIs such as HIV/AIDS, syphilis and gonorrhea as well as lost opportunities and barriers of economy that often follow. Parents, schools, religious institutions, and community based organizations have a crucial role of providing detailed sex education to young people (Wight & Fullerton, 2013).
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How it relates to the Field
As a health care practitioner, this project of sexual education is central to my practice. We are charged with the responsibility of ensuring that the public engages in activities that do not predispose them to health risks. We have a mandate of ascertaining that high health standards are maintained in the community. It is our duty to enlighten the public on the consequences of certain activities that impair the quality of life of the people and may lead to high mortality rates.
Therefore, provision of sexual education is one way of ensuring that people lead a healthy lifestyle by avoiding STIs and teenage pregnancies. The school is the appropriate environment of offering sexual education since it is often in regular contact with a large percentage of young people, with virtual all teenagers attending it before they engage in risky sexual behavior.
PICOT Question
Population: Teenagers attending public schools in the US. Students that were cognitively handicapped, school dropouts, delinquent, institutionalized, or emotionally disturbed were not considered for this project since they address different needs and characteristics.
Intervention: Sexual education on the importance of abstinence behavior.
Comparison: The results of this study were compared to those of studies that focused of a group of students in public schools who had not received sexual education
Outcome: The results that were determined include; delay in onset of intercourse, decease in intercourse frequency, and decrease in the number of sexual partners.
Timing: Evidence was gathered from studies where by the intervention was implemented for a period of one year and results obtained.
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IOWA Model
According to Schaffer et al., 2013, health care providers are encouraged to use updated research evidence to promote better patient outcomes and inform actions, decisions, and patient interactions to deliver quality care to patients. Different models have been developed by scholars to promote the use of EBP in healthcare.
One of these models is the IOWA model. This model is quite crucial in my project since it will serve as a guide on the steps I should follow for successful completion of this project. For instance, it has seven steps that each researcher should follow when conduct a study. These steps are;
Selection of a topic
Forming a team
Retrieval of evidence
Evidence grading
Developing an EBP standard
Implementing EPB
Evaluation
With this model, I will be in a better position to actively read, critique, and grade evidence that will aid in promoting my project of sexual education among young people.
Feedback
A well designed PICOT question is an essential guide in retrieval of evidence in literature research. The question provides information on the type of population to be considered in the study, the implemented interventions, the control parameter, the outcome as well as the timing of the research.
Adhering to these steps makes a literature research simple even for novice researchers. The formulation of the PICOT question also supports an EBP project since one can select literature on the research topic and use the steps to gather evidence, implement it, and determine the outcomes of the project.
Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence‐based practice models for organizational change: overview and practical applications. Journal of advanced nursing, 69(5), 1197-1209.
Wight, D., & Fullerton, D. (2013). A review of interventions with parents to promote the sexual health of their children. Journal of Adolescent Health, 52(1), 4-27.
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Back Pain
Introduction
Back pain is a common and costly disorder in Australia. Hoy et al., (2014) report that about 25% of Australians suffer from back pain and approximately half of them seek medical attention. The direct costs for treatment of this condition in Australia have been estimated to be approximately $ 1 billion with an addition of $ 8 used in indirect costs (Buchbinder et al., 2013).
The condition is also prevalent within the healthcare professionals where nurses have a higher likelihood of developing back pains unlike individuals from other professions. In South Australia alone, back injury accounts for over $2 million in every financial year (Lorig et al., 2013). Surveys of patient self-managing their back pain as well as those managed in primary care have indicated that usual care is not often evidence based hence hindering provision of best outcomes to patients.
Consequently, there has been a growing demand to address the ramifications of back pain through changes in health policies, investments, and service delivery. Healthcare providers, are charged with the responsibility of ensuring that patients receive effective prevention and treatment strategies to curb this menace.
In my visit to John’s home, there are a number of activities that I will conduct to examine John’s condition and the proper intervention that he needs for effective management of his condition. Some of these activities that I will examine include;
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Patient Education
In my initial visit, the first is educating John on chronic back pain. I will highlight clearly that the condition may arise due to an injury or diseases on different body structures such as the muscles, joints, ligaments, or nerves. According to Traeger et al., (2014), the type of pain varies and can be felt as muscle pain, bone pain, or nerve pain. I will also emphasize that it is important for patients to seek medical attention the moment they have back pains and not wait until the disorder worsens to promote effective management of the condition.
At this point, it will be of great significance for me to let John know that he is not the only one suffering from back pain. He should understand that back pain is a massive problem in Australia that sends more people to seek medical attention more than any other condition except common cold (Driscoll et al., 2014).
Nutrition and Weight loss
Normally, patients who are overweight and suffer from back pain, such as John, may not be aware their excess weight aggravates their condition (Brady et al., 2016). It is well known that obese patients are at a greater risk for back pain, muscle strain, and joint pain unlike those that are not overweight. Moreover, obese patients also complain of fatigue and shortness of breath which makes them refrain from exercises worsening their back pain (Heuch et al., 2013).
When patients do not get enough exercise for quite some time, the back’s supporting structures become weak, stiff, and deconditioned which further increases pain (Silisteanu & Covasa, 2015, November). It is for this reasons that I will encourage John to have a weight loss program which may involve gentle low-impact activities such as walking, jogging, or water therapy. I will also advise John to avoid eating foods with high fat content. He should also stick to a rational nutrition plan which involves changes in eating habits as a step toward effective management of his back pain.
During the visit, I will observe John’s posture and position. Reviewing of John’s curvature of the spine, shoulder symmetry, and the iliac crest will also be of great importance. I will conduct a physical examination through palpation of John’s paraspinal muscle to identify any form of tenderness and then initiate proper interventions as per the findings.
Pain Alleviation
For pain reduction, I will encourage John to take timed bed rests and adjust his position to improve flexion of the lumbar region. I will teach him to regulate and adjust the pains that traverse through the respiratory diaphragm. Relaxation can also help in reducing muscle tension that contributes to back pain. John should also adjust his sitting position regularly or even engage in other activities such as reading books, watching a movie or take part in yoga.
I will advise John to request his wife, Donna, to gently massage his back. It has been proven by Kumar, Beaton & Hughes, 2013; Schulz et al., 2014) that massage aids in reduction of muscle spasms, reducing damming, and improve blood circulation.
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Depression
Depression is the most common emotion linked to chronic back pain. Patients with chronic back pain have major depression which is said to be four times greater in such patients than in the general public in Australia. John is not an exception from this statistics since he reports that he is depressed because he can no longer take part in activities such as hiking and cycling that he has always loved.
Research has revealed that depression can trigger back pain (Steffens et al., 2012). It affects the intensity, frequency and the rate of healing of back pain. Consequently, I will advise John to communicate about the depression. Mostly, many patients do not talk to their physicians about their depression, anxiety, or stress (Center, 2012). Individuals that are stressed tend to tense their back muscles which in turn trigger the onset of low back pain or make it even worse.
They believe that the emotions will go away once the initial pain problem is solved. Therefore, John should regularly keep me updated about his feelings so that I may provide desirable care to him. I will also recommend John to interact with other people, for instance, he can occasionally visiting his daughter or son or play with his grandchild to avoid being lonely and stressed up.
The two activities that I will give priority in my subsequent visits are;
Adherence to Medication
Generally, healthcare providers are aware of the considerable increase in rates of opioid prescribing. Opioids have long been used as pain management agents. However, they are associated with adverse reactions such as nausea, vomiting, constipation, respiratory depression, addiction, and even death. The side effects usually limit their use by patients. Therefore, in my first visit and subsequent visits, this is an issue I will be reviewing.
In these visits, I will assess the effectiveness of the prescribed analgesics and inquire from John on whether what he feels after taking the drug. I will then initiate appropriate adjustments according to the patient’s condition for effective pain management. Besides, other pain management therapies such as acupuncture, yoga, chiropractic care, and herbal medicines such as ginger, capsaicin and feverfew can be used (Ferreira et al., 2014).
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ii) Exercise
According to Searle et al., (2015)exercise should be the first treatment choice for a patient with back problems such as John. This is because exercise matches the fact that individuals with chronic back pain should be physically active and involve themselves in their management. Moreover, treatments such as massage, acupuncture, and manipulative therapy are passive hence the patient is not involved in the therapy.
Falla et al., (2014) further highlight that exercise provides other health benefits beyond back pain management, for instance, in terms of bone and cardiovascular health. Therefore, I will encourage John to take part in usually low grade oscillatory exercises such as knees side to side rotation, knee to chest stretches, pelvic tilts, and press ups. I will also help John to come up with an exercise program which I will be supervising to ensure he follows it.
There are several forms of exercise and there is no genuine reason of expecting that one approach would be better than the other (O’Sullivan, 2012; Elden et al, 2013). As a result, I will give John a list of beneficial exercises he can engage in and enquire from him which type he would prefer so that it is included in the exercise program. The best form of exercise for any patient is the one they are enthusiastic about and willing to continue with.
For instance, John says he likes cycling; an activity that has been recorded to have desirable outcomes in patients with back pains. This can be included in his program. I will advise John not to take part in heavy physical activities, circular motions, and sways which often worsen the condition. I will encourage John to switch activities while sitting, lying or walking for a long time.
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Conclusion
Back pain is a common health problem in Australia (Cramer et al., 2013). However, its prevalence can be reduced significantly if patients and clinicians work together. Patients, for instance, should seek early medical attention and adhere to the prescribed medications and the recommended activities. On the other hand, physicians should keep a close surveillance on these patients and ensure that desirable patient outcomes are realized.
References
Brady, S. R., Hussain, S., Brown, W. J., Heritier, S., Billah, B., Wang, Y., & Cicuttini, F. M. (2016). Relationships between weight, physical activity and back pain in young adult women. Osteoarthritis and Cartilage, 24, S10-S11.
Buchbinder, R., Blyth, F. M., March, L. M., Brooks, P., Woolf, A. D., & Hoy, D. G. (2013). Placing the global burden of low back pain in context. Best Practice & Research Clinical Rheumatology, 27(5), 575-589.
Center, C., Relief, P., Covington, L. A., & Parr, A. T. (2012). Caudal epidural injections in the management of chronic low back pain: a systematic appraisal of the literature. Pain Physician, 15, E159-E198.
Depression Goesling, J., Clauw, D. J., & Hassett, A. L. (2013). Pain and depression: an integrative review of neurobiological and psychological factors. Current psychiatry reports, 15(12), 1-8.
Driscoll, T., Jacklyn, G., Orchard, J., Passmore, E., Vos, T., Freedman, G., & Punnett, L. (2014). The global burden of occupationally related low back pain: estimates from the Global Burden of Disease 2010 study. Annals of the rheumatic diseases, annrheumdis-2013.
Elden, H., Gutke, A., Kjellby-Wendt, G., Fagevik Olsén, M., Stankovic, N., & Östgaard, H. C. (2013). Back pain in relation to pregnancy: A longitudinal 10-year follow-up of 369 women diagnosed with pelvic girdle pain during pregnancy. In Advances in multidisciplinary research for better spinal/pelvic care. The 8th Interdiciplinary World Congress on Low Back & Pelvic Pain, Oct, 2013. Dubai.
Falla, D., Gizzi, L., Tschapek, M., Erlenwein, J., & Petzke, F. (2014). Reduced task-induced variations in the distribution of activity across back muscle regions in individuals with low back pain. PAIN®, 155(5), 944-953.
Ferreira, P. H., Ferreira, M. L., Maher, C. G., Refshauge, K. M., Latimer, J., & Adams, R. D. (2013). The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Physical therapy, 93(4), 470-478.
Heuch, I., Heuch, I., Hagen, K., & Zwart, J. A. (2013). Body mass index as a risk factor for developing chronic low back pain: a follow-up in the Nord-Trøndelag Health Study. Spine, 38(2), 133-139.
Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A., Bain, C., & Murray, C. (2014). The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Annals of the rheumatic diseases, annrheumdis-2013.
Kumar, S., Beaton, K., & Hughes, T. (2013). The effectiveness of massage therapy for the treatment of nonspecific low back pain: a systematic review of systematic reviews. Int J Gen Med, 6, 733-741.
O’Sullivan, P. (2012). It’s time for change with the management of non-specific chronic low back pain. British journal of sports medicine, 46(4), 224-227.
Schulz, C., Leininger, B., Evans, R., Vavrek, D., Peterson, D., Haas, M., & Bronfort, G. (2014). Spinal manipulation and exercise for low back pain in adolescents: study protocol for a randomized controlled trial. Chiropractic & manual therapies, 22(1), 1.
Silisteanu, S. C., & Covasa, M. (2015, November). Reduction of body weight through nutrition intervention reduces chronic low back pain. In E-Health and Bioengineering Conference (EHB), 2015 (pp. 1-3). IEEE.
Steffens, D., Ferreira, M. L., Maher, C. G., Latimer, J., Koes, B. W., Blyth, F. M., & Ferreira, P. H. (2012). Triggers for an episode of sudden onset low back pain: study protocol. BMC musculoskeletal disorders, 13(1), 7.
Traeger, A. C., Moseley, G. L., Hübscher, M., Lee, H., Skinner, I. W., Nicholas, M. K., & Hush, J. M. (2014). Pain education to prevent chronic low back pain: a study protocol for a randomised controlled trial. BMJ open,4(6), e005505.
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The success of a business is influenced by the level of employee motivation. Productivity and profitability are the results of happy and hardworking workers. Motivation is dependent on individual employee since some may be motivated by money, others promotion and others are motivated by having equity in the business. The only way to motivate employees is finding out what each wants and making it available or assisting them to earn it. If all employees are motivated, the result will be high productivity and profitability.
The author carried out the research to identify the existing motivational strategies in National Alcohol and Liquor Factory and assess their impacts on productivity. The quality of the motivating system, type of motivation, and roles played by the motivated employees are some of the items analyzed to address the issue of employee productivity. By carrying out the research, the company was able to identify gaps in its motivational system and focus on motivation since it affects the productivity of the organization.
Construction industry lagged behind in productivity compared to other industries. Attitude, employee-employer relationship, and lack of communication are some of the main issues affecting motivation in the workplace. Work climate, employee development, perceived equity, work objectivity, and organizational climate should be addressed with relation to employee motivation.
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An environment that fosters motivation makes employees feel that there is constant communication, have control over their work and are respected. According to the research, firms that had motivated employees had a subsequent increase in their stock prices resulting in high dividends for shareholders. Being less strict on internet use, measuring performance with set goals, and consistent measurement of performance are some of the ways the author indicates crucial in improving productivity.
The study was carried out in the United States telecommunication industries due to the increased downsizing of workers. Systems theory was used to assess the available strategies for managers to increase the motivation of the retained workers. Communication is the most crucial element in motivating the workers.
High performers are the most productive compared to average workers according to the research. High performers are few in the workplace yet they the most satisfied with their jobs. The best strategy should be to increase retention rates for the high performers. The study was conducted in 27 countries to determine the future expectations of the workforce. Base pay and bonuses are what satisfies most employees.
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Culture is critical in an organization as it drives performance and affects business processes. A good culture encourages play, potential, and purpose while at the same time reducing economic and emotional pressure. The research was carried in 50 companies around the world.
According to the author, morale can be defined as an individual’s state of mind resulting from emotions and feelings. It is an elusive quality that determines the attitude towards other team members, workplace environment, and the overall organization. Job insecurity, excess outsourcing, perceived unfairness, and poor compensation lead to poor morale. Thus, employees focus on how to improve their careers instead of being productive. Managers are encouraged to build an organization culture that meets the needs of each employee to increase their motivation and productivity.
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Organizations are focusing on having an equitable balance between employee contribution to the firm and the firm’s contribution to the workers. Recognition, benefits and compensation are some of the rewards associated with the balance between the firm and the employees in the bank. Balance leads to motivation hence increase in productivity.
The author applied Maslow hierarchy of needs to analyze motivation in relation to productivity. Strategies must be put in place to address the misunderstandings that happen when there are changes in organizations. Attitude, beliefs, and background can result in destructive or constructive acts that affect workplace performance.
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Impact of Employee Motivation on Employee Productivity
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Impact of Employee Motivation on Employee Productivity
Anar Nesibov (2015). Impact of employee motivation on productivity
The author talks about the challenges faced by business in the competitive market. Managers are called to effectively manage all the factors of employee retention and production such as the machines, men, and materials. Human resources, unlike other factors of production, need control of emotions and thoughts for productivity. Successful organizations have motivated employees. The challenge faced in motivating the employees is how to integrate the different employee skills with the other factors of production without interfering with the goals of an organization thus the author explores all other factors related to employee motivation.
Barbra, (2011). The effect of motivation on productivity
According to the author, there are different factors that lead to employee motivation and being motivated an employee’s choice. Motivation is internal, and if an employee is motivated, they end up being more productive in an organization. Instead of bringing up motivational speakers, firms should concentrate on the specific factors that make an individual motivated since they differ. When organizations understand what motivates employees, it can make them productive. The article discourages use of motivational speakers, yet some of the employees are encouraged through them. The author notes the limitation of motivational speakers and comes up with other strategies.
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Carla Valencia (2015). Motivation and productivity in the workplace
Motivation has been an issue for organizational leaders since unmotivated employee is unproductive, do not like being in the workplace, run from their jobs, and produce low quality. The author noted that employees are motivated differently, and it’s up to the leaders to get to know their employee well to know their needs and wants that will make them motivated for high production. The main limitation is in understanding the needs of employees since they are many hence the author uses one industry as a case study.
Sherrie Scott (2014). Motivation and productivity in the workplace
Employees need to feel good about their work to perform well. Some of the employees are motivated through recognition while others are motivated through incentives. For whatever reason that make employees motivated, for as long as they are motivated they tend to be productive. The author notes that employees are different and brings up the aspect of diversifying motivation.
Todd Vernon (2014). Four ways to keep employees motivated and productive
The authors talk about start ups and the challenges they have to face before establishing themselves in the market. Managers are known to use disciplinary actions and to use long working hours to increase motivation, but it’s never the case. Managers are encouraged to treat their employees as investors and use timelines instead of dashboards. The author assumes that employees have the best interest of the organization.
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Mark Panay (2015). Five psychological theories of motivation to increase productivity
The author narrates about the theories that lead to employee motivation. Hertzberg two-factor theory, Maslow hierarchy, and Hawthorne effect are some of the applicable theories to motivate employees. The theories suggest employees inner needs together with being mindful of their outside affairs as the main motivating factor for productivity. The conducted studies do not exhaust all factors that lead to motivation making the theories limited in their scope but uses different examples for each of the theories.
Charles Foster (2015). Motivational case studies exercise
The article talks about the Hellespont Swim as an exercise is done by employees for self and group motivation. Through the case study, several aspects of employee motivation are demonstrated: communications, team work, team building, inspirations, role model, and fun. All these factors aim at making employees more productive. In the case study, time factor and financial constraints are not considered since organizations do not have the same capital resources.
ICM (2010). Motivation: A short case study
The article is about how different employee engagements encourage or discourage productivity. While an employee feels inspired by his senior, other employees, who do not like the senior managers discourage the other making him lose his motivation and hence productivity. However, the article does not talk about the employees who encourage others making it biased. Negative motivation is also motivation so it should not be discouraged but should be used professionally.
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Chris Johnson (2012). Impact of employee motivation in the banking industry
The author explores the banking sector and notes that the staff in banks the least motivated due to the public notion that banks provide the best incentive and working conditions. The management in banks has become sluggards in enticing their employees leading to low productivity especially in the sales department. The author noted that the banks that encouraged their employees were more productive than those who did not motivate employees. The study is only carried out in banks to remove biasness.
James (2015). The importance of employee motivation: Wetherspoon
Other than understanding the market and ways to make its product attractive, a successful business knows how to recruit, train, and motivate employees. The company operates in various regions and in all the branches the employees are considered as the main factor for productivity. The friendly and confident employees found in the pubs are as a result of motivation though incentives and training. The study was not carried in all the company’s branches but assumed that all the outlets behave the same hence did not cover all the aspects of motivation.
Wall Street Journal (2011). Motivating employees
The Journal talks about the different relationship within an organization and how they reveal the culture of an organization. To motivate employees, the author suggests using the frontline employees to make decisions regarding strategies to improve the operations and satisfy customers. Employees are encouraged to come up with new ways of doing business by challenging the existing practices. By doing so, employees feel part and parcel of the organization making them motivated and hence become more productive. The author assumes that employees have the same goals as the organization which is not necessarily the case.
