Category: Health care

Gerontological Nursing: Case Analysis

Gerontological Nursing: Case Analysis

Gerontological Nursing: Case Analysis

Gerontological Nursing: Identification and Description of the Interviewed Individual

            The interviewee is a male individual aged 80 years, and who currently stays with his wife and their son in the city. This client is a retired accountant who has been out of work for the past five years. Also, he is married with three children; two sons aged 25 and 36, and one daughter aged 40.  Furthermore, the patient participates in three major health promotion activities including walking regularly, limiting consumption of salt and sugary foods, and participation in community’s social support groups.

The interviewee believes that increased consumption of fruits and foods rich in sorghum and millet help people to live long. Being 80 years old, the interviewee is considered to be the oldest family member who has ever reached such age. Furthermore, the interviewee is on insulin medication to help with management of diabetes clinical problem. He visits the doctor at least twice a week for a general medical check-up and to obtain clinical guidance on how to effectively manage diabetes symptoms.

Gerontological Nursing: Identification and Description of the Cultural Implications for the Individual

            Personal values and beliefs about old age and health have a great implication to the care of the interviewee. For instance, the interviewee’s philosophy on living a long life may make it difficult for him to appreciate the fact that aging is a normal process. He believes that living long is God’s blessings while deaths that occur when people are still young are associated with curses.

Also, the interviewee has unique thoughts about people who are considered to be of old age. He feels that for a person to qualify to be of old age, lack the capacity to perform daily physical activities, be unable to maintain an upright posture, and must put on glasses to assist with vision. These cultural beliefs may impact negatively on the care of this client because the clinician will find it difficult to change the interviewee’s perceptions and replace them with new ones that can promote positive health outcomes (Shrack et al., 2016).

Additional cultural implication related to the interviewed person include; his or her beliefs regarding health and illness and his values about health status and treatment of older adults. The most appropriate way of eliminating the impact of the person’s cultural values and beliefs is through maintenance of cultural competence throughout the interview and when giving interventions.

Gerontological Nursing: Comprehensive Functional Assessment

To establish what the interviewee can accomplish as well as those that he cannot do properly at his age, a comprehensive functional assessment has been performed using four tools namely; Tinetti Balance and Gait Evaluation, Katz Index of Activities of Daily Living, Assessment of Home Safety, and The Barthel Index. The person’s movement ability has been assessed using the Tinetti Balance and Gait Evaluation.

The client’s ability to perform various activities independently has been evaluated using the Katz Index of Activities of Daily Living. The most appropriate tool that has been used to measure the safety of the patient’s environment is the Assessment of Home Safety, while that which has been used to examine whether the identified individual can accomplish some daily tasks independently is The Barthel Index.

A duly filled Tinetti Balance and Gait Evaluation, Katz Index of Activities of Daily Living, Assessment of Home Safety, and The Barthel Index tools used during the interview have been provided in the Appendix section of this paper.

Gerontological Nursing: Comparison of Age-Related Changes

There are similarities and differences between the expected age-related changes and those observed in the interviewee. Older adults are expected to present with some physiological, physical, pathological, sensory, and motor changes, which significantly affect their ability to perform their activities of daily living and to make various physiological controls. According to Shrack et al. (2016), older adults aged 65 years and above have problems with maintaining gait and balance.

Similarly, the interviewee experiences problems with maintaining gait and balance, both while he is seated and whenever he is standing. Also, Tkatch, Musich, MacLeod, Alsgaard, Hawkins, and Yeh, (2016) point out that older adults often need assistance with various activities of daily living such as dressing, cooking, washing, and toileting. Although the interviewee is 80 years old, he needs assistance only in certain activities of daily living such as rising from a chair.

However, he is still strong enough to feed alone once the food is made available for him. Older adults are at high risk of falls, and there is therefore great need to keep their home environment free from objects that may increase the possibility of falling (Phelan, Mahoney, Voit, and Stevens, 2015). Similarly, the interviewee is at a high risk of falling considering the fact he has a problem controlling balance and gait.

For this reason, his home environment is often kept free from equipment that may increase the risk of falling. Again, as it happens in older adults, the interviewee occasionally finds it difficult to control his bladder and bowel and therefore may always want people to stay around to assist.

Gerontological Nursing: Preliminary Issues Assessed from the Interview

 Four major preliminary issues have been assessed from the interview. The four issues include; age-related changes that are taking place or that have taken place in the interviewee, health promotion activities that the interviewee is currently involved, the interviewee’s cultural values over old age and living longer, as well as actions that have been taken to promote safety at the interviewee’s home environment.

As Tkatch et al. (2016) explain, nurses who are providing care to older adults must be able to understand the impacts that their age-related changes have on their abilities to perform daily activities. Using this information, these nurses must recommend relevant health promotion activities for their clients, including how they can keep their home environment safe for living. The nature of care given as well as the nature of health promotion strategies recommended will depend on the client’s cultural values and beliefs over old age and long life (Tkatch et al., 2016).

From the current assessment, the interviewer has discovered that the interviewee has undergone various physiological, physical, pathological, sensory and motor-related changes as a result of old age that greatly affect his ability to perform daily activities. Furthermore, the interviewer has found that the client engages in a few health promotion activities such as frequently walking to keep fit and consuming fruits.

Through current assessment, it has also been established that some actions have been taken to keep the interviewee’s home environment safe by eliminating objects that may increase the risk of falls. Most importantly, the interviewer has found out that the interviewee believes that God helps people to survive through old age, that the society is less concerned about assisting the aging population, and that God promotes healing and recovery.

Based on results obtained from this assessment, the interviewer understands health problems that majorly occur in older adult as well as factors that must be taken into consideration when establishing the most appropriate health promotion strategies of the elderly (Shrack et al., 2016).

Gerontological Nursing: Alterations in Health

            The interviewee has alterations in health in three major functional areas namely; physiological functions, motor functions, and physical functions. Concerning physiological functions, the interviewee is struggling to manage diabetes, which is a common chronic health problem among older adults. Due to old age, the interviewer’s body cannot control blood sugar levels as required, and hence the observed onset of diabetes (Kezerle, Shaley, and Barski, 2014).

As far as motor functions are concerned, the interviewee has a problem with bladder and bowel control, which makes him have short call accidentally and long call at any time. This problem occurs mainly because of reduced motor function, which is greatly influenced by old age (Westra, Savik, Oancea, Choromanski, Holmes, and Bliss, 2011).

Furthermore, the interviewee experiences physical problems related to balance and gait maintenance, which put him at high risk of falls. He has reported that he needs support when rising from a chair and when moving upstairs. This means that his physical movement has been limited by old age. Therefore, the nature of intervention that would be recommended for the interviewee must target physical, physiological, and motor functional areas described in this section (Tkatch et al., 2016).

Gerontological Nursing: Interventions for Identified Problems

            Interventions should be implemented based on individual health problems that the interviewee is currently suffering from. The most appropriate interventions for diabetes include nutrition counseling, exercise training, and drug adherence training. The interviewee should be guided on those foods that he should avoid keeping his blood glucose level low. Also, he should be trained on the importance of exercise in managing weight, and his family members should be guided on how to offer the right support.

Again, the interviewee should be reminded of the importance of drug adherence in reducing diabetes symptoms (Kezerle, Shaley, and Barski, 2014; & Tkatch et. al., 2016). Three different interventions can be implemented to help the interviewee to reduce risks of falls. First, the interviewee should be guided on how to perform simple exercises that will help him to improve balance and gait.

Second, his family members should be taught on strategies for reducing hazards in the interviewee’s environment to maximize safety. Third, risks of falls can be eliminated if the patient is trained in safety-related behaviors and skills (Phelan et al., 2015). The best interventions for bowel and urinary incontinence include training the interviewee on how to perform pelvic floor muscle exercise, offering nutritional counseling, and educating him on usage and side effects of anticholinergic for the bladder that is overactive.

Frequent pelvic muscle exercise will help to avoid incontinence actions of the urinary bladder and the bowel. Again, the interviewee should be taught to limit fluid intake and to avoid foods that cause bladder irritation. Furthermore, correct use and adherence to anticholinergic can help the interviewee to effectively manage bladder and bowel incontinences (Westra et al., 2011).

References

Kezerle, L., Shaley, L. & Barski, L. (2014). Treating the elderly diabetic patient: Special considerations. Diabetes, Metabolic Syndrome, and Obesity: Targets and Therapy, 7: 391-400. doi:  10.2147/DMSO.S48898

Phelan, E. A., Mahoney, J., Voit, J. C. & Stevens, J. A. (2015). Assessment and management of fall risk in primary care settings. Medical Clinics of North America, 99(2): 281-293. doi:  10.1016/j.mcna.2014.11.004

Shrack, J. A., Cooper, R.,…& Harris, T. R. (2016). Assessing daily physical activity in older adults: Unraveling the complexity of monitors, measures, and methods.  Journals of Gerontology-Series A Biological Sciences and Medical Science, 71(8): 1039-1048. 10.1093/gerona/glw026

Tkatch, R., Musich, S., MacLeod, S., Alsgaard, K., Hawkins, K. & Yeh, C. S. (2016). Population health management for older adults: Review of interventions for promoting successful aging across the health continuum. Gerontology and Geriatric Medicine, 2 (1): DOI: https://doi.org/10.1177/2333721416667877

Westra, B. L., Savik, K., Oancea, C., Choromanski, L., Holmes, J. H. & Bliss, D. (2011). Predicting improvement in urinary and bowel incontinence for home health patients using electronic health record data. Journal of Wound Ostomy & Continence Nursing, 38(1): 77-87.

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Development of a Health Care Policy

Development of a Health Care Policy
Development of a Health Care Policy

Development of a Health Care Policy

Introduction

            Development of a health care policy is one of the ways through which developing nations can be influenced to take actions that promote public health and reduce mortality rates, especially in countries where health inequality is a common problem. The Nature of health policy developed largely depends on specific health care problems that exist in a country at any given time.

Furthermore, one has to consider various social determinants of health in a country before developing and implementing a health policy (Kumar and Preetha, 2012). According to Kumar and Preetha (2012), social factors such as demographic patterns, political and economic changes, cultural issues, and learning environments are believed to influence health situations of many countries around the world.

A health policy that is aimed at reducing health inequality can be effective in promoting public health, and can greatly be supported by a country whose health is negatively impacted by disparities in health care. This paper explores the concept of health policy development and implementation about health inequality while giving special consideration to Malawi.

Health Care Policy: Rationale for Selecting Malawi

            Malawi has been chosen for this case study because it is one of the world’s developing countries whose public health is negatively impacted by health inequality and lack of health policy to guide proper health care delivery. According to Daire and Khalil (2015), failure to access primary health care is one of the causes of high death rates among children aged below five years in Malawi.

Daire and Khalil (2015) further assert that health care for socio-economic barriers largely face Children in Malawi that policy makers in the health sector must address to promote positive child health in the country. Children who are born to low-income families in Malawi are highly likely to experience limited access to health care as compared to those who come from wealthy families. The main reason for the high infant mortality rates among low-income families in Malawi is a lack of primary health care policy.

According to Makaula, Bloch, and Muula et al., (2012) and Ustrup, Ngwira, and Fischer, et al., (2014), Malawi continues to experience low life expectancy because it currently lacks a primary health care policy to guide health care access among poor families with children aged below 5 years. Now, Malawi utilizes the Essential Health Package (EHP) program to implement primary health care.

This has impacted negatively on health care access among poor households and a significant reduction in life expectancy in the country. In this regard, Malawi is one of the developing countries that are experiencing high rates of infant deaths due to lack of primary health care policy and would; therefore, attract the attention of health policy makers (Daire and Khalil, 2015). 

Social Determinants of Health in Malawi and Why they should be Addressed

            There are two major social determinants of health in Malawi that need to be addressed. According to Kumar and Preetha, (2012), social determinants of health refer to factors in the social setting that influence the ability of a country’s population to obtain care at any given time. Examples of social determinants of health include socio-economic factors, family patterns, cultural beliefs and attitudes, learning environments, and demographic patterns.

In Malawi, the two social determinants of health that should concern policy makers are; economic affordability and geographic accessibility of health care facilities. These two social determinants are highly rampant among residents of rural Malawi. Rural populations in Malawi cannot access quality health care due to limited finances and high concentration of health care facilities in urban areas (Ustrup, Ngwira, and Fischer, et al., 2014).

            In a study conducted by Ustrup, Ngwira, and Fischer, et al., (2014), the researchers have found that health care facilities are mainly located in urban Malawi, and this makes households based in rural Malawi to travel to the urban areas to seek for care. Ideally, rural Malawi does not only lack adequate health care facilities, but it also has poor roads that make it difficult for occupants to reach urban areas.

The long travel time coupled with high costs of transport prevent children from low-income families from receiving quality care, hence the observed high infant mortality rates in the country (Makaula, Bloch, and Muula, et al., 2012).  Furthermore, variation in economic affordability among affluent and low-income families determines the nature of care that these two groups of populations can receive in Malawi.

Families in rural Malawi with either small or lack of basic income are faced with the challenge of obtaining care for their children as opposed to those in wealthy regions with high basic income. For this reason, limited economic affordability among residents of rural Malawi presents significant economic burden which prevents families from obtaining quality care for their children (Ustrup, Ngwira, and Fischer, et al., 2014; & Makaula, Bloch, and Muula, et al., 2012).

There is a great need to address social determinants of health about economic affordability and geographic accessibility of health care facilities to increase access to care for families in rural Malawi. As Daire and Khalil (2015) explain, one of the ways through which health inequality in Malawi can be solved is by addressing those factors that hinder citizens from accessing health care.

It is only by addressing these social determinants of health that Malawi will be able to reduce infant mortality and to achieve the Millennium Development Goals. Health care accessibility in Malawi will greatly be improved if the ability of low-income families to meet health care costs and to access health care facilities is enhanced (Daire and Khalil, 2015).

Potential Public Issues that might be encountered

Two major public issues may be faced in Malawi in an attempt to influence health policy development in the country. The possible general issues that may be encountered are related to the level of cultural awareness and health literacy among the country’s population. Health literacy refers to the ability of individuals to comprehend basic health information and their capacity to utilize it in decision-making.

High health literacy is directly related to improved health outcomes while limited health literacy is associated with poor public health. According to Smith-Greenway (2015), high infant mortality rates in Malawi are largely attributed to limited health literacy among low-income families in rural areas. Residents of rural Malawi rarely receive health education, and the public sector has not initiated any programs in those areas to keep citizens informed about health.

Also, the majority of households in rural Malawi can only speak their local language, and they do not understand any information presented to them in pure English (Smith-Greenway, 2015). Lack of public health education and proper communication of public health information are the primary causes of limited health literacy in Malawi. Consequently, limited health literacy may impede successful development and implementation of health policy in Malawi (Ustrup, Ngwira, and Fischer, et al., 2014).

The other public issue that may be encountered during health policy development and implementation in Malawi is the level of cultural awareness among the country’s population. According to Daire and Khalil (2015), cultural knowledge in a country determines the possibility with which a new policy can be developed and implemented. In this regard, it becomes difficult to implement a health policy that goes against the cultural beliefs and values of a country’s population.

As Reiney, Watkins, Ryman, Sandhu, Bo, and Benerjee, (2011) explain, low cultural awareness is a big problem in Malawi because it negatively affects health utilization among the country’s population. Specifically, cultural beliefs and values of the country’s population largely influence the patterns of health utilization in the country in the sense that, health underutilization is common in rural Malawi where occupants do not believe in care that is being offered by health care organizations. Ideally, low cultural awareness among rural populations in Malawi may prevent successful implementation of health policy in the country (Ustrup, Ngwira, and Fischer, et al., 2014).

Relationship Between Health Inequality and Life Expectancy in Malawi

There is an inverse relationship between health inequality and life expectancy in Malawi. In this regard, high disparities in health are associated with low life expectancy while low disparities in health are related to high life expectancy in Malawi. Life expectancy is low when infant mortality rate is high while life expectancy is high when infant mortality rate is low (Deurzen, Oorschot, and Ingen, 2014).

According to the World Health Organization report of 2017, health disparity in Malawi is significantly higher than that of Japan. Furthermore, an infant born in Malawi is highly likely to die at the age of 47 while a child born in Japan will probably die at the age of 87. Therefore, when health inequality is high in Malawi, life expectancy in the country is significantly low, especially among the rural populations (World Health Organization, 2012).

The inverse relationship between health inequality and life expectancy among poor populations is supported by research evidence. In a study conducted by Deurzen, Oorschot and Ingen (2014) the researchers have found that the rate of infant mortality is higher among the poor than among the rich populations. Therefore, a policy that can reduce health inequality will help to reduce infant mortality rate and eventually raise life expectancy (Deurzen, Oorschot, and Ingen, 2014).

Current Efforts in Malawi to Reduce Health Inequalities

            The government of Malawi has worked hard to reduce health inequalities in the country with the aim of reducing infant mortality rates that occur among its rural populations. These efforts are geared towards addressing two major social determinants of health: economic affordability and geographic accessibility of health care facilities. As Ustrup, Ngwira, and Fischer, et. al., (2014) explain, governments can increase geographic accessibility of health care facilities by constructing additional organizations in rural areas.

Between 2003 and 2010, the Government of Malawi constructed a total of 39 health centers in the rural areas. This has helped its rural populations to access health care and to save time and money that could have been spent in traveling to the urban areas to seek for health care.  Additionally, Malawi has taken appropriate actions to mitigate financial barrier among its rural populations by increasing their ability to meet health care cost.

In the year 2010, the Government of Malawi signed an agreement with facilities that operate under the Christian Health Association of Malawi (CHAM) to allow free health care services for mothers and children. With free access to child and maternal health care services, Malawi has been able to record a decrease in infant mortality rate with a slight increase in life expectancy (Ustrup, Ngwira, and Fischer, et. al., 2014).

Health Policy

            The best health policy to address health inequality in Malawi would be that which will get the support of the country’s population, considering the fact that residents of rural Malawi have limited health literacy and do not have trust in the care offered by health care organizations (Makaula, Bloch, and Muula, et al., 2012).

An example of a policy that might be developed to reduce health inequality in Malawi is the creation of a National Development and Social Fund to support programs that facilitate construction of health care facilities in the rural areas, while at the same time meeting the health care costs of mothers and children who reside in rural Malawi.

The Government of Malawi should set aside funds to facilitate implementation of this policy to ensure that both rural and urban populations have equal access to health care. Successful implementation of this policy will result in a reduction in infant mortality rates among the poor populations in Malawi, which will eventually translate into high life expectancy in the country (Ustrup, Ngwira, and Fischer, et. al., 2014; Dairen and Khalil, 2015).

References

Daire, J. & Khalil, D. (2015). Analysis of maternal and child health policies in Malawi: The methodological perspective. Malawi Medical Journal, 27(4): 135-139.

Deurzen, I. V., Oorschot, W. V. & Ingen, E. (2014). The link between inequality and population health in low and middle-income countries: Policy myth or social reality? PLoS ONE, 9(12): e115109. https://doi.org/10.1371/journal.pone.0115109

Kumar, S. & Preetha, G. S. (2012). Health promotion: An effective tool for global health. Indian Journal of Community Medicine, 37(1): 5-12. doi:  10.4103/0970-0218.94009

Makaula, P., Bloch, P…..& Muula, A. S. (2012). Primary health care in rural Malawi: A qualitative assessment exploring the relevance of the community-directed interventions approach. BMC Health Services Research, 12: 328. doi:  10.1186/1472-6963-12-328

Reiney, J. J., Watkins, M., Ryman, T. K., Sandhu, P., Bo, A. & Benerjee, K. (2011). Reasons related to non-vaccination and under-vaccination of children in low and middle-income countries: Findings for a systematic review of the published literature, 1999-2009. Vaccine, 29(46): 8215-8221. doi: 10.1016/j.vaccine.2011.08.096

Smith-Greenway, E. (2015). Are literacy skills associated with young adults’ health in Africa: Evidence from Malawi. Social Science and Medicine, 127: 124-133. doi: 10.1016/j.socscimed.2014.07.036.

Ustrup, M., Ngwira, B…& Fischer, T. (2014). Potential barriers to healthcare in Malawi for under-five children with a cough and fever: A national household survey. Journal of Health Population and Nutrition, 32 (1): 68-78.

World Health Organization, (WHO). (2017). Fact file on health inequality. Retrieved from http://www.who.int/sdhconference/background/news/facts/en/

Children and Teens Obesity

Children and Teens Obesity
Children and Teens Obesity

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Children and Teens Obesity 

Recently, the idea of taking body mass index (BMI) measurements within the school premise for surveillance purposes has gained much attention from school officials, researchers, the media, and legislators. While a considerable number of children across the United States are underweight, a huge number of them are overweight or obese.

According to a survey done by the Center for Disease Prevention and Control, there were about 13.7 million children between 2 and 19 years suffering from obesity in the US (Sliwa, Brener, Lundeen, & Lee, 2019). While some policy makers support the idea of school-based BMI measurement, others do not. 

One of the biggest reasons for supporting school-based BMI measurement is because many children are suffering from chronic diseases such as diabetes and cardiovascular disease due to overweight and obesity. According to Nihiser et al. (2017), the implementation of school-based BMI measurement will help policy makers to identify the number of children that are underweight, healthy, overweigh, and obese in various schools and apply the necessary measures.

These measures can include ensuring that children that have unhealthy weight have access to specialized diets and exercise while at school. School administrators can also use the generate information to help parents take care of their through proper diets at home. 

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Children and Teens Obesity 

According to Madsen et al. (2020) some institutions and policy makers feel that schools may not provide the necessary environment to ensure privacy and confidentiality while taking the measurements. Many students are very sensitive about their bodies due to the increase of bullying cases among overweight and obese children.

Policy makers therefore feel that children with unhealthy weights will be subjected to an unhealthy environment. Most parents also feel that they also have the right to be consulted before their child’ body mass index is measured and they also have the right to decline or accept the initiative. 

The available data is not conclusive as to whether school-based BMI measurement is effective or not. However, it is recommendable that every school have a supportive and safe environment for children of all body weights. 

Children and Teens Obesity 

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References

Madsen, K. A., Thompson, H. R., Linchey, J., Ritchie, L. D., Gupta, S., Neumark-Sztainer, D., … & Ibarra-Castro, A. (2020). Effect of school-based body mass index reporting in California public schools: a randomized clinical trial. JAMA pediatrics.

Nihiser, A. J., Lee, S. M., Wechsler, H., McKenna, M., Odom, E., Reinold, C., … & Grummer‐Strawn, L. (2017). Body mass index measurement in schools. Journal of School Health, 77(10), 651-671.

Sliwa, S. A., Brener, N. D., Lundeen, E. A., & Lee, S. M. (2019). Do schools that screen for body mass index have recommended safeguards in place?. The Journal of School Nursing, 35(4), 299-308.

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Nutrition and Physical Activity Programs

Nutrition and Physical Activity Programs
Nutrition and Physical Activity Programs

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Nutrition and physical activity programs

  1. Background 

In the United States, the prevalence of obese and overweight children aged 2–5 years has almost grown three times over the past 3 decades. These increased levels are alarming and a call for action because children who deal with overweight challenged when they are less than 5 years are more likely to be obese later in life, which leads to detrimental health complications (Hesketh et al, 2017). This can be accomplished by implementing nutrition and physical activity programs.Current statistics show that over 13.7 million children and teenagers in the United States are struggling with obesity.

Out of these 13.9 percent is among children aged between 2 and 5 years, 18.4 percent aged 11 and 20.6 percent aged between 12 and 19 years. Most of the families that have been affected include low-income families and those from ethnic/racial minority groups though they are disproportionately affected. During the early years of development physical activity and eating a healthy and balanced diet are crucial for optimum health, development as well as growth (Hesketh et al, 2017).

It is evident that unbalanced diets and the lack of physical exercise increases a child’s risk for obesity and other consequent health conditions such as diabetes and high blood pressure. Sadly however, the physical exercise and the diet patterns among the preschoolers, particularly those living under or slightly above the poverty line as well as those from racial/ethnic minorities, do not often meet the national standard guidelines.

As such, there is an absolute need to implement effective interventions so as to help in improving the preschoolers’ physical activities and food programs as well as cultivate behaviors that minimize the chances of being obese and the development of related conditions. 

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Nutrition and physical activity programs

Making intervention plans for children between the ages 0-5 years is a beneficial strategy as it will help to prevent obesity resulting from poor diets, sedentary life, and physical inactivity. In is crucial that the interventions start before a child enters elementary school. Across the United States, about 11 million children aged 5 and below have enrolled in organized care facilities in an effort to minimize the levels of obesity (Elias, 2018).

Research shows that early care and education programs can be very helpful to families and their children struggling with excess body weight and obesity (Kohl, Fulton, & Caspersen, 2011). Strategies that implement practices and policies relating to sedentary behaviours, physical activity, and nutrition have the potential of influencing the health of toddlers, infants, and preschoolers in a positive way through the programs.

Childcare programs create a valuable opportunity were children and parents can learn about the benefits of physical exercise and balanced diet. Currently, over 70 percent of children whose parents are working late hours are enrolled in childcare programs and spend over 40 hours per week exercising which helps them to burn excess calories. 

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Nutrition and physical activity programs

  • Purpose of the study 

There is an alarming number of children in the United States who live in homes where consistent availability of a healthy diets is challenging. Most of them access foods that lead to overweight or obesity while others do not have access to the recommended amount of daily foods and physical exercise. The purpose of this study is to assess child/parental nutrition and physical activity programs within healthcare facilities in the United States. The paper discusses the strategies that can assist healthcare facilities to create and implement successful programs that can address the health and wellness needs of the children and their family members. 

  • Research question 

What initiatives are healthcare facilities in the United States implementing to facilitate child/parental nutrition and physical activity programs?

  •  Significance of the study 

This paper is important because it will help parents to understand the benefits of proper nutrition and physical exercise which will in turn help children to get healthy stay healthy as well as lead healthier lives. The study also informs healthcare facilities about new exercise and diet programs that are beneficial for parents and their children.

This information is very beneficial because it will help to reduce the increasing number of children who battle over overweight and obesity as well as other condition such as diabetes and blood pressure. 

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  • Methodology 

This paper is a qualitative paper that uses secondary materials to summarize recommendations about obesity prevention programs based on reviews from expert guidance from secondary sources such as the American Medical Association, the American Academy of Pediatrics, the National Institute for Health and Clinical Excellence, and the Institute of Medicine among others. 

Nutrition and physical activity programs

  •  Literature Review

According to Smith et al (2017), healthcare providers as well as organizations should seek to implement more holistic goals in their roles as public health leaders. Specifically, healthcare facilities hold a significant responsibility to the employees, patients and the public as they are expected to be role models as they provide public health and also act as infection control agents and health promotion advocates.

Through the integration of such practices into the health organization’s operations, healthcare institutions and provides can achieve their duties as professional and take advantage of their unique positions to create change in health behaviors. The widespread challenges concerning overweight and obesity have detrimental consequences on mortality and morbidity due to hypertension, diabetes, cardiovascular disease and hypercholesterolemia among other diseases.

The Centers for Disease Control and Prevention (CDC) asserts that across the US, 69.2 percent of adults between the ages of 20 years and above are overweight, 35.9 percent are obese (Rothstein, 2014). More so, 18.0 percent children between the ages of 6 and 11 years and 18.4 percent of teenagers aged 12 to 19 years are obese. The CDC argues that poor diet contributes heavily to obesity and it is very crucial for overweight and obese parents and children to break unhealthy eating habits and to adopt new ones that promote a healthy body.

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Norman, Zeebari, Nyberg, and Elinder (2019) argue that healthcare institutions and providers have the ability and opportunities to play a symbolic and direct role so as to help patients in adopting improved nutrition and better diet by providing healthy food as well as drinks at the institution. Sadly, instead of providing healthy diet options, some healthcare facilities, which include pediatric hospitals, actually allow fast-food restaurants to sell food within their facilities.

For instance, most hospital organizations have restaurants such as McDonald’s, and some facilities have three to four fast-food restaurants. In these restaurants, the chief patrons include workers employed by the healthcare facility and other guests (Rothstein, 2014). It is essential to however provide more tasty and nutritious food to patients and to ensure that the cafeterias are selling healthy food.

A fast-food restaurants symbol in a healthcare facility is vulgar and unmistakable today. With the current alarming levels of obesity, diabetes, hypertension, and cardiac diseases hospitals cannot afford offer silent support to the public and encourage patients to eat at fast-food outlets that do not provide healthy food choices. 

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According to Rothstein (2014), one does not have to get the full fast-food menu to realize some of the “comfort value” prices offered by some fast-food restaurants. After the Philadelphia Children’s Hospital closed McDonald’s, it opened a food service that provided milkshakes for its pediatric patients. Nonetheless, it is true to say that healthy food option are often more expensive as compared to fast-food restaurants.

As a result, to establish and maintain a healthy food restaurant within the facility will require the hospital additional income and also the number of employees who are low-income workers, patients, and visitors may be significantly subsidized.  Most hospitals therefore allow fast-food restaurants so that the can gain more profit (Rothstein, 2014).

However, optimizing profits should not be a justification for establishing fast-food restaurants within a healthcare facility just as it would be unfathomable to install a cigarette machine in the hospitals’ lobby. Over the years Healthcare organizations have been in the forefront and led campaigns to ban smoking on their facilities. It would be recommendable if they also took control of the types of foods and drink sold to the children and parents who visit the hospitals every day with the same leadership valor they showed in cigarette cessation.

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Another leading factor that had contributed to obesity, particularly among children, is the lack of physical exercise. Physical exercise refers to any form of activity that is structured, planned, as well as repetitive. The main aim for exercise is improving as well as maintaining a healthy weight and the components of physical fitness. Exercise can include activities such as body composition, anaerobic and aerobic capacity, strength, muscular endurance, and power, balance, and flexibility all of will in turn help to reduce excessive weight and obesity.

Some of the structured activities that a person can engage in may include conditioning programs to improve muscular strength, running programs to enhance aerobic capacity and lose fat, or stretching programs with an aim of increasing joint flexibility. Exercise activities are divided into resistance exercises that involve the musculoskeletal system and cardiorespiratory exercise that involves the respiratory and cardiovascular system. 

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The main purpose for resistance exercises is developing neurological, physiological, and biochemical components in the skeletal muscles while cardiorespiratory exercises take into consideration the dynamics of the whole body particularly in exercises that involve large skeletal muscle mass. According to Floriani and Kennedy (2008), the intensity of resistance and cardiorespiratory exercises are expressed in either relative or absolute terms.

Absolute exercise intensity is expressed in terms of kilocalories or kilojoules and is determined by the total energy expenditure. The decimal system that is internationally agreed upon is 1 calorie=4.18 kilojoules. In essence, a kilojoule refers to a unit of energy that is equivalent to 1000 joules. 1 joule refers to the total amount of energy needed to accelerate a kilogram of mass at the rate of 1m/sec.  Kilocalories are a unit of measurement equivalent to 1000 calories.

A calorie refers to the total amount of energy needed to raise the temperature of a gram of water by 1 degree Celsius. Relative exercise intensity can be defined as activities that are relative to a person’s maximum capacity to undertake a certain exercise. 

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Most healthcare organizations and facilities receive hundreds of clients, patients, visitors, and staff members on a daily basis. Instead of installing video games and television on the hospital walls, the facility can have playground areas as well as gymnasiums that these individuals, particularly employees and their children can use (Rothstein, 2014).  Where establishing such a facility is not possible, the hospital can provide opportunities for minimal exercises such as walking grounds and climbing stairs.

In most healthcare institutions across the United States, the only way of reaching various destinations is by using a lift. In some facilities located within multipurpose complexes, it is almost impossible for employees and others to find their way across buildings because the pavements are badly constructed, the lighting is insufficient, or there are structural obstructions (Rothstein, 2014).

Given that healthcare institutions act as employers of millions of healthcare workers across different occupations, they have a responsibility to offer maximum quality and efficient wellness programs that offer weight management programs, smoking cessation, food education programs and other services concerting physical wellness. Healthcare organizations ought to make exercise facilities as well as the workout equipment readily available for all its stakeholders. 

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Hospitals such as Jersey City Medical Center, an RWJBarnabas Health facility, support their healthcare practitioners to achieve healthy lifestyle goals. One of these initiatives included noting the healthy foods and calories that the medical center sells at the hospital cafeteria. According to Bopp (2016), employers should partner with other health organizations to offer Healthy Wellness Programs. It is recommended that these programs should be fun, interactive, engaging, and also accessible online through mobile phones.

The employees should choose activities based on their personal goals and as per recommendations and earn rewards for making positive, healthy choices. The employees should also be encouraged to involve their families in the program, as there is a probability that families focused on health will be more successful. Hospitals and all healthcare centers should emulate the above named hospitals to maintain their employees fit and happy.

In accomplishing this, they should employ several useful initiatives, which may include programs on opium use, exercise programs, and tobacco addiction counseling programs aimed at lowering the risk of cancer, obesity, heart and mental diseases (Tu, O’Connor, Baranowski, & Mâsse, 2017).

They should also offer healthy food options to their employees as well as providing discounted rates at gyms and fitness centers to ensure that their employees do exercises regularly. For healthcare organizations that do not have enough space, particularly in older organizations, the management can make arrangements and partner with other wellness facilities to allow cost-free, convenient, or subsidized-cost access to off-site activities.

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Hospitals also have a responsibility of educating their patients on how to access and make use of various online exercise programs and diet programs found on different websites. In the Internet Age, healthcare facilities should integrate patient education with technological advancements that can help the patients as well as employees to benefit substantially from the information offered online (Daniels, & Hassink, 2015). Given that not all websites are genuine, the healthcare facilities should help the stakeholders to assess the credibility of the evidence provided.

Some of the means that the healthcare facility can use include investigating the credibility of the author and publication of the evidence and assessing whether author is expert in the nutrition and exercise field. Sometimes, individuals with great interest in nutrition and exercise can write articles or open YouTube channels though they do not have any educational background in nutrition or exercise.

These websites may seem very attractive as they promise exponential changes but disappoint exercisers in the long run as they are not based on scientific evidence. The healthcare providers can therefore assist patients dealing with diabetes, obesity, blood pressure, and overweight to examine the evidence provided to support the nutrition choices as the best choices demands one to have some background knowledge about exercise and nutrition.

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It is impossible to blush off the impacts that healthcare practitioners as well as health plans have on the choices that parents make for themselves and their love ones including children. In the present information-loaded world, where individuals bombard daily with health nutritional and exercise messages, it is hard to differentiate credible information from the misleading ones. As such, credible, useful, and evidence-based information is lost in the static and 24-hour news cycle of websites. Educating patients and employees on how to use various exercise and nutritional websites such as BodyFit,

Calorie King, FitnessBlender, Fit Men Cook, and Ace Fitness database will help nurses and other practitioners to provide patient education. The workout plans as well as the nutrition information offered by such websites help with training, fat loss, and cardio training among others. The instructional videos provided in workout website covers over 3,000 exercise activities and help an exerciser to avoid injuries.

The how-to-images provided in the website provides the exerciser with thousands of workout pictures that show them how to do a certain activity with precision even before they begin exercising. The website also provided step-by-step instructions that help an exerciser to do the right thing every time. 

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A website such as Calorie King for instance can be used to find nutrition facts on foods from different food chains and supermarkets (Borushek, 2013).  This can be helpful for tracking macros and calories. This database incorporates nutritional data from credible brands in the United States, Australia, and United Kingdom. The website provides nutritional information and effects regarding breakfast bars and cereals, alcoholic drinks, beverages, breads and cookies, and baked goods.

It also provides information about chocolates and other supplements, cheeses, creams, and yogurts, desserts, and animal protein products. Lastly, there is information about vegetables and fruits, fast foods, fats and sauces, packaged and frozen foods, grain foods, snacks, sugars and syrups (Borushek, 2013). Apart from foods, the website also provides information regarding body mass index (BMI) and how to calculate it.

According to calorie King Website, when the BMI is 25 and above, a person is either overweight or obese and risks conditions such as type-2 diabetes, cardiovascular diseases, some cancer forms, and high blood pressure. This site however cautions against the use of BMI because it does not differentiate between muscle and body fat. For instance, in athletes, the BMI can overestimate the body fat due to the muscular build or underestimate body fats in older people who have lost their muscles.

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Nutrition and physical activity programs

  • Conclusion and recommendation 

Conclusively, health organizations that do not offer well-being programs expose their employees and patients to high risks obesity, diabetes, addiction problems, and mental problems among others. Organizations that provided one to two wellbeing programs experience very low rates of employee turnover as compared to companies that implement a minimum of five programs.

When healthcare facilities provide such programs for employees, patients, and other stakeholders, the offer them a channel to relieve stress as well as receive beneficial information regarding how they can take care of themselves as well as their family members.  In the 21st century, healthcare workers are expected to learn about new technologies all the time, be innovative and creative, adhere to new policies and regulations, as well as provide patient-centered services.

As a result, these employees become very tired and unavailable emotionally to the point where they lack of empathy for their patients and medical mistakes increase. To overcome these challenges, medial organizations are encouraged to offer wellness programs such as fitness facilities, counseling, educational programs, workshops, and health food programs to ensure that employees reach their intrinsic goals. 

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References

Bopp, S. (2016). Promoting the Health of Employees. Retrieved from: https://www.the-hospitalist.org/hospitalist/article/121385/leadership-training/promoting-health-healthcare-employees

Borushek, A. (2013). The CalorieKing Food and Exercise Journal.

Daniels, S. R., & Hassink, S. G. (2015). The role of the pediatrician in primary prevention of obesity. Pediatrics, 136(1), e275-e292.

Elias, P. H. (2018). Care Providers’ Perceptions in Promoting Healthy Eating and Physical Activity in the After-School Setting.

Floriani, V., & Kennedy, C. (2008). Promotion of physical activity in children. Current opinion in pediatrics, 20(1), 90-95.

Hesketh, K. R., O’Malley, C., Paes, V. M., Moore, H., Summerbell, C., Ong, K. K., … & van Sluijs, E. M. (2017). Determinants of change in physical activity in children 0–6 years of age: a systematic review of quantitative literature. Sports medicine, 47(7), 1349-1374.

Kohl III, H. W., Fulton, J. E., & Caspersen, C. J. (2011). Assessment of physical activity among children and adolescents: a review and synthesis. Preventive medicine, 31(2), S54-S76.

Norman, Å., Zeebari, Z., Nyberg, G., & Elinder, L. S. (2019). Parental support in promoting children’s health behaviours and preventing overweight and obesity–a long-term follow-up of the cluster-randomised healthy school start study II trial. BMC pediatrics, 19(1), 104.

Rothstein, M. A. (2014). Promoting public health in health care facilities.

Smith, T. M., Blaser, C., Geno-Rasmussen, C., Shuell, J., Plumlee, C., Gargano, T., & Yaroch, A. L. (2017). Peer Reviewed: Improving Nutrition and Physical Activity Policies and Practices in Early Care and Education in Three States, 2014–2016. Preventing chronic disease, 14.

Tu, A. W., O’Connor, T. M., Baranowski, T., & Mâsse, L. C. (2017). What do US and Canadian parents do to encourage or discourage physical activity among their 5-12 Year old children?. BMC public health, 17(1), 920.

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Obesity in Woodbury Iowa

Obesity in Woodbury Iowa
Obesity in Woodbury Iowa

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Obesity in Woodbury Iowa

Obesity in Woodbury Iowa is a significant public health concern. The prevalence of obesity in in Woodbury County Iowa is 38.3 % among the females. In Iowa State, the prevalence of obesity among the females is 35.9% while the prevalence of obesity among the females at the federal level is 36.1%.

Therefore, the prevalence of obesity among the females in Woodbury County exceeds the Iowa state and the national statistics. 37.5 % of the men in Woodbury County, Iowa, are obese. At the state and the national levels, 36.3% and 33.8% of men are obese respectively (Centre for Disease Pprevention and Control, 2015). Similarly, the prevalence of obesity among the men in Woodbury County, Iowa, supersedes both the state and the national prevalence rates.

Obesity in Woodbury Iowa

Contributing Factors

Obesity is affected by both the race and age. In Iowa, the prevalence of obesity is highest among the Hispanics and Non-Hispanic blacks and lowest among the Non-Hispanic whites. Obesity increases with age and is mostly affects adults aged 60 years and above and is lowest among the adults aged 20 to 39 years of age. The level of education impacts on obesity as well (Office Of Disease Prevention and Promotion , 2018 ).

Obesity reduces with the increase in the level of education. Education increases the level of awareness on the factors associated with obesity as the preventive measures. Obese patients who have a diploma or a degree have shown increased life expectancy.  The positive impact of education on obesity is uniform across all age groups. 

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The level of income impacts obesity as well. Higher levels of income are associated with reduction in the prevalence, the severity and the effects of obesity. Higher levels income impact on the access to healthcare services. Families that can afford insurance policies or out of pocket payments access healthcare services for managing obesity. Therefore, the prevalence of obesity among such individuals is reduced, as compared to individuals in lower socio-economic class.

Individuals with low income cannot afford the foods that are nutrient intensive. Generally, the foods that are sugar and fat intensive are cheap in the United States markets. Sugar and fats are predisposing factors to obesity.   Culture affects obesity. Culture dictates the type of foods that the members of the particular culture dependent on as food. Culture also affects health seeking behavior (ODPP, 2018).

Culture impacts on the perception of the specific cultural group on the engagement in physical activities that significantly affect obesity. Healthcare policies determine the impact of obesity to any community.  Healthcare policies determine the access by the respective members of the community to healthcare services regarding the management of obesity.

Healthcare politicizes on financing healthcare determine the access to care for obese to the individuals who cannot afford the care. Healthcare policies also affect the availability of resources and facilities for managing obesity. The county’s and the national policies in managing healthcare community services such facilities for physical exercises and educational resources and personnel are key to implement obesity management strategies (Galloway-Gilliam, 2013).  

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Obesity in Woodbury Iowa

Interventions  

One of the programs that have been undertaken in my state to prevent obesity is early childhood care. Statistics indicate that on average, children spend most of their time per week under non-parental care.

The State of Iowa in partnerships with the Center for Disease Control and Prevention (CDC)  have drawn up programs on adequate diet, performance of  physical activities and reduction in care time. The state government supports the programs in schools and children care centers through funding, provisions of evidence based recommendation for early child care to prevent obesity (Benson at al., 2013).

The programs support the breastfeeding mothers and the availability of nutrient rich diet to the children that prevents obesity.  The hospitals within my community have initiated hospital strategies aimed at reducing obesity. The initiative targets the hospital employees and the patient under the care. The initiatives encourage healthy food and beverage choices, physical activities within the hospitals environment and support for lactating mothers.  

The hospitals also partner with the community to increase healthy living behaviors for the community members. The hospitals provide education on obesity prevention and management using the locally available resources.

Obesity in Woodbury Iowa

Scope and Role of Nursing and Public Health Nursing on Obesity in Woodbury Iowa

Nurses have a role in encouraging patients to maintain healthy diet. Nurses possess the knowledge on the foods that contribute towards obesity and that prevent the occurrence of obesity. Nurses spend a significant amount of time with admitted patients. Additionally, nurses interact with patient at the community level in offering primary healthcare services.  Nurses educate patients on physical activities as part of the measures to prevent obesity as a public health issue.

Physical exercises reduce the amount of fats that accumulate in the body. Nurses educate on the type, the duration and the intensity of the physical exercises that are appropriate for each of the patients presenting with or at risk of obesity. Nurses conduct assessments of patients who present with obesity. Nurses provide care to a patient in clinical setting. Assessment is the initial step of the nursing process (Schofield et al., 2011).

Assessment, as part of the nursing process, involves collection of data about the patient thorough history taking, physical examination, and clinical tests. Nurses take history of patients on their diet, performance of physical activities, and the impact of obesity on every individual patient during the clinical visits. The nurse also conduct laboratory tests including lipid profile tests in order to assess the risks of development of cardiovascular disease as a complication of obesity.  Part of the nurses’ assessment focuses on vital signs such as blood pressure measurements.

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Expansion of the Scope of Obesity in Woodbury Iowa

One of the ways to increase the scope of community health nursing interventions in addressing obesity is through partnerships.  Community partnerships involve creation of community based networks. The collaboration with the population level partners allows the nurses and public health professionals to gauge the factors that contribute to obesity the community level.

The aim of the partnerships should be to do community specific assessments on the prevalence, causes, and impacts of obesity on the local community (Betancourt, Green, Carrillo, & Firempong, 2016). Further, the aims of the local community partnerships should be to recommend, initiate and implement strategies that are suitable for the local community , based on the population specific needs identified during the assessment.

Policy development is another way of increasing the scope of the nurses’ and public health professionals’ roles in combating obesity.  Nurses and public health professionals are key stakeholders in managing obesity, as a public health issue. The professional input is critical in developing policies that are specific to the local community population.

The professionals collaborate with the department of health, which is responsible for drafting policies for public healthcare such as obesity ((Betancourt et al., 2016). The public health issues should be alignments with the national statistics on obesity, ways of preventing obesity and the federal government’s regulation in combating public health problems.

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References

Benson, G. A., Sidebottom, A., VanWormer, J. J., Boucher, J. L., Stephens, C., & Krikava, J. (2013). HeartBeat connections: A rural community of solution for cardiovascular health. Journal of the American Board of Family Medicine, 26(3), 299–310.

Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.

CDC. www.cdc.gov. (19 August 2015). 13 December 2018 https://www.cdc.gov/ dnpao/division-information/policy/obesity.htm>.

Galloway-Gilliam, L. (2013). Racial and ethnic approaches to community health. National Civic Review, 102(4), 46–48.Course Library Guide.

Office of Disease Prevention and Health. (12 December 2018 ). 12 Decembe 2018 <https://www.healthypeople.gov/>.

Schofield, R., Ganann, R., Brooks, S., McGugan, J., Bona, K. D., Betker, C., Dilworth, K., … Watson, C. (2011). Community health nursing vision for 2020: Shaping the future. Western Journal of Nursing Research, 33(8),1047–1068.

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Positive Health Behaviors Essay

Positive Health Behaviors
Positive Health Behaviors

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Positive Health Behaviors

One of the most basic instruments of modern public health and preventive medicine is disease screening and positive health behaviors. Screening programs have a long and illustrious history in efforts to prevent infectious disease outbreaks and focus chronic illness therapy. Pregnant women are frequently tested for a complete blood count, blood type, diabetes, syphilis, and other diseases. The approach of disease screening has been demonstrated to save lives, save health-care expenditures, and alleviate suffering.

Breast and cervical cancer screening has been particularly effective in decreasing the disease burden in women (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005). Health screenings should be a top priority for everyone to promote good health. some of the most important advantages of health screening Early diagnosis of illnesses can lead to improved treatment and management, lowering the risk of complications and improving the odds of a positive health outcome.

Positive Health Behaviors

Health screening determines if a patient is at risk for, or already has, a disease or condition (Farrington & Mikkelsen, 2020). Furthermore, health screening can aid in the prevention of cardiovascular disease, stroke, and diabetes in those who have a family history of these conditions, as well as offer prompt treatment (Farrington & Mikkelsen, 2020). Age is a key risk factor for a wide range of life-altering illnesses. Early identification and treatment, on the other hand, might provide the body with the strongest resistance against these disorders (Farrington & Mikkelsen, 2020).

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Positive Health Behaviors

Screening, however, can be harmful. When three characteristics of screening programs work in concert, the impact is greater than often recognized. As an example due to the fact that the majority of people who are checked do not have the illness, screening can potentially damage more people than it can help (Farrington & Mikkelsen, 2020). There will always be false positives and negatives since screening tests are not 100 percent sensitive or specific.

Early identification of diseases can lead to overdiagnosis, which is when a person is diagnosed with a condition that will never damage them in their lifetime (Farrington & Mikkelsen, 2020). Also, the ability to reach the desired audience, load on the government, and how everyone involved approaches the problem. Every Woman Counts initiative, which aimed to provide women with preventative health care, proved ineffectual.

In looking at the enrollees in the Nebraska Every Woman Matters program who were getting checked for breast and cervical cancer, it was discovered that there was a link between socio-demographic factors and obtaining cancer screening. As a result, getting cancer screening services is hampered by people’s social position, income, and knowledge.

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Because the advantages and risks of screening are diverse in nature and are assessed and valued differently, it’s impossible to compare them. Valuing benefits and harm is affected by such things as the economic capability of individuals. That is why organizations such as Every Woman Matters (EWM) which is a state-run federally funded program were formed to reduce financial and public awareness barriers to preventative breast and cervical cancer screening by improving public knowledge of the danger and making screening more affordable for low-income women (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005).

A clinical breast examination, mammography, and Papanicolaou smear test are provided at a reduced or free cost to eligible women. Practices can use the EWM program’s services to help them implement the program. With the aim to reduce the number and impact of risks as well as improving their service delivery in hospitals and clinics, the EWM program conducted an analysis using the GAPS method (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005).

They included office employees at each phase of the GAPS model to improve preventive care and alter office operations: goal-setting, analyzing existing routines, planning routine modification, and giving support for these improvements (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005). The findings of the analysis showed that the main reasons why program was not effective in meeting its preset goals include lack of enthusiasm from some physicians and staff, lack of leadership skills of individuals who are in charge of the facilities and also organizational problems hence some internal instability (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005).

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Despite the obstacles that prevented large improvements in screening in some of the practices, we feel the GAPS model’s ideas are valid and propose it as a realistic structure for bringing desired change to a complex organizational system like a clinical practice (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005). In addition, additional process factors like as leadership, cohesion, resources, and shared vision were emphasized in our research (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005).

Positive Health Behaviors

There are a good number of successful advocacy programs for early cancer screening and evaluate the characteristics that are deemed effective and are given credit for the work they do. A good example is the American Cancer Society who promote a healthy lifestyle to help prevent cancer for all people. By supporting cancer advocacy in nations with growing cancer societies, the ACS has taken a leadership position in global cancer advocacy (ACS, n.d.).

The centerpiece of the ACS global effort is training international cancer control leaders through the American Cancer Society University (ACSU) in all aspects of running a community-based cancer control organization or program (ACS, n.d.). The ACSU program begins with a week-long course, which is held a few times each year in different parts of the world, followed by support of participants in home countries (ACS, n.d.).

This society donates millions of dollars annually to cancer clinics and hospitals, all of which is utilized in cancer research, cancer prevention, cancer screening and many other services (ACS, n.d.). Another such organization is The International Union Against Cancer, also known as UICC, which is the most prominent and inclusive international body dedicated to cancer control. It is a membership organization with a small administrative head office, with controlling committees made up of volunteers (Mortara, 2011).

The World Cancer Congress, conducted every two years in a large city, most recently in Washington, DC in 2006, is the most conspicuous UICC activity (Mortara, 2011). Thousands of people from all walks of life attend these conferences, the vast majority of whom are from high-income nations, but with a growing focus on establishing efficient cancer management in those countries (Mortara, 2011).

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Positive Health Behaviors

Those involved in the health care system, nurses, physicians, patients, and others play increasingly interdependent roles. Problems arise every day that do not have easy or singular solutions. Leaders who merely give directions and expect them to be followed will not succeed in this environment.

What is needed is a style of leadership that involves working with others as full partners in a context of mutual respect and collaboration. To accomplish the objective of a reformed health-care system, strong leadership will be necessary. Strong leadership is critical if the vision of a transformed health care system is to be realized.

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References

Backer, E. L., Gesk, J. A., McIlvain, H. E., Dodendorf, D. M., & Minier, W. C. (2005). Improving Female Preventive Health Care Delivery Through Practice Change: An Every Woman Matters Study. The Journal of the American Board of Family Medicine.

Farrington, J., & Mikkelsen, B. (2020). Screening programmes: a short guide. Copenhagen: World Health Organization.

Mortara, I. (2011, July 18). The International Union Against Cancer. From touch oncology: https://touchoncology.com/immunotherapy/journal-articles/the-international-union-against-cancer/

ACS. (n.d.). Facts About the American Cancer Society. From American Cancer Society: https://www.cancer.org/about-us/who-we-are/fact-sheet.html

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EMR system

EMR system
EMR system

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EMR system

Managing Health Care Business Strategy                                                                                                              

What elements (at least two) are missing from the action plan in Table 9.1 for the EMR system? Justify your choice

Piloting is a very important element which has been omitted from the action plan. Piloting helps to ensure that the vendor will supply a truly tested and proven system which is relevant to the organization. The risk of not piloting is too high given that a lot of money goes into acquiring such a system.

Failure to pilot a system can lead to multiple challenges such as loss of funds in that, after procuring the system, most likely it will be a custom – made one and therefore in the event it malfunctions, the vendor might not accept it back since the specifications, coding and even the program used is tailor made for the organization which ordered for the EMR system and therefore the vendor cannot resell it. 

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Another problem associated with failure to pilot the system is the possible loss of data in that a malfunction if system is fully implemented without piloting will lead to difficulties if the system fails. Loss of man power hours is also a likely outcome of an EMR system which was not properly tested before implementation. Also employees are known to oppose changes especially those which touch on their work. EMR systems digitalize the records of an organization and therefore an EMR should be effective in providing the relevant information in as far as medical records are concerned (Moseley III & George, 2008).

The EMR should function so well that all users in a medical set up should be able to access information with ease. This is only possible if employees get a chance to try the system way before it is implemented. This in turn creates an opportunity for the management and the vendors to receive feedback from the employees and deliver a final product which is not only user friendly but also one which will make the employees feel like they own it. Finally piloting serves to improve a system in that system bugs will be identified and fixed therefore the hospital will end up with a cost effective system.

EMR system

Funding is very important in any system implementation process and this requires the involved stakeholders to budget for the project. It also calls for approval from the top management such as the organization’s board of directors. Indeed, many good plans in organizations end up unimplemented due to lack of funding or sometimes underfunding which can cause a project to stall even at its very final phase.

Therefore the managers should ‘count cost’ before initiating an EMR project. The stalling of a project can cause conflicts in an organization, stemming from disillusioned employees. Sometimes this can lead to big losses in the future.

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Project auditing which is also known as a preliminary needs analysis is a very crucial step which serves to give project credence. This also ensures that processes are done in a transparent manner. Since the auditing will answer questions such as; is the project important? Is it timely? Is it cost effective? And if it will add value to the organization, this is very important because it’s the auditing report can even cause the project to be dropped altogether.

Describe the activities that should be implemented to address the missing elements.

For piloting activity, the system will have to be implemented in one department first before approval and subsequent application in the whole organization. Testing and piloting therefore need to happen so as to give a preview of what to expect upon project implementation. It will not be prudent to skip this stage/phase only to end up with a system installed but hat which cannot fulfill its intended purposes

EMR system

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Describe where these activities would be added to the list (relative to the other activities already listed).

The three activities can each be arranged with the help of a Gantt chart which serves to show what activities must be completed first before which others. In this case auditing or needs assessment should be the first step towards a successful implementation of an EMR. This is because the verdict given at this stage influences whether the EMR is necessary and profitable for the organization.  Project piloting or testing will follow thereafter if the needs assessment of auditing gives a nod for the organization to implement fully the project. The second last step should be the piloting step which should happen just before full implementation.

Funding on the other hand ensures that enough finances and other resources are set aside to carry on the projection to completion. Without the EMR system being factored in the budget, it only means the project will not take off let alone starting.

Project auditing calls for a team of experts in a given area. The experts in EMR implementation offer a neutral stand point which is regarded with honor by many and therefore by allowing the auditing process, needs are identified and solutions suggested. This leads to a process that is smooth and devoid of avoidable errors.

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Specify exactly which people from the hospitals and practice will participate in these new activities and justify your choice.

The three additional activities suggested will need to be handled by experts in their respective fields. It is however worthy noting that in all steps of the project process, stakeholder identification and involvement is very crucial. Employees at various levels in the hospital are very important stakeholders and must be involved in the system design and implementation so that they may own it. Those who audit the EMR should be experts in the area as well as the managers in the relevant departments.

EMR system

As for the funding the organization, the chief executive officer or the board must be involved because they are the one to authorize money to carry on the other phases. Finally piloting and testing needs to be done by two technical teams, one from the supplier and the order one representing the interest of the hospital. In conclusion, it is clear that despite the enormous advantages of an EMR system, its purchase and installation needs more than just consulting with the physicians; it as well requires careful considerations so that the resulting product is the best value for money.

References

Moseley III, George B. (2008) Managing Health Care Business Strategy. Jones & Bartlett Publishers. 

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Health Record Policies

Health Record Policies
Health Record Policies

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Health Record Policies

Evaluate the two policies in the attached “Health Record Policies” by doing the following:
 
Discuss what information should be included in an addendum pertaining to a shadow chart.

Generally, an addendum includes amendments or corrections in the primary medical records.This must bear the client’s signature, the amendment date and the amendments themselves. This avails the information that was missing at time of original entry.

Discuss how information technology staff can help decrease incidents of security breaches.

Security breaches especially related to data cause negative consequences for healthcare institutions, their clients and employees. The information technology staff should take preventive measures to avoid this. Encrypting confidential data is essential. All computers in the organization must have password protection. Also a backup of all data must be kept to avoid loss of data in case of data loss.

Thirdly, controls must be placed on data access and storage to avoid unauthorized access. Disposal of outdated data and equipment should be done carefully, and there should be regulation on use of laptops and other portable storage media and devices (Pendrak & Ericson, 1998).

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Discuss one situation from Montana Code 41-1-402 (2a through 2d) that may result in criminal liability to the organization if not followed.

A situation that may result in criminal liability for a healthcare institution is if for example an abortion is procured on a minor from a stable family and under the care of her parents without the parent’s consent.

Summarize how HIPAA defines criminal liability.

HIPAA has put a penalty for any unauthorized access to a patient’s medical records with or without knowledge of this law. Employees in healthcare institutions can also be charged with breaching the confidentiality of patients without authority to do so. 
Explain which part of 2a through 2d of Montana Code 41-1-402 would directly impact actions of clinical staff.
            Part 2 (d) would impact actions of the clinician. If a minor needs treatment for STDs, drug and substance abuse, then if the clinician accepts to offer treatment, they are also mandated to offer counseling the minor or refer them to a counselor.

Health Record Policies

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 Discuss one situation from Montana Code 50-16-603x (1 through 7) specific to health record identification that may result in a legal claim against the organization if not followed.

 If a healthcare institution uses pictures of their former patients for its advertisement on the media without written consent from the former clients.
Develop a confidentiality policy statement (suggested length of 1–2 sentences) using either Montana Code 41-1-402 or Montana Code 50-16-603.

Disclosure of a patient’s presence: This should not be disclosed to unauthorized parties, even in a manner that would reveal nature of disease without the consent of the patient as it will be a breach of confidentiality. 

Compare three points in the Montana codes to HIPAA laws as they refer to release of information.

50-16-542. 1(a) Release of information will be denied if the healthcare provider thinks it will cause negative effects on the recipient. 50-16-542. 1(c) if the information will cause danger to the recipient’s safety and 50-16-542. 2(a) if the minor has a mental condition. All these show that information can only be released if it will not cause any adverse effects on the patient.

Health Record Policies

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Develop a release of information policy statement (suggested length of 1–2 sentences) using either Montana Code 50-16-541 or Montana Code 50-16-542 for a policy book.

Releasing information of patient over the phone of fax: This is not encouraged as the there is no evidence provided to show that the caller or fax destination are eligible recipients of the patient information.

References

Pendrak, R. F., & Ericson, R. P. (1998). Information technologies need to protect patient confidentiality.Healthcare Financial Management, 52(10), 66-8. Retrieved from http://search.proquest.com/docview/196382179?accountid=45049;

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Children Health Insurance

Children Health Insurance
Children Health Insurance

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Children Health Insurance

Medicaid and the Children Health Insurance Program (CHIP) Health Care Policy 

1-What legislation introduced Medicaid, and what are the funding sources for the program?

2-What are some of the changes, including CHIP, that have occurred to the Medicaid program since its inception?

3-What are the demographics of the majority of people covered by Medicaid, and how many people in the United States are covered by Medicaid?

4-Evaluate the changes that have occurred to Medicaid with the inception of the Patient Protection and Affordable Care Act. What are the current changes in Medicaid based on current legislation?

5-Assess social and cultural changes and their impact on developing new health policies to make Medicaid and CHIP more effective.

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Medicaid was established in 1965 in conjunction with Medicare as part of the Social Security Act. Medicare is a health-insurance program for retirees, disabled employees, and their spouses and dependents that is funded and administered by the federal government (United Health, 2021).

Medicaid, on the other hand, is a combined federal-state program in which states and territories receive federal financial assistance in providing health and long-term care to federally designated low-income families and individuals (United Health, 2021).

Prior to the passage of Medicaid, states received limited federal reimbursements for health care services paid on behalf of public assistance beneficiaries. In 1960, Congress approved open-ended federal matching funds to states for impoverished elderly people’s health care. Still, the breadth of the health-care services that states financed for low-income individuals and families varied significantly (United Health, 2021).

The original law provided states the option of obtaining federal funds to assist in providing health care coverage to children from low-income families, their caregiver relatives, the blind, and the handicapped (United Health, 2021). Medicaid was created to give low-income individuals and families more access to mainstream health care. States would receive funds from the federal government to cover half or more of their expenses in providing services to beneficiaries.

At the same time, the program was designed to offer states a lot of flexibility in how they structure their medical aid programs. States that choose to participate in the program were obligated to provide a baseline range of health care to those receiving public assistance (United Health, 2021).

They were also authorized to provide extra services at their discretion, such as serving medically needy people who did not get government aid. The federal government has consistently strengthened the rules and regulations governing state Medicaid programs.

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Children Health Insurance

Many changes in federal Medicaid legislation have occurred during the last four decades, including substantial changes in eligibility, benefits, payment arrangements, and other administrative issues (Smith, Kennedy, Knipper, & O’Brien, 2005). These developments, when paired with state judgments about the scope of their programs, have resulted in Medicaid expanding well beyond its original focus on providing mostly acute care services.

Furthermore, Medicaid has surpassed private insurance as the primary source of funding for long-term care for persons with disabilities (Smith, Kennedy, Knipper, & O’Brien, 2005). Despite several revisions in federal legislation, the essential basis of the federal-state partnership in the program has remained relatively same. The Supplemental Security Income (SSI) program was established in 1972 (Smith, Kennedy, Knipper, & O’Brien, 2005).

This nationally financed income support program for persons with disabilities replaces the previous federal-state cash assistance programs for the elderly, blind, and handicapped. SSI and Medicaid eligibility were intertwined. Many obligatory and voluntary eligibility categories were expanded in the 1980s, with a particular focus on extending Medicaid coverage to low-income pregnant women and children who did not receive public assistance payments (Smith, Kennedy, Knipper, & O’Brien, 2005).

States were obligated to contribute increased Disproportionate Share Hospital payments to hospitals that cater to a significant number of Medicaid recipients and other low-income people under the Omnibus Budget Reconciliation Act of 1981. The Personal Responsibility and Work Opportunity Act of 1996 broke the historical relationship between Medicaid eligibility and the financial assistance program for Aid to Families with Dependent Children.

For low-income households, a new obligatory Medicaid eligibility group was formed; Medicaid eligibility was no longer automatically linked to receipt of public assistance cash payments (Smith, Kennedy, Knipper, & O’Brien, 2005). The Children’s Health Insurance Program (CHIP) was enacted into law in 1997 and provides states with federal matching money to offer health care to children whose families’ earnings are too high to qualify for Medicaid but too low to buy private insurance.

Through their CHIP programs, all states have greatly increased children’s coverage, with virtually every state providing coverage for children up to a minimum of 200 percent of the Federal Poverty Level (Smith, Kennedy, Knipper, & O’Brien, 2005). The federal Medicaid statute has been amended several times since it was enacted. Federal mandates have grown, particularly in the field of low-income children’s programs.

The creation of 51 extremely diverse Medicaid programs has come from the mix of Medicaid mandates and alternatives. These programs function under broad national principles but are influenced by state judgments regarding who is eligible and what they are eligible to receive (Smith, Kennedy, Knipper, & O’Brien, 2005).

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The sources of funding for Medicaid include Federal Medical Assistance Percentage (FMAP), through Enhanced Matching Rates, Disproportionate Share Hospital payments (DSH) and State Financing of the Non-Federal Share (Rudowitz & Snyder, 2015). The federal government guarantees states matching payments for eligible Medicaid expenditures; states are promised at least $1 in federal money for every $1 spent on the program by the state.

As economic conditions change, FMAP, which is an open-ended funding system, permits federal funding to flow to states depending on real costs and requirements (Rudowitz & Snyder, 2015). Medicaid offers a greater matching rate for certain services or populations in some cases, the most famous example being the ACA Medicaid expansion enhanced match rate. The federal government will cover 100 percent of Medicaid expenditures for newly eligible people in states that expand (Rudowitz & Snyder, 2015).

DSH hospital payments are another source of funding for hospitals that treat a lot of Medicaid and low-income uninsured patients. These DSH payments have been critical to the financial viability of safety net hospitals in several states (Rudowitz & Snyder, 2015). Lastly, States have a lot of flexibility when it comes to deciding how to support the non-federal portion of Medicaid spending.

State general fund appropriations are the major source of money for the non-federal portion. The utilization of alternative monies by governments has risen modestly but consistently over the last decade. This is most likely due to states’ growing dependence on provider taxes and fees to fund the state portion of Medicaid (Rudowitz & Snyder, 2015).

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Children Health Insurance

Pregnant women with low income, children from low-income families, children in foster care, individuals with disabilities, seniors with low income, and parents or caregivers with low income are all served by Medicaid programs(Lee & Jarosz, 2017). States can also opt to include additional categories, such as low-income adults who may or may not have children, in their eligibility. In 2015, the ACS recorded about 66.4 million participants nationwide, accounting for 91.7 percent of the 72.4 million reported by the Centers for Medicare and Medicaid Services in mid-2015 (Lee & Jarosz, 2017).

According to the Center for Medicaid and CHIP Services, there were 74 million Medicaid and CHIP members as of March 2017, with almost 36 million of them enrolled in CHIP or children enrolled in Medicaid. Children and teens account for over half of all persons covered by means-tested public health insurance (Lee & Jarosz, 2017). Nearly 11 percent of adults are 65 and older, many of whom are low-income and rely on Medicaid to supplement Medicare.

Adults who are disabled or institutionalized make up another 14%, while women who have given birth in the last year make up just under 2%. More than seven out of ten people in means-tested health insurance plans belong to these vulnerable categories (Lee & Jarosz, 2017). Only 12% of those left work full-time or part-time.

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Children Health Insurance

References

Smith, G., Kennedy, C., Knipper, S., & O’Brien, J. (2005, January 24). ASPE. From USING MEDICAID TO SUPPORT WORKING AGE ADULTS WITH SERIOUS MENTAL ILLNESSES IN THE COMMUNITY: A HANDBOOK. A BRIEF HISTORY OF MEDICAID: https://aspe.hhs.gov/report/using-medicaid-support-working-age-adults-serious-mental-illnesses-community-handbook/brief-history-medicaid#chap1

United Health. (2021, April 05). From What is Medicaid and what does it cover: https://www.uhccommunityplan.com/dual-eligible/benefits/medicaid

Rudowitz, R., & Snyder, L. (2015, May 20). KFF. From Medicaid Financing: How Does it Work and What are the Implications?: https://www.kff.org/medicaid/issue-brief/medicaid-financing-how-does-it-work-and-what-are-the-implications/

Lee, A., & Jarosz, B. (2017, June 29). PRB. From MAJORITY OF PEOPLE COVERED BY MEDICAID ND SIMILAR PROGRAMS ARE CHILDEN,OLDER ADULTS, OR DISABLED: https://www.prb.org/resources/majority-of-people-covered-by-medicaid-and-similar-programs-are-children-older-adults-or-disabled/

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