Community Health nursing teaching and assessment Assignment

Community Health nursing teaching and assessment - Assignment Example In the meantime, community nursing using the available resources at hand can play a valuable part in lifting the health and spirit of local communities. Our war veterans are a source of esteem and joy not only to their own generation but to the present and coming ones as well. They are a symbol of America’s pride and have served the nation in its time of need. Many of them have been in the thick of combat, fighting wars in Vietnam, Cambodia, the Gulf, Afghanistan and Iraq as they defeated the armies and militants of opposing forces. Some have even been physically and mentally incapacitated as they bear the psychological scars that even time will not heal. We owe them a debt of gratitude. Facilities for war veterans where they are properly looked after cared for and understood is one way of repaying them for their efforts. At least they should be able to live out the rest of their lives in peace and quiet, comfortable in the knowledge that their work is done and now a new gener ation has risen to take charge. The Department of Veterans Affairs in the USA operates a number of veterans’ homes all across the nation. ... They try to promote, support and maintain the patient’s independence while providing advice for safe and healthy living and also assisting caregivers as needed. This paper will focus on providing community based nursing care to veterans of Long Island who are in need of support because of having chronic health problems or disabilities. They may need a caregiver to take them around and lack the transportation to do so themselves. Experience has shown that providing community health services through the caregivers, community helpers or even friends and neighbors can often be a viable and easily managed alternative. In such a case, the required procedures and medication are always kept at hand, the dosage is known and remedies or first aid for accompanying conditions is practiced till proficiency is achieved. All that remains is for the caregiver or the veterans themselves to phone the community nursing center or provider and get the required advice so that his condition is corre cted or relief is made possible. In this paper we will make use of a community health model after assessing the patient needs, so that his or her condition is known and remedies can be ascertained. The use of tele-health devices like high definition audio and video conferencing equipment is increasing for making diagnoses, recommending treatments and reaching far off remote locations at the touch of a button. You can see, hear and communicate with doctor and patient online in real time. A caregiver can also be trained online to administer a particular treatment or to measure symptoms that can alert the doctor to current and potential health problems. It cuts the

Health Management Plan for Smoker with Heart Disease

Health Management Plan for Smoker with Heart Disease Introduction Cigarette smoking is still the leading cause of preventable death in the developed world. In the UK it is estimated to cause serious illness in 4.5 million people and kills about 300,000 people each year. Frieden estimates that it kills 5 million people in the world annually. (Frieden et al. 2005) This essay will consider the management plan for an idealised patient who smokes and has recently been diagnosed with ischaemic heart disease. There is a great deal of evidence in the literature which links smoking with both increased incidence and increased morbidity and mortality in heart disease. (Molyneux et al. 2004). It follows therefore that every effort should be made to encourage a patient who smokes to quit at the first opportunity. There is some evidence to suggest that one of the optimum times to successfully persuade a patient to quit smoking is when they have had a smoking related health event. (Ferguson et al. 2003) In the context of this essay one can assume that, having just been diagnosed with some form of heart disease, this would be an optimum time to instigate such an intervention. Pathophysiology Cigarette smoking is known to be a major health hazard. It is significantly implicated in virtually all aspects of both cardiovascular morbidity and mortality. (Missel et al. 2008). In terms of pathophysiology, cigarette smoking has an effect on all phases of the atherosclerotic process from the earliest detectable signs of endothelial dysfunction to clinically significant thrombotic clinical events. There appears to be little difference in the implications of active or passive smoking as the effects appear to be largely dose (exposure) related. (Heiss et al. 2008). The mechanisms by which cigarette smoking exerts its pathological effects are complex, but it is known to increase inflammation, enhance the thrombotic processes and increases the oxidation of LDL cholesterol. Cigarette smoking increases the oxidative stress on the body. (OConnell et al. 2008). These smoking-specific effects are accumulative. And there is evidence to support the view that persuading a patient to reduce hi s intake is beneficial, even though this is clearly not as beneficial as complete cessation. (Wood-Baker 2002) Goals Any management plan should ideally have goals. This does not imply that they will all be achieved, but all of the processes identified and activities embarked on should have the ideal goal as their ultimate target. In this particular case, one can define several goals which will assist in the process of smoking cessation and management of their heart disease. A) To ensure that the patient understands their condition. B) Empowerment and education of the patient so that they can participate in their management plan with understanding and commitment C) To assist the patient in the medical treatment of the acute phase of their condition. D) To rehabilitate the patient after the acute stages are stabilised E) To engage with the patient’s carers (formal and informal) to optimise the patient’s return to health F) To assist the patient to quit smoking G) To support the patient as they negotiate their illness trajectory. Clearly there may well be other goals that could be considered and may arise in specific cases. This essay however, is dealing with the generalised patient. These goals are therefore designed to be applicable to the majority of cases of patients who smoke and have heart disease. Assessment The assessment of a patient begins at the first point of contact. Information can be gleaned from many sources and should be appropriate to the presenting condition. Assessment should be holistic and thorough. In this specific case, one should make particular enquiries relating to factors that are relevant to the patient’s lifestyle (relevance to their heart disease) and to their personal habits (relevance to their smoking pattern). One should pay particular attention to the factors that may make them wish to persist in their habit of smoking so that they can be specifically addressed when smoking cessation is discussed. Targeted interventions are more likely to be effective than blanket ones. (Rigotti et al. 2004). In consideration of their heart disease, one should make specific enquiries in relation to their eating and exercise habits as well as their willingness to participate in any proposed lifestyle change programme that may be suggested. Interventions and broad nursing strategies. Clearly the term â€Å"heart disease† covers a multitude of potential pathologies and it is not practical to consider specific interventions for all possibilities. In the context of this essay, one will consider broad strategies which are applicable to most situations. 1) Encourage compliance with drug regimens: Drugs are commonly prescribed in association with heart disease. They can be as part of a primary intervention such as controlling blood pressure (antihypertensives) or perhaps for improving cardiac output (digoxin) or for controlling secondary pathologies (viz. lipid lowering medication, diabetic treatment, anticoagulants). There is a case for using nicotine replacement medication. If this is the case then compliance with an appropriate dose and reducing regime will enhance the likelihood of success. (Parrott et al. 2004) The nurse can assist by encouraging the patient to comply with the regime. They may choose to do this by explaining to the patient why the various drugs are important and how they work or, if compliance is a persistent problem, by acting as the patient’s advocate and discussing with other healthcare professionals if alternative dosing regimes may assist compliance. 2) Facilitate recovery from the illness: This is a vast topic and will, to a large extent, be dependent on the disease process. Clearly the patient who has modest hypertension will require quite different input from the patient who has just sustained a major myocardial infarction. In the acutely debilitated patient, the nurse will need to play a more active and practical role than with the ambulant and largely well patient. Because of the emphasis of this essay on smoking cessation one can specifically include this as a major task in this area of the management plan. The specific details and treatment options will be discussed later. There is evidence that by assisting the patient to quit smoking, this will directly assist in the recovery process from the heart disease. (Siahpush et al. 2003) 3) Provide emotional support: This may be relevant in the patient who smokes primarily for reasons of anxiety or stress. Exploration of the causative factors is clearly relevant if any targeted approaches are going to be effective. If the heart disease is newly diagnosed, additional support may be required to help the patient adapt from a perceived wellness role to an illness role. (Roy. 1991). In this segment one should note that there is some suggestion that the anxiety sometimes caused by the process of smoking cessation can be counter-productive to the treatment of some forms of heart disease. There does not appear to be a strong evidence base to support this intuitive view however. (Sullivan et al. 2007) 4) Prevent the disease: It is known that patients who have smoked will always have a higher lifetime risk of disease than those who have never smoked. Absolute prevention is therefore not possible. Patients who smoke and are then persuaded to stop, can reduce their risks very considerably. It is known that patients who stop smoking will reduce their risks of myocardial infarction by 50% in the first year of smoking cessation. (Prescott et al. 1998) Expected outcome One can hope to assist the majority of patients to quit smoking. To a degree, one has to accept that there will always be a resistant nucleus of individuals who will (for whatever reason) simply not give up. It is not possible to predict, in advance of the intervention, which patients will be in the group that eventually relapses, therefore all patients should be helped equally aggressively. If one considers the results of the Hilleman trial, one is faced with the remarkable prospect that in a study of post CABG patients (who one might assume had the greatest incentive to quit smoking) a staggering 84% were back smoking within 10 weeks of the operation despite a huge input of anti smoking propaganda. (Hilleman et al. 2004) Patient empowerment and education A number of sources highlight patient empowerment and education as one of the prime predictors in a positive decision to quit smoking. (viz. Edwards 2004). If a patient understands the reasoning behind why they are being asked to undertake a health programme they are more likely to comply with it. Education is therefore one of the major factors in the various programmes designed to help patients give up smoking. Empowerment is another prime factor. Many studies have highlighted the need to stress self-belief in the patient and that the degree of self-belief equates strongly with a positive result. (viz. Miller et al. 2003) Smoking cessation A brief overview of the literature on smoking cessation will indicate that the subject is vast and that many different approaches have been tried with varying degrees of success. It is not appropriate to consider all of the various options, but this essay will cover those that appear to have the greatest reported degrees of success. Fung considered interventions that were suitable for hospitalised patients and of the four different regimes trialed, found that a regime which incorporated face-to-face counselling to identify risk factors for smoking Maintenance, individualising advice about quitting, involving patients in education measures (particularly exploration of the health effects and the benefits of quitting), was the most effective. (Fung et al. 2005). The authors also make the comment that the single most effective strategy was to get the smoker to adopt specific coping strategies such as disassociating the act of smoking from their normal daily routine and habits. They were asked not to smoke inside the home or inside the car, not to smoke with coffee or when reading or directly after a meal. Encouraging the family and friends to support them was the next most effective strategy. (Town et al. 2000) Many authorities advocate the use of nicotine replacement therapy (viz. Sullivan et al. 2007). Currently this is available in several presentations with the transdermal patches appearing to give the best rates of prolonged abstinence (about double that of placebo). Even the best results from trials however, do not give a success rate above 35% with the majority giving results in the region of about 20% abstinence at six months. (Hilleman et al. 2004) Follow up Because of the high relapse rate in smoking cessation programmes, follow up is an essential part of the management plan. The literature is full of various follow up strategies ranging from time intensive home follow ups to phone call contacts. It would appear that no one particular form of follow up is significantly more effective than any other. It has been found that any form of follow up is more effective than no follow up at all. Conclusions The evidence base to link cigarette smoking and heart disease is unchallengeable. Advising and helping a patient who has demonstrable heart disease to give up the habit is almost certainly going to have a beneficial effect on their long term health. In reaching this conclusion, one should not loose sight of the fact that there is a substantial failure rate. Any management plan to encourage the patient who smokes to quit, should make use of targeted interventions with follow up and consider using the approaches with optimum outcomes in order to achieve the best achievable response. References Edwards, R (2004) The problem of tobacco smoking. BMJ 328, 217 219 Ferguson, J A, Patten, C A, Schroeder, D R, et al (2003) : Predictors of 6-month tobacco abstinence among 1224 cigarette smokers treated for nicotine dependence. Addict Behav 2003; 28, 1203 1218 Frieden T R, Blakeman D E. (2005) The Dirty Dozen : 12 Myths That Undermine Tobacco Control. American Journal of Public Health . September 2005, Vol 95, No. 9 1500 1505 Fung P R, Snape-Jenkinson S L, Godfrey M T, Love K W, Zimmerman P V (2005) Effectiveness of Hospital-Based Smoking Cessation Chest. 2005; 128 : 216 223. Heiss C, N. Amabile, A. C. Lee, W. M. Real, S. F. Schick, D. Lao, M. L. Wong, S. Jahn, F. S. Angeli, P. Minasi, et al. (2008) Brief secondhand smoke exposure depresses endothelial progenitor cells activity and endothelial function : sustained vascular injury and blunted nitric oxide production. J. Am. Coll. Cardiol., May 6, 2008; 51 (18) : 1760 1771. Hilleman D E, Mohiuddin S M, Packard K A (2004) Comparison of Conservative and Aggressive Smoking Cessation Treatment Strategies Following Coronary Artery Bypass Graft Surgery. Chest. 2004; 125 : 435 438. Miller, M, Wood, L (2003) Effectiveness of smoking cessation interventions: review of evidence and implications for best practice in Australian health care settings. Aust N Z J Public Health 2003; 27 : 300 309 Missel E, G. S. Mintz, S. G. Carlier, J. Qian, S. Shan, C. Castellanos, R. Kaple, S. Biro, M. Fahy, J. W. Moses, et al. (2008) In vivo virtual histology intravascular ultrasound correlates of risk factors for sudden coronary death in men: results from the prospective, multi-centre virtual histology intravascular ultrasound registry Eur. Heart J., July 2, 2008; (2008) ehn 293 v1. Molyneux, A Nicotine replacement therapy. BMJ 2004; 328 : 454 456 OConnell E D, J. M Nolan, J. Stack, D. Greenberg, J. Kyle, L. Maddock, and S. Beatty (2008) Diet and risk factors for age-related maculopathy. Am. J. Clinical Nutrition, March 1, 2008; 87 (3) : 712 722. Parrott, S, Godfrey, C (2004) Economics of smoking cessation. BMJ 2004; 328 : 947 949 Prescott E, Hippe M, Schnohr P, Hein H O, Vestbo J. (1998) Smoking and risk of myocardial infarction in women and men : longitudinal population study. BMJ 1998; 316 : 1043 1047 Rigotti, N A, Munafo, M R, Murphy, M F G, et al (2004) Interventions for smoking cessation in hospitalised patients (Cochrane Review). The Cochrane Library. Issue 3, 2004 John Wiley Sons. Chichester, UK: Roy C (1991) An Adaption model (Notes on the Nursing theories Vol 3) OUP : London 1991 Siahpush, M, Borland, R, Scollo, M (2003) Factors associated with smoking cessation in a national sample of Australians. Nicotine Tob Res 2003; 5 : 597 602 Sullivan K M, Seed S E, DeBellis R J. (2007) State of the Art Reviews : Smoking Cessation. A Review of Treatment Considerations . American Journal of Lifestyle Medicine, Vol. 1, No. 3, 201 213 (2007) Town, G I, Fraser, P, Graham, S, et al (2000) Establishment of a smoking cessation programme in primary and secondary care in Canterbury. N Z Med J 2000; 113 : 117 119 Wood-Baker, R (2002) Outcome of a smoking cessation programme run in a routine hospital setting. Intern Med J 2002; 32 : 24 28 ########################################################### 3.8.08 Word count 2,503 PDG

Essay examples --

The legality of cannabis varies from country to country. Possession of cannabis is illegal in most countries and has been since the beginning of widespread cannabis prohibition in the late 1930s. However, many countries have decriminalized the possession of small quantities of cannabis, particularly in North America, South America and Europe. Furthermore, possession is legal or effectively legal in the Netherlands, Uruguay and in the U.S. states of Colorado and Washington as the federal government has indicated that it will not attempt to block enactment of legalization in those states. The medicinal use of cannabis is legal in a number of countries, including Canada, the Czech Republic and Israel. While federal law in the United States bans all sale and possession of cannabis, enforcement varies widely at the state level and some states have established medicinal marijuana programs that contradict federal law—Colorado and Washington have repealed their laws prohibiting the recreational use of cannabis, and have instated a regulatory regime that is contrary to federal statutes. Som...

All Quite on the Western Front

HIST 234 March 21 All Quiet on the Western Front All Quiet on the Western Front is narrated by Paul Baumer. Paul was only a nineteen year old fighting in the German army on the French front with some of his classmates: Albert Kropp, the clearest thinker among them; Muller, a physics-inclined academic; and Leer, who wears full beard and lusty nature for girls. Their friends include Tjaden, a skinny 19-year-old locksmith who love to eat; Haie Westhus a large peat-digger, also 19; Deterring, a married peasant; and Stannislaus Katczinsky their wise and crafty 40-year-old leader.Page 3 they all joined the army voluntarily after listening to the stirring patriotic speeches from their teacher, Kantorek. But after experiencing ten weeks of brutal training at the hands of the petty, cruel Corporal Himmelstoss and the unimaginable brutality of life on the front, Paul and his friends have realized that the ideals of nationalism and patriotism for which they enlisted are simply empty line. They no longer believe that war is glorious or honorable, because they live in constant physical terror.At the very beginning of the book Erich Maria Remarque says â€Å"This book is to be neither an accusation nor a confession, and least of all an adventure, for death is not an adventure to those who stand face to face with it. It will try simply to tell of a generation of men who, even though they may have escaped shells, were destroyed by the war. † Page 0 This novel does not focus on daring stories of bravery, but rather gives a view of the conditions in which the soldiers find themselves. According to the writer â€Å"no one has the vaguest idea what we are in for. The wisest were just poor and simple people.They knew the war to be a misfortune. † page 11 The monotony between battles, the constant threat of artillery fire and bombardments, the young soldiers struggle to find food and the lack of training of young recruits meaning lower chances of survival. In the novel the author writes â€Å"our early life is cut off from the moment we came here and that without our lifting a hand† page 19. The young soldiers would often look back and try to find explanation but never quite succeed, since they consider themselves young and extraordinary vague because they were in the 20’s they only had their parents and maybe a girl, hich was not consider too much influences. Whereas older men have a strong background that cannot be destroy, they linked to various life for example they had a family, wife, children, occupations, interest and a background which was strong, which means that war cannot destroy their memory of family. During the war soldiers spent their time on the front line, in an infantryman and in front line trenches. The working conditions became very predictable since it was spent mostly in the trenches. Soldiers recall the boredom of life in the dreary, lice-ridden, diseases spreading, muddy and dusty trenches.The writer describe s the unsanitary conditions of life at the front as Tjaden, tired of killing lice one by one, scrapes them off his skin into a boot-polish tin. He kills them by heating the tin with a flame. Haie’s lice have red crosses on their heads, and he jokes that he got them at a hospital where they attended the surgeon general. Paul remembers he and his friends were embarrassed to use the general latrines when they were recruits but now they find them a luxury. With Behm’s death, Paul and his classmates lost their innocent trust in authority figures such as Kantorek.Kantorek writes a letter to them filled with the empty phrases of patriotic fervor, calling them â€Å"Iron Youth† and glorifying their heroism. The men reflect that they once idolized Kantorek but now despise him; they blame him for pushing them into the army and exposing them to the horror of war. They would wake up middle of the night by hearing loud booms. According to Paul he believed that they â€Å"ha ve lost their senses of other consideration because they are artificial since only the facts are real and important to them.Page 21 As Paul sits with Kemmerich who knew his leg has been amputated, he tries to cheer him up, but Kemmerich is convinced he will die, Paul has seen friends die before, but growing up with Kemmerich makes life harder, the orderlies were not helpful, and when they return, Kemmerich has died. Paul collects his things and they remove the body to free up the bed for more wounded. As younger soldiers arrived, Paul and his friends feel like mature veterans. Paul believes every company has one or two resourceful people, but Kat, a cobbler by trade, is the smartest he knows. Page 37.Paul is glad to be his friend, and tells a story to illustrate his strength as a leader. For example Kat, bunking in a small, ravaged factory one night, Kat finding straw for the men to sleep on, and when they are hungry with no food, Kat goes off again and returns with bread and horse- flesh without providing an explanation. page 37 It was assumed that Kat's sixth sense help locating food and his special talent. As men return from the fronts, they see the shells shattered and coffins pilled by the dozens, however they made jokes in order to distance themselves from the unpleasant knowledge that coffin are made for them.Their first front was completely demolished by a direct hit and the second only to discover it has been buried. Captured Russian soldiers, who are reduced to picking through the German soldiers’ garbage for food, which means there might not be any food in the garbage. Food is so scarce that everything is eaten. Looking at the Russian soldiers, Paul can scarcely believe that these men with honest peasant faces are the enemy. Since nothing about them suggests that he is fundamentally different from them or that he should have any reason to want to kill them.Many of the Russians are slowly starving, and they are stricken with dysentery in large numbers. But most people simply ignore the prisoners begging, and a few even kick them. When Paul returns to the front, he finds Kat, Muller, Tjaden, and Kropp still alive and uninjured. He shares his potato cakes with them. There is excitement among the ranks: the Kaiser, the emperor of Germany, is coming to see the army. In preparation for his visit, everything is cleaned thoroughly, and all the soldiers are given new clothes.But when the Kaiser arrives, Paul and the others are disappointed to see that he is not a very remarkable man. After he leaves, the new clothes are taken away. Paul and his friends muse that if a certain thirty people in the world had said â€Å"no† to the war, it would not have happened. They conclude that wars are useful only for leaders who want to be in history books. During the Great War millions men lost their lives in one of the greatest acts of barbarity the world has ever seen. The heroism and sacrifice of troops in the trenches is probably wi thout parallel.The pretexts for execution for British soldiers had a common theme: many were suffering shell shock or now recognized as Post Traumatic Stress Disorder. Most of those men were young, defenseless and vulnerable teenagers who had volunteered for duty. Millions of men lost their lives fighting for war and millions of men came home without a leg, an arm, or blind, or deaf, or mentally broken due to the things they had to live through in the trenches. Others had their lives cut short through the effects of poison gas, and injuries due to blast, with collapsed lungs.While others came home whole in body, appearing normal, but with such serious nervous and mental conditions that they could not work, and were confined to mental hospitals for the rest of their lives. It should be noted that most, especially on the Allied side, later believed the war to have been worthless. Technological and military innovations such as poison gas, the machine gun, and trench warfare revolutioni zed combat during World War I, and Remarque effectively dramatizes how these innovations made the war bloodier, longer, and more costly.In almost every case, military innovations make the soldiers’ lives more dangerous, while medical innovations lag increasingly far behind. Kemmerich, for instance, dies from complications from a relatively light wound. Glory and patriotism cease to be rational ideals in the conflict because advanced technology limits the effect that an individual soldier can have on the conflict and alienates him from the consequences of his actions. Life and death thus become meaningless.

Interests of Social Harmony Essay

To quote John Stuart Mill, â€Å"The actions of individuals should only be limited to prevent harm to other individuals.† Hate speech by an individual is something that has an adverse effect on society causing mayhem and chaos. Society comprises various individuals as well as the one who gave the speech. So how does Hate Speech affect the society? It does so by harming the individuals of the society and that individual too who delivered the hate speech. I believe all of us will agree to the fact that the makers of our Constitution were thinkers of the very highest kind. Our Constitution is an advocate of subtle restrictions on free speech, and to quote it, â€Å"Restrictions can be made on free speech, in the interests of the sovereignty and integrity of India, public order and morality, against contempt of court, defamation or incitement to offence! If such great thinkers supported certain restrictions on free speech, what reason do we have to debate upon them? I agree with my opponents till the extent that our laws are a bit subjective in their nature. However, this is no excuse for not having them! We cannot not have curbs on free speech as it will only be a recipe for perfect anarchy. Amendments in the Constitution can happen, but removal of such a pivotal restriction is too extreme and inhibitory step to take. The carrying out of laws in India is a little weak, however there have been numerable instances in the past where the authorities have shown the law’s teeth and prosecuted the guilty in acts of hate speech. Take the recent example of AkbaruddinOwaisi who tried to spurn sentiments of hate in the people of Andhra! He has been booked by the law. The 3rd Reich under Adolf Hitler is held responsible for the initiation of the 2nd World War. But what spurned the people of Germany into action? They were the words of Adolf Hitler, whose appalling hate speech led to the most heinous of crimes in human history, the genocide and holoca ust. The example of the mass exodus of North-East origin Indians living in other parts of the nation, to their hometowns is an alarming and eye opening one. The outrageous fire-like dissemination of the false alarm via the internet begs us to have curbs on free speech! Take the example of the 10th article of the European Convention on Human Rights, â€Å"Everyone has the right to Freedom of Expression, however, the exercise of these freedoms, since it carries with it duties and responsibilities, may be subject to such formalities, conditions, restrictions or penalties as are prescribed by law and are necessary in a democratic society†. The misuse of the freedom of expression may encroach upon the most fundamental right of all, the Right to Life! Something so small like the shouting out of the word ‘fire’ can cause frenzy in a cinema hall. We are talking about a democratic nation over here my friends, something much too big and much too fragile.