Author: UniqueWritersBay

The Role of the RN / APRN in Policy Making

To be successful, nurses must begin viewing themselves as change makers and experts in their own right capable of impacting practice by actively participating in decision-making. This involves direct involvement in issues linked to prevailing healthcare delivery systems while guaranteeing the provision of first-rate services. The existing nursing environment and the leading nursing organizations offer such opportunities and play a significant role in promoting nurse’s participation in the decision-making process.

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The clinical environment is an ideal starting point for Registered nurses and Advanced Practice Registered Nurses aspiring to participate in the decision-making process and establishing change management frameworks. A set of unique expertise and credentials qualify nurses to participate in discourse on the efficiency of healthcare delivery frameworks, especially since they are typically tasked with affecting the implementation process (Chadwick, 2013). This is crucial in ensuring delivery programs and systems are always working at optimum level and capable of improving patient outcomes and the clinical environment. Furthermore, the clinical environment is fundamental as an ideal environment for presenting concerns for policy review with the ultimate aim of improving the overall state of the workplace environment. Nurses also have a responsibility to oppose policy changes likely to be detrimental to the quality of care provided and welfare of clinical staff.

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Leading nursing organizations also serve as an important avenue for presenting foremost clinical concerns coupled with members’ active participation in the decision-making process. Organizations such as the National League for Nursing (NLN) provide an incomparable platform for members to directly engage healthcare stakeholders and identify areas in need of drastic overhaul or policy review (Hart & Scarlett, 2017). RNs and APRNs are particularly instrumental due to their experience and a high likelihood of being aware of key areas in need of instantaneous top-level intervention. Additionally, participation of nurses within nursing organizations is also beneficial for clinical staff since they are characteristically aware of the challenges encountered within the contemporary clinical environment and can, therefore, propose actionable propositions within the context of  a decision-making process (Roberts & Holland, 2013). Nurses are, therefore, obligated to identify opportunities for them to them to participate in the decision-making process with the aim of integrating the highest standards of care into practice and ultimately shape its future.

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However, poor reception by high-ranking stakeholders is often a major impediment to nurses’ participation in today’s clinical environment while exclusive membership rights hinder involvement in nursing organizations. As a rule of thumb, nurses are often required to be acutely and prepared for holdups likely to hinder their propensity to successfully participate in the decision-making process (Gawthorpe, 2013).  Such scenarios are likely to emerge when a nurse upper management fails to acknowledge concerns presented or their impact on the clinical environment. In other instances, poor knowledge of proposed and implemented policy changes may ultimately hinder their efficacy when put to use (Leufer & Cleary-Holdforth, 2013). On the other hand, bureaucracy in the process applied when admitting members into high-profile nursing organizations may hinder their participation in the decision-making process. This particular challenge can be addressed by adopting simplified admission mechanisms for recruiting members while focusing on professional leadership qualities as a pillar for nursing organizations.

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Capacity building during collaborative policy work and focus to shrewd leadership are useful tools which can be harnessed to communicate decision-making opportunities present within the profession. Realizing capacity building is central addressing health policy issues by essentially elevating the expertise and awareness of RNs and APRNs in a rapidly-evolving workplace environment. On the other hand, able leadership guarantees appropriate guidance and management of novel policy changes while ensuring nurses are aware of any recently instituted changes for posterity and smooth transition.

Derailed Strategies of Covid-19

The COVID-19 pandemic, arguably, represents one of the most impactful and damaging public health crises confronting the world in recent times. Its negative impact has been attributed to a high rate of transmission and a pure lack of understanding on applicable strategies to manage the pandemic. This emerging sense of confusion has seen nation after nation impose a wide range of restrictions in a desperate bid to slow its spread particularly among highly-populated metropolitan localities. Yet, one of the defining hallmarks of such decisions was their arbitrary nature and the fact that those proposing them had a limited understanding of the disease itself. The resulting chaos set the stage for an economic crisis when most businesses, across a spectrum of sectors, were required to shut down in definitely and fail to recover given the resurgence of wave after wave of the infectious disease (Aslam, 2020).

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Even with vaccines in hand, the same problems seem to bed plaguing the political brass on the measures to impose in order to achieve a semblance of normalcy, albeit momentarily.  The geo-economic risks of the pandemic have been sweeping and, to an extent: threatening the global image as we know it. Today, volatility and inflation are norms many nation-states and major corporations confront as a manifestation of the challenge we are currently confronted with. This is further compounded by the fact that experts in the field seem divided when providing individual perspectives on the most effective response to the pandemic. Thus, a sizeable majority of the high-income countries hardest hit by the pandemic in the developed world are yet to come to a joint agreement on the most appropriate response to implement to mitigate risks posed by events such as a global pandemic.

Although policymakers target herd immunity as a lasting solution to threats such as those posed by the COVID pandemic, an interdisciplinary approach is paramount in gaining a better understanding of the mechanism underpinning such scenarios. A comprehensive understanding of such underlying factors then creates favorable conditions for actors involved in the daily management of responses to the pandemic by depending solely on a multifaceted approach to avert its consequences while actively promoting the sharing of information among partners in this fight (Fong, 2021). Also, mitigation strategies can only thrive in an environment where major state and non-state actors are receptive to change and apply change key aspects of change management in addressing a variety of issues, including capacity constraints and fluctuations in the value of currency. However, the resulting negative impact of the solution may have direct links to high-level competition among nation-states and a proclivity to becoming a leader in the field at the expense of detractors. For instance, China and Russia immediately adopted a divergent stance to the West’s narrative of the emergence and spread of the COVID-19 pandemic and how to mitigate its impact (Cadet, 2020). Among the suggestions made was for them to maintain their production capabilities at peak level to meet global demand and maintain a steady workforce even with the risk of transmission posed by the disease.  On the other hand, the West has proposed measures such as the large-scale adoption and recommendation of risk premiums as a solution to addressing some of the uncertainties introduced by the pandemic. Testing such solutions will be central to their overall applicability and their potential benefit in the future within a similar context. It is, thus, fundamental to consider the most appropriate strategies to implement to mitigate negative impacts of pandemics such as COVID-19 and activities my company should engage in as an appropriate response in the future.

 Literature Review 

Pandemics pose a serious and immediate threat to organizations and multinational corporations due their novel nature and new challenges posed.  Poor responses to similar challenges are a consequence of limited strategies to address similar strategies and on a long-term basis. While pandemics such as COVID-19 and SARS are capable of shaping modern society as we know it, leaders remain responsible for the course taken by organizations in addressing any of the challenges posed. As a rule of thumb, competent leadership is the bedrock of appropriate responses and the outlook adopted within an organization. Companies are, therefore, only able to respond appropriately to such challenges when they actively invest in the rigorous selection of leaders to take charge of an organization (Esmaeilzadeh & Mirzaei, 2021). Within their capacity, they become fully capable of initiating strategies and successfully implementing strategies primarily seeking to improve conditions within the organization in case challenges become commonplace. Atypical transformational leadership encourages leaders to avoid alienating staff and adopting strategies to boost compliance to any of the strategies proposed for introduction during periods of crisis. This breed a workplace environment where reestablishing normalcy in the wake of a disruptive is simplified while employees acknowledge each step within the framework of each proposed strategy. For instance, proactive leaders who envisioned the likelihood of a pandemic such as the one that has gripped the world in the past two years have had a better chance at responding to the crisis and bouncing back compared to their counterparts. Within such a framework, employees would be aware of standard operating procedures such as management of the work load to manage risk and even opting to work from home. A hybrid workplace system also boosts employee more and reassures them of a company’s preparedness and ability to respond appropriately to prevailing conditions.

Risk mitigation should also involve setting up elaborate operational frameworks as a response to future challenges. They should cover scheduling within the organization and its subsidiaries, production volume, employee capacity, and stress-management for employees. The latter is particularly important given the central role played by employees in managing risk and ensuring that mitigation strategies are implemented as expected (McLaren & Wang, 2020). As part of the decision-making team, the should also be in the right frame of mind to avoid slip-ups likely to force an organization into making hasty and unplanned decisions likely to jeopardize its position among competitors. Capacity building should, therefore, form the core of actions supporting and bolstering risk mitigation strategies in the long haul.  An ideal situation is one where regular coaching is commonplace and employees trained frequently to adopt some of the most fitting strategies to address emerging challenges. This strategy should also involve addressing psychological conditions likely to spike in a high-stress environment. For instance, absenteeism among members of staff within an organization may lead to an overall increase in workload and an overall reduction in productivity. Investing in wellness equips employees to respond appropriately during periods of crisis and emboldens them to implement mitigation strategies. Employees aware of a robust operational framework can avoid burnout and become more productive while also working on improving their skill for overall growth.  Furthermore, an organization’s assets that are well under its mandate of custom and administration should be reevaluated to enable leaders to plan for the possibility o f a negative outcome and an accompanying response.  During conditions such the recent COVID-19 pandemic, organizations must mitigate investing risk by avoiding rash decision-making and basing any such decision on empirical financial data.

Resolving competing interests also empowers companies and organizations to respond suitably to crises such as the COVID-19 pandemic. A clear-cut mode of operation gives little wiggle room for alterations that are likely to hinder progress made thus far and the integrity of the managerial team given the impact of such a reality on productivity (Troger, 2021).  My organization would proactively prepare for such an eventuality by establishing an elaborate system of critical infrastructure to promote resilience in the face of external pressure. Part of this strategy involves acknowledging the list of challenges likely to have direct links to the current problem plaguing an organization. Prior knowledge improves fidelity and an overall capability of becoming acutely aware of potential vulnerabilities such as those that emerge in the cyber sphere. Each fine-tuned response should also be executed within an early-detection framework which strives to identify minute baseline changes during events prone to vulnerabilities. Goldman Sachs is known for its application of this mitigation strategy that has essentially served as a foundation for newer subsidiaries under the organization’s unique co-operate brand. Resolving clear competing interests also prevents fragmentation as a major limitation to change management and the mitigation of emerging risks. A technologically-inclined organization is also likely to adapt and respond appropriately during times of crisis and will suffer little to no effect on its productivity.  For instance, financial delays can be mitigated by diversifying payment options available for staff to also include digital and mobile transactions. Collaborating with such organizations translates to a paradigm shift and a rethinking of our association with technology and how it serves our needs in the long run when mitigating. Thus, robust frameworks such as cyber security and a digital financial infrastructure provide a positive sense of security in an organization’s operational framework.

            Policy action targeting the transmission of infectious disease such as COVID-19 significantly improve positive outcomes for an organization in question and serves as an elemental mitigating factor. To prevent the crippling effects of an infectious disease and the ensuing pandemic, organizations must actively participate in safeguarding staff within their respective workplace environments (Hong et al., 2021). Consistency in measures geared towards this end creates uniformity; boosting awareness of proposed protocols within the said environment and creating safe environment to promote productivity. Policy recommendations should also need to be in line with government directives and specifically those provided by the Department of Health and Human Services (HHS).  Additionally, policy actions on mitigating the impact of global pandemics within the workplace environment should also be based on occupational safety requirements outlined by both the World Health Organization (WHO) and the International Labor Organization (ILO) (Qu et al., 2020). Populations more susceptible to infection, such as elderly employees and those with pre-existing health conditions, should also be taken into account within such a framework by creating safety provisions such as having them work remotely. This should also be accompanied by the implementation workplace restrictions for specified areas and worksites to minimize contact between staff. Infectious diseases such as Ebola, Bird-flu, and SARS-CoV-2 pose a significant risk to organizations given their transmission rate and the impact on productivity. Standard mitigation practices should involve social distancing within the workplace environment, avoiding person-to-person contact, regular screening of employees, vaccination, isolation of infected individuals, disinfecting offices, and contact tracing. My organization could particularly benefit from occupational health surveillance policies as a deterrent when confronted with the possibility of disease transmission.  This will create a healthy and symbiotic relationship where the organization strives to improve its profit margin while also considering the socioeconomic wellbeing of individual employees.

Mitigation Strategies Linked to my Organization – Executing a COVID-19 Workplace Assessment to Minimize Risk

            To mitigate risks associated with COVID-19 in my workplace environment, a workplace assessment will take precedence as one of the most reliable instruments in gauging potential occupational exposures and vulnerable populations.  Numerous interdependent variables influence the spread of infectious disease such as COVID-19, which is why shrewd leaders become an asset in identifying them and enforcing appropriate countermeasures to mitigate their impact (Reshi, 2020). For instance, creating a risk profile identifies the vulnerable cross-section of staff within a workplace environment followed by a customization of mitigation plans that include occupational health plans in case they contract the disease. The organization should also hold regular meetings to raise awareness on the danger posed by the condition in the hope that preventive measures and company protocols will be observed to the letter.

Regular health drills on non-healthcare employees within a workplace environment further boosts basic knowledge about the organization and the course of action to be taken in the event of transmission. The low exposure risk section should include assignments with minimal direct human contact within the workplace environment. On the other hand, medium exposure risk should cover an average level of contact with fellow employees; posing a possible risk of transmission. High-exposure risk should routinely incorporate contact tracing due to a high likelihood of transmission to close person-to-person contact. By evaluating the degree of transmission within the location in which the organization is located, leaders should be able to make executive decisions to curtail the spread of the disease within the workplace environment while targeting zero transmission. A return to work policy for employees outside their usual workplace environment should be implemented based on a practical framework while considering possible occupational risks.

 Workplace Measures to Minimize Revenue Loss

Working Remotely and Planned Reopening

The implementation of workplace measures such as working remotely and a planned reopening of the workplace will be crucial in mitigating the possible impact of the pandemic and in managing its spread. This process should commence with clamoring for a reduced workplace density as one of the most reliable strategies in mitigating and preventing the actual spread of COVID-19.  As a result, office spaces will hold fewer staff; significantly reducing close-range physical contact and the spread of the disease. Social activities should also be closely monitored to ensure they are in line with preventive protocols proposed by the HHS and management (Haq, 2020). The rescheduling of regular shifts during such instances will also prevent unnecessary commotion and confusion stemming from social activities, thus reducing and minimizing physical contact.

 Working remotely also reduces risk of transmission, especially among senior citizens and workers with pre-existing health conditions. In particularly, my organization can benefit immensely by applying this framework by encouraging non-essential service providers to work remotely. However this should also be accompanied by workplace incentives such as capacity building and an opportunity for employees in such a position to hone professional skills likely to benefit the organization in the long haul. This system can also be applied and used interchangeably among staff to create a sense of continuity at the workplace and also reduce the risk of transmission by extending schedule periods. It is worth noting that, upon their return, each employee will be expected to report to their respective supervisions on the progress made and their current knowledge or health protocols.

Planned reopening is an important element of a restructured response to the pandemic in an attempt to mitigate risks and avoid exposing employees to the ever-present possibility of contracting the disease.  A premature reopening of the workplace environment, without proper consideration of potential hazards, may have permanent and far-reaching implications for the organization. Any reopening after a lockdown period should be preceded by a simulation of the practicality of the proposed resumption. The organization also stands to benefit from phased reopening given work plans are scheduled to correspond with the current capacity of the workforce while basing operational strategies on an attempt to reduce transmission.

Routine Screening

            As a rule of thumb, routine screening is typically recommended in pandemic scenarios involving highly infectious diseases such as Ebola and Covid-19.  The most reliable mitigation strategy for my organization will also integrate routine screening with the aim of ensuring each member resuming work has a clean bill of health (Krishnadas, 2020). In the rare event that a positive case is identified after screening, contact tracing should be initiated to promote a safer workplace environment and actively participate in the actual management of the condition. Isolation and quarantine are recommended for positive cases or suspected cases. On-site medical testing will-therefore go a long way in promoting such efforts and in ensuring workplace health protocols are initiated for positive cases.


The recent global health pandemic is one of the most damaging phenomena witnessed today, with implications that are likely to reverberate in the next decade. Key takeaways from this current reality are the importance of laying a foundation for mitigation strategies within an organization and a workplace setting. The immediate results are cumulative gains for the organization and an improved role of executive leaders in managing contemporary challenges. Organizations and multinational corporations alike should focus on reducing the damaging impact of the pandemic while elevating the significance of worker’s health. Thus, I recommend executing a workplace assessment procedure, working remotely, planned reopening, and routine screening as crucial steps in mitigating risks associated with infectious health pandemics.

Mexican People Culture Analysis Paper

Today, we live in a multiethnic and multicultural society driven by globalization, a wide range of geopolitical factors and socio-economic influences.  The classic clinical setting is best known for offering unique opportunity to hone cultural competence by working with clients from different cultures other than your own. Such experiences provide an opportunity for clinical staff to gain a better understanding of patterns in human behavior specific to a particular group and some of the defining tenets of their culture. My culture paper written assignment features my experience working with a Mexican client.  The accompanying discussion will include an in-depth review of the cultural characteristics of the Mexican people, activating events causing their migration to the United States, my prior knowledge of this culture, popular biases and myths, recommendations for working with this cultural group, my reflection and a conclusive summary.

Population’s Cultural Characteristics

            During our first meeting, my Hispanic client self-identified as a Mexican. I immediately assumed that he was either born in Mexico, is a Mexican national, or of Mexican parentage. Further inquiry revealed that the client was, in fact, a Mexican national recently granted U. S. citizenship after satisfying requirements for asylum seekers set by the United States Citizenship and Immigration Services (USCIS).

            Mexicans have a rich and vibrant culture punctuated by key exceptional characteristics. The turn of the 21st century and the recent drive towards industrialization saw a sizeable majority of Mexicans move to larger towns and cities mainly in search of employment opportunities. Yet, the archetypal Mexican culture seems intact and is majorly preserved by pockets of rural populations in the country’s hinterland. The Mexican culture consists of Amerindian-Spanish groups and a minority white Ibero-American population.

            Although indigenous groups such as the Maya still live in Mexico, the main language spoken by a majority of Mexicans is Spanish. Furthermore, Spanish influence is still evident among Mexicans in their staunch adherence to Roman Catholicism and Christian values systems (Rankin & Berger, 2011). The Mexican culture also underscores the importance of family and living in harmony with the immediate community. It is, therefore, common for Mexicans to live in households consisting of tight-knit families; inclusive of both nuclear and extended family members.

            Mexican culture also emphasizes greatly on traditional gender roles.  While the man is generally viewed as the traditional head of a household, women have often been expected to play the role of homemaker and taking care of the family (Morlock, 2017). Additionally, Mexican culture is also underpinned by respect for parents and elders.  The culture is further enriched by an exceptional cuisine, embroidery shawls, and popular arts such as Mariachi folk music.

Activating Events Causing Migration

            The migration of Mexican nationals into the U.S. is a long and well-documented phenomenon. Initially, immigrants from northerly regions such as Durango and Jalisco were recruited by U.S. employers desperate to address a shortage in labor within the service industry. After the 1970s, the U.S. was now forced to grapple with illegal immigration as a reality mainly along cities such as Texas and El Paso as a new wave of migrants sought dwindling economic opportunities across the Mexican border (Juckett, 2013).  Several activating push and pull factors are behind the Mexican migration to the United States.

            Economics play a central role in fanning the migration of Mexican nationals to the United States. As of 2020, Mexico was still regarded as an emerging market economy and fell short of being classified as a developed country. Its nationals, therefore, grapple with limited economic opportunities, an ever-rising national debt, and erratic fluctuations in currency value (Telles & Sue, 2019). On the other hand, the United States is on an upward economic spiral and greatly expanded its service labor market; attracting Mexican nationals in a desperate search for reliable employment opportunities.

            Migration to the United States is also a consequence of the United States’ image as a pinnacle of globalization in the West. This is further exacerbated by the stark differences evident in Mexico, even with its close proximity to the United States.  Migrating to the United States, either legally or illegally, is viewed by many as second chance at life, especially given the promise of educational opportunities and social progress. Additionally, relaxed migration policies, the presence of a porous Mexico-U.S. border, and new policies such as family reunification have further promoted migration.

            Moreover, the civil unrest and public violence witnessed in Mexico also influences migration to the United States.  The civil unrest witnessed since the early days of the revolution to Mexico’s current status as a multi-party state has failed to cement a sense of stability among its people. This is further worsened by the on-going so-called “war on drugs” by the United States and unending skirmishes between local drug lords for control of this highly lucrative illegal trade. Mexican nationals are ultimately able to migrate and settle in the United States due to the latter’s refugee policy and commitment to protecting vulnerable populations against human rights abuses.

Prior Knowledge of Culture

            While my spoken Spanish is negligible, I had prior knowledge of the Mexican culture. Two of my close friends are of Mexican descent and I too had spent hours reading about different cultures I was likely to encounter in my practice. My client was a 55-year-old senior citizen requiring routine dialysis. From the onset, I made certain that I approached her in a respectful manner given her advanced age.  I was fully cognizant of the value of respect in Mexican culture and the primary reason why veneration took precedence. Initially, one of the nurses on duty briefly played the role of interpreter before being assigned to a new patient. I made the most of this opportunity to communicate directly with my client and obtain important background information before proceeding with the assessment. As a sign of respect, I routinely addressed her using the courtesy title Señora to establish rapport. However, after the sudden exit of my translator I resorted to using the Cyracom phone service to access a translator.

 My knowledge of the importance of family in the Mexican culture also played a leading role during my assessment. I started by inquiring about my client’s family and why she had reported to the community care health clinic alone, especially considering that Mexican’s pride themselves in their tight knit families. I soon learnt that my client was living with her son who was also the sole breadwinner for their extended family. She explained that he was at work and would pass by the hospital as soon as his shift ended at a local automotive manufacturing company. Furthermore, I was preoccupied with my client’s wellbeing and was keen on providing a level of reassurance. My knowledge of the Roman Catholicism as the bed rock of Mexican culture came in handy during this period. I was quick to inform her that her family was likely praying her at that very moment and that her health would certainly improve given the expertise of our world-class team of clinical staff.  Additionally, I personally assured her that I would be praying for her with the hopes of raising her spirits and increasing the likelihood of receptivity to some of the most suitable treatment options. The experience was both eye-opening and exciting since it exposed me to Mexican culture in a clinical environment and how to use prior knowledge of the culture to improve patient outcomes.

Biases and Myths about the Mexican Culture

            Stereotyping is often viewed as part and parcel of the human condition. It is, therefore, no wonder that American society is awash with numerous biases and myths about Mexican people and their culture. A better understanding of major stereotypes serves as a guide for the public and clinical staff while ensuring that decisions made are based on informed judgments.

            One of the main biases about individuals from the Mexican culture, especially in the United States, is that they have a penchant for breaking the law and are probably illegal immigrants. However, this is often not the case.  The population of Mexicans living in the United States does not purely consist of illegal immigrants but Mexican nationals granted legal citizenship status. In my case, my client was a legal immigrant who was previously granted asylum by the United States Citizenship and Immigration Services (USCIS).

            Today, the myth the prevalence of social vices such as drug dealing and crime in the Mexican culture is widespread in the United States. Part of this paranoia is fueled by populist leaders such as the rhetoric by former President Donald J. Trump about Mexican people as people with criminalistics tendencies. Furthermore, limited public awareness of Mexican culture also hinders the dissemination of truthful information. While the narcotics trade maybe situated and directed from Mexico,  a sizeable cross-section of immigrants migrating to the United States are actually victims fleeing the brutal reign of drug cartels and accompanying lawlessness.

            Another common stereotype about Mexican immigrants is that they are largely uneducated and with a low level of intelligence. This erroneous assertion may be informed by the fact that Mexican immigrants are majorly employed in the service labor industry and in jobs requiring minimal skilled labor (Telles & Sue, 2019). However, this is a generalization since Mexicans in the United States can be found working in a spectrum of professions, both skilled and unskilled. Mexican immigrants often work in the service labor industry as a consequence of personal circumstances, its availability, and flexibility in cases where a valid work permit is not required.

Policies and Practices Affecting Interaction

            The implementation of clinical standards and policies is meant to guarantee that the highest standards of care are always upheld to improve patient outcomes and promote wellbeing. Yet, some of these very policies and practices may also impede interaction between clinical staff and patients. Knowledge of this fact is key to the application of progressive polices focusing exclusively on patient welfare.

            Limited knowledge of special medical concerns may affect interactions and hinder the timely provision of appropriate healthcare. For instance, diabetes mellitus and morbid obesity is disproportionally higher among Mexican Americans in comparison to other ethnicities such as non-Hispanic whites. Poor knowledge of this fact may result in diagnosis during advanced stages of disease progression and a reduced chance of having comorbid conditions such as hypertension treated.

            Attitudes to healthcare and folk healing are also poorly explored by healthcare professionals and may affect interactions with individuals from this healthcare.  Latinos are known for their strong spiritual beliefs and the application of reference to folk healing as is the case with the Mexican curanderismo (Holland, 2016).  Prior evaluation of the patient should involve questions on whether they previously visited traditional healers to review the type of help offered and whether it had any lasting impact on their wellbeing.

Recommendations Working with the Culture

  • Hospital units should always have a member well-versed in Spanish or translation services such as those offered by Cyracom phone services in care the client cannot communicate in English.
  • Understanding family dynamics and their subsequent involvement in treatment is crucial for Mexican patients and has major impact on the patient outcomes.
  • The approach to care when working with patients from the Mexican culture should involve a deep understanding of cultural and folk values and their attitudes towards healthcare.


            Working with a client from the Mexican was one of my most insightful and educational experiences yet.  My awareness of nuances informing the behavioral aspects of the culture, such as the significance of family, religion, and showing respect to elders, made it possible to provide holistic care to my client while adhering to the highest standards of care. In retrospect, I believe that prior knowledge of the culture played the foremost role in improving patient outcomes and should be underscored as part of cultural competence


            The reality of multiplicity in modern society now means that medical professions should always be prepared to encounter patients from cultures different from their own. My experience with a Mexican client taught me the importance of cultural competence in a clinical setting and its role in improving patients in the long haul. This knowledge should span cultural characteristics, activating events causing their migration, my prior knowledge of the culture, popular biases and myths in order to improve the approach to care, especially by community primary care provider.

Conceptual and Theoretical Frameworks

The terms conceptual and theoretical framework are closely related due to their frequent use in research, but are distinct and refer to two different ideas. Conceptual frameworks are commonly used in new areas of research and are subsequently developed by researchers based on theory.  Concepts are, therefore, presented by the researcher with the sole aim of establishing an informed understanding of the research being undertaken (Jones, 2018). On the other hand, theoretical frameworks are developed over time in a specific area of study and are based on existing theory and historical background. Theoretical frameworks focus mainly on exploring a current research problem through the lens of an existing theory based on existing literature.

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Common Differences between a Conceptual and Theoretical Framework

            Key differences exist between a conceptual and theoretical framework. Conceptual frameworks only function as structural frameworks for research. They only provide an elaborate model for a researcher on how to conduct a study and meet a desired end (Augustine, 2016). A theoretical framework, on the other hand, is the foundation of research inquiry and provides much-needed guidance on how to approach a thesis.  The foundation of conceptual frameworks used in research concepts which are later linked to specific variables.  Conversely, theoretical frameworks are grounded in existing theories that have been tested consistently over time and can be supported by other researchers.

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While conceptual frameworks only focus on core ideas identified in their respective studies, theoretical frameworks adhere to an extensive and expansive guideline to inform research. Conceptual frameworks are also presented as a researchers own creation and as a unique inquiry on a given phenomenon and the most appropriate answer. Theoretical frameworks have a deeply ingrained need to be widely accepted after their initial introduction, which is why they are generally well developed (Dash, 2017). While conceptual frameworks follow a logical progression before during research inquiry, theoretical frameworks focus on the most reliable approach to identify the unknown in research. Furthermore, conceptual frameworks consist of interrelated concepts responding to a specific research problem while theoretical frameworks comprise interrelated propositions.

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Importance of a Conceptual Framework

            A conceptual framework is fundamental in research today. It is commonly utilized as an analytical tool which can be implemented within a variety of contexts in research. It provides a general overview of the research problem under review with the aim of guaranteeing comprehension of some of the basic defining elements. Conceptual frameworks are also reliable since they are based on a strong foundation relying on concepts capable of being applied in a practical setting. It also provides an elaborate conceptual distinction for authors, which ultimately allows them to apply major defining principles.

Multiple conflicting issues can also be evaluated using a conceptual framework due to its broad nature and a clear dichotomy between theoretical principles. They also play an important role in organizing empirical research and developing a clear objective for such endeavors based on scientific inquiry (Johnson, 2017). An example of a conceptual framework is a model that focuses on quality healthcare outcomes by combining nursing system characteristics, desired health outcomes, patient-centered nursing interventions, and patient trait characteristics.

The Importance of a Theoretical Framework

            A theoretical framework plays an important role in research today by linking scholars with the existing body of knowledge. This ensures researchers area capable of identifying relevant knowledge and theories to support the initial hypothesis and to also inform the hypothesis and research methods used. Researchers are, therefore, able to answer the “why” and “how” in their area of study while also being highly capable of examining the limits of their generalizations and key variables informing their inquiry (Costa, 2020). A theoretical framework provides researchers with sufficient support to explain a particular phenomenon and are, therefore, relevant in research studies. The self-care deficit theory by Dorothy Orem is an example of a common theoretical framework.

Healthcare Policy Evaluation Analysis – Medicare


Medicare is, arguably, one of the most successful healthcare policies in the history of the United States. Its relative success has often been attributed to its origins as a federal health insurance policy and the support it has received from successive administrations ever since its inception in 1965. Medicare comprises of a three-pronged approach that seeks to improve the provision of hospital insurance, medical insurance, and coverage for prescription medication to vulnerable sections of the American population.

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How was the success of the program or policy measured?

Proponents of Medicare today cite senior citizens, middle-aged individuals living with various forms of disability, and those with permanent kidney failure as vulnerable segments of the general population who benefit the most from Medicare’s comprehensive health insurance coverage. For instance, inpatient services provided in hospice care benefits low-income earners; allowing them to receive comprehensive access to healthcare (Moon, 2018). The success of the Medicare program was, therefore, measured through its ability to provide insurance cover to retirees, the disable, and individuals with advanced cases of kidney failure while promoting the implementation of related services to boost preventative care.

How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected?

Since its inception in 1965, the Medicare program has been hailed for it success in promoting key aspects of universal care and its reach within the American population. Current estimates place the total number of individuals covered by the program at 42 million, with the number projected to experience further growth within the coming decade (Moon, 2018). Its success within a relatively short period is mostly attributed the dedication of policy makers from the Department of Health and Human Services (HHS) whose primary focus was on increasing the population of vulnerable segments of society covered by the policy. This has had a significant impact in the United States. Benefits of Medicare are now evident in the reduction the population of American citizens living under the poverty line, an overall improvement in the quality of care provided by major healthcare providers due to an overall circulation of financial resources. Its success was largely gauged using client satisfaction as a useful parameter in gauging overall success within a specified period. The results have been commendable. Medicare is rated highly by its clients and often recommended in mainstream society compared to acclaimed insurance providers.

What data was used to conduct the program or policy evaluation?

Life expectancy and the functional basis of the populations covered by Medicare formed the basis of its evaluation. For instance, the disabled and elderly are disproportionately affected by chronic health conditions such as hypertension, cardiovascular disease (CVD), and diabetes (Schmeida & McNeal, 2013). Medicare’s success can, therefore, be ascertained from data gathered from the number of vulnerable patients whose outcomes and quality of life are greatly improved by services offered under the program and the level of satisfaction recorded among patients. This data was, therefore, instrumental in painting a complete picture of health coverage under Medicare to the disabled, the elderly, and those with chronic health conditions.

What specific information on unintended consequences were identified?

The main unintended consequence of the widespread implementation of the Medicare services was an increase in the cost of crucial medications such as those prescribed for patients with bladder cancer. This reality first became apparent between 2004 and 2006 when patients were treated to unprecedented changes in the cost of office-based prescribed medications that are normally recommended by physicians (Elnour et al., 2015). Although the full extent of its impact is yet to be documented comprehensively in peer-reviewed journal articles, complaints lodged to the Centers for Medicare and Medicaid Services indicate that a considerable population of patients suffering from bladder cancer were affected by this new directive which ultimately hindered access to specialized care.

What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.

Medicare is based on an elaborate structure and system also tasked with the responsibility of evaluating and reviewing the program. Major stakeholders responsible for conducting the preliminary evaluation include federal and state actors such as executives from Agency and Medicare, state Governors, healthcare providers, the legislature, and patients. Each of the stakeholders play an autonomous and invaluable role in the evaluation to ensure the Center for Medicare and Medicaid Services receives a complete and truthful overview of the services provided and their quality. The reporting then benefits a number of groups. They include senior citizens, persons living with intellectual or physical disabilities, those with a psychiatric problem, and those unable to secure private insurance. Each state is evaluated on the basis of the quality of services offered and whether the framework implemented in each of the jurisdictions identified promotes patient outcomes.

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Did the program or policy meet the original intent and objectives? Why or why not?

The current position of Medicare as the most popular federal healthcare insurance provider is evidence of its success and ability to meet set objective. It succeeded in insuring senior citizens, the disabled, those living under the poverty, individuals deemed ineligible to receive private insurance coverage, and patients with end-stage renal diseases (ESRD) (Wells & Root, 2015). Furthermore, the Center for Medicare and Medicaid Services has been actively involved in patient education campaigns while promoting preventative care in order to curb the emergence and proliferation of chronic diseases. The program has also succeeded in dramatically reducing the number of uninsured people living under the poverty line across all states within the United States.

Would you recommend implementing this program or policy in your place of work? Why or why not?

Yes, I would recommend the implementation of Medicare in my workplace environment. It is deeply entrenched in providing healthcare service to vulnerable sections of society. I would particularly recommend it within the context of my workplace environment, especially as a significant healthcare program that addresses the immediate needs of employees after retirement.

Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after one year of implementation.

Nurses can also play a significant role in evaluating perceived benefits introduced by a given healthcare program. This can be done by conducting a comprehensive review of the actual quality of the services provided and the cost of office-based prescription drugs. The quality of healthcare services can be assessed by interviewing patients and assessing their review of the services offered and whether they met their expectations (Bury, 2012). This will provide a complete picture of the overall effectiveness of recommended services, their impact in reducing hospitalization stints and improved patient outcomes. Similarly, the cost of office-based prescription drugs is an important indicator of whether the program has succeeded in its plan to reduce the overall cost of medications on offer.

General Notes/Comments

Medicare is one of the most impactful healthcare programs ever implemented in the United States. It has had far-reaching consequences for at-risk populations within the United States and has steadily sought to address the disproportionate provision of healthcare services across the board. Medicare has, therefore, become one of the most iconic healthcare programs in the United States due to its focus on the provision of cost-effective care while also striving to reduce the population of ineligible persons living under the poverty line.

Prescribing for Children and Adolescents with Post-Traumatic Stress Disorder

Physicians are typically tasked with the critical role of making the most fitting clinical decisions when prescribing appropriate interventions for patients suffering from psychiatric disorders. The most common among these are FDA-approved medications, off-the label drugs, and non-pharmacological interventions; all of which can be prescribed in addressing post-traumatic stress disorder (PTSD) in children and adolescents. Such interventions seek to address patient’s trauma associated with a traumatic event with the ultimate aim of improving their quality of life by addressing their psychological distress. This discussion will evaluate Zoloft (Sertraline Hydrochloride), Pexeva (Paroxetine Mesylate), and hypnotherapy as highly recommended interventions in treating PTSD among children and adolescents.

Read also CDC Guideline for Prescribing Opioids for Chronic Pain Summary

FDA-Approved PTSD Medication: Zoloft (Sertraline Hydrochloride)

            Zoloft, marketed generically as sertraline hydrochloride, is a selective serotonin reuptake inhibitor (SSRI) approved by the FDA and prescribed in the treatment o an assortment of mood disorders, chief among them being PTSD.  It is highly recommended by physicians due to its efficiency in improving mood, its inherent ability to reduce frequency of panic attacks, proven competence in minimize invasive thoughts, and balancing serotonin levels in the brain. It is taken by mouth in liquid or capsule form, with the dosage dependent solely upon the severity of symptoms.

Read also Prescribing Trends in Schizophrenia

            Physicians are typically advised to consider the risks and benefits of Sertraline as a leading FDA-approved medication before prescribing it for use among children and adolescents suffering from PTSD. Perhaps the most fundamental risk posed by Sertraline use among minors is an overall elevation in impulsivity and suicidal ideations; facts that currently inform the placement of a “black-box” label warning on the drug by the FDA (Espinel & Shaw, 2018). The medication withdrawal symptoms associated with the drug may also worsen PTSD in children, triggering severe bouts of anxiety, agitation, and invasive thoughts. Yet, benefits associated with prescribing Sertraline in treating PTSD include attenuating symptoms associated with the condition after exposure to stressful events, an overall reduction in the frequency of flashbacks, and a higher likelihood of leading a return to normal life. American Psychological Association (APA) currently recommends use to range between 50 mg and 200 mg daily (American Psychological Association, 2019). This forms the basis of clinical practice guidelines for the use of Sertraline today.

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Off-Label PTSD Medication: Pexeva (Paroxetine Mesylate)

            Pexeva, marketed under generic name Paroxetine Mesylate, is a common off-label selective serotonin re-uptake inhibitor (SSRI) prescribed to treat PTSD and other manifestations common with anxiety disorders. It acts by restoring a state of equilibrium in the brain and using this chemical balance to promote an overall state of wellbeing in persons struggling with PTSD. Paxeva is taken either as an oral suspension or an extended-release tablet.

            Likewise, a risk assessment should always take precedence when prescribing Pexeva to children and adolescents with PTSD. As is common with off-label SSRIs, Pexeva is also associated with suicidal tendencies among minors and adverse changes in mood after prolonged use (Stein, 2016). Physicians prescribing Pexeva to minors are, therefore, required to communicate this fact to their patients and request them to seek immediate medical attention once noted as part of patient education. Additionally, prolonged use of Pexeva is associated with a high risk of seizures, coordination loss, agitation, and dizziness which may have an adverse impact on school-going children. Benefits of taking the drug in the treatment of PTSD are extensive. Patients typically report an improvement in their interest in daily life, an overall reduction in the frequency of panic attacks, and an elevation in energy levels. Clinical practice guidelines to optimize the efficiency of Pexeva in treating PTSD in minors includes understanding its interactions with pimozide, monoamine oxidase inhibitors (MAOIs) and thioridazine prior to prescribing the drug (Stein, 2016).

Read also Empirically Supported Treatments For Post-Traumatic Stress Disorder

Non-pharmacological intervention: Hypnotherapy

            Today, hypnotherapy is recommended as an ideal non-pharmacological intervention for children and adolescents that have undergone severe trauma linked to mental conditions such as PTSD. It is a form of guided hypnosis where a therapist serves as a conduit to an elevated state of consciousness; allowing the victim to revisit past events objectively and address their fears from the perspective of an altered state of mind.

            Taking the potential risks and benefits of incorporating non-pharmacological interventions such as hypnotherapy into account is often at the crux of its application when attempting to treat PTSD. The most common risk associated with hypnotherapy is the emergence of false memories, commonly referred to as confabulations, and an exponential increase in levels of anxiety (Bisson et al., 2020). However, hypnotherapy presents potential benefits as one of the most highly-recommended non-pharmacological evidence-based interventions for PTSD. Prolonged application of this particular intervention may guide patients to identifying the underlying cause of persisting symptoms, reduction in stress levels, and the subsequent titration of memories associated with a stressful life event (Kohen & Kaiser, 2017). Patients with the condition are, therefore likely to benefit a great deal from its application.

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Controversy Associated With Dissociative Disorders

The name “Dissociative Disorders” is a common umbrella term in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to describe mental disorders featuring behavioral, perceptual, and identity problems as major defining characteristics. Today, Dissociative Identity Disorder (DID), and Dissociative Amnesia (DA) Depersonalization/De-realization Disorder (DPDRD), Other Specified Dissociative Disorders (OSDD) and Unspecified Dissociative Disorder (UDD) are the only mental disorders recognized under this category (Matuskey, 2017). Yet, their inclusion in the diagnostic manual remains a controversial matter. Part of this controversy stems from questions raised on the actual authenticity of Dissociative Disorders as a legitimate psychiatric illnesses.

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Moreover, Dissociative Disorders is thought to develop as a direct consequence of extreme and continuous childhood abuse or trauma. Proponents of its legitimacy theorize that dissociation is used by patients to cope with traumatic experiences by essentially repressing traumatic memories thoughts, and actions. The concept of the existence of repressed memories is particularly controversial since mental health experts doubt the validity of the presence of a causal relationship between repressed memories and childhood abuse. Instead, they hold the dissenting view that traumatic childhood experiences are rarely forgotten victims and the reemergence of so-called “repressed memories” is likely an erroneous finding by overzealous therapist and troubled clients. Furthermore, Dissociative Disorders are sometimes regarded as social constructs driven by sociocultural expectations and elements of modern society such as mass media.

Read also Mental Health Assessment- Dissociative Identity Disorder

My Professional Beliefs about Dissociative Disorders

Although dissociation and dissociative disorders (DD) currently represent a divisive subject, I hold the professional belief that DDs are real; a fact further supported by published scientific literature. Currently, clinical data supports the theory that a direct correlation exists between dissociation and traumatic experiences (Bailey et al., 2019).  The rationale behind my choice is further supported by incidences where individuals diagnosed with the condition are generally within a healthcare setting and are, generally, representatives of a control clinical population. Psychiatric patients with any sub-type of Dissociative Disorders typically record significant improvements after starting recommended treatment options (Myrick & Brand, 2016). I, therefore, believe that it is important to advocate for the spread of relevant information about disorders in under this group to the public to support early intervention and promote further research.

Read also DSM-5 Category Summaries Introductions

Furthermore, dissociation is a mental state emerging after a traumatic experience; further supporting its position especially since is accompanied by a clear departure from normal pathology. Psychological detachment from a traumatic experience is common among victims of severe abuse since it mitigates the effects intrusive thoughts and memories (Staniloiu & Markowitsch, 2018). This is consistent with the idea that traumatized patients will often attempt to segregate their awareness from the reality of past traumatic experiences. Dissociative Disorders should, therefore, be recognized and accepted as a real psychiatric disorder since this will promote efforts geared towards identifying the most effective interventions for stabilizing patients with the condition. This will, thus, improve patient’s quality of life and minimize the possibility of self-harm or engaging in self-destructive behaviors.

Strategies for Maintaining a Therapeutic Relationship with client with Dissociative Disorders

A strong therapeutic alliance forms the foundation of clinical interventions and is fundamental when treating a patient with complex psychological conditions such as Dissociative Disorders. I would, therefore, strive to first develop a rapport with the patient during our initial meeting and help them feel welcomed, notwithstanding the unfamiliar environment. Furthermore, it is also imperative to remember that therapeutic relationships may take a long time to develop. This is normally the only guarantee that a strong, close, and trusting relationship can be forged, which is especially important for DD clients haunted by past traumas (Lynn et al., 2015). A .neutral environment will enhance the quality of therapy sessions by allowing the client to express deep-seated thoughts and emotions while feeling heard.

A therapist should also avoid judging clients. Instead, one should focus on treating them with compassion while avoiding offering advice on sensitive matters such as religion. A therapist should always take charge of each session to provide a sense of direction and focus on managing their emotions. An open patient-therapist discussion should also be conducted on the primary objectives of each therapy sessions to help the client to better understand what exactly they want from it and how to achieve set goals (Sanders, 2018). Therapists should always remember that their clients are vulnerable persons in need of high-quality care and attention which they are capable of providing. In the event they are unable to meet the client’s needs, they should make a conscious decision to discontinue the services and refer them to another therapist.

Ethical and Legal Considerations Related to Dissociative Disorders

Likewise, ethical and legal considerations should always be taken into account when treating patients to guarantee adherence to the highest standards of professional practice. First, clients presenting the symptoms of Dissociative Disorders have a right to know the preliminary diagnosis. Relaying this information during the first meeting is an important step in guiding treatment based on the most appropriate treatment option available. This treatment option should also be based on a client’s individual needs. Clients who confess to having frequent self-harm ideations should also be placed under suicide watch as failure to do so may have grave implications for a therapist and the respective healthcare provider.

Why do Adolescents Use Drugs?

Drug use among adolescents and young adults is a key emerging problem in the United States today. Over the past century, an alarming surge in illicit drug use has been witnessed among the American youth and, essentially, drawing national attention to this existential scourge. Today, the Department of Health and Human Services (HHS) strives to address this challenge by providing unlimited access to evidence-based information on drug abuse prevalence among the youth, emerging drug-related challenges such as the opioid epidemic, and by providing an assortment of much-needed healthcare resources. 

Read also Drug and Substance Abuse Among School-aged Youth

Alcohol, marijuana, stimulants, and hallucinogens are among the most common categories of drugs currently abused and misused by adolescents and emerging adults today. According to a survey conducted by the American Addiction Centers (2020), the United States has experienced a persistent upsurge in substance abuse incidences among adolescents and young adults; with statistics placing the current figure at 34.1 million young adults (ranging between 18 and 25 years of age). This is mostly worrying given the fact that a sizeable population of young adults starts abusing drugs at a comparatively younger age compared to antecedent generations. This is a major source of concern given that they are most impressionable at this age and are mostly susceptible to irreparable physical and psychosocial damage due to drug dependence. They may also fail to understand the short-term and long-term implications of their choices at present and serious consequences such as the health risks involved, the possibility of death due linked to drug overdose events, and the implications of physical and psychological dependence.

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An in-depth focus on the scope of drug abuse among adolescents and emerging adults is, therefore, necessary; in addition to conducting and thorough overview of its defining characteristics among this sociodemographic population. Furthermore, this discussion will also focus on the main reasons behind the current substance abuse prevalence among adolescents and young adults compared to other age groups and the most appropriate interventions available today, coupled with potential family implications.

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Scope of the Problem

            Illicit drug use, more so among adolescents and emerging adults, remains an ever-present healthcare challenge in the United States today.  To behavioral health experts such as Ronald Chervin, substance abuse is a serious public-health challenge given that users are typically oblivious of the burden drug use places upon them, their families, and the community as a whole.  Even more worrying is the influence of major emerging trends that have, seemingly, occasioned, an exponential increase in the use of new drug subtypes such as CNS stimulants, inhalants, dissociative anesthetics, opioids, behavior such as binge drinking, and a sudden shift towards the use of electronic cigarettes (e-cigarettes).

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The American Academy of Pediatrics and the U.S Preventive Service Task Force have continually been at the vanguard of this problem through various efforts geared towards evaluating the scope of substance abuse among the youth to put the problem into perspective. Among one of the most impactful surveys which initially brought the issue to national attention was a 2015 qualitative program dubbed the Youth Risk Behavior Survey whose results indicated that 10% of school-going adolescents were already indulging in illicit drugs at home and within the school campus (Czaderny, 2020).

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However, it is noteworthy to acknowledge that a common thread among cases involving school-going adolescent drug users is the abuse of alcohol, tobacco, e-cigarettes and vaping, marijuana, and hallucinogens such as Salvia divinorum and Psilocybin mushrooms. This current state has mostly been attributed to erroneous “low-risk perceptions” by adolescents and an overall increase in the non-medical consumption of prescription drugs such a prescription opioids and codeine cough syrup.  For instance, McGue & Hicks (2016) states that opioid-related hospitalizations of adolescents and young adults between 1997 to 2012 increases by 165% and portends an upsetting drug-related public-health reality confronting the United States in the coming decade.

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Characteristics and Comorbidities

            Several key factors distinguish drug use among adolescent and younger adults from its antecedents and other age-groups. Perhaps the most common among these is the fact that drug users in this demographic currently use drugs in an environment quite different from the ones their precursors were attuned to. The wide range of societal and technological changes experienced within the second half of the 20th century have had a major profound impact on drug use trends among the youth today. One such case in point was the shift from traditional cigarettes to e-cigarettes; which is mostly recognized as a key catalyst for a general increase in drug abuse incidences among the youth. Additionally, drug abuse among adolescents and the youth is also characterized by drug-dependence and frequent mood swings when unable to access their drug of choice. Users also develop strained interpersonal relationships with close family members and also find it difficult to keep friends. Their financial condition may also deteriorate given that considerable amount of their budget is allocated to drugs and often prioritized over other needs. This ultimately increases the overall likelihood of their involvement in illegal activities such as prostitution, inappropriate sexual behavior, extortion, and a myriad of street crimes. Moreover, sociodemographic differences are also evident in drug use patterns in the United States today. According to Wilson & Janoff (2016), the prevalence rate drug use among male adolescents is considerably higher compared to female users and closely tied to associated comorbidities. While male adolescents are most likely to use scheduled prescription-type illicit drugs, females are known to abuse non-medical options such as tranquilizers. Yet, the most common comorbidities associated with illicit drug use among adolescent males and females are untreated mental illnesses, environmental influences such as stress and trauma, and a wide array of genetic and epigenetic influences.

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Prevalence of Drug Use among Adolescents

Apart from its extant recognition as a global public health concern, drug use among the adolescents and young adults has physical and psychosocial consequences for users. Even with comprehensive knowledge of these facts, coupled with concerted drug-prevention efforts by agencies such as the Healthy People Consortium, drug use remains an existential problem for the youth and their advancement in contemporary society. This is more apparent in the ever-soaring prevalence of drug use disorders mostly attributed to early initiation into substance abuse.

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According to a recent survey by the National Survey on Drug Use and Health (NSDUH), in 1 every 5 noninstitutionalized minors have used either a single or spectrum of illicit drugs within the past year, with the number expected to double two-fold within the coming decade (U.S. Department of Health and Human Services, 2021). Among the population of adolescents and young adults in the United States, drug use of this type is commonly punctuated by the illicit use of alcohol, marijuana, and prescription painkillers. The current prevalence of drug use among individuals within this particular demographic has mostly been attributed to untreated mental health illnesses such as major depressive disorder (MDD), generalized anxiety disorder (GAD) and mood disorders such as borderline personality disorder (BPD) and bipolar disorder (BD). This is further exacerbated by a limited access to professional to diagnose the specific mental health condition ailing the individual in question while kick-starting the treatment process (Santrock, 2013). Peer influence at home and within the school campus also plays a major role in influencing vulnerable populations such as individuals exposed to high levels of stress and trauma into drug use.

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Interventions and Family Implications   

            Early interventions are necessary for adolescents and young adults is necessary to inhibit the progression of unhealthy behaviors while avoiding cumulative effects associated with substance use disorders. Early intervention is also necessary in preventing the life-long physical and mental health problems associated with drug dependence today. The following are major evidence-based interventions currently recommended for adolescents and young adults and accompanying family implications. Today, schools at the very frontline of the fight against substance abuse in society, which is why school-based interventions are increasingly becoming popular. This has mostly been influenced by the increased prevalence of substance abuse and initiation, particularly among school-going adolescents across state. School-based interventions are, therefore, an effective deterrent against substance abuse among a vulnerable population. For instance, such efforts have been hailed for preventing the youth from indulging in illicit alcohol and tobacco use while significantly reducing incidences of smoking initiation (Donovan, 2015). However, it is crucial to also consider the family implication for the school-based intervention program. Families are commonly expected to enroll students into programs of this type while also actively participating in follow-up interventions to build their social competence. Moreover, the community has long remained one of the most effective tools in combating emerging problems such as drug abuse in society through community-based drug prevention programs.

Today, community-based drug prevention programs essentially function as a conduit for positive character influence on at-risk populations such as the youth. Such programs also seek to identify adults guilty of initiating vulnerable persons into drug use and proceeding to report them to the relevant authorities.  Hoffmann (2017) also asserts that community-based drug prevention programs also have major family implications, during and after implementation. Among the most common impacts is its ability to streamline family functioning among vulnerable individuals, especially through respected community leaders.

National Database of Nursing Quality Indicators, Patient Quality and Patient Safety


            Hello everyone. I welcome you all at the Coliseum Northside to the Medical-Surgical Unit, where our mission is to offer exceptional and compassionate service care to our clients every day. At this facility, I am a board member of the Quality Improvement Council. This presentation will explore how the National Database of Nursing Quality Indicators (NDQI) can improve patient quality and patient safety.

How a Health Care Organization Uses Nursing Sensitive Quality Indicators

            Zadvinskis et al. (2019) indicate that NDQI was developed in 1998 by the ANA to integrate nursing knowledge and particular information to improve the quality of care and patient safety. Data-centered research is gathered from the nationwide facilities, and they are compared to assess the nursing care quality. It affects patient outcomes at different levels of the healthcare system. The NDQI houses the nursing-sensitive indicators, which the ANA refers to as the documentation standards. These are the components of nursing care that directly impact patient outcomes. According to ANA documentation standards, there are three nursing-sensitive indicators, namely structure, process, and outcomes. Structure talks about the nursing skills and the nursing staff, and the level of education. Process delineates nursing interventions and patient assessment alongside nursing job satisfaction. Outcome sensitive indicator refers to meeting expected patient outcomes.

            The nursing quality indicator chosen for analysis in this assessment is the patient fall.  Zhao et al. (2018) coincide that the amount and the quality of nursing care given to patients directly impacts the probability of these patients experiencing a fall. The NDQI shares data which healthcare organizations use to compare in-house fall rates. In simple terms, the NDQI provides a measuring tool for healthcare organizations regarding how good or not present standards, policies, and procedures are documented, implemented, and maintained. As nurses, we must prevent falls within our facilities to continue building trust in the community, improve the organization’s financial viability, and satisfying the ANA documentation standards. Nurses play a significant role in the prevention of falls and fostering patient safety. Coliseum Northside is mainly a medical-surgical facility. Studies like those by Tsuda (2017) indicate that falls have a higher tendency to occur in medical surgical sections than in other hospital units.

            Multiple studies have shown that thousands of patients experience falls in different hospitals throughout the country each year. Consequentially, it has led to a financial burden for both the patients and healthcare organizations. Kobayashi et al. (2017) mention loss of income, litigation expenses, and temporary placement in rehabilitation centers as examples of financial obstacles clients may incur after a nasty fall. For the healthcare organization, repairing patient harm experienced during the fall becomes a huge burden because reimbursement is no longer provided. Moreover, Medicaid and Medicare services believe that falls occurring due to injuries in hospitals are avoidable incidences, and they no longer cover such costs.

Justification Of How a Nursing-Sensitive Quality Indicator Establishes Evidence-Based Practice Guidelines for Nurses

            As noted earlier, nurses play a pivotal role in preventing the occurrence of patient falls in hospitals. Since the nurses are the frontline soldiers in avoiding falls, they should implement interventions like examining patients for fall risks, setting bed alarms, creating awareness about falls to the patients and their families, and ascertaining that bed wheels are locked; nurses can effectively prevent falls. Michalcova et al. (2020) show that highly engaged nurses have a higher probability of integrating best practices, which have proven to reduce fall rates and boost family and patient satisfaction, positively impacting patient safety.

            I interviewed one of the Quality Improvement Practitioners at Coliseum Northside to better understand how data is used and transmitted to help advance patient safety. The practitioner said that when patients face a fall in the hospital, the assigned RN submits a report via an online reporting database known as the safety portal. Such information helps the quality improvement practitioner identify a problem at hand, leading to a comprehensive analysis of the patient chart.

            Coliseum Northside uses MEDITECH, an electronic medical record for documenting patient interventions. Certified Nursing Aids, registered nurses, Licensed Practice Nurses like the MORSE Fall Scale for assessing fall risks, ambulation abilities, hourly rounding, assistance needs, patient orientation, and the utilization of bedside sitters in the MEDITECH, which is then made available when required for analysis. After the practitioner has analyzed the data in the chart and MEDITECH, the fall is transferred to New York State Database. The interdisciplinary meeting is organized every Monday by the Quality Improvement Practitioner to explore the quality indicators and root cause analysis to create a solution to what is causing the fall or to mitigate the falls that have been occurring. Moreover, assessing pertinent findings in the client’s chart, including communication between physicians and nurses, happens.

            For example, suppose a nurse communicated concern to the doctors regarding the side effects of medications such as lethargy or dizziness. In that case, we want to know if these side effects can increase the probability of a patient experiencing a fall. On the physician’s side, the advantage versus the danger of prescribing medication is assessed. At the same time, additional or new approaches must be implemented on the nurse’s end to ensure the patient’s safety. As nurses, adequate documentation and assessment ascertain that our patients are given the best quality care that meets their satisfaction.

            The meeting findings directly show what new mandates or education and policies need to get implemented to prevent further patient falls. When inquired about the challenges encountered during the execution of quality improvement meetings, the quality improvement practitioner fostering change within the nursing staff said that giving direct patient care was the most challenging task. No person likes change; however, sometimes change is inevitable to grow patient safety, especially in avoiding patient falls positively.

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             I want to emphasize the importance of nurses communicating through shift reports, documentation, and assessments. Besides being a requirement by the Joint Commission responsible for accrediting hospitals that every facility must perform a fall risk assessment, nurses also take oaths to safeguard those in care facilities. Prevention of falls is among the approaches nurses are using to bring changes to the safety of patients. I urge my fellow nurses to expand the scope of their education to gain knowledge about nursing-sensitive indicators and how we can bring change to the healthcare system. Once more, I welcome you to the Coliseum Northside team. I look forward to working with you.

Workflow, Data Mining and Advancing Patient Outcomes – Annotated Bibliography


At the center of hospital bustle, overwhelmed staff scramble to remain on top of the paperwork cycle. Miscommunication and frequent errors frustrate nurses and inhibit the delivery of healthcare. Approvals are delayed, patients are left waiting for long hours, and information is misplaced – proving a critical challenge for a healthcare facility. While most hospitals have already adopted EHRs, and medical software, other fundamental processes like patient transfers to other facilities remain disorganized.  Omitting a single step in hospital workflows can create detrimental impacts for patients and hospitals alike. Managing different types of patient workflow in a facility is key to smooth operations. Patient workflow management refers to streamlining various tasks needed to process information by automating predictable and repetitive procedures. Patient workflow solutions assist in minimizing human errors, improve compliance to rules and regulations, reduce redundancies, oversights and ensure patients receive quality treatments. Data mining is a potential approach for building knowledge obtained from practice data in decision making. This annotated bibliography demonstrates how workflow and data mining helps in advancing patient outcomes.

Annotated Bibliography

Baek, H., Cho, M., Kim, S., Hwang, H., Song, M., & Yoo, S. (2018). Analysis of length of hospital stay using electronic health records: A statistical and data mining approach. PLoS ONE, 13(4), 1–16.

            In this article, the authors presented the factors related to the hospital’s length of stay (LOS). The article notes that LOS is an essential measure of the effective utilization of medical practices to examine the effectiveness of patient quality care, functional evaluation, and hospital management. The authors of this article argue that a reduction in the LOS rate has been associated with a decrease in the risks of causing opportunistic ailments and side effects of medication. Furthermore, the article adds that a drop in LOS is linked to lower mortality rates and improved health outcomes. Moreover, the article notes that shorter stay in hospital facilities lowers the burden of increased cost and a high turnover in beds, increasing profit margins for the hospitals and reducing social costs. EHRs processes and data mining techniques are integral factors in assessing the impact of LOS in hospitals.   

de Leoni, M., van der Aalst, W. M. P., & Dees, M. (2016). A general process mining framework for correlating, predicting and clustering dynamic behavior based on event logs. Information Systems, 56, 235–257.

            This article explored various processes of mining study approaches and suggested a new model that hospitals can use in data mining. The study showed that process mining research usually starts by discovering the process that constitutes automatic learning of raw data through process models. According to the authors, during this learning process, uncovering and conformance of constrictions occur. The article highlights that a person would want to understand why things exist at such a juncture. However, this can only be attained through the correlation of various elements assembled in the research processes. These elements are usually based on effective workflow management, which explains the next stage to be implemented. The conformance perspective, data flow, the organization perspective and the time perspective are among the characteristics that determine the following action to be executed. However, this source also argues that data components could feature fixed and variable operating costs during the implementation procedure. This leads to confusion and critical challenges. To mitigate these challenges and confusion, this article proposes a model comprising a broad and extendable series of elements related to data flow, organization management, control flow, time resources, and conformance in future nursing studies. Moreover, the article also proposes that researchers utilize a generic model designed with dependent variables comprehensively explained using correlating independent variables.

Heath, S. (2017). E-consent forms useful for patient data sharing in research. Retrieved from

            This article explores different studies discussing e-consent tools and how they determine the sharing of patient information. The author highlights that using e-consent to access patient’s data needs maximum assurance of data security. Furthermore, the author shows that facilitating patient consent to share their information is essential with the growing need for patient data in quality healthcare delivery. The article adds that many research teams have shown that medical findings mainly utilize social determinants, genomic information and biospecimens to perform scientific solutions. Unfortunately, these researchers require the patient’s consent to use their data in advancing research in the clinical environment. The author notes that patients have always supported using their data to research in the medical fields with the condition that their privacy and confidentiality will be provided to their information. In addition, the author argues that he decided to use e-consent tools to obtain the patient’s data because there are numerous ways researchers get patient data. Each of them presents different characteristics and level of satisfaction to patients. But with e-consent tools, patients have a better understanding of how they can share their data via EHRs, learn about various research avenues and give permission for their data to be used on electronic machines such as computers and tablets. The author finishes by commenting that the assurance of the researcher should serve as the standard rule that creates ethical and clinical policies for collecting consent from patients.

Heath, S. (2018). AMIA outlines data use guideline for patient-centred care, PGHD. Retrieved from

            This resource delineates that AMIA is an excellent tool for delivering patient-centred care, especially when looking into healthcare providers can evaluate the social determinants of health. The article coincides that better governance of information leads to constructing seamless data applicable in inpatient settings. The author adds that social factors of health are at the center stage of healthcare. Therefore, this can be achieved by encouraging community care collaborations and integrating social health factors. Nevertheless, collaboration and integration alone are not enough as they need a skeleton of guidelines for obtaining data for quality care to become a reality in communities. To substantiate the presented arguments, this article relied on various pieces of research from other resources to show that patient-based care can be attained from external sources within the community. According to the author, the social determinants of care include sociodemographic status, environment, and educational accomplishments. These social determinants of health, if not well curbed, can impact the delivery of care. But the author shows that with the growing technology, social determinants can be handled differently. Adoption of EHRs and strict data governance will help in eradicating the limitations of care. AMIA acknowledges that the patient is the pillar in the development and refinement of nurse informatics.

USF Health. (n.d.). Data mining in healthcare. Retrieved from

            This study assessed the steps in a workflow process in an actual clinical setting to examine precise departmental information systems that addressed patient flow. The authors note that nursing departments that want to mitigate contemporary challenges and bring care reform should begin with getting access to operational and clinical data and establishing and maintaining goals towards improving the quality of care. Additionally, the authors argue that implementing electronic medical record (EMR) is key to understanding the level of performance in different healthcare organizations. This is because EMR assists in streamlining workflow and data mining. Finally, the article quotes that the Society for Imaging Informatics in Medicine (SIIM) acknowledged that quality data standards and better performance are significant indicators of improved workflow.


            Workflow management is associated with the effective handling of patient’s data. A streamlined workflow has been shown to minimize medication errors, improve the quality of care delivered, and increase HIPAA policies’ compliance. Even though the healthcare industry has gone through numerous struggles to design and redesign a robust workflow system, it should invest more funds in building an effective workflow structure and adopt modern data mining techniques to boost efficiency, minimize the cost of running hospitals, and eradicate unwanted pressure increase patient flow.