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Final Medical Condition Paper: Sickle Cell Crisis

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Abstract

Sickle cell crisis (SCC) is an inherited disorder affecting millions of people especially African-American and Hispanic-Americans. The paper has focused more on the epidemiology and the economic cost of this health problem. SCC cannot be prevented, neither can it be treated. The paper considers the application of the Orem’s theory of selfcare in guiding the patient on how to manage and prevent infections that worsens the crisis. The theory is well supported by the evidence-based approaches, proposed by the American Journal of Nursing in 2019 to guide healthcare providers in managing pain caused by SCC. These guidelines need to be evaluated based on the effectiveness of the principles and recommendations. It has also considered health promotion, illness prevention and maintenance of functions. The role of the Advance Practice Nurse (APN) is presented to guide the patient on management of the disorder. Through education, people living with SCD learn about their condition and ways to address the significant issues associated with SCD.

Keywords: Sickle cell crisis (SCC), sickle cell disease (SCD), Advance practice nurse (APN), holistic care, theoretical nursing models, evidence-based approach, self-management model, and patient education

Health Problem

Sickle Cell Crisis (SCC) describes various acute conditions including chest syndrome, dactylitis, hepatic crisis, hyper-hemolytic crisis, splenic sequestration crisis, aplastic crisis and Vaso-occlusive crisis. The most common SCC is Vaso-occlusive crisis which has a sudden onset that last for 5-6 days and may be localized in a specific part or the general body. A group of RBCs disorders can be inherited leading to SCD. A health RBC is round and easily move through the small blood vessels carrying oxygen to all parts of the body (Clopton, 2017). In the cases of those who inherit SCD, the red blood cells become had, sticky and look like a C-shaped farm tool called Sickle. More than 50% of people with SSD, experience acute chest syndrome because of the small vessels in the lungs (Clopton, 2017). The most common signs and symptoms of SCC include throbbing, stabbing and dull. The severity of the symptoms varies from with different people. Some pain may be felt in the chest, belly, arms and legs hands and feet, and lower back. Some may experience extreme tiredness, breathing problem, dizziness and headache, yellowish skin color, weakness ad painful erection in males (Borhade & Kondamudi, 2021). Other complications include meningitis, venous thromboembolism, priapism, pneumonia, avascular necrosis, stoke, sepsis and osteomyelitis (Borhade & Kondamudi, 2021). Sickle Cell Crisis The signs and symptoms differ from one person to another ranging from mild to severe. At birth, the infants don’t show the symptoms since the fetal hemoglobin protects the RBC from sickling. Later after the baby is about 5 months, the hemoglobin is replaced by the Sickle hemoglobin leading to sickling of the cells. The most common triggers of SCC include stress, dehydration, infections, temperature changes and being in high attitude areas. The purpose of this presentation is to help the learner to understand Sickle Cell Disease (SCD), epidemiology, pathophysiology, theoretical framework of SCD, guidelines for pain management APN role interventions and patient education to help manage the disease.

Objectives

By the end of the end of this presentation, the learner will be able to;

Verbalize how what SCC is and how it occurs.

Discuss theoretical framework of dealing with SCC patient.

Tell triggers of SCC, prevention of infection and health promotion strategies.

Tell the role of APN in management of SCC

Epidemiology

SCD affects about 1in 36,000 Hispanic American children and 1 in 500 African American children (Centers for Disease Control and Prevention, 2017). Other groups commonly affected include Spanish-speaking regions, Saudi Arabia, Italy, turkey, Greece and in western Hemisphere (South America, central America and Caribbean). The number of people living with SCD in the US is unknown. It is estimated that approximately 100,000 Americans have SCD (Centers for Disease Control and Prevention, 2017). About 1 in 13 Black American babies is born with sickle cell trait (SCT). About 8-13% of African Americans carry sickle factor (HbS) (Johnson, 2017). One of the primary critical features in SCD is acute painful crisis which requires hospitalization. These Sickle cells dies early leading to a constant shortage of RBCs. Those who inherit SCD have signs during the first teat of life probably after 5 months. SCD patients have less access to comprehensive care team compared to patients with genetic disorders such as cystic fibrosis and hemophilia.

Cost Of SCD

SCD patients have lower lifetime income because of employment differences and lower life expectancy. The life expectancy is about 54 years, which is 22 years shorter than the general population (Lubeck et al., 2019). The average income for SCD patient is about $1.2 million compared to $1.9 million general rate (Lubeck et al., 2019). The estimates do not take into account lost education potentials, lost working days and time spent in hospital. SCD affect employment and job retention rate. In the United States, the incremental economic cost of SCD was estimated to be $2.98 billion per year. Inpatient expenditures accounted for 57 percent of the $2.98 billion (Huo et al.,2018). The prices imply that a patient will spend $15,040 on SCD on average. On average, employed patients lost an estimated $15,000 per year: $10,000 from missed work and $5,000 from lost productivity due to pain at work (Weatherford, 2021). Outpatient expenditures accounted for 38 percent of national SCD costs, or $10,079 per patient on average (Huo et al.,2018). Out-of-pocket expenses account for an average of $1,293 per SCD patient. As a result, SCD incurs significant social expenditures and places a financial burden on patients. Advanced practice nurses should propose interventional techniques that address elements such as early diagnosis, regular examinations, and tailored care to lessen the economic burden of SCD. About (80%) of healthcare costs for SCD are associated with hospital visists. Others costs are associated with nursing home care, home healthcare, prescription drugs, doctos’s visit and emergency department use.

As highlighted above, SCD affects million of people around the world (Chaney, 2020). The cost of SCD can be discussed through the effects on patients’ quality of life. According to a survey done by the Sickle Cell World Assessment Survey (SWAY), about (60%) indicated that SCD affect them emotionally. They were worried about the symptoms and worsening of the disease (Osunkwo et al., 2021). About (62%) also reported avoidance of intense physical activities (Osunkwo et al., 2021). SDC limits most patients from their careers, prevents them from attending work and attendance of school. They symptoms ranges from headache, bone ache and fatigue.

Theoretical Framework

Theoretical Basis for The Intervention in Management Of SCC

One of the best theoretical models to adopt is the Orem theory of nursing. The theory of self-care deficit theory was pioneered by Dorothea Orem, an America’s foremost nursing theorists (Mcewen & Wills, 2019). The Orem’s theory of selfcare deficit focuses of individual’s ability to perform selfcare. Selfcare refers to the activities that an individual initiates an performs on their own behalf. The theory is made of three interrelated theories; theory if selfcare deficit, theory of selfcare and theory of nursing system. Situations such as management of SCC and in rehabilitation settings requires a patient o bring out the best in themselves. The patients are trained to be more independent after being give nursing and physician care. The theory covers a broad scope with general concepts covering all instances of nursing. In nursing, the practitioner of nursing gives care to the person with a healthcare need. The nurse intelligently participates in the medical care the individual receives from the physicians. Human concept represents children, men and women cared for either social units or singly and regarded as the material objects for nurses and other people who provide direct care. The environment refers to the biological, chemical and physical features including the family, culture and community (Matthie et al., 2017). Health concept being functionally and structurally whole which include the heat of individual, groups and human health. Self-care concept explore the practices or performances of activities that individuals initiate on their own behalf to maintain life, health and wellbeing. The self-care agencies are practicing that individual initiate and perform on their behalf to maintain health and if affected by basic conditioning factors such as gender, age, social orientation, family, healthcare system, environment, availability and resources.

How This Orem’s Is Being Used to Guide Advanced Nursing Practice in Managing SCC

In SCC, selfcare guides in pain crisis prevention, management of pain, making self-care relevant in enhancing well-being of the patient. Sickle cell disease management focuses on prevention of infections, hydration, pain prevention and other complications. The general strategies include avoiding extreme temperatures, getting enough rest, eating healthy foods doing regular moderated physical exercises while staying hydrated. Self-care is recommended for young adults since pain is more experienced between the age of 19 to 39 (Matthie et al., 2017). Similarly, re-hospitalization and utilization of health care are highest between the age of 18 to 30 (Matthie et al., 2017). Self-care, social-demographics, social support and self-efficacy has been noted as critical concepts that assist in management of SCC. The selfcare resources (social support, selfcare action, coping behaviors e.tc) medicate between the vulnerability factors and the health outcome. The vulnerability factors for SCC include overprotection, number of acute pain episodes, and number of complications. Selfcare resources (selfcare actions, self-care ability, social support, self-efficacy and assertive communications assist in the management of daily activities necessary for living with SCD. Self-efficacy links the perception and actions of the patient acting as a mediator of health behaviors. Some studies shows that higher level of self-efficacy led to reduced pain, fewer self-reported symptoms, increased adherence to medication and increased use of adaptive copying mechanism.

An Example of How Selfcare Theory Guides the Practice

Grace, is a mother, wife and a content creator who lives with SCD. She briefly narrates how she adopt selfcare theory in managing her condition. She says that one of the many ways that makes her stay healthy while living with SCD is being intentional about her self-care. Through self-care she is able to deal with her stress. The second think she is keen with is avoidance of triggers of SCD through self-care. According to her, mental and emotional stress are among the triggers doer SCC so she needs to be intentional in order to minimize the triggers. The third thing she does is to adopt health habits. One the habit is meditation when in low moods. She finds a quite place and reflet on the good things in her life and positive affirmation especially when she wakes up. She ensures that she goes for regular counselling therapies where she gets guidance from specialists. In this condition, mental and physical health is important. Other thing that she focuses on include going for vacations, date nights and massages all these targeted to enhance mental health.

Advance Practice Nurse’s Approach as Interventionist

Evidence-Based Approach (Advanced Plan of Care) In This SCD

As an advance practice nurse (APN), there are variety of available evidence-based approach that that can be used to deal with SCC. I will focus on the evidence-based approach that will help understand the complications of SCD. The American College of Emergency Physicians, 2019 provides an overview of major SCD related complication and the nursing implications (Tanabe et al., 2019). I will consider evidence-based approach in management of acute pain and chronic pain.

Acute pain persists four at least four hours and can be explained as Vaso-occlusion. Vaso-occlusion is the major cause of acute pain in SCD and requires medical attention. Vaso-occlusive episodes (VOEs) can be managed through administration of proper analgesics and rapid pain assessment. A nurse’s thorough pain evaluation, which includes noting the location, intensity, and duration of the pain episode, is invaluable. APN helps identify what relieves the pain and whether the current pain in the patient is typical VOE or Acute Chest Syndrome (ACS). A nurse as a primary care provider works with clinicians to ensure the patient is prescribed with adequate analgesia. Through patient -nurse relationship, they can discuss the nonpharmacologic adjunct therapies that can help relive pain. Most patients prefer heat applications since the application of ice is contraindicated in VOEs. Vaso-occlusion increases pain by reducing oxygen delivery. other therapies that can be used in SCD management include megavitamins, hypnosis, herbal therapies, acupuncture, relaxation techniques, prayers, biofeedback and cognitive behavioral therapies (Tanabe et al., 2019).

After relieving the pain, the nurse and the patient can determine the potential triggers of VOE and best way to avoid them (Centers for Disease Control and Prevention, 2017). The patient can be guided on how to take the pain medicine in order to manage the pain. The nurse plays a great role in helping the patient understand the role of hydration in preventing VOEs by reducing blood viscosity and increasing plasma volume. Fluid intake is always encouraged unless it is contraindicated by conditions such as renal diseases and heart failure. The nurse can also encourage patients who may have challenges with movement due to pain to walk and use the incentive spirometer always to prevent pulmonary complications and blood clot.

There are three subtypes if chronic pain that the APN and the patient need to be aware of. There is chronic pain with the contributing SCD complications, mixed presentation and chronic pain without SCD complications. Just like the other types of chronic pain, pain experienced through SCD can make the patient t experience hyperalgesia, central sensitization and altered opioid metabolism. Chronic pain causes discomfort and precipitate mood changes, behavior dysfunction, emotional disturbances which affects different facets of patient and family life. Apart from conducting a comprehensive pain assessment for acute VOEs, the APN can further determine the type of pain the patient may be experiencing (Centers for Disease Control and Prevention, 2017). For example, in case of hip pain, the patient may be evaluated for orthopedic evaluation for AVN and possible surgery. The APN need to obtain the history of patient medication including the opioid and nonopioid pain medication. Most SCD patients require both short and long-acting opioids and medication for anxiety, sleep and pain. through the help of a nurse, the patient understands how to use long-term opioids most effectively encourage use of nonpharmacologic interventions as adjunctive therapy. According to the National Heart, Lung and Blood Institute Expert Panel Recommendations for SCD, health maintenance requires prophylaxis at age 5 and vaccination against streptococcus pneumoniae for all ages (Tanabe et al., 2019). There is need to screen children annually from between 2-16 years with transcranial doppler for stroke risk.

The intervention of patient education support culturally sensitive care of patients. The intervention is ethically acceptable since it does no harm but is good to the patient. Most of these nursing implications are patient centered. The APN and the patient determine the best way to manage acute and chronic pain. The implications are also practical in such a way that patients understand the triggers of pain. Upon following the guidelines of the nurse, the pain becomes manageable. Through proper patient-nurse relationship, they can agree on the interventions that are culturally sensitive to the patient. Most of these interventions are nonpharmacological and hence cost-effective since they are related to lifestyle modification such as physical exercises, stress reduction and hydration. However, come interventions requires medications which can be very affordable if the patients have got some healthcare coverages.

Evaluation

The best evaluation method is patient follow-u to identify if the interventions are working well with the patient. The evaluations can be determined through the patients’ symptoms. If the patient is improving with reduced symptoms, the intervention is therefore successful. However, if the patient is deteriorating, the intervention is unsuccessful and this require checking on an alternative intervention. Healthcare provider can also check on whether the incidences of crises have reduced, maintained or increased in order to determine the best intervension. Through nurse can be able to determine if the patient’s self-esteem has improved. Proper results will show decrease o absence of complications. Questions and answer method can help the nurse to get the actual health status of the patient. The nurse can give a rating scale for the patient to respond to for each intervention used in pain management. Through education and guidance, the nurse can ask questions so that patient to determine if he has understood the interventions properly. The nurse use evaluation reports to determine gaps that need to be improved for quality healthcare.

Discussion Of Concepts

Education On Illness Prevention

SCD is an inherited blood disorder in which a patient is born with. There is not way the disease can be prevented from being passed from the parent to the child. The only way is preventing the infections that worsen the disease. Flu is a common illness that is dangerous for a patient with SCD. The patient can be educated on simple steps that can help prevent the infections. Handwashing is a good way of preventing infections. People with SCD, including caretakers and family members need to wash their hands with clean water and soap as many times as possible. If soap is not available, they can use gel hand cleaners with alcohol in them (Centers for Disease Control and Prevention, 2017). The best time of washing hands include before making food and before eating. They can also wash hands after using a bathroom, after sneezing, coughing and blowing the nose. They should clean hands after touching things or people that carry germs. These includes diapers, food that is not cooked including raw eggs, meat and unwashed vegetables, animals and their waste and trash. They should wash hands upon touching child who has used toilets and sick people.

The second tip of infections preventions include observing food safety. Salmonella, found in some food is a bacterium that is very harmful to children with SCD. The bacteria is also found in reptiles and children need to be warned against touching them. They need to stay away from lizards, turtles and snakes (Centers for Disease Control and Prevention, 2017). There are tips that patients, friends and family friends can be educated to help staying safe when cooking and eating food. The patient’s cook needs to wash hands, knives, cutting boards, counters and after they touch uncooked foods. The patient needs to wash fruits and vegetables well before eating them. In cooking meat, ensure that the juices are run clear an no pink inside the meat. Patients should not ear raw and undercooked eggs. These eggs could be hiding Caesar, homemade hollandaise sauce and homemade salad dressing, frostings, cookie dough, homemade mayonnaise, homemade ice cream and tiramisu. Do not eat raw or unpasteurized milk and dairy products (cheeses). The patient needs to check to ensure that these products have a label that says they are “pasteurized”.

The other preventive measure is vaccinating against infections (Centers for Disease Control and Prevention, 2017). Adults and children with SCD need to educated on all recommended vaccinations which includes flu vaccination. People with SCD are considered “high risk” for certain infections and need to follow a special vaccination schedule for certain vaccines. These vaccines include meningococcal, pneumococcal and haemophilus influenzae type b (Hib) vaccines (Centers for Disease Control and Prevention, 2017). Parents with SCD children need to understand the benefits of giving penicillin and other prescribed antibiotics to the children until the get to the age of 5. The penicillin attacks wide range of bacteria that can cause complications to SCD.

Education On Health Promotion

proper education on how to live a healthy life can help SCD patient enjoy most of the activities that other people do. Health promotion tips requires the patient to find a good medial care. SCD is a chronic and complex disease and requires quality healthcare from nurses and doctor who knows more about the disease and can help the patient prevent some serious problems. Where possible, chose a hematologist who can work with a group of specialists in addressing SCD (Centers for Disease Control and Prevention, 2017). The patient needs to be educated on benefits of regular checkups. Regular checkups with healthcare provider can help the prevent some of serious problems. Patient and specialist relationship will help determine the symptoms and ways of relieving the pain. it can be done through medicines and other relief methods such as physical therapy and heating pads. The patient can discuss with the doctor about the over-the-counter drugs that are best for you. Its necessary since some medications such as ibuprofen (Advil, Motrin) or naproxen sodium (Aleve), may affect the kidneys.

The patient needs to be educated on healthy habits. It’s advisable to take at least 8-10 glasses of water every day and healthy food that will keep the body hydrated. SCD patients need to maintain a balanced body temperature by avoiding getting either too cold or too hot. Drink more fluid is one is doing exercises or is an extreme hot weather. There is need to eat healthy fruits, vegetables, proteins and whole grains. According to Centers for Disease Control and Prevention, (2017), Moderated exercises such as biking and walking for about 2.5 hours per week is helpful. Before taking a new routine on exercises, it is good that the patient discusses with the doctor. Despite those physical exercises is key to a good health, SCD patient need not to overdo it.

SCD patient need to take medicine as prescribed by the doctor. There is a need to get medical lab tests that are recommended by the doctor. Staying on up-to-date vaccines is recommended. The patient needs to take all recommended vaccines including meningococcal vaccines, annual flu shot and pneumococcal. The patient can also look for clinical studies and SCD magazines which can help the patient know treatment options and access new medicines. There is a need to look for support group or Community Based Organization (CBO) that can provide information, assistance and support.

Maintenance Of Function

Maintenance of stable body functions is good education for SCD patient. Through the guidance of the doctor, the patient can be able to identify the main triggers. Anytime the patient is in pain, he can try to figure out the probable cause. Although it may not be obvious initially, a long list of triggers can help you find the link of the common triggers of pain. the patient also needs to be aware of what works for him. The best things to try include the warm baths or massages or doing thigs that help relax e.g., dancing, listening to music and hanging out with friends.

Other maintenance of function include coping with stress. To prevent stress, the patient needs to be educated on planning ahead, and being prepared for stressful events. Sometimes, its hard to avoid stressful events. Patient need to recognize when in stressful mood, rake time to relax, eat healthy and be active while sharing feelings with friends, family members a counsellor. The patient should always avoid extreme temperatures. They can choose to dress properly for the weather and avoid sudden temperatures such as swimming in cold water. high attitude needs to be avoided since there is lack on enough oxygen. They need to avoid smoking since it tigers lung conditions such as chest syndrome. Alcohol also can cause dehydration in the body (Centers for Disease Control and Prevention, 2017).

The patient needs to be educated together with the family about the treatment, assessment and monitoring of the disease. They need to know about chelation therapy and device management. They need to be educated on the importance of consistent communication between themselves and with the healthcare provider to ensure regular follow-up.

Payment Plan

SCC patients often experience high health insurance cost. Its costly to pay for healthcare cost, medical procedures and prescriptions of drugs. In US, health insurance is complicated and expensive Medicaid and Medicare are two government programs that provide coverage to people. Medicare covers patients above the age of 65 and younger people with SCD. However, for SCD patient to quality at a younger age, the disease must have prevented him from working. there are factors that can help determine if one is eligible for SCD insurance. Complications of anemia that require at least 3 hospital stays. Low hemoglobin results for at least 3 times within a year. the third one is painful cries that requires injections or IV opioids for at least 6 times within the mast year. however, there are ways for approving SSD patients even if they don’t meet the above criteria. Low-income adults, children, parents disabled people and pregnant women can get coverage from Medicaid.

People who have worked long enough and paid Social Security taxes on their earnings are eligible for benefits under the Social Security Disability Insurance (SSDI) program. Monthly money and medical care are among the benefits. If your SCD has made it impossible for you to work, you may be eligible for SSDI compensation. Medicaid is run by individual states unlike Medicare run by federal government. About 42,000 people with SCD get their health insurance from Medicaid programs. Patients need to their state Medicaid agency for more information about Medicaid coverage within their state. Each state has its own guideline to decide if they are eligible for Medicaid.

Support Intervention

Role Of Advanced Practice Nurse

APN has a great role in helping SCC patients in managing pain. AN can consider to use subjective description of pain and pain ratings on a pain scale to use and guide analgesic agents (Belleza, 2017). The APN can get history and physical information from the patient to help determine the best course of therapy, treatment and management. They can help support swollen joints till swelling diminishes. They can guide on the best breathing and relaxation techniques. After diminishing of the painful episode, the patient needs to implement aggressive measures to preserve functions. The APN need to monitor the patient manage and prevent infection. They can monitor their signs and symptoms, prescribe right antibiotics and assess the patients for the signs of dehydration. The have the role of teaching the patients how to take prescriptions for oral antibiotics a home by emphasizing the need to complete the full course of prescription.

the role of APN considers promoting coping skills in the patient. To promote therapeutic relationship, the APN need to educate the patient of pain management based on mutual trust. In this process, the APN has to focus on the strengths of the patient rathe than deficit to enhance effective coping skills. Through a good rapport, the APN can help patient determine the daily activities and care to increase the feeling of selfcare and control. The APN has more knowledge of the situations that triggers SCC and the necessary steps that can be taken to diminish and prevent such crises. They can be advised on moderate warmness, maintenance of hydration and how to avoid stressful situations. APN has the role in managing potential complications such as leg ulcers. The leg needs to be protected from contamination and traumas. The other complication is priapism leading to impotence (Belleza, 2017). The patient needs to be educated on emptying the bladder at the onset of the attack, exercise and take a warm bath. It the episode persist for long; the patient needs to seek medical attention. The APN need keep regular checkup with the patient to help determine adherence to the medication. In case of noncompliance, he should also find out the reason for it (Belleza, 2017). The APN need to inform patients on where they can see referral/ specialist just in case they need further healthcare or incase of emergencies. Though a good rapport, APN can determine the financial capability of the patient. They can find ways of helping the patient get quality care at an affordable cost especially through use of generic medicines. They can also guide the patient in getting healthcare coverages to help him receive necessary healthcare. People with SCD require treatments that avoid hospital readmissions and shorten hospital stays in order to save money. Hydroxyurea, for example, saves roughly $5,000 per year on average in hospitalization costs.

Conclusion

SCC is a chronic disorder and cannot be cured. Patients can only follow the guidelines provided by their healthcare providers. They need to adopt health lifestyle habits such as moderate physical exercises, hydration, eating healthy food and prevention of infections. There are updated clinical guidelines provided that APN can use to provide care to the patients. The intervention of APN needs to be guided by these EBPs. The patients need to observe their emotions by reducing stress and planning in advance to avoid stressful events. Patient education on SCD triggers is one of the main components of the self-management model, and the best intervention APN can use to provide quality care to SCD patients. Through education, people living with SCD learn about their condition and ways to address the significant issues associated with SCD. Through selfcare, the patients can be able enjoy most activities just like the normal people. Because many doctors are unfamiliar with SCC, it is critical that the patient take an active role in your own care management. To make crucial judgments, he must first learn about SCC, then grasp your treatment options before making the best decisions for your health.

References

Belleza, M. (2017, December 12). Sickle Cell Anemia Nursing Care and Management: Study Guide. Nurseslabs. https://nurseslabs.com/sickle-cell-anemia/#evaluation

Borhade, M., & Kondamudi, N. (2021). Sickle Cell Crisis. StatPearls. https://www.statpearls.com/ArticleLibrary/viewarticle/29014

Centers for Disease Control and Prevention. (2017a, July 13). Infections and Sickle Cell Disease. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/sicklecell/healthyliving-prevent-infection.html

Centers for Disease Control and Prevention. (2017b, July 27). Sickle Cell Disease Clinical Guidelines. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/sicklecell/recommendations.html

Centers for Disease Control and Prevention. (2017c, August 31). Data & Statistics on Sickle Cell Disease. Centers for Disease Control and Prevention; CDC. https://www.cdc.gov/ncbddd/sicklecell/data.html

Chaney, P. (2020, December 21). Effects of Sickle Cell Disease on Daily Life, Symptoms, and Disease Management. Hematology Advisor. https://www.hematologyadvisor.com/home/topics/anemia/quality-of-life-outcomes-in-patients-with-sickle-cell-disease/

Clopton, J. (2017, February 28). What Is a Sickle Cell Crisis? WebMD; WebMD. https://www.webmd.com/a-to-z-guides/sickle-cell-crisis

Huo, J., Xiao, H., Garg, M., Shah, C., Wilkie, D. J., & Mainous Iii, A. (2018). The economic burden of sickle cell disease in the United States. Value in Health, 21, S108.

Johnson, C. S. (2017). Sickle Cell Crisis – an overview | ScienceDirect Topics. Www.sciencedirect.com. https://www.sciencedirect.com/topics/medicine-and-dentistry/sickle-cell-crisis

Lubeck, D., Agodoa, I., Bhakta, N., Danese, M., Pappu, K., Howard, R., Gleeson, M., Halperin, M., & Lanzkron, S. (2019). Estimated Life Expectancy and Income of Patients With Sickle Cell Disease Compared With Those Without Sickle Cell Disease. JAMA Network Open, 2(11), e1915374. https://doi.org/10.1001/jamanetworkopen.2019.15374

Matthie, N., Jenerette, C., & McMillan, S. (2017). Role of Self-Care in Sickle Cell Disease. Pain Management Nursing, 16(3), 257–266. https://doi.org/10.1016/j.pmn.2014.07.003

Mcewen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.

Osunkwo, I., Andemariam, B., Minniti, C. P., Inusa, B. P. D., El Rassi, F., Francis‐Gibson, B., Nero, A., Trimnell, C., Abboud, M. R., Arlet, J., Colombatti, R., Montalembert, M., Jain, S., Jastaniah, W., Nur, E., Pita, M., DeBonnett, L., Ramscar, N., Bailey, T., & Rajkovic‐Hooley, O. (2021). Impact of sickle cell disease on patientsʼ daily lives, symptoms reported, and disease management strategies: Results from the international Sickle Cell World Assessment Survey ( SWAY ). American Journal of Hematology, 96(4), 404–417. https://doi.org/10.1002/ajh.26063

Tanabe, P., Spratling, R., Smith, D., Grissom, P., & Hulihan, M. (2019). Understanding the complications of sickle cell disease. AJN, American Journal of Nursing, 119(6), 26–35. https://doi.org/10.1097/01.naj.0000559779.40570.2c

Weatherford, G. (2021). The true cost of sickle cell disease: $1.5 billion in lost productivity per year. VCU News. https://news.vcu.edu/article/2021/09/the-true-cost-of-sickle-cell-disease-15-billion-in-lost-productivity-per-year

Supply Chain For Personal And Protective Equipment Essay Help Free

QUESTIONMAY 06, 2020

A problem in nursing at this current time frame is the lack of Personal protective Equipment in this COVID19 pandemic. According to Rowan (2020), “there is growing international concern regarding the shortage in supply chain of critical one-time-use personal and protective equipment (PPE).” This is an active issue in the nursing profession where nurses quiet like ourselves are risking our lives to save others and are not being given the appropriate equipment to deliver a critical job. There isn’t enough N95 mask, face shields, gloves, protective gowns, and possibly shoe covers to help nurses fight this new virus, which, employers are making staff reuse their same PPE. Now given that this issue is a new understandable economic 101 problem, it should be followed and researched. This problem should be studied in the sense of how many nurses are being exposed with reused PPE or just due to the lack of PPE and endangering themselves of catching this deadly virus. A study should be proposed in which we gather statistical analysis to find out how many nurses are being found positive and critically ill up to including death due to this pandemic issue where manufacturers are not able to meet the demand unfortunately.

Rowan, N. J., & Laffey, J. G. (2020). Challenges and solutions for addressing critical shortage of supply chain for personal and protective equipment (PPE) arising from Coronavirus disease (COVID19) pandemic – Case study from the Republic of Ireland. Science of the Total Environment, 725. https://doi-org.lopes.idm.oclc.org/10.1016/j.scitotenv.2020.138532

Nursing research has the potential to influence future nursing practices and improve patient outcomes by acquiring knowledge through research. The nursing profession has always sought to improve care provided to patients, patient outcomes, and clinical practices. These goals can be reached through continuing education and performing research (Helbig, 2018). One problem that we are facing today is nursing shortage. For example in the hospital I work in there has been about 2 floors that have been closed due to COVID-19, on top of this we had a recent exposure in our unit where employees were exposed to the virus and got sick and had to leave work and be placed on quarantine. The closing of the other units has affected those nurses unable to work on their floor and have to be floated to other floors where they may not feel comfortable taking care of such patients. One case is the oncology floor that closed down and now those nurses are being floated to telemetry floors and many of those nurses don’t feel comfortable taking care of patients with drips or other issues. This has caused a great deal of dilemma in the units. With this going on and people getting exposed and sick with COVID-19 nursing shortage has definitely been an issue. It is important this problem is studied as this can affect patient safety and the nurses well being. Being in an unrecognized environment and not feeling comfortable is not how any employee should feel when walking into work. It can cause a great deal of stress, which can lead to errors and increase patient care and safety.

Reference:

Helbig, J. (2018). History and Process of Nursing Research, Evidence-Based Nursing Practice, and Quantitative and Qualitative Research Process. Retrieved from https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-practice/v1.1/#/chapter/1

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Quantitative and Qualitative Research Process. essay help: essay help
QUESTIONMAY 06, 2020

PICOT is Patients/Problem, intervention, Comparison, Outcome and Time (Helbig, 2018). These are the source of proving evidenced based practice (EBP) problems focusing on nursing solutions. A nursing practice problem will dedicate its attention on the aftermath of the holistic care of the patient while managing the disease. The nursing practice will focus on developing care plans on helping the patient manage the disease for example diabetes. While a patient is undergoing the management phase, the nurse will assist in meal plans as well as making sure the patient has access to meals that are appropriate for their health and if not making sure the patient is given resources. Medical practice problems are related toward the actual care of the patient on managing their disease medically by checking their labs, right medications, understanding of the disease and goal of managing the disease. By allowing PICOT to be used to prove evidenced based practice will allow nurses to gain the correct information to apply to their nursing care for patients. This is a very important practice that nurses should always challenge and use PICOT to support their EBP.

Helbig, J. (2018). History and process of nursing research, evidence-based nursing practice, and quantitative and qualitative research process. In Nursing research: Understanding methods for best practice. Retrieved from: https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-practice/v1.1/#/chapter/1

The difference between a nursing practice problem and a medical practice problem is the focus of the patient is not the same. A nursing practice problem, the focus is on the patient as a whole such as caring for the patient’s physical health and emotional health. The nursing practice problem centers on the many ways to improve the all-inclusive care as well as the patient’s outcome (Helbig, 2018). A medical practice problem focuses on treating a medical condition, disease or injury by using medication or surgical procedures. For example, I work in obstetrics, the doctor’s goal is to deliver the baby either vaginally or by cesarean section and then prescribe medication for pain or other treatments for maintaining comfort. The goal of the nursing practice is to prevent complications after the birth, pain management, provide emotional support, education and collaborate with other health care team members such as lactation consultants or social workers. Most nursing interventions use Evidence-Based Practice which help nurses to provide improved quality of care for patients (Helbig, 2018). It is important to ensure the PICOT question is based on a nursing practice problem because it helps the nurse to identify a problem regarding a patient which requires attention. By following the PICOT outline, P-patients/problem, I-intervention, C-comparison, O-outcome and T-time, the nurse can develop a plan of care, interventions and make sure they are evidence-based.

References

Helbig, J. (2018). History and Process of Nursing Research, Evidence-Based Nursing Practice, and Quantitative and Qualitative Research Process. In Nursing Research:Understanding Methods for Best Practice. Retrieved from https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-practice/v1.1/#/home

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Process of Nursing Research in Healthcare essay help tips
QUESTIONMAY 06, 2020

References

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Contemporary Public Health Issue in Healthcare rice supplement essay help: rice supplement essay help
QUESTIONMAY 06, 2020

Contemporary Public Health Issue Although the United States is among the wealthiest nations in the world, it is far from being the healthiest. Life expectancy and survival rates in the United States h

Contemporary Public Health Issue

Although the United States is among the wealthiest nations in the world, it is far from being the healthiest. Life expectancy and survival rates in the United States have improved dramatically over the past century, but Americans have shorter lifespans and experience more illness than people in other high-income countries. This assignment gives you an opportunity to put together what you have learned in this course, including, but not limited to:

public health policy, policymaking process, and law;public health and the legal system;individual and human rights in public health; andsocial justice, ethics and public health policy.

Choose a contemporary public health issue (e.g., bioterrorism, gun violence, or natural disasters like hurricanes, tornadoes, and wildfires), its impact on public health, and strategies for mitigating and managing it once the issue occurs.

Following APA guidelines, create a PowerPoint presentation of 17-20 slides (plus title and reference slides) on the contemporary public health issue you have chosen and a human rights ethical dilemma. You will present this work to a team of Centers for Disease Control and Prevention (CDC) officials tasked with developing global policies for addressing the impact of contemporary public health issues around the world.

Your presentation should assess:

the human rights concerns associated with the selected issues in public health policy,the conflicts of interest between public health policies and your selected emerging public health issue, andthe gaps in the current health law that apply to the contemporary public health concern you selected with recommended suitable policy interventions to address the selected contemporary public health issue.

Your assignment must be supported with evidence from three to five peer-reviewed references, two of which must be from the CSU Online Library and no more than five years old.

Ensure your presentation includes visuals such as images and graphics to supplement your message. These images or graphics must be cited according to APA standards as well. Your title and reference slides do not count toward the total slide requirement.

Your assignment must be supported with evidence from three to five peer-reviewed references, two of which must be from the CSU Online Library and no more than five years old.

Teitelbaum, J. B., & Wilensky, S. E. (2017). Essentials of health policy and law (3rd ed.). Burlington, MA: Jones & Bartlett Learning.

Please follow the directives to the letter.

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Challenges facing nurses in care delivery. buy argumentative essay help
Challenges

Assignment:

Nursing: Today and Beyond

Write a 1500 – 2000-word APA essay addressing each of the following points/questions. Be sure to completely answer all the questions for each of the bulleted points below.

There should be three main sections, one for each of the Main bullet below. Separate each section in your paper with a clear heading such as Challenges in Nursing

Support your ideas with at least three (5) scholarly sources using citations in your essay. Make sure to cite using the APA writing style for the essay

Describe at least three challenges nurses face today in care delivery. These can be ethical, legal, financial, or social.Provide at least one way to successfully overcome each challenge.Explain each of the Institute of Medicine’s five core competencies and describe ways in which nursing practice can meet each of these.Identify at least one obstacle for each and explain in detail how it can be overcome.https://www.coursehero.com/file/p2cp41v/Institute-of-Medicines-Five-Core-Competencies-There-are-five-core-competencies/https://www.wku.edu/nursing/documents/organizations/institute_of_medicine_core_competencies.pdf.In the Institute of Medicine’s 2010 Future of Nursing report, the committee developed four key messages. https://nam.edu/perspectives-2013-the-future-of-nursing-a-look-back-at-the-landmark-iom-report-2/Choose one message, explain the message in detail, and why it is important to the nursing profession.

Recommended Headings

Title

(After the title of the paper, begin the introductionto the paper. What is the problem, whyit is important, what it cost/impact, and then tell the reader what the paper will discuss.)

Challenges in Nursing (Level One)

How to overcome Challenges (Level two)

Institute of Medicine

Nursing’s Role

Institute of Medicine’s 2010 Future of Nursing

Conclusion

(Again, pay close attention to the minimum page requirement for each section and total sources required for each section!! There should be one reference page which has the textbook and the 4 additional sources listed! That is a total of 5 sources for the entire paper!)

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The field of health care in project management writing an essay help
QUESTIONMAY 04, 2020

Instructions for Research Project: The research project is based on each student selecting a workplace issue or opportunity within a health care organization and the field of health care management a

Instructions for Research Project:

The research project is based on each student selecting a workplace issue or opportunity within a health care organization and the field of health care management and presenting the information about its current state. The learner will deliver typed paper. The components of the research must include the elements listed below: • Description of one major workplace issue or opportunity based on a systematic review of a healthcare organization • Detailed discussion of the major workplace issue or opportunity • Description of the relevant stakeholders or personnel groups involved in the workplace issue or opportunity (particularly the student’s role as supervisor or manager) • Discussion of the affect the workplace issue or opportunity has on the relevant stakeholders or personnel groups • Sufficient background discussion to frame the context of the workplace issue or opportunity • Discussion of best practices or benchmarks used by the organization to address the workplace need • Discussion of barriers faced by the supervisor/manager in efforts to resolve the issue or advance the opportunity • Explanation of alternatives developed to resolve the workplace issue or advance the opportunity The research project must fit within the following parameters: 1. Typed paper 2. Outline summary (including title page and Bibliography) a. Length = 6–9 pages b. Format = typewritten, double-spaced c. Margins = one-inch on top, bottom, left, and right of each page d. Font style/size = Times New Roman or Courier/12 point e. Written in APA style f. References = citations in the body of the paper and in the Bibliography  In-text references: • Required within the body of the research project to indicate the source of the information presented • Students must not cite themselves; original thoughts/discussion from students are expected  The Bibliography must include a minimum of four citations/sources

This is the foundation of the research paper i have attached previous paper

I have loaded my syllabus please look at the research project

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Discussion on the issue of race and sexism popular mba argumentative essay help: popular mba argumentative essay help
QUESTIONMAY 04, 2020

Cultural Book of Choice SynthesisDiscuss the issue of race ,sexism, prejudice, discrimination or persecution by synthesizing ideas from your book of choice, The Gardener video and your own experience. Essay length should be 1000-1200 words not including the reference list.Begin your discussion by briefly explaining and describing The Gardener related to race only (see Jones 2000) and a discussion of the book you read. You can also include in your discussion other issues in the book or from your own experience related to sexism, persecution or prejudice.Your paper needs to include a thoughtful and thorough discussion of the following questions:

Share an example of racism, sexism, or persecution that you have witnessed, experienced, or read about in your book of choice. Be specific. Choose an example of discrimination based on observable behavior. What was actually said or done that was discriminatory? What is the level of discrimination (think in terms of Gardener’s levels of racism) and why do you think so? Identify one intervention that you or someone else might have contributed to a better outcome in the example you shared. How might this intervention improve the disparity in health between racial groups? Finally, describe two elements (event, incident, dialogue, discussion, scene, etc.) that you consider highlights in the book and why that a highlight.

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The purpose of informative writing in research project college essay help online
The purpose of informative writing is to inform your readers about a topic. Please i need one more page added to this essay pretty much complete

Rodriguez 5

Tannia Rodriguez

Professor Ashley Benson

English 103

May 3, 2020

Is “fake news’ a problem in American journalism

Whether it’s on television, paper, or solely on your phone, the news is unavoidable to the average person. Even on social media sites, articles will appear in the random feed. Fake news is a phenomenon where media creates articles with false information. Fake news is not new, but it is inevitable and inescapable. It’s a severe problem in the era where it can be a disservice to the American people. Fake news in American journalism was a real issue in the presidential race, sown discord among the people, and affect American journalist.

Fake news is a real issue, it’s an extreme issue, and it’s an issue that requires substantial research to be explained. The political consequences of fake news are very self-evident, for instance, the 2016 U.S. presidential race. Social media was an essential yet not overwhelming source of news in the run-up to the race. With 14 percent of Americans considering social media “most critical” source of election news; fake news stories showed up three months before the presidential election decision. Those favoring Trump have shared a sum of thirty million times on Facebook, while those endorsing Clinton who shared eight million times. The typical American saw and recollected 0.92 Trump fake news stories and 0.23 pro-Clinton fake news stories, with directly over a portion of the individuals who saw fake news stories and believing them. For fake news to have changed the result of the decision, a separate false article would have a similar enticing impact as 36 television campaign ads (Nyhan 33).

Numerous Americans trust fake news is sowing confusion. In the wake of the 2016 decision, everybody from President Obama to Pope Francis has raised worries about fake news and the potential effect on both political life and guiltless people. Some fake news has been generally shared. A specific example of fake news was the so-called “Pizzagate.” The scheme which began on Twitter the story that alleged sexually abused kids were hidden at Comet Ping Pong, a Washington D.C. pizza polar, and that Hillary Clinton knew about the sex ring. It appears to be so sensitive to some that a North Carolina man headed to the capital city with an assault weapon to look for the abuse kids. In the wake of being captured by the police, Welch said:” that he had pursued online that the Comet eatery was harboring child sex slaves and that he needed to see with his own eyes for himself that they were there and expressed that he was armed” (Fisher 13).

As reviewed by Pew Research Center, most Americans speculate that fake news is having an impact. Around two-in-three U.S. adults (64%) state manufactured news stories cause a lot of confusion about the essential certainties of current issues and events. Though they sense these accounts are spreading chaos, Americans express a lot in their trust very own capacity to distinguish fake news, with around four-in-ten (39%) somewhat confident perceive news that is made up and another 45% are not sure. Generally, about (32%) of Americans state they frequently observe political news stories online that are made up (Mitchell 1).

While fake news turned into an issue among the profoundly charged 2016 presidential race battle, Republicans and Democrats are about similarly prone to state that these accounts left the American people to be confused about recent developments thoroughly. Around six-in-ten Republicans state, fake news though independents outpace Republicans (69% state fake news causes a lot of confusion), they are keeping pace with Democrats. (Mitchell 4)

American, by and large, is sure about their capacity to distinguish fake news. Even though Americans see fake news as causing a lot of confusions, most are in any event to some degree certain about their capacity to recognize when a news story is made up. Around four-in-ten (39%) are confident, while another 45% are reasonably sure. Just 9% are not satisfied, and 6% are not under any condition sure (Mitchell 2).

The news industry should keep on concentrating on high-quality journalism that constructs trust and pulls in a more prominent group of onlookers. But, there have been steep drops in open confidence in the news media in recent years; this has damaged the ability of a journalist to report the news and hold leaders accountable. It is essential for the news organizations to call out fake news and deception without legitimizing them. They can do this by depending on their in-house experts and all-around well-respected fact-checkers. To Politi-Fact, Factcheck.org, and Snopes judge the accuracy of leaders claims and write stories detailing truth or lack of in those developments. People can shield themselves from false news and the misinformation by the depending upon a few similar news sources confines the source of material accessible to individuals and builds the chances that may fall victim to hoaxes or false bits of gossip. This strategy isn’t fool-proof, yet it expands the possibilities of hearing very much adjusted and diverse perspectives. (Born 34)

Finally, fake news is a significant problem that faces American journalism whether it has misled people and leaves the audience unable to discern if fake news is real or fake. At the same time, everyone has the responsibility to combat the misfortune of fake news and disinformation.

Works Cited

Bakir, Vian, and Andrew McStay. “Fake News and the Economy of Emotions.” Digital Journalism, vol. 6, no. 2, pp. 154-75. Digital Journalism, doi:10.1080/21670811.2017.1345645. Accessed 10 Mar. 2019.

Fisher, Marc, et al. “Pizzagate: From Rumor to Hashtag, to Gunfire in D.C.” Washington Post, 6 Dec. 2016, www.washingtonpost.com. Accessed 30 Mar. 2019.

Mitchell, Amy, et al., editors. “Many Americans Believe Fake News is Sowing Confusion.” Pew Research Center, edited by Amy Mitchell et al., 15 Dec. 2016, www.journalism.org/2016/12/15/manyamericans-believe-fake-news-is-sowing-confusion/pj_2016-12-15_fake-news_0-01. Accessed 30 Mar. 2019.

“Why the Fact-Checking at Facebook Needs to be Checked.” The New York Post, 23 Oct. 2017, sec. B. Pp. B2+, www.nytimes.com. Accessed 30 Mar. 2019.

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Adolescent Development and Juvenile Justice. professional essay help: professional essay help
need a thesis for my annotiated bibliography and one social media resource i will attach what i have please help What i have is not good enough

Rodriguez5

Tannia Rodriguez

Professor Ashley Benson

English 103

April 23rd, 2020

Topic: Should minors be tried as adults?

Many controversies exist on the question, “Should minors be tried as adults?” Those who commit a crime, including minors, should be penalized according to the law. Many people claim that a child did not know any better or was brought up with the conception that this behavior is acceptable. Many controversies surround minors being rehabilitated rather than going through the justice system, but studies show that minors are not fully developed to be tried as adults. Minors should not be tried as adults because minors have less chance for rehabilitation, they face danger, and they’re not psychologically developed enough to deal with the prison environment.

Annotated Bibliography

Bishop, Donna M., and Barry C. Feld, editors. Adolescent Development, Delinquency, and Juvenile Justice. Oxford Handbooks, 2011. Oxford Handbooks Online, doi:10.1093/oxfordhb/9780195385106.013.0005. This book focuses on the essential aspects of adolescent delinquency and justice processing. It examines the cognitive factors which develop during adolescence, which illustrates that adolescents appear to perform comparably to adults about the age of sixteen. Following this, it examines psychosocial factors of susceptibility to peer influence and future orientation and their continued development in the adolescent period. It also reviews the developing challenge of regulating emotions and affective responses that continue well into adulthood.

Demeter, Lori A., and Nokuthula Sibanda. “Neighborhood Risks and Resources Correlated with Successful Reentry of Youth Returning from Massachusetts Detention Centers.” Journal of Juvenile Justice, vol. 6, no. 1, Mar. 2017, p. 15+. Questia Online Library, http: www.questia.com. This article is about a Massachusetts detention center in 2008 that was analyzed using logistic regression. The results showed that available neighborhood resources such as schooling and prosocial activities were statistically related to the rates of reoffending among youth reentering the community following incarceration. These results have essential policy-making, education, and legal implications in reducing the reoffending rate of juveniles who have been released from incarceration.

Elliott, John D., and Anna M. Limoges. “Deserts, Determinacy, and Adolescent Development in the Juvenile Court.” Dakota Law Review, vol. 62, no. 3, Sept. 2017, p. 750+. Questia Online Library, questia.com. In this article, it talks about the transformation of juvenile sentencing. Children were viewed as those who have less control over their actions compared to adults. This coincided with the social science reformation of the penal law to a criminal justice system with an emphasis on rehabilitation. It also talks about the transformation from rehabilitation to more punitive treatment was also shown by states such as New York and Illinois beginning to treat juvenile offenders differently.

Kupchik, Aaron. Judging Juveniles: Prosecuting Adolescents in Adult and Juvenile Courts. NYU Press, 2006. Questia Online Library, www.questa.com. This book is about by comparing how adolescents are prosecuted and punished in juvenile and criminal (adult) courts. Aaron Kupchik finds that prosecuting adolescents in criminal court does not fit with our cultural understandings of youthfulness. As a result, adolescents who are transferred to criminal courts are still judged as juveniles. Ultimately, Kupchik makes a compelling argument for the suitability of juvenile courts in treating adolescents. “Judging Juveniles” suggest that justice will be better served if adolescents were handled by the system designed to address their special needs.

Pagnanelli, Enrico. “Children as adults: the transfer of juveniles to adult courts and the potential impact of Ropper v. Simmons.” American Criminal Law Review, vol. 44, no. 1, Dec. 2007, p. 175+. Military and Intelligence Database, link.galegroup.com/apps/doc/A162790183/PPMI? This article is about the aftermath of the Supreme Court’s ruling decision in the Roper v. Simmons case. It’s a landmark case that set a bright-line rule barring the use of the death penalty for juveniles. The legal precedent established in Roper, that juveniles diminished culpability due to social, physiological, and psychological underdevelopment warrants a bright-line rule for precluding the use of the most severe forms of punishment of violent offenders. It explains the demand for reexamination of current transfer policies and underscores an ideological shift towards a rehabilitative focus in juvenile jurisprudence.

Wood, Andrea. “Cruel and Unusual Punishment: Confining Juveniles with Adults After Graham and Miller.” Emory Law Journal, vol. 61, no. 6, 2012, pp. 1445-90. Emory Law, law.emory.edu/elj/content/volume-61/issue-6/comments/cruel-and-unusual-punishment.html#section-e353dbe42c8654f33588d4da0b517469. This article talks about how thousands of juveniles are currently confined with adults in detention and correctional facilities throughout the United States. Juveniles confined in adults’ facilities face grave dangers to the safety and well-being, including significantly higher rates of physical assaults, sexual abuse, and suicide than their counterparts in juvenile facilities. These dangers and other conditions of juvenile’s confinement with adults give rise to concerns of Constitutional dimension. In its Eighth Amendment jurisprudence, the United States Supreme Court created categorical rules prohibiting the imposition of specific punishments on entire categories of offenders as cruel and unusual punishment.

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Description on philosophy of health care free essay help: free essay help
QUESTIONMAY 02, 2020

I am studying FNPHere is some information you might want to share with your classmates: Describe your philosophy on providing health care . Discuss your professional goals. Where would you like

I am studying FNPHere is some information you might want to share with your classmates: Describe your philosophy on providing health care . Discuss your professional goals. Where would you like to be professionally in five years? What type of job would you like to have? Describe your “ideal” practice setting, how many hours a week you would like to work, how the position will remain viable and how you will attract new clients and retain those clients you have at the time.

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I am studying FNPHere is some information you might want to share with your classmates: Describe your philosophy on providing health care . Discuss your professional goals. Where would you like

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QUESTIONMAY 02, 2020

A 35-year-old personal assistant was referred to your practice with severe pain and muscle weakness to her first 3 three digits of her palmar surface. You ask the patient take position her hands and

A 35-year-old personal assistant was referred to your practice with severe pain and muscle weakness to

her first 3 three digits of her palmar surface. You ask the patient take position her hands and arms (a

Phalen’s test) to confirm your suspicion of carpal tunnel syndrome.

Which component of the nervous system is most likely affected by carpal tunnel syndrome?

A. The motor pathways

B. The autonomic nervous system

C. The sensory pathways

D. The somatic nervous system

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Major cause of heart related diseases. college essay help online
QUESTIONMAY 02, 2020

Obesity has many effects on children and youth health. It’s a major cause of heart related diseases. Parents are supposed to have a clear healthy nutritional guide for their children to avoid obesity.

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Challenges and implemention of new technologies college essay help service
QUESTIONMAY 08, 2020

respond FYI: This is feedback from student to my PICOT question. Hi , and thank you for your post! I am an innovator with technology at my current place of work with technology and design new aspects

respond

FYI: This is feedback from student to my PICOT question.

Hi , and thank you for your post! I am an innovator with technology at my current place of work with technology and design new aspects and tools with our EMR to make our practice run smoother, so I am quite excited to read more about your project over the next eight weeks. There are a lot of challenges with implementing new technologies and changes. The first time I tried to make changes, I received significant push back, and needed to find ways of over coming it. One of the best ways I’ve found to garner staff buy-in is to make the change a) pertinent to their job and b) pertinent to their patient outcomes. For example, if we can demonstrate that the change will improve patient safety, nurses will be more likely to adopt the change because patient safety is something they care about.

What do you think, given the scenario, will be the biggest barriers to implementing this system? Will it need to be a system that is created as a standalone, or will it be integrated into the current EMR if there is one? Thank you for your insights!

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Systematic review of a healthcare organization college essay help near me: college essay help near me
QUESTIONMAY 02, 2020

Instructions for Research Project: The research project is based on each student selecting a workplace issue or opportunity within a health care organization and the field of health care management a

Instructions for Research Project:

This is the foundation of the research paper i have attached previous paper

I have loaded my syllabus please look at the research project

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Legalization of physician aid in dying. nursing essay help
2 full pages only. See the attached file.

Watch the video re: Dr. Kevorkian, who led groundbreaking work on patients’ right to die. Then read the article on legalization of physician assisted suicide. Likely we will see this issue voted on in FL before too much longer.

What are your views on this subject? Should people have the right to have physicians help them end their life? Under what circumstances? What about the physician’s right to refuse? Where is the line for “do no harm”? Contrast the beneficial aspects as well as potential dangers/pitfalls that could result? Would you participate in a patient’s “prescribed” suicide?

Legalization of physician aid in dying. Support for physician-assisted dying continues to increase. Last year, California became the fifth – and the largest – state to legalize the practice, passing a law that allows physicians to prescribe a lethal dose of medication for terminally ill patients who want to end their lives. California joins Oregon, Washington, and Vermont, which have similar statutes, and Montana, where physician aid in dying is legal by case law. In New Mexico, however, a lower court decision permitting the practice was overturned on appeal. Legislation to legalize physician aid in dying has been introduced in 22 states. Unlike the laws in the United States, new and pending legislation in other countries do not restrict aid in dying to terminally ill patients. The Netherlands just legalized euthanasia for people with dementiawho had written advance directives that expressed the wish for it should they develop the condition. Pending legislation in Canada could permit physician aid in dying for competent adults who have “a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.” The legislation would put into practice a unanimous decision by Canada’s Supreme Court last year. Look for news about more law and policy initiatives in the U.S. and abroad concerning physician aid in dying.

Read more: http://www.thehastingscenter.org/News/Detail.aspx?id=7720&utm_source=News+in+Context+Bioethics+News+Watch+2016&utm_campaign=NewsinContext20160221&utm_medium=email#ixzz3xuJEJaNU

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Roles of the NP in a primary care setting college essay help nyc: college essay help nyc
This a discussion board post. Please follow the RISE Model attached to files with discussion post. Reflect (Recall, Ponder, and Communicate): I relate/concur/disagree with X because…I like what you d

Robin (Post)

Which roles of the NP in the primary care setting you would find most fulfilling?

The role of the NP that I would personally find the most fulfilling would have to be the direct patient care. Taking all the pieces that the patient brings to us and putting them to form a picture, then taking that picture, analyzing it and applying interventions to the patient’s life to improve their life. I look forward to combining my current training as an RN and my training as an NP into one cohesive practice.

A NP can diagnose an illness, prescribe medication as and interventions as needed, all the while treating the patient, treating the patient holistically. Physicians diagnose an illness, prescribe medications, order interventions to treat and/or diagnose a patient – just like NPs. The difference according to Nurse Practitioner Schools (2020), is that physicians are trained in a manner that does not provide the same holistic approach as nurses and nurse practitioners are trained.

Which roles of the NP in a primary care setting you would find most challenging?

The role of the NP that I would find the most challenging is the legal role that faces a NP. As an RN we have legal and ethical challenges and issues that we must be aware of and adhere to. These challenges for an NP have very similar ramifications as a physician in many states.

Consistency throughout the United States is a very large problem and barrier for NP. The scope of practice, certifications, requirements to prescribe, and wages vary greatly from state to state. According the Association of American Medical Colleges (2017), by the year 2030 the physician shortage could reach more than 100,000. That number is astronomical and NP add a layer to healthcare that covers the ability to treat patients while also being affordable. Unfortunately, as our video points out, government on the state and federal levels have not yet seen the importance of the NP.

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The Patient Protection and Affordable Care Act cbest essay help: cbest essay help
QUESTIONAPR 30, 2020

The Patient Protection and Affordable Care Act (generally referred to as the Affordable Care Act, or ACA) is the most monumental piece of U.S. federal health policymaking in nearly 50 years. It reorders not only many aspects of the health insurance and healthcare delivery systems but also long-standing relationships that underpin those systems. Yet beyond the sheer scope and content of the ACA and the policy trade-offs that led to its passage lies another story: its implementation and subsequent effect on the lives of tens of millions of Americans. In addition, there no doubt will be legal rulings in state and federal courts across the country that will alter the trajectory of the law and its implementation. (Teitelbaum & Wilensky, 2017, p. 169)

When President Barack Obama introduced the Affordable Health Care Act (ACA), several states banded together to challenge its constitutionality. On January 31, 2011, a federal judge ruled parts of the act unconstitutional. Obama’s law team formally appealed the decision in Florida et al. v. U.S. Department of Health and Human Services et al. Click here to access the appeal and read pages 55–67 (starting with section B. Congress’s Power under the Spending Clause).

For this case study assignment, review the aforementioned pages of the court case, and ensure you address the following items:

the key components of the ACA and the impact of the ongoing legal implementation issues on public health,the barriers to the implementation of the ACA relating to the legal aspects in question,the argument for appeal presented by President Obama’s team,the negative implications of the legal aspects in this case on public health research and practice and recommended actions to address the identified challenges, andstrategies that can be taken by public health stakeholders and leaders to transform public health research findings into practice.

Your case study must be a minimum of three pages not counting title and reference pages, which are required. You must use the aforementioned court case and your textbook as your source material for your case study.

For information on using APA Style to cite court cases, please see this resource created by the Writing Center:

http://columbiasouthern.adobeconnect.com/legalcitations/

You may use other sources but ensure the textbook and court case are used. All sources used must be referenced; paraphrased and quoted material must have accompanying citations in APA format

Course Textbook: Teitelbaum, J. B., & Wilensky, S. E. (2017). Essentials of health policy and law (3rd ed.). Burlington, MA: Jones & Bartlett Learning

Please follow the directives to the letter

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Write an Essay on Identifying A Clinical Question college essay help service
QUESTIONAPR 29, 2020

***1 Go to the NINR website: https://www.ninr.nih.gov and identify the four current priorities for nursing research under NURSING RESEARCH DEVELOPS KNOWLEDGE TO…. Do you agree with the priorities or would you recommend addition or elimination of some of the priorities? Describe how these research initiatives can be translated into evidence-based practice in your work environment.

Remember to submit your work following the file naming convention FirstInitial.LastName_M01.docx. For example, J.Smith_M01.docx. Remember that it is not necessary to manually type in the file extension; it will automatically append.

Start by reading and following these instructions:

1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.

2. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.

3. Consider the course discussions so far and any insights gained from it.

4. Create your Assignment submission and be sure to cite your sources if needed, use APA style as required, and check your spelling.

Assignment:

Identifying A Clinical Question

Write a 1000-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be three main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least five (5) sources using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.

Identify a clinical question related to your work environment, write the question in PICOT format and perform a literature search on the identified topic.

Purpose

To enable the student to identify a clinical question related to a specified area of practice and use medical and nursing databases to find research articles that will provide evidence to validate nursing interventions regarding a specific area of nursing practice.

Review the Application Case Study for Chapter 3: Finding Relevant Evidence to Answer Clinical Questions as a guide for your literature search.

Guidelines

Identify a clinical question related to your area of clinical practice and write the clinical foreground question in PICOT format utilizing the worksheet tool provided as a guide.Describe why this is a clinical problem or an opportunity for improving health outcomes in your area of clinical practice. Perform a literature search and select five research articles on your topic utilizing the databases highlighted in Chapter 3 of the textbook (Melnyk and Finout-Overholt, 2015).Identify the article that best supports nursing interventions for your topic. Explain why this article best supports your topic as you compare the article to the other four found in the literature search.

Assignment Expectations:

Length: 1000 – 1500 wordsStructure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of five (5) scholarly sources are required for this assignment to support the topic.Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.Format: Save your assignment as a Microsoft Word document (.doc or .docx) or a PDF document (.pdf)File name: Name your saved file according to your first initial, last name, and the assignment number (for example RHall Assignment 1.docx)

Posted: 12 hours agoDue: 30/04/2020Budget: $15

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