Smoking and Public Health

Abstract
Smoking has been closely related to public health according to studies that have been conducted throughout the years. It has been related to diseases such as cancer, respiratory diseases, and disabilities among other conditions. Smoking is a public health problem that affects all the demographics globally. Cultural differences, social norms and peer groups of smokers are causes of people to begin smoking. Due to the increase in the smoking trends, which have also affected the teenagers, policies have been put in place to reduce the tobacco products intake. Public policies put by the government and other institutions are important in ensuring that people quit smoking and improve the public health. Social influence in smoking contributes both positively and negatively depending on the social context. To curb the smoking and public health issues, policies need to be made more realistic and effective considering the morbidity and mortality rate associated with smoking.

Introduction

Smoking and public health are both correlated. A correlation between smoking and cancer was hypothesized in the early 1900s, with a few limited studies conducted in the United States. These studies did not provide a conclusive argument for the relationship between smoking and cancer, and it was not until a study that began in 1952 and concluded in 1955, interviewing and recording the health of 188,000 volunteers that the medical community in the United States believed that there was a confirmed connection between smoking and cancer (Mendes, 2014). This study was led by two members of the American Cancer Society, E. Cuyler Hammond, Ph.D., and Daniel Horn, Ph.D.

Following this study, the US Surgeon general used the American Cancer Society’s study and other associated studies to develop a conclusive federal level report in 1964 stating the fact that smoking causes cancer. Shortly after this report, in 1966 the first caution label was placed on cigarette packing warning of negative health risks associated with smoking (Mendes, 2014). Since this point in history, American culture has moved away from smoking and tobacco use products gradually. 54 years later, in modern-day 2020 America, smoking still causes a negative public health impact, with an estimated 480,000 deaths annually in the United States alone. In addition to the mortality rate, the Centers for Disease Control (CDC) estimates that over 16 million Americans live with disabilities directly related to smoking, increasing national health care costs by $170 billion annually.

To address this issue, regulations have been placed on the tobacco industry and tobacco users on both state and federal levels. These regulations have been effective in mitigating tobacco use, specifically smoking, to some extent. To more effectively mitigate healthcare impacts caused by smoking, a combination of social influence and public policy must be utilized in conjunction with one another.  

Impact on the individual

There is a quantifiable disparity of impact to a wide variance of the population. Smoking can be associated more closely with particular demographic sections of the population. To develop an ability to have a positive effect on public health through public policy, regulation and social change are dependent on recognizing the most at-risk categories for smoking and developing an understanding of the underlying cause of smoking’s persistence. Key indicators based on socioeconomic class indicate an inverse relationship between income, education, and increased risk of lung disease and smoking. In 2017 approximately 4.2% of adults in America had less than a high school diploma, 28.9% of the adult population had completed high school only, and the poverty rate (annual individual income of less than $15,000) was approximately 12.7%. (United States Census Bureau, 2017) According to the CDC, adults with lower education than a high school diploma, and making less than poverty-level wages are more than twice as likely to smoke as those who make more than twice the poverty level income wage and have a college or technical school degree (CDC, 2018). This is thought to be contributed to by the social acceptance of smoking within lower-income groups, partial resistance to “social norms” generally established by more successful groups, targeted marketing by tobacco companies, and inclusion of more smokers within social groups. The adage of “iron sharpens iron” supports the thought that when surrounded by others who smoke, the ease of access to cigarettes and lack of social support to quit negatively impact cessation efforts by those in these lower socioeconomic groups.

Often thought of as the action of a masculine individual, smoking is still more predominant in the male population within the United States. In 2018, it was estimated by the CDC that 18% of adult men were smokers, while only 12 percent of women were smokers. Studies indicate that a portion of this is due to the positive reinforcement pathways in the neurological development of the male vs the female brain. Nicotine and physical habit responses have an increased impact on male neurology response by releasing increased dopamine response. Male study participants had predictive relapses in smoking cessation during times of low cortisol, a stress hormone, while typically the inverse was observed with the female study participants (Cosgrove KP, 2014). Compounding the neurological aspect of the male trend in smoking is the social acceptance for smoking to be a masculine trait. American media firms developed film and television shows showcasing men smoking regularly, and while women were shown smoking on occasion, the quintessential strong male lead character was a highlighted smoker. Early American tobacco marketing utilized female models not to encourage women to smoke, but to use a sex-driven marketing strategy to attract more male customers.  

Race can affect the prominence of smoking and the success of cessation within multiple demographic groups. When surveyed, all racial and ethnic groups show a consistent 20 percent downward trend except for American Indian or Alaskan descent. These two groups had the highest rate of smokers at 24.3% of reported males and 23.4% of reported females. Not only were these groups higher than the other racial and ethnic groups, the survey results indicated an increase in cigarette use in recent years (Cosgrove KP, 2014). Possible racial and ethnically related causes of smoking are cultural differences, social norms, and peer groups of smokers encourage new smoking and make cessation more likely to fail.

The most alarming trend is the emergence of new smokers in the age of information. In 2020, in the United States of America, information is available through internet access. There is no lack of community knowledge that smoking is expensive, losing social acceptability and damaging to the health of an individual. Many factors are involved in the creation of new smokers. Being raised in a home with smoking parents increases the likelihood that a child will smoke as an adult. The more exposure to smoking children while growing increases their likelihood of finding smoking acceptable if not becoming a smoker themselves. Lack of parental supervision, like the “latch key” generation of the late 1980s and early 1990s, also has an impact. Finally, a newly developed technology was able to temporarily skirt the US ban on smoking advertisements by creating a product that was not tobacco, but nicotine suspended in a flavored fluid, vaporized and inhaled similar to a cigarette. This new trend, referred to as “vaping” was appealing to the younger audience because it is flavored, has an attractive smell, is less detectable by adults because the odor does not linger, and has an appealing technology aspect that youth use as a social device (trading juices and devices). The use of vaping has been found to form a smoking parallel habit of use and nicotine addiction (Cancer Action Network, American Cancer Society, 2014). These addictive traits evolve into more progressive use of nicotine products and a softened view on smoking, occasionally resulting in the poly-use of tobacco products including ZEN pouches, smokeless tobacco, and cigarettes.

Introductory conclusion

Smoking is a costly, devastating public health situation that affects all demographics within the United States. In the interest of saving a life, reducing the national health care burden, and improving the quality of life for smokers now, and protecting future citizens at risk of becoming tobacco users it is imperative to develop a national effort to mitigate tobacco use. This can only happen through an effective combination of public policy and social influence.

Analysis

Effectiveness of public policy

To evaluate the effectiveness of the public policy on public health within the context of smoking by the public, a contrast can be made between the United States and Indonesia. At the federal level, the United States has enacted laws on tobacco products regulating the manufacturing, sale, and distribution of these products. As of 2019, no tobacco products will be sold anywhere in the United States to persons under the age of 21. The Food and Drug Administration (FDA) of the United States regulates the ingredients and manufacturing process of all tobacco and the application of warning labels before the retail sale (Maher, 2013). Below the federal level, individual states can choose to enact regulation more stringent than federal guidelines, but not less than. Currently, 22 out of 50 States have not passed comprehensive smoke-free workplace laws and have more lenient regulations allowing private establishments to determine to allow or deny smoking within their place of business.

In direct contrast to the United States is the Republic of Indonesia. Until 2013, there was little regulation in the tobacco industry in Indonesia. Beginning in 2013, however, the president of Indonesia, Susilo Bambang Yudhoyono, signed the Tobacco Control Regulation into country law. This regulation intended to develop an informed consumer base for tobacco products through labeling and regulation on the sales and distribution of these items. Indonesia currently has set federal standards requiring smoke-free environments in healthcare facilities, public education buildings, and places of worship (Maher, 2013). The national law in Indonesia requires the establishment of local-level regulations to support and further define national law. This results in a lack of local-level enforcement of smoking laws and often goes unchallenged as smoking can be seen regularly in individual localities within Indonesia. A 2013 documentary created by vice media group examined the tobacco centric culture of Malang, Indonesia. The culture in Malang seemingly revolves around tobacco use. As seen in the documentary, there are medical treatment providers who are not traditionally licensed promoting tobacco use as a health treatment for ailments such as non-Hodgkin’s lymphoma, hypertension, and glaucoma among other things. This practice is disputed by traditionally educated physicians in the area, but a lack of regulation allows for this activity to occur unchallenged.

While it has not been contested that tobacco can be directly linked to negative health outcomes with little benefit, the sale and use of tobacco are legal in much of the contemporary world. From a population health perspective, the ultimate solution to mitigate the negative population health effects of smoking and tobacco use would be to prohibit the manufacture, transportation, and retail sale of tobacco products globally. The tobacco industry, globally, is an approximate $808 Million per year venture. The controlling interests have a financial incentive to maintain and grow this revenue. This is evidenced by the annual revenue growth chart presented below (Statista.com, 2020). The result of the preservation of self-interests by the tobacco industry is a financial investment in political influence and marketing. The more lenient the legal guidelines are for the tobacco industry; the greater the profit margins can be attained. Currently, tobacco regulation and enforcement efforts have stalled in Indonesia as a result of political and monetary influence from the tobacco industry (Maher, 2013).  

 (Statista.com, 2020)

 Since the institution of regulation on the tobacco industry in 2013, Indonesia’s smoking rates have continued to slowly rise until 2016, which is the most recent data available at the time of this report. In 2011, Statists reported 57.96 million smokers, and in 2016, the same survey reported 63.33 million smokers, an increase of almost 10% in 5 years (Centers for Disease Control, 2018). The United States has shown a sharp decline in smoking in the same period, in 2011 with 43.8 million smokers, and trending downward to 37.8 million smokers. A decline of approximately 14% and 6 million people.

The two notable factors in the decline in smoking in the United States that are not present within the Indonesian community are governmental regulation on the national, state, and local level and the social trending of society to move away from tobacco use. Unlike the 1950s when many characters portrayed in television and film were smoking, modern Americans have developed an observable shift away from the social acceptance of tobacco use. This is evident in media, where smoking occurs rarely, and if it does, it is likely portrayed in a negative light. Restaurants and bars in 28 states have been restricted by state-level laws and enforcement to prohibit smoking indoors, while other retail facilities have chosen to prohibit smoking as a response to an increase in revenue, or a local patchwork of city and town level laws (Cancer Action Network, American Cancer Society, 2014). To further expand on the financial advantages of a smoke free environment in the public sector, research indicates that smoking cessation will reduce the number of sick days used, reduce doctor’s office visits, lower insurance costs, and improve quality of life for the employee. A better quality of life will likely result in a more positive employee and workplace environment.

In Indonesia, the prevalence of smoking has constantly been on the rise annually and more so in the adolescent's groups. In the United States, research shows that adolescents consume tobacco products every day. Smoking has become a more important issue among adolescents globally. Due to these statistics, the Indonesian government has set policies to deal with smoking behaviors. These policies include several regulations geared toward regulating cigarette advertisements, smoking-free areas, and healthy living behaviors. In schools, smoking behaviors are tackled through health education on the health dangers of smoking and setting up free smoking areas (Kumboyono, Hamid, Sahar & Bardosono 2020). However, these policies are not enough to curb the rate at which smoking is increasing. It is therefore important for the government to come through in developing strategies that will assist in overcoming the smoking behaviors. For these strategies to be effective, the government has to involve the community for them to be successful. Adaptive response for the community is significant to help prevent and control this smoking behavior in early adolescents. The response is used to expound protective features in the prevention of the developing process of smoking risk factors. The protective features in the community can be used to strengthen early adolescents to reject being initiated in smoking behavior. Protective features can come from internal circumstances within adolescents, the relationship between the adolescent, his peers, and the family, and the health promotion program. Through this, community response is the ability of adolescents, having the support of peers, parents, nurses, teachers in charge of the health program against smoking.

Smoking has been closely associated with leading risk factors for premature death and disability. It has been estimated to be the cause of death, approximately taking the lives of 6 million people annually. To reduce this problem, mass media cessation program campaigns have been seen to have a positive impact. Campaigns vary in different ways for them to be effective and research found out that harm focused messages appear to have more impact in developing quitting cognitions and behavior compared to those that focus on anti-industry or themes on how to quit. A campaign dubbed Stoptober was designed putting its focus on creating a positive quit prompt for many people and support a social program around a particular movement that was not to smoke for 28 days. The campaign was publicized through traditional and modern mass media including social media platforms. The key psychological principle for the campaign was the use of Specific, Measurable Attainable Realistic, and Time-sensitive objectives (Brown et al 2013). SMART objectives are aimed to help people attain a difficult behavioral goal by inspiring them to start with a realistic goal. The stopober campaign set people out for the challenge of not smoking in October. This was reinforced by a positive message conveying that individuals who would achieve this goal would be five times closer to becoming permanent ex-smokers by being able to recover from cravings and withdrawal symptoms. Another key psychological understanding was the use of the PRIME theory which is a theory of motivation which suggests that the motivational system is not stable and needs balancing inputs to maintain a persistent behavioral pattern. This is because the theory maintains that behavior is determined on a time to time basis by motivational inputs. The stoptober campaign appears to have been effective because according to their survey, a third of a million and more smokers quit smoking in October 2012.

Despite the reduction of US smoking adults, research shows that smoking is still high in socioeconomically disadvantaged groups and the e-cigarette increase in young people. Even with the celebration of the reduction, there is still a need to focus on tobacco regulating efforts. The solution for enforcing these regulating measures includes establishing tobacco-free rules for indoor and outdoor environments. Prices for cigarettes should be elevated by increasing the taxes to discourage the consumers which have been implemented in most of the states. Additionally, three government organizations have continuing interventions, for example, the CDC’s pieces of advice from past smoker's campaigns. This includes individuals who are living with disabilities and diseases which were are a result of smoking (Printz 2019). This acts as a convincing strategy that was effective and convinced half a million Americans to stop smoking from the year 2012-2016. The CDC also plays the roles of funding quitlines in 50 states which connects individuals to behavioral counseling and free nicotine substitute treatment. Another program is the FDA “every try counts campaign” which provides pieces of advice and message provision programs. There is also the National cancer institute’s quitline and the smokefree.gov website. Cigarette smoking rates have declined in the past two decades but have stalled in 2017 and 2018. 

The E-cigarette has shown a significant increase with an increased number of users including high school and middle school students. The e-cigarette has been used immensely by students of which some did not know it contained nicotine but used them because of the many flavors they contain. The conversation about getting rid of the e-cigarettes to help students and younger adults not to use it is contradicted by the e-cigarette companies pointing out that the products help adults to quit smoking. They also argue that different flavors attract adults. Following this, many states have been prohibition the sale of e-cigarettes that have been flavored, and the FDA who had proposed the banning of e-cigarettes handed out a draft suggestion which required the stores to only make it available in places that can hardly be reached by persons not older than 18 years of age. Other countries have also put strict measures toward regulating these products. Countries such as Hong Kong and Israel have banned all e-cigarettes, the United Kingdom restricts particular quantities of nicotine in the item for consumption and the allowable e-cigarette rate has been lowered.

Impact of Social Influence

Social influences such as close associates and relatives are thought to influence decisions made about quitting smoking. Research shows that the smoking rates are higher among unmarried people or those that live alone, people with low social-economic positions, and the socially secluded ones (Martin et al. 2019). Studies showed that being married or having and living with a companion contributes highly to the chances of a smoker quitting. Also having a partner that does not smoke surges the probabilities of quitting. Evidence too has shown that having a companion was a smoker and quit may have a better influence over smoking cessation compared to a partner who does not smoke. Studies about the influence of social-economic positions on smoking cessation maintain that there may be a social incline in the accomplishment to quit. It may be less successful for women of lower social-economic status to quit smoking compared to men. Participating in social events might also have a positive impact on smoking cessation.

Evidence shows that smoking for adolescents is associated with the social setting in which it happens. The smoking behavior of an adolescent tends to be similar to that of his peers. The debate over the similarity of the smoking behavior suggests that it is caused by peer influence. Studies show that isolated adolescents are more likely to smoke and the social setting of their peers plays a significant role in influencing their smoking deeds. Emotional support is positively connected to smoking in that the closeness that is developed from a person who supports the other one emotionally strengthens the social bond as friends and peers smoke together. Through the bonds developed through emotional support and friendships, adolescents can also use that to support each other in quitting smoking and remaining non- smokers (Lakon, Hipp & Timberlake 2010). This friendship and emotional support bond could be significant for an intervention established for a school. This could be used to either help the adolescent to remain nonsmokers or assist each other to quit smoking. This strategy could be enforced by educating minorities on how to use emotional support as a way to help each other not to indulge in smoking and also to consider quitting. From this adolescents could also learn self-regulatory methods to assist each other in identifying the signals in the social environment that prompt interest in smoking. Every participating adolescent in this strategy could create task forces in schools and start smoking awareness movements. Common associations could become a network through which anti-smoking messages infuse individual and school systems. Studies outline that famous youths tend to set the standards in a school context, therefore if a popular youth smokes, others will emulate him. Hence it is important to strive towards popular youths adopting antismoking norms for the programs to be effective. These interventions will include educating adolescents on the dangers associated with smoking, hoping that they will embrace the antismoking norms, which will be emulated by their friends.

Teenagers always want to be accepted by their friends and the social environment and through this, they are bound to be influenced positively or negatively, smoking is being one of the negative influences. The inclusion of youths in different groups gives a teenager confidence which helps them ion the development of social skills. The friendly environment for adolescents has a great contribution to the initiation of smoking and adopting smoking behaviors. Research shows that adolescents smoked to make sure they followed the smoking rules of certain social groups or rules of a friend who smokes. There is also an influence on teenagers got from advertisements. There is a direct and indirect promotion of tobacco products which seems to be pushing young individuals to smoke. In the U.S.A, 20% of outdoor billboards show tobacco products, and about 3% of teenagers in the US were influenced by advertisements. A study that was carried out on teenage smoking showed that the prevalence of systematic teen smokers is high and might be because there are no antismoking policies put in place. Another reason for this could be the prevention programs that are not effective (Vasilopoulos, Gourgoulianis, Hatzoglou & Roupa 2015). Scientists agree to the fact that smoking advertisements have an influence on adolescents and drive them to start smoking. Advertising encourages teens to begin smoking through the message presented that smoking is a sign of independence and freedom. These studies show that there is a need for careful design and a comprehensive smoking policy for young people. According to Bellatorre, Choi & Bernat (2015), to curb the youth and adolescent smoking social influences, public policy initiatives to increase taxes on tobacco products should be made effective. Indoor smoking should be banned and tobacco products advertisements and point of sales of these products should be restricted for minors.

 The consumption of tobacco by adolescents in Indonesia is among the highest globally. The negative outcomes of smoking which include diseases that harm organs in the body and affect the overall health of an individual are mostly experienced by the low and middle-income nations. The impact is severely felt in these areas because the prevalence of smoking is extremely high. There is little regulation of tobacco companies in most of these nations. The habits of smoking cigarette and getting addicted according to research is likely to begin during adolescence. Nicotine is very addictive and can damage brain development in adolescents. This calls for the push for tobacco control methods that should be focused on stopping the early instigation of smoking. In Indonesia, research conducted in 2011 showed that 33% of young adults with 15 years and above smoke daily. The connection between smoking and social-economic aspects was from a study that showed that smoking prevalence was higher in areas where individuals were poor and uneducated (Kusumawardani, Tarigan, Suparmi, & Schlotheuber 2018). It also indicated that the general prevalence of recent smoking was more in the middle- income nations compared to low-income nations. In Indonesia, adolescents who only attended primary school had a greater prevalence in smoking compared to those that had furthered their education to secondary or higher education. The urban-rural prevalence showed a minor difference indicating a higher prevalence in the rural areas compared to the urban areas. These social-economic differences display the need for the tobacco control measures to apply precise policies founded on gender, age, economic positions, and the physical location of youths. Creating appropriate tobacco- control strategies targeted on these sub-groups is a crucial part of the intervention in and outside schools. This intervention will be used to reduce the prevalence and prevent the instigation of smoking which is likely to produce achievements in reducing illnesses and deaths that are caused by smoking in Indonesia.

Discussion

            To curb this critical issue of smoking and public health, the tobacco control association should advocate for policies that will support smokers to acquire effective treatments, both pharmacologic and behavioral. This will help smokers to overcome their nicotine addiction. The tobacco control association should remove the bureaucratic hindrances that slow down the delivery and interrupt the reimbursement of smoking cessation treatments delivered in health care settings (Cummings 2016). The association should incentivize healthcare organizations to focus on providing tobacco cessation support to their patients. Policies that improve the training of clinicians on effectively treating nicotine addiction should be promoted. They should promote policies that encourage companies to create and market cost competitive harm reduction replacements for cigarettes. They should stop commercial welfare for tobacco companies, permit them to collect profits from selling cigarettes while passing off the downstream healthcare costs of treating the addiction of nicotine and other related diseases to the taxpayers. Increasing tobacco taxes that compensate the state for the healthcare expenses and saving money to cover the costs of smoking cessation services would be a good move. Federal and state policies that defend the cigarette manufacturers from being liable for selling defective products need to be remedied. The cigarette industry needs to be held accountable for manufacturing and promoting products that cause diseases and even death. 

Cigarette smoking is a health hazard that needs immediate appropriate remedial action. These remedial actions need to be adopted globally to ensure that smoking does not harm public health. This will help to prevent premature death and other related diseases caused by smoking. Some of these remedial policies that need to be adopted and have worked in the past include, spreading of information and public education. The public information and education interventions would be accomplished through warning labels on the cigarette packets, and advertisements (Warner 2014). Television and radio stations need to give airtime to antismoking messages which will balance the pro-smoking advertisements. Informing people about the dangers of smoking, using real people who have suffered because of smoking would be effective. This will help individuals work towards quitting and encourage non-smokers not to start. Health education on tobacco in schools should be made a priority to save the teenagers and the younger generation. Teachers should be well trained and given enough resources to manage health education on tobacco programs.

Taxation on tobacco products has been known to cause a decrease in consumption. This is a strategy that should be adopted because it has been effective in the past both for adults and youth. Taxation causes people to quit smoking and also reduce consumption due to the price increase which is more impactful on youths because they are more price responsive compared to adults. The lower-income smokers will also be affected by the price rise and will therefore quit smoking meaning that taxation will contribute to public health. Smoke-free workplace policies need to be implemented, prohibiting smoking in all workplaces, including restaurants, bars among others (Warner 2014). Complete smoke-free workplaces will help achieve public health benefits such as workers will not be exposed to toxins from cigarette smoke and there will be a decrease in the daily consumption by smokers. The employer costs for healthcare are bound to decrease and reduce exposure to respiratory diseases and other related diseases. A truth campaign through the media would be an effective intervention to help decrease the number of youths that engage in smoking and also encourage smokers to quit. This will involve strategies such as having real people who have been affected directly or indirectly by smoking. Tobacco products advertising and promotion should be banned and this will contribute to public health. This is because individuals will not be introduced to or constantly be reminded of tobacco products through advertisements. Tobacco products should be regulated including smokeless tobacco products. Laws that prohibit the use and possession of tobacco for youths should be strictly adhered to and action taken for those that do not adhere to them.

For the younger generation, school intervention programs should be practiced, focusing more on the early training of students against being influenced to experiment smoking. Social skill training could assist students to resist the temptations from their peers to start smoking. Students need to learn at an early age the health dangers of smoking, know the influences of relatives, peers, beliefs, and other related factors (Pierce, White & Emery 2012). They need to develop personal abilities to fight back temptations and practice the decision-making abilities to defend themselves against use. These interventions should be included in the school curriculum which means that the teachers need to have proper training about this topic. They also need to be given the required resources to be able to effectively perform their duties concerning the Schools should involve parents and families in these interventions and support cessation for teachers, staff, and students. This will help avoid and reduce the initiation of minors into smoking which will be an enhancement in public health. Cautionary labels and plain packaging on the cigarette packets will be an effective initiative since it serves in providing health information for smokers and non-smokers and more so the minors. Restricting the access of cigarettes to minors is an initiative that should be followed by all the stores that sell tobacco products to ensure that it is successfully implemented.

Health promotion is significant in reducing the growing burden of chronic diseases globally caused by the consumption of tobacco products. Public education is a significant part of the efforts of preventing the initiation of smoking and encouraging smoking cessation. By providing information and knowledge about smoking cessation techniques, health professionals can encourage smokers who are interested in quitting (Golechha 2016). Peer education is one of the health promotion methods which includes sharing information in small groups or among peers. Peer education will work towards educating, motivating peers about behavioral skills, and the effects of smoking. The theatre should be used as a platform for creating awareness about good health. People love being entertained meaning that through the theatre, many people will gain information through dramas associated with the effects of smoking and peer influence.

Media advocacy as a health promotion intervention will help to pass information through the media platforms with the perception of altering the public mind about smoking. Social marketing which is a systematic application of marketing techniques to develop, communicate, and provide value to influence a target audience to acquire specific behavioral goals will be a good initiative. It is a behavioral methodology that helps to develop a long term sustainable effect upon the choices people make (Golechha 2016). Motivational interviewing could be used to encourage positive behavior change to smokers and non-smokers. This is done by showing sympathy, supporting self-efficiency, developing divergence, and progressing with resistance to have a successful smoking cessation. 

Community-level programs that work towards mobilizing individuals to educate them about the health risks of smoking will be effective (US Department of Health and Human Services 2012). This is because the programs will be focused on a particular group or community hence they will be developed according to the beliefs, norms, and practices of that particular community. Well co-ordinated, community programs will work towards reducing smoking among the minors and will work better and efficiently compared to single strategies. Because of the several strategies combined to make up these programs, when the programs reach many communities, the outcome will be positive. The good thing about community-level programs is that they try to reach as many people as possible, people from all genders and ages will be included in these programs.

Other intervention strategies should include increasing the age of individuals purchasing any tobacco item for consumption to twenty-one years. The use of e-cigarettes should be barred in smoke-free zones. Public health messaging movements should be developed for the young people, guardians, instructors among others focusing on the point that nicotine has a high rate of addiction and also affects the developing brain and could cause addiction to other drugs (Printz 2019). These interventions will help to reduce the initiation of young people to smoking, help people quit smoking, and protect their overall health.

Cerebral cortex

Modules 1 and 2 response

 The concept that I found most challenging is the cerebral cortex. I had trouble with understanding the functions of the left and right hemisphere which then splits into four main divisions. To clarify this concept, I used two strategies; first I concentrated on discipline-specific or the existing knowledge, and secondly, I conducted my research about brain function. I was interested in learning more about how the brain works and even understand new concepts that have not been demonstrated in the classroom. I conducted a detailed study from different scientific fields and the fields have provided a complete picture and clarification about the cerebral cortex and its functions.  In modules 1 and 2, I learned the basic concepts but I had a weak level of understanding but after conducting research, I have gained scientific thinking.  Research knowledge is very important as it has helped reach my learning goals and I have gained a scientific understanding of the complex topic that curriculum could not offer. 

              The research has provided clarification that the cerebral cortex has two parts. The right hemisphere and the left Hampshire. Both have corpus callosum which aids in communication, and both Hampshire plays a similar role in controlling muscles and glands on the right and left side of the brain. Each hemisphere has four lobes which help in processing somatosensation, processing memory formation, planning movement, and recognizing the visual world (Van Essen et al. 2018). In general, the cerebral cortex helps in remembering, speech production, reasoning, sound recognition, learning, and other roles. For the cerebral cortex to carry out these functions, there are subcortical structures that send and receive information. However, the cerebral cortex has cortical regions and these are the main regions that help the cerebral cortex carry out its role. For example, the sensory areas receive information from the sensor, motor areas control voluntary movements, and association areas help in abstract thinking and language (Van Essen et al. 2018).  One real-world example that may help understand the cerebral cortex is that children with higher socioeconomic status have higher reading and language abilities than children from low socioeconomic status. This is because children from a wealthy background have a larger cortex and children from poor backgrounds have less cortical surface. Note that low socioeconomic status affects brain development since children suffer from insufficient nutrition, stress, and other factors. On the other hand, children with higher socioeconomic status grow in enriching environments that enhance brain growth and increase brain activity (Javed & Lui, 2019). Thus, it is important to alleviate childhood poverty and enrich the environment hence increase the child's executive functions.

 Finally, I have learned that knowledge about human cortical development is important as it helps understand the neurodevelopmental conditions which occur not only due to genetic factors but also environmental factors. For instance, Attention-Deficit/Hyperactivity Disorder occurs as a result of reduced cerebral and cortical volume. The decrease results to decrease cortical folding hence DHD (Javed & Lui, 2019). Abnormalities in cortical folding affect the frontal and posterior cortical which increases executive control. In general, the brain defines our humanity and understanding how the brain work may help keep it healthy. My take way from modules 1 and 2 is that the frontal lobe helps me in planning a schedule, and make reasoned arguments. It also helps with taste, touch, and movement. Another takeaway is that the cerebral cortex is part of the forebrain and it is the largest part of the brain. 

References

Van Essen, D. C., Donahue, C. J., & Glasser, M. F. (2018). Development and evolution of

cerebral and cerebellar cortex. Brain, behavior and evolution, 91, 158-169. https://www.karger.com/Article/Fulltext/489943

Javed, K., & Lui, F. (2019). Neuroanatomy, Cerebral Cortex. In StatPearls [Internet]. StatPearls

Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537247/

Dietary Patterns and their Association to Obesity

Topic Summary

Dietary patterns and their associations to obesity is a topic of concern because, in recent years, the prevalence of obesity has been on the rise across the globe. Obesity is a chronic disease and therefore needs to be understood because it is connected to the increased risks of hypertension, heart diseases, and some types of cancers among other health issues. Obesity and the health risks it is associated with have been a cause of death to many people and this makes it a serious problem that should be researched (Roman et al. 2019). The analysis of dietary patterns may give insights into the impact of the overall diet on obesity. The research on dietary patterns will help develop more understanding of the different dietary patterns people have and their impact on their overweight issues. It will be used to show the impact of healthy dietary patterns on obesity and if it helps in the reduction of obesity and the overall weight.

The dietary patterns research is being conducted because there is a major concern for the researchers in being able to identify the dietary components that may play a role in the prevention of obesity and the health issues it is associated with (Roman et al. 2019). One of the reasons that could make the findings controversial is the traditional single nutrition-based approach in nutritional epidemiology which is commonly used in most of the researches. Hence the recommendation of an overall dietary intake pattern which reflects the dietary intake intricacy as a methodology to examine the association between diet and obesity. 

Article Summary

This research article clarifies the connection between dietary patterns and obesity. The dietary patterns approach offers a complete assessment of the general diet, the mixture of different nutrients, and food clusters (Roman et al. 2019). It shows the regularity of their intake and also agrees to the relations between several nutrients taken together. In this article, a priori and a posteriori are two methods of analysis that have been incorporated to evaluate dietary patterns. A priori is used to employ diet scores to assess the mark of a person’s observance of different dietary guides. A posteriori is used to recognize the dietary patterns within residents devoid of creating any prior norms on these patterns.

Studies from the article were about obesity in Romania, its prevalence, and the associated risk aspects within the residents of Romania. The methods used for this research were observation, and cross-section which was performed in eight centers throughout Romania. (Roman et al. 2019). The sample representatives enrolled were adults from all ages and country regions and the main aim of being evaluating the prevalence of obesity and overweight and lifestyle behaviors. Physical activity was evaluated using 9 queries based on the regularity of work-related and physical activities. Dietary consumption evaluation was done using a semi-quantitative food regularity question form which assessed the frequency intake of 90 food items including beverage categories. After the eating behaviors were analyzed, there was a high rate of unhealthy habits that were reported. The three dietary patterns that were identified in the research were high meat, western, and prudent. 

When testing the connection between obesity and dietary patterns, high meat was connected to a greater possibility of the obesity occurrence. The prudent pattern was connected to a lesser possibility of an obesity occurrence (Roman et al. 2019). A high percentage showed that the population had an increasing trend of consuming fast foods mostly for people living in the urban region. The research showed that choices that involve unhealthy diets remain to be an issue within the residents of Romania. Other unhealthy behaviors that were reported included, irregular habits of food consumption, eating while working among others. Analysis of the association between obesity and dietary patterns revealed that high meat intake was connected to higher chances of being overweight and prudent pattern was connected to lesser chances of being overweight. The research of dietary patterns can be a starting point for the development strategies that target particular groups intending to improve nutrition and prevent future development of obesity and other related health issues.

Conclusion

The association of obesity and dietary patterns is a topic that has generated different discussions on the impact of the dietary patterns on obesity. This research has been helpful and insightful in showing the importance of having a dietary pattern being that it reduces the risks of having obesity. The research also incorporates good eating habits and physical activity which is also important in reducing the risks of being overweight. I believe that dietary patterns are highly associated with obesity because the participants that did not observe their diet and consumed high meat had a more chance of having obesity. On the other hand, the other ones that observed a dietary pattern had a low chance of being overweight. Lifestyle behaviors are also part of this topic and this research shows that healthy lifestyle behaviors prevent and reduce the chances of being overweight. Individuals that did not practice healthy lifestyle behaviors such as irregular habits of eating were more prone to having obesity.

References

Roman, G., Rusu, A., Graur, M., Creteanu, G., Morosanu, M., Radulian, G., Amorin, P., Timar,

R., Pircalaboiu, L., & Bala, C. (2019). DIETARY PATTERNS AND THEIR ASSOCIATION WITH OBESITY: A CROSS-SECTIONAL STUDY. Acta endocrinologica (Bucharest, Romania : 2005), -5(1), 86–95. https://doi.org/10.4183/aeb.2019.86

Research project

 A topic of interest: Abortion-rights movement

 In a journal of gynecology and obstetrics, Stifani et al (1) assert that abortion is a human right in Colombia. Feminist groups, healthcare providers, nonprofit organizations, civil society, and other stakeholders have played a significant role in implementing the law. However, despite the abortion legalization, there is no a successful implementation of the new law since unsafe abortion is common. The Colombian Constitution of 1991 recognized the fundamental rights and mandated that in making laws, the court should put into consideration the protection of the fundamental rights (Stifani et al, 1). On matters of reproductive health, women focused on their rights to end an unwanted pregnancy. Nonprofit organizations and individuals supported the women's movement for abortion rights and the movement made the court to protect women's right to abortion. Sometimes women find themselves in situations that they cannot control and thus, they should be allowed to make their decision concerning the pregnancy to prevent psychological problems (Stifani et al, 1).The Wikipedia source also addresses the topic by saying that the abortion-rights movement aimed at giving women liberty and freedom to end up unwanted pregnancy. Countries such as the United Kingdom, United States, Asia, South Korea, and others have taken into consideration matters of reproductive health and they have legalized abortion (MediaWiki, 1). 

Both Wikipedia and the journal provide great information about the abortion-right movement. They both agree that advocates have supported the abortion law and abortion should be legalized to help women whose life is in danger. However, information from Wikipedia is not quality due to lack of authority. The information lacks scholarly authority and therefore it is not a legitimate source (MediaWiki, 1). On the other hand, the journal has provided a detailed report, authors have subject expertise, the article uses specialize terminology, and it reports experimental findings. For example, in 2017, an advocacy group conducted a survey and 65% of households reported that women should have the right to end the pregnancy. However, 50% of Colombian women are aware that the court legalized abortion but they face many barriers (Stifani et al, 2018). For example, some are not aware that abortion services are free and they end up having unsafe abortions to avoid the costs of services.

 From both sources (Wikipedia and journal), the court has recognized the women's right to an abortion but there are administrative barriers and stigma. The study finds that healthcare providers are not playing actively in implementing the law and also they are not educating the women about the law. For example, 32% of obstetricians/gynecologists do no provide abortion services. This is because physicians as well as the recipient of the services are inadequately informed (Stifani et al, 1). In general, even though the civil society and advocacy groups have facilitated the implementation of the law, the health sector is resistant to implementing the law. The healthcare system should be at the forefront to provide the services and educate patients about abortion services.

Research questions

• Doctors are barriers to abortion. On what grounds do medical professionals refuse to provide abortion services?
• What are the effects associated with the failure of medical professionals to provide abortion services?
• Should physicians need specified information about the law prior to the implementation?

 Doctors are barriers to access safe abortion. On what grounds do medical professionals refuse to provide abortion services?

Preliminary outline

• Introduction
• Evidence that doctors are barriers to access to safe abortion
• Grounds on which physicians refuse to provide abortion service
• Analysis of the effectiveness of legal abortion
• Conclusion 

Work cited

Stifani, Bianca M., et al. "Abortion as a human right: The struggle to implement the abortion law

in Colombia." International Journal of Gynecology & Obstetrics 143 (2018): 12-

18.https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.12672

 MediaWiki. Abortion-rights movements. WIKIMEDIA PROJECT 2020 https://en.wikipedia.org/wiki/Abortion-rights_movements

The Use of Data Analytics to Enhance Patient Safety

             The current society is under immense pressure to improve patient outcomes and attain quality medical care management. However, based on medical examinations only a paltry 10% of the medical institutions use data analytics to solve medical problems. Even though the application of data analytics is not common in the medical sector, it gives medical facilities a chance to upgrade medical care leveraging additional value and comprehensions that come with data analytics (Ammouri et al., 2015). Medical data analytics facilitates quality medication through the use of real-time data to make evidence-dependent decisions hence upgrading patient safety. Subsequently, data analytics change raw data into valuable actionable information. Furthermore, medical experts can identify high risk patients thus easily formulating interventions during the medication. In the end, the outcome is valuable and acceptable. In terms of assessing community data, data analytics helps in gathering general information from the public in relation to patient groups. This way, medical users are able to define risks, gaps, and tendencies and then ultimately use the positive impact.

The Effective Adoption and Use of Data Analytics for Ensuring Patient Safety

 The first step is the improving the collection of data across various medical systems. Even though various medical facilities collect data, the data does not flow into these medical institutions in a coherent or standardized manner. Health care systems’ bodies encounter numerous problems when gathering race, culture and dialectal data from patients and other types of people (Raghupathi, & Raghupathi, 2014). Clearly, stating the logic behind the data collection and then teaching workforce, management leadership and the entire community on how data collection can improve medical situation is an uphill task because people value privacy.

Nevertheless, addressing medical care inequalities needs the full support of other organizations which possess a strong reliable infrastructure for valuable measurement and improvement. Although medical institutions and health workers can play crucial roles in integrating race, cultural and linguistic data into already existing database, quality reporting influences the quality of the data collected (Mehta, & Pandit, 2018). In order to identify, the necessary phases needed to improve data collection, medical institutions should ensure that challenging barriers are eradicated from the data collecting process. Some of the ways through which medics can collect data is by asking questions related to race, ethnicity and even communication needs. Consequently, the staff can be trained on how to elicit information in an acceptable mannerism.

 After collecting and standardizing information, one can then share it across the medical care system. The medical system is made up of various public and private data collection frameworks such as medical surveys, managerial registration and billing records. To some extent, medical institutions are designed in a manner that is suitable for the collection and retention of medical data from all the patients (Archenaa, & Anita, 2015). The administration and delivery of medical systems determine the impact of data analytic methods. Conventionally, medical care systems are episodic hence people only use medical institutions for the detecting symptoms or during annual medical checkups. Data analytic procedures permit an all-inclusive approach to supervising a persistent assessment of patient’s health. Thus, a patient can predict his or her own medical status based on certain population features and then take certain prevention actions in order to avoid extensive expenditure and emergency appointment to the medical institutions. Wearable devices such as smart watches, smart water bottles and virtual medical consultations give medical experts enough data on patients’ lifestyles which in turn can give medics a hint a preventive measures. More so, the creation of digital dashboards integrate medical data with other data sources hence helps in balancing different medical strategies.

The increasingly use of telehealth has helped medical systems offer providers virtual opportunities to extend medical services to various locations hence promoting competition and the collection of data for analytics. More so, data analytics has a direct correlation between patient safety and medical care delivery (Nambiar et al., 2013). It offers readily accessible data to health providers in order to enable decision making. For example, a patient medical dashboard can combine the vital information and then display it in a more interpretive manner. Therefore, medical experts find data analytics as an efficient instrument for making medical patient decisions.

 Most of the times, medical institutions have information systems for collecting data and reporting on a patient progress. Thus, a medical institution’s organizational structure is designed to collect data from patients. It vital to note that effective feedback from information technology systems affect how medical experts interpret and use data for delivery of quality medical services (Priyanka & Kulennavar, 2014). In spite of the extensive advancement and execution of incident reporting in the medical sector, research claim that data analytics can be applied to formulate operational safety mechanisms. Also incident reporting allows data analytics to rectify outdated data. Thus data analytics defines the medical systems operational frameworks and then develop a basis for medical treatment within health facilities. In terms of outlining  suitable medical practices, data analytics can easily identify effective from ineffective practices and set the a cause of action for properly advancing a suitable medical procedure.

References

Ammouri, A. A., Tailakh, A. K., Muliira, J. K., Geethakrishnan, R., & Al Kindi, S. N. (2015). Patient safety culture among nurses. International nursing review, 62(1), 102-110.

Archenaa, J., & Anita, E. M. (2015). A survey of big data analytics in healthcare and government. Procedia Computer Science, 50, 408-413.

Mehta, N., & Pandit, A. (2018). Concurrence of big data analytics and healthcare: A systematic review. International journal of medical informatics, 114, 57-65.

Nambiar, R., Bhardwaj, R., Sethi, A., & Vargheese, R. (2013, October). A look at challenges and opportunities of big data analytics in healthcare. In 2013 IEEE international conference on Big Data (pp. 17-22). IEEE.

Priyanka, K., & Kulennavar, N. (2014). A survey on big data analytics in health care. International Journal of Computer Science and Information Technologies, 5(4), 5865-5868.

Raghupathi, W., & Raghupathi, V. (2014). Big data analytics in healthcare: promise and potential. Health information science and systems, 2(1), 3.

 Part 1

Paracetamol and Ketine’s Pharmacodynamics and Pharmacokinetics

Paracetamol is a painkiller and also reduces fever. Medics are yet to define its active mechanisms. The drug is also used to treat various illness such as headache and arthritis. It reduces pain (Gibb, & Anderson, 2008). However, it does not have any influence on internal inflammation and join swellings. There are numerous paracetamol brands accessing in various medical outlets. Paracetamol can only be used under recommended dosage. More so, the drug can combine with other over-the counter-drugs to make other types of medicine.

Paracetamol is a p-aminophenol imitation which demonstrates analgesic and antipyretic actions. The drug does not have anti-inflammatory actions. Paracetamol generates analgesia by inhibiting prostaglandin amalgamation. The physical structure of contains a key analgesic effect initiated via serotonergic trails (Allegaert et al., 2013). Due to its anti-inflammatory effects, the medicine rarely interferes with cylindrical emissions of uric acid which in turn retains the acid-base balance when administered in correct doses. In addition, paracetamol cannot interfere with hemostasis and the blood clotting process. Patients rarely get allergic reactions from paracetamol. The only method of administration is orally. The non-inflammatory pathway and exertion impact of the drug enabled patients to actually relive pain due to the consequential effect which influences thromboxane chemicals within hypertensive agents and platelet aggregation mechanisms.

  On the other hand, Ketamine is a drug used in initiating and preserving anesthesia. It causes a trance-like state once injected into a patient’s system (Zanos et al., 2018). The drug hinders sensory perceptions. It can be used on both humans and veterinary services. In 2019, the drug was certified for the treatment of depressed patients experiencing suicidal thoughts and character

 In the past five decades Ketamine proved to be a harmless anesthetic medicine with analgesic qualities. The energetic enantiomer in Ketamine is positive. Ketamine is digested in the form of nor-ketamine, a dynamic metabolite (Morgan et al., 2012). Throughout its interaction within the human body, the drug breaks down into components which can be easily interpreted in the sensory inputs and may even reach receiving regions but some parts of the body may fail to decipher its functions. Ketamine advances the descending inhibits serotoninergic routines and affects anti depressive nerves. The analgesic impact of the medicine continues and binds to plasma saturations within the hypnotic zones. Activation of the ketamine chemicals enables or triggers D- Aspartate receptors due to the long term effects it might have on hyperalgesia ad opioids. The antagonistic nature of the drug tends to initiate the nervous receptors and initiates the sleepy or drowsy nature associated with the drug. Thus, ketamine is a racemic concentration of S and R ketamine groups. The dissociative characteristics are commonly known for the analgesic impact it has on people. Ketamine is a phencyclidine compounds and functions mainly as an antagonist of the N receptors (Domino, & Warner, 2010). The drug lacks gamma affinities hence can be absorbed in different parts of the central nervous systems. Ketamine has a chiral physical arrangement made up of optical isomers.

Part II

Clinical Use

Paracetamol is used to relief pain and minimizes fever. Paracetamol can be used to treat conditions such headaches and toothaches. In mild arthritis, it reduces aching but does not hinder the internal inflammations and swellings on jointed regions (Zanos et al., 2018). Before administering the medicine, one has to ensure that he or she has no past hypersensitive reaction to paracetamol. For instance, if a patient is an alcoholic, suffering from liver disease, it might be prudent to seek a medic’s advice before taking paracetamol. The effects of paracetamol on an unborn child are not yet known. Before a pregnant woman takes paracetamol, she should first inform a doctor (Domino, & Warner, 2010). This is because paracetamol can be absorbed into the breast milk and eventually harm an infant. More so, paracetamol should be taken based on the label and instructions from a certified medic. Any patient should not take more than the recommended dosage (Allegaert et al., 2013). For example, each adult only needs to consume 1 gram in 24 hours. If a patient consumes alcohol, he or she needs to see a doctor before taking the drug. In fact anybody who consumes more than three glasses of alcohol should not take more than 2 grams of paracetamol within 24 hours. In terms age, there are different pediatric paracetamol meant to treat children. Anyone aged two years and below should not take paracetamol.

            On the other hand clinicians use Ketamine to reduce or treat pain. Ketamine is made up of water and lipids hence is soluble in most solvents (Morgan et al., 2012). Also, it is administered in different modes so that medical experts can cure various treatments with the drug. However, the most common mode of Ketamine administration is through intravenous modes. It is vital to note that during emergencies, the medicine cannot cater to teenagers and obese patients. Over time, medics have made it possible to administer Ketamine through intraosseous means hence making the drug more effective. The oral bio accessibility of Ketamine causes extreme vomiting hence patients are not advised against oral administration of the drug. In terms of side effects, Ketamine causes extreme nausea and vomiting. On a positive note, Ketamine does not affect respiratory systems when injected slowly. Ketamine might increase saliva secretion due to airway blockage. While in therapy Ketamine is used in the management of extreme pain. Besides, post-operative mechanisms incorporate ketamine in order to increase analgesic needs of the patients under the operating table. Nevertheless, is primarily preferred than other medicines under the same category such as propofol.

References

Allegaert, K., Naulaers, G., Vanhaesebrouck, S., & Anderson, B. J. (2013). The paracetamol concentration‐effect relation in neonates. Pediatric Anesthesia, 23(1), 45-50.

Domino, E. F., & Warner, D. S. (2010). Taming the ketamine tiger. The Journal of the American Society of Anesthesiologists, 113(3), 678-684.

Gibb, I. A., & Anderson, B. J. (2008). Paracetamol (acetaminophen) pharmacodynamics: interpreting the plasma concentration. Archives of disease in childhood, 93(3), 241-247.

Morgan, C. J., Curran, H. V., & Independent Scientific Committee on Drugs (ISCD). (2012). Ketamine use: a review. Addiction, 107(1), 27-38.

Zanos, P., Moaddel, R., Morris, P. J., Riggs, L. M., Highland, J. N., Georgiou, P., ... & Gould, T. D. (2018). Ketamine and ketamine metabolite pharmacology: insights into therapeutic mechanisms. Pharmacological Reviews, 70(3), 621-660.

THE EFFECT OF FUNDING GAP ON ADULT CARE PROVIDERS IN ENGLAND AND WALES

 Digital healthcare

Historical Analysis

The major issue that the strategic plan is likely to encounter is related to training. Throughout history, professionals in the field have relied on traditional methods to carry out their duties. With introduction of new technology, caregivers will be required to learn new skills needed to operate the digital technology. The training should therefore be carried out effectively to ensure that the caregivers have the right attitude and motivation to learn the new skills and incorporate them in their work culture.

Evidence from literature

            The management has the responsibility to ensure that employees are informed of any changes likely to occur in order to ensure that they a positive attitude towards the change (Akbarisari, 2018). Communicating to employees about the changes ensures that employees have adequate time to prepare and that they are aware of the changes that will be introduced such as the need for training.

Attempts to Incorporate Digital Health

            In the past, attempts to incorporate new forms of technology in the workplace have involved giving employees early notice regarding the changes likely to be introduced. Informing employees about new forms of technology helps to prepare them mentally (Svendsen, 2016). Involving them in the decision making process further ensures that they remain positive about the training as they are aware of the positive change it is likely to bring.

Stakeholders in the Strategic planning process

            The top management and department heads’ involvement in the planning process is crucial to its success. These departments are responsible for communicating information to other employees (Laaser et al, 2015). Involving department heads will make it easier to communicate to junior staff in ample time to allow for feedback and input from stakeholders needed to ensure that the plan is successful.

Financial Implications

            The project is likely to have a positive impact if well implemented. Although a significant amount of capital will be used to purchase the technology and train caregivers, the inclusion f digital technology in healthcare will help overcome various challenges and ensure that patients get the highest quality of medical care possible.

References

Esfahani, P., Mosadeghrad, A. M., & Akbarisari, A. (2018). “The success of strategic planning in             health care organizations of Iran”. International journal of health care quality assurance,             31(6), 563–574, retrieved from,  https://doi.org/10.1108/IJHCQA-08-2017-0145 

Svendsen V, (2016) “What is challenge based development?” Acadal, retrieved from,             https://acadal.com/challenge-based-development/

Terzic-Supic, Z., Bjegovic-Mikanovic, V.Vukovic, D., Santric-Milicevic, M., Marinkovic, J.,      Vasic, V., & Laaser, U. (2015). Training hospital managers for strategic planning and    management: a prospective study. BMC medical education, retrieved from,       https://doi.org/10.1186/s12909-015-0310-9 

Multidimensional care in nursing

Name

Institution

Professor

Course

Title

Date

Multidimensional care in nursing

As a nurse, applying strategies that promote safe and effective multidimensional nursing practice when providing basic care and comfort for patients helps to promote physical health and wellness. I learnt that the care and comfort that a client receives lowers the risk of contracting health complications and further increase their ability to manage such conditions. One of the strategies I used is the basic care and comfort which involved assisting clients to perform activities they engage in on a daily basis such as personal hygiene. A simple activity such as a sponge bath assisted me to gain the confidence of my clients and lift their moods during treatment. The knowledge gained from this experience will help me to offer better basic care and comfort to clients and also improve my own personal hygiene. 

            When providing multidimensional care to clients experiencing alterations in mobility, the most appropriate nursing interventions are those that assist the patient to restore mobility where possible or maintain the existing mobility. One of the interventions I used involved helping clients with muscle exercises whenever possible or when the patient was out of bed. Some of the activities the client would engage in include standing on the tip of toes, hopping on one foot, knee bends and other abdominal tightening exercises. The interventions sought to the clients’ compensatory body parts and also improve their sense of balance. The knowledge gained will assist me in offering special multidimensional care to patients experiencing alterations in mobility by assisting them with nutrition and work out plans. The information will also help me to create a safe and comfortable environment that motivates patients and speeds up the healing process.

            Administering medication is one of the components of multidimensional nursing care for clients with musculoskeletal disorders under the activities of daily living. It incorporates the use of a low profile medication cart and cartridge dispenser to administer medication. The experience taught me how to dispense medication with more precision and in a shorter time compared to when I started. The process also involved classifying medication in accordance with the time of day it was supposed to be administered so as to keep track of treatments given to different patients. From the experience, I learnt that low profile carts were ideal for use in health organizations as they are suitable for both short and tall people. I also learnt that cartridges that have a flip top are more ideal for storing drugs before they are administered. This is because the patient only needs to flip the top instead of having to unwrap or break a seal thereby increasing the ease of use. 

            When providing care for patients experiencing sensory and perception disorder, I learnt that the most effective and safe strategy to use is one that seeks to offer care from the patients perspective. Take a client with sensory alteration as an example. As a nurse, the best strategy would be to start by assessing the patient’s pathophysiology of deficits that already exist and also examining what factors influence the patient’s sensory functions. I learnt various skills such as adjusting my communication style and focusing on communication cues that focus on patients with hearing deficits. The information gained will help me in future to assist patients adjust to their new condition, manage their condition and focus on stimuli that makes it easier to interact with the client’s environment.

            Knowledge of integumentary disorders when providing safe and effective nursing care is important as it determines the level of effectiveness of care offered. Take the case of a patient with pruritus as an example. Multidimensional nursing care is achieved through a colloidal oatmeal bath, following which, an occlusive ointment is applied. I gained knowledge on the importance of immediately applying the occlusive agent to make the skin damp and I will use the information in future to prevent evaporation which occurs when the occlusive substance is not applied within five minutes or longer.

            Assisting patients to assume comfortable sleeping and rest positions is one of the strategies that promote safe and effective multidimensional nursing practices. When caring for patients with immunologic infectious and inflammatory disorders, I learnt that patients are more comfortable when the positioning of the bed is elevated and with pillow support. The position is however suitable for daytime when patients are seated. I also gained knowledge on how limiting visitors is a multidimensional nursing practice. Controlling the number of people who have access to the patient during the acute phase of the disease can help prevent excess stimulation and therefore reduces stress. Pace strategy is also an activity that can be used for patients whose activity has become reduced due to their condition. Patients can be recommended bed rest during the acute phase of their disease to lower the metabolic processes that occur in the body. The information is useful as it helps develop new ways to assist the patient especially because it ensures that energy is dedicated to healing and facilitate recovery.

Summary

 COVID 19 changed how the entire management systems work.  The disruption of existing systems forced an overhaul of the entire framework. American Management Association sought to unveil the extent to which the recent pandemic ways of life among its members. It is vital to note the fact that out of the 500 respondents, 95% were severely affected by the pandemic. For instance, 70% of the respondents worked at home. The transition period hampered the manner in which the people had to come up with daily routines hence this created new mechanisms of going about their daily business (Palazzo, 2020). Moving from office settings to domestic frameworks encouraged people to invest more in online professional training. Out of the 500 respondents, 81% had acquired an interest in webinars and an estimated quarter claimed that they considered enrolling in numerous online classes so that they could horn their skills. An additional 65% of the rest were managers or sat on the board of well-known brands and organizations. Based on the information from this survey, managerial leaders remained committed to professional advancement of their careers during the pandemic period. Due to the widespread confusion and disruption, effectual management was key in sustaining or maintaining significant company performance, cohesive cooperation and morale. Working from home, whether on a day to day basis each week, became the new normal for most organizations hence changing the entire organizational structure of most companies. Managers had to seek better ways of training their workforces and build additional skills for maintaining the supplementary demands of working under a virtual work surrounding. Workers had to develop a strong work ethic and still have a constant relationship with fellow workers. In order to achieve a balance and adapt a new ways of working and still retaining top performance among workers, managers motivated, delegated, communicated effectively and coached other workers on the importance of team work and the objectivity of the work at hand. This way, the teams were able to stay focused on contribute to the vital aspects of the company without paying much attention to the pandemic and other interruptions caused on its wake.

Relevancy

 The relevance of this article is seen in the application of the various management skills. Most of the time delegating duties helps in completing a huge workload in a shorter time span without increasing the number of resources needed to fully complete one task. For instance, within a virtual work environment, managers had to learn how to communicate with all the workers without adhering to hierarchy regulations (Ansoff et al., 2018). More so, in a virtual surrounding everyone hears each other and communicates based on the arising needs or the situation at hand. Furthermore, agreeing with people is easier and streamlines the operations of the day as compared to physical environment where the formalities and work schedules hinder proper application of real time decision making and skills. Furthermore, cooperating with team members ensures that each one of them adheres to strict deadlines and conduct themselves with the same serious required of them. Thus the article details the actionable mechanisms top managers used in the management of various workforce without giving interfering with the previous workflow (Wheelen et al., 2017). The ease with which one can attain maximum performance depends on how people can interact with each other harness proper mechanisms developing an effective work ethic within a virtual and external surrounding.

Reaction

This student seems to think that the article focuses on the management advancements managers have put in place to manage and maintain good performance despite of the changing external environment. In the wake of the pandemic, most people were losing their jobs and some businesses seem to thrive while others made losses. Nevertheless, in such an unpredictable surrounding, making changes and focusing the cost-effective interventions to fight off the negative effects of the pandemic and keep the workforce motivated and satisfied with the workflow. Most managers are normally unreachable but the virtual environment has forced them to be at the center of everything the company does. In the meantime, managers have to delegate duties while developing stable relationships with the rest of the workers. Additionally, having the ability to use the mechanisms needed to steer the workforce to top performances assists in shaping the vision of the company and retaining the needs of the entire company. Besides, effective communication is at the center of everything a manager does, from meeting people to instructing the rest of the workers on what needs to be done by certain companies shapes  and influences the morale of the entire company. Even though moving from an office setting to a more relaxed domestic framework does not in any way indicate sluggish work ethic, coaching and retaining the needs of the workers may be a challenge as they might have to cope with the psychological effects of the pandemic as the pandemic might affect their families, friends or even children. Thus, the managers have to strategize the management of its personnel from a different perspective and manner.

References

Ansoff, H. I., Kipley, D., Lewis, A. O., Helm-Stevens, R., & Ansoff, R. (2018). Implanting strategic management. Springer.

Palazzo. P., (2020) Improving Management Skills Remains a Priority During Pandemic, Says American Management Association Survey

Wheelen, T. L., Hunger, J. D., Hoffman, A. N., & Bamford, C. E. (2017). Strategic management and business policy (p. 55). Boston, MA: pearson.

 Statement of the problem

The problem in the article is clearly stated in the first paragraph of the article. This is because the researcher focuses on the challenges of transitioning from a registered nurse to a nurse practitioner. The problem has been narrowed down well enough for study because the researcher has put a focus on the main factors that influence the transition process which are the personal and environmental factors (Barnes 2015). The researcher points out that transitioning from an experienced registered nurse to a nursing practitioner is less difficult compared to a registered nurse with less experience than a nursing practitioner. The problem is significant to the nursing practice because there is an increase in the shortage in the number of nursing practitioners that are needed in healthcare. The employment rate for the nursing practitioners is double in number compared to those of physicians and researchers on the nursing practitioner role transition has shown to have many difficulties that the NP might experience. This problem has shown that identifying factors that influence the transition process of experienced and inexperienced registered nurses to nurse practitioners may differ in what they need for this process.

Research questions and hypothesis

This study was used to determine the factors that influence the transition process into nursing practitioners for the experienced and inexperienced registered nurses (Barnes 2015). The dependent variable in this research was the nursing practitioner whereby the transition scale was used to measure what the nursing practitioners perceive the role of transition from their own experience. The independent variables of previous registered nursing experience and were being formally oriented in their first nursing practitioner position were determined through single item questions. Questions for the RN experience included how long the RN worked for before working as an NP. The question on the formal orientation was if the RN were orientated in their first NP position. There is no relationship between the variables because the NP role transmission did not have any significant relationship with previous RN experience.

Review of Literature

Being the first study that explored the relationship between an experienced RN transitioning to a PN and an inexperienced one, it gives the initial work for future studies. According to the transitions theory, the NPS that were formally oriented reported better transition experiences (Barnes 2015). The institute of medicine recommends that programs to help nurses during the transition should be established. Nurse researchers maintain that NPs who are oriented have an easier and quicker transition and find the role more satisfying. The research is important because of the increased interest in orientations and supporting the new NPS across healthcare settings and will also help to support the efforts to come up with orientation programs for NPs.

The sources and documentation are appropriate because they all focus on the subject which is the nursing practitioners, registered nurses, and healthcare. The organization of the review is well-done because it first begins by explaining the aim of the study. It then elaborates on the findings from the study and the factors that affect the transitioning processes. The article describes a theoretical framework where Meleis’s theory of transition was used to guide the research (Barnes 2015). The framework helped to determine the personal and community levels of transition conditions that are anticipated to either support or prevent transition. The framework guided the research is showing that a successful transition was characterized by a sense of well-being, confidence, knowledge, and skills. The unsuccessful transition was characterized by negative emotions, lack of confidence, and less support.

References

Barnes H. (2015). Exploring the Factors that Influence Nurse Practitioner Role Transition. The

journal for nurse practitioners : JNP, 11(2), 178–183. https://doi.org/10.1016/j.nurpra.2014.11.004