Crohn’s Disease is a life-long, debilitating form of Inflammatory Bowel Disease (IBD) that can cause many complications. Like most autoimmune diseases, these complications and unpleasant symptoms may be unpredictable and difficult to control, which can cause a sense of powerlessness and lead to depression. A. Lei Correa
Because Crohn’s Disease affects mental as well as physical health, the nurse promotes wellness by thoroughly educating the patient on the disease process of Crohn’s Disease, nutrition and pharmacological management, and uses specialty skills to provide care and emotional support using a holistic approach.
The most common and initial indicators of Crohn’s Disease are fatigue, diarrhea, abdominal pain, gastrointestinal bleeding, and weight loss. These symptoms may also be present in patients with other forms of IBD, therefore thorough assessments and specific diagnostic testing is extremely important to avoid misdiagnosis. Since Crohn’s Disease is most often autoimmune (the body tissues attacking itself), patients may experience a multitude of other complications and exacerbations including arthritis, osteoporosis, anemia, malnourishment, fistulas, renal and hepatic disorders, vision problems and sensitive skin, just to name a few. Rayhorn and Rayhorn (2002) explain that this disease does not always effect just the bowel, “Internal organs, the eyes, blood, skin, and the musculoskeletal system are all potential targets for the devastating effects of this disease, known collectively as extraintestinal manifestations, or EMs”.
Gaining knowledge of Crohn’s Disease is the first step to remission. Patient education is one of the most important aspects of nursing; what is told to the patient about the disease and what to expect, and how well that information is understood will determine the patients’ self-perception, self-care, and choices in regards to disease management. The nurse educates the patient according to their learning ability, and (with permission of the patient to protect health information) educates family members who may be taking on the role of care-giver. An individual experiencing the unpleasant signs and symptoms of Crohn’s Disease is not necessarily eager to learn, and the nurse prepares for this by providing resources, pamphlets, and other reading material so it is convenient for the patient when they are ready to soak in more information. The age of the patient is also a factor. The patient should be informed of support groups in their area and can also be referred to the Crohn’s and Colitis Foundation of America (http://www.ccfa.org) (Rayhorn, 2003). Providing information with pictures will of course make it easier to visualize that which cannot be seen. The severity of the patient’s condition should be clearly understood, as well as warnings of potential problems.
Nutrient deficiency is a complication that should constantly be monitored because it can occur during flare-ups or while the patient is in remission. A significant amount of calories and carbohydrates for energy, and adequate hydration every day is absolutely vital in maintaining optimal health. Nutrient absorption is decreased in patients with Crohn’s Disease because the intestines do not function as well as in a healthy individual. Patients will become aware of the type of foods that will irritate their bowels and which foods are well tolerated. According to a webpage created by the New York Methodist Hospital, foods that have irritation potential include raw vegetables, alcohol, simple sugars, and caffeine because they are associated with inflammation. Other inflammatory foods are fruits with a lot of sugar such as grapes, watermelon or pineapple (2002). Sometimes medications can be the culprit for malnutrition. For example, Prednisone is a common drug for Crohn’s Disease patients, but it can cause osteoporosis, and therefore is treated with calcium and Vitamin D supplementation. Iron deficiency is also common, but oral iron supplementation is often not tolerated in patients with Crohn’s Disease and would then iron delivered intravenously or by injection. In extreme cases of the disease, enteral feeding can induce remission, as well as TPN in which bowel rest may be required (Jeejeebhoy, 2002).
Such a debilitating disease can cause the patient to feel powerless and depressed. Being a counselor and an active listener can make a drastic difference in the patient’s self-perception and quality of life. Specialty nurses who have become active participants in gastroenterology have made a huge difference in patients with Crohn’s Disease. Specialty nurses can improve disease management on a whole different level than just a practitioner. There is a motivation for change in the healthcare system as we advance and make new discoveries. Kamm & Norton (2002) agree that, “Changes may also come from a real desire to move the focus of healthcare away from an insensitive technological approach to one based on holistic care” (p. 331). Patients can be taught how to self-medicate when they are having a flare-up; this means utilizing home remedies and adhering to pharmacological measures as instructed. This will increase autonomy and decrease clinic visits. Kamm and Norton (2002) also provide evidence showing, “in a controlled study this reduced clinic visits by 30%, decreased the delay between symptom onset and treatment from 4 days to under 24 hours, increased the quality of life scores, and decreased costs” (p. 334). Patients with Crohn’s disease need a high level of nursing care; one that combines holistic as well as technical approaches.
Crohn’s Disease does not follow a predicted cycle of flare-ups and remissions; rather it can be rollercoaster of unexpected events. Patients are experiencing a total loss of control over their bodies and overall health. Uncontrollable bowels and discomfort can be extremely embarrassing and disheartening. The exacerbation of other problems caused by this disease, adds to this disparity. The pain and discomfort the patient experiences can be managed more effectively through proper education, pharmacological/nutritional management, and emotional support. This is an opportunity for nurses to take advantage of their specialty skills while providing a holistic type of care.
References
Jeejeebhoy, N. K. (2002). Clinical nutrition: 6. Management of nutritional problems of patients with crohn's disease. Canadian Medical Association Journal, 166(7),
913–918. Retrieved January 29, 2007, from PubMed Central Database.
Norton, C, & Kamm, M.A. (2002). Specialist Nurse in Gastroenterology. Journal of the royal society of Medicine. 95(7): 331-335. Retrieved April 22, 2007, from PubMed Central Database.
Rayhorn, N. (2003). Inflammatory Bowel Disease. Nursing, 33(11), 54. Retrieved November 07, 2007, from Proquest Database.
Rayhorn, N., & Rayhorn, D.J. (2002). An in-depth look at inflammatory bowel disease. Nursing, 32(7), 26-36. Retrieved November 07, 2007, from Proquest Database.
What is the Role of Diet in Crohn’s Disease? (2001). New York Methodist Hospital. Retrieved February 05, 2007, from http://www.nym.org/healthinfo/docs/103/doc103diet.html
Intervention 1: Nutrition therapy along with pharmacological Management
Disadvantage 1: Debilitating side effects from necessary drugs.
The immunosuppressive drugs that are necessary for disease remission are life-long, and produce very unpleasant side effects that although the patient is in a state of “remission”, day-to-day life is still difficult. Remicaid (infliximab) is a drug used for the treatment of rheumatoid arthritis, and is used in Crohn’s patients to keep symptoms at bay, maintain remission, and treat rheumatoid arthritis that gets exacerbated by the disease. However, this drug can cause abdominal pain, nausea, vomiting, fatigue, headache, infusion reactions, and drug-induced lupus (Deglin & Vallerand, 2007, p.642). Azathioprine (Imuran) is another immunosuppressant that can cause the same kind of G.I. upset, along with thrombocytopenia, anemia, and hair loss (Deglin & Vallerand, 2007, p. 180). Methotrexate (Rheumatrex) is a heavy duty immunosuppressant that is actually used on cancer patients, as well as severe Crohn’s Disease. This drug can cause anorexia, G.I. upset, nephropathy, anemia, rashes, malaise, hair loss, and hepatotoxicity (Deglin & Vallerand, 2007, p. 772). In addition to any of the mentioned drugs, prednisone is usually used in addition to a chosen drug therapy. This drug can cause depression, muscle wasting, G.I. upset, peptic ulceration, abnormal fat deposits, and cushingoid appearance (moon face, buffalo hump) (Deglin & Vallerand, 2007, p. 323-327). Unfortunately, the Crohn’s patient will likely go through different therapies such as these before finding one that is effective and somewhat tolerable. Physicians use an algorithm of which drugs to try first, and depending on the reactions, what the next step would be (Knutson, Greenberg, & Cronau, 2003).
Deglin, J, & Vallerand, A. (2007). Davis’s drug guide for nurses. (10th ed.). Philadelphia: F.A. Davis Company.
Knutson, D, Greenberg, G, Cronau, H. (2003). Management of crohn’s disease – a practical approach. American Family Physician. 68(4), 707-14, 717-8, 595-7. (CINAHL Accession No. 2004070944)
Disadvantage 2: Unknown underlying G.I. problems preventing remission.
Some patients with Crohn’s Disease may also have other things going on with their digestive tract even before the onset of their disease. They could have just IBS, and therefore diet will be more selective. There is also a strong possibility of the patient having Celiac Disease (glutten-sensitive enteropathy), which would mean even more diet restrictions to take into consideration. Once Crohn’s Disease has been diagnosed, it seems imperative to also screen for Celiac Disease. It is quite common, affecting 1 in 100 to 1 in 300 (Edwards, 2006). Celiac, like Crohn’s, can cause similar symptoms of G.I. upset, so misdiagnoses can be more common than preceived. If a Crohn’s patient adheres to their drug regimen, and still not feeling well, it is difficult to assess if it is just the wrong drug regimen for them or if they actually have Celiac Disease as well and the glutten ingestion is inhibiting remission.
Edwards, M. (2006). Coeliac Disease – an update. Practice Nurse. 31(7), 42-4. (CINAHL Accession No. 2009176315)
Intervention 2: Specialty nursing
Disadvantage 1: Shortage of specialty nurses.
The field of gastroenterology indeed needs more specialty nurses. However, there is a shortage of nurses in general all around the world, as well as in specialties. It is a huge intervention to attempt to recruit individuals into the nursing field, let alone encouraging nurses to further specialize. The ICN conducted a survery and found some reasons why the number of nurses are declining. Nurses are already dealing with high nurse to patient ratios, long working hours, inadequate compensation, and reduced time with patients due to overburdened administration (“Where”, 2007). The ICN has called on the WHO, but the nursing shortage continues to rise.
(2007). Where are all the nurses. Australian Nursing Journal. 15(1), 19. (CINAHL Accession No. 2009645084).
Disadvantage 2: Not enough. Need communication - team medicine.
Crohn’s Disease can cause extra-intestinal manifestations (rheumatoid arthritis, anemia, osteoporosis, ulcers, malnourishment, renal and hepatic disease, etc.). These other diseases, mean other specializing physicians. One patient with Crohn’s Disease, may be seeing a rheumatologist, gastroenterologist, nephrologist, pharmacist, and dietician, as well as their general physician. If these physicians are not actively and accurately communicating, the patient’s health may be in jeopardy. It is suggested that stress can exacerbate Crohn’s symptoms, and Crohn’s symptoms can exacerbate stress. The need to see so many different doctors can be quite stressful, and may even be detrimental if it is not an efficient team. The patient’s stress level, and means of seeing the necessary specialties are not taken into account as much as it should.
Smith G,D, Watson, R, Roger, D, McRorie, E, Hurst, N, Luman, W, & Palmer K,R. (2002). Impact of a nurse-led counselling service on quality of life in patients with inflammatory bowel disease. Journal of Advanced Nursing. 38(2): 152-60. (CINAHL Accession No. 2002073703).span>
Tuesday, March 4, 2008
Crohn's Disease
Preventing Malnutrition in the Elderly.
Clint Webster
Preventing Malnutrition in the Elderly
With the increasing number of baby boomers reaching an older age, malnutrition is a serious problem today. Many of these elderly will end up in nursing homes and up to 85% suffer from malnutrition (Crogen, 2006). This is an alarming number of malnourished patients for the Registered Nurse to take on. However, the knowledgeable nurse can aid elderly patients by providing adequate nutrition in a vulnerable population prone to malnutrition, and prevent the resulting problems. Three nursing strategies can include acquiring knowledge on malnutrition risk factors and signs/ symptoms, in order to identify the problem, know how to improve food consumption via different dining atmosphere, and supplement the types of foods the elderly consume by improving taste and nutrient density.
Malnutrition can be managed, but it requires skilled nurses and medical teams. In understanding that elderly malnutrition is a dramatic problem of epic scale today, this issue is not taken lightly by the medical community. Nursing homes are managed by nurses and this is where malnutrition is extremely prevalent. Mortality and morbidity are correlated with malnutrition (Brownie, 2006). Nutrition plays a large role in the severe problem of pressure sores due to protein loss. Adequate nutrition and protein are necessary in helping prevent and heal these pressure ulcers. Malnutrition makes pressure sores more likely and more difficult to heal (Dambach, 2005). The immune system is also hindered by malnutrition and this at risk population is already more susceptible to communicable diseases (Brownie, 2006). Conditions like pneumonia and bronchitis are much more serious in an elderly patient and malnutrition weakens their defenses. Registered Nurses are key in the fight against elderly malnutrition because they give the most direct care to elderly populations, and hence spend the most time with this high risk population. The nurse working with the elderly population should acquire detailed knowledge of malnutrition in order to identify the problem. The Mini Nutritional Assessment (MNA) is one valuable tool at the Registered Nurse’s disposal to judge malnutrition in the elderly. It consists of a survey of the patient’s level of malnutrition. Depending on the extent or score, it will recommend appropriate interventions that the Registered Nurse will implement (Vellas, 2006). Tools like the MNA incorporate many aspects of nutrition in the elderly to objectively identify who is at risk, but nurses still need to understand the process themselves. Knowing that the elderly client has decreased bodily function related to consuming and absorbing nutrients is important. Diminishing taste and smell senses can make food less appetizing than in the past. Dental problems can make consuming foods difficult. Poor fitting dentures can cause difficulty and pain in chewing and swallowing (Crogen, 2006). Factors such as reduced stomach acid and absorption problems can make garnering nutrients from food difficult. These can be exacerbated by the various medications the elderly take (Eliopoulos, 2005). Motor coordination is sometimes affected by medications. Elderly often already have some motor coordination deterioration. Further impairment by medications can hinder them from adequate consumption in limiting their ability to feed themselves (Crogen, 2006). The nurse should be educated on these issues and understand that they influence the clinical manifestations of malnutrition in the elderly. These can include “weight loss greater than five percent in the past month, weight ten percent below or above ideal range, serum albumin level lower than 3.5g/100mL, hemoglobin level below 12g/dL, and hematocrit value below 35 percent” (Eliopoulos, 2005, 202).
With knowledge on aging changes and identifying who is at risk, nurses should implement appropriate strategies to improve nutrient consumption. Elderly clients in nursing homes can be aided by an environment that is suitable for food consumption. The Registered Nurse in these settings can change lighting and table setting contrast to aid elderly nutrition. In one study, researchers found that placing white plates on blue trays laid out on a green table cloth with more evenly distributed light markedly increased nutrient consumption over three days (Brush, 2007). In those patients who eat in their rooms at the hospital or nursing home, it is especially important that unappetizing objects such as urinals and related items are not near or on the dining area. These objects detract from the dining environment (Calverly, 2007). Promoting a proper dining atmosphere is a valuable tool in nursing care of elderly malnutrition.
Improving the atmosphere of the dining experience can help in the nurse’s ability to manage elderly nutrition, but foods the elderly consume are the most important factor in preventing malnutrition. According to Dunn (2007), many foods and strategies for increasing their consumption do not work. Serving smaller more frequent meals does not improve nutrition. Oral supplements are also not very beneficial and often go wasted or conflict with medications. However, fortified foods (foods with added vitamins and minerals) and nutrient dense foods (foods that naturally have large quantities of vitamins and minerals for the amount of calories they contain) have been found to be effective. Fortified foods work best when they taste like their regular counterparts. Nutrient dense foods have been found to be very effective in promoting nutrition (Dunne, 2007). Improving taste is one of the best and simplest ways of improving nutrition. In some cases it is more important that elderly patients simply consume calories. Elderly patients have the same taste preferences as they have had all of their life, and thus low sodium, low fat meals are not always as appetizing as the normal version of a food with naturally high fat and sodium content (Calverley, 2007).
Malnutrition will always be an issue for the ever growing elderly population. It is important that this issue be dealt with correctly in order to prevent pain and suffering, increased healthcare costs, staff burden, and mortality (Brownie, 2006). A knowledgeable nurse can aid elderly patients by providing adequate nutrition in a vulnerable population prone to malnutrition. Nurses should be aware of the risk factors and signs via greater knowledge and insight, implementing strategies to improve food consumption, and offering different food choices to improve the amount of nutrients ingested. These strategies all help to minimize the devastating effects of malnutrition by promoting nutrition.
References
Brownie, S (2006).Why are elderly individuals at risk of nutritional deficiency?. Journal of Nursing Practice. 2, 115.
Brush, J. A., Meehan, R. A., & Calkins, M. P. (2002). Using the environment to improve intake for people with dementia. Alzheimer's Care Quarterly. 4, 330-339. Retrieved January 9, 2007, from Expanded Academic ASAP database.
Calverley, D (2007).The Food Fighters. Nursing Standard. 22, 20-21.
Crogen, N, & Alvine, C (2006). Testing of the Individual Nutrition Rx assessment process among nursing home residents. Applied Nursing Research. 19, 102-104.
Dunne, J.L., & Dahl, W.J. (2007). A novel solution is needed to correct low nutrient intakes in elderly long-term care residents. Nutrition Reviews. 65. Issue 3, 135-139.
Eliopoulos, C (2005). Gerontological Nursing. Philadelphia, PA: Lippincott Williams & Wilkins.
Vellas, B, Villars, H, Abellan, G, Soto, ME, Rolland, Y, & Guigoz, Y (2006). Overview of the MNA--Its history and challenges. Journal of Nutrition, Health, and Aging. 10, 456-463.
Intervention 1: Improving the dining atmosphere to improve nutrient consumption in elderly.
#1) While it is documented that improving the dining atmosphere will increase nutrition in the elderly, there are obstacles to overcome. One issue is that some elderly in nursing homes are very messy eaters for various health related reasons. This can be a distracting and unappetizing occurrence for the rest of the elderly eating there. Even if the lighting and contrast are adjusted for proper atmosphere, the elderly themselves can end up being a distraction. This can be dealt with by having these individuals in a side room (Andreoli, 2007).
#2) The timing of meals is also important. No matter how nicely laid out the dining atmosphere is, if the meal is during a portion of the day when an individual does not have an appetite, then that person will miss out on a meal until the next one comes around (Jhavari, 2006). This system will prevent a proper dining atmosphere from counting for anything because of poor timing.
Andreoli, N.A., Breuer, L, Marbury, D, Williams, S, & Rosenblut, MN (2007). Serving Culture Change At Mealtimes. MN Nursing Homes: Long Term Care Management. 9, 48.
Jhavari, T. (2006) Enhancing the dining experience in senior living. Nursing Home Magazine. October Issue, 58
Intervention 2: Improving nutrient density of foods, implementing fortified foods, and improving taste will help the elderly improve nutrition.
#1) While these techniques and foods have been shown to work, they do not account for the economic status of the elderly. Some may not have the financial means to afford these services and foods (Holman, 2005). The elderly may have someone else doing the shopping for them if they are not in a home, and this can leave their nutritional options in the hands of the person shopping (Holmes, 2006). Similarly, a common problem can be an elderly person who had a spouse or relative do their shopping for them and they are suddenly no longer capable of shopping. In these instances it leaves those elderly to do shopping on their own or not at all, and if they do end up shopping on their own, their nutritional knowledge could be a new problem.
#2) In other instances the elderly may have a host of issues that deter them from adequate consumption of nutrient. Of these, psychosocial issues such as an elderly person losing a loved one and being lonely can make them disinterested in eating (Holmes, 2006). Many other issues may affect a persons desire to eat as well, limiting nutrition.
Holmes, S. (2006) Barriers to effective nutritional care for older adults. Nursing Standard. 3, 51-54
Holman, R.N., Nicol, M. (2005) Promoting adequate nutrition. Nursing Older People. 17, 31-2
References:
Andreoli, N.A., Breuer, L, Marbury, D, Williams, S, & Rosenblut, MN (2007). Serving Culture Change At Mealtimes. MN Nursing Homes: Long Term Care Management. 9, 48.
Holman, R.N., Nicol, M. (2005) Promoting adequate nutrition. Nursing Older People. 17, 31-2
Holmes, S. (2006) Barriers to effective nutritional care for older adults. Nursing Standard. 3, 51-54
Jhavari, T. (2006) Enhancing the dining experience in senior living. Nursing Home Magazine. October Issue, 58
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Issues challenging obese population.
Many research studies have addressed ways obesity affects the human body biologically, but few have actually highlighted other surrounding issues that affect obese population such as discrimination and lack of accommodation in public places. Therefore, this paper will highlight and address great roles that nurses can play to bring a change in perspective of “other” ignored issues about obesity. Joe Njenga
To make this possible a nurse can implement the following strategies.
1. As health care provider, the nurse can set a good example by not practicing bias and discrimination against obese population.
2. As a manager of a health care organization, the nurse can mobilize resources to ensure equipment like oversized beds, commodes, walkers and wheelchairs are available and ready for use by bariatric patients.
3. A nurse can act as an educator to help in creating public awareness about obesity with the correct perception.
The first strategy is for the nurse to be open-minded, understanding, resourceful and free from bias and discrimination. This can prove to be a big challenge to the body image obsessed society which has done little to help address and solve issues of obesity. Instead, the society has marginalized and labeled obese individuals as lazy, irresponsible and, generally of less worth. As a result, many obese individuals are hesitant to go out in public places like colleges, churches, hospitals and gymnasiums.
A research study found physicians and nurses to be among predominant groups that were most stereotypical about obesity. Physicians associated obesity and other negatively perceived conditions with poor hygiene, noncompliance, hostility, and dishonest. Doctors were less motivated and less optimistic when caring for obese patients because they viewed them as unsuccessful, weak willed and unintelligent. (Puhl & Browell, 2001)Therefore, it is important that nurses set a good example for the rest of the society to follow by caring for obese patients with dignity and an open minded approach. For instance if a bariatric patient requested for bed change and the nurse needed some help to turn the patient she should kindly respond, “Let me get someone to help me” instead of “ You are too heavy I need someone to help me roll you over”.
A second strategy involves the nurse as a manager of a healthcare organization and a patient’s advocate. A nurse can mobilize resources to ensure that facilities and equipment can safely accommodate obese patients. This goal can be achieved by construction of infrastructure that can support the growing obese population such as investing in wider beds that can accommodate weights between 300 and 800 pounds, building wide doorways, purchasing or renting wider wheelchairs, lifts, commodes, gowns, bariatric beds, commodes, and walkers. In addition, hiring more staff to help in safer transfers of obese patients is key to avoid back injuries as, Gallagher (2005) explains “Injuries that result from manual lifting and transferring of patients are among the most frequent causes of nurse related injuries with more than half of strains and sprains being attributed to manual lifting tasks while assisting dependent patients with their mobility needs” (Pg 1). Although this may mean additional expenses, this will serve as a long-term investment as the numbers of overweight patients persistently keep rising.
The third strategy is education of the public. Nurses can change the way the public views obesity through education and enlighten on cause of obesity and surrounding factors. But before the healthcare professionals can educate the public, Maxwell (2005) urges all healthcare professionals to educate themselves and other hospital staff first on ways of being sensitive to the plight of the obese people. In her article Obesity: Pain and Prejudice (2005) she exemplifies, “Don't be like the doctor who told his patient that she would have to be weighed at the zoo” (Pg 4). In comparison to HIV/AIDS epidemic, education about obesity will lead an overall public awareness and change of attitude hence change of behavior. Additionally, early education on obesity is paramount to young children to serve as a preventive measure before they turn into young obese adults by creation of healthy food programs in school such as reduction or eradication of vending machines in schools and promotion of Physical education (Malone, 2005)
After, the nurse sets a good example by not practicing bias and discrimination against obese population, mobilize resources to ensure equipment like oversized beds, commodes, walkers and wheelchairs are available and ready for use by bariatric patients and, educate people to create a public awareness about obesity. This will improve empower and encourage public awareness about obesity with the correct perception and aid obese population to lead healthier lives.
Reference:
Gallagher, S. ((2005)). Caring for the Child Who is Obese: Mobility, Caregiver Safety, Environmental Accommodation, and Legal Concerns. Batriatric Nursing Surgical Patient care , 1.
Malon, S. (2005). Improving Quality of dietary intake in the school setting. Journal of School Nursing , 21, 70-76.
Maxwell, B. (2005). Obesity: Pain and Prejudice. Medscape General Medicine , 7, 3.
Puhl, R., & Browell, D. (2001). Bias, discrimination and obesity. The NOrth American Associaton for the study of Obesity , 9, 788-805.
Joseph Njenga
NUR 211
John Miller
Research paper
2/4/2008
Intervention 1
As a manager of a health care organization, the nurse can mobilize resources to ensure equipment like oversized beds, commodes, walkers and wheelchairs are available and ready for use by bariatric patients
Disadvantage 1
One major disadvantage of this intervention is lack of enough funds to meet the need of this intervention. Limitation in coverage of most bariatric procedures by insurance has done little to improve the situation at hand. With scarce resources that the facilities have to depend on, tight budget cuts in many healthcare facilities have been enforced leaving no room for expansion in provision of bariatric services and purchase or required equipment. In a research study to find ways of predicting cost by a bariatric clinic, Mosti states, “Although bariatric surgery is highly effective for controlling obesity and its complications, it is uncovered by third-party payers in many countries. High cost and unpredictable expenses account for the lack of coverage”
Disadvantage 2
The second disadvantage is multiple stages of managerial approval in many organizations. The more the stages of approval the hard it becomes to approve any policy in an organization; this is because each stage of a policy approval questions the chances of success in implementation of an idea. Although it is essential to assess the chances of success of any policy before investing, this practice discourages creative employees from coming up with good idea that would in fact help the organization grow. For instance in the Wikipedia encyclopedia (Espo, 2007), the Stem cell research has gone over multiple challenges and yet it has not been approved as illustrated:
The bill passed House of Representatives by a vote of 238 to 194 on May 24, 2005.[1], then passed the Senate by a vote of 63 to 37 on July 18, 2006. President Bush vetoed the bill on July 19, 2006.
The House of Representatives then failed to override the veto (235 to 193) on July 19, 2006. In a second trial The bill passed the Senate on April 11, 2007 by a vote of 63-34, then passed the House on June 7, 2007 by a vote of 247-176. President Bush vetoed the bill on June 19, 2007,[2] and an override was not attempted..
Intervention 2
The second intervention is for nurses to educate the public about obesity through creation of the right perception about obesity and factors that can be employed to reduce it.
Disadvantage 1
As a result of the well known fact about nursing shortage, this phenomenon has affected nursing educators too. Andrea (2007) in her article states, “Of the 2900 nursing doctoral students who enroll each year, only 440 graduate. The average age of a new doctoral graduate in nursing was 45.7 years and 6.5% of the graduates were 55 years or older.” She goes on to say that this demographic has done little to improve the situation of the nursing scholarly culture. In return there is a shortage of faculty that is supposed to teach new nurses and the public in general. The few nurses that graduate from nursing school are hence siphoned to more critical healthcare system like the hospitals. This means that community based care that is meant to be the primary mode of prevention has been left with no educators creating a whole new challenge for public education on issues such as obesity.
Disadvantage 2
Unavailability of health care centers, information coupled with public illiteracy has been a major disadvantage for wellness promotion through community education. Nurses who teach on the community level greatly depend on this resource for their service as educators to be effective. Lack of this resource has lead to an increase in health care cost through Emergency department response and chronic diseases such as diabetes and hypertension. Parker( 2005) states, “Widespread problems with health literacy significantly limit effective dissemination and understanding of relevant health information in society, especially among many vulnerable populations where health literacy challenges are especially pervasive” she goes on to explain that an improvement in community healthcare will reduce disparities, cost and quality of care. Therefore a well furnished community health care center can greatly reduce the cost of health care in the long run (Parker, 2005)
Bibliography
Andrea L. Smesny, P. J. (2007). Barriers to Scholarship in Dentistry, Medicine, Nursing, and Pharmacy Practice Faculty. American Journal of pharmaceutical education , 5 (71), 91.
Espo, D. (2007, April 12). Stem Cell Research Enhancement Act. Retrieved Feb 5, 2008, from Wikipedia: http://en.wikipedia.org/wiki/Wikipedia:Text_of_the_GNU_Free_Documentation_License
Mosti M, D. G. (2007, nov 27th). Calculating Surgical Costs: How Accurate and Predictable is the Cost of a Laparoscopic Roux-en-Y Gastric Bypass? Obesity surgery , 1555-7.
Parker, L. G. (2005). Library outreach: overcoming health literacy challenges. Journal of the medical library association , 4 Suppl (93), S81- S85.