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Depression in Patients after Cerebral Vascular Accident

Depression in Patients after Cerebral Vascular Accident

Introduction

Cerebral vascular accident (CVA) is the abrupt disruption in brain function due to disturbance in the cerebral blood supply (Warlow, 2007). A third of these patients eventually develop depression. Depression is a mood disorder which significantly impairs the psychosocial functioning of a person, and further leads to somatic symptoms. Such depression is also known as post stroke depression (PSD) (Warlow, 2007). Therefore, it is imperative to identify aspects pertaining to this disorder that will help in according the best cure or prevention. In order to do these, this paper seeks to explore the topic of depression in post stroke patients by utilization of critically appraised articles and past literature.

Background

Stroke is identified as the third leading cause of death and the most devastating and disabling disease. It has devastating emotional impact on the patient, family and society. According to Schwartz, Speed and Brunberg (2001), about 30% of the patients diagnosed with stroke develop depression within their lifetime. Following stroke, depression is often persistent and severe interfering with the rehabilitation process of the patient. The exact etiology of post stroke depression has not been identified. However, this type of depression is responsive to treatment.

Various research studies have been conducted seeking to identify the factors contributing to post-stroke depression. Advancements in technology have enhanced neuropsychiatric studies in understanding post-stroke depression. According to Astrom, Adolfsson & Asplund (2003), age and socio-economic status of the patient play no role in the development of post-stroke depression. Poor social function of the patient following stroke results from the depression rather than a cause of it. Astrom , Adolfsson & Asplund (2003) argue that the degree of disability following stroke is related to the development of depression. Previous social functioning, personality and mood disturbance play a crucial role in the development of post-stroke depression. Alcoholism and drug abuse before the stroke also contribute to the development of post-stroke depression.

Literature suggests a relation between the location and size of lesion after stroke and depression. Large, anterior lesions located in the left cerebral hemisphere have been shown to be associated with post-stroke depression. A study conducted by Herman (2001) revealed that post-stroke depression may be attributed to biochemical derangement. In the study, depressive stroke patients exhibited abnormalities in the neurotransmitter concentration, alteration of the sensitivity of the cortical receptor and derangement of the electrophysiological parameters. In addition, these patients have decreased cerebral blood flow.

Robinson (2003) highlighted that higher incidence of post-stroke depression are seen in patients with left hemisphere lesions. According to the author, the severity of depression is related to the distance between the anterior pole of the left hemisphere and the location of the distance. Literature also suggests that lesions located on the basal ganglia and left frontal lobe are linked with severe post-stroke depressive disease. In addition, lesions located in the left hemisphere basal ganglia play a vital role in the development of major depressive disease following acute stage of stroke.

According to the biological theory, children who are genetically predisposed to depression and suffer loss at an early age experience alteration of the biochemical state resulting in depression. According to this theory, family genetics and environment at an early age play a crucial role in developing depression during one’s lifetime. In the cognitive behavioral theory, depression results from low self esteem. Literature on the transactional theory reveals that depression results from interaction between the society and environment (Wade, Legh-Smith and Hewer, 1997). Certain disruptive changes, for example, family disruption and drug abuse, in the society and environment predispose an individual to depression. Stressful events, for example, separation at an early age, have been implicated as antecedents or precipitants of depression.

Post-stroke depression is associated with poor clinical outcome. This is because depression interferes with the recovery and rehabilitation process of the patient following stroke. The patient is not able to improve or maintain improvement following intensive rehabilitation if they are depressed. Clinically important results of post-stroke depression were found to be poor long term functional recovery, reduced social functioning, social contacts and quality of life (Lishman, 2008). This significantly interferes with the prognosis of the patient following stroke. Therefore, it is crucial to manage depression before engaging the patient in intensive rehabilitation.

Literature Review

3.1 Search Methodology

Inclusion Criteria

The articles included in this study are journal publications between 1st January 2002 and 2012. This particular data was chosen as it would reflect the current state of technology and not rely on outdated research (Vishweshwars, 2000). There were several databases used including Medline, CINAHL (EBSCO Host), BMJ, E-Journal, MEDLINE and PsyArticle and the Cochrane Library.

The studies included research on both males and females, and the type of papers that were included were clinical trials, meta-analysis and randomized control trials. Data was included from adult patients who developed stroke after the age of 18 years onwards. In the beginning of the review, 12 studies were obtained but, after reading through the abstract only 5 articles were found to be related to the topic. 7 articles hand searched were also included as they were relevant to the topic area. Altogether 12 articles were in included and appraised . Majority of the articles included in the study focused on the management of patients with depression following CVA.

The qualitative studies reviewed in this research included Vickerey (2008), Hackett (2010), Schonberger (2006), Williamson (2011), Tang (2011) and Yi (2010). Vickerey (2008) focused on the relationship between self-esteem and recovery in stroke patients while Hackett (2010) discussed the development of negative cognition in stroke patients. Schonberger (2006) described the relationship between stroke brain injury and various parameters of patient compliance during stroke rehabilitation. On the other hand, Williamson (2011) elaborated on validating various tests in patients with acute stroke to identify neglect. Tang (2011) demonstrated the link between cerebral micro bleeds and development of post-stroke depression. Yi (2010) described the assessment of the anti-depressant flouxetine in the management of PSD.

The quantitative studies included Kim (2012), Fatoye (2009), Buijck (2012), Tsai (2011), Schmid (2012) and Mikami (2011). These studies were conducted to demonstrate the quantitative parameters of evidence including higher incidence of depression in stroke at a community level (Kim, 2012), greater incidence of PSD in poor nations (Fatoye, 2009), the presence of a greater number of neuropsychiatric symptoms in elderly patients following stroke (Buijck, 2012), importance of social role functioning in the rehabilitation of PSD (Schmid 2012), and the prevalence of PSD following treatment with antidepressants (Mikami , 2011).

Exclusion Criteria

These included books, non-medical journals, journal reviews, letters, comments and clinical practice guidelines. In addition, articles that focused on depression in children following CVA were excluded from the study. Further, articles that did not provide clear scientific methodological approaches were excluded from the study.

3.2Qualitative Studies ——you don’t have to put this as a sub heading . you need to just mention that the study is a qualitative as you appraise the paper .

All studies used appropriate tools to collect and analyse the data as per the study designs. Vickery (2008) elaborated on the relationship between self-esteem and functional recovery in patients with acute stroke by conducting a bivariate correlational analysis and multivariate regression analysis on the functional status and self-esteem of patients with depressive symptoms. The research methodology utilized in the study was appropriate.what is the rationale of using appropariate method with textbook reference . The survey was conducted in an acute in-patient rehabilitation hospital which was appropriate for the study. The researchers recruited 176 participants for the research. This sample size is sufficient to give reliable results that can be used to demonstrate on the general population what is the rationale of using appropariate sample size with textbook reference .. However, information generated from this sample population can only be applied in patients who have suffered an acute CVA attack. The analysis method used in the survey was adequate and appropriate to produce reliable results. The authors concluded that self-esteem ratings may have a moderating role in the relationship between emotional outcome and function. The information generated from this survey can be used for future studies. However, the authors did not consider the potential biasness resulting from the relationship between the participants and surveyor.

Hackett (2010) conducted a prospective, hospital based cohort study that sought to find out whether significant negative cognition measures were missed in conventional approaches used for screening patients with acute stroke for depression. The methodology and analysis technique utilized by the researchers was appropriate for the study what is the rationale of using appropariate method with textbook reference . However, the sample size recruited for the study was not adequate to generate results that can be reproduced on the general population. In addition, the follow-up period for the study generated inconsistencies as a majority of the patients recruited in the initial study did not return to the hospital for follow-up results.

Schonberger (2006) used tools such as WAI, EBIQ, awareness and compliance levels to collect data, and prospective tools to analyse the data. The methodology used was appropriate for the study. However, the sample size was not adequate to generate results that reflect the general population. In addition, the analysis techniques used was adequate to address the hypothesis of the study. The information generated in this study is reliable and can be applied in future studies.

Williamson (2011) reported on the validation and functional correlation of patients in chronic and acute stroke using Apple’s Test. The study was conducted in three stages seeking the functional and validation correlation of patients diagnosed with acute and chronic stroke. The methodology was extensive generating complex data that address the purpose of the study. The analysis procedure was adequate and information generated from the study is reliable. However, the sample size used in the study is not adequate to generate results that can be practical for the general population. In addition, the methodology used in this study generated complex and cumbersome results, which served as a source of limitation when analyzing the results.

Tang (2011) examines the relationship between cerebral microbleeds and post-stroke depression. The methodology and analysis used in the study was appropriate. The research setting and population size was adequate to generate reliable results. The use of an MRI to confirm the diagnosis of cerebral microbleeds and structural brain changes resulting in post-stroke depression is appropriate for this study as the findings are scientific based. However, the relationship between the researcher and patients during the follow-up period introduced potential bias in the study results.

Yi (2010) collected data using relevant information from the literature reviews on fluoxetine. Statistical tools like odds ratio and weighed mean difference were used to analyse the data. The literature review adequately addressed the research questions for the study. In addition, the methodology and analysis method employed by the researchers was appropriate for the study. The sample population was adequate to generate reliable information that can be applied in the general population.

3.3 Quantitative Studies

Kim (2012) used the data collection tools CESD (Centre for Epidemiology Studies – Depression including the components Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA)), and Mini-mental state Examination (Korean Version). For the analysis, he used SPSS 17.0 and AMOS 7.0, for CFA, EFA, and internal consistency of Cronbach’s alpha. Kim (2012) had a sample size of 203 patients undergoing stroke rehabilitation in primary care settings, in Korea. This was nearly similar to the 118 patients who were undergoing rehabilitation in a Nigerian Teaching Hospital demonstrated in Fatoye (2009). The results of Kim (2012) study suggested that CESD scale is an imperative tool when it comes to screening for depressive symptoms. Comprehending the psychometric properties of the CESD scale would help health professionals in the assessment of community-residing stroke patients.

Fatoye (2009) used Beck’s Depression Inventory and the Mini-mental state examination (MMSE) to collect data, and statistical methods used to analyse the data. The method employed to conduct the study was a clinical trial of comparing cases with controls, and was relevant as it involved comparing cases with controls in a third-world nation (Nigeria). The results were that there were three variables that had a significant correlation with depressive symptoms. This included low education, paresis and cognitive impairment. Post stroke depression patients with any of these variables had higher symptoms.

Buijck (2012) undertook a study to determine that course and prevalence of neuropsychiatric symptoms in post-stroke elderly patients admitted to rehabilitation facilities. It was a longitudinal multicenter study (involved 15 facilities). The author studied the neuropsychiatric symptoms in elderly patients that were admitted to skilled nursing facilities (across the Netherlands). The author used a sample size of 145. Data was collected using the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) at admission, and compared with discharge. Data was analyzed using statistical methods. The findings of the survey revealed that the overall prevalence of Neuropsychiatric symptoms was lower than that reported by other studies. The findings of this study suggest that neuropsychiatric symptoms should be optimally managed so as to improve the rehabilitation outcome.

Mikami (2011) was a clinical drug trial involving comparison of a case with a control in an RCT setting. Treatment with antidepressant (escitalopram, an SSRI), psychotherapy (Problem-solving therapy/PST) and a placebo were studied. Data was collected using DSM-IV-TR and HRDS, and analysed using Kruskal-Wallis test (for continuous variables), along with Fisher’s extract test (for categorical variables). In the findings, Hamilton Depression scores and new onset major depression scores were increased 6 months after drug discontinuation, compared to the PST or placebo group. Therefore, antidepressants have an imperative role in decreasing post-stroke depressive symptoms.

Tsai (2011) was a double-blind randomized placebo-controlled trial, and like Mikami it was also relevant as it included studying a drug (milnacipran in patients with acute ischemic stroke) with placebo. Data was collected based on the DSM-IV-TR tool at frequent intervals (0, 1, 3, 6,9,12 months) (for identifying the signs of depression) and analysis done using appropriate statistical methods. DSM-IV-TR in both the drug trials was used as a tool to determine the presence of depression in post-stroke patients. Mikami and Tsai were both drug trials that compared an antidepressant to a placebo and other forms of treatment. The sample size of both the studies was similar (108 and 92 respectively). Tsai found out that Milnacipran had a significant role in preventing the development of Post-stroke depression. Therefore, the drug might prevent the development of depression within one year after stroke.

Schmid (2012) undertook a quantitative study to determine the role of social role functioning in the development of depression in post-stroke patients. This study was a cohort study, and data was collected using interventions such as phone calls for Patient Health Questionnaire Version 9 (PHQ9), which was ideal to complete information on the questionnaire. The social section of Stroke-Specific Quality of Life Scale tool was used to determine social role functioning. Schmid (2012) study had the highest sample size number with 372. Comorbidities and depression were found to have an independent association with a twelve week social role functioning. Therefore, improvement in social-role-functioning leads to depression improvement. It is important for rehabilitation providers to screen for and manage post-stroke depression.

All studies involved obtaining an appropriate sample, as the studies were conducted on patients with stroke and were undergoing or were supposed to be undergoing stroke rehabilitation. The duration of the studies were also appropriate as it would take PSD the same duration of time to develop as noted in the quantitative studies mentioned.

4.0 Themes in the Literature Review Articles

Several major themes were recurrent in these articles. These include: risk factors for depression and stress after stroke; symptoms and diagnosis of depression in cerebral vascular accidents (CVA); self-esteem and depression in CVA; therapeutic working alliance and antidepressant use in these patients; functional outcome and recovery; and lesion location after stroke in determining depression.

4.1 Risk factors for Post Stroke Depression

Previous history of depression is also noted as a strong precursor for the development of stroke by Miller and McCrone (2005). However, Burvill et al. (2005) study disputes some of these factors as being risk factors for depression development in these patients. These factors include sex, age and severity of stroke.

According to the findings of a study by Fatoye et al. (2009), the rates of post stroke depression are similar in African and western society. From this finding, it is possible to draw a conclusion that race or ethnicity may lack a significant role in influencing the development of depression following a stroke. However, it is imperative to note that cerebral vascular accidents are more common in African Americans than in Caucasians. Therefore, the overall ratio of patients with depression after a stroke may be higher in this group.

4.2 Self esteem and depression following acute stroke

According to Vickery et al (2008), self esteem is associated with individual functioning status following acute stroke. Following stroke, patients tend to have low self esteem because of their inability to perform various tasks. Anson and Ponsford (2006) suggest that self esteem acts as a mediator of improved psychosocial functioning and quality of life by allowing individual to adjust to stressful conditions. On the other hand, Schroevers et al. (2003), argues that self esteem is a personal attribute that buffers individuals against negative effects resulting from stressful events in life.

Vickery et al. (2008) also demonstrated a direct relationship between self esteem, depression and treatment outcome. According to the authors, self esteem acts as a modulator that moderates the effects of depression in patients undergoing intensive rehabilitation following stroke. The exploratory analysis conducted by the authors suggests that self esteem ratings facilitate the relationship between individual report on depression and functional outcome following discharge. On the other hand, Fatoye et al. (2009) relates depressive symptoms to lower education levels, age, motor and cognitive disabilities of the patient following acute stroke.

Vickery et al (2008) clearly elaborated on the effect of low self esteem on the functional recovery of the patient. Fatoye (2009) argues that decreased functioning of the stroke survivors is negatively influenced by the cognitive and motor deficits of the patient following rehabilitation. Both articles agree that depression in the post-stroke patient negatively influences the overall functioning status of the patient.

4.3 Symptoms and Diagnosis of Post-Stroke Depression by the Therapist

There are various studies, which show that primary care givers in the health sector under-diagnose depression, in up to 50% of patients (Kim et al., 2012). This is supported by a randomized controlled trial carried out by Williamson et al. (2011). According to Kim (2011), problems in the diagnosis of depression in the primary care setup arise because not many patients present with clearly identifiable symptoms and signs of depression. This means that some of these patients fail to reach the diagnostic criteria threshold for major depressive disorder. Problems may also arise because the patients fail to accept the diagnosis or when the patient has much mental comorbidity that competes for the attention of the clinician (Klinksman, 2005).

Tools such as Centre for Epidemiology Studies – Depression (CESD) are imperative in the assessment of Post-Stroke Depression (Kim et al., 2011). This will enable early initiation of appropriate management (Schmid et al., 2012). Depression symptoms according to Miller and McCrone (2005), with decreasing order of frequency, include: depressed mood; fatigue or loss of energy; insomnia or hypersomnia; alteration in appetite; diminished interest in activities; suicidal ideations; and decreased concentration. This is relevant to the scope of this paper in that it helps the primary care giver, including the nurse, in identifying patients with depression. Other symptoms that have been noted include feeling guilty, worthless or hopeless.

4.4 Lesion location and depression after stroke

According to Schonberger et al (2006) study, patients with right hemispheric lesions were more predisposed to developing depressive symptoms after six months. There was no notable discrepancy in the severity of depression in relation to anterior and posterior lesions. However, right hemispheric lesions were associated with major depressive syndromes. Unlike depth of the lesion, the size of the lesion directly correlated with the severity of depression. Patients with right anterior lesions reported a higher incidence of emotionalism than patients with lesions at other regions. Vickery et al (2008) and Fatoye et al (2009), relates low self esteem to emotionalism that is characteristic in patients with depression following acute stroke. Tang (2011) related geriatric cerebral microbleed resulting in stroke to depression. The MRI changes following cerebral microbleeds resulted in focal lesions that affected the functional outcome and neurological functioning of the patient.

4.5 Therapeutic Working Alliances

In providing treatment for those with depression after cerebral vascular accidents, it is imperative for the health providers to work in synchrony in affording the patient with the best care possible. In their retrospective case control study, Miller and McCrone (2005) note that mental health clinicians agree with primary care givers in the diagnosis of depression in 66-76% of the time. This shows that primary care givers have the skills needed in identifying depressed patients. Hackett (2010) noted that significant negative cognitions may be missed when post-stroke patients are screened for depression. It is thus imperative to include a sensitive exploration technique on the psychological effects of stroke in the patients so as to determine whether they are at risk of developing depression. Williamson (2011) recommended the application of Apple’s Test in predicting the functional outcome of the patient. The functional outcome of the patient plays a significant role in determining the development of depression following CVA.

Shmid et al., (2012) noted that of the best care that a patient with depression can be afforded with. Patients who were treated for depression in primary care setting with the collaboration of the psychiatric unit experienced better outcomes. In order to increase the therapeutic efficacy in treatment of depression, it is imperative for physicians to be alert to the most essential aspects of post stroke depression. Therapeutic collaboration is imperative in proper management of these patients (Schmid et al., 2012). In a randomized control study by Fatoye et al. (2009), physicians who were aware of depressive symptoms and associated factors of post stroke depression had better outcomes in affording a cure for their patients. Treatment of this condition leads to quality of life improvement among this group of patients.

4.6 Antidepressant treatment of patients with CVA

Post-stroke depression significantly affects the cognitive functions and motivation of the patient to engage in the treatment process. Vickery et al (2008) acknowledged that depression in stroke patients interferes with the patient’s ability to improve and maintain improvement following intensive rehabilitation. Tsai (2011) attributes poor functioning recovery to inability to cope with rehabilitation challenges in post-stroke depressed patients.

Miller (2005) argues that antidepressants are effective in countering the depressive symptoms associated with negative effects on the rehabilitation process. According to Mikami (2011) early detection and treatment of depression significantly contributes to the patient’s ability of full recovery. Drugs such as escitopram are imperative in decreasing the symptoms of post-stroke depression (Mikami, 2011). Yi (2010) highlighted that flouxetine is effective in preventing post-stroke depression in patients who are at risk. However, Fatoye (2009) urged that improvement of the cognitive and motor functioning of the patient influenced the functioning recovery of the patient. According to Fatoye (2009), antidepressant drugs were not necessary in the rehabilitation process of post-stroke depressive patients.

5. Discussion

The incidence of depression following stroke is clearly higher especially between 6 months and 24 months following the stroke episode. The exact cause for the development of depression following stroke may be difficult to determine, though in general, it may be multi-factorial in origin. Some of the factors that are responsible for the condition include biological factors, familial factors, social factors among others. Biologically, depression may be associated with biochemical changes in the brain. During stroke, certain focal areas of the brain are involved, and this may also be responsible for the development of depression. Tang (2011) demonstrated that the cerebral micro vascular bleeds noted through MRI scans, was closely associated with the development of depression. MRI Scans are also useful in a variety of neurological disorders to identify the presence of lesions in the CNS (Hamdy, 2011). In the developing world, some of the associated factors of depression in post-stroke patients include cognitive problems, low education levels and paresis (Fatoye, 2009).

Anderson et al. (2004) reported from 12 trials involving 1200 subjects that antidepressants did not have a prophylactic effect compared to a placebo. However, PST was found to have a positive impact and needs to be pursued by long-term and large studies. The finding of the inefficiency of antidepressants also needs to be substantiated from long-term and larger studies. Tsai et al (2011) noted that antidepressant therapy administered prophylactically at an earlier date (one month compared to the third month), had a better functional outcome in post-stroke patients. This drug employed as a prophylaxis in this study was milnacipram. The effect of the antidepressant drug lasted for about 2 years. Supported by Reid et al (2011), Narushima et al (2003) also notes that the effect of antidepressants such as SSRIs and others is much more superior to a placebo.

Miller et al (2005) noted that in primary care settings, the referrals for patients with depression with mental health specialty clinics were high when a diagnosis of CVA or CVD was being made. The referrals and the problems were especially high when a large number of medications were taken.

Vataja (2004) noted that a brain lesion in the pallidum strongly predicted for depression following stroke. Earlier, several studies were disproved as they could not precisely suggest the location of the brain infarct that could result in depression (Rickards, 2005). When the brain rehabilitation programme enabled greater rapport between the client and the therapist, the outcomes were better (Schonberger, 2006). Neglect in post-stroke patients increased risk of depression (Williamson, 2011).

6. Conclusion

Incidences of cerebral vascular accidents are on the rise. This is attributed to lifestyle changes and increased longevity. A significant proportion of the stroke patients will develop depression. Depression in stroke patients is associated with poor outcomes. It is futile if we as the health care providers fail to address the CVA and its risk factors. With good dietary habits and exercise, most of the CVAs can be prevented. Though screening for depression in post stroke patient has been shown to be effective, minimal research has been done in assessing the best screening tools (Miller and McCrone, 2005). This is a potential area for further research. It will enable disease prevention, rather than cure, which will decrease the disease burden. Henceforth, a research question that comes up is “what are the best practices in screening for depression in stroke patients?”

References List

Anderson CS & House AO (2004) Interventions for Preventing Depression afterStroke: The Cochrane Library Issue 3

Buijck B Zuidema SU Geurts AC Spurit-van EM Koopmans RT (2012) Neuropsychiatric symptoms in geriatric patients admitted to skilled nursing facilities in nursing homes for rehabilitation after stroke: a longitudinal multicenter study. Int J Geriatric Psych 27(7) p734-74 online at: HYPERLINK “http://www.ncbi.nlm.nih.gov/pubmed/21932248″http://www.ncbi.nlm.nih.gov/pubmed/21932248 [ Accessed on : 01 December 2012]

Burvill P W Johnson G A Jamrozik KD Anderson CS Stewart-Wynne EG Chakera T (2005) Prevalence of depression after stroke: The Perth Community Stroke Study. British Journal of Psychiatry 166 pp. 320 – 327

Calpadi VF & Wynn G (2010) Post stroke depression: treatments and complications in a young adult Psychiatr Q 81(1) p73-79 oneline at: HYPERLINK “http://www.ncbi.nlm.nih.gov/pubmed/20033774″http://www.ncbi.nlm.nih.gov/pubmed/20033774 [ Accessed on : 10 December 2012 ]

Chau JP Thompson DR Chang AM Woo J Twinn S Cheung SK Kwok T (2010) Depression among Chinese stroke survivors six months after discharge from a rehabilitation hospital J Clin Nursing 19 [21-22]

Depression in Dimentia

Depression in Dementia

Depression is a usual disorder that bedevils many people in the world. Research indicates that women are twice likely hit by the problem than men during their lifetime. The problem can occur at any stage of a person’s life regardless of their ethnicity, income, race, and education. Depression is a significant public health issue that brings about suffering, diminishes functioning and health and may lead to economic burden to the society, personal, and third-party payers. When proper treatment is not sought, the disorder may have a disabling influence that results in poor self-care, personal suffering, impaired personal relationships, and lack of follow-up of medical treatments, substance-use, and physical illness, loss of income, self harm, and even suicide (Storandt, 2003).

The subject under study is an elderly woman suffering from dementia. The woman was a client at Compcare. The reason for her choice is because assessment and follow-up gets easier and cheaper. Pharmacological medication is the form of treatment used for the patient. After she got diagnosed with dementia, depression set into her life. The study took a period of one month. It started on May 23rd, 2013 and ended on June 23rd, 2013. Most studies on dementia focuses on clinical recognition, prevalence, assessment, and treatment. The above study focuses on dementia and the effectiveness of various intervention methods. The client was under the supervision of a therapist and the agreement made was for her to cut down on screaming, cursing, and wandering. Counting the number of times the client defaulted those agreements formed the basis for asssessment. The subject signed an Informed Consent Form (Appendix).

Dementia is a group of symptoms brought about by disorders and diseases that affect the brain, including (AD) Alzheimer’s disease, strokes, (PD) Parkinson’s disease, and much more. It involves continuous loss of memory and other cognitive senses such as emotional control and problem solving. Research shows that the earliest stage that one gets diagnosed with the problem is commonly called MCI (mild cognitive impairment). As the problem advances, the victim’s ability to conduct instrumental and daily activities gets impaired.

In the year 2005, nearly 24.3 million people in the world had dementia and 4.6 million new cases crop-up annually. This number, according to some scholars will double after every 20 years. WHO (world health organization) report (2003) shows AD and other dementias ranked as the fourth course of problems and burden in adults 60 years old. The other diseases that outranked dementia include chronic obstructive pulmonary disease and heart disease. AD is the most prevalent type of dementia, followed by VaD (vascular dementia), FTD (frontotemporal dementia), PD associated dementia, and DLB (dementia with Lewy bodies (Thompson, 2006).

Psychological and behavioral signs of dementia (BPSD), also called neuropsychiatric symptoms of dementia, affect almost all with dementia during illness and often manifest during the first stages. Developed classifications on dementia indicate that BPSD falls into two groups. One is behavioral and the other is psychological. Behavioral gets identified through observation of the patient, and include wandering, screaming, restlessness, sexual disinhibition, cursing, physical aggression, hoarding, shadowing, and culturally unexpected behaviors. Caregivers and patients give psychological symptoms such as anxiety, depressive moods, delusions, and hallucinations.

BPSD have adverse effects in older adults. They cut their quality of life of a patient, increase functional and cognitive decline, and get linked with increased mortality. Moreover, these symptoms give stress to caregivers, and get associated with advanced rates of depression in caregivers. They also add to the risk of institutionalization. Managing dementia costs close to a third of the total cost of caring for dementia.

Behavioral symptoms of dementia are usually more distressing and plain to observers than psychological signs, and are generally more common in medium to severe dementia. However, psychological signs may bring more harm to the patient during the earlier instances of dementia, as victims develop insight about the effect of the diagnosis on their future life.

For the patient picked, the use antidepressants and antipsychotics was the main form of medication. The woman had more adverse effects of depression in dementia compared to other patients. Men generally suffer less than women from depression in dementia.

Intervention and rationale

The symptoms exuded by the woman called for an intervention. Screaming, undesirable behaviors, wandering, and restlessness characterized her behavior. These problems formed the basis for the study and treatment. The medication options sought targeted reduction of such behaviors. The treatment option that this document discusses gets based on the most proper approach for reducing depression in dementia. Pharmacological medication is the treatment option used. The form of intervention used was for the patient to reduce most of these behaviors. The exact behaviors under study are: screaming, cursing, and wandering. A reduction in the number of undesirable behaviors would result in a handsome shopping from me and a waiver for her medication. An increase would lead to no waiver and no shopping at all. No behavioral change meant moderate help. This is the most effective method as behavioral change is accompanied by a reward. Rewarding the patient stimulated her behavioral change.

The client was under the supervision of a therapist. The therapist administered treatment to her as he checked her progress. There are both non-pharmacological and pharmacological treatment approaches for the problem. The two intervention methods help in cutting down the depression associated with dementia among older adults. Many forms of medications get used, and have varying degrees of success. Non-pharmacological treatments like structured activity programs and behavioral change programs reduce depression, but with modest outcomes. Dosing with gingko biloba extract is a new technique of intervention that has registered success (Rabins, Lyketsos, & Steele, 2005).

Pharmacological treatment got preference to other forms of treatments as it has a higher degree of success compared to other forms of treatment. It works better than non-pharmacological options, which has moderate outcomes.

Pharmacological treatment for depression in dementia

Neurotransmitters or receptors targeted by pharmacological therapists include amino acid receptors, cholinergic receptors, and catecholamine receptors. Clinicians have difficulties in treating depression with dementia. Old patients with dementia bear greater comorbid illnesses than non-demented peers, with almost three-fifths of those with AD bearing 3 or greater. This increased level of comorbidity comes from use of many medications. Therefore, polypharmacy and drug interactions help provoke depression in some patients diagnosed with dementia. Because older adults with dementia have cognitive and physical frailties, they are also susceptible to other adverse effects. Caregivers and clinicians must see patients’ behaviors carefully for evidence of adverse effects when new treatments get introduced because dementia patients communicate rarely. Medication options for the elderly should always take a slow approach. They should start slowly and continues slowly (Sarbadhikari, 2005).

Antidepressants

Antidepressants get prescribed on continuous basis for older adults with dementia. A recent analysis, in 2007, endorsed treatment of depression with selective serotonin reuptake inhibitors and tricyclic depressants in patients with dementia. The research findings of the analysis indicated that remission and patient treatment response got superior to the placebo response in the joined effort from all the studies. Other reviews support treatment with various antidepressants, such as fluoxetine, trazodone, movlobemide, and sertraline, on depression in dementia. Citalopram and sertraline get commonly prescribed. Reviews show trazadone and mirtazapine as other options but there are fewer trials that support their use.

Antipsychotics

Different categories of antipsychotics treat depression with varying levels of success. However, older adults with dementia who take haloperidol are at a significant risk of extrapyramidal signs including tardive dyskinesia and parkinsonism. Because of the above reason, most clinicians focus on “atypical” antipsychotics like olanzapine and risperidone, which have vital, thought moderate, effects, and fewer adverse effects than typical antipsychotics at lower doses.

Care is very imperative as both olanzapine and risperidone have increased risks of stroke and associated mortality, and many safety warnings limit their use for treatment of depression in older adults with dementia. There are disagreements over the real risk involved and people suggest that increased cardiac arrest occur at high doses. Other scholars claim that patients of stroke have other risk factors besides the use of risperidone in dementia (Hay, Klein, & Hay, 2003).

Reduced cholinergic activities, mainly resulting from reduced acetylcholine concenctrations brought about by dementia-linked changes; result from decreased cognitive ability in dementia, and increases in BPSD. Cholinesterase inhibitors, including tacrine and donepezil, gets used in targeting increasing levels of acetycholine, with success, especially in patients with mild to medium dementia. A review on the effects of rivastigmine on BSPD shows that there are positive effects on patients with a range of dementia, and that anxiety and apathy form the list of behavioral domains showing the most consistent positive response.

Results

The above approach forms one of the most significant methods of treating depression in dementia. After a period of six months whereby the patient was under scrutiny and medication, good results got registered. The patient improved greatly and emerged with less stress than her first state. Earlier symptoms such as restlessness and screaming ceased completely.

The use of pharmacological approach for treatment of depression with dementia is very proper and effective. Antidepressants and antipsychotics have varying levels of success on reduction of depression in dementia. The use of various forms of antipsychotics and antidepressants served the purpose. They greatly cut down on the level of depression for the elderly woman. Since the medication worked well, this paper recommends its use.

EMBED Excel.Chart.8 s

Day of the week Behaviour Total tally

screaming wandering cursing Monday 10 8 12 30

Tuesday 8 6 10 24

Wednesday 4 4 8 16

Thursday 6 3 9 18

Friday 5 3 7 15

Saturday 2 2 6 10

Sunday 2 3 4 9

References

Hay, D. P., Klein, D. T., & Hay, L. K. (2003). Agitation in Patients With Dementia: A Practical

Guide to Diagnosis and Management. Arlington: American Psychiatric Pub.

Rabins, P. V., Lyketsos, C. G., & Steele, C. (2005). Practical dementia care. New York: Oxford

University Press.

Sarbadhikari, S. N. (2005). Depression and dementia: Progress in brain research, clinical

applications, and future trends. New York: Nova Science Publishers.

Storandt, (2003). Neuropsychological assessment of dementia and depression. American

Psychological Association.

Thompson, S. B. N. (2006). Dementia and memory: A handbook for students and professionals.

Aldershot, England: Ashgate.

Appendix

CONSENT TO PARTICIPATE IN A SINGLE SYSTEM RESEARCH DESIGN

I am aware that this research design is being conducted by D.C., who is a Graduate Student in the Rutgers University School of Social Work. This intervention is to fulfill the requirements of a mandatory assignment for Research II, Section 19:910:595, with Professor Raymond Sanchez-Mayers.

The purpose is to measure the effect that moderate exercise, antipsychotics and, antidepressantswill have on my Dismentia. I am the only subject participating in this intervention.

The intervention will take 30 days to complete. The data recorded will be on Compcare wher I am recently receiving medication.

I understand that the following requirements are necessary for this intervention:

Week 1 (Days 1-6) – ingestion of antidepressants

Week 2 (Days 7-12) – ingestion of antidepressants and antipsychotics

Week 3 (Days 13-18) – ingestion of antidepressants and antipsychotics and moderate exercise

Week 4( Days 19-28)- exercise only

Every effort will be made to stick to the set schedule for my assesment. The Intervention consists of 10 minutes of warm-up, 15 minutes of brisk walking/slow jog, and 10 minutes of cool down after undergoing pharmacological medication.

I realize that there are risks involved with any exercise program. I agree to stop the intervention if at any time I feel pain, shortness of breath, or any other symptom of discomfort that seems above and beyond normal exercise symptoms.

It is understood that the benefits of exercising have been shown to parallel a healthy lifestyle, which my focus and reason for volunteering for this research project. I hope to have this be the incentive for me to continue exercising on a frequent basis.

il(student) for my participation.

If I have any questions about this research that D.C. is not able to answer, or any complaints regarding this intervention, I may contact Professor Sanchez Mayers at:

Rutgers, The State University of New Jersey

School of Social Work

536 George Street

New Brunswick, NJ 08901

(732) 932-7520 Ext. 111

Email: write email

Signature on FileSignature on File

_____________________________________________________________

D.R.L. – Research Subject D.C., Student

Date: May 23, 2013

Nursing theories

There are various nursing theories that are used by nurses as a guide to their day to day practice in nursing. This paper will look give views on theory-driven and evidence based of two nursing theories.

One of these theories is the self-care theory by Dorothea Orem. The major concept in this theory is an art through which the nursing practitioner gives assistance that is specialized to individuals with disabilities that makes more than ordinary assistance necessary for meeting the needs for self-care. Self-care requirements are actions that are directed towards providing self-care presented in three categories; universal self-care requisites, development self-care requisites and health deviation self-care requisites.

Assumptions of Self-Care Theory

There are various assumptions that were made in this theory such as people have to be self-reliant and responsible when it comes to their own care as well as others within the family needing care. It also assumes that people are distinct individuals and nursing is a form of action that involves an interaction between two or more people. Another assumption is that meeting universal and development self-care requirements is a crucial component when it comes to the primary care prevention and illnesses. There is also an assumption that an individual’s knowledge of potential health problems is an important thing when it comes to the promotion of self-care behaviors (Gonzalo, 2011).

Applications of Self-care theory

This theory is applicable for nursing by those beginning the practice as well as the advanced people. In this theory nursing is needed when a person can not maintain continuously the amount and quality of self-care that is required to sustain life and health recover from an injury or disease or cope with the effects from illnesses or injuries.

Another nursing theory is the need theory by Virginia Henderson. The background of the theory was the emphasis on the importance of increasing the independence of a patient in order for progress after hospitalization not to be delayed. It aims at assisting individuals in gaining independence in relation to performance of activities that contribute to their health or recovery. According to this theory the role of nurses is substitute, supplementary, complementary with the main aim of helping the individual become as independent as possible.

Assumptions of Need Theory

There are several assumptions in this theory one is that nurses are supposed to care for patients until they are able to care for themselves once again. Another assumption is that nurses are willing to serve and that they will devote themselves to patients day and night (Currentnursing, 2012).A lot of focus on Orem’s work is self-care. Even if there is a wide scope as seen when it comes to encompassing theory of the nursing systems, Orem’s goal of letting readers look at nursing care as a way of providing assistance to people was apparent when it came to all the concepts that were presented. From the definition, health that is sought as rigid can now be refined through making it suitable to general view of health as a state that is ever changing and dynamic. The role of nurses when it comes to the mantainace of health of patients was set by Orem with a lot of coherence according to the life-sustaining needs of every person. This theory appears simple but yet it is quite complex, the use of self-care agency, self-care deficit, universal self-care can be quite confusing. The theory does not recognize the emotional needs of an individual (Gonzalo, 2011).

The needs theory is based on four major concepts the individual, who has basic needs which are component of health. The second concept is environment is the setting which an individual learns of unique pattern of living. The third concept is health whereby nurses are required to stress on promoting health and prevention and cure of illnesses. The final concept is nursing that assists and supports individuals in life activities as well as their attainment of independence. The theory puts emphasis on basic human needs as a central focus of the nursing practice which has led to the development of theory when it comes to needs of an individual and how nursing can be used to meet these needs (Currentnursing, 2012).

References

Gonzalo, A. (2011). Theoretical Foundations of Nursing. Retrieved October 7, 2014 from http://nursingtheories.weebly.com/dorothea-e-orem.htmlCurrentnursing. (2012). Virginia Henderson’s Need Theory. Retrieved October 7, 2014 from http://currentnursing.com/nursing_theory/Henderson.html

Nursing Staff Shortages in the Health Care System

Nursing Staff Shortages in the Health Care System

Abstract

The shortage of nurses is a global health issue that negatively affects healthcare delivery, and the problem is expected to worsen with the increasing demand for healthcare providers caused by the aging population. To goal of this paper is threefold. Firstly, the paper seeks to uncover the causes of nurse shortages. Secondly, the paper aims to uncover the adverse effects of nurse shortages. Lastly, the paper aims to uncover practical solutions for minimizing nurse shortages in healthcare facilities. The most common causes of nurse shortages include low income, poor funding for nursing education, low expenditures on healthcare, nurse burnout, low levels of income, reduced supply of nurses, poor recruitment plans, ineffective planning, improper use of the available nursing resources, and lack of cultural competence and cultural diversity. Effects of nurse shortages include sleep deprivation, which negatively affects nurses central nervous and cardiovascular systems. Nurse shortages also cause in-hospital deaths, HAIs, medication errors, increased medical costs, reduced job satisfaction, burnout, and moral distress. Possible solutions to minimize nurse shortages include improving nurses’ job satisfaction, increasing healthcare expenditure, increasing funds for nursing education to make it affordable for students to pursue a career in this field, and establishing laws that promote retention of nurses. Minimizing nurse shortages will help improve the patient outcome and quality of life.

Nursing Staff Shortages in the Health Care System

Introduction

Nursing is an integral part of the healthcare system and accounts for about 56% of any hospital’s staff (Shamsi & Peyravi, 2020). Nurses are renowned for being proponents of healthcare promotion, training patients and the society about how to avoid diseases and injuries, taking part in rehabilitation, and offering assistance and care. Despite the important roles played by nurses, healthcare facilities today face an increasing challenge of nurse shortage. Supporting this statement, Shamsi and Peyravi (2020) claim that nursing staff shortage is a significant and multifaceted problem and has reached a warning threshold. It is also expected that the issue of nurse shortage will continue to worsen due to increasing demand for healthcare providers caused by the aging population (Stokes & Iskander, 2021). It is approximated that by 2029, there will likely be 73% more Americans over the age of 65, which will increase the demand for healthcare practitioners to provide medical services. This paper provides a comprehensive understanding of the issue of nursing staff shortages in health care system. Specifically, it also illustrates the causes of nurse shortages, the effects of nurse shortages, and the possible solutions to this problem. The purpose of pursuing this topic is to reduce the negative effects of nursing shortages in the health care system. This goal is realistic when the government works together with the health facilities to achieve it.

To help with research and understand the causes, effects, and possible solutions of the issue of nurse shortages, various research questions from different perspectives of inquiry have been used. The different perspectives of inquiry include scientific, analytical, ethical, and cultural perspectives of inquiry. For each perspective of inquiry, one Level 1 and one Level 2 questions were selected. For the scientific perspective of inquiry, the chosen level 1 research question is “Which body systems are affected?” while the formulated level 2 research question is “What are the effects of nursing staff shortages on the patient outcome?” On the other hand, the level 1 research question from the analytical perspective is “What are the economic issues involved?” while the level 2 research question under this type of inquiry is “what are the causes of nursing staff shortages, and how can this problem be solved?”. Furthermore, the chosen Level 1 question from the ethical perspective of inquiry is “What laws pertain to the issue?” while the formulated level 2 question from this perspective is “What are the ethical implications of nursing staff shortages?”. The chosen level 1 question from the cultural perspective of inquiry is “Which cultural values influence the issue?” and the corresponding level 2 question is “How does cultural diversity affect nurse shortage?” The answers to these questions have been combined to develop the paper.

Causes of Nurse Shortages

In order to define practical solutions to a problem, it is important to first understand the cause of the problem. Therefore, it is important to explore the factors which contribute to the nursing staff shortage. Nursing shortages are caused by a number of reasons. One of them is the fact that the nurses are growing old and need to retire (Mac et al., 2019). They however lack people to replace them and some of them are forced to continue working even during old age. This mostly brings about inefficient work. Another cause of nurse shortage is nurse burnout. This is mainly caused by the availability of few nurses who are forced to work overtime (Manyisa & Aswegen, 2017). Other causes of nurse burnout include low shifts, high workloads, and low staffing (Dall’Ora et al., 2020). When nurses experience burnout, fewer nurses are left to attend to patients; thus, a healthcare facility may experience a nursing staff shortage. Additionally, since most of the nurses are females, they are forced to leave the profession to go and bear children and take care of their families. In some American states, the number of nurses is high compared to others. This results to shortages in states that have few nurses. This is also due to the fact that nurses will prefer to work in regions that are good for settling with their families (Haddad et al., 2022). Some nurses complain of emotional and physical abuse caused by the stressful hospital environment.

Another cause of nurse shortages is lower income levels. Drennan and Ross (2019) reveal that low-income countries experience nurse shortages since nurses move to low-income countries to seek employment. On the same note, Fawaz et al. (2018) reveal that relatively low pay contributes significantly to the nurses’ deficit. Based on the classic economic theory, income level is a major factor in pushing or attracting people from one job to another as well as from one market to the other (Drennan & Ross, 2019). Also, the lack of funding to support nursing education contributes to the nurse shortage. Supporting this point, Drennan and Ross (2019) argue that the nursing staff shortage is high due to the poor funding for nursing education. Lastly, underfunding of the healthcare system contributes to nurse shortages. Marć et al. (2019) claim that low healthcare expenditures translate into nurses’ low salaries. Consequently, this results in nurses quitting their job and hence the problem of nurse shortage. In relation to the economic effects of nursing staff shortages, Haddad et al. (2022) reveal that nurse shortages lead to medical errors. These medical errors may lead to patients’ prolonged stay in the hospital, which increases the cost incurred in the hospital.

Furthermore, lack of cultural competence also causes nurse shortages. Notably, cultural competence is recognized as one of the cultural values that influence the issue of nurse shortages. Cultural competence is the set of values, practices, behaviors, and attitudes within an organization system or even individuals, which allows them to work effectively across different cultures. Cultural competence influences nurse shortages because when nurses are not culturally competent, they tend to get stressed, which results in nursing burnout. Another cultural value that influences nurse shortages is cultural diversity. Cultural diversity is the existence of many cultures in the same society. Nurses must be well prepared to serve culturally diverse patients. Unless nurses are culturally competent, they cannot be in a position to provide quality care to patients. When nurses cannot provide quality care, they get stressed and end up quitting their jobs. The last cultural value that influences nurse shortage is cultural awareness. Nurses’ cultural awareness is their comprehension of differences between themselves and patients from other cultural backgrounds. Similar to cultural competence, a lack of cultural awareness may result in nurse shortages.

Lastly, cultural diversity causes nurse shortage. Research reveals that nurses without a firm understanding of cultural differences may experience frustrations and stress when dealing with culturally diverse patients (Balante et al., 2021). Consequently, this may result in nurse burnout. Burnout is one of the leading causes of nurse shortages. Thus, it can be concluded that nurses’ lack of cultural competence indirectly results in nurse shortages. On the contrary, cultural competence allows nurses to provide inclusive healthcare service, improves nurses’ job satisfaction, and facilitates patient satisfaction. When nurses are satisfied with their job, they tend to retain their profession. Consequently, this minimizes nurse shortages.

Impacts of Nurse Shortages

Nurse shortages cause a huge negative impact on the health care systems today. One of these impacts include, increase in patient deaths. This is because patients will be sent home to be taken care of by care givers rather than nursing professionals. Another impact is the increase of medication errors (Haddad et al., 2022). Studies have shown that 46.8% of nurses have committed errors in the last one year. These errors include giving medication to wrong patient, omission of medication, mistaken medication and giving a patient medication twice instead of once. Lastly, nursing shortages increase overcrowding in emergency rooms. This is because the nurse-to-patient ratio is uneven. By solving the nurse shortage problems, these negative impacts will be reduced.

Furthermore, the shortage of nurses indirectly affects the nurses’ body system, where it causes sleep deprivation. Nurse shortages force nurses to work overtime. The long working hours put nurses at an increased risk of short sleep duration, sleep disturbances, and fatigue. Sleep deprivation and fatigue affect the nurse’s central nervous system making their brain not to function correctly. Also, research reveals that lack of sleep among nurses may lead to psychological issues such as memory loss, serious thought retardation, stress, anxiety, and depressive symptoms (Deng et al., 2020). Sleep deprivation due to long working hours also affects nurses’ cardiovascular system. This is because sleep affects processes that affect blood pressure and body sugar levels. Research reveals that sleep deprivation causes severe cardiovascular diseases such as heart attack and stroke (Ahmad & Didia, (2020). On the same note, Liew and Aung (2021) reveal that sleep deprivation causes high blood pressure, a leading risk factor for stroke. It also makes it easier for blockages to occur in arteries causing strokes.

Also, nurse shortage is shown to affect patient outcome. Ghafoor et al. (2021) reveal that the shortage of nurses adversely affects patient care leading to health decline in the nation at large. On the same note, Haegdorens et al. (2019) reveal that lack of sufficient nurse staffing in healthcare facilities is associated with negative events such as hospital-acquired infections (HAIs), patient falls, in-hospital mortality, and medication errors. Also, nurse shortages result in rationing time to care, increasing the risk of missed care. This translates to poor patient care delivery. According to Janatolmakan and Khatony (2022), missed nursing care results in patient dissatisfaction, psychological and physical complications, and even death. Missed care may also result in delayed treatment and medication.

Nurse shortage leads to the medical errors in the process of service delivery and the data entries. The medical errors are caused by the overworking conditions of the working nurses that may make them exhausted to deliver the approved quality services (Haddad et al., 2022). Hospitals with high patient to nurse ratio are characterized by the nurse experiencing of the burnout, dissatisfaction. As such the dissatisfaction creates a mechanism where the nurse may unknowingly error in medical service delivery. The error in service delivery henceforth causes the higher mortality of the patients and failure to rescue the ailing patients

Furthermore, persistent nurse shortages across the world challenge the values and beliefs of this profession and result in various ethical implications. One of these ethical implications is poor patient care. One of the ethical obligations that nurses must fulfill during their line of duty is ensuring that patients are protected from harm (Haahr et al., 2020). However, nurse shortages make it challenging for the nurses to fulfill this obligation as the hospitals assign them to cater for many patients. Since chronically ill patients require holistic care, inadequate staffing denies nurses an opportunity to provide such care to these patients, resulting in poor patient care. Another ethical implication of nursing staff shortages is nurses’ reduced job satisfaction. Usually, ethics assist nurses in making the right decisions guided by their morals. However, nurse shortages leave nurses dissatisfied with their jobs because they do not have sufficient time to communicate with their patients and provide holistic care. Moral distress is another ethical implication of nursing staff shortages. Nurses who serve in healthcare facilities with shortage of nursing staff experience moral distress since they feel that they are compromising their ethical obligation of ensuring patients are protected from harm by providing inadequate patient care (Bayat et al., 2019). Also, nurses who work in health care facilities facing the issue of nurse shortage may suffer moral distress because they feel that they would have rendered better patient care if they were not assigned many patients. Lastly, burnout is another ethical implication of nurse shortages. According to Mullen et al. (2017), increased ethical conflict at work may result in emotional stress and mental burnout. Consequently, this may result to nurses quitting their profession, leading to nurse shortage.

Possible Solutions to Nurse Shortages

The best-known solution is increase in nurse salaries and incentives. This will make more people consider the nursing field. It will also make them feel motivated especially for the nurses who work in the unfriendly areas (Haddad et al., 2022). The male gender is also highly encouraged to join the nursing field so as to enable women to have maternity leaves and go take care of their families when need be. Male patients feel more understood when they are taken care of by male nurses. Health care institutions should also provide training and counseling to their staff. These will enable nurses to speak about the issues they face at work, prompting the management to find the solutions to the issues hence decrease in nurse turnover (Manyisa & Aswegen, 2017). In the event of pandemics or flu, the management of health institutions should hire temporary nurses to help the permanent ones. This will reduce chances of nurses getting burnout. Another solution is having policies that make health centers carry out effective nurse staffing which will increase job satisfaction and nurse retention rates therefore reducing nurse turnover (Holmberg et al., 2018). Nursing programs can also help reduce nurse shortages by increasing wages for nursing educators and therefore motivating them. The nurse students can also receive scholarships which will encourage them to start and finish the nursing courses without financial problems (Marc et al., 2019). Having nursing online classes will motivate more people to take up the nursing career since they do not have to travel to access institutions of higher learning.

Additionally, concerning how nurse shortages can be minimized, research reveals that policy attention is needed in all elements of human healthcare resources and to avoid policy-making that relies overly on oversimplified linear thinking (Drennan & Ross, 2019). For instance, policymakers should not only focus on increasing the number of individuals who enter nursing training but should also make policies that seek to increase the numbers entering the workplace and increase burses retention. Also, improving nurses’ job satisfaction can help reduce nursing staff shortages. This can be achieved through improving role transitions and orientations. According to Lockhart (2020), transition programs for new graduates improve job satisfaction and increase nurse retention. Other ways of improving nurses’ job satisfaction identified by Lockhart (2020) include nursing mentorship programs and improving the workplace environment. Increasing the salaries of nurses may also improve their job satisfaction.

Also, nurse shortages can be minimized by implementing rules and regulations. Since different countries have different laws that pertain to this healthcare issue, the focus of this paper will be on the US laws that pertain to the issue of nursing staff shortages. One of these laws is the Nurse Reinvestment Act, P.L. 107-205. The 107th Congress passed the Nurse Reinvestment Act on July 22, 2002. Congress had been significantly engaged since the 1960s with the goal of providing the US with sufficient nurse manpower. The Act was later signed into law by President George W. Bush on August 1, 2002. The Nurse Reinvestment Act pertains to the issue of nursing staff shortages because Title I and Title II pertain to nurses’ recruitment and retention, respectively. Title 1 of the Act provides two ways of boosting nurses’ recruitment. The first initiative is the development and broadcasting of grant-based funding of local and state public service announcements to promote and advertise the nursing profession. During broadcasting, the rewards ad advantages of the nursing profession should be highlighted, and people are persuaded to enter into this profession. The second initiative entails the revision of provisions of the National Nurse Service Corps (NNSC) related to items such as scholarships, loan repayment, funding, and reporting and eligibility requirements. Boosting nurses’ recruitment helps in addressing the main health care issue selected, which is nurse shortages. Title II of the Nurse Reinvestment Act presents policies intended to improve the retention of nurses. The provisions of Title II relate to areas such as creating career ladders and retaining high-quality nurses through retention grants and nurse education, developing and funding comprehensive geriatric education, and creating and running a nurse faculty loan program to improve the number of qualified nursing faculty. Title II of the Act helps address the issue of nurse shortages by ensuring nurses do not quit their profession. Another law that pertains to the issue of nursing staff shortage in the US is the Nurse Training and Retention Act of 2007, S.2064. The 110th Congress passed this Act on September 18, 2007. This Act aims to ensure comprehensive programs are funded to facilitate a sufficient supply of nurses. Increasing the supply of nurses helps deal with the selected healthcare issue, nursing staff shortage.

Investing in the long term-training of the nurses to enhance the professional development has enabled the healthcare organization to mitigate the detriment of the nurse staff shortages. Medical institutions should create a lifelong learning for nurses through the promotion to innovative and management positions (Challinor et al., 2020). The conditions for the promotions get based on knowledge provision and skills through distance learning, on-site classes, and the self-tutorials by the employers. Notably, avoiding the expensive and immediate training can get achieved by the organizations through the adoption of the fun training for the senior nurses.

Another approach of reducing the nurse shortage by the healthcare organization is the conversion of the current nurses into compensate for the referrals and the recruiters. The conversion will enable the nurses to communicate in one language hence creating a framework of delivering the quality services through limiting the time w3astyage in service delivery. The act of cp0nvertiong the nurses to compensate for the referral and he recruiters get achieved through monetary compensation to encourage the nurses in their duty delivery hence creating a position of recruiting other nurses to the organizations.

Moreover, offering the altered schedules for the accommodation of the professional and the personal needs of nurses remains an initiative of addressing the nurse shortage in the healthcare organization. However, maintaining and achieving professional and personal life balance sometimes becomes difficult for the nurses. As such, the immediate improvement strategies that should be achieved by the nurse leaders get based on offering the altered schedules for the nurses to accommodate the professional and personal needs like offering the special mum shifts for the busy mothers who may have opted to take a leave (Buchan & Aiken, 2008). Also, the ability of the organization to create a part time shift in service delivery accommodate the personal and the professional needs of the nurses hence are creating a framework of choosing the options that fits the personal obligations. Choosing the fit shift makes nurses happy with the service delivery hereby enhance the work balance and promoting the satisfaction and wellness within the organization.

Furthermore, the use of the onboard programs to make new recruited nurses feel welcomed in the service delivery creates the group cohesion hence effective and efficient service delivery which bridges the gap of the nurse shortage and encourages their retention. Also, good onboarding program eases new recruits into the job market hence reduce overwhelming at the first few days at the new job (Challinor et al., 2020). As such, the organization and the management should avoid assigning nurses to the new patients immediately after recruitment. The onboarding program continues to involve the use of new mechanisms that enable the new nurses to know the current nurses for the sense of community encouragements. As a result, the nurses tat feel part of the nursing community are likely to retain their jobs and bring along the qualified friends. Nurse residency program continues to characterize the onboarding program through provision of accommodation that make the nurse feel easier to transit from being the student nurse to handling the nurse responsibilities. The initiative creates a mentorship program through combination of the new nurses with the experienced nurses to create a comprehensive knowledge of caring for the patients.

Conclusion

Overall, the nursing unit forms an integral part of the healthcare system. As such, the increasing challenge of nursing staff shortages poses an increased risk to the health outcome of patients. The main causes of nurse shortages include low income, poor funding for nursing education, and low expenditures on healthcare. Other causes of nurse shortages include nurse burnout, low levels of income, reduced supply of nurses, poor recruitment plans, ineffective planning, and improper use of the available nursing resources. Lack of cultural competence and cultural diversity also cause nurse shortages. It has been established that nurses’ body systems, including the central nervous and cardiovascular systems, are indirectly affected by this healthcare issue. Usually, nurse shortages cause sleep deprivation, thus negatively affecting the aforementioned systems. Also, nurse shortage has shown to impact patient outcome, where the issue results in missed care, in-hospital deaths, HAIs, and medication errors. Furthermore, shortage of nurses is associated with increased medical costs, which are associated with prolonged stays in hospitals. Other effects of nurse shortages include reduced job satisfaction, burnout, and moral distress. Nursing shortages can be improved by improving nurses’ job satisfaction. This can be achieved by launching nursing mentorship programs and improving the workplace environment. Also, increasing healthcare expenditure may increase nurse satisfaction since they will receive higher pay. Increasing nurses’ salary will also make more people to consider pursuing a career in this field. Another solution to reduce nurse shortage is increasing funds for nursing education to make it affordable for students to pursue a career in this field. Also, laws such as Nurse Reinvestment Act, P.L. 107-205, and the Nurse Training and Retention Act of 2007, S.2064 help minimize the problem of nurse shortages. Notably, the Nurse Reinvestment Act pertains to the issue of nursing staff shortages because Title I and Title II pertain to nurses’ recruitment and retention, respectively. On the other hand, the Nurse Training and Retention Act of 2007 aims to ensure comprehensive programs are funded to facilitate a sufficient supply of nurses.

References

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