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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 Intervention

Depression Intervention

Psychotherapy is a term for treating mental health problems which entails consulting with a psychiatrist, psychologist, or other mental health providers. During psychotherapy, an individual learns about their conditions, moods, feelings, thoughts, and behaviors. It does help one in learning how to take control of their life and respond to challenging situations with essential healthy coping skills (Minuchin, & Fishman, 2004).

There are various specific types of psychotherapy, with each psychotherapy approach being unique on its own. The type of psychotherapy that is right for an individual varies within the diverse individual needs and demands. Therefore, each person is entitled a choice of psychotherapy that suits his/her personal conditions. Psychotherapy is a distinct profession in its own right, with many different types of professionals and practitioners engaging in it regularly with a range of qualifications. Such qualifications include psychiatry, clinical psychology, counseling psychology, clinical or psychiatric social work, mental health counseling, marriage and family therapy.

Rehabilitation counseling, school counseling, play therapy, music therapy, art therapy,drama therapy,  dance/movement therapy, and occupational therapy are among other professional qualifications. Besides, this group of professional specializes in psychiatric nursing, psychoanalysis, and other psychotherapies. Individuals wishing to practice this lucrative profession may opt for clinical psychologists, psychiatrists, counseling psychologists, marriage and family therapists, counselors, social workers, mental health counselors, occupational therapists and psychiatric nurses (Compas, & Gotlib, 2002; Minuchin, & Fishman, 2004). Psychotherapy may be legally regulated, voluntarily regulated, or unregulated based on the jurisdiction. Requirements of the mentioned professions vary, but they often require graduate school and supervised clinical experience.

Clinical psychologists are largely responsible for the intervention and reduction of depressions among patients. These clinical specialists are charged with the responsibility of assessing and treating mental illness, abnormal behavior, and psychiatric problems. Psychotherapy incorporates science of psychology with the treatment of complex human problems. Clinical psychologists, in most instances, work in medical settings, private practice, or academic positions at universities and colleges. Some of the specialists in the private practice work directly with clients, those suffering from severe psychiatric disorders.

Some of the clinical psychologists prefer working in private therapeutic settings offering short-term and long-term outpatient services to clients who need help coping with psychological distress. Others will work in other settings specializing in research, teaching university-level courses and offering consultation services (Henrik, 2010). One needs to graduate with a degree in psychology followed by professional examination and evaluation to qualify as a psychiatrist. Besides, psychiatrists must have medical and clinical training. A masters or doctoral degree, and a license, are required for senior psychologists. A doctoral degree usually is required for independent practice as a psychologist.

Cognitive Behavioral Therapy use in Depression Intervention

The cognitive behavioral therapy model entails a vast number of techniques focusing on the construction and re-construction of people’s emotions, behaviors, cognitions (Minuchin, & Fishman, 2004). The therapist, through CBT, helps clients assess, realize, and deal with problematic, dysfunctional ways of behaving, thinking, and emoting. CBT model’s characteristics are time limited, among the most rapid in terms of results. It normally offers a sound therapeutic relationship between the therapist and client, based on the scientifically supported assumption that most emotional and behavioral reactions are learned, it is structured and directive in the sense that therapists have a specific agenda for each session (Compas, & Gotlib, 2002).

Study samples have shown that CBT is an effective method in getting rid of depression. Therefore, it is worth recommending CBT to people suffering from depression and for sure, this form of therapy would be very effective for such group of people. In most instances, depression entails one’s feelings and emotions having been hurt (Henrik, 2010). Through consulting with counselors and psychotherapists, studies have shown that the counseling session is very effective in reducing depression and hence, relieving the patients of the despair.

References

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2008-09 Edition, Psychologists, on the Internet at HYPERLINK “http://www.bls.gov/oco/ocos056.htm” http://www.bls.gov/oco/ocos056.htm

Compas, Bruce & Gotlib, Ian. (2002). Introduction to Clinical Psychology. New York, NY: McGraw-Hill Higher Education.

Henrik, R. (2010). The Psychotherapy Handbook. The A-Z handbook to more than 250 psychotherapies as used today. New American Library.

Minuchin, S.& Fishman, H. C. (2004). Family Therapy Techniques. Harvard University Press.

Depression is the most well-known mental issue among adolescents

Background

Depression is the most well-known mental issue among adolescents with commonness rates going from 15-20% among adolescents between the age of 14-19 year, and it is accepted to be a significant helping variable in Adolescent suicide. In addition, depressive issues are fundamentally more regular in females than in males, with lifetime predominance of 14.1% for females and 8.6% for males. Some epidemiological, group and clinical studies have demonstrated that girls commonly have been found to show more elevated amounts of depressive side effects than young men. This has been ascribed to hereditary qualities, expanded predominance of nervousness issue in females, organic changes connected with pubescence, cognitive inclination and sociocultural variables. Few Canadian studies were directed to research the commonness and symptomatology of pre-adult gloom (). In a study including an example of essential and preparatory schools in the city of Alexandria 10.3% of students showed depressive scores, which were most astounding among the most established age amass (20.3%) (Kerr et al,. 2010). Girls had higher depressive scores when they were contrasted and young men. Adolescents who had a constructive history of suicide endeavors had essentially higher melancholy scores (93.7%) (Kiesner, Poulin & Dishion, 2010).

In the 1999 national study of Canadian adolescents, 59% of the example reported encountering sentiments of apprehension or tension. Forty for every penny of kids with tension issue had a comorbid depressive issue. In the National Comorbidity Survey, most cases reported intermittent depressive scenes and critical part debilitation, including endeavored suicide among 21.9% of those with MDD. Conceal gloom could be diagnosed in adolescents showing hyperactivity, forceful conduct, or misconduct on the off chance that they showed discouraged influence and indicated depressive or negative subjects on projective tests (Kiesner, Poulin & Dishion, 2010).

Dysphoria and/or fractiousness may take the spot of satisfaction and euthymia as the youngster’s prevailing inclination state. Expanding levels of misery, mournfulness, outrage responses, or candid wraths set off by insignificant or minor incitements may be taken note. Abnormal amounts of ecological push and also a couple of key distressing occasions were connected with suicide endeavors; a late sentimental separation or being attacked added to suicide endeavor hazard, past the impacts of psychopathology (Leatherdale & Ahmed, 2010). Once in a while do adolescents look for, all alone, contact with mental wellbeing experts for assessment of creating state of mind indications, in spite of the fact that they might all the more every now and again reach accessible experts or administrations spotted on location in school settings. Adolescents uncover their depressive sentiments all the more frequently through reports toward oneself than to their guardians

Aim of the study

Through this study, the creators pointed:

1- To gauge the predominance of depressive issue in Canadian adolescent females.

2- To gauge the trademark side effect profile of Canadian adolescent females (if there is a trademark profile).

Hypothesis

The speculation of this study was that depressive issue are profoundly predominant among Canadian female adolescents, and that there is a particular symptomatology describing the depressive issue in this age bunch. However accessible writing gives no direction in this matter. Methods

Design of the Study

This study is a descriptive, cross-sectional, school based study.

Site of the Study

This study was led in Ontario, Canada. A specimen of female Adolescent school understudies in Eastern Ontario was drawn. Six schools were chosen from two instructive regions, one locale speak to higher financial status (3 schools) and alternate less well-off status (3 schools). From each one school, 3 classes were chosen and all understudies in each one class were incorporated. Selection (Leatherdale & Ahmed, 2010). Essentially a strategy for examining was taken after permitting every significant variable to help in the constitution of the example an impart that was proportionate to its weight in the guardian populace. Determination of the span of this example was carried out after the interview of a statistician, examining was performed arbitrarily at five levels:

The city (Ontario) has 5 major geological territories from which one was chosen (Eastern Ontario).

2- Educational framework in Eastern Ontario was isolated into two real classifications (Private and Public) focused around financial profile.

From every classification three schools were picked.

Schools were looked over two instructive regions, one speaks to higher financial status (non-public schools) and alternate less well-off status (state funded schools), and those locale were (Heliopolis and El-Zaytoun).

From each one school, 3 classes (one class speaks to every auxiliary evaluation) were chosen and all understudies in each one class were incorporated. Choice of the classes was dictated by the school powers.

Ethical considerations

Amid the time of information gathering there was no moral panel (as of late settled in McGill University), be that as it may; the creators got the acknowledgement of power figures in McGill University and the Ministry of Education before beginning the study methods. Likewise, an educated assent was gotten from every member; they were educated about the surveys being utilized as a part of the study and acknowledged their offering in the study.

Procedures

The information were gathered by immediate talking with of the subjects in suitable settings inside their schools amid a period from the earliest starting point of November 2006 to the end of March 2007. At the time of the examination, an aggregate number of 602 pre-adult female understudies took part in the study, while the quantity of non-partaking female understudies was around 74 understudies. The clear explanation behind non-investment was their unlucky deficiency from school at the time of the study or being missed amid lessons or the time of the break.

The subjects of the study completed the following tools:

The General Health Questionnaire (GHQ), it is a screening instrument for psychiatric sickness so as to recognize potential cases which could then be checked and the way of which could be dictated by utilizing a second stage instrument as it shouldn’t be utilized as a sole standard for analysis, it is basically used to discover casernes. The form utilized as a part of this study is the Canadian rendition of a short 28-things scale with the example scorer technique which is (0-0-1-1). The cut-off purpose of GHQ was 7 as per comparative past national studies to minimize the related misrepresentations with the first low edge score.

The Children Depression Inventory (CDI), which is intended to be utilized as a screening instrument for melancholy in an ordinary adolescent specimen or as a measure of indication seriousness. It is helpful for furnishing the clinician with organized, age and sexual orientation standard referenced data about the tyke symptomatology. The scale is suitable for adolescents and adolescents from seven to eighteen years of age. It comprises of 27 gatherings of proclamations; each gathering comprises of three announcements speaking to the subject’s inclination at the most recent two weeks. The score is from 0-2 as per the manifestation seriousness and the aggregate score extends between 0-54. The cut-off point utilized for this study was 24 as comparative past national studies. It has been institutionalized and meant Canadian dialect. Adolescents who scored more than 24 on (CDI) were further assessed by the accompanying polls:

Structured Clinical Interview for DSM-IV Axis I Disorder (clinician rendition) (SCID-I), a semistructured demonstrative meeting focused around a productive yet careful clinical assessment. The study utilized the Canadian adaptation of the Structured Clinical Interview for DSM-IV hub I Disorders (SCID-I).

The Hamilton Rating Scale for misery (Ham-D) intended to measure the seriousness of depressive manifestations in patients with essential depressive indications, it is the most ordinarily utilized eyewitness evaluated depressive side effects rating scale. Its interior consistency (Cronbach’s alpha) was 0.76, and 0.92. It is an agenda of things that are positioned on a scale of 0-4 or 0-2. Scoring: extremely serious >23, extreme 19-22, direct 14-18, mellow 8-13 and typical < 7.

Statistical Analysis

All information were recorded and exchanged on Statistical Package for Social Sciences (SPSS) Version 17. The results were classified, assembled and factually examined utilizing the accompanying tests:

• Descriptive detail were accounted for as means and frequencies.

• Pearson Chi square test (X2): to distinguish whether there is a critical relationship between diverse downright variables.

• Student t-test: used to test for measurable centrality of fluctuation between two examples implies.

• P quality: used to demonstrate the level of importance: critical is P < 0.01.

Results

The mean age for the mulled over specimen was 15.7 + 0.9 years and 15.4 + 0.99 years for higher and lower social class schools individually. A rate of 15.3% of the mulled over specimen were assessed to meet criteria for sadness as indicated by the CDI cut-off point. While, by the utilization of SCID-I around 13.3% of the mulled over populace was found to have depressive issue, appropriated as 5% sub-edge depressive side effects, 5% MDD and 3.3% dysthymic issue. As per Ham-D, 10% of discouraged female adolescents included in the study were named having moderate depressive state, while 30% had gentle depressive state and 60% of them had subthreshold depressive state (Table 1)

Table 1. Circulation of seriousness of dejection among discouraged understudies, as measured by Ham-D.

In this study the exhaustion or absence of vitality (discovered by Ham-D) was by a long shot the most widely recognized side effect among discouraged female adolescents (81.3%) took after by negativity with respect to the future, feeling miserable, low self regard, psychomotor hindrance, absence of focus, blame, suicidality, sleep deprivation, anhedonia, hypersomnia, weight addition, and ultimately weight reduction and psychomotor unsettling (Table 2).

Table 2. Dispersion of depressive side effects among discouraged understudies, as measured by SCID-I.

This study uncovered that 75.5% of youthful females evaluated as having moderate depressive state had suicidal indications (recognized by Ham-D), 52% of Adolescent females appraised as mellow depressive state accomplished the same side effects, and 43% of understudies with subthreshold depressive state additionally had suicidal manifestations.

Suicidal ideations (answer 3 for the inquiry regarding suicide in Ham-D) were the most well-known of the suicidal indications in Adolescent females, 20% of the specimen of discouraged female adolescents, while the rate of genuine endeavors was 2.5% of the example.

Concerning between depressive issue and other psychiatric issue (evaluated by SCID-I) summed up uneasiness issue was the most pervasive comorbid finding (32.5% of discouraged understudies), emulated by social fear (20%) then substance misuse (8.8%) then over the top impulsive issue (0.1%) (Table 3). Likewise screening by GHQ uncovered minor psychiatric bleakness in 46.4% of Adolescent females.

Table 3. Dissemination of comorbid psychiatric conclusions among discouraged youthful females as per SCID-I.

Discussion

I-Prevalence of depression

A rate of 15.3% of the mulled over specimen were assessed to meet criteria for sorrow as indicated by the CDI cut-off point. The study addressed the first piece of the fundamental theory of the study. It uncovered the point commonness of depressive issue among this specimen of Adolescent females as indicated by SCID-I to be around 13.3%. This commonness is moderately high when contrasted with comparable studies. Kessler and Walters inspected adolescents and youthful grown-ups and discovered the 30-day commonness was 5.8% (significant misery) and 2.1% (minor despondency) as indicated by DSM-IV (Morse et al,. 2008).

Higher predominance of depressive issue among pre-adult females in an Canadian group may be the consequence of a foundation of social, social and enthusiastic insecurity describing this particular age amass notwithstanding the oppression females predominating social orders in a large portion of the underdeveloped nations some of the time announced and more often than not denied, trying to wear cultivated behavior and practices.

II-Symptoms

The second piece of the primary speculation was a trial to outline a particular symptomatology describing misery among Adolescent females. The symptomatology portraying melancholy in pre-adult females was prevailed by weariness and absence of vitality (more than 80%), at times with psychomotor impediment (around 2/3 of the example). Likewise negativity, trouble and low self regard were communicated (around 3/4 of the example). A sleeping disorder was accounted for (45%) ordinary citizen than hypersomnia (33.8%). Weight put on and weight reduction were accounted for, both were accomplished practically ambiguously (around 1/3 of the example for each). Sociality was discovered to be generally high (around 1/2 of the specimen) (Morse et al,. 2008).

Somatic symptoms

In this study the exhaustion and absence of vitality were by a long shot the most widely recognized side effects among discouraged female adolescents (81.3%), notwithstanding psychomotor impediment (62.5%), and psychomotor fomentation (20%). This was as per aftereffects of more established Canadian studies. The clinical profile of psychiatric issue (DSM-III and III-R individually) in the Canadian group was formerly mulled over and they found that physical indications were the most well-known manifestation, among the discouraged Canadian populace. The results were about like that of McCormick, Mathews, Thomas & Waters (2010) who found that the most widely recognized depressive manifestations (measured by CBDI) were exhaustion and physical indications in an example of Canadian adolescents.

Notwithstanding; these results were not the same as those of different studies performed in western nations, the most widely recognized manifestations among discouraged adolescents were sentiments of pity, dismalness, discouraged temperament and slumber aggravations. The error in the middle of eastern and western groups as respects the way the youthful females experience and express their discouragement may be an intriguing zone for future investigates.

In Canadian society, individuals have a tendency to cover their influence with substantial protests, which involve the closer view and the emotional part of their ailment subsides to the foundation. This may be because of more noteworthy social acknowledgement of physical objections than of mental dissentions which are either not considered important or are accepted to be cured by rest or begging. Physical disease and substantial sign of mental misery are more satisfactory and prone to incite a minding reaction than the dubious objections of mental trouble which can be ignored or considered as a shortcoming or a level of craziness. A late study performed by Stein et al (2010) inspected ethnic/racial contrasts toward the start of treatment among members in the Treatment for Adolescents with Depression Study (TADS). African American and Latino youth were contrasted with Caucasian youth on indication presentation and cognitive variables connected with sadness. In opposition to speculation, there were no noteworthy contrasts in indication presentation as measured by the meeting based things of the Children’s Depression Rating Scale-Revised (CDRS-R) (Kendall et al,. 2010).

Emotional symptoms

Adolescent females in this study demonstrated a scope of passionate and cognitive side effects in the setting of depressive manifestations. Negativity (75%), pity (73.8%), and low self-regard (73.8%) were the commonest (Table 2). The self-impression of discouraged adolescents normally are checked by sentiments of insufficiency, mediocrity, disappointment, and uselessness. Assessment of this rule is testing on the grounds that numerous adolescents don’t straightforwardly recognize such negative self-observations. Numerous adolescents specifically report a discouraged disposition a great part of the time, in any case; sorrow in adolescents generally communicates as a bad tempered inclination, on the grounds that numerous adolescents fail to offer the passionate and cognitive advancement to effectively distinguish and compose their enthusiastic encounters

In agreement to the current study, Kendall et al,.(2010) showed a solid relationship between depressive manifestations and thought toward oneself. Contrasted and alternate gatherings, adolescents in a custom curriculum at danger for passionate and behavioral issue demonstrated a noteworthy diminishing in thought toward oneself after age 15. Also, high disguising conduct was connected with more depressive side effects and lower thought toward oneself. In spite of the fact that unequivocally denied by the Canadian group, sentimental connections and fizzled relationships may assume a real part in the etiology of depressive side effects among pre-adult females. These adolescents need to face their disappointments and fix their mix-ups either alone or looking for the assistance of the unpracticed companions and associates.

Vegetative symptoms

Adolescent females in this study had vegetative indications extending in the middle of run of the mill and atypical side effects of discouragement: (45%) experienced sleep deprivation, while (33.8%) accomplished hypersomnia. Audit of writing uncovered distinctive patterns: an inclination to portray atypical depressive indications in the pre-adult age bunches. This may be ascribed to the personality disarray and revolting state of mind towards customs and standards intimated by the family and the general public, prompting evident changes in the slumber example and beat. Rest aggravation is normal in discouraged adolescents, (interviewed by the Schedule for Affective Disorders and Schizophrenia for School-Age Children-and finished the inclination and emotions report toward oneself misery poll) a large number of whom depict their slumber as non-remedial and report trouble getting up in the morning. Rest aggravation shows as a sleeping disorder, hypersomnia or huge movements of slumber example over the diurnal cycle. These discoveries were not as per the current study. Definite dissection of the slumber example ought to be assessed in further research (Hankins et al,. 2010).

As respects weight changes, weight increase was an indication in (33.8%) of the discouraged females, and weight reduction was accomplished by (30%) of them (Table 2). The adolescents are demonstrating an over concern with their physical appearance which is generally the aftereffect of their adjustment to companion gathering impact. Different studies demonstrated distinctive comes about longing and weight changes: anorexia is more common in juvenile girls. While a few adolescents with depressive issue want and consume more particular sustenance (i.e. trash nourishment and carbs) and as needs be put on more weight than anticipated amid their youthful development spurt. Further assessment of longing and weight changes among discouraged Adolescent females is required.

Suicidality

In this study suicidal manifestations (counting last requests, suicidal ideation and suicidal endeavors) were pronounced by (48.8%) of discouraged adolescent females. The recurrence of suicidal side effects was 75.5% among subjects with moderate depressive express (8 subjects). While of the adolescent females enduring of mellow depressive express (23 subjects), 52% accomplished suicidal indications. Interestingly, of the subjects who accomplished sub-limit depressive express (49 subjects) 43% additionally accomplished suicidal indications. These discoveries are higher than the discoveries of different studies however as per them: One of these studies demonstrated that 35% of discouraged adolescents had suicidal indications, Another study demonstrated the rate of suicidal side effects to be 30% among discouraged understudies while a third study uncovered endeavored suicide among 21.9% of the adolescents with real misery. An alternate Canadian study uncovered that suicidal ideation and endeavors were regular among discouraged Canadian adolescents, 30% of the specimen reported that they had solid last requests (measured by CDI) or had a plan to damage themselves (Paus et al,. 2010).

The rate of suicidality in the current study was much higher than the rate recognized by Torros et al (2004) who found that suicidal indications (measured by CBDI) were sure in 6.9% of discouraged Canadian adolescent girls, this variety in results may be clarified by social and religious contrasts bringing about underreporting of suicidal side effects because of alarm of disgrace or blame. The current study uncovered that discouraged adolescent females may have suicidal side effects, notwithstanding the seriousness or number of depressive indications. This discovering shades light on the way that the sub threshold depressive indications in youthfulness -not simply clinical sorrow ought to be considered important. Subjects with sub threshold sorrow ought not to be delegated “non-cases” not one or the other to be dealt with just as they have a comparative anticipation to the individuals who are asymptomatic.

A study performed by Paus et al,. (2010) analyzed suicide endeavors among discouraged essential forethought youthful patients, youth named suicide attempters demonstrated hoisted levels of psychopathology, particularly depressive manifestations, externalizing behavioral issue, nervousness substance utilization, lunacy and PTSD indications. Further assessment of suicidality in this particular age gathering need to be carried out in future exploration.

III-Psychiatric comorbidity

In this study, summed up uneasiness issue was the most common co-horrible conclusion among discouraged adolescent females, notwithstanding social nervousness issue, and substance use (Table 3). This is consonant with different studies which demonstrated that uneasiness issue was the most well-known comorbid issue with despondency.

In the study led by Paus et al,. (2010) aggregate nervousness and stress and oversensitivity side effects were found to anticipate later depressive manifestations more unequivocally for girls than for young men. Physiological nervousness predicts later depressive side effects for both young men and girls. These discoveries which are consonant with the aftereffects of the current study, highlight the criticalness of uneasiness for the advancement of sorrow in youth, especially stress and oversensitivity among girls.

Strengths and limitations

As one of the few studies that have explored the commonness and the symptomology of juvenile gloom, the present study has utilized an extensive battery of psychiatric devices for screening, conclusion and appraisal of seriousness of sadness, the utilization of a semi-organized clinical meeting for finding, not depending on the reports toward oneself. The meetings utilized were straightforwardly tended to understudies not in vicinity of their families which is additionally easing to female adolescents, they want to discuss their emotions in their associate surroundings instead of before parents.

In spite of these qualities, there are a few confinements of this study that require cautious attention in the translation of the discoveries. In the first place, the extent of the example was generally little. Second, the psychiatric analyses were chiefly focused around clinical meetings of study subjects without questioning their guardians. Past studies have demonstrated low assention among kid, guardian, and instructor witnesses in reporting adolescents’ passionate and behavioral issues and the need to join educators’ reports into the distinguishing proof of depressive symptomology. Third, a more complete study would include an instrument for a definite identity evaluation, to prohibit the impact of some identity characteristics on the subjects’ conduct, e.g.suicidality. Fourth, the estimation of suicidality was focused around inquiries inside the Ham-D, this would better be surveyed by a particular scale for suicidality. At last, the setting for the study, as it is realized that administrating self-reports in non-clinical populace may bring about expanded scores. The absence of complete data in psychiatric conclusions for all study subjects has hindered the likelihood for detailed longitudinal examines of psychiatric indications.

Conclusions

The physical side effects were by a long shot the most well-known exhibiting indication for female adolescents experiencing depressive issue. Depressive phenomena including unexplained weariness, diminished vitality, psychomotor changes, absence of fixation, weight changes and self-destructive ideations may be the exhibiting objections rather than the exemplary miserable state of mind.

Further studies are required to check if early recognition of depressive issue in adolescents may influence the course of the depressive disease, and its entanglements i.e. Substance misuse, educational disintegration and suicidality. Further examination of danger variables, longitudinal course of depressive manifestations, level of working, examples of comorbidity, and the psychopathological foundation of juvenile populace at danger would be finishing the picture around there of exploration.

References

Chettiar, J., Shannon, K., Wood, E., Zhang, R., & Kerr, T. (2010). Survival sex work involvement among street-involved youth who use drugs in a Canadian setting. Journal of Public Health, 32(3), 322-327.

Kiesner, J., Poulin, F., & Dishion, T. J. (2010). Adolescent substance use with friends: Moderating and mediating effects of parental monitoring and peer activity contexts. Merrill-Palmer quarterly (Wayne State University. Press),56(4), 529.

Leatherdale, S. T., & Ahmed, R. (2010). Alcohol, marijuana, and tobacco use among Canadian youth: do we need more multi-substance prevention programming?. The journal of primary prevention, 31(3), 99-108.

Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., … & Morse, J. Q. (2008). Sexual orientation and adolescent substance use: a meta‐analysis and methodological review*. Addiction, 103(4), 546-556.

McCormick, C. M., Mathews, I. Z., Thomas, C., & Waters, P. (2010). Investigations of HPA function and the enduring consequences of stressors in adolescence in animal models. Brain and cognition, 72(1), 73-85.

Montaner, J. S., Lima, V. D., Barrios, R., Yip, B., Wood, E., Kerr, T., … & Kendall, P. (2010). Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. The Lancet, 376(9740), 532-539.

Strathdee, S. A., Hallett, T. B., Bobrova, N., Rhodes, T., Booth, R., Abdool, R., & Hankins, C. A. (2010). HIV and risk environment for injecting drug users: the past, present, and future. The Lancet, 376(9737), 268-284.

Toledo‐Rodriguez, M., Lotfipour, S., Leonard, G., Perron, M., Richer, L., Veillette, S., … & Paus, T. (2010). Maternal smoking during pregnancy is associated with epigenetic modifications of the brain‐derived neurotrophic factor‐6 exon in adolescent offspring. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 153(7), 1350-1354.

Tonmyr, L., Thornton, T., Draca, J., & Wekerle, C. (2010). A review of childhood maltreatment and adolescent substance use relationship. Current Psychiatry Reviews, 6(3), 223-234.

Depression, Counselling Theory

Depression and Counselling Theory

Counselling Theory Paper

George is an elderly man, aged 68 years, who showed serious signs of depression and addiction to alcohol and narcotics. He also exhibited signs of being a mentally ill man, who knows his past mistakes in life and sees no reason to even try changing his current situation. He is a divorced man who has little contact with the social world and the only relationship that he currently has is with his dog Spike. I decided on using the Cognitive Behavioral Therapy (CBT), as the most appropriate counselling theory to help him.

Rationale for Selection of CBT

The rationale behind choosing this specific theory is due to the capabilities of the theory and the nature of the case at hand. According to David, 2006 CBT, it is based on the premise that people should learn to let go of their past and focus on improving the future. Central to this therapy is that it focuses on talking. This allows people to express what they feel without fear of judgement (Williams, et al, 2013). According to Blehar, 1997, CBT works also when used with people who have an addiction to something.

George can very well express himself and his life with detail and precision; this is why this therapy best suits him. For a person of his age, he has good memory and is able to remember issues that had happened earlier in his life even under the influence of alcohol. George has serious cognitive impairments; he was able to score 15 in the MMSE test and a 45 out 60 in the CES-D score which is a clear indication of cognitive impairment. George is also an alcoholic, he uses drugs like marijuana and even hard core drugs to help him ease his thoughts and to feel better. George is also willing to corporate with the therapy; this is mainly because he recognizes the fact that his life is not exactly how he wanted it to be at his age. As much as the therapy is not meant to cure the physical ailments and addictions of George, it is meant to create an empowering foundation and a more optimistic way of dealing with his problems. His fear to face the future is hindering him from achieving the best he can in relationships.

Initial Problem Selection

George is a man troubled by many issues but I chose to deal with two of his problems, depression and addiction to alcohol and narcotics. From the interview, it was clear that George’s divorce had taken a toll on him. This was because it made him lose all personal contact that he had maintained earlier on. He has also lost touch with his religion. As a Muslim he was a dedicated follower but all that was lost ten years ago when he started eliminating himself from the society and all types of relationships.

According to Knight, 2006, depression is usually revealed when the individual pulls himself away from the society. This is because they feel that they are better off being alone as nobody wants to be with them. At this point George feels like there is no way his problems can be solved by anybody. This explains the reason as to why he is afraid to patch things up with his ex-wife. At this point he is afraid of starting any form of relationship with anybody and that is why he has had no intimate or friendly relationship with anybody in a long time.

Roth, Pilling and Hill, 2009, state that depression is associated with low self esteem and self criticism. Counselling for depression is a model that targets emotions that mostly are underlying and are the root cause of the depression. It is also meant to bring out the emotions that make sense to the person but must initially come from them for them to be willing to try them out in their lives. Roth, Piling and Hill devised a framework on how to help people with depression called the humanistic framework. It is based on allowing all the negative emotions and issues to come out and then the positive ones will slowly come out. The results of the experiment done at the Pearson Centre proved that people do indeed have the ability of coming up with the best solution for themselves but first they must be given that chance to do it themselves and must be dedicated to it as well.

The framework will work for George because from the interview it was clear he is suffering from clinical melancholy, which is depression couple up together with some cognitive problems.

Discussion of the Model

I will show how the qualifications that make George to fit into this framework.

The framework focuses on a step to step follow up of the individual who experiences different events in his life that ultimately lead to depression while others are as a result of the depression (Scherer, 2009).

First the individual makes a few wrong decisions in their lives. George had always wanted to have the life that everybody wants, a nice job and a lovely family. But somewhere down the line he made some few mistakes that caused him to lose some of these things and he now sees his mistakes.

The next step is that the person is caught up in looking at his mistakes instead of finding clear solutions to them. Instead of focusing more on what he still had even after making his small and major mistakes, he focused on the mistakes. This is evident from the fact that after he divorced his wife he completely cut all contact and relationship with everybody else. After his divorce, he saw no need of going to mosque and with that he lost a relationship with his God. He also let his relationship with his mother be reduced to an occasional phone call. His relationship with his brother is no longer the same and the one with his daughters is even worse. This cannot even describe the relationship with his friends because i is no longer in existence, he believes that they avoid him since he has his problems.

The third step is that the persons self esteem is seriously affected and they criticize themselves very harshly. George’s self esteem was seriously affected; this is the reason why on looking at him during the interview he looked unkempt. His uniform was dirty and he was not shaven. Hours after his shift ended he is still in his uniform while most people cannot wait to leave work and take off their uniform. This is because he sees no need to do that, to him it is not worth the trouble. He also believes that nobody wants to be associated with him, according to him he is not the one who pulled away from his friends, they are the ones who avoid him because they believe that he is mentally unstable. He is even not sure about reconciling with his ex-wife and it is not because he does not love her and does not long to have some company but it is because he feels he has failed her too much in the past and he doesn’t deserve her taking him back. He feels like he is failure and does not deserve to have someone with him.

The last step is when the person takes up a destructive addiction or activity that helps him escape from the world and feel better for just a while. The other step was George turning to alcohol and drugs and becoming addicted to them. He consumes alcohol because he believes it is the only way he can relieve himself of the stressful issues that he has. To him, there is realistically no way of solving as it is too late. Time has passed too much and there is not much that can be done. Once he uses these drugs and consumes alcohol he goes to another world where he gets the chance to get away from all the worries.

At the heart of the model is the interaction of emotions that lead to some cognitive and behavioural attributes;

Lacks of paying attention to the small things in life, for instance most people do not brush their teeth nor shave their beard. This is the behavioural character that is very visible on George. People also forget the day of the week, George can hardly remember the date and avoids doing any calculation on the test and does not write much on the questionnaire. This is because he probably finds it difficult to do simple addition and subtraction. This means that he is not interested in the events and occurrences of the country for instance politics, economics and even security matters. To him they are of less concern and there is no need to get to know them.

Poor communication skills are exhibited; this is because the people feel like others cannot understand them when they speak calmly. They may feel the need to act it out when trying to explain a specific point. This is reason as to why George feels the need to throw his arms out while speaking. This is because in his mind, he thinks that what he is saying will not be understood unless he actually demonstrates it using hands.

Denial is also a major emotional and cognitive defence mechanism. This is exhibited by tendency not to admit to some situations (Scherer, 2009). During the interview, George also skips over things that he does not feel like talking about. This means that his problem is actually bigger than he is willing to agree. The fact that he believes that he only drinks because he is lonely at times and not because he is an addict is also another point of denial.

Implications for Treatment

The treatment will be done in three phases the early, middle and final stage. This will be done in roughly 15- 20 sessions with George. At the end of the treatment there will be certain expected results and changes.

According to Williams, et al, 2013, the move to another stage will only be possible after the successful completion of the previous stage. The early stage is made up of discussion with George on the strategy to be used, to collect the necessary data required and all relevant information. It is in this stage that George gets to reveal his expectations at the end of the sessions and after several months after the sessions as well.

After that we shall move on to the second stage, at this point there will be several experiments performed to see if the strategy and the framework completely fits his situation, several adjustments can be made to ensure that the strategy is efficient (Blehar, 1997). It is also at this stage that we deal with George’s emotions, as stated earlier he will let all the negative emotions come out and with little assistance he will come up with a suitable and realistic solution that can solve his depression, fears and help mend his relationships. In the final stage, there will be the termination of the sessions and also the implementation of a strategy that will avoid relapse into depression and alcoholism.

During the first stage, all information and data pertaining George will be revealed. This is because the information in this stage will be used in the next stage. George is expected to grasp the seriousness and conceptualize the CBT and all the expectations from him. All the pre existing issues from his decision to leave the basketball sponsorship will be addressed and will act as a foundation in his case.

In the second stage George will bring out all the negative emotions, what he actually and truly feels so that it can lead him to alcohol and to shut himself away from the rest of the world (Blehar, 1997). All the broken relationships will be discussed and the various ways in which they can be amended. It is obvious that George knows some of his mistakes but what he does not seem to know is how to solve them especially at this time when he has grown old. As a father, a son, a brother and a friend he has a role to play in these relationship. He has to come up with the solutions but a relationship at a time to avoid overwhelming him. Having closure is something important in any relationship, it may not mend it but it will help one not to carry emotional baggage.

In this stage George will explain how his life was like before all the changes and which aspects were there and he would like to have back. He will experiment by trying out some of the interests that he had prior to adopting the alcohol drinking habit. It is also at this point that all the negative side effects of his current life will be made to him; however he has to be the one to point out what exactly he feels he is ready to start changing. This will give him the chance to voluntarily give out information.

In the final stage, as the sessions are terminated there will be strategy that will be aimed at ensuring that George will have a social life that includes at least taking spike for a walk in the park full of people and trying out the outside world with his new friend and see if he can make new friends. George is expected to create a new habit that takes the place of drinking alcohol, for instance playing a sport or even reading a book. Then termination will occur with follow up to take place periodically.

Further Discussion

Although this paper is basically supposed to be dedicated to George and his psychological issue of depression, it is also going to dedicate on a few other issues that George is going through and how to best resolve them. These are issues that can be solved by CBT and others cannot be solved by it. It is limited to the psychological aspect of George.

At the age of 68 years George is still physically able to provide for himself but with time he will retire and will be dependent on other people. this is the high time that he solves the issues to do with his mother and daughters before it gets to the point that he completely has no other alternative.

George has cognitive impairment that requires to be treated. This is evident from his lack of coordination of the issues during the interview. This can be as a result of alcohol consumption over the years. This is because alcohol with time decreases proper mental and physical coordination. This may be the reason as to why his hygiene is questionable. Medical intervention is required as there be other physical negative effects that he has developed over the years and during the interview I was not able to detect. For a proper evaluation, a full body check up should be embarked on.

Due to years of withdrawing from the social world, he may be willing to go out there to make friends but may not know how to. He may require a few sessions to be conducted outside in the open where there is interaction with people. This being a person who is looking to stop alcohol intake and is looking for a new hobby, a visit to a golf court would be highly recommended. This however easily follows during the follow up sessions.

Conclusion

George has gone through many traumatic and tough times and he is only human to feel stressed. However he feels judged and this has made him to shrink further and further away from the society. At this point his ex wife is trying to reach out to him but he is way too deep and sees just a failure who will fail her again.

George dedication to the process and strategy will help him to be able to restore his life to the way it was if not better, but he still requires all the other to be willing to help in this process as well. This is because someone may dig themselves into a hole that gets too deep. But when at low place the only other place to go is up and this is his situation. He is willing to come up but he just needs the people around him to help dig his way out.

With a little help from his family and friends George will be able to solve all his psychological problems and become a well off productive citizen.

References

Cognitive-Behavioral Interventions With Older Adults: Integrating Clinical and Gerontological Research, Derek D. Satre, Bob G. Knight, and Steven David, 2006, Professional Psychology: Research and Practice, Vol. 37, No. 5, p 489-498

Psychotherapy for Depression in Older Adults, Edited by Sara H. Qualls and Bob G. Knight, 2006, Wiley Series in Clinical Geropsychology

Counselling for Depression; Critical look at Cognition, Roth, Pilling and Hill, (2009), Pearson Print Press

The Psychological Treatment of Depression, J. Mark, G. Williams, 2013, University of Oklahoma Print Press, p324-455

The cognitive Psychology of Depression at Old Age, Ian H. Gotlib, Howard S.Kurtzman, Mary C. Blehar, 1997, p 94- 150

Self stigma and Psychological Depression; Help Seeking for Depression, Joshua Scherer, 2009, p 7-56.

Nursing as Moral Argents

Nursing as Moral Agents

A moral agent does things with reference to knowing what is wrong or right and can personally be held responsible for his or her actions. In the nursing profession, nurses are seen as people who care for patients in almost every aspect of life. Their main duties being to provide the best possible care a patient can receive. In their code of professional conduct and business values, they should be responsible for every action and decision they make in their line of duty (Allen, 2011). Nursing can be practiced by anybody, for example, a family member may decide to take care of another sick family member. The only difference here is that a professional nurse works with certain set codes of nursing conducts and business ethics.

It, therefore, means that, nurses must hold moral competency in their duties for the delivery of good healthcare to the patients. Competency is the ability of a person to deliver good outcomes in their duties at all times. Competency in nursing includes the possession of basic nursing skills and the technical knowledge of handling different medical equipment and the ability to read and interpret medical reports that will lead to the delivery of the desired services by the patients. Morally, competent nurses will always advocate in the best interest of their patients. Many nursing councils have adopted advocacy as an essential part of the nursing career with the main focus being on the safety of patients

Reports of past occurrence show that patients get involved in fatal incidents such as injection of wrong drugs, suffocation due to lack of enough oxygen and also prescription of wrong medication. In a bid to help nurses act more responsibly, the American Nurses Association (ANA) have developed new work standards for nurses.

Nurses on their parts, have to demonstrate high levels of competence in caring for patients. They must possess the necessary basic skills required to carry out their duties. Nurses also should have and uphold the values that their profession demands. The values range from personal, social, and professional. These are the major indicators of ethical competence in the nursing profession. Nurses do a great deal of work in terms of caring for the patients. It doesn’t only involve classwork as there is so much of practical work involved. Nursing is a field that demands much more than just classwork. They must have desire to help a suffering person. According to Allen (2011), compassion is another key component in the moral competence of a nurse. It is not just only responding to the suffering of others, but is more of an obligation in the nursing practice. Kindness and loving are other core values in the moral competency. Nurses must always feel love for the patients they care for and be kind to them at all times. As a result, strong trust will develop between the nurses and their patients, thereby aiding in the recovery process of the patients. Consequently, these two values should be included as values of moral competence that nurses must exhibit and uphold in the nursing practice.

Responsibility is a value that expresses the level of accountability by the nurses. It implies that nurses do what is right and make decisions from an informed position, for example, call for an emergency when it is necessary. Therefore, nurses need to recognize mistakes and quickly correct them so as not to compromise their moral obligations. Discipline is another key value for nurses who want to be morally competent (Basavanthappa, 2008). Being disciplined in nursing is the ability of nurses to carry themselves with dignity in discharging their duties and be able lead an organized life. With high levels of discipline maintained among nurses, they can perform much better in a social environment where they get to interact with many people of different kinds. It goes a long way in cultivating the liaison between nurses and their patients. This value, however, should come from the inside of a person and not necessarily leant or practiced. Studies have shown that nurses who uphold high standards of discipline in their jobs have goods records of successful recoveries of most patients. Honesty is another value that focuses more on the nurses to uphold the truth and avoiding deceit as well as being truthful to others. Consequently, nurses will be able to make good judgments on their actions. It also involves clearing up any misunderstandings that may arise and thereby creating a healthy working environment for both the nurses and their patients. Lastly, respect for human values is very crucial for nursing practice. Without the respect for human values, patients may feel lost and as not being part of others. Nurses meet different patients with different needs, but all these patients must be treated equally to help them feel appreciated and respected for who they are (Basavanthappa, 2008). As a result, this will aid in improving their general health and at the same time reducing the sense of feeling lonely among them.

In conclusion, nursing profession calls for more than just passing exams in the classwork. It should reflect the passion one has for helping others. Nursing practice is a field that is guided by the set work ethics, and also the ethical standards that a person aspiring to be a nurse must uphold.

References

Allen, J. E. (2011). Nursing Home Administration. New York: Springer Pub.

Basavanthappa, . (2008). Community Health Nursing. S.l.: Jaypee Bros. Medical P.

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

Act, N. R. PL 107-205 (2002). Washington, DC: US Government Printing Office.

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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

Dementia, Pathophysiology and Etiology

Dementia: Pathophysiology and Etiology

Dementia is a brain disorder that affects an individual’s thinking and reasoning capacity. Dementia involves a combination of many neurodegenerative diseases and conditions that affect daily activities as opposed to a single disease. It mainly affects neurons and cells in the cerebral cortex causing deterioration of function in the cortex (Alzheimer’s Association Web). Dementia mainly affects older people aged 65 years and above because old age is a contributing factor. Neurodegenerative disorders are the main causes of dementia, with Alzheimer’s disease contributing 60-70% of the cases (Davis Web). Other diseases associated with dementia include dementia with Lewy bodies and frontotemporal dementia. The diseases often cause brain damage leading to premature brain degeneration and cell death. Thus, an individual’s mental activity is affected, causing memory loss and thinking incapability. The collection of isolated proteins in the brain is the main cause of brain damage that leads to dementia. Dementia is often not a hereditary disease, but a few cases of frontotemporal dementia and Alzheimer’s disease can be hereditary. Shortage or interruption of blood supply to the brain often causes vascular dementia. Other causes of dementia include vitamin B and thyroid hormone deficiency, head injury, brain tumors, prolonged alcohol abuse, and depression (Bourgeois and Ellen 17).

Signs and Symptoms of Dementia

Dementia often manifests itself in various symptoms, both mental and physical. Memory loss and inability to reason are the main symptoms of dementia, where an individual fails to keep track of vital things such as wallet and keys, forgets to pay bills, prepare meals, or appointments. The individual also experiences difficulty communicating, organizing, planning, handling complex tasks, coordinating and other motor functions. In addition, the individual also suffers detrimental mood swings, hallucinations, paranoia, irritability and other personality changes. Visual perception and disorientation such as getting lost easily are also symptoms associated with dementia. Most dementia signs and symptoms are progressive and worsen with time; thus, early diagnosis is recommended for treatment, management and future planning (McNamara 35).

Treatment of Dementia

Most cases of dementia such as Alzheimer’s diseases have no cure, and treatment options often aim at reducing symptom development. Both drug and nondrug options are available for the management of dementia. Drug based options include medications that help in boosting the levels of chemicals associated with memory and judgement in the brain. The drugs include galantamine, rivastigmine and donepezil. Memantine is another drug that helps in the regulation of glutamate, a brain chemical that controls essential brain activities such as memory and learning. Nondrug options include therapies and lifestyle adjustment (Bourgeois and Ellen 133). Occupational therapies are often recommended to help an individual cope with the condition and adapt to daily activities and movement while living with dementia. Modifying the environment helps an individual function and focus by reducing noise and clutter. Handling the individuals with care, such as avoiding scolding, correcting, or quizzing them helps improve the condition. Making tasks easier to reduce confusion for people with dementia is also essential in managing the condition.

Prevention of Dementia

Dementia can be prevented by adopting various behavior and lifestyle changes. Both physical and mental activity helps in delaying the onset of the condition and reducing its symptoms. Engaging in various activities such as board games, memory training, sports, and social interactions help in keeping an individual active. Lifestyle changes such as adopting habits that aim at lowering the blood pressure and quitting smoking help in reducing the risk of dementia. Maintaining a healthy diet rich in omega 3 fatty acids, vegetables and fruits helps in boosting an individual’s health and reducing the risks of dementia. Research has also revealed that reading and pursuing education helps the brain to build a strong network of nerve cells that help in compensating the brain damage caused by neurodegenerative diseases (MediLexicon International Limited Web). Thus, education helps in reducing mental decline that often leads to dementia.

Works Cited

Alzheimer’s Association. What Is Dementia? 2014. Web. 26 May 2014.

Bourgeois, Michelle and Ellen Hickey. Dementia: From Diagnosis to Management – A Functional Approach. Boca Raton: Taylor & Francis, 2011. Print.

Davis, Charles. Dementia. Medicine Net, 1996. Web. 26 May 2014.

McNamara, Patrick. Dementia. Santa Barbara: ABC-CLIO, 2011. Print.

MediLexicon International Limited. What is dementia? The signs, symptoms and causes of dementia, 13 Mar. 2009. Web. 26 May 2014.

Democracy in America Review

Democracy in America Book Review

Introduction

Democracy in America is a book that consists of two volumes. The author of the book, Alexis de Tocqueville, completed the first volume in 1835 and the second one in 1840. In 1831, Tocqueville was working as a lawyer in his country (France) when the county’s government sponsored him for a nine-month visit to America to study various aspects related to American democracy. Tocqueville was sent together with Gustave de Beaumont, who was working as a magistrate. The two gathered information through interviews from more than 200 Americans on various topics related to social practices, law and politics (Tocqueville, 2007). Although the primary aim of the book is to examine the purpose and extent of democracy in America, it has extensive information pertaining communication studies. Among other concepts, the book explains the source of American culture and language. The impact of democracy and institutions such as Jury and religion freedom of speech in America is also explicit in the book. The second volume provides an extensive explanation of how democracy influenced Americans to focus on practical science rather than theory. The ultimate impact was deficiency in quality of their products, including drama, literature and poetry works (Tocqueville, 2007). The book is unique in the sense that some of these concepts are hardly explored in communication studies. The extensive exploration of such concepts makes the book qualify for the purpose of study in our communication class. This paper provides a reflective analysis of various concepts that relate to communication studies in the book.

Analysis

In the first volume of the book, Tocqueville begins with exploration of social and cultural aspects of people who lived in different parts of America in early 19th century. Tocqueville notes that the Red Indians who inhabited different parts of North America prior to the entry of people from other regions were socially disorganized and relied more on hunting than agriculture. As people from different parts of the world moved to America, they interacted and started using the same language, which ultimately ended up in building American English (Tocqueville, 2007). The natives also learned the new language and started sharing it with the immigrants. English language was more influential since North America was once a British colony. The Britons, who migrated to America, exerted their influence to the natives and slaves in different aspects of life, including language. They applied criminal and political laws which were borrowed from Britain in North America. However, there was slight modification in laws that were meant to meet the conditions that existed in America (Tocqueville, 2007). Also, people from different social and cultural backgrounds practiced some social and cultural aspects of their forefathers, especially the natives. They also shared different cultural aspects. As a result, American people had a unique culture and language. When reading the first three chapters of the book, I found out that it provided a brief explanation of how the current unique America culture developed. The book enhanced my knowledge about how people from different cultural and racial backgrounds in America ended up having one common culture and language . Exploring how a society built up its culture and language is one of the key concepts explored in communication studies.

In chapter sixteen of the fist part of the second volume, Tocqueville gives an elaboration about how the unique language of Americans was built. According to Tocqueville, the myriad of changes in cultural aspects of American people was highly facilitated by the presence of democracy that was practiced by rulers, rather than aristocracy that was present in countries such as Britain and France (Tocqueville, 2007). Tocqueville notes that the English language that was being spoken by educated people in Britain had significant variations from the English language that was spoken by educated people in America. According to Tocqueville, language usually remains static in a country where autocracy is embraced. Changes hardly occur to the existing words and new words are hardly invented in an autocratic system. This, according to Tocqueville, explains the fact that no significant changes took place in the English language that was being spoken by educated persons in Britain (Tocqueville, 2007). On the other hand, Tocqueville noted that persons in democratic systems like making changes even without good reasons. This is evident in their politics, as well as in their language. Even when they do not have to change words, they try to transform them. In most cases, the new words that are invented by people in a democratic system tend to represent new ideas. They borrow ideas from the daily activities they engage in. According to Tocqueville, this explains the reason many words added by Americans to their English language were acquired from the language of trade, mechanical arts and jargon of parties (Tocqueville, 2007). I found this chapter being quite relevant for communication studies since it provides an explanation of the impact of democracy and aristocracy on language. I had never encountered the concept before or thought about the connection. I learned that democracy and aristocracy have different impacts on language.

In the second chapter of the firsts part of the first volume, to Tocqueville explores the issue of equality and freedom in American society. Tocqueville noted that people of American had a passion for equality and freedom. Tocqueville also explores the same issue in chapter two of the second part of the second volume. Although Tocqueville is concerned with the possible negative impact of too much passion for equality, he notes that equality and freedom coexisted in American society (Tocqueville, 2007). According to Tocqueville, the two were able to coexist because of existence of a local government that supported ways of exercising freedom by citizens. Tocqueville elaborates the issue through explaining key local liberties that were offered to citizens in laws in chapter five of the first part of the first volume. Also, Tocqueville explains that the existence of an independent jury that supported and propagated the local liberties played a major role in enhancing freedom in America. The impact of the jury is explained in length in chapter sixteen of the first part of the first volume. In addition to the existence of jury and laws supporting freedom, Tocqueville noted that religion played a major role in enhancing freedom in America. According to Tocqueville, religion played the role of teaching Americans how to utilize their freedom well. As a result, the government hardly intervenes through interference of freedom. Tocqueville gives a lengthy explanation of the connection between religion and freedom in chapter nine of the first part of the first volume. One of the key impacts of the ultimate freedom noted by Tocqueville is freedom of speech. Tocqueville notes that journalists were hardly restricted in writing content on newspapers. Also, people had freedom of speech which was recognized in laws. Thus, after reading the book, I learned that freedom of speech existed in America for a long time ago. I discerned the source of the current rights of freedom of speech that that are enjoyed by American people (Tocqueville, 2007). I felt that this might have been one of the factors that led to growth of journalism in America. Freedom of speech and how people utilize it is an important concept for communication studies and thus, I found the issue as being important for exploration in our communication class.

In chapter ten of the first part of the second volume, Tocqueville noted that Americans were more concerned with practical science than theory. According to Tocqueville, this is due to the fact that democracy is not conducive to abstract knowledge that is applied in theoretical science, which requires mediation and thought. Although this leads to an increase in material prosperity and innovation, people may end up forgetting principles and hence, dwindle away civilization (Tocqueville, 2007). In the next chapter, Tocqueville notes that this is one of the reasons why Americans focused on quantity and not quality when producing their artistic works. They were less concerned with reality and more concerned with appearance. This could also explain the reason why the Americans did not attach importance to the meanings of monuments, despite being plenty. Rather than taking an intellectual endeavor in literature, Tocqueville notes that people in a democratic society perceive it as a trade and take an industrial spirit. Tocqueville elaborates this issue in chapter fifteen of the second volume in which he explores the differences between American literature and Latin and Greece literature. According to Tocqueville, Latin and Greece literature of aristocratic ages indicated that they did nothing at random or with haste; rather they concentrated on every line that they wrote and tried to achieve perfection. In short, their literary works portrayed exceptional skills (Tocqueville, 2007). On the other hand, the literature works written during democratic ages, such as during the period when Tocqueville visited America, were naturally deficient and did not portray keenness. In addition, Tocqueville noted that the literature works produced during aristocratic ages have remained relevant throughout, unlike most of the literature works of democratic ages, which quickly became irrelevant. According to Tocqueville, the same applies to other aspects of literature such as poetry and drama. For these reasons, Tocqueville argued that the significant disparity between literature works of aristocratic ages and democratic ages implied that literature of democratic ages should not be read (Tocqueville, 2007). When reading chapters nine to eighteen of the first chapter of the second volume, I realized that Tocqueville exposed the negative impacts of democracy on various communication aspects of people, including artistic works, literature, poetry and drama. I did not know about the connection before. I learned that much of the existing literature is borrowed from countries in which aristocracy has existed for a long time and hardly from countries in which there has been democracy. This is an issue that relates to communication studies and would like to explore and understand it further.

Overall, I found Democracy in America as being a useful book for communication studies. Tocqueville gives a background that enables the reader to understand the source of the current unique culture and language of Americans, despite the fact that their forefathers have different cultures and languages. Further, the Tocqueville explains the impact of democracy and institutions such as religion and jury in enhancing freedom in America, which has had a positive impact on freedom of speech among Americans. As well, the book gives an elaborate explanation of the reason why American literature, poetry, drama and other communication aspects created during democratic age might be deficient in comparison to those that were create in aristocratic ages in other countries. The existence of such concepts, which are extensively explored, explains why the book can be recommended for reading in class.

References

Tocqueville, A. (2007). Democracy in America. Ed. Isaac Kramnick. Trans. Henry Reeve.

New York: Norton.

Nursing Staffing challenges in Maryland

Nurse Staffing challenges in Maryland.

The medical profession has been witnessing rapid growth mostly in the demand for the primary care services. Although this growth was somehow expected, it has not been accompanied by an increase in the number of doctors. This has led to the health care industry in Maryland calling upon the nurses into action.

Unfortunately, the nursing field is also facing its own shortages in staff numbers and who operate under very demanding schedules. Previous studies like the one by the University of Maryland Nursing School (Nursing research 2011 quoted in Rajaraman, 2013). One of the issues that were associated with low numbers of staff was the long hour shifts. These long hours at work and reduced off job hours contributed to poor patient handling and even deaths from avoidable errors.

The cadres that have been targeted mostly to replace the physicians are the nurse practitioners who have the skills to perform the tasks of a physician. This is only a stop gap measure since as indicated above; this has a domino effect on the lower job cadres.

Currently, Maryland’s population of nurses stands at 49,600, registered nurses who are active. Of these, 3,500 are nurse practitioners which mean they hold master’s degrees and a board of nursing license. The Government of Governor Martin O’Malley has committed to increase the population of nurses by 25% by 2020 partly via improving educational access as well as address the burden the medical staff faces (Gantz 2012).

In the words of Phyllis Snyder the vice president of the council for adult learning, it is not business as usual and we have to develop a variety of new pathways. One of these ways has been the concerted effort by health advocacy groups and nursing training institutions towards increase their drives towards having more students in the college level to choose nursing as a career. The groups are also encouraging nurses who are already in practice to pursue higher qualifications (Hoffman & Kaplan, 1998).

Schools have also embarked on missions to make nursing studies more accessible and affordable through inter schools partnerships, credit earned against prior experience and offering support towards tuition. The state on its part is designing ways in which it enhances access to nursing training as well as attracts more nurses into the state’s workforce.

An earlier report from the CGME (Council for Graduate Medical education) had established that only fewer than 20% of med school grandaunts pursue primary care as careers instead going for specialties with higher pay (Goldfarb, Goldfarb & Long 2008).Under the prevailing circumstances, nurses have been more than willing to take up the challenge of filling the gap but are forced to grapple with regulation and bureaucracy issues. For example, an assistant dean at the school of nursing University of Maryland Jane Kapustin bemoans the fact that she can legally diagnose diabetes at the university of Maryland Medical Center diabetes clinic, issue a prescription for insulin and commission tests but if she were to recommend special shoes, a physician would have to sign against the order.

It is encouraging to note that nurses in collaboration with advocacy organizations are exerting pressure to have the barriers reduced and it is hoped that these efforts combined with the pressure from increased need for additional primary care providers will eventually break the barriers.

References

Gantz S (2012). Maryland Nurses Come to fore as care landscape shifts, Baltimore Business Journal. Retrieved from http://www.bizjournals.com/baltimore/print-edition/2012/07/20/nurses-come-to-fore-as-care-landscape.html?page=all.Top of Form

Goldfarb, M., Goldfarb, R., & Long, M. (January 01, 2008). Making Sense of Competing Nursing Shortage Concepts. Policy, Politics, and Nursing Practice, 9, 3, 192-202.Top of Form

Hoffman, S., & Kaplan, M. (January 01, 1998). Problems encountered in the implementation of dementia care programs. American Journal of Alzheimer’s Disease and Other Dementias, 13, 4, 197-202.

Rajaraman M (2013) Study suggests link between lengthy Nurse shifts and patient deaths. Southern Maryland online. Accessed from http://somd.com/news/headlines/2011/13155.shtml.Bottom of Form