Tests and Nursing papers

TOPIC:

The purpose of this paper is to introduce the Licensed Practical Nurse to the ethical and legal principles that guide a Registered Nursing practice by reading an excerpt from Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital by Sheri Fink and applying the ethical and legal principles that guide nursing practice.

PAPER DIRECTIONS:

Overview of the ethical/legal issue:

Summarize an ethical/legal issue from Five Days at Memorial.

Identify the ethical/legal issue.

Identify the stakeholders in the situation.

Identify possible solutions:

Identify two possible solutions

Analyze each possible solution using:

The Pa Nurse Practice Act: https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/Pages/Board-Laws-and-Regulations.aspx (Links to an external site.)

Identify the best solution:

Choose one of the two possible solutions to the ethical/legal issue and discuss why it is the better choice.

Support your choice with evidence (references).

THIS IS THE EXCERPT TO READ TO HELP WITH THE QUESTIONS

“AFTER A DAY and night working downstairs, LifeCare nursing director Gina Isbell returned to the seventh floor and was surprised to see “Miss Alice” Hutzler and her roommate Rose Savoie still in their shared room instead of in an evacuation line. Hutzler looked dehydrated and barely responded to her. Isbell felt guilty. She remembered she had promised Hutzler’s daughter she’d take good care of her.

   Isbell took a short break in an empty room, peeling off the thick white T-shirt, blue scrub pants, and tennis shoes she had worn for days. She washed herself down as best as she could with baby wipes and put on a clean pair of jean shorts and a light gray T-shirt she had picked up from her car, where she had enjoyed another burst of air-conditioning. She sat down to have a Ding Dong and make some instant iced tea. A doctor passed the room. Isbell didn’t know her name, but she recognized the short woman with the fluffy hair, having seen her on the floor earlier in the week.

   Isbell offered Anna Pou a packet of powdered iced tea for her water. “I think I will have a tea,” Pou said softly. She wore a scrub shirt with the arms ripped off and little shoes. She looked sad as she walked away.

   One of Isbell’s favorite nurses, a friend from school, Andre Gremillion, approached her looking upset. He had been down to the second floor. The other workers, he said, didn’t seem to realize there were still patients on the seventh floor. One told him they were under martial law, that “Baptist” was evacuating its employees, and anyone who could walk needed to go. “From what they telling me downstairs,” he said, “everybody’s leaving.” He was afraid LifeCare staff members would soon be the only ones there, with nine patients still to transport from the seventh floor. “If everybody leaves, who’s gonna move the patients?”

   Several LifeCare leaders went down to find Susan Mulderick.

   “IF YOU WANT your suitcase that badly, you’ll have to swim out with it!”

   Mulderick lost her temper with a hospital employee’s family member who insisted on the right to carry a very large suitcase onto an evacuation boat. The rule was at the most one small bag, sometimes just a wallet, no suitcase, no pets.

   Mulderick couldn’t take two steps without running into someone having a conniption and who felt the need to share it with her. She had walked the floors for two days, shouldering people’s tension, anxiety, and panic. Two nurses who had brought teenage children to Memorial had come to her in tears saying they had to get out. When she told them there were still patients to be cared for, they had yelled at her. Other nurses had been allowed to leave. Why not them? Mulderick defended the departed nurses—they had gone to help people at the boat drop-off point—even though she had asked them, too, to stay at the hospital.

   When Mulderick passed through the second floor, people sitting with their animals and their packed bags asked her when they could leave. A therapist erupted when she told him he had to stay; there were still many patients to move. He yelled at her. He had a bad back. Carrying patients was a job for younger men. Mulderick walked away. There was too much happening to argue with every person who was upset.

   After the fight over the suitcase, three senior staff members from LifeCare approached her. They said they were getting low on rubbing alcohol and a few other supplies and wanted to know what the plan was for nine patients who remained on the seventh floor—as if they expected her to tell them what to do! They said they weren’t sure they could move the patients on their own, including a large paraplegic patient. One of the LifeCare staff members had told Mulderick earlier that two of their patients were in grave condition, running extremely high temperatures of 104 and 105 degrees.

   Mulderick told the LifeCare team the plan was not to leave any living patients behind. She asked them to talk to Dr. Pou. After all, the doctors working on the second floor were the ones who had stopped LifeCare’s DNR patients from being brought down to the staging areas on Wednesday, saying it was too crowded. Were the patients dying, would they not attempt to move them; or would they proceed with getting them in the staging area for evacuation? Whatever the LifeCare leaders were going to do, Mulderick told them, they needed to decide and get it done.

   During their conversation, a uniformed man began yelling, “All women and children!” More boats had arrived, and people streamed toward the ER ambulance ramp as if the man had announced the last one was leaving.

   One of the LifeCare staff members, physical medicine director Kristy Johnson, excused herself to fight through the crowds. She wanted to bring the news of the family evacuations to the seventh floor, where two daughters of LifeCare patients remained.

   CEO René Goux came to the ramp and asked the doctors why the hell they were loading family members onto boats. The doctors who had gone out that morning to the drop-off point had marshaled resources, including ambulances. “We’re trying to get the patients out!” he said.

   “Everybody’s a patient, including us,” Dr. John Kokemor said. He, like many others, had been concerned for his life. He kept a credit card on him to use if he made it out of the hospital and a driver’s license for others to identify him in case he did not. Patients were slow getting onto the ramp. If the boats quit at five-thirty as he expected, they would all be there another night. Kokemor’s goal was to get as many people on board each boat as quickly as possible; that included two of Memorial’s oldest doctors, one of whom was Horace Baltz. Kokemor wanted to get Baltz’s older sister out too, and her daughter, an ICU nurse. They had medical problems, and Kokemor didn’t think they were doing well. “I’ll move you to the front of the line,” Kokemor told them, “and you guys get out of here.”

   Baltz accepted the offer even though he had not asked to leave. His longtime colleagues Dr. Ewing Cook and Susan Mulderick both hugged him and told him tearfully that they loved him. Their uncharacteristic emotion surprised the elder doctor. This wasn’t a normal goodbye.

   Two men in camouflage caps who appeared to be National Guard soldiers helped Baltz step down into the unstable boat. Baltz, in shorts with white socks, held one young man’s rifle for him while the man helped others aboard. Baltz looked back at his beloved hospital. He was sure he was watching it die.

   ANGELA McManus couldn’t believe that three men who looked like police, holding sawed-off shotguns, could be demanding that she leave her mother’s bedside near the nursing station on the LifeCare floor. They told her they were evacuating the hospital and she had to go.

   “You’re going to stand over my mom’s bed with a gun pointed at me? Have you lost your mind? Shoot me!”

   After staff had said her mother was being evacuated on Wednesday, McManus had waited in the boat line and had spent the night downstairs. This morning she had run into her mother’s nursing aide, whom she’d befriended.

   “Angela, Mama’s doing good,” the aide said. “She’s a strong woman.”

   “What do you mean?” McManus asked. “She’s still here?”

   She climbed back up to the seventh floor and found her mother in the hallway near the nursing station where her bed had been rolled after Angela left her. Her mother was being given a cooling alcohol rubdown. “What’s going on here?” Angela McManus asked. “Why’s she so lethargic?” Angela was told patients had been given Ativan. “She can’t take Ativan!” she said, even while noticing that this time the drug seemed to have achieved its intended effect of calming rather than exciting Wilda.

   Wilda was a little too calm for Angela’s liking. She kept dozing off, and Angela repeatedly woke her to make sure she was OK.

   Now, as the policemen told Angela she had to go, she refused.

   “I’m not leaving my mom,” she said. “I’m not leaving until they get her out of here.”

   “Oh no, you’re leaving,” one of the policemen said. He lowered his gun, which had been pointed up at the ceiling, and Angela screamed. She noticed her mama didn’t awaken. Something seemed very wrong. Was it the Ativan?

   “I need to talk to my mom,” Angela told the police. “Y’all move so she can’t see you.” The men moved behind the head of Wilda’s bed.

   Angela roused her mother. “Mom,” she said, “the police are making me leave the hospital. They’re evacuating.”

   Wilda McManus asked what was happening.

   “They want us to get out of the hospital,” Angela said. “I can’t go with you.”

   Angela tried to soothe her mother with words she used frequently. “It’s OK for you to go and be with Jesus. Daddy’s waiting for you, Grandma and Grandpa, Auntie Elois, waiting for you.” She had a sense that she was not only leaving her mother, but her mother was also about to leave her.

   Wilda McManus couldn’t sit up, but she raised herself a little, looked intently at Angela, and screamed.

   Angela kept calming her. “Mama, do you understand what I just told you?”

   “I’m going home.”

   “Yes, you’re going home.”

   Wilda McManus asked her daughter to sing. Angela sang again like she always did, like it was church. She sang the gospel song “Near the Cross,” about the soul finding rest, and Wilda shut her eyes.

   Angela asked her mother’s nursing aide to make sure her mother continued to receive nutrition through her feeding tube. “I’m going to be with her,” the nursing assistant said, “no matter what happens.”

   Angela cried so hard during the walk downstairs that she had trouble seeing. In the heat, carrying her belongings, she quickly grew winded. LifeCare physical medicine director Kristy Johnson, who had come up to get her, guided her down the dim staircase with a flashlight and helped carry her bags. They walked slowly, taking rests between floors. When they reached the first floor, Johnson bulldozed Angela through the crowds to the front of the boat line. Because Angela was traveling alone, a spot on a boat was quickly found for her.

   KATHRYN NELSON also didn’t want to leave her mother. LifeCare nurse executive Therese Mendez was trying to convince her to go now or she’d never get out of the hospital. Nelson had inscribed Mendez in the “Especially Nice to Mother” list she had maintained throughout her mother’s hospital stay. Mendez was listed twice, meaning the smart, take-charge executive had been especially nice to Mother on at least two occasions. When Nelson told Mendez she didn’t care about missing the boats, Mendez responded so sharply Nelson felt that she had undergone a Jekyll-and-Hyde switch. “Your mother is dying!” Mendez said, after days without sleep, having worked overnight on what she called “First Floor Beirut.” She was worried it was Nelson’s last chance to leave.

   “I’m dying too!” Nelson said and told Mendez she had cancer. She didn’t, and later she would wonder how she had come up with something so ridiculous. She would say or do anything to protect her mother.

   If her mother really was dying, then why would Nelson want to leave her now after she had been with her every day in the hospital for more than a month and a half? When she had first been told to leave, on Tuesday, she had asked if she could be admitted as a patient so they could travel together. Nelson looked the part of a patient. She had taken to wearing hospital gowns during her mother’s stay.

   The last time she had been made to go downstairs, she hadn’t stayed away long. She couldn’t bear to be separated from her mother. Though she had been told on Wednesday her mother would soon be evacuated, she’d had a sense that her mother and the other bed-bound LifeCare patients would be staying for a while. She had peered at the helipad through a window and watched people, including a male nurse she recognized, boarding helicopters. The able-bodied were leaving, not the sick.

   Nelson had gathered her ample belongings, bundled in a sheet-like a cartoon hobo’s, and dragged them back up the stairwell Wednesday evening, but she ran into blockades: first a LifeCare nurse and then three men who seemed to be guards or police. The guards told her she couldn’t go back upstairs. They called her a “security risk.”

   The security risk, all five-feet-four and 108 pounds of her had stood her ground, arguing with the guards until a woman arrived who had just received word that her own children, not in the hospital with her, had survived the disaster. Whoever she was, she took pity on Kathryn and, with authority, told her to go ahead upstairs and spend as much time as she wanted with her mother.

   Nelson found her mother in a new room—she’d been moved closer to the nursing station after the doctor’s visit—with a nurse at her bedside fanning her. A makeshift suction device, a plastic tube attached to a syringe, was being used to remove secretions from her airways. Her eyes were glazed and she was breathing with what seemed like a great effort.

   Kathryn requested medication to help her mother breathe more easily. The nurse agreed, saying she thought Nelson’s mother needed a bit of comfort. Her temperature, 106 degrees, was extremely high, and her chest was congested. The nurse administered a small dose of morphine and Ativan according to the orders the infectious diseases doctor had left earlier Wednesday night in case any patients needed them. Afterward, the nurse told Kathryn Nelson that the drugs sometimes made patients like her mother stop breathing altogether. This so upset and alarmed Kathryn that she kept vigil at her mother’s side all night, not sleeping.

   Overnight, Elaine Nelson’s high fever broke. In the morning her body felt cooler to the touch, her color was better, and her eyes were open but no longer glazed. The nurse did not hear the congestion in her lungs. Kathryn still had a hangover of worry, but the roar of helicopters landing one after the other on the helipad cheered her. The intensity of the rescue made her feel proud of whoever had come to save them.

   Therese Mendez returned with reinforcements, some sort of security guard or policeman who might or might not have been armed. Kathryn was given a few minutes to bid her mother goodbye.

   Kathryn had been trained as a registered nurse and knew from working in the ICU that even patients in comas could hear and remember what was said to them. She told her mother she was the best mom any girl could have and she was proud to be her daughter. At around eleven fifteen a.m. she kissed her mother good-bye, said a prayer over her, and, with the nurse executive, departed LifeCare.

   AROUND A CORNER from Elaine Nelson’s room, on the other side of a long corridor, LifeCare nursing director Gina Isbell walked into a meeting in progress between several other staff members and the fluffy-haired doctor with whom she’d shared her tea. Her staff nurse and friend Andre Gremillion was crying and shaking his head. He brushed past Isbell into the hallway, and she followed, grabbing his arm and guiding him to an empty room.

   “I can’t do this,” he kept saying.

   “Do what?” Isbell asked. When Gremillion wouldn’t answer, Isbell hugged him and tried to comfort him. “It’s going to be OK,” she said. “Everything’s going to be all right.”

   Isbell searched for her boss, LifeCare’s pregnant assistant administrator, Diane Robichaux. “What is going on?” Isbell asked, frantic.

   Robichaux told her that staff members from Memorial had arrived and were taking over the care of their patients.

   “Are they going to do something with these patients?”

   “Yeah, they are,” Robichaux said, in tears. “Our patients aren’t going to be evacuated. They aren’t going to leave.”

   Isbell swore. She cried. She asked Robichaux why no one was coming to help. Robichaux didn’t have an answer.

   Robichaux said the task now was to get all the stuff off the floor except the core leadership team. Isbell tried not to think about what was going to happen. For five days she and her colleagues had tried so hard to keep everyone alive. She didn’t want to accept that they couldn’t save everyone who had made it this far. A colleague told her that they were under martial law. Isbell believed she had to follow orders. She did what she was instructed to do.

   Isbell, Robichaux, and other LifeCare leaders split into two groups and headed for different parts of the floor. “Everybody get out of here now,” they told the nurses who were on duty. “Get your stuff, we got to go now. Let’s go!” Cindy Chatelain, about to pass medicines to Elaine Nelson, was told to drop everything and leave without so much as signing off her patients to another caregiver. Andre Gremillion, who was tending to two patients, was told to go. He asked if someone would care for the patients. “Yeah,” he was told. “Get your bags and go ahead and evacuate now.”

   As the LifeCare administrators cleared the floor of all but a few senior staff members, Robichaux sent Isbell to the back staircase to make sure nobody reentered. It was quiet there, and Isbell was grateful to sink into a chair. She sat alone, itching from a heat rash, aching from oozing skin wounds, drained and upset. Isbell let the occasional staff member through to retrieve belongings from the closets. She saw the fluffy-haired doctor walking back and forth for a while, and then noticed that she had gone. She thought again of her promise to Alice Hutzler’s daughter and felt a pang of guilt. She prayed that help would come before her patients died; she didn’t want to believe that no one would come.

   It was close to noon when Isbell and the LifeCare leaders left the seventh floor to join the evacuation lines. On the way down, they passed the other LifeCare nursing director. He wanted to know what was happening. Isbell avoided his eyes. Tenet people had come up to LifeCare, she told him. Their patients were, she said in a near whisper, “gone.”

   Their intention was to stop on the second floor to check on “Ma’Dear” Carrie Hall and several other LifeCare patients who had been moved downstairs on Wednesday. From there the LifeCare leaders planned to proceed through the hole in the machine-room wall to the garage with a dose of Ativan for a staff member they had heard was having a breakdown there. But a Memorial employee blocked the LifeCare team at the stairwell exit on the second floor. A doctor had told certain staff members to direct people away from the patient area on the second floor where the DNR patients lay.

   “Should we just make a break for it and just go looking?” one of Therese Mendez’s coworkers whispered in her ear. “Don’t do it,” Mendez said. “We’re going to end up shot or arrested.”

   For now only the LifeCare pharmacist was allowed onto the second floor, to go directly to the garage with the medicine. The Memorial employee blocking the entrance gave the others an e-mail address they could use later to find out which of their patients had died. Someone took a pen and wrote the address on Mendez’s scrub shirt.

   DR. KATHLEEN FOURNIER walked back into the second-floor lobby at around noon. Her acquaintance from medical school Bryant King was grabbing his bag, looking upset and angry. “I’m getting out of here,” he said. “This is crazy.” She asked him for a hug. She was upset and angry, too. She told him she knew why he was leaving”

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Initial PostPender’s Health Promotion Model

 – Review the following Evidence-Based-Care sheets. Choose one of the models for your original discussion post.

Reflect on whether the model you have chosen applies to the physiological changes seen in the aging population. Your original post should explain why or why not, and include 1 or 2 specific examples that will support your statements.

• According to Nola Pender, nurse theorist and founder of the Health Promotion Model (HPM), health is defined not as the absence of disease but as “an evolving life experience” that involves the “actualization of inherent and acquired human potential through goal-directed behavior, competent self-care, and satisfying relationships with others”⁽⁸⁾

  • Health promotion is a holistic approach to patient care that focuses on improving the overall wellbeing and health-related quality of life (HRQOL) of individuals, whether or not illness is present, by increasing and sustaining health-promoting behaviors^(6,9)

    • Examples of health-promoting behaviors are regular exercise, consumption of a nutritious diet, stress management, and adequate rest

    • Health promotion shares common elements with primary prevention in that activities that aim to prevent disease also tend to improve wellbeing and HRQOL (e.g., exercising to reduce risk for cardiovascular disease can also increase energy level and improve mood; eating a diet low in saturated fat can improve cholesterol levels and also contribute to healthy weight loss)⁽⁶⁾

• Pender’s HPM, first developed in 1982 and revised in 1996, is a patient care model that guides nurses in understanding patient behavior regarding health promotion; when patient behaviors are better understood, individualized support can be provided to strengthen lifestyle factors to enhance patient health and prevent illness or disease^(6,8,9)

  • The HPM is rooted in the following three human behavioral theories:⁽⁶⁾

    • The theory of reasoned action, which states that an individual is more likely to perform an action if he or she perceives that the action will have a desirable effect and perceives that others are in favor of it

    • the theory of planned behavior, which states that an individual is more likely to perform an action if he or she perceives having control over the action and situation

    • Bandura’s social-cognitive theory, which states that self-efficacy (i.e., confidence in one’s ability to perform an action as planned) directly influences an individual’s decision to engage in that action such that a high level of self-efficacy can motivate behavior toward action even when challenges are present

  • According to the HPM, behavioral outcomes are influenced indirectly by an individual’s characteristics and experiences (i.e., prior related behavior and the individual’s biologic, psychological, and sociocultural factors) and are directly influenced by behavior-specific cognitive factors and affect, which are classified as six modifiable variables:⁽⁹⁾

    • Perceived benefits of action (i.e., what the patient believes to be the rewards of committing to the health behavior)

    • Perceived barriers to action (i.e., what the patient believes to be preventing commitment to the health behavior)

    • Perceived self-efficacy (i.e., the patient’s self-confidence in the ability to successfully carry out the health behavior)

    • Activity-related affect (i.e., the patient’s emotional status and feelings before, during, and after performing the health behavior)

    • Interpersonal influences (i.e., the perceived role that persons who are involved in the patient’s life have on promoting or preventing the health behavior [e.g., the presence or absence of family support])

    • Situational influences (i.e., the perceived role that the patient’s environment has in promoting or preventing the health behavior [e.g., whether or not other, more attractive alternatives to the behavior are present])

  • According to Pender’s model, the patient’s commitment to the plan of action is affected by the presence and strength of competing demands (e.g., family commitments) and preferences (e.g., distractions); commitment to the plan of action is less likely to produce the desired behavior if competing demands need immediate attention and/or competing preferences are more desirable⁽⁹⁾

• The HPM has been applied in research studies and clinical practice as a tool for understanding and managing behaviors that impact health in various patient populations, age groups, and settings^(1,9)

  • In an integrative review of the literature on health promotion in adolescents published during the period 1995-2004 (which encompassed studies on asthma self-management, physical activity, and diet), investigators found that self-efficacy was the strongest predictor of health-promoting behavior in adolescents of diverse cultural backgrounds⁽¹¹⁾

  • In a study of 500 adolescent females in Iran, investigators found that the HPM variables predicted 71% of the differences in HRQOL among the study participants; self-efficacy (as measured by the Perceived Health Competence Scale [PHCS]) was identified as the single most important, direct predictor of participation in a health-promoting lifestyle⁽⁷⁾

  • In a Korean study of 596 patients with chronic cardiovascular disease, investigators found that self-esteem and health-promoting behaviors directly affected HRQOL; the HPM variables predicted 63% of the variance in HRQOL among study participants⁽²⁾

  • In a meta-synthesis of nine qualitative studies involving patients with diabetes, investigators sought a better understanding of the factors that contributed to patients’ perceptions of self-empowerment, which can lead to better diabetes self-management. Using the HPM, the investigators identified common factors in the categories of perceived barriers (e.g., inaccessibility of the language used in education regarding diabetes), activity-related affect (e.g., attitude regarding performing routine physical activity), interpersonal influences (e.g., perceived empathy of others), and situational influences (e.g., perceived hurriedness of clinician consultations) that should be addressed and corrected whenever possible to formulate effective, sustainable self-management plans for patients with diabetes⁽³⁾

  • HPM was successfully applied to improve dietary behaviors and nutrition of obese and overweight women, providing information about risk factors associated with obesity and healthy habits, in the cultural context of an Iranian community. Researchers reported a high participation rate in training sessions, intended to promote self-efficacy⁽⁵⁾

  • Researchers assessed the predictive power of the HPM on promotion of self-care behavior in hypertensive patients from a rural Iranian community. Self-efficacy and perceived benefits had an inverse correlation with the age of participants, mainly due to perceived barriers in older adults. The model had a predictive power of 71.4% of changes in systolic blood pressure⁽⁴⁾

• One point that emerges from the literature is that perceived self-efficacy is an important determinant of participation in health-promoting behavior and achievement of an improved HRQOL^(3,7,11)

  • As a trusted source of health information and support, nurses are in an optimal position to influence the self-efficacy variable of the HPM in everyday patient care through such interventions as^(7,10)

    • providing patient education about the benefits of engaging in certain lifestyle changes and about ways to overcome perceived barriers

    • modeling health-promoting behaviors and allowing for patient practice to build skills that are necessary for self-confidence

    • verbally encouraging health-promoting behaviors

What We Can Do

• Become knowledgeable about Pender’s HPM so that you can accurately assess your patients’ overall wellbeing and the factors that directly and indirectly contribute to their behaviors regarding health; share this knowledge with your colleagues

• Use the HPM as a systematic approach to assess your patients’ perceptions of and affect toward health-promoting behavior; use your assessment findings to collaborate in the development of individualized, patient-empowering plans of care for health promotion that encourage realistic, sustainable health-promoting activities

  • For examples of the use of Pender’s HPM as a clinical assessment and intervention tool, refer to Pender’s Health Promotion Model Manual at https://deepblue.lib.umich.edu/bitstream/handle/2027.42/85350/HEALTH_PROMOTION_MANUAL_Rev_5-2011.pdf?sequence=1&isAllowed=y

• For more information about the use of self-efficacy ratings to determine patients’ perceived ability to perform health-promoting, self-care skills, see the series of Nursing Practice & Skills regarding patient, parent, and family education topics

References

1. Alkalaileh, M. A., Khaled, M. H. B., Baker, O. G., & Bond, E. A. (2011). Pender’s health promotion model: An integrative literature review. Middle East Journal of Nursing, 5(5), 12-22. (SR)

2. Han, K. S., Lee, S. J., Park, E. S., Park, Y. J., & Cheol, K. H. (2005). Structural model for quality of life of patients with chronic cardiovascular disease in Korea. Nursing Research, 54(2), 85-96. (R)

3. Ho, A. Y. K., Berggren, I., & Dahlborg-Lyckhage, E. (2010). Diabetes empowerment related to Pender’s Health Promotion Model: A meta-synthesis. Nursing & Health Sciences, 12(2), 259-267. doi:10.1111/j.1442-2018.2010.00517.x (R)

4. Kamran, A., Azadbakht, L., Sharifirad, G., Mahaki, B., & Mohebi, S. (2015). The relationship between blood pressure and the structures of Pender’s health promotion model in rural hypertensive patients. Journal of Education and Health Promotion, 4, 29. doi:10.4103/2277-9531.154124 (R)

5. Khodaveisi, M., Omidi, A., Farokhi, S., & Soltanian, A. R. (2017). The effect of Pender’s Health Promotion Model in improving the nutritional behavior of overweight and obese women. International Journal of Community Based Nursing and Midwifery, 5(2), 165-174. (RCT)

6. McCullagh, M. C. (2013). Health promotion. In S. J. Peterson & T. S. Bredow (Eds.), Middle range theories: Application to nursing research (3rd ed., pp. 224-234). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. (GI)

7. Mohamadian, H., Eftekhar, H., Rahimi, A., Mohamad, H. T., Shojaiezade, D., & Montazeri, A. (2011). Predicting health-related quality of life by using a health promotion model among Iranian adolescent girls: A structural equation modeling approach. Nursing & Health Sciences, 13(2), 141-148. doi:10.1111/j.1442-2018.2011.00591.x (R)

8. Pender, N. J. (2011). The Health Promotion Model manual. Retrieved June 13, 2018, from http://deepblue.lib.umich.edu/bitstream/2027.42/85350/1/HEALTH_PROMOTION_MANUAL_Rev_5-2011.pdf (G)

9. Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health promotion in nursing practice (6th ed.). Boston: Pearson. (GI)

10. Ronis, D. L., Hong, O., & Lusk, S. L. (2006). Comparison of the original and revised structures of the Health Promotion Model in predicting construction workers’ use of hearing protection. Research in Nursing & Health, 29(1), 3-17. doi:10.1002/nur.20111 (R)

11. Srof, B. J., & Velsor-Friedrich, B. (2006). Health promotion in adolescents: A review of Pender’s Health Promotion Model. Nursing Science Quarterly, 19(4), 366-373. doi:10.1177/0894318406292831 (SR)

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Public Health and Community Issues

Public Health and Community Issues

Influenza in Texas

Reports on Influenza in the years 2019 and 2020 indicate that the cases are rising exponentially. The significant types of Influenza detected are A and B with numerous subtypes. Transmission of the disease is through droplets from an infected person that results from sneezing or coughing. Influenza manifests through a headache, pain throughout the body, or a sore throat. Also, the condition causes ear infections and pneumonia. The high mortality rate among the vulnerable population in Texas attributes to Influenza. The report also noted the severity of the flu cases in Texas compared to other geographical locations in the United States (US), thus causing a need to reduce the risk of infection through vaccination and distancing from infected individuals (Liu, Srinivasan & Meyers, 2019).

Earth Quakes in California

The New York Times reported an earthquake in Central California on June 24, 2020. The strike caused a rockslide in Mount Whitney. The US geological survey indicated that the earthquake’s magnitude was 5.8 and affected the  Lone Pine, Calif, and  Death Valley National Park in Central California. Ten other quakes accompanied the strike in the same location. The impact of earthquakes was felt even in San Francisco and Las Vegas, far from the Lone Pine Strong (Earthquake Strikes Central California 2020).

Why Influenza in Texas and Earthquakes in California are Public Health and Community Issues

Influenza is a public health issue as Reports from the Centers for Disease Control (CDC) indicate approximately nine million-45 million infections attributed to the flu. Thus, causing tentatively 140,000-810,000 in patients, which consequently leads to an average of 12,000-61,000 deaths every year since 2010 in the US(Liu, Srinivasan & Meyers, 2019).The earthquake in  California is a community health issue as it caused the displacement of people from the Mount Whitney area due to the rockslide. It also created the destruction of business facilities and disruptions of daily lives. However, while there were no injuries from the earthquakes, there is a chance that future strikes may cause injuries, thus shifting it to a public health issue(Earthquake Strikes Central California 2020).

References

Liu, K., Srinivasan, R., & Meyers, L. A. (2019). Early Detection of Influenza outbreaks in the United States. arXiv preprint arXiv:1903.01048.

Strong Earthquake Strikes Central California. (2020). Retrieved July 1, 2020, from https://www.nytimes.com/2020/06/24/us/lone-pine-earthquake-california.html/ 

Describe the vulnerabilities of runaways in our country- human trafficking

According to Finklea (2012), runaways are highly vulnerable to sex trafficking and human trafficking. A study funded by the federal government revealed that about 1.7 million youth’s runaway or are forced out of their home. Approximately 36,800 runaway youths are sexually assaulted, land in the hands of sexually abusive strangers or are forced to engage in commercial sex activities. The runaways are susceptible to pimps and trafficking as they have inadequate resources to cater to their needs. They lack a supportive network when they get into unfamiliar environments. The runaways are approached by traffickers at the bus and train stations and in the public spaces. They engage in commercial sexual activities to create money for basic needs or get necessary adults’ necessary provisions.

Discuss the hopelessness and frustration experienced by family members who try to recover their child from a trafficking situation

Nicole presents a story of the hopelessness and frustrations that families experience in recovering their child from trafficking. She expresses that every morning she looked everywhere, including in the closet, hoping to find her daughter or a written note even in the closet. Sadly, her husband, Tony, was going through the same situation. She expresses that her daughter’s absence was like a daily nightmare. Her husband went out at night to look for her daughter in unimaginable places, handing over fliers. He would later look at the websites at night with the hope of finding their daughter. It is unfortunate that even after the victim called to wish her mother a happy birthday, she would not agree to come home (TEDxSeattle,2020).

What did you believe was an important point the mother made about law enforcement’s response to human trafficking victims? 

Nicole says that law enforcement must have trained first responders. These responders would help detect the signs that the victims of trafficking present and take corrective action. She says that untrained responders think that the victims are lying (TEDxSeattle,2020).

What did you find most poignant about this mother’s account of her daughter’s experience in human trafficking? And Why?

It is disheartening that the mother had to listen to her daughter to account for her predicaments about how she was sexually abused and sold for sex. She has always heard about such things happening overseas and could not believe that they occur in her backyard, particularly to her daughter. She almost breaks down as she accounts for this situation. The worst experience was losing her daughter to sex trafficking for the second time, and she felt like it was a daily nightmare with her daughter gone without a word for forty-seven days (TEDxSeattle,2020).

References

Finklea, K. M. (2012). Sex trafficking of children in the United States: Overview and Issues for Congress. DIANE Publishing.

TEDxSeattle (2020) Child sex trafficking in America: Nacole at TEDxRainier -. Retrieved 18 November 2020, from https://tedxseattle.com/talks/child-sex-trafficking-in-america-nacole-at-tedxrainier/