Nursing (192)

Thursday, 04 January 2018 06:38

Wound management of diabetic patient

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Wound management of diabetic patient

Name: Harinder Dosanjh


Course title:

Date: December 17, 2017


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Diabetes is a condition that occurs as a result of the body not effectively using sugar. As of 2030, it is estimated that over 550 million people across the world will have diabetes. Proper control of diabetes can help prevent serious complications; however, failure may lead to serious complications such as patients encountering diabetic wounds. In this essay, it provides an in-depth examination of wound management of diabetic patients.

Wound management

Diabetic wounds fall into three categories that include ischemic, neuropathic, and neuroischemic. Having an understanding of each of these categories is necessary to identify wound infection, progression, and health. The common barriers to wound healing are infections, nutritional deficiencies, wound hypoxia, metabolic disorders, the presence of debris, and inhibitory medication. It is through minimization of these factors that the wound healing agents are going to be effective (Busse, 2016). Diabetes mellitus is considered as a complex metabolic disorder that usually effective wound healing indirectly and directly. Diabetes does cause the alternations in nerve functions, the immune system, and microvasculature.

Lack of identifying the type of wound can result in ineffective wound treatment plan that may cause long-term complications or even amputation. The foot ulcers tend to be the most common wound of diabetic patients. Diabetic patients are usually prone to developing ulcers of the feet because of neuropathy leading to poor wound healing. According to Doupis & Alexiadou (2012), about 60-80% of foot ulcers will heal while 10-15% remains active and 5-24% will lead to the amputation of the lower limb within 6-18 months of the first evaluation. Foot ulcers can be very serious when left untreated. According to Doupis & Alexiadou (2012), between 14 and 24% of people with diabetes and develop ulcers are likely to end up having lower limb amputation. Healing of the wound may be slowed when the patient has diabetes, and it is vital to remember that wound in this people heal slowly, and it can get worse very fast; hence, require close monitoring.

According to Busse (2016), various factors influence would heal in a diabetic patient such as the blood glucose level. The elevated blood glucose level tends to stiffen arteries causing narrowing of blood vessels. As a result, it has major effects including the origin of wounds and also the risk of proper wound healing. The narrowing of the blood vessels leads to a decrease in the blood flow and oxygen to the wound (Khalil et al. 2014). With elevated blood sugar level, it reduces the function of the red blood cells that tend to supply nutrients to tissues. It does lower the efficiency of blood white cell and without sufficient oxygen and nutrients; it is not possible for the wound to heal fast. The main issue with diabetic wounds is delayed healing or poor healing. The healing problems occur as a result of peripheral arterial disease and the peripheral neuropathy that happen with diabetes (Khalil et al. 2014). Some interventions such as ensuring adequate perfusion, glycemic control, and infection control are vital to the management of diabetic patients with chronic wounds.

With management of diabetic wounds, it is vital to note that every wound is a health concern and it requires immediate attention. The best treatment for wounds with diabetic patients is prevention because medical treatment for these would do offer very limited help. In prevention of diabetic wounds, it is essential for patients to ensure an active and normal life. Diabetic wounds can be life-threatening and disable in some case, and it is important to take measures to prevent it (Khalil et al. 2014). However, in the case that wounds happen, a good way of managing them is through ensuring healthy die. Maintaining proper nutrition is primary and can aid in wound healing. Staying active and quitting smoking does help to improve insulin sensitivity, and that helps the sugar to enter the cells more efficiently; thus, promoting health and healing.

Uncontrolled diabetes has a significant impact on wound healing, and diabetic patients must understand the importance of good glucose control in the healing period. Poor control of diabetes does decrease the number and also the availability of small blood vessels that usually contribute to tissue hypoxemia. Glycosylation of protein tends to decrease the number of growth factors and signal proteins available during the inflammatory phase of wound healing (Busse, 2016). The impaired use of glucose does negatively impact fibroblasts and neutrophils; hence, leading to an increased risk of infection and reduction in collagen synthesis.


Diabetic wounds are not the same as any other wounds as they are slow to heal and that makes it challenging for treatment with conventional topical medications. Wound healing is a complicated process that involves skin repair after an injury. Hence, a diabetic wound should be treated holistically so that to determine the underlying issues and also reduce the risk factors that causes the wound in the first place. Management of diabetic wounds is essential considering the negative impact they have on the patient’s quality of life.



Doupis, J & Alexiadou, K (2012) Management of Diabetic Foot Ulcers. Diabetes Therapy 3(1)

Gan, S Islam, A Alam, F & Khalil, I (2014). Honey: A Potential Therapeutic Agent for Managing Diabetic Wounds. Evidence-Based Complementary and Alternative Medicine

Busse, B (2016). Wound management in urgent care. Springer Publishing


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Communication Modes for Individuals with Hearing Loss


Successful communication entails the inclusion of all persons involved in the conversation. When communicating with persons with hearing loss, it is vital that the speaker adopts specific communication methods. When selected the communication method to adopt, an individual should establish the age of the onset of the hearing loss and the types of hearing loss.   An individual must also establish the convenience of a selected communication method. In an educational setting, for instance, the communication method selected may vary depending on the information being conveyed, and the persons involved in the conversation. The paper below highlights the different communication methods that individuals with hearing loss can adopt so as to enhance communication and information sharing.  Additionally, the paper addresses the communication strategies that individuals can adopt to enhance communication with persons with hearing loss.  Individuals with hearing loss have the right to lead a normal life and effective communication enhance the probability of a normal life.


Hearing Loss

Hearing loss is the most prevalent abnormality in newborns.   Hearing loss is a sensory disorder that occurs because of sensorineural and or conductive malfunctions, in the ear.  Hearing loss can affect both ears of one ear.  Additionally, hearing loss can occur during or shortly after birth or after trauma or a disease.  Hearing loss is associated with speech and communication because it can occur before a child acquires his speech and language or after the acquisition of speech and language.  Hearing loss begins mostly, in infancy; however due to delayed detection and diagnosis, the condition remains hidden for a while, before an accurate decision is made (Carseta, 2008). Early detection ascertains that children with impaired hearing receive appropriate intervention measures that include learning ideal communication methods, the world.

 Whereas some individual can be born with hearing loss from the time of birth, some individuals experience hearing loss as they become older.  Age-related hearing loss occurs as an individual ages.  Age-related hearing loss is a prevalent problem for elderly persons.  Age-related hearing loss is mostly associated with sounds of high pitch, chirping birds and high-itched house.  A person experiencing age-related hearing loss must establish the severity of the hearing loss (Willems, 2003).

Effects of hearing loss and communication

Hearing loss especially after experiencing pleasure of hearing and communicating can cause distress, depression and isolation. An individual can feel left out of conversations because he cannot hear properly.   An individual also develops hearing impairment that can affect his communication skills. Communication problems can be affected by a person’s level of deafness.  Partial deafness leaves a person with residual hearing that he can utilize together with sign language (Gravel, 2003).  Communication can also be affected by the degree of amplification that a person selects. The age of onset also plays a fundamental role of determining the development of language and subsequent ability of the individual to communicate.  Individual with hearing problems from the time of birth experiencing increased difficulty in functioning and communication compared to individual who acquires language and speech prior to the loss of hearing.

Sign Language

Sign language is the predominant language of communication for deaf persons and individuals experiencing hearing loss.  The language mainly develops in deaf communities and thus does not have a specific formula of creation. A deaf community can comprise of interpreters, friends and families who desire to communicate with each other.  Sing language is a true language as it contains the essential linguistic components of any other language.

 Sign language entails the use of manual communication and body language so as to pass information. Sign languages involve the use of handshapes, orientation and movement of hands, arms and shapes.  Facial expressions can also be used so as to express the speaker’s thoughts.   A speaker communications with an individual with hearing loss must be familiar with basic sign language to deliver his message to the individual with hearing loss.   The individual with hearing loss must also be knowledgeable of sign language so that he can express himself. Sign language is not significantly different from the spoken language hence the reference of sign language as a natural language. Sign language develops as an individual grow.  An individual who is born deaf acquires basic sign language that later develops to   intricate sign language that he can use for formal discussions and communication. Sign language differs according to region and locations (Carseta, 2008).  Parents, for instance, with a child who is deaf or who is hard at hearing, will develop a sign language that they can utilize. However, in an academic setting an individual with hearing loss can learn the formal sign language such as the American Sign Language

American Sign Language

The American Sign Language is a fully developed natural language with grammar, syntax and vocabulary.  ASL is mostly used by individuals from English speaking countries such as Africa, Canada and parts of Africa.  ASL employs the use of hand, facial expression and body posture for purposes of communication. ASL does not follow the English language structure and format thus ASL users considers English as their second language (Klein, & Cook, 2001).  ASL provides individuals with hearing loss with an effective communication strategy. ASL enables an individual with hearing loss to acquire essential vocabulary for communication. Similarly, the individual acquires finger spelling skills that enable him to form words through the signing of letters.  In general, the use of ASL enables an individual to acquire basic grammar that is essential for communication.  An individual with hearing loss can learn ASL, over time.  The first level involves the acquisition of basic grammar. The final level entails acquisition of skills that enhance communication and the ability to hold a conversation. The Americans sign language is popular in deaf communities. However, other regions have their sign language that is differentiated according to region.  Examples of other sign languages include; British sign language, New Zealand sign language and Mexican Sign language.

Finger Spelling

 Individuals can also communicate using the finger spelling method.  The finger spelling method does not focus on auditory conversation, but instead emphasizes on making hand shapes so as to curve the letters of the alphabet.  Finger spelling is mostly used together with other modes of communication such as the American Sign Language and the manually coded English. The finger spelling emphasizes on   spelling out names.  An individual who is conversant with finger spelling can hold a conversation with another person who is familiar with the language (Gravel, 2003).  The art of finger spelling can be taught when a child is young so that he can build up on his language skills.   When a child is trained to communicate using the finger spelling, he acquires the language like any other language that he could have been trained.

Contact Language

Persons  who are deaf or struggling with hearing loss can use contact language to communicate. Contact language was previously known as Pidgin Sign English (PSE).  PSE is the combination of ASL and manual English. When learning ASL, an individual can be exposed to the natural English language.   During the learning process, an individual can acquire the ASL and the natural English language.  The individual may thus opt to combine the two language when communication.  The pidgin sign English employs the English grammar and thus users apply the English word order. The communication can be used together with the voice English (US department of health & human services, 2014).   In the classroom, for instance, a teacher teaching a mixed class students with hearing loss can use the pidgin sign language to communicate.  Students without the hearing problem can focus on the spoke English while students with hearing loss can focus on the PSE.

Signing Exact English (SEE)

 SEE mode of communication for people with hearing loss entails the use of the English language as it is known.  Users of the language employ the word order and structure of the English language.   The individuals with hearing loss also use grammatical markers, endings, suffixes and prefixes as they are found, in the natural English language (Willems, 2003).  The SEE mode of communication utilizes the visual system of communication. The communication method is best introduced to children who are deaf or are experiencing hearing loss. The children can thus gradually learn the language as they grow.

Auditory Verbal Unisensory

The auditory-verbal unisensory enable an individual with hearing loss to develop listening and verbal skills through one-on-one therapy.  The successful use of auditory verbal unisensory lies in the ability of an individual to make use of residual hearing. Residual hearing remains after a person experiences hearing loss.  The success of auditory verbal unisensory method of communication depends on the extent of hearing loss (Angell, 2009).  Individuals who are partially deaf have great residual hearing that the individuals who are permanently deaf.   The individual with hearing difficulties can utilize artificial hearing aid to enable him to communicate using the auditory verbal unisensory method.   

Cued Speech

Individuals with hearing loss can also communicate using cued speech. Communication using cued speech makes spoken English visible.  The speaker provides cued phonemes and is thus sound based.  Similarly, the user utilizes eight hand-shapes in four locations, in combinations with natural mouth movements. The individual with hearing loss can pick a conversation using cued speech.  Similarly, an individual can communicate using the cued speech (Carseta, 2008). The use of the cued speech enables an individual to distinguish between sounds that look the same, on the speaker’s lips.

Oral auditory

The use of oral auditory emphasizes on users, to utilize their residual hearing by using amplifications.   An individual with hearing loss can utilize a hearing aid, cochlear implants and assistive listening devices (ALDs) to enhance his hearing.  The oral-auditory form of communication method encourages the individual to use his voice to communicate (Klein, & Cook, 2001).

Lip Reading

Lip reading is a communication method that individuals who are deaf or experiencing hearing loss can embrace so as to participate in the conversation.  In lip reading, the speaker is speaking the standard language of communication.    The deaf persons or an individual with difficulty in hearing looks at the speaker’s lips so as to comprehend the conversation.  Lip reading is applicable to persons of all ages; however, the speaker must be aware that he or she is communicating with persons who are hard at hearing.   The knowledge will ascertain that he stands at a vantage point where the listeners can see his lip movement.

Strategies to ascertain effective communication

Effective communication for individual with hearing loss not only requires the adoption of appropriate communication methods, but also requires the adoption of effective communication strategies. First, the speaker must ascertain that he faces the person with the impaired hearing.  Facing the individual with hearing loss enables the listener to pick on body language and cues that he may miss if the speaker is facing another direction (Zand, & pierce, 2011).    The speaker should ascertain that he is facing the light so that he is visible to the person with hearing loss. Secondly, effective communication entails engaging in conversation when the speaker and the listener are in the same room.  The individual with hearing loss may be using hearing implants, but may still have a problem hearing persons who are distant. Additionally, individuals using sing language have to communicate when contact with the listeners.    An individual with hearing loss that is used to lip reading can only participate in communicating if he can read the speaker’s lip (Angell, 2009).   The speaker should ascertain that he is physically near the individual with hearing loss. 

 A speaker should also be aware that a person with hearing loss may require that they talk slowly so that they can follow the conversation. However, the speaker should ascertain that he is not insultingly slow. Similarly, the speaker should ascertain that he does not engage in rapid conversation.   The speaker should ascertain that he speaks moderately slow and affirm that the individual with impaired hearing comprehends the conversation. Additionally, the speaker should ascertain that he is not irritatingly loud when communicating to the individual with hearing loss (US department of health & human services, 2014).  Shouting distorts the sound of speech that the listener is expected to capture so as to understand the content of the conversation.  When communicating to a deaf person or a person who is experiencing hearing loss, the speaker should ascertain that he introduces himself.  Similarly, the speaker should mention the listeners name to attract his attention.   When talking to a person experiencing hearing loss, he can miss the initial information, at the start of the conversation.   The individual may miss to realize that the speaker was talking to him.  If using sign language for instance, it is crucial for the speaker to face the listener and get his attention before conveying a message (Zand, & pierce, 2011).

When conversing with a person who has speech impairment, it is also necessary that the speaker keeps his hand off his face.  An individual with hearing loss can comprehend the content that he can speech-read. Activities such as chewing, eating and smoking can disrupt the listener’s ability to understand a conversation.   A speaker should also construct sentences that are short and easy to understand.  An individual with hearing loss may experience difficulties following a conversation that comprises of complex sentence structures (Willems, 2003).  A conversation with a person struggling with hearing loss can proceed smoothly if the speaker gives the listener a heads-up on the general content that is to be discussed.  The speaker should give the listener time to express his opinion. Allowing the listener to speak allows the parties involved to be, on the same page, in relation to the content of the discussion.


Hearing loss can impede a person’s communication ability.  Unfortunately, when a person fails to acquire elaborate communication methods, he can be isolated from everyday conversation with family, friends and colleagues.  It is mandatory for an individual with hearing loss to acquire alternative communication strategies such as the use of sign language to boost communication. Similarly, individual communicating with persons with hearing loss must realize the special circumstance thus engage in effective communication with the person with hearing loss.  The individual may have to learn sign language or adopt unique communication strategies such as moderately slow reading to allow the reader comprehends the conversation.


Angell, C. (2009). Language development and disorders. Jones & Bartlett publishers

Carseta, S. (2008). Providing effective communication for clients who are deaf, hard of hearing or deaf/blind. A hand book for Florida attorneys

Gravel, J. (2003). Communication options for people with hearing loss. Mental retardation and developmental disabilities research review. Vol. 9: 243-251

Klein, D. & Cook, R. (2001). Strategies for including children with special needs in early childhood setting. Cengage learning

US department of health & human services, (2014). American Sign Language. Retrieved from

Willems, P. (2003). Genetic hearing loss. CRC press

Zand, D. & pierce, K. (2011). Resilience in deaf children. Springer publishers

Rosemary Charles is an academic writer and an editor and she offers dissertation writing help. Thus, people that doubt their own writing abilities can use the best custom paper writing service and forget about their fears and unconfidence by visiting

Thursday, 28 December 2017 07:21

Long-Term Care

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Long-Term Care


Long-term care refers to medical and non-medical needed provided to individuals with chronic illnesses or with disabilities. Long-term care focuses on the provision of personal care needs. Individuals with terminal diseases or disabilities may require assistance to perform basic personal task aimed at making their life comfortable. The simple non-medical activities are known as activities of daily living (ADLs) and refer to activities e.g. showering, dressing; using the bathroom or simply movement from point A to point B. Long-term care also entails the provision of instrumental activities of daily living. The instrumental activities include the completion of housework, taking medication at the right time, preparation of meals and cleaning of utensils, as well as shopping for personal items and groceries.


This week’s reading on long-term care has changed my perception of the concept. I had the assumption that long-term care is provided to old people who are taken to nursing homes. My visualization of long-term care was with reference to the services offered at nursing homes. I had assumed that the services are described as long-term because the elderly person requires constant care. However, reading this week’s readings, I have realized my understanding of long-term care was narrow. Long-term care is also provided to the sick, and persons who are recovering from temporary and permanent disabilities. I have learned that long-term care serves a wider population that I had assumed.

Populations in need of Care

There are three main long-term care populations in my local community. Persons who are of advanced aged are likely to require long-term care. When a person advances in age, he begins to lose his abilities gradually. A once energetic individual would find it difficult to climb the stairs after he attains the age of 65. Additionally, most old people grapple with age-related illnesses and complications such as arthritis, Alzheimer’s, and osteoporosis that affects their standard of living. When the age-related conditions become serious with age, long-term care may be required. Long-term care is mandatory for old individuals who live alone (Pratt, 2010). Elderly persons living with their relatives can receive care from their immediate family.

Persons with disabilities are also likely to require long-term care. The extent of the need for long-term care depends, on the seriousness of the disability. An individual with prosthetic legs, for instance, can lead an independent life with minimal care. However, an individual without his arms and legs may require long-term care. Similarly, a person who becomes blind may require long-term care before he adapts to a life without sight.

Individuals with chronic conditions e.g. cancer, diabetes and heart problems may require long-term care despite their age. The patients need long-term care as they recover from their illnesses. Additionally, if the disease is terminal, long-term care so that the caregiver can ascertain the patient eats a healthy diet and takes his medications when needed (Singh, 2010). Long-term care for ailing persons is also necessary so that the caregiver can provide the patient with physiotherapy and exercise if the patient is immobilized.

Current events

The first event related to long-term care focuses on the continuing debates on the existences of finances to boost operations, in long-term care delivery. The government has failed to offer adequate finances for the provision of long-term care. The lack of finances will minimize the availability of long-term care. The public appears ignorant of the reality that the baby boomers generation is turning 65 years. People in need of long-term care services might increase, as the baby boomers age. Unfortunately, the lack of adequate finances means that many elderly persons in need of long-term care will not access the service (Singh, 2010). America has also noted an increase in long-term care campaigns aimed at familiarizing the public with the need for preparing themselves for life-situations where they will require long-term care. The rise in the campaigns is associated with the rise in of individuals who are found unprepared.

The events are an indicator of the increasing appreciation of long-term care services in healthcare facilities. The calls for funds may increase awareness as the government, and the public will get to understand the expenses incurred with the provision of long-term care. The effective provision of long-term care requires an adequate workforce. The workforce must be skilled in the provision of healthcare services. The populations in need of long-term care may also require medication and support facilities which are costly. Increased awareness of the expenses the long-term care facilities incur may lead to increased support from the government through financing (Pratt, 2010). An increase in awareness campaigns also increases public knowledge on the need for the services.


Long-term care is mandatory for any community as it entails offering supportive services to persons who are unable to help themselves. The rising population of the elderly calls for enhancement of long-term care services. Additionally, other groups such as the sick and the disabled must be considered when rendering long-term service. The overall purpose of long-term care is to provide the aged, the disabled and the sick with medical and non-medical services.


Pratt, J. (2010). Long-term care. Managing across the continuum. Jones & Bartlett publishers

Singh, D. (2010). Effective management of long-term care facilities. Jones & Bartlett publishers

Rosemary Charles is an academic writer and an editor and she offers dissertation writing help. Thus, people that doubt their own writing abilities can use the best custom paper writing service and forget about their fears and unconfidence by visiting

Thursday, 28 December 2017 06:55

Health Policy Proposal Analysis

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Health Policy Proposal Analysis


Nurses engage in the policy sphere are often required to provide information of a healthcare topic of interest to policy makers. This task is achieved through the development of a policy brief. A policy brief is an approach of packaging research evidence that supports a particular recommendation with the aim of informing policy decision (Lavis et al. 2009). In this paper, the student presents a policy brief that seek to advocate for the removal of the scope-of-practice barriers in the nursing profession. This recommendation was conceived in the IOM the Future of Nursing: Leading Change, Advancing Health report.

Removal of the Scope-of-practice barrier

In the IOM Future of Nursing Report, it is recommended that the scope-of-practice barriers be removed to as to enable advanced practice registered nurses (APRNs) to practice the full scope of their training and education (Institute of Medicine, 2010). The report made various suggestions to the congress in order to realize this recommendation. First, the report suggested that the Medicare program be expanded to incorporate coverage of advanced registered nurse services. The report also suggested the amendment of the Medicare program so as to permit APRNs to execute admission assessments and certification of patients for home healthcare service (Gutchell, Idzik & Lazear, 2014). The report also proposed the extension of the Medicaid reimbursement rates for primary care to incorporate APRNs providing similar primary care service.


Nursing professionals form the bulk of the American healthcare workforce with a membership of over 3 million nurses (The Institute of Medicine, 2010). The nurses’ large number warrants their active engagement in the healthcare issues. In addition, recent years have been characterized by a declined in the number of physicians and a rise in the demand for health services (Nicholson, 2009). Increased demand for healthcare services is fueled by the factors such as prevalent of chronic illnesses, aging of the American population, reforms in the healthcare financing system, and increased life expectancy. Consequently, a gap between demand for healthcare and supply of health services has emerged. Nicholson (2009) projects that the demand for primary health service will exceed the supply for these service by 85,000 0 20,000 physicians, by the year 2020. Empowering nursing to practice healthcare to the full scope of their training and education can help reduce this gap. Nurses also work on the frontline of the care delivery process. They spend the longest time with the patient; hence, they can promote continuity of care when allowed to take up a more advanced role in the administration of healthcare (Brassard, 2011). However, the full participation of nurses in healthcare is hindered by a number of legal and institutional barriers. Some regional and federal laws, as well as, some hospital policies limit the extent to which advanced registered nurses can take part in the administration of health services.   

Current Characteristics

This recommendation advocates for increased involvement of APRNs in the administration of healthcare. An APRN is a certified nursing professional who has a master’s degree or higher, has passed national certification exams, teaches and counsels patients, refers patients to physicians, and coordinates care (Brassard, 2011). The current level of involvement of APRNs in the administration of care varies of region to region. Currently, APRNs have prescriptive privileges in all states. This privilege implied that APRNs have the authority to prescribe a medication regime or change existing prescriptions for patients. However, only 48 states allow APRNs to prescribe controlled substances. Prescriptive authority is one of the few areas where uniform regulations exist.    

Currently, only 43% of APRNs have hospital privileges (Gutchell, Idzik & Lazear, 2014). This statistic means that only 43% of APRNs have the authority to admit patients into hospitals. Hospital privilege is largely determined by hospital policies. However, this privilege has a significant implication on the contribution of nurses to the healthcare system given that the majority of nurses are employed by hospitals. APRNs role in primary care is expanding. Consequently, it is necessary to give them hospital privileges so as to enable them to provide primary care of the highest quality.

At present, Medicare regulations permit APRNs to conduct physical examinations and take patients’ history in an outpatient setting (Brassard, 2011). However, Medicare regulations prevent APRNs from executing patients’ examination in hospital or inpatient setting. Medicare regulations demand that the medical history and physical examination of the patient be conducted not more than 48 hours after or seven days before the patient admission by a doctor of medicine or osteopathy (Gutchell, Idzik & Lazear, 2014). This provision implies that APRNs have no authority to take medical history and conduct physical examinations in hospitals. APRNs are qualified to take medical history and conduct physical examinations; hence, the Medicare regulation limits them from practicing the full level of their skills and training. Although these regulations are specific to Medicare, there are often applied to Medicaid cases.   

Impact of Recommendation

Full involvement of APRNs in the delivery of care has the potential of increasing the quality of care. Studies also show that women benefits from APRNs care. APRNs comprised of various categories of nurses including Certified Nurse Midwives (CNMs). Studies have recorded lower rates of cesarean sections, higher rates of breastfeeding, few cases of episiotomies where care administered by CNMs as compared to contexts where care is administered by physicians (Brassard, 2011). Similarly, active involvement of APRNs has the potential of reducing the quality of care. Similarly, allowing APRNs to take advanced roles in the administration of healthcare will promote continuity of care. Continuity of care is enhanced when it is the same person who has to take a physical examination, take medical history, admit the patient to hospital, prescribe medication and release the patient (Gutchell, Idzik & Lazear, 2014). There is also an improvement in coordination when APRNs are allowed to participate in these crucial stages of the care delivery process.

The cost of healthcare can reduce costs when an APRN has the authority to conduct physical examinations, take the patient’s history and admit the patient to the hospital. In the maternal care setting, CNMs can further reduce costs by delivering the baby and administering postpartum care (Gutchell, Idzik & Lazear, 2014). The rules that require physicians to conduct a physical examination and take patients’ history even in cases of normal delivery add unnecessary costs. Removing barrier for APRNs can also reduce the rate of readmission thereby reducing the cost of healthcare. Studies reveal that 20% of Medicare patients are readmitted within 30 days due to poor coordination and transition care (Brassard, 2011). Patients transitioning from hospital to communities are readmitted due to medication discrepancy as physicians are not in a position to offer sufficient follow-up of the patient.

Allowing APRNs to practice their professions fully will also foster interprofessional collaboration (Gutchell, Idzik & Lazear, 2014). When APRNs membership into medical teams is permitted, physicians and APRNs can learn from each other and gain deeper understanding of the other’s expertise and profession. Physicians can learn more about nursing while APRNs can learn more about medicine.

Current Solutions

Several policy options can assist in implementing the recommendation. The first solution is standardizing APRNs practice acts across different states. State practice acts pose a significant barrier to the full practice of APRNs (Brassard, 2011). Different states have different laws concerning the practices of APRNs. Some states governments do not permit physicians to prescribe controlled substances while others do not allow APRNs to conduct admission assessments (American Nurses Association, 2013). These rules also have a momentous impact on the management of public systems such as Medicare and Medicaid. Therefore, a Federal law is needed in order to standardize rules that apply to the practice of APRNs.

The second policy solution entails changing Medicare regulations to ensure reimbursement parity. Medicare regulations do not permit APRNs to conduct physical examinations and take patients’ history in an inpatient context; hence, APRNs cannot be reimbursed for these services (Gutchell, Idzik & Lazear, 2014). This regulation needs to change. Similarly, Medicaid, Medicare and some private insurers reimbursed APRNs at 75%- 80% of what is paid to physicians for similar services (Brassard, 2011). There is no analytic reason for this disparity of payment; hence, this regulation needs to change.

Final conclusions

The landscape of the healthcare industry is changing. The industry is facing a significant challenge in terms of meeting the demand for physician services. An enormous gap between the supply and demand for primary-care physical has emerged due to factors such as aging of the population and healthcare financing reforms (Nicholson, 2010). APRNs can execute 80% of health services and 90% of the pediatric services that are currently being provided by primary-care physicians because they have the necessary qualifications and training (Brassard, 2011). Consequently, APRNs can help reduce the gap between demand and supply of primary-care. Allowing APRNs to practice their practice their profession fully will also enhance the quality of care and lower costs. Policies that standardized APRN practice acts and that introduce uniform reimbursement regulations in Medicare are needed in order to support the full practice of APRNs.


Brassard, A. (2011). Eliminating barriers to APRN care. Available from

Gutchell, V. Idzik, S. & Lazear, J. (2014). An evidence-based course to eliminating APRN practice obstacles. The journal for Nurse Practitioners. 10 (4), 255- 261

Lavis, J. et al. (2009). Support tools for evidence-informed health policymaking. Health Research Policy and Systems. 7 (1), 1-9

Nicholson, S. (2010). Will the U.S. have a shortage of physicians in 10 years? Robert Wood Johnson Foundation. Retrieved from

The American Nurses Association (2013). Advanced practice nursing. Retrieved from /Medias/ANew-Age-in-Health-Care.pdf

The Institute of Medicine (2010). The future of nursing: Leading change and advancing health. Retrieved from

Rosemary Charles is an academic writer and an editor and she offers dissertation writing help. Thus, people that doubt their own writing abilities can use the best custom paper writing service and forget about their fears and unconfidence by visiting

Thursday, 28 December 2017 06:49

Impact of technology to health care

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Impact of technology to health care


Advancement in technology today affects every aspect of our lives. There are many new inventions in technology whose major purpose is to make things easier. All the aspects in life require technology advancement. That’s why every industry tries to catch up with the latest trends in its field.  In all those other areas, the field of medicine and health care has been immensely affected by it. The recent technological advancements in this field have changed the mode of service delivery hence the need to embrace it. The recent changes include; medical records stored electronically, bio-medical engineering and better health care through sophisticated machines. This paper explains in details how technology has affected the healthcare both positively and negatively.

The internet acts as a source of information.

It has become a very efficient source of medical information. Right from the professionals in this field to the entire public population, internet is used to gather a lot of vital data.  For those practicing healthcare, there are many situations that require research, and this is done from the internet. Moreover, much of what they do have already been done by others hence retrieving the information is easy. Healthcare means a lot to many people and requires of them to understand fully about the issues affecting them. Those diagnosed with diseases they don’t know anything about, find it easy to get the information from the internet. Sometimes people even do not visit the doctors since they already understand what is disturbing them from their research on the net. However, even though internet is of importance, it can also be disastrous if misused. It’s always good to consult further even after getting the information one requires from the internet.

 In connection to this, there are many services that are offered online by doctors, nurses, health facilities and even health research institutions. Some hospitals even use the social media to establish contacts with their patients. It helps them to answer questions as asked by their patients and also establishing sensitization programs. It saves time and energy because a large population is reached within a short time. 

Internet facilitates easy research because a lot of information can be retrieved from it. For health practitioners in this field, internet provides a platform for this. Sometimes when faced by a challenge, they consult other colleagues wherever they are through internet.

Improved treatment with minimal suffering of the patients

In the olden days, health care involved basic equipment that was cumbersome to use both to the patient and also to the doctor. But in the recent past, the machines that have been developed are patient friendly, and treatment process takes lesser time than before. For instance, in cancer treatment, there are so many methods that have developed. They include; surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy and others. It depends on the patients’ choice and capability. In most of them, direct insertion on the patient is avoided currently, unlike previous methods.

The new machines developed in this field improve the chances of survival to many patients. Health care is more efficient when the equipment used is automated than using manual methods. Some treatments just require the patient to be enclosed within a certain room then the doctor operates the machine to diagnose the problem. Due to improved technology, the time spent by patients in hospitals has reduced. Initially, treatments that took a long time now take less time. It reduces congestion in hospitals and helps save more lives within a short time.

Reliable and quality medicine

Since research on better healthcare continues on a daily basis, better medicine has been developed to fight diseases. These days, there are many strains of the same viruses and bacteria which cause certain diseases. Through research, better medicine has been developed to counteract the strains. The advancement in technology has helped in the analysis of the major components of these medicines thus a patient knows exactly about their contents. In early days, some patients were heard complaining that the drugs they took affected them. It is an issue with the counter-reactions of the body to the drugs. Through technology, this has minimized to low levels. The drugs developed undergoes through rigorous analytical procedures before releasing them to the market. Technology advancement has ensured that drugs manufactured meet the health demands of patients in an efficient way.

Better patient care and worker efficiency

Nurses and doctors these days use computers to record the patients’ details and progress of treatment. Their laboratory results are fed in a database that can be accessed anytime to show the patients history. It enhances better patient care and saves on time. Technology has enabled the health practitioners schedule activities to be done in the process of treatment of a patient. Thus, many patients can be attended to in a short time. The methods of treatment in use today are efficient and results oriented. That’s why patients are assured of quality services by the doctors.

Influx of Telemedicine health practitioners and consultants

Audio visual gadgets have been developed and can be used by doctors everywhere to provide health care. These doctors understand the elements of diagnostic evaluation through remote sensing technologies. They are also capable of working together with other widely dispersed teams of health care providers to deliver centralized services to their patients. Although they require special training, this method has a direct impact to patient satisfaction. Others specialize in offering online consultancy services through this method and then direct their patients to specific doctors near them for examination. They also advise health care professionals on the best technologies to use and hence contribute to improved health care. Medical consultants in pathology and radiology are done via the internet where the patient is an image. It reduces the cost since no travelling is required.

Some surgeries are even done using remote sensing technology whereby robots are used. The chief surgeon is located in the control room looking through the camera and not the patient. It is much applicable in microsurgeries whereby as long as the connection is available and not interrupted, the surgeries continue normally.

People can remain valuable and productive members of the society

Some health conditions if not well handled lead people to be dependants of others only. However, the recent advancements in technology have helped in treating these illnesses. When accidents occur, it’s the hope of every survivor to return to their original physical conditions. Though not all times, these patients are treated and can live normal lives using the technological advancements. It restores dignity to many and improves the quality of life to them.

Through technology, some diseases that were termed as fatal now have drugs that keep people healthy for long. Some like HIV and AIDS now have drugs that prolong life. In this way, people remain productive for a long time even though they are carriers of certain diseases.

Fast economic growth to a country

Medical technology is a key contributor to the economy of any country. It leads to job creation and promotes innovation through research. When the citizens of a country are healthy, economic growth is realized in a fast way because less time is lost in treatments. It can only be achieved through the improvement in technology in the health sector. Through the improved health care, people can live comfortable lives and thus work towards the growth of the economy. On the contrary, if they are not healthy, their productivity is low.  

In India for instance, its healthcare market was at 35 billion US dollars in 2007 and has registered a positive double growth since then. Though the growth can be attributed to high demand from other countries, the major contributing factor is the advancement in their healthcare technology.

Allows treatment of pre-mature babies

Very little could be done in this area in 1950s but currently its possible due to technology advancement. So many equipments have been developed to assist in this field. Many women used to suffer at the verge of their unborn children, but the problem has been minimized. It has also led to increasing life expectancy to the infants who are born pre-maturely.

Apart from the positive effects technology has brought in health care, it also has negative impacts. They are as described below though they cannot overdo the positive effects.

Emergence of unprecedented evils

The advancement in technology can be risky at times. The new medical systems developed involve a lot of unknowns that have the possibility of affecting many patients. As stated by Mc Mahon, “Technology is a positive contributor to healthcare and improves the quality of life. However, it has a negative impact to the healthcare by increasing expenditures and causing more exposure to liability.” Even though, technology is beneficial; it poses great danger both to patients and to the healthcare providers. The myriad of drugs developed at times cause the pathogens to mutate and hence causing adverse effects to the user. None of the practitioners thinks about this when administering them but when a problem arises, it becomes a cause of an alarm.

Negative results

Most of the technologies developed are meant to save lives, but they still have their risks to the patients. For instance; surgical operations, chemotherapy and radiation therapies offer a lot of benefits but also leads to some risks. It is true for any chemical used because even the simple ones have negative effects if used wrongly. Some operations still may lead to death even though the doctors’ intention was to save a life. The modern medicine developed is used to cure diseases. On the contrary, it can be damaging when used wrongly. An example is LASIK (Laser-Assisted In-Situ Keratomileusis) that is an eye surgery for correcting vision. During its trial steps, it led to unsuccessful results where the patients were affected immensely.

 Gamma rays are used to eliminate the cancer cells in vital organs like the brain without the use of open surgery. Though developed with the main intention being to eliminate the cancerous cells, it can be fatal. The amount of radiation used can as well destroy other cells surrounding the affected area. It leads to brain damage, and thus, a precaution is necessary when using it.   

Increased cost of treatment

For any health care equipment to be found in the market, intensive research has to be done on it by the developer. Thus, to give profit to the developer and cater for the maintenance, the cost of treatment has to rise above the normal rates. If the technology advancement offers a solution to a chronic disease, then it comes with extra payments. Due to the increased costs, many patients are not able to access good healthcare but instead end up succumbing to the diseases affecting them. In addition, most of these machines use the power that has to be paid. It leads to increased cost of treatment to the patients.

Loss of jobs

Technology has been used in almost all areas that required human services. The use of robots, software and even automation can replace people and in the long run lead to loss of jobs. According to Brynjolfsson and McAfee report (2013), though this technology is efficient, instead of creating jobs, it’s destroying them so fast. Less number of people are needed to work in the area than before when using technology because much of what is done is automated.

Lack of privacy

The medical history of a patient can be stored in a database that contains all information regarding the treatment. It may include; laboratory results, medications and bills. This method is convenient other than use of files that at times are not easily accessible. However, the data can be liable for misuse and manipulation leading to loss of data and patient-information privacy. Since software is prone to hacking, people may use fraudulent ways in accessing the information with bad intentions.  Overdependence on technology can be risky because, in such instances, no one is to blame.

Time factor

Quite a great deal of time is needed in the development of a new technology because of the tests to be done. The new technology requires rigorous training of the people to use it. It’s expensive and also, time-consuming. It is done to ensure safety to the patients and minimize the negative side effects to the user. It is done through quality assurance departments which take a lot of time before certification.


Advancement in technology in the health sector is vital to those infected with diseases and those injured. Some depend on it fully for their survival like those suffering from asthma that uses the breathing machines. Through the technology developed, people live longer lives even beyond their life expectancy. Thus, technology has many benefits to the people concerned, and since medical technology touches a crucial aspect of our life, it’s the most important of all the advancements. However, it has some negative effects that can be minimized through taking precaution and following instructions. The advantages that have come up with it have more emphasis and not the negative effects. What’s important is to ensure that the technological advancements benefits humanity as a whole.


David M & Mark Mc, (2001) “Is Technological Change in Medicine Worth It?” Health Affairs

Eucomed Medical Technology, Retrieved from

Field, M.J (1996). Telemedicine: A guide to assessing Telecommunications for health care Retrieved from


Francis D, (1999). Healthcare information technology

  1. Lamb, (1982) A Decade of Clinical Librarianship,Clinical Librarian Quarterly

National library of medicine, Fact sheet: “Medline,” (2002)

Retrieved from 

Robert Wood Johnson Foundation (1998) A Forecast of Health and Health Care in America: The Future Beyond 2005.

Sciences 360: Negative effects of modern medicine.


Rosemary Charles is an academic writer and an editor and she offers dissertation writing help. Thus, people that doubt their own writing abilities can use the best custom paper writing service and forget about their fears and unconfidence by visiting

Thursday, 28 December 2017 06:45


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            Malaria is among the most widespread mosquito-borne diseases in the tropical and sub-tropical country. It is a disease of poverty inflicting a serious negative impact on health and socioeconomic development in the poorest of the world that cannot afford to succeed. Malaria remains a chief public health issue and an ailment of poverty because in areas of high transmission, pregnant mothers and their newborn babies are most affected by malaria morbidity and mortality. A recent report by the World Health Organization (WHO) (2011) estimates that 3.3 billion people were at risk of contracting malaria, in 2010.  Populations living in sub‑Saharan Africa (SSA) have the highest risk of contracting malaria. The region recorded 174 million episodes of malaria, in 2010, which is approximately 81%, of the 216 million cases reported worldwide. There were an estimated 655,000 of malaria deaths in 2010, of which 91% were from Africa. Malaria is among the principal causes of maternal and childhood morbidity and mortality, despite the availability of effective interventions.


  1. Malaria Parasites – The Silent Killers

            Many cases of malaria are caused by two protozoa specie; Plasmodium falciparum (P. Falciparum) and Plasmodium vivax (P. vivax) (Karunamoorthi, 2014). P. falciparum is spread by the female Anopheles mosquito. This parasite causes the falciparum or malignant malaria, which is the most dangerous form of malaria. Falciparum malaria has high rates of mortality and complications. The P. Falciparum is deadly because it has a high reproduction cycle. The Over 75% of cases of malaria in Africa are attributed to P. falciparum. P. vivax causes debilitating and recurring infections, but hardly kills (Nambozi, Malunga, Mulenga, Van geertruyden, D'Alessandro, 2014). P.vivax is less potent than the P. falciparum. The parasite is also spread by the female anopheles mosquito. The P. vivax is prevalent in the Middle East, the Americas and Asia. Small cases of malaria are caused by the Plasmodium malariae and Plasmodium ovale.

  1. Lifecycle of Plasmodium Parasite

The life cycle of parasites is extremely complex and comprises morphologically and antigenically distinct stages that are targeted by stage‑specific immunity. The plasmodium parasite enters the human body when an infected mosquito feeds on a human. The sporozite stage of the parasite finds its way into the bloodstream after the bite and is carried to the liver.. The sporozite develops into large “hepatic schizont’ at the liver over duration of seven days. The ‘hepatic schizont’ contains over 30,000 invasive parasites known as merozoites (Nambozi et al., 2014). The merozoites are released into the blood after the rupture of the liver cells, where they invade the red blood cells. The merozoite turns into a trophozoite 20 minutes after entering the blood stream. The trophozoite feeds on the contents of the red blood cells and decomposes haemoglobin to haem and amino acids. After some time, the trophozoite divides a number of times to generate 12-32 merozites that fill the red blood cell causing the cell to rupture. The same cycle is repeated after the rupture of the red blood cell. The newly released merozites invade uninfected red blood cells, transform into the trophozoite, feed on the content of the cell and produce additional merozites.

III.       Signs and Symptoms of Malaria

Malaria is typified by a wide variety of signs and symptoms. A significant symptom is high body temperature and chills (Wykes, Horne-Debets, Joshua Leow, Deshapriya, 2014). Infected persons develop fever because of the rupture of red blood cells and release of toxins into the blood stream. A person may also experience headaches due to the release of toxin and disrupted supply of oxygen as a result of the destruction of red blood cells. An infected person may also develop muscle, joint and abdominal pain. The aches, nausea, fevers and chills are also caused by immune reaction of the body. A person may also experience diarrhea, palpitation and a general feeling of weakness. The symptoms are often become evident 7 to 18 days after infections depending on the specific parasite (Wykes et al., 2014). People infected by the P. Falciparum may develop severe complications such as organ failure and breathing problems.

  1. Effects of malaria on healthy body functions

Malaria has a myriad of effect on the body of the infested person. A significant effect is the destruction of red blood cells. The plasmodium parasite invades red blood cell and feed on their content causing them to rupture (Nambozi et al., 2014). The destruction of red blood cells causes iron-deficiency among pregnant women. Malaria also causes damage to the liver as parasites invade liver cells causing them to burst. The parasite also releases toxins to the blood leading to the overburdening of the liver. The P. falciparum can cause psychological disruptions, impaired consciousness, coma and death. This parasite modifies the surface of the red blood cells making them sticky (Karunamoorthi, 2014). The sticky cell can lodge into small blood vessels that direct blood to key organs such as the brain and kidneys causing malfunction and organ failure. Blockage of capillaries that supply blood to the brain may cause brain swelling and brain damage. Malaria can also cause hemolytic anemia when the bone marrow cannot generate new red blood cells at the pace of the destruction of the cells. Malaria parasites may also spread to the meninges causing inflammation, which lead to meningitis. Malaria also drives T cells to exhaustion. 

  1. Risk factors and preventive steps

There are diverse risk factors, as well as, preventive factors related to malaria. A significant risk factor is the birthplace. Malaria is common in the tropical region with 90% of infection cases occurring in sub-Saharan Africa (Utzinger, Tozan, Singer, 2001). This is because the tropical climate provides an appropriate environment for mosquitoes, which are the main vectors for the disease causing organism. Another risk/ protective factor is the living environment. Living near water bodies and littered environment increases the chances of contracting malaria. Littered environment and water bodies provide habitat and breeding grounds for mosquitoes. The vegetation coverage within the living environment can also act as a risk or protective factor. Thick bushes and heavy vegetation are risk factors for malaria as they provide a suitable habitat for mosquitoes.

Construction in the living area can also act as risk/ protective factors. Structures that allow accumulation of water and have hiding places for insects increase the risk of malaria infection. The sleeping condition also determines the level of exposure to malaria (Wykes et al., 2014). Outdoor sleeping increases the risk of contracting malaria. Use of treated bed-nets reduces the chances of contracting the disease. Education is also a protective factor against malaria. Educated individuals can take better protective measures than uneducated people. Similarly, educated people are likely to live in environments that do not support the breeding and spread of mosquitoes.

  1. Maintenance of quality of life

People can maintain a quality life by ensuring that their environment is clean. Responsible disposal of waste, drainage of trenches and clearing of vegetation can reduce the spread of malaria (Utzinger, Tozan, Singer, 2001). Modification of river boundaries and elimination of man-made water bodies can also reduce the spread of malaria. Mosquitoes breed on water. Therefore, ensuring that human settlements are away from water bodies can reduce the spread of malaria. The quality of life can also be enhanced by increasing the number of medical facilities in the tropical and sub-tropical regions. Malaria can easily be treated through the administration of anti-malaria drugs. Increasing the number of health facilities will ensure that people have access to treatment.

  • Diagnostic and Therapeutic tools

There are several approaches of diagnosing and treating malaria. The syndromic approach is one of the diagnostic approaches. This approach entails identifying easily recognizable signs and groups of symptoms associated with malaria (Nambozi et al., 2014). This approach is suitable for facilities that do not have adequate testing equipments. Another diagnostic method is microscopy examination. This entails the examination of blood samples using the microscope. RDT (Rapid Diagnostic Test) examination is also a common approach for diagnosing malaria. The RDT is a chemical approach of diagnostic that uses cassette and dipstick format to generate results. A sample of the patient’s blood is applied on the test card, and a reagent is applied to produce results in 20 minutes. Malaria can also be diagnosed using the clinical or presumptive diagnosis. Presumptive test is where clinical judgment is made without using confirmatory tests.

Therapeutic techniques for malaria include the use of anti-malaria drugs or injections, intake of vitamins and water, cold shower and social support (Wykes et al., 2014). Malaria can only be cured by administration of anti-malaria drugs or injections. However, there are effective drugs that eliminate the parasite with a short period. Infected person are also advised to take a lot of vitamins, water and fluids so as to facilitate the production of blood. Cold showers are often used to manage high temperatures and fever. Social support is essential to help the patient deal with emotional and psychological aspect of the illness. Administration of these therapeutic procedures will lead to normal functioning of the body. The body will also develop immunity and regenerate red blood cell and T-cells. Future researches are focused on developing an effective vaccine for the disease. Researchers have also focused of developing preventative mechanism such as the use a species of mosquitoes that feed on the larvae other mosquitoes.


Malaria can be prevented and well managed when the preventive measures are well utilized, and the therapeutic tools are well put in place. Over the past several decades, the experience and lessons teach us that although the existing conventional interventions are competent to minimize the malaria burden considerably, they remain unproductive to eradicate malaria. The introduction of a malaria vaccine could be one of the most sustainable and cost effective approach in the malaria prevention and control strategy. At the moment, than ever before we do have much substantial knowledge and better understanding on life cycle of malaria parasites, disease transmission dynamics and immunogenicity of the host. The present scrutiny results clearly suggest that certainly we have attained a sustainable progress to devise the ideal malaria candidate vaccine, and the recent clinical trial results are quite encouraging and optimistic. However, there are numerous challenges to the attainment of a safe, effective, tolerable, and affordable malaria vaccine that need to be addressed effectively and immediately.


Karunamoorthi, Kaliyaperumal (2014). Malaria Vaccine: A future hope to curtail the global malaria burden. International Journal of Preventive Medicine. 5 (5), 529-538

Nambozi, Michael; Malunga, Phidelis; Mulenga, Modest; Van geertruyden, Jean-Pierre; D'Alessandro, Umberto (2014). Defining the malaria burden in Nchelenge district, Northern Zambia using the WHO malaria indicators survey. Malaria Journal. 13 (1), 1-15

Utzinger J; Tozan Y; Singer BH, (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine & International Health. 6 (9), 677-87

Wykes, Michelle N.; Horne-Debets, Joshua M.; Chiuan-Yee Leow; Karunarathne, Deshapriya S. (2014). Malaria drives T-cells to exhaustion. Frontiers in Microbiology. 5 (1), 1-5. DOI: 10.3389/fmicb.2014.00249.

Rosemary Charles is the Managing Director of a globally competitive essay services which is the premiere provider of Essay Writing Services, Research Paper Writing Services at Term Paper Writing Services at very affordable cost. For 9 years, she has helped a number of students in different academic subjects.

Thursday, 28 December 2017 05:58


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According to WHO, 347 million people worldwide are diabetics. It is estimated that 3.4 million people succumbed to high fasting blood sugar in 2004. Low-income and middle-income countries experience more than 80% of deaths from diabetes. Healthy diet, avoiding tobacco, exercise and normal body weight prevents or delays the onset of diabetes type 2. (WHO, 2013)


Diabetes is classified as a metabolism disorder. Metabolism refers to the chemical processes occur within living organisms that are important for the continuity and maintenance of life. Some food is broken down to produce energy for fundamental processes while others are synthesized. The body uses digested food to produce energy and for growth. Most food we take is broken down to form glucose.

Once food is digested, glucose is then absorbed into the bloodstream. However, glucose cannot be absorbed into our cells without the presence of insulin. Insulin enables the cells to absorb the glucose.
Insulin is produced by glands in the pancreas. The pancreas produces enough amounts of insulin to move the glucose present in blood into cells. Once the glucose enters the cells, glucose levels in the blood drops

People with diabetes have conditions in which the quantity of glucose in their blood is too elevated. It happens because their bodies do not produce enough insulin, produce no insulin, or have cells that do not respond properly to insulin produced by pancreas. The result is too much glucose build up in their blood. The excess amount of blood glucose is passed out of the body as urine. As much as the blood contains plenty of glucose, cells cannot get it for their essential use to produce energy and growth requirements if insulin is absent.

History of diabetes

Diabetes was recognized for the first time around 1500 B.C.E. by ancient Egyptians, who termed it a rare condition in which a person frequently urinated and lost weight. According to Dobson, The term diabetes mellitus reflected the fact that urine of the infected patients had a sweet taste. The term was used by the Greek physician Aretaeus. The physician lived from around 80 to 138 C.E. come to the year 1776; Matthew Dobson measured the urine to investigate the concentration of glucose. The glucose in the urine of diabetic patients was found it to be high (Dobson, 1776)

There are three types of diabetes:

Type 1 Diabetes

According to Bryan, Type 1 diabetes comes as a result of the body not producing insulin. It is sometimes referred to as insulin-dependent diabetes, early-onset diabetes or juvenile diabetes. Majority of People develop type 1 diabetes the age of 40, mostly in early adulthood or teenage years. Type 1 diabetes is not so as common compared to type 2 diabetes. It only accounts for approximately 10% of all diabetes cases. For Patients diabetes type 1, it is a requirement to take insulin for the remaining part of their life.

They are also advised to make sure that proper blood-glucose levels are maintained by carrying out regular blood tests and by following the recommended diet.

Type 2 Diabetes

Type 2 diabetes, is brought about as a result of the body failing to produce adequate insulin for proper functioning, or the body cells fail to react to insulin. It is approximated that 90% of all diabetes cases in the world are of type 2. Type 2 diabetes is controllable by healthy dieting, losing weight, exercise, and monitoring blood sugar levels. Type 2 diabetes is medically a progressive disease. It gets worse with time and the patient probably ends up having to take insulin in tablet form. The risk associated with developing diabetes of type 2 increases by Being overweight, eating wrong foods and being physically inactive. Age is also a risk factor to developing type 2 diabetes. Those with close relative with type 2 diabetes, people of African descent, Middle Eastern, or South Asian descent, have shown to have a higher risk rate of developing the disease.

Gestational Diabetes

Gestation diabetes affects females during pregnancy. Some Women record very high levels of glucose in their blood during pregnancy. Their bodies are incapable of producing enough insulin to transport all glucose into cells, resulting to increasingly rising levels of glucose. Diagnosis of this type of diabetes is done during pregnancy. Most gestational diabetes patients can control diabetes with exercise and diet. However, some of them may need to take blood-glucose-controlling medications. Undiagnosed or uncontrolled gestational diabetes raises the chances of having a complicated childbirth. The complications come because the baby may grow bigger than he/she should be. The risk of gestational diabetes rises in women whose diets prior to pregnancy had high quantities animal fat or cholesterol (Bryan, 2004)

How to Determine Diabetes

Doctors can detect whether a patient has abnormal or normal metabolism, diabetes or prediabetes or several ways through three possible tests:

The A1C test
-diabetes- at least 6.5%
-prediabetes- between 5.7% and 5.99%
-normal levels- less than 5.7%

The FPG test
- diabetes-at least 126 mg/dl
-prediabetes- between 100 mg/dl and 125.99 mg/dl
-normal levels- less than 100 mg/dl

The OGTT test
- diabetes-at least 200 mg/dl
-prediabetes- between 140 and 199.9 mg/dl
-normal levels- less than 140 mg/dl

Controlling Diabetes

All types of diabetes are treatable. There is no cure currently for diabetes type 1. Type 2 diabetes lasts a lifetime; however, there are some people who manage to get rid of their symptoms without medication. They have managed through a combination of diet, exercise and body weight control

In recent findings, gastric bypass surgery can reverse patients with type 2 diabetes. However, within three to five years the disease recurs in approximately 21% of them. The findings suggest that, obese diabetic population will increase the durability of remission of Type 2 diabetes if early surgical intervention is done.

Patients with type 1 diabetes

They are treated using regular insulin injections combined with exercise and special diet.

Patients with Type 2 diabetes

They are treated using tablets combined with special diet and exercise. In its advanced level, insulin injections are also given. Failure to control diabetes leads to many complications that become difficult to reverse.

Complications that are linked to failure to control diabetes:

There are some complications that result from badly controlled diabetes. Examples of such include eye complications, foot complications, skin complications and heart problems. Also hypertension, mental health, hearing loss, gum diseases, Gastro paresis, ketoacidosis and Hyperosmolar The complications also include Hyperglycemic Nonketotic Syndrome, Neuropathy, peripheral arterial disease, Nephropathy and stroke

Facts and Myths about Diabetes

Many presumed "facts" are written in the media regarding diabetes. Many of them are in fact, myths. It is of importance that everybody gets an accurate picture of the disease. Below are some myths about diabetes.

The most common myth concerning diabetes is that people with diabetes should not exercise. That is not true. People with diabetes need to exercise like everybody else. Exercises are important helping manage body weight, blood sugar control, improves cardiovascular health, improve mood and relieves stress. It is that Patients discuss with their doctor first concerning exercises.

The second myth is that overweight people eventually develop type 2diabetes. A person who is overweight is at a higher risk of becoming diabetic. The fact that they are risk factors does not mean that obese people definitely become diabetic. Many people diagnosed with type 2 diabetes were never overweight.

Thirdly, there is a myth that Diabetes is a nuisance, but not serious. Two-thirds of diabetes patients succumb prematurely to stroke or heart disease. The life expectancy of a diabetic person falls to about five to ten years below compared to other people. Diabetes, therefore, is a serious disease.

Children can outgrow diabetes; this is not true. Majority of children have type 1diabetes. That means that insulin-producing beta cells in the pancreas have been destroyed and never come back. Children with type 1 diabetes are required to use the insulin injectable for the remaining part of their lives.

Don't eat too much sugar, you risk becoming diabetic. It is not true. A diet that is high in calories, which can make people overweight, only raises the risk of developing type 2diabetes.

Diabetes diets are different from other people's diet. The diet recommend being taken by diabetes patients are healthy ones and healthy for everybody. The diet recommended contains plenty of, fruits vegetables, whole grains, less sugar, low salt and low saturated fat.

High blood sugar levels are normal to some, while to others they are a sign of diabetes. High blood-sugar levels are not normal to anybody. Some illnesses, drugs containing steroids and mental stress can cause temporary rises in blood sugar levels even though the person does not have diabetes. Everybody with higher than normal blood sugar levels should be checked his or her blood sugar and urine for diabetes by a medical professional.

Diabetic people cannot feed on bread, pasta or potatoes. People with diabetes can food containing starch; however, they must be careful about size of the portions. Whole grain starchy foods are better, just as even for people without diabetes.

Diabetes can be transmitted or is infectious from one person; this is not true. Just like a broken leg, diabetes is not infectious. A parent may pass on to their offspring through genes. The offspring develops a higher vulnerability to developing the disease.

Only older people develop type 2 diabetes. Things have changed. In the recently, a large number of children and teenagers have developed type 2 diabetes. Experts say that the trend is linked to poor dieting, the explosion in childhood obesity rates and lack of physical activity.

People who use insulin have developed severe diabetes. People are advised to take insulin when diet alone cannot provide enough control. Also, the insulin can be recommended when diet with non-insulin injectable drugs are not capable of providing good enough diabetes control that's all. Insulin only helps in diabetes control and is not necessarily used due to the severity of the disease.

Symptoms of diabetes:

The most common symptom is frequent urination. If insulin is ineffective or absent, the kidneys cannot be able to filter glucose back into the patient's blood. Instead, the kidney takes water from the blood in order to dilute glucose. The water is responsible for filling up the bladder causing frequent urination.

Diabetes causes disproportionate thirst. As a result of frequent urination, there is a need to replace the lost liquid.
Intense hunger is also a common symptom of diabetes. The hunger is a result of the bodies urge for more energy. Inadequate energy in the body is due to the improper functioning of insulin.
Diabetes can result to Weight gain. Weight gain might result from intense hunger.
Unusual weight loss is common among people with diabetes type 1. Since the body is not making insulin, it seeks out another energy source. Fat and muscle tissues are broken down for energy. Weight loss is more noticeable in type 1 due to its sudden onset compared to type 2 which is much gradual.

Increased fatigue due to improper functioning if insulin leading deficiency of glucose in cells Other signs of diabetes include; irritability, blurred vision, Cuts and bruises delaying to heal properly or quickly. Other signs include More skin or yeast infections, Itchy skin, red or swollen gum and Frequent gum disease. Also Sexual dysfunction among men, Numbness or tingling, particularly in patient’s feet and hands

If glucose exceeds in a person blood, it damages nerves and also extends to the tiny blood cells that are useful in feeding the nerves. The result of the damage brings about tingling and/or numbness in the patients' hands or legs
Diagnosis of diabetes

Diabetes is detected by carrying out a urine test to determine whether it contains excess glucose. A urine test can be backed up by a blood test. A blood test is also useful in confirming cause of the symptoms is diabetes.

Causes of diabetes

Insulin resistance

According to Midvei, Type 2 diabetes is associated with insulin resistance. The bodies have high rates of insulin intolerance.

Insulin deficiency

Insulin deficiency is a result of the intolerance is due to autoimmune destruction of pancreatic beta cells leading to type 1 diabetes.

Genetic factors

Genetic factors have been seen to contribute to high rates of getting diabetes. Individuals with variants have an increased risk of diabetes. (Medvei, 1993)


Bryan, Jenny (2004). Just the Facts Diabetes Chicago, Illinois: Heinemann Library a division of Reed Elsevier Inc

Dobson, M. (1776) Nature of the urine in diabetes Medical Observations and Inquiries 5: 298–310

Medvei, Victor Cornelius (1993). The history of clinical endocrinology Carnforth, Lancs U.K Parthenon Publishing Group

World Health Organization (2013) Media Centre Diabetes Retrieved from

Rosemary Charles is the Managing Director of a globally competitive essay services which is the premiere provider of Essay Writing Services, Research Paper Writing Services at Term Paper Writing Services at very affordable cost. For 9 years, she has helped a number of students in different academic subjects.

Friday, 22 December 2017 11:50

Telenursing, the Future is Now

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Telehealth is a concept that entails management and delivery of health care at a distance (Fairchild, Elfrink & Deickman, 2008). Nursing professionals have a significant role to play in this concept of healthcare. Nursing professional can also conduct nursing practice and provide nursing care at a distance in what is referred to as telenursing. This paper explains the concept of telenursing with a specific focus of what this concept entails, the technologies involved in the nursing environment, the advantages and demerits of this concept of nursing.


Telenursing is a subset of telehealth. Telenursing is not a specialty in nursing as a nurse in any setting can apply technology in order to interact with patients (The American Telemedicine Association, 2011). Telenursing is used to monitor patients’ physiological parameters such as weight, respiratory flow, oxygen levels, blood glucose, heart sounds and blood pressure. The concept of telenursing can also be used for consultation on issues such as administering insulin injection and dressing a wound. Telenursing can also be used to implement patient education programs, medical assessment and test. 

There has been a fervent debate on whether a nurse providing services using technology amount to nursing practice. Critics of telenursing argue that administering services remotely cannot be considered nursing practice since nursing practice requires the use of physician-approved protocols. However, boards of nursing from various states examined this matter and arrived at the conclusion that nursing practice occurs when a trained practitioner utilizes judgment skill, knowledge and critical thinking that is intrinsic in nursing education to solve patients’ problems (Hutcherson, 2010). Therefore, provision of services remotely are within the definition of nursing practices as practitioners who engage in this practice use their nursing skills and knowledge to solve patients’ problems.  


Telenursing relies heavily on technological medium to deliver nursing care. This concept of care entails delivering health services using telecommunications and electronic information technologies (Fairchild, Elfrink, and Deickman, 2008). Telecommucations and information technologies enable nurses to monitor and interact with patients remotely. Therefore, nurses need to develop technological competencies in order to practice this nursing concept. Nursing professionals need to develop competencies in using technologies such as the internet, telemonitoring equipments, telephones, video and audio files, and digital assessment tools. Development of new technologies such as artificial intelligence and nanotechnology will advance the concept of telenursing.  

Telenursing technologies differ in each situation and can vary from telephone calls to video game system. Studies have found that some technologies to be more effective than other when it comes to telenursing. Fairchild, Elfrink and Deickman (2008) found that technologies that facilitate real-time, two-way communication between nurses and patients were more successful in administering education and counseling services than technologies that do not facilitate two-way communication. Therefore, nurses practicing in a telenursing environment need to select technologies carefully in order to optimize the care delivery process.


The telenursing concept of care is linked to a number of benefits. The first benefit is improved access to care for patients located in remote regions. Persons living in far-flung areas do not have access to expert care because these regions are medically underserved (Fairchild, Elfrink, and Deickman, 2008). These people are often compelled to travel long distances so as to access medical care leading to loss of substantial amounts of time and the rise in the cost of receiving health services. The telenursing concept has made healthcare services easily reachable to persons in far-flung regions as it has provided a platform for these people to interact with caregivers at different locations. People located in rural areas do not have to journey lengthy distances so as to receive care. 

Telenursing also has the potential of reducing the cost of healthcare. The sum of cash that patients spend on health services is drastically reduce when the concept of telenursing is applied since patients do not have to cover lengthy distances so as to receive healthcare services (Hutcherson, 2010). Similarly, this concept reduces organizational costs since telenursing enables hospital to make effective use of their human resources. Telenursing enables nurses to serve a large number of patients within a limited duration; hence, reduce human resource costs. Telenursing also increases the productivity of nurses as nurses do have to spend a substantial quantity of time traveling to the patient’s location.

The telenursing concept can also improve health outcomes by promoting patients adherence to healthcare plans. Patients’ adherence to healthcare plans is a critical determinant of health outcomes (Fairchild, Elfrink, and Deickman, 2008). However, many patients are unable to adhere to medical plans due to faulty understanding of treatment plans, miscommunication, lack of access to facilities, and lack of proper follow-up mechanism. The telenursing concept provides patients with a platform for seeking clarification on treatment plans. It also provides nursing practitioners with a platform for conducting follow-up activities. Nurses can communicate with patients outside the acute care setting; hence, they can monitor the patient’s progress.

The concept of telenursing also increases the rate of healthcare utilization. A section of the American population do not seek care especially on issues such as maternal care, prenatal care, preventative screening and health checkups because of limited access to healthcare facilities (Hutcherson, 2010). The telenursing concept enables this section of the population to receive health services without having to travel over long distances. This concept makes the care delivery services more convenient for people located in remote locations; hence, it motivates these people to seek medical services.


There are more than a few disadvantages that are connected to telenursing. A significant demerit of the telenursing concept is that it threatens the patient’s right to privacy (Fairchild, Elfrink, and Deickman, 2008). Telenursing calls for the use of technologies such as sensor and infrared to monitor patients in remote locations. These technologies enable health practitioners to track the movement of patients in order to detect falls, illnesses and injuries. While these technologies enhance the safety of patients, they undermine these patients privacy. Using these technologies, health practitioners can intrude into the patients’ private life.  

Telenursing also threatens the confidentiality of patient’s information. Confidentiality is an ethical principle that demands that the patient’s information should not be disclosed to other parties without the patient’s consent (Fairchild, Elfrink, and Deickman, 2008). Most technologies that are used in telenursing make the patient’s information prone to unauthorized access. Information conveyed via the internet can easily be intercepted because the nurse and the patients have no control over the internet infrastructure. Telephone conversations between nursing practitioners and patients can also be intercepted since the patients and the nurse have no control over the telephone networks. Similarly, information sent via email can be accessed by hacking the authentication codes of the patient’s email.

The telenursing concept also raises a number of quality and regulatory issues. Since telenursing entails administering care using technology, it is possible for a nursing professional to provide care to patients in different states, regions, countries and event continent. This raises the question on where nursing care occurs in the telenursing environment (Hutcherson, 2010). A dilemma occurs regarding whether the healthcare services administered using this concept should be subject to standards within the patient’s jurisdiction or standards within the nurse’s jurisdiction. This dilemma has led to increased calls for the standardization of healthcare standards. Standardization will ensure that nurses are only required to adhere to the same standard regardless of the location of the patient.

Conclusion and Recommendations

            Telenursing is a concept that entails remote administration of nursing care using telecommunications and information technology (Fairchild, Elfrink, and Deickman, 2008). It is not a specialty is nursing; hence, any nursing profession can use this concept. Technology is an important element in the telenursing concept. Therefore, Manuel needs to develop technological competencies so as to excel in this nursing environment. Manuel needs to familiarize himself with different technologies and how they are applied in the nursing context. He also needs to be conscious of the strength and weaknesses of each technology as this knowledge will enable him to know which technology should be applied in a given situation.

            Telenursing present numerous benefits to hospitals, patients and the health system. This nursing concept has the potential of increasing people’s access to healthcare, reducing healthcare costs, improving health outcomes and increasing health utilization especially among rural communities. However, manual needs to be aware of several legal and ethical issues that affect nursing practicing in the telenursing environment. These issues include patients’ privacy, confidentiality, licensing issues, and handling patients’ documents.


Fairchild, L. Elfrink, V. and Deickman, A. (2008). Patient Safety, Telenursing and Telehealth. Rockville; Agency for Healthcare Research and Quality

Hutcherson, C. (2010). Legal consideration for nurses practicing in a telehealth setting. Journal of Issues in Nursing. 6 (3), 27- 31

The American Telemedicine Association (2011). Telehealth nursing fact sheet. Retrieved from

Janet Peter is an academic writer and an editor and she offers best dissertation writing services. Thus, people that doubt their own writing abilities can use the best custom paper writing service and forget about their fears and unconfidence by visiting MeldaResearch.Com.

Friday, 22 December 2017 11:46

Antitrust and managed care

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Antitrust is a policy that allows competition among the health care providers. It allows competition in the field of research on health, issues to do with health care provision to consumers. It is believed that if there is no competition among the providers, the consumers will have to pay more for the services. With the competition, the consumers will get better-improved services. It also ensures that the health providers are on their toes, come up with innovations that benefit the consumers. For instance, the pharmaceutical companies will manufacture high-quality drugs that will be of benefit to the consumers. On the other hand, health institutions such as the hospitals will hire high qualified physicians and doctors to keep up with the game of other health providers. The antitrust policy allows health providers to have a joint activity, allowing them to exchange ideas; thus, they have evolved on health provision in meeting the consumer demands and competition.

Managed care organizations are those that provide health services to the consumers in contract with the government. They get paid every end of the month by the state for the services they have provided. The common features of the managed care are that the members receive services from their homes by either a registered social worker or a nurse. The services can also be provided at other residential settings such as nursing homes, adult family homes among other settings. Another common characteristic of the organization is that the consumers determine the services they want to be given, for example, physical therapy, mental health services or even specialized care. People who are under the managed health care receive services that help them in achieving their goals in life and employment; for example, living skills training.


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ammer, P. J., & Sage, W. M. (2002). Antitrust, Healthcare Quality, And The Courts. Columbia Law Review, 102(3), 545.

Zebrack, B. J., & Chesler, M. A. (2000). Managed Care.31(2), 89-103.

Janet Peter is an academic writer and an editor and she offers best dissertation writing services. Thus, people that doubt their own writing abilities can use the best custom paper writing service and forget about their fears and unconfidence by visiting MeldaResearch.Com.

Friday, 22 December 2017 11:44


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                                                Healthcare can be defined as a diagnosis, prevention and treatment of illnesses, diseases, mental or even physical impairments in humans. Access to healthcare depends from country to country depending on the legislation put in place to govern and control the health sectors in those countries. A good healthcare should ensure that the people covered can access affordable and quality health services. Provision of good healthcare may involve the creation of health insurance by the government to cover individuals who cannot afford to cover themselves. The governments put in place regulations to guide these health plans to shield the citizens from insurers who may want to deny them coverage by citing reasons such as health status  or by charging higher premiums.

                                                An example of a good healthcare is the Obamacare that intends to cover all the American citizens and the legal immigrants. The laws guiding this healthcare are spelt clearly in the patient protection and affordable care act. The act sets guidelines on the health provision to the citizens. The law requires that all employers should offer affordable healthcare to their employees and whoever fails to do, so there are penalties involved. All individuals are supposed to purchase insurance with premiums making it affordable to the majority of the citizens since those who cannot afford due to poverty levels can purchase the premiums on cost-sharing. Every government must ensure that all its citizens can access free preventive care and are protected against healthcare fraud.

                                                In today’s health provision systems, everything is based on contracts either with the government, physician, insurers or even the patient. An example of this contract is Indemnification/ hold harmless provision. The contract maybe entered between a health plan and the physician. It protects one party from any liability arising from the omissions or the actions of the second party in performing its requirements therein. It is important that an indemnification is modified such that there is mutual protection arising from omission or actions of both parties making both parties to handle their responsibilities/liability.


Qing, L., Xin, T., Jiang, T., & Xinping, Z. (2014). BMC Health Services Research, 14(1)

Raynald, P., Da Silva Roxane, B., Alexandre, P., Michel, F., Audrey, C., Sylvie, P., & Jean-Frédéric, L. (2014). ): a 2003-2010 follow-up. BMC Health Services Research, 14(1)

Janet Peter is an academic writer and an editor and she offers best dissertation writing services. Thus, people that doubt their own writing abilities can use the best custom paper writing service and forget about their fears and unconfidence by visiting MeldaResearch.Com.

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