Sunday, January 26, 2020

Epilepsy and Type 2 Diabetes Mellitus: Case Study

Epilepsy and Type 2 Diabetes Mellitus: Case Study People with chronic and complex conditions are usually characterized by complex causality, multiple risk factors, a long latency period, a prolonged course of illness that cannot been cured, and functional impairment (Wilkes, Cioffi, Warne, Harrison, Vonu-Boriceanu, 2008). These people are often treated by primary care professionals such as the community care. Community care plays a key role in our health system; it can avoid patient readmission to the hospital, reduce healthcare costs, and make patients feel more comfortable when they have treatment at home (Wilkes et al., 2008). In the case study, Jessica is suffering epilepsy and Type 2 Diabetes Mellitus, which affects her daily life and her self-care behaviour. As a community care registered nurse (RN), I will promote Jessica’s knowledge about her chronic illness and health history, perform nursing assessments, and support her and her family with regard to her continuing nursing care. My primary goal is to improve Jessica ’s health condition and help her maintain her normal daily social and career life style (Lubkin Learsen, 2013). As an RN, on the first day visit with Jessica. At the beginning, I will establish therapeutic relationship with her by communication and also observing her facial expression, body language and listening voice tone. Arnold Boggs (2011) stated the foundation of nursing skills are approaching to therapeutic relationships and good communication in nursing practice and identifies trust, respect and honesty which are guiding professional actions. Meanwhile, her health history needs to be obtained by using oral communication skills, such an interview with her and her partner, without any judgment and by using open-ended short questions (Lubkin Learsen, 2013). In addition, the RN need perform a physical examination that includes general observation and checking BP, pulse, temperature, BGL, height, and weight. The information obtained during this phase contributes to an overview that identifies Jessica’s current and past health state and provides a baseline assessment to evaluate fut ure changes (Brown et al., 2014). It is important for the RN to indicate Jessica’s past and present medical conditions and treatments, which can create a suitable care plan and provide unique care. Ekman et al. (2011) believe all care providers should create personalized nursing care to people with chronic illness and help them to achieve their individual goals. The research shows epilepsy is the most common serious chronic neurological disorder of young people, with public misinterpretation inducing fear and social stigma, which leading to prejudice and discrimination in school, workplace, and community (Coker, Bhargava, Fitzgerald, Doherty, 2011). As a RN should educate Jessica by explaining the pathophysiology of epilepsy; for example, McCance, Heuther, Brashers, Rote (2014) state that â€Å"seizures are the abnormal discharge of electrical activity within the brain; the epilepsy is repeated recurrence of seizure activity which results from underlying disorder of the Centre Nerves System (CNS)† (pp. 679). In the past, Jessica’s seizures have been infrequent, brief, and often well controlled by medication. However, she may also suffer from greater degrees of depression, anxiety, and be prone to the social and vocational limitations that the illness usually brings (Coker et al., 2011). Furthermore, there are many risk factor s that can cause breakthrough seizures; these include diet, medication withdrawal, and alcohol consumption. Jessica may not aware of such factors due to a lack of specific knowledge (Coker et al., 2011). At the moment, Jessica is starting to withdraw from her anticonvulsant medications and avoiding her GP’s advice by continuing to drive her car; she also went to a dance club and drank alcohol. All of these affect her health conditions. Jessica also has Type 2 diabetes, a common chronic multisystem disease related to abnormal or impaired insulin production, with high risk of macrovascular and microvascular complications that lead to illness or disability and death (Hicks, 2008). There is no specific research on the association of epilepsy and Type 2 diabetes, but studies have found that seizures can occur during diabetic ketoacidosis when the body cannot get enough insulin; meanwhile, in many cases, epilepsy-related seizures may be mistaken for the symptoms of hypoglycaemia (Schober Holl, 2011). The aim of treatment is to control her blood glucose level (BGL) between 4 to 7 mmol/L, which reduces the risk of diabetes complications (Hicks, 2008). Currently, Jessica’s BGL shows12.9 mmol/L because of poorly controlled diet and excessive weight, which presents a greater great risk of cardiovascular, kidney, and metabolic diseases. After explaining the two chronic diseases to Jessica, during the time as an RN, I will perform a nursing assessment that includes a neurological observation assessment, nutritional assessment include regular BGL checks, behavioural assessment, and psychological assessment. Neurological observation is the collection of information on a patient’s central nervous system and neurological status, incorporates monitoring of the patients level of consciousness, pupil reaction and motor function, and observation of vital signs (Brown et al., 2014). It is important to monitor Jessica’s neuron function due to frequent seizures, especially after being hospitalized with tonic-clonic coma and unconsciousness. Regular BGL checks will help with her awareness of her glucose level and encourage regular administration of her hyperglucagonemia medication. The aim of intervention for Jessica is to control her high BGL and assess her normal diet, which can reduce diabetes complications so t hat she can achieve the quality of life she desires. Research has found that to control chronic complications from diabetes, a patient needs good self-care behaviours; for example: healthy diet, regular exercises, weight loss, taking medications as prescribed, blood sugar monitoring, and good support from family (Huang, Hung, Stocker, Lin, 2013). Behavioural assessment can help monitor her health condition and achieve goal setting, problem-solving, and medication adherence. The nurse can provide an accessible, relaxed environment to help Jessica focus on what she can do rather than what she cannot do, and act as a channel for her and her partner to discuss their fears and anxieties associated with her chronic illness (Welsh, 2008). She also told her GP that she did not need any more prescriptions for her anticonvulsant medication. Studies show that withdrawal from epilepsy medication has significant implications for lifestyle and circumstance, and that the patient should stop drivi ng (Coker et al, 2011). As the result, as an RN I need to consider Jessica’s dilemma carefully as it impacts her independence regarding transport and that, in turn, impacts her employment and income, self-esteem, and quality of life. The nursing intervention can include broader aspects of care including assessing Jessica’s needs, providing advice on associated topics to help her understand her condition and the management plan, and asking her partner to join her care (Welsh, 2008). For example, her partner, Martin, should be aware of her health condition including driving, potential pregnancy, alcohol use, employment restrictions, and other safety issues. On the point of RN also provide referrals to other professionals such as dietitian, social workers, counselling services, and family support groups. The role of the community RN is not only managing a patient’s chronic illness, but also to seek more assistance or research to improve the effectiveness of patient cares (Chen et al., 2012). The research shows that education in combination with psychological intervention can support medication adherence (Dean, Walters, Hall, 2010). In Jessica’s case, the RN needs to understand the negative impact that psychological issues can have on her lifestyle and chronic disease management, for example the chronic disease may cause her anxiety, and depression. As the result, we might arrange for Jessica to attend some group meeting or study conference about young people with chronic diseases. The fundamental nursing requirements are skills in communication, listening, counselling, and teaching to support the patient and her family (Welsh, 2008). There are two priorities for the RN’s follow-up with Jessica. As we noticed that before the current seizure, Jessica had weened herself off her anticonvulsant medications because she wanted to become pregnant and is perpetually in noncompliance with regard to her diabetes. The aim of the community service nursing intervention is to improve Jessica’s quality of life through needs-led primary health care with a person-centred approach to her individual needs and create a treatment plan that will improve health outcomes (Ekman et al, 2011). As Jessica is of child-bearing age with epilepsy, she merits unique consideration. Because withdrawal her antiepileptic drugs will increase seizure frequency, as an RN will need to be informed when Jessica contemplates pregnancy and refer her to a specialist before conception. Meanwhile, an occupational therapist will assess any risks in her home environment; a counselling service also be needed. From this point, the RN should consider the patient’s needs and communicate with a multidisciplinary team (Lubkin Larsen, 2013). We will need to motivate Jessica to take responsibility for her own self-care by using motivational interviewing and health coaching to incorporate behaviour change principles that promote healthy activities (Lubkin Larsen, 2013). For example, as an RN need to understand and explore Jessica’s motivation for becoming pregnant and keep her current life routine by listening with empathy because her opinion and methods may be different than they would be with a person who didn’t have complex medical issues. This will empower Jessica, encouraging her hope and optimism to follow the current treatment plan as well as to consult other health professionals. The primary goal is to maintain good self-care attitudes that will enable Jessica’s knowledge and understanding related to her ability to successfully cope with the disease in her normal life (Coker et al., 2011). A study by Soubhi et al. (2010) shows that strong self-management programs are amongst the best evidence- based interventions for improving outcomes. Thus, promoting self-care will empower Jessica to make independent decisions. The result will be an improvement in her quality of life and a reduction of psychosocial problems. In conclusion, from a community nursing service perspective, the experience of care giving to Jessica with her chronic and complex conditions has been extensively addressed. Meanwhile, an RN with an increased understanding of Jessica’s experiences will gain greater insight into the care she needs to improve her health and provide more effective healthcare delivery in the community (Soubhi et al., 2010). References Arnold, C. E., Boggs, U. K. (Eds.). (2011). Interpersonal Relationships: Professional Communication Skills for Nurses (6th ed.). Missouri: Elsevier. Brown, D., Edwards, H., Lewis, S. L., Heitkemper, M. M., Dirksen, S. R., O’Brien, P. G., Bucher, L. (Eds.). (2014). Lewis’s medical-surgical nursing: assessment and management of clinical problems (4th ed.). Chatswood, Australia: Elsevier. Coker, M. F., Bhargava, S., Fitzgerald, M., Doherty, P. C. (2011). What do people with epilepsy know about their condition? Evaluation of a subspecialty clinic population. Elsevier Ltd: Seizure 20, 55-59. doi: 10.1016/j.seizure.2010.10.007 Chen, M. S., Creedy, D., Lin, S. H., Wollin, J. (2012). Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: A randomized controlled trial. Elsevier Ltd, International Journal of Nursing Studies, 49, 637–644. doi:10.1016/j.ijnurstu.2011.11.011 Dean, J. A., Walters, J., Hall, A. (2010). A systematic review of interventions to enhance medication adherence in children and adolescents with chronic illness. Arch Dis Child, 95, 717–723. doi:10.1136/adc.2009.175125 Ekman, I., Swedgerg, K., Taft, C., Lindseth, A., Norberg, A. †¦Sunnerhagen, S. K. (2011). Person-centered care-ready for prime time. European Journal of Cardiovascular Nursing 10, 248–251. doi: 10.1016/j.ejcnurse.2011.06.008 Huang, C. M., Hung, H. C., Stocker, J., Lin, C. L. (2012). Outcomes for type 2 diabetes mellitus patients with diverse regimens. Blackwell Publishing: Journal of Clinical Nursing, 22, 1899-1906. doi: 10.1111/jocn.12123 Hicks, D. (2008). Recent developments in the management of type 2 diabetes. British Journal of Community Nursing, 6(11). doi: http://dx.doi.org/10.12968/bjcn.2001.6.11.9458 Lubkin, I., Larsen, P. (Eds) (2013). Chronic illness: Impact and interventions (8th ed.). Burlington, MA: Jones Bartlett. McCance, L. K., Heuther, E. S., Brashers, L. V., Rote, S. N. (Eds.). (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Elsevier. Schober, E. Holl, R. (2011). Epilepsy in children and adolescents with type 1 diabetes. Diabetes Voice 56(2), 43-44. Retrieved from https://www.idf.org/sites/default/files/attachments/DV_56-SI2_Schober-Holl.pdf Soubhi, H., Bayliss, A. H., Fortin, M., Hudon, C., Akker, V. D. M., Thivierge, R. †¦ Fleiszer, D. (2010).Learning and caring in communities of practice: Using relationships and collective learning to improve primary care for patients with multimorbidity. Annals of Family Medicine, 8(2), 170-177. doi:10.1370/afm.1056 Welsh, M. (2008). The practice nurse’s role in the management of epilepsy. British Journal of Community Nursing, 6(3). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11923723 Wilkes, L., Cioffi, J., Warne, B., Harrison, K., Vonu-Boriceanu, O. (2008). Clients with chronic and complex conditions: their experiences of community nursing services. Journal of Clinical Nursing, 17(7b), 160-168. doi:10.1111/j.1365-2702.2008.02454.x

Saturday, January 18, 2020

Prison Nursery Essay

The authors describe prison nurseries as living arrangements within a correctional facility that allow incarcerated mothers to keep their infants (born during their incarceration) with them through all or part of their sentence. This article brings to question whether these women should be treated any differently than any other incarcerated women and who should pay for these programs. The authors note that this may be one of the most controversial debates surrounding the imprisonment of women. At the time of this study, the authors note that there are currently 8 states that provide prison nursery programs: California, Indiana, Illinois, Nebraska, New York, Ohio, South Dakota, and Washington. This is up from only 3 states in 1998 and notes that New York has had a prison nursery program since 1901. The authors illustrate studies that have shown that the recidivism rate among women who have been allowed to keep their children in prison nurseries is lower than that of other women. Howev er, limited studies have been cited concerning the development of children born into and raised within a prison nursery program. The authors discuss the cost of prison nursery programs as being one major hurdle into starting and/or continuing these programs. Most nursery programs are segregated from the general prison population and are staffed with both civilian and correctional staff, allowing for public and private funding to be used. The authors’ note that a large percentage of the children in prison nursery programs would otherwise be cared for through public dollars whether it be within the foster care system or public assistance to the interim caregiver during the mother’s incarceration so there seems to be little difference in the funding or use of funding in terms of child care. Through several studies the authors note the strict guidelines for eligibility for these programs, including type of crime, past history of abuse, and length of sentence. Each program has its on set of criteria and rules but the authors state that the idea behind the programs is the same wherever it is incorporated and that is to provide an opportunity for mother and child to succeed. The authors conclude that prison nurseries should be more widely available as the trend of women being incarcerated has continued to rise and no decline seems to be forthcoming. They note that studies into the long term effects on children born into prison nurseries is also needed as well as re-entry into society must be closely monitored and facilitated in order for true results to be determined.

Friday, January 10, 2020

Benefits of Data Mining

Data mining is defined as â€Å"a process that uses statistical, mathematical, artificial intelligence, and machine-learning techniques to extract and identify useful information and subsequent knowledge from large databases, including data warehouses† (Turban & Volonino, 2011). The information identified using data mining includes patterns indicating trends, correlations, rules, similarities, and used as predictive analytics. By employing predictive analytics, companies are actually able to understand the behavior of customers. Predictive analytics examines and sorts data to find patterns that highlight customer behavior. The important behavioral patterns are those that indicate what customers have responded to and will respond to in the future. Also, patterns can indicate a customer base that is in jeopardy with the company, customers that are not company-loyal and are easily lost. Predictive analytics of customer behavior can be of great benefit to the business (Turban & Volonino, 2011). Companies are able to build specific marking campaigns and models such as direct mail, online marking, or media marking based on customer preference and are better able to sell their products to a more targeted customer base. Knowing what the customer wants, what they will respond to, and which customer base to focus on takes the guesswork out of marking and product development. Taking the information retrieved and using it correctly will only increase profits (Advantages, 2012). Association discovery using data mining provides a huge benefit to companies. Association discovery is finding correlations or relationships between variables in a large database. For example, in terms of a supermarket, it is finding out that customers who buy onions and potatoes together are also highly likely to buy hamburger meat. These correlations where one set of products predict the buying of another is referred to as associations. Data mining can employ association discovery allowing business to predict buying patterns and allow for more effective operations management and can better pinpoint marketing strategy of coupons and incentives (Association Rule 2012). Web mining is another aspect of data mining. Web mining uses the data collected on the Internet to analyze customer data and gather information beneficial to the company. Any time someone visits a website, uses a search engine, clicks on a link, or makes an electronic transaction data is generated subject to analytics. Companies use web mining to gain customer preference and insight. The information gathered is used to improve websites and create a better user experience for the customers. Web mining can also be used alongside of predictive analytics. For example, on e-commerce sites every transaction is analyzed. When a customer clicks on a product, web mining tools can present a list of products he/she may also be interested in because of other customers with the similar buying interests/habits. This tool can be extremely effective in gaining business intelligence of the buying habits and preferences of customers (Turban & Volonino, 2011). Data mining also employs clustering to find related customer information and to provide valuable information to the company. Clustering gathers information and designates clusters of similar products and objects. In data mining, clustering is usually the first step. It identifies similar information and groups them to be further examined. Customer information and demographics are an example of these clusters. The group characteristics are analyzed against desired outcomes to understand the buying habits of customers and what marketing campaigns will enhance customer response (Ali, Ghani, & Saeed). Reliability of Data Mining The benefits of data have been examined, but it is important to look possible implications as well. Data mining uses algorithms to predict patterns and customer behaviors. Constant measures are needed to make sure the algorithms are working correctly, but the issue of reliability stems a little deeper. Algorithms and data analysis can only be as reliable as the actual data analyzed. Data gathered from different sources can potentially be t or even conflicting. This greatly affects the validity and result of algorithm, especially predictive analysis. It could alter the customer’s historical purchases or demographic information rendering the information useless and even costly. Data mining is a useful tool and should be trusted up to a point. It should not be the only solution. Companies should not only use data mining for marking and operations decisions. The costs of mistaking customer preference and predicting behavior could be catastrophic (Data Mining). Privacy Concerns of Data Mining. One of the major disadvantages of data mining is the privacy concerns associated with the technique. Three major privacy concerns raised by consumers are identity theft, misuse of personal information, and the â€Å"big brother is watching you† feeling (Orwell, 1954). The first concern is identity theft. With the increasing trend of e-commerce and electronic funds, identity theft has been a huge issue. The sheer amount and speed of information processing through data mining has led to a rise in identity theft making this valid concern. The information could easily fall into the hands of anyone (Exforsys Inc, 2006). The second concern is the misuse of personal information. Companies gather information as specific to customer purchases, names, phone numbers, addresses, and other information then store it in a database. Once obtained, copies can be made with little effort. Companies can easily sell this information to other companies. This is the exact concern of consumers. Consumer information can certainly be misused, exploited, or for discrimination making this a valid concern (Advantages, 2012). The last concern addressed in this paper is the total loss of privacy, feeling controlled or watched. The government uses data mining to track patterns of criminal activity have considered using the technique to track the movement of people. Some people feel this goes too far, and not giving the consumer the choice of having his/her information in the database takes away personal freedom. This concern is tied into the misuse of information because what stops companies to selling information to governmental or private agencies with the sole purpose being to control or watch an individual. With the volatile nature of crime, and the increasing use of technology by government agencies, this concern is also valid (Advantages 2012). Measures have been taken to alleviate these concerns. Companies that utilize data mining are required to take certain actions that protect their customer’s privacy. One of these actions is to remove and identity related attributes from each customer record before the data is transferred to analysts. Also banks allow for identity theft protection services to alleviate the concern of financial security. All of these concerns are still important and steps will have to be continuously made and adjusted to protect the security and privacy of personal and financial information (Li & Sarkar, 2006). Real World Examples of Predictive Analytics Predictive analysis and how it is beneficial to companies has been discussed above in theory. To completely understand how predictive analysis is used is to look at real world examples. The first example is how a fast food restaurant used HyperActive Technologies to predict what customers might order. HyperActive Technologies developed a system that allowed cameras to track vehicles pulling into the parking lot and track customers through the entire ordering process. Using predictive analysis of the data gathers from the cameras, the restaurant was able to conclude that at lunchtime; approximately twenty percent of cars entering the parking lot would order at least one cheeseburger. With this information, the cooks were able to get a head start in food production cutting down on wait time for customers and increasing overall productivity (Turban & Volonino, 2011). Another example of a company that uses predictive analysis is that of INRX, the leading provider of traffic information. INRX uses data mining by evaluating real time traffic measuring traffic problems and congestion. This data is collected from road censors, toll tags, traffic incident data, and commercial vehicles equipped with a GPS that continuously report their speed and location. Using predictive analytics, the data is studied to determine traffic patterns at certain locations and times. Drivers now have access to real time traffic information. This information has proven to be extremely effective and useful to drivers allowing them to make better decisions and avoid unnecessary delays (Turban & Volonino, 2011). The flower company, 1-800-FLOWERS. om, has also used data mining techniques, specifically predictive analytics. The company collects and analyses data at all contact points. Data collected includes historical purchases to discover trends, anticipate customer behavior, and meet customer needs and preferences. This technique has proven to be an effective way of increasing the response rate to customers, identifying profitable customers, and establishing customer loyalty. Customer reten tion increased by over fifteen percent after the implementation of predictive analytics solidifying its effectiveness (Turban & Volonino, 2011). As shown through academic research and real world examples, data mining is a real and effective way of predicting customer behavior and buying patterns. Measures need to be taken not only to overcome the stigma that data mining is unsecure and takes away personal freedom, but to make sure individual information is, in fact protected. If these measures are taken, data mining is a win-win for both businesses and consumers. Consumers will feel heard, understood, and taken care of. Businesses can actually focus resources on building that business-to-customer relationship and will be able to give the people what they need. References Advantages and disadvantages of data mining (2012). Retrieved December 9, 2012 from http://www.dataminingtechniques.net/data-mining-tutorial/advantages-and-disadvantages-ofdatamining/ Ali, R., Ghani, U., & Saeed, A. (n.d.) Data clustering and its applications. Retrieved December 5, 2012 from http://members.tripod.com/asim_saeed/paper.htm Data mining: issues. (n.d.) Retrieved December 7, 2012, from http://www.anderson.ucla.edu/faculty/jason.frand/teacher/technologies/palace/ issues.htm Exforsys Inc. (2006). Data mining privacy concerns. Retrieved December 5, 2012 from http://www.exforsys.com/tutorials/data-mining/data-mining-privacy-concerns.html Li, X. & Sarkar, S. (2006) Privacy protection in data mining. Retrieved December 6, 2012 from http://dl.acm.org/citation.cfm?id=1245621 Turban, E., & Volonino, L. (2011). Information technology for management improving strategic and operational performance (8th ed.). New Jersey: John Wiley & Sons, Inc.

Thursday, January 2, 2020

Autistic Children in Mainstream Schools - 1753 Words

â€Å"The current prevalence rates of Autism Spectrum Disorders range from 0.5 to 6.7 per 1,000 among children ages 3 through 10 years† (Shtayermman 88). With this dramatic change in the frequency of autism comes the development of special education schools and, in turn, a rise in the presence of autistic children in a general classroom setting. While many think that a child with Autism Spectrum Disorder, or ASD, in attendance at a regular school would be beneficial to the child in question, there are instances where it would be unwise to place them in such an environment. Considering the characteristics of children with ASD, the victimization they go through in a regular classroom, and the lack of knowledge amongst teachers, the experiences†¦show more content†¦Since they have difficulty in understanding the rules of conversation when they are speaking, there is an inability to link phrases together, sometimes repeating words or expressions out of context. Along with communication with others, children with ASD find it difficult to understand group interactions. This is often the reason why many of them are without friends; there is a preference of remaining aloof in the mind of a child with autism. The quality of life for a child with autism in mainstream schools is definitely at odds with how the school itself is structured. Due to changes in educational policies over the last decade, there are increasing numbers of children with ASD that are being educated in a regular classroom setting. Many may deem this inclusion as being positive for those students, but there are faults that accompany these types of circumstances, the reason being that many schools do not have the capacity to keep pace with such changes in order to include children with ASD. Many teachers find it tough to merge the academic talents of students with autism with their often severe difficulties in interacting with others socially. 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