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FORUM 7, 8-516, 7, 8:529, 7, 8:428. 1

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(By Insert name)

Course Codes

Professor’s Name

Institutional Affiliation

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Osteoarthritis is typically a slow progression condition that occurs over several decades.

As the years pass, the patient becomes less and less active and more susceptible to indispositions

associated to declining physical activity and a times increase in body weight. Pain is usually the

reason behind morbidity in osteoarthritis and primary symptoms are deep achy joint pain

aggravated by extensive use. There is also stiffness lasting less than half an hour, during rest

(Webb, 2010).

Whereas initially the pain may be relieved by simple analgesics and resting, as the

condition progresses, joints becomes unstable, pain becoming prominent and nonresponsive to

medication.

Pathophysiological underpinnings

The main tissue affected by this condition is the cartilage and the main cell found here is

chondrocyte.

The cells come from chondroblasts, a precursor cell, and get trapped within developing cartilage

in spaces called lacunae. From the site hey produce constituents such as collagen that gives

cartilage its functional characteristics. It is very unfortunate to have these chondrocytes located

within lacunae because they are unable to migrate to damage areas and consequently cartilages

have low propensity to heal. These among other factors create barriers to immune cells such as

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lymphocytes and immunoglobulin which should help healing process. Due to luck of blood

supply to the cartilage, matrix formation is slow and this essentially limits ability to recover (Li

et al. 2013).

Among the risk factors for one to develop this condition include;

• Age-the older you are the higher the prevalence

• Gender-prominent to females

• Bone structure and body weight-thinner women are at greater risk.

• Menopause and menstrual history-early menopause increases risk of developing this

condition.

• Lifestyle-smokers and alcohol consumers are at high risk.

• Family-susceptibility to fractures may be partly hereditary.

Complementary and alternative medicine options;

Primary prevention strategies include;

• Weight control,

• Control of infectious disease,

• Increasing physical activity,

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• Injury prevention,

Secondary prevention

Patients should be given advice on;

• Where to have appropriate information,

• Activity and exercises,

• Interventions for weight loss for over weights,

To relief pain, the patients can be given non-steroidal anti-inflammatory or COX-2

inhibitor is prescribed protein pump inhibitors should be given automatically. Others include

Transcutaneous electrical nerve stimulation (TENS) can help with knee pain short-term control

whereas on hip and knee, thermal modalities may be effective (Webb, 2010).

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References

Li, G. et al. (2013). Subchondral bone in osteoarthritis: insight into risk factors and

Microstructural changes. Arthritis Res Ter, 15 (6), 223, Doi:10.1186/ar4405. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061721/.

Webb, M. (2010). Primary and secondary prevention of osteoarthritis. Gig cymru NHS Wales.

Retrieved from

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ve

d=0ahUKEwj87-iNw4XSAhWnL8AKHf-

mAY8QFgggMAE&url=http%3A%2F%2Fwww2.nphs.wales.nhs.uk%3A8080%2Fhealthservic

eqdtdocs.nsf%2F5633c1d141208e8880256f2a004937d1%2F6b3ca32d27caaceb80257775002d8

59f%2F%24FILE%2F10%252006%252011%2520Rheumatoid%2520arthritis%25201.doc&usg

=AFQjCNEh7UQQkB_-pILa7oYLiDIjnFSGHg&sig2=PnIa7H6-zHOn-

cMtQVDrDA&bvm=bv.146496531,d.ZGg

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Open ended question

When Anna a 26 years mother of a year and 4 months old son visited her nurse after a

seizure, the nurse from the EHR realized that Anna was epileptic and she was not responsive to

convectional anti-seizures medication and was previously recommended to find alternative

https://dx.doi.org/10.1186%2Far4405

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwj87-iNw4XSAhWnL8AKHf-mAY8QFgggMAE&url=http%3A%2F%2Fwww2.nphs.wales.nhs.uk%3A8080%2Fhealthserviceqdtdocs.nsf%2F5633c1d141208e8880256f2a004937d1%2F6b3ca32d27caaceb80257775002d859f%2F%24FILE%2F10%252006%252011%2520Rheumatoid%2520arthritis%25201.doc&usg=AFQjCNEh7UQQkB_-pILa7oYLiDIjnFSGHg&sig2=PnIa7H6-zHOn-cMtQVDrDA&bvm=bv.146496531,d.ZGg







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modalities and among them yoga. She has not been in any anti-seizure medication for 8 months

now and she notes this is the second time she is having an attack. Just to try she has been

practicing Yoga for the last six months and this was her fist since she started yoga. Is there

therapeutic value of yoga in neurological disorders and would this really help Anna? Has

therapeutic yoga recorded positive results where anti-seizure medication failed and can this be

taken as future solution? Why are there few medical students interested in neurology whereas

neurological related complications are on increase and demand for these skills high?

Reply

Is there therapeutic value of yoga in neurological disorders and would this really

help Anna? Has therapeutic yoga recorded positive results where anti-seizure medication

failed and is this the future solution?

When non-randomized clinical trials were conducted on patients with drug-resistant

epilepsy, subjected to therapy twice a day, 19/20 subjects reported decreased seizures within

three months and 6 of those recorded 50% reduction in seizure frequencies (Mishra, et al. 2012).

Peripheral Nervous System Disorders-A study done on 20 diabetic neuropathy subjects

for 40 days yoga sessions and other 20 subjects in a non-randomized controlled study on nerve

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condition velocity. Results indicated improvements in median nerve conduction velocities of

58.81+/-1.1 m/sec and 52.46+/-1.0 to 54.75+/-1/1m/sec respectively (Mishra, et al. 2012).

Why are there few medical students interested in neurology whereas neurological related

complications are on increase and demand for these skills high?

Neurology is one of the difficult modules in the medical curriculum. It has there been

associated with phobia. When a cross-sectional survey was done among clinical fourth and fifth

year students at a Faculty of Medicine Sciences, Universities of the West Indies, St. Augustine,

Trinidad and Tobago using the same survey tool, to assess perceived difficulty levels, knowledge

and interest in neurology, cardiology among other conditions; results indicated that 167/255

subjects identified the subject as most difficult with 3.98+/_ 0.068 and least knowledge of

2.32+/-0.072 (Youssef, F. 2009).

The results indicated that ‘neurophobia’ among students indeed existed and thus

imperative to revisit the current approach to neuroscience to change it to increase likeability by

students to make it in tandem with the disease trends.

References

Mishra, S., Singh, P., Bunch, S. & Zhang, R. (2012). The therapeutic value of yoga in

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neurological disorders. Ann Indian Acad Neurol, 15(4), 247-254, retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548360/

Youssef, F. (2009). Neurophobia and its implications: evidence from Caribbean medical school.

BMC Medical Education, 9(39). Retrieved from

http://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-9-39

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LETTER TO THE LEGISLATOR

Tuesday, February 09, 2017

The Honorable James Beach,

District 6 (Burlington and Camden)

United States Senate.

Dear Senator (Hon. J. Beach)

I am a practicing nurse at Trinitas hospital in New Jersey and an ongoing nursing student at

Thomas Edison University set to graduate on June 2017 with BSN in Nursing. I am writing to

first support NJ S2866 Establishing social innovation loan guarantee pilot program and study

commission within New Jersey Health Care Facilities Financing Authority concerning opioid

and other substance use disorders and secondary express my views about the bill.

I am pleased that someone realized agonizing pain and suffering that comes with substance abuse

and disorders thereof and it importantly pleases me that it has to be my Honorable


http://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-9-39

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Representative. I with no doubt thousands if not millions of people in the entire State and indeed

country warmly welcomes this progressive bill, I thank you. After going through the bill, I

certainly agree that the amendments to invest in innovation loans guarantee though in pilot

program for the purposes of attracting private investments in Health Care more so for treatment

and prevention of opioid and other substance use disorders. Treatment and rehabilitation of this

and other disorders can be expensive and this bill sought to bring down public expenditure on

related services is truly welcome and well thought.

My only concern on this bill is the effects that Patient Protection and Affordable Care Act

(PPACA) popularly known as Obama Care bill have on the bill considering the president’s

decision to repeal it. PPACA has played a major role in caring for youth especially foster youths

a majority of whom are substance users and PPACA for instance required Medicaid to offer

uninterrupted medial insurance for youths previously in foster care till when they attain 26 years.

This bill complements the PPACA bill and therefore I would be forgiven if I worry about what

happens that PPACA was reprieved by the President. There is a lot of contribution made by

PPACA and during the debate; I wish that plausible effects of reprieving PPACA will equally be

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10


debated to ensure that the proposed bill will be enacted for the good and prosperity of American

populace.

Thank you for taking time to consider my views. I am glad that I can openly and directly share

my personal views more so on healthcare issues at your convenience.

Sincerely,

Jannina Azabache

Comment on at least two other student’s letters

On RN Irene Brown’s letter to Sen. Nellie-Paterson NJ, she raises a fundamental concern

for many RNs because being able to practice outside the State is not only advantageous to nurses

employment concerns but also addresses more pressing issues such as shortage on RNs. Nursing

Compact as proposed in the Bill is such an initiative and Irene’s plea with her Senate

representative is founded on believe that Nurse Licensure Compact will help alleviate RNs

shortage currently experienced in New Jersey among other States.

In her letter to Congressman Rodney Frelinghuysen, RN Megan Pierce seeks support for

a controversial bill on Planned Parenthood Act 2017. Proponents of the bill are concerned about

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mothers and teens having sex education that helps them in family planning matters including

abortion. On the other hand, critiques of the bill particularly church organizations and

conservative pro-life American populace are against any form of abortion or ending life of a

baby regardless of the circumstances of them being conceived and stage of development they

are. The church particularly the Catholic church is known to be strongly against family planning

and therefore, this Bill whose main agenda revolves around family planning, contraception and

abortions is likely to have heated debated in congress just as it is in the public domain. If medical

reasoning carries the day, the bill will have it easy; however, if morality as seen in the eyes of

majority conservative Americans raises consolidates their seemingly majority support, they

might have their say in congress as far as the bill is concerned.

Describe two ways the US finances health care

In the U.S. health care is technologically advanced but punitively expensive for majority of

American citizens. As a result the government spends trillion of dollars in health care alone and

this high spending does not necessarily translate into better health.

Healthcare is financed or paid for in various ways in the U.S. private citizens may pay directly

for services received (Almberg, 2016). Others may opt to use health insurance coverage which is

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12


usually a tax deductible benefit from their employment. Military personnel and their dependents

and veterans have federal government coverage. The older people depend on Medicare while low

income mothers and children, and persons with disability have access through Medicaid and for

children who may not otherwise have received medical attention may get it through State

Children’s Health Insurance Program (SCHIP).

Identify and discuss two ways the Affordable Care Act (ACA) cuts costs.

High Deductible Plans: ACA advocates for high deductible plans as a cost sharing

measure for insurers. This allows insurers to lower their premium thus making it affordable for

many citizens. This way, more people are covered due to lower premiums.

Another includes penalizing hospitals by reducing government Medicare reimbursements

to them for having an excess number of patients released form hospitals, but then readmitted

within a month for heart attacks, heart failure and pneumonia.

The Act also provided that insurance policies cover preventive care customers may also

reduce overall long-term healthcare costs. The idea behind this point is that if people received

preventive care, they will be less likely to suffer chronic conditions that are expensive to manage

and cure (Persaud, 2013).

References

Almberg, M. (2016). Government funds nearly two-thirds of U.S. health care costs. American

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13


Journal of Public Health study. Retrieved from

http://www.pnhp.org/news/2016/january/government-funds-nearly-two-thirds-of-us-health-care-

costs-american-journal-of-pub

Persaud, V. (2013). How the affordable care act will cut health spending. Retrieved from

http://www.nbclosangeles.com/news/health/How-the-Affordable-Care-Act-Will-Cut-Health-

Costs--226111101.html

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Health reforms in New Jersey

Medical Liability Reform

When policies of the day have an adverse effect or is negating the actual benefits that it

was supposed to bring in the first place, then it should be scrapped, revised or better still

amendments moved by a legislator (Mason, 2016). It is not any different in healthcare and

therefore reforms are made to change the status quo.

http://www.pnhp.org/news/2016/january/government-funds-nearly-two-thirds-of-us-health-care-costs-american-journal-of-pub

http://www.pnhp.org/news/2016/january/government-funds-nearly-two-thirds-of-us-health-care-costs-american-journal-of-pub

http://www.nbclosangeles.com/news/health/How-the-Affordable-Care-Act-Will-Cut-Health-Costs--226111101.html

http://www.nbclosangeles.com/news/health/How-the-Affordable-Care-Act-Will-Cut-Health-Costs--226111101.html

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There has in the recent past tremendous increase in lawsuits translating to high liability

insurance costs for physicians so much such that many are limiting their practice, moving out of

New Jersey or opting to retire.

This phenomenon has now pushed New Jersey Civil Justice Institute in collaboration

with healthcare professionals and providers to advance some reforms that will preserve patients’

access to care and help reduce health care costs.

According to New Jersey Civil Justice Institute (nd.), in their pursuit for the medical

liability reform, major hurdles laid ahead of them because New Jersey may not be in a position to

utterly ensure that shoddy evidence does not reach courtroom because of failing to adopt Daubert

Standards expert testimony.

As a result of this short coming, NTCJI is in favor of recently introduced bill, A3620 which

gives circumstances when affidavit of Merit can be filed with the complaint.

Reference

New Jersey Civil Justice Institute (nd.). Medical liability reform. Retrieved from

http://www.civiljusticenj.org/issues/medical-liability-reform/

http://www.civiljusticenj.org/issues/medical-liability-reform/

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Mason, D., Gardner, D., Outlaw, F. & O'Grady, E. (2016). Policy and Politics in Nursing and

Health Care, (7th ed revised reprint). St. Louis: Elsevier Inc. ISBN-13: 978-0323241441

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5 disciplines of the “learning organization” and how it would influence change how to

manage change in workplace

System thinking; involves looking at the bigger picture of things and seeing ‘wholes’.

This discipline establishes interrelationships and patterns of change as opposed to snapshots of

situations. To influence change through this process, would involve looking at the bigger

picture to enable decision making as to know who to trust with undertaking certain tasks

depending with their strengths for example, where attention is needed more and so on.

Personal mastery; is a description of personal growth, learning and these people with

high degree of mastery continue increasing their abilities in pursuit for skills they seek. This

increase in skills in their never ending quest for self-improvement and self-discovery drive he

change in an organization. To manage change at work place would involve facilitating these

masters amass as much skills as possible so that they can steer the change.

Shared vision; does not necessarily mean sharing an idea, it means that there is a

shared commitment that bind these people to a common aspiration. This discipline is

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important because it provides the energy and desire to learn and create a sense to accomplish a

mission. These aspirations drive the change and despite the direction, so long as the vision is

shared, change will be experienced. To achieve change, I would ensure that there is a shared

vision by constantly reminding ourselves of where we need to be and why. This would bring

the attention of everyone to the same direction.

Team learning; this discipline is a build up from personal mastery discipline in that it

is a progression that integrates developing and aligning the aptitude of a team to accomplish

the set goal desired by members. To influence change every team member has to participate

thus share responsibilities to all and aligning and developing capacity without disregarding

member’s abilities and strengths.

Mental models; this discipline is formulated on the understanding that individuals

have personal views, ideas, worries and prejudices and all this affects their interactions with

others. To influence change, system thinking has to be developed and when individual’s

mental models are entrenched in past experiences and beliefs, that change will remain a pipe

dream. Therefore modeling the mind to focus on the future and let the past not blur the vision

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and this would involve leaders using ladder of inference and reflective inquiry to practice

making their mental models clear to others to unsure that a shared understanding becomes

possible.

Discuss how you feel about change. What are your responses to change?

Change is inevitable in any workplace, what is pivotal is good management of the

change process because it determines whether the change process happens or fails to happen.

Good and constant communication ensures that workers are aware of the developments

happening and this helps them adjust psychologically, and this minimizes resistance and

enhances preparedness like shifting of allegiance for leaders.

As an employee, there are occasions when there is a strongly no enthusiasm about

change especially when he end result is not clear. There is sudden worry about the effect the

change will do to my job security, if the position is threatened for instance there is need to

reduce number as nurses, as a nurse I would hesitant to embrace change. Therefore there is no

precise reaction to change it depends with the goal of that change intend to achieve.

How could communication improve in your workplace?

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Helps in diversity; employees in a workplace can be from different cultures and

countries, and because they at any given time would like to pass a message, good

communication skills reduce the barriers erected by language and cultural differences (Buresh

& Gordon, 2013). When these barriers are removed, cultural diversity sets in.

Team building; effective communication allows managers and subordinate to have

meaningful work related conversations thus helping employees work together harmoniously.

When everyone works as a team productivity and efficiency is realized to the benefit of

everyone.

Employees morale; employees are happier when they are able to communicate

effectively with their seniors and this boosts their morale. This generates a healthy work

environment by reducing frustrations and confusion due to in effective communication among

employees.

Some of the communication pitfalls that you encounter and how they could be corrected

Failing to listen; often than not people interrupts the speakers or they are busy

scheming what they will say in response and fail to listen to the very end. Others are non-

verbal communications such as rolling of eyes and yawning when a comment is made or

certain speaker takes the podium.

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To correct such a problem, begin the conversation by pointing out the importance of listening

nd paying attention to the discussion, tell the audience to listen first then scribble notes

afterwards, keep their contribution as brief and precise as possible and focus on the person and

what they are saying.

Attitude and ego; many times in an office teamwork spirit is broken because of

individual’s ego, they fail to admit they could be the problem, as a result conflict arises.

Another cause of conflict could be inequality and instead of righting the wrong and taking

responsibility, someone becomes defensive.

To correct this problem, the person in charge should take back the conversation and dig out

the underlining problem and address it.

Gender bias: often than not there are “battle of the sexes” with arguments and counter

arguments of which sex makes better mangers for example and this deviates the focus from the

real issue. To solve this problem, one should not wait to be given a chance to speak, and should

instead speak loudly and express views, establish eye contacts and own your space and avoid

unwarranted apologies.

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Cliques, groups and friendships; some employees grouping can turn individuals

problematic to the management especially so if they are not objective.

To counter this problem, avoid character references or label, stress the need for all workers to

assimilate so that differences are minimized and cooperation attained.

Discuss a team that you are on or have been on. What roles do you take? Evaluate the

effectiveness of the team using the attributes of effective teams listed in Table 18-2 (also in

the Chapter 18 Checklist).

There was an upgrade of management system in a facility I worked in the course of

internship. We were grouped into three teams and I was in the Administration and finance team

where we were supposed to assist in capturing, verification and indeed testing the system before

being rolled out for use. Within that team there were sub teams to ensure duty allocation is

aligned to people’s skills. I was assistant team leader in a finance sub team where we were to

capture existing finance data and incorporate recommended changes.

As the team leader assistant, I was in charge of the team when the leader was

representing our tem in the change committee which comprised of all team leaders. My duty as a

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21


deputy was to ensure smooth execution of team’s mandate solve challenges and offers solutions

in his absence.

According to Sturt & Nordstorm, (2015) effectiveness of a team is usually evaluated by;

• Having a clear vision as to what the team intends to achieve,

• Having a leader, who inspires team members to do their tasks,

• Having a team spirit where if one fails, the entire team has failed,

• Establishment of a constructive communication within the group,

• Appreciation all around where everyone’s efforts are appreciated regardless of skills needed.

Reference

Buresh, B., & Gordon, S. (2013). From silence to voice: What nurses know and communicate to

the public (3rd ed.). Ithaca, NY: ILR Press.

Sturt, D. & Nordstorm, T. (2015). 5 must have attributes of every successful team. Forbes.

Retrieved from http://www.forbes.com/sites/davidsturt/2015/10/29/5-must-have-attributes-of-

every-successful-team/2/#26bbe5dabe3e

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http://www.forbes.com/sites/davidsturt/2015/10/29/5-must-have-attributes-of-every-successful-team/2/#26bbe5dabe3e

http://www.forbes.com/sites/davidsturt/2015/10/29/5-must-have-attributes-of-every-successful-team/2/#26bbe5dabe3e

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The need for collective action and the forms it can take.

It is imperative to have collective action at the work place because it signifies existence

of team work. According to Siegal et al. (2009) collective action occurs when number of

people work together to achieve a certain set goal or objective. The reason why it is important

is while everybody in a team shares interest with each other, there are also conflicting

individual personal interests which may crumble the groups’ goal. Therefore to avoid this,

collective actions are instituted.

Forms of collective actions

Strikes-a collective action can escalate into strike or strike threats so as to seek

audience with the other party. Here all nurses agree to withdraw their services collectively. For

instance nurses can issue strike notice through their registered union’s o the employers to force

the employer address their concern.

Collective bargaining-here members of a certain labor union or group through their

dully elected officials enter into agreements with their employer on certain terms and

conditions that are wage and working conditions related so as to protect the interest of

employees (members of the labor union).

Quality improvement process

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Nurses have a key role to design and improve and implement new models with the help

of new and improved technology solutions aimed at improving the quality of care outcomes. It

therefore follows that it is a continuous process of collaborative working together of departments

for client’s sake. Based on this premise, it therefore follows that those in direct service of care

are at the best position to provide client’s health progress status and work on improving

processes that these services are being provided.

Describe a quality project you have been involved in. What was the outcome? What did

you learn?

While working at a children’s hospital during internship, there were high numbers of

communication errors and teamwork breakdown translating to prolonged LOS consequently high

patients’ bills. As a result, the management orders an improvement process whereby

communications during dairy rounds was improved thus reducing medical errors. This improved

client satisfaction by thirty four percent and team agreement with physicians and laboratory team

by eighty percent. To improve communication, all pediatric intensive care unit staff members

were taken back to routine basics of daily rounding.

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Discuss the National Patient Safety Goals for hospitals. Give evidence of what your

agency is doing to meet them.

These are goals that are geared towards patient safety improvement and focusing on

problems in the health care safety and formulating solutions.

Identification of patients correctly NPSG.01.01.01; requires use of more than just name

to identify patients example use of birth date. It also ensures correct blood group is given. The

agency ensures that all patients have name, birth date and license number where possible for

identification.

Improve staff communication NPSG.02.03.01 getting the test results to the right person

on time. The agency ensures that each staff has a unique personal identification number which

they use to log in to the system, so test will only be directed to your online number.

Use of alarms safety NPSG.06.01.01 this requires improvements to ensure that alarms on

medical equipment’s are heard and responded to on time. The agency has positioned alarm bell

strategically for all to hear.

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IOM report on medical errors on the internet and discuss strategies for lowering medical

errors

• This can be done by implementing safety systems in healthcare organizations to ensure that safe

practices are adhered to at every practice level.

• Medical errors can also be reduced through identification of the errors and using them as a

learning tool by developing a countrywide mandatory public reporting system. This should be

done by encouraging healthcare organizations and practitioners to develop and take part in

voluntary reporting system.

• Errors can be reduced by establishing a nation focus to create leadership, research, tools, and

protocols to enhance knowledge base about safety.

• By raising performance standards and expectations for improvement in safety through actions

such as oversight, accountability, professionalism and incorporating attention to patient safety in

training programs and having good collaborations with other disciplines.

An experienced nurse on a medical-surgical unit has made the same medication error

two days in a row. As the nursing manager, describe how you would decide whether this

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is a systems problem or is related to the nurse. How would the manager correct the

problem?

The best way to handle this is to understand the root cause of the error first, critically

look at the error with an open mind and get to the cause. The nurse manager should critically

look at the level of skills of the nurse, abilities such as working under pressure, presence of

personal problems bothering them (American Nurses Association, 2015), and above all call

the nurse and ask how they would approach the problem if it arose again. Based on answers

provided and a critical analysis of factors that would plausibly lead to wrong medication learn

where the mistake is then start working on righting it.

Reference

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.

Silver Spring.

Siegal, G., Siegal, N. & Bonnie, R. (2009). An account of collective actions in public

health. American journal of public health, 99(9), 1583-87, retrieved from


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