Dissertation writing service is your all-in-one assistant

Melisa A. Smith Dr. Kathryn Skulley Eng 122-500 22 November 2011 Crisis in America Back in the late 1930’s, American men were drafted to go off and fight in World War II while women at home had to learn a new way of life to support their families and support the soldiers. A woman named Florence Nightingale who was recognized as one of the first nurses to care for the wounded soldiers during the Crimean war helped to influence other women to learn how to become nurses and care for the sick and wounded.
After the war ended in the mid 1940’s, thousands of soldiers returned home to begin the next chapter in their lives by starting a family while women returned to homemaking. In fact, due to the major population shift after the war, thousands and thousands of babies were born in which it would be named the Baby-Boomer generation. Now fast forward to the year 2010, several decades later, the baby-boomer generation is aging and approaching there sixties and beyond at a time when healthcare is beginning to be used more frequently by many others.
Now that America is beginning a new era of healthcare with the creation of healthcare reform that soon will create access for the uninsured and underinsured to gain access to healthcare treatments. On March 23, 2010, “The Affordable Care Act” was signed into law by President Obama that would create healthcare access for millions of Americans. This is turn would create a huge strain on the American healthcare system at a time when concerns are rising due to the increased need of services for the baby-boomer generation and the current nursing population to care for them.

You can read also Coronary Artery Disease Nursing Care Plan
If Americans already planned on facing a nursing shortage with the baby-boomer generation, then how would the shortage affect everyone else when healthcare reform becomes active in the year two-thousand-fourteen? This paper will discuss some individual points more in detail and evaluate the nursing shortage situation from the beginning of nursing history to present day that could affect all healthcare workers now and in the future. The nursing shortage topic in America has always been a debatable question where it will be analyzed further in detail starting with some statistical data.
Looking at the national level for current nursing employment, the U. S. Bureau of Labor and Statistics stated that, “2,655,020 registered nurses were currently employed as of May two-thousand and ten” (U. S. Bureau of Labor and Statistics: Occupation section). The information presented here did not account for self-employed nurses or one’s that currently work multiple jobs. Now on a smaller scale looking at the State of Colorado’s population and registered “nurses per 1000 rate is 7. 98 as compared with a national average of 8. 6 with an additional need of 1,780 nurses to meet the national average” (The Demographic Challenges Facing Colorado’s Health Care Workforce 15). The information noted here did not account for rural areas and small towns where the population is considerably lower. Next, the discussion will continue on about nursing school factors affecting the nursing shortage. Additionally when someone is attracted by the potential for a nursing career and advancement, they must look at all avenues first before deciding and making a commitment to nursing school.
However, when someone has made the decision to enroll they must take several prerequisite classes and take a nursing entrance exam before being accepted into a nursing program. Furthermore, after students have taken the required prerequisites, they may not easily be accepted into a nursing program because of limited number of slots available and teaching constraints. In fact, it has been well observed by many schools that the major factor in the nursing shortage is due to the lack of qualified nursing instructors.
In the United States, “nursing schools turned away 67,583 qualified applicants from baccalaureate and graduate programs in 2010 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors and budget constraints” (2010-2011 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing 2). Another factor that contributes to the nursing shortage is that nursing faculty members and educators are being lured away from colleges by higher compensation, which in turn reduces the number of potential educators to meet the demands needed.
Consequently, most educators are generally older with a limited number of years of teaching left before retirement which in turn could also leave more potential nurses waiting on a list that could reduce the national shortage. Furthermore, the United States started facing some major healthcare challenges with the baby-boomer generation beginning to impact the healthcare system in two-thousand ten. Now that this generation is in their sixties many of them will be facing increased health problems due to aging thus putting a greater demand on the healthcare system for treatment and prevention.
Consequently, this generation will begin turning sixty-five at a rate of approximately ten thousand baby-boomers per day for the next nineteen years starting in the year two-thousand eleven. This in turn will create a huge stressor to the already problematic nursing shortage. In addition to the baby-boomer generation, America will soon be forced to provide healthcare to millions of individuals who previously did not have insurance starting in two-thousand fourteen when the Affordable Care Act goes into full force.
Furthermore, “healthcare reform will soon provide subsidies for thirty-two million citizens to more fully utilize the healthcare system” (Joint Statement from the Tri-Council for Nursing on Recent Registered Nurse Supply and Demand Projections 2). This in turn will create a huge stress on the medical profession especially the nursing sector, as the healthcare system is grappling in the shortage of nurses to care for the baby-boomers. Emergency rooms and physicians’ offices will soon be faced with a massive influx of patients to provide care for, which would cause an increased demand for more medical staff including nurses and physicians.
Patients then would be going to local hospitals for elective surgeries and diagnostic testing which would cause a surge and a need for more hospital beds to accommodate the needs of patients. When the demand exceeds the amount of resources available people could be facing other challenges such as emergencies or disasters of magnitude. With the introduction of the healthcare reform and the baby-boomer generation, the healthcare system could also be facing emergency preparedness scenarios that have not been attempted before with the combination of emergency disaster plans currently available.
Some may remember the hundreds killed and injured from the two-thousand eleven tornado outbreak or the terrorist attacks on the twin towers that caused mass casualties and injured numerous people on September 11, 2001. This is just to name a few disasters that America was impacted by with the need for emergent healthcare services. Additionally in the United States, “there is little flexibility for unanticipated fluctuations in patient acuity and demand on a daily basis, and an absence of standby capacity for large-scale emergencies” (McHugh 442).
Consequently, if the United States doesn’t come up with a large scale disaster plan that has been attempted before, then many will be faced with total destruction and demise. Nurses have gone through the grueling process to begin and succeed in their careers from the dedication of going to school to meet entry level standards, as well as taking the national licensure examination prior to practicing. Some nurses graduate with the expectation that the wages and demands of the job will be satisfying to keep them in their current role.
But some people may know very little about the profession until they are faced with the reality of the job demands versus the salary. A new graduate nurse just beginning his/her career maybe making less than the more experienced nurses, but still held to the standard of providing the same type of care to all patients. According to the U. S. Bureau of Labor and Statistics, the national median wage for registered nurses as of May two-thousand ten was “$67,720 annually” (U. S. Bureau of Labor and Statistics, Occupational Employment and Wages).
However this statistic did not report the level of education held other than the title of registered nurse. Furthermore, nurses are held to a high standard to uphold to their duties and continue to give accurate, compassionate and safe care to all patients. Nevertheless, nurses play many roles other than a care-taker or pill pusher, they are expected to know about possible medication interactions that could harm a patient since they are the last line of protection for patient. Nurses have also been trained to think critically in times of crisis and to intervene with life-saving interventions without the supervision of a physician.
Many of the “hazards on the job, include blood and body fluid exposure as well as musculoskeletal injuries related to ergonomic hazard from lifting and repetitive tasks” (Stone et al. 1984). During times of busy patient demands, nurses may also run the risk of harm to themselves, especially during the administration of an injection that could cause a needle puncture that may potentially be from an infected needle, or come in contact with the splashing of body fluids on exposed skin.
However, many hospitals have currently up-graded equipment to help prevent unwanted needle stick exposures through the use of needle free systems, but there is still work to be done to keep nurses and patients safe. Furthermore, nurses may also be exposed to occupational injuries while lifting a patient in bed, or when a patient falls on a staff member and injures them in the same turn as well. Obviously some hospitals have improved the safety for staff, and patients with the use of lifts or ssistive devices, but time maybe of essence. With this in mind, the physical and mental demands of the nursing profession may take a toll on a person’s body, or it may potentially provoke thoughts of a career change from the risks involved. However, since nurses are also held accountable for mistakes made even when times are proven difficult, in hind sight turn this could potentially create a stressful environment full of expectations without satisfaction.
Furthermore, “nurses’ working conditions have been associated with medication errors and falls, increased deaths, and spread of infection, but nurses report making more errors when working shifts greater than twelve hours, working overtime, or working more than forty hours per week” (Stone et al. 1984). In some hospitals nurses are given an assigned number of patients to care for, but patients are coming into the hospitals’ sicker than in previous years which can create a dilemma when assigning patient care.
Some hospitals’ have been designated as a Magnet hospital where the maximum ratio is one nurse to five patients which could help ease some demands to be able to provide better care to patients, but this trend is still new to some healthcare systems. On a typical working shift nurses are responsible for medication administration, physical assessments and general care of the patient, but during times of staffing shortage nurses may have to provide all the care for all assigned patients.
Generally speaking, nurses care for four to eight patients per shift while “an additional patient within this range was associated with a seven percent increase in the odds of dying within thirty days of admission and a seven percent increase in the odds of death following complications such as shock or pneumonia” (Keenen 1). In addition patients have a greater risk of infection due to lack of adequate infection control from proper hand washing by healthcare staff when staffing shortages occur.
When nurses are held accountable for a certain number of patients, and one person falls out of bed down the hall while they were getting another patient up to the bathroom can create an unsafe and unsatisfactory environment for all involved parties that in turn can cause higher morbidity in patients. With a stressful environment and combined fear of making a mistake which would result in punitive action against them, “the U. S. healthcare system contains a safety climate which blames individuals for errors instead of the system or organizational failures that may really be at fault” (Fox and Abrahamson 235).
With that said, more nurses feel pressured to not make any mistakes instead of being human. However, when hospitals’ are dealing with staffing issues and nurses are not able to give proper attention to their patients this in turn could create a dangerous situation for patients that have an increased mortality risk due to complications or co morbidities. Studies have shown that staffing insufficiencies increase the mortality risk in patients due to the inability to adequately care and educate patients on complications such as pneumonia or bloods clots which can be proven fatal.
Nurses are also expected to perform many tasks that include life saving techniques in critical situations, but in order to keep these individuals with these skills employed by a specific facility it takes a clever approach to nursing retention. However, “research shows that nurses contribute heavily to the quality of patient care, reimbursement based upon performance outcomes would likely increase the economic value of nurses, thus improving wages, work environment and recruitment and retention” (Fox and Abrahamson 235).
In the past, when hospitals were dealing with nursing shortages some would offer a sign-on bonus or a contract to pay for a portion of education expenses as an incentive to attract employees for difficult to recruit positions such as night shifts. Due to cost constraints some facilities were beginning to do away with sign-on bonuses and offer other assistance after a specific time period of employment. On the contrary, most facilities do not recognize nurses with compensation based on performance other than an increase in cost of living wages, but could benefit further through increased recognition programs.
Since World War II the nursing profession had always been a female dominant profession until now, with the addition and encouragement of male nurses in the profession. Most patients saw nursing as a female dominant profession due the delicate nature of caring for sick patients and the need for gentle interactions and nurturing. Furthermore, working conditions were often poorer in nursing with a predominately female occupation.
During times of economic recession more nurses were choosing to work, or continue employment to help meet the financial expectations of their households especially in times when other family members are facing a layoff or furlough. Although when the economy improves the shift of nurses actively working may change and create an even bigger nursing shortage while some may change careers or retire all together. Furthermore, with the introduction of men in nursing things have begun to change and more and more men were joining the nursing profession for career stability and advancement opportunities in an already female dominant profession.
A man named James Derham “in 1783 who was a slave earned money to buy his freedom by working as a nurse” making him the first male nurse (Bonair and Philipsen 19). Nursing schools began offering scholarships to male nursing students as a way to attract more people to the nursing profession. With men in a female dominant profession they were making up “five to ten percent of the workforce in the UK, USA and Write my essay for me – CA Essay writer Canada” while in the nursing profession they were more likely to be promoted into leadership roles (Brown 120).
Male nurses generally started a nursing career at a younger age compared to their female counter parts. As working nurses were getting older many of them were planning for retirement at a time when a majority of people were retiring with the baby-boomer generation. More and more people began to choose a nursing career later in life, so consequently most nurses ended up retiring earlier due to the strains of the job or age factors. Consequently, the average age of nursing students graduating was thirty-one, while the average age of the working nurse is forty-six years old.
Due to the popularity of nursing for some it is becoming a second career for individuals after many years of employment in other fields such as business, or computer industries that have had many changes and layoffs that contributed to the employment shift. With this new employment shift new nurses that began a nursing career as older adults are not working in the field as long and retiring sooner. Furthermore with the short periods of nursing employment, this again creates problems with fixing the nursing shortage across the country.
Now that the factors of the nursing shortage have been described in detail, the next discussion will be about ways to fix the nursing shortage problem in America from the faculty shortage to loan forgiveness programs. If America is going to get out of the nursing shortage crisis the first step is to address the shortage of educators, and nursing faculty that teach and train the future nursing students. In order to create an interest in teaching there needs to be some changes with regards to income levels, and more education assistance to give nurses the ability to increase their knowledge. Some hospitals ffer opportunities to take a leave of absence from their jobs to pursue further education options without the fear of job loss. However, this in turn would not only be an asset to the individual but the facility as well that encouraged their employees to seek more education. Another factor in the nursing shortage is the number of clinical sites needed to give adequate clinical experiences for nurses to learn in. In hospitals today nursing schools generally have clinical experiences five days a week instead of an additional two days on the weekend to meet more needs of clinical experience time.
By offering the additional two days per week, nursing students would meet their clinical expectations ahead of schedule therefore they could graduate earlier and begin nursing practice sooner. This in turn would help to ease the shortage of trained nurses sooner and decrease the waitlist time for entrance into nursing school. In order to attract more nurses to continue advancing their education there needs to be more monetary compensation to pay for the cost of education in order to encourage more nurses to advance into teaching.
Furthermore in order for the healthcare system and colleges to meet the recruitment demands and the shortage requirements there needs to be some collaboration between facilities for education and tuition assistance. Consequently to address the aging of the nursing faculty, more people need to be encouraged to continue their education without any lapse of time after graduation. Nevertheless, since most nurses cannot afford to pay for the higher expenses of college and continue to work then only a selected few would advance their education.
However, some nurses may choose not to continue their education due to conflicts with work schedules and family, unless there was some loan assistance or forgiveness program widely used. The United States currently has loan forgiveness programs that pay the entire amount of the loan after requirements are met. Furthermore, after a nurse has completed two years of service in a hospital then they can apply for the loan forgiveness program that may take up to six months before a decision is made, and only a limited number of individuals are selected.
In addition, if the United States invested in more healthcare facilities and offered more loan assistance and scholarships then people would be more attracted to the nursing profession and possibly reduce the nursing shortage. In conclusion, after discussing the many challenges that the nursing profession faces, it is still considered a highly respected field by many but may not be the choice for everyone. However, until the United States aggressively pursues a solution to the nursing shortage, better wages, and working conditions, then healthcare reform will define the critical needs of nurses that may end up costing more lives than money.
In the end, if the nursing shortage continues, it could be catastrophic to American society at a time when healthcare has made so many advances to increase the life expectancy rate. Works Cited “2010-2011 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. ” Fact Sheet-Nursing Shortage (2011). <http://www. aacn. nche. edu/Media/Factsheets/NursingShortage. htm>. Bonair, Jennifer, and Nayna Philipsen. “Men in Nursing: Addressing the Nursing Workforce Shortage and Our History. ” Maryland Nurse.
CINAHL Plus with Full Text. EBSCO, 10. 3 (May-July 2009): 19. Web. 29 Oct. 2011. Brown, Brian. “Men in nursing: Re-evaluating masculinities, re-evaluation gender. ” Contemporary Nurse: A Journal for the Australian Nursing Profession. CINAHL Plus with Full Text. EBSCO, 33. 2 (2009): 129. Web. 29 Oct. 2011 Fox, Rebekah L. , and Kathleen Abrahamson. “A Critical Examination of the U. S. Nursing Shortage: Contributing Factors, Public Policy Implications. ” Nursing Forum. CINAHL Plus with Full Text. EBSCO, 44. 4 (Oct-Dec. 2009): 244. Web. Sept. 2011.
Joint Statement from the Tri-Council for Nursing on Recent Registered Nurse Supply and Demand Projections. AACC, n. d. Web. 4 Sept. 2011. <http://www. aacn. nche. edu/Media/NewsReleases/21/tricouncil. html>. Keenen, Patricia. “The Nursing Workforce Shortage: Causes, Consequences, Proposed Solutions. ” Issue Brief. CINHL Plus with Full Text. EBSCO, (2003): 6. Web. 31 Oct. 2011. McHugh, Matthew D. “Hospital Nurse Staffing and Public Health Emergency Preparedness: Implications for Policy. ” Public Health Nursing. 27. 5 (Sept/Oct 2010): 449.
CINAHL Plus with Full Text. EBSCO. Web. 29 Oct. 2011. Stone, Patricia w. , et al. “Nurses’ Working Conditions: Implications for Infectious Disease. ” Emerging Infectious Diseases 10. 11 (2004): 1989. Web. 28 Sept. 2011. <http://www. cdc. gov/eid>. The Demographic Challenges Facing Colorado’s Health Care Workforce. Colorado Center for Nursing Excellence, n. d. Web. 4 Sept. 2011. <http://www. coloradonursingcenter. org/colorado>. U. S. Bureau of Labor and Statistics. Occupation: Registered Nurses. http://data. bls. gov, May 2010. Web. 1 Nov. 2011.

The term “genetic engineering” was first coined by Jack Williamson in is science fiction novel Dragon’s Island, published in 1 951 ,one year before Dona’s role in heredity was confirmed by Alfred Hershey and Martha Chase, and two years before James Watson and Francis Crick showed that the DNA molecule has a double-helix structure, DNA stands for (desorbing cultic acid). For many years, there has been a controversy surrounding the morality of genetic modifying organisms.
Some it’s unethical since it may lead to side effects such as mutation, others say it’s totally acceptable since it can make a stronger healthier and smarter organism. I tryingly believe that genetic engineering should be banned for multiple reasons such as religion, morals, physical attributes and crossing species boundaries. In every country there is different religions and these religions have different views. One of these views are on genetic engineering, whether it is acceptable or not modifying genes.
God created us human not perfect so why do we want to reach perfection when it is not a human trait. Other people who lack faith will tell you humans seek perfection it’s in their nature so it’s k modifying genes, but if we reached perfection what do we have to seek, we loud be perfect and lose our touch of humanity. Is genetic engineering ethical to do, children who are made with specific genes are produced for one specific reason and it is to help another person medically in other words they are made for being spare for the specific person.

In my sister’s keeper a book about a girl who was a genetically modified to help her dying sister from cancer for 12 years she was used as a spare for her sister and when they wanted to take a kidney, she took matter in her own hands and sued her parents for emancipation. So it is not moral or right to bring a person just to be spare. Although other people will contradict and say that by doing so they are saving lives, but they don ;t think of the lives they are destroying .
Gene modifying is not a 100% accurate, it has many mishaps one of the mishaps is a chronic disease which happened in 2001 at a reproductive facility in new jersey were thirty babies who are genetically modified and have genes of three different people, two women and a man some of these thirty children had turners syndrome and turners syndrome happens to one in very 2500 baby and in thirty babies it occurred more than twice is alarming. There people contradict that genetic modification has many benefits, like it increases polymorphism but what about mutations that occur in the children that born. Are they supposed to live with disabilities because some scientists wanted to play god. What about modifying genes to create a new species, are we ready to see a new type of species walking around with us, scientists are talking about a new kind of humans that have the outer look of humans and the abilities of animals, do we want a human tiger that may be aggressive and be a hazard to other normal humans?

Major Research Areas of Bioinformatics Engineering is a diverse discipline, which includes several different fields and different branches. One important branch of engineering is biomedical engineering that consists of the study and design of new technologies related to biology and medicine. The field of biomedical engineering is further divided into additional areas, one being bioinformatics.
Bioinformatics is a special part of biomedical engineering that focuses mainly on the development and enhancement of approaches for the purpose of storing, retrieval, organization and analysis of different forms of biological data. The field includes the development of different software tools that provide biological knowledge and advancements. One major part of bioinformatics is research and thus we would discuss some of the major research areas of bioinformatics. Sequence analysis is a new and one of the most important research areas of bioinformatics.
It is nothing but the study of the DNA and genome sequences of different organisms. The study of such sequences help in the comparison of genes and thus leads to the development of new approaches and new technologies for the development and use of genome sequences for different purposes and for the development of new species. These studies can even be used for the identification of causes and treatment options for genetic disorders. Evolutionary biology is another major research area that makes use of bioinformatics for further developments.

Biology is no longer limited to theories and theoretical models and studies. Bioinformatics is used in different ways for calculating different aspects of biology, whether it is DNA sequencing or some other numbering. The research in computational evolutionary biology helps in examining the information related to different species and organisms that can be further used for the enhancement of the field into future developments. The study of protein expression is also a major research area for bioinformatics.
The working of the human body or any other organism on earth is highly dependent on the way the proteins in their bodies work and function. Thus, an analysis of proteins present in the bodies of different organisms helps in better statistical and theoretical analysis. Cancer mutations are difficult to analyze and study but not for bioinformatics. The examination of the cancer mutations is one of the major research areas of bioinformatics and thus can slowly and steadily helps in the treatment of he currently incurable disease of cancer. This research area includes several things, starting from the study of tumor lesions to the mutants that can help in curing the disease. The research areas of bioinformatics are vast and include several different areas and fields. Comparative genomics, network and systems biology and high-throughput image analysis are some of the other research areas and these areas would continue to multiply in number with time. Reference link: http://classof1. com/homework-help/engineering-homework-help

ICTs are technologies that have spread widely and are cheaper for use by the general public. Even though information and communication technologies could tackle some of the heath care challenges that face the modern society, the utilization of ICTs is faced by numerous challenges for social as well as historical transformations that are associated with other natural rights.

The case is not different in the field of telemedicine. Telemedicine is an example of ICT that has been used in the world for over forty years. Modern telemedicine applications employ high quality image and video in addition to audio capacities.

These technologies range form excellent resolution still images to complex teleconferencing apparatus. Recent developments in ICT are encouraging and they include the use of internet, wireless ICT diffusion, and the exchange of medical information electronically in addition to remote consultations.
Infrastructure factures that have an effect on the outcomes of telemedicine include: the national ICT infrastructure in addition to the governments preparedness, approach, as well as policies towards information and communication technology. Technically sophisticated telemedicine applications are currently employed across a wide range of healthcare settings.
This technology allows medical personnel to transmit images through mobile phones and sophisticated wireless devices (Martínez, Villarroel, Seoane, and Pozo 2005, p. 1).
3.1.2 E-Health Policies
Various shareholders of the telemedicine sector have numerous opportunities to become deeply involved in the development policies that affect the industry. Shareholders of this sector include vendors of information technology, manufacturers of medical devices, health care professionals, decision makers and the government.
E-health policies are set in such a way as to improve network capacity, enhance ability of transcending geo-political, social, economic and cultural obstacles.
Policies should be set in such a way as to allow teleconsultation beyond national borders. Patients in addition to medical care professionals should be offered with a chance of seeking evidence based opinion as well as treatment from overseas through teleconsultation (Lee, Mun, Levine and Ro 2000, p. 28).
3.3 Capabilities of health sector institution
The modern health care system has undergone numerous modifications in order to meet the ever increasing heath needs of the population. One of the modifications is the implementation of telecommunication in health care. All modifications in the health care sector are carried out with the patient being the center of focus.
Telemedicine and telegraphy are some of the most recent telecommunication strategies that have been incorporated in the health care sector. Currently, digital images of a patient can be sent over a wireless device to a medical personnel and medical consultations carried out over the internet (Tanriverdi and Iacon, 1998, p, 40).
3.4 Analysis of Telemedicine case studies in developing countries
The emergence to telemedicine is associated with the search for communication-oriented solutions to make it easy for rural populations to access medical services. Telemedicine is considered as one of the most appropriate ways through which contemporary medical services can reach the underserved regions (Lee, Mun, Levine, and Ro 2000, p. 16).
Reality has however, gone in a different direction. Extensive studies with telemedicine in developing nations have not yet demonstrated the potential of telemedicine. There are a number of factors that need to be implemented in order that telemedicine services in rural areas become sustainable.
A highly robust organizational strategy needs to be implemented, a radio based system should be erected and resources utilized properly; remote maintenance systems should be implemented; a high technological base should be established; and all information and communication should be satisfied through simple and synchronous systems (Kifle, Salmon, Okoli, and Mbarika 2008, p. 5).
Despite the numerous benefits associated with telemedicine, the program has been slow to come into routine use in both rural and urban zones.
4. Evaluation of the current situation of Telemedicine in rural and urban zone
Telemedicine holds a great hope for health care and medical centers both in rural areas and urban centers. Rural areas in particular have for long been faced by shortage of medical personnel, scarcity of means of transportation in addition to other access issues such as unfavorable weather conditions.
Telemedicine allows for teleconsultation that utilize a variety of technological advancements such as voice over internet, digital images, digital video teleconferencing, in addition to other emergency services (Martínez, Villarroel, Seoane, and Pozo 2005, p. 70).
However, there are various issues that affect the implementation of telemedicine in rural areas. These include: poor infrastructure, limited bandwidth availability in network systems, and scarcity of internet providers.
Telemedicine is not only about the provision of medical care in the rural areas, but it is very beneficial in linking suburban, urban and inner city medical facilities in a network offering intensive medical care services (Richard 2001, p. 3).
4.1 Advantages of using Telemedicine technologies
An increased use of telemedicine would bring about a number of benefits ranging from enhanced medical care, better utilization of health professionals, increased patients compliance, to enhanced delivery of medical care services outside clinics and hospital setting and in rural as well as the underserved regions.
Telemedicine allows for frequent monitoring of vital sign information rather than using periodic visit by physicians. It also improves care of the elderly, physically incapacitated as well as the home bound patients, because it reduces hospital visits thereby increasing convenience and compliance for incapacitated patients.
As a result it improves general health of the community and population because it reduces exposure to various illnesses from other patients. It also empowers patients in relation to their own health. It is a source of innovative and creative employment in the health care system.
It is a significant strategy of tackling likely future scarcity of medical personnel.  It brings down the rate of death, injuries and infections as a result of medical errors due to inaccurate patient information.
Presence of telemedicine programs in rural areas enhances care by reducing transportation costs; deploying medical professionals and specialists; and through providing medical care delivery regardless of geographical barriers (Hein 2009, p. 9).
4.2 Challenges of adapting Telemedicine
There are numerous challenges to generating dependable evidence concerning the effects of the use of telemedicine. Scrutiny is rarely carried out as a fundamental part of implementation, and as a result resources are not absolutely dedicated to evaluation.
However, there are times when resources are dedicated to scrutiny after implementation, therefore prospective gathering of baseline data is impossible. Retrospective gathering of medical data is faced by numerous hurdles in terms of appropriate source identification in addition to collection techniques.
These issues make difficult the scrutiny of various interventions, even as the actual nature of evaluation of telemedicine presents further difficulties (Brear 2006, p. 24). Besides evaluation, other challenges that face telemedicine, as indicated by Paul, Pearlson and McDaniel (1999, p 281), include: various social, cultural, economic, technical and organizational hurdles that health care systems must deal with before achieving the full benefits of telemedicine.
Other factors that derail the implementation of telemedicine in developing countries are: poor telecommunication and electric power infrastructure; domination in addition to high cost of internet services; lack of government involvement; difficulties in sustaining implementation of telemedicine; substandard organizational strategies; and user discontent  with low band-width as well as delayed response.
Patients, medical professionals and decision makers lack essential knowledge on telemedicine services as well as their potential for medical care. Lack of proper funding is the other challenge that faces telemedicine.
Despite its recommendation by the world health organization telemedicine is yet to be realized as a technical service in many national ministries of health (Kifle, Salmon, Okoli, and Mbarika n.d, p. 3).
5. Conclusions
It can therefore be concluded that telemedicine is one of the most significant modern medical strategies that can be employed in tackling the numerous health care challenges that face populations living in both urban and rural areas.  Various benefits of telemedicine include: improvement of patient care, reduction of patient transfers to tertiary health centers and providing physicians a good access to tertiary consultation.
Telemedicine improves the general health of the community because it reduces expose to various illnesses from other patients through reduction of hospital visits. There are however, various challenges that are associated with implementation of telemedicine and these include: evaluation challenges, poor telecommunication, misinterpretation of information, and lack of awareness and commitment by the government and decision makers.
Telemedicine is faced by various issues including information technology policies, E-Health policies, and data security policies. Even though there are numerous benefits associated with telemedicine, the program has been slow to come into routine practice both in rural and urban zones.

Bibliography:
Brear, M. 2006, Evaluating telemedicine: lessons and challenges, Health Information
Management Journal, Vol 35, no. 2, pp. 24
Hein, M. 2009, Telemedicine: An important force in the transformation of healthcare,
Journal of High Speed Networks, Vol 9, no. 15, pp. 9 –30

 Please make a reply to this student post adding something extra of what the student already did. APA references and less than 20 % similarity. 

Question 1

To be culturally competent means to address a patient’s needs while observing specific cultural variations that are important to them and understanding how these affect their view of medical treatments (Purnell, 2013). As a culturally competent nurse it is important to take the patient’s culture into account while completing an assessment. It is crucial to assess their perception of the condition, how this is viewed in their culture and how said views can affect how they care for their child. Some cultures view certain conditions as punishment for example. The level of understanding from the parents also plays a major roll. The nurse must be aware of the educational level of the parents and how prepared they are to receive information and apply it when caring for their child.
A nurse’s understanding that Down syndrome is disorder that occurs during cell division, involving a complete or partial extra copy of chromosome 21 while in utero is important in alleviating some the stress experienced by the new parents wondering if this was caused by them or hereditary (Perkins, 2017). This can help them obtain accurate information on the condition, what to expect and development of the child in the future. The nurse can be a source of information for the parents
When faced with the adversity that your child has a health issue the first concern is how this will affect them, their development and the prognosis of this condition. As a parent I would be concerned about health implications, risks and precautions I need to have to care for my child.

Question 2
a. Helping Michelle understand the possibility of her baby’s condition can result in successful management and prevention of exacerbation periods if she were to have it. It is important to explain to her that sickle cell disease is a disorder that affects the hemoglobin portion in red blood cells that carries oxygen to cells in the body. The hemoglobin molecule seen in sickle cell is called hemoglobin S. This hemoglobin S affects the shape of the red blood cells making it look like a crescent shape. This an autosomal recessive condition which means the child inherits a copy of the gene from each parent even if the parent shows no symptoms of the condition (NIH, 2020). Although there may be few exceptions, sickle cell disease is inherited from both parents which means they would have to have the gene in order for the baby to have this as well. In contrast sickle cell trait can be present when the baby inherits the gene from one parent only which means they will carry it but not show any symptoms of the disease.
b. A test can be done to identify if the person has sickle cell disorder however it would be most reasonable to see a genetic counselor who can offer valuable information on genetic blood disorders as well as family history (CDC, 2019). Testing should be encouraged because in the future there could be complications if the child engages in competitive sports such as heat stroke and muscle breakdown stemming from rigorous training (CDC, 2019).
c. Some of the factors that can shape the conversation is recognizing Michelle’s educational level and knowledge of this condition in general. This can be a guide to how to approach the subject, how much information to provide and how to ascertain it has been understood. It is important to discuss the prevalence of this disease among African Americans and how it affects 1 in 500 in the population (Purnell, 2013). Becoming familiar with the statistics may assist Michelle in understanding this is something that affects many people like her and her husband and some people are able to lead a healthy life without major complications.
Question 3
a. A disorder of the blood in which the amount of hemoglobin is low is, particular to people of Mediterranean descent is called Thalassemia. In this disorder due to the lack of hemoglobin the red blood cell’s life is remarkably shorter in the body (CDC, 2020). It is important for the nurse to be aware of this as to differentiate what is normal in this population and not. Also, to prevent providing certain medication that can increase the possibility of a hemolytic crisis (Purnell, 2013).
b. Low hemoglobin levels prevent oxygen from reaching every part of the body preventing it from working appropriately. The condition caused by this consistent low hemoglobin level in the blood is called anemia. Anemia can have many causes some including vitamin deficiency, bone marrow abnormalities or hemolytic cause such as in Thalassemia. Anemia can cause a person to feel a variety of symptoms including, shortness of breath, tiredness, weakness, dizziness, pale skin, fast heartbeat and increased fatigue (CDC, 2020). Anemia can be addressed depending on the causative agent in order to correct it and prevent further complications. Some of the treatments include vitamin supplementation, blood transfusion or dietary supplement
Reference
Perkins, A., & Vermont Tech. (2017). The lowdown on Down syndrome : Nursing made Incredibly Easy. Retrieved from https://journals.lww.com/nursingmadeincrediblyeasy/Fulltext/2017/03000/The_lowdown_on_Down_syndrome.10.aspx
Purnell, L. D. (2013). Transcultural health care: a culturally competent approach (4th ed.). Philadelphia: F.A. Davis.
Sickle cell disease – Genetics Home Reference – NIH. (2020, May 12). Retrieved May 16, 2020, from https://ghr.nlm.nih.gov/condition/sickle-cell-disease#inheritance
What is Thalassemia? (2020, April 15). Retrieved May 16, 2020, from https://www.cdc.gov/ncbddd/thalassemia/facts.html
What You Should Know About Sickle Cell Trait. (2019, October 21). Retrieved May 16, 2020, from https://www.cdc.gov/ncbddd/sicklecell/documents/SCD factsheet_Sickle Cell Trait.pdf

The first sexual intercourse is a milepost in the physical and psychological development of every adult male or adult female. It can besides ensue in unplanned gestations, insecure abortions and sexually transmitted diseases ( STDs ) , ( Singh et al 2000 ) .
Harmonizing to the World Health Organisation ( WHO ) , two-thirds of all STDs occur among the young person ( WHO 1993 and 1995 ) .This estimation can be explained by the high hazard sexual behavior of stripling, such as multiple sexual spouses and unprotected sexual intercourse ( Rosenberg et al 1999 ) .
The demand for more policies and programmes in turn toing STDs among striplings should hence be a precedence for every authorities. However, the argument on sexual and generative wellness ( SRH ) is absent or hapless in many states, as the issue of gender and sexual intercourse make people really uncomfortable ( WHO 2006 ) . Again, most sexual wellness programmes for striplings globally tend to concentrate on instruction and bar, go forthing out services which enable striplings to show their frights, concerns and acquire interventions for STDs and other sexual wellness issues ( Nworah et al 2002 ) . This state of affairs can be disputing in some parts of Africa particularly the West where as an stripling, sexual wellness issues are non discussed in schools or places and there are no sexual wellness services for striplings.

However, this state of affairs is altering, particularly with the outgrowth of Human Immunodeficiency Virus ( HIV ) infection hitting every three in 10 striplings in Africa. This has led to the committedness of more resources for intercessions in turn toing STDs in many states ( WHO, 2003 ) .
In this paper, I will be looking at programmes and intercessions used in covering with STDs in Nigeria among striplings, barriers to accessing STD attention for striplings, societal building of sexual wellness and proposed programmes to better on the bing SRH attention for striplings.
1.2 STDs among striplings in Nigeria
Nigeria is the most thickly settled state in Africa, situated on the western portion of the continent with an estimated population of 151,212million ; of this 32 % are between the ages of 10-24 old ages ( UN 2008 ) .With such a vernal population and the high prevalence of HIV in Africa, one will presume there will be policies which are effectual in turn toing STDs among striplings in the state. However, the age of presenting SRH instruction to striplings continues to be debated, whereas recent surveies indicate an addition in sexual activities among this age group, therefore the demand to explicate steps to understate the negative impact of these sexual activities ( Okonofua 1999 ) .
Among the factors lending to high rate of STDs among striplings include ; the deficiency of equal information about SRH, dislocation of traditional household control and globalization ( Okonofua et al 1999 ; Odion and Ataman 2010 ) .
Although there are no accurate informations on the Numberss of STDs among striplings in Nigeria, several population based surveies indicate an addition in STDs among striplings than grownups ( Okonofua et al 2003 )
In an attempt to turn to the issue, the Nigerian authorities in 2000 collaborated with other international administrations and non- governmental administrations ( NGOs ) to develop a national SRH policy. The subdivision of the policy on striplings focused on forestalling hazardous sexual behavior and the purpose was ”to addition cognition of generative biological science and promote responsible behavior of striplings sing bar of unwanted gestation and sexually familial infections ” ( Federal Ministry of Health 2001 ) . The following were the marks for the policy ;
Increased entree of appropriate generative wellness information to all striplings in and out of school.
The debut of gender and household life instruction in school course of study.
Increasing the entree of comprehensive youth-friendly wellness services including reding for all striplings, including the disabled by 20 %
Enforcement and reappraisal of Torahs relevant to adolescent wellness
To run into these marks, the national council on instruction decided to incorporate gender instruction into school course of study to turn to the high rate of STDs among striplings. However, force per unit area from the media, spiritual groups and conservative politicians reasoning that gender should non be taught in schools, therefore naming for more dilution of the programme ( Federal Ministry of Education 2008 ) .Sexuality instruction was hence changed to household life and HIV instruction ( FLHE ) , which is more acceptable by all stakeholders.
FLHE was integrated into bing topics and all 36 provinces were allowed to learn to accommodate the socio cultural demands of striplings in each peculiar province. The course of study was besides divided into two degrees ; sensitive issues such as sexual orientation, preventives and onanism was specifically taught in senior secondary and the basic sexual wellness issues in junior secondary schools ( Federal Ministry of Education 2003 ) .
Second, to increase entree to reproductive wellness information, SRH nines are organised in schools where striplings can hold forums, arguments, essay composing competitions and interact amongst themselves on sexual wellness issues. These nines besides organise wellness consciousness runs and seminars where wellness professionals distribute educational stuffs and give negotiations on bar and intervention of STDs among striplings ( Federal Ministry of Education 2003 ) .
Third, some members of the nine are selected by their co-workers and trained as equal pedagogues. Their preparation on STDs comprises of bar and intervention, acknowledgment of symptoms, spouse presentment, postponing of sexual intercourse pieces on intervention for STDs, benefits of early intervention, where STDs can be treated and the demand for professional aid. They so advocate pupils on one-on-one or in a group on STDs and other wellness issues. They besides distribute information on SRH issues and refer pupils with STD symptoms to the appropriate wellness professional for intervention ( Federal Ministry of Education 2003 ) .
Finally, to guarantee enforcement of the policy, all province schools in Nigeria were made to incorporate the policy into bing school topics. The FLHE is the merely sanctioned SRH programme included in school course of study towards the bar of STDs ( UNSECO 2010 ) .
In a reappraisal of the policy in 2004, the determination was made to develop more instructors who will specialise in SRH and Teach in senior secondary schools. There were besides sensitisation meetings with educationalists and NGOs working in SRH in an attempt to reenforce the programme in schools and increase the range of administrations working towards its success ( ( UNSECO 2010 ) .
A long running rating of the programme, was carried out from 2003 – 2009 in Lagos and claims were made to the followers ; pupils exposed to the programme were more knowing about gender, HIV and other STDs, addition usage of preventives, misss were confident to decline sexual progresss from male childs and better apprehension of relationships ( Philliber Research Associates 2009 ) .In malice of these claims, surveies done earlier and after the execution of the SRH policy indicate that educational programmes have non improved on the Numberss of striplings undertaking STDs ( Adeokun et al 2009 ) . There is therefore the demand to look into why STDs among striplings continue to be high in Nigeria.
1.3 Why STDs Remains a Problem among Adolescents in Nigeria
Even though the incidence of STDs among Nigeria young person is said to be high, there is no defined steps in aiming striplings for intervention and bar of STDs.
Surveies have shown that in malice of sexual wellness instruction, striplings lack cognition in STD bar, intervention and other sexual wellness issues ( Okonofua et al 2003 ) . Parents do non discourse sexual wellness issues with their kids, and information from the media is largely deformed taking to striplings seeking sexual wellness information from equals who besides lack accurate information about the topic, hence misinform others ( Fatusi and Blum 2008 ) .The deficiency of cognition about STDs leads to high incidence of unprotected sex, inability to place symptoms of STDs and reluctance to sought intervention ( Nmari et al 2010 ) .
The few province wellness services or clinics are besides adult oriented and guidelines in handling striplings are nonexistent hence striplings feel unwelcome in such installation and hence do non utilize the services at all when they are infected with STDs ( Okonofua et al 2003 ) .
This state of affairs is possibly due to how sexual wellness is perceived in societies in Nigeria and West Africa.
1.3a Barriers in accessing wellness attention vs. societal building of SRH
The societal building of gender functions has brought about inequality in every society.SHR is one country affected by gender inequality in Nigeria. Gender functions have made work forces accountants of birthrate and gender of adult females ( Connelly et al 2000 ) ; doing adult females subordinators with less power in sexual relationships refering contraceptive method, abortion, and gestation while work forces determines the footings of the relationship ( Dixon-Mueller, 1993 ) .
However, in a survey by Shefer et al 2002, adult females are blamed for being the causers of STDs, even though they have less power in negociating for safer sex.
Individual ‘s behavior or actions on SRH reflects what is socially acceptable or non in communities. This besides explains society ‘s perceptual experience on striplings SRH.
The societal building of SRH for striplings in Nigeria explains why most wellness services for STDs are adult oriented. SRH for striplings is a sensitive issue in Nigeria. Both traditional and spiritual leaders believe that adolescent generative wellness should non be discussed until a male child or miss is ready for matrimony. Traditionally, striplings are taught generative wellness during the rites of transition when they are ushered into manhood or muliebrity and ready for matrimony ( Marcusan et al 2010 ) . In the same manner, the Bible or the Koran forbids pre-marital sex hence supplying information about it will promote striplings to indulge in sexual activities before they marry ( Marcusan et al 2010 ) .This besides explains the force per unit areas from the media, spiritual and conservative political leaders to alter the initial gender instruction programme into FLHE.
Most striplings besides complain about clinics non being youth friendly and missing privateness therefore their refusal to seek sexual wellness advice or intervention for STDs. The deficiency of privateness is besides a societal issue, from personal experience working in sexual wellness clinic, service suppliers adopt a domineering attitude in relation to service users and tend to handle patients their ain manner with small respect for their rights and self-respect. This state of affairs is worse when covering with patients with STDs. In a survey carried out in South Africa by Shefer et al 2002, patients with STDs were verbally abused by wellness workers by naming them names and this de-motivate striplings from seeking information and intervention for STDs.
Again, due to cultural perceptual experiences about STDs, where it is seen as grownup job, striplings who present with STDs are stigmatised by their communities. This stigmatization influences the possibility of an adolescent seeking intervention. Often times, they besides hesitate in seeking intervention because of the possibility of run intoing people they know therefore compromising the confidentiality of their visit to the STD clinic ( Shefer et al 2002 ) .
Confidentiality as frequently used in professional codification of moralss can be broken when person ‘s life is threatened. Confidentiality in this state of affairs can be broken non because person ‘s life is threatened but for societal grounds. In most portion of West Africa, people act as their neighbor ‘s keeper, hence it is the responsibility of grownups to describe a kid or striplings if they are seen indulging in harmful patterns ( hypertext transfer protocol: //www.ajol.info/index.php/og/article/viewFile/57930/46296 } . As mentioned earlier, STDs are diseases of grownups non striplings hence parents must be informed when their kids are seen accessing information or intervention for sexual wellness.
Other grounds why striplings do non seek intervention or information for STDs is the high cost of infirmary fees which they are unable to afford. Some striplings therefore entree intervention from traditional therapists, where fees are low-cost, where they will non meet any of the jobs they face at western type of clinics and in line with societal building of diseases. For case STD was perceived as penalty from the Gods or witchery ; hence intervention must be sought from traditional therapists or the fetish priest who were seen as the oral cavity pieces of the Gods on Earth ( Nworah et al 2002 ) . Having said these, there were besides few cringle holes in the 2000 policy which can be improved upon.
1.5 Loopholes in the policy/programme
The ends of the policy indicate that non merely is STDs a job among striplings but besides unwanted gestations. Broadening the range of the marks to cover SRH in general was a good thought as there may be other sexual wellness jobs faced by striplings which were non documented, but at that place should hold been specific marks for STDs and unwanted gestations as it was the focal point of the policy.
Again, marks must be clip edge, nevertheless all four marks had no clip frame ; hence mensurating it will be hard. For case, 20 % was mentioned in the 3rd mark but the per centum of entree to comprehensive youth friendly wellness service before the policy was non mentioned, therefore hard to mensurate accomplishment.
The policy was for striplings in and out of school, but there was no reference of how the out of school programme was implemented, it is hence ill-defined if those out of school were exposed to the programme. It is non surprising that the rating indicated addition cognition of SRH among striplings exposed to the programme. Again, some subjects were merely taught in senior secondary while basic subjects were for junior secondary but there were no reference of which topics the juniors were taught and whether it was relevant for them. The motivation for learning different subjects was non mentioned but this may connote that some striplings who are older but in junior secondary missed out on indispensable SRH subjects important for striplings their age.
Specialized instructors were trained for senior schools, this once more may connote those learning in junior schools were non specialised, and speaking about SRH to striplings can be abashing for both instructors and pupils and may impact the quality of instruction every bit good as pupils non inquiring inquiries to clear uncertainties.
Finally, the force per unit areas from the media, conservative politician and spiritual leaders faced the authorities to alter gender instruction to FLHE. This is a instance of people concealing behind faith, civilization and political relations to oppose a societal plan instead than rationally looking at the jobs facing their state.
To beef uping SRH programmes and cut down the incidence of STDs among striplings, there will be the demand to suggest programmes to better on the bing one.
1.5 Proposed schemes to better programme
The purpose of the programme will be awareness run for STDs and behaviour alteration among striplings.
The programme will be restricted to striplings aged 11 to 24, therefore the junior and senior secondary age. This age group is chosen to acquire blessing from parents and besides to affect them, as a survey carried out by Wilson et Al in Ghana indicate that most parents will be unhappy for their ten twelvemonth old kid to be taught on SRH issues.
To forestall resistance to the programme, audience will be held with parents, instructors, spiritual and community leaders, politicians and the media to explicate the graduated table of the job, why it is of import to learn striplings issues about STDs and SRH in general and seek their positions on the issue.
Another audience will besides be held with pupils ‘ representatives, community and spiritual young person leaders to edify me and other sexual wellness experts on the sexual wellness demands, cognition and behavior of striplings in the state. This is important to the programme as surveies have shown that most SRH instruction programmes are affected by disused and hapless information ( Slap et al 2003 ) .
The programme will affect striplings in and out of school. For those in schools, the current course of study would be maintained but subjects taught will be the same for both those in junior and senior categories to forestall the juniors seeking information from the senior category which they might non cognize and mislead them.
Specialized instructors and SRH professionals will make the instruction to cut down the sum of embarrassment, trusting to construct the assurance of instructors and pupils with clip, so that they can hold more unfastened treatment about SRH issues.
In add-on to what equal pedagogues are already making, they will besides be involved in given negotiations making seminars and runs as this is proven to be effectual ( Okonofua et al 2003 ) .
For striplings out of school, community and spiritual young person leaders will be given the same preparation as those in schools to take the function of equal pedagogues. Seminars will be organise in churches, mosque and young person assemblages within communities where equal pedagogues will be joined by specialized instructors and SRH professional to give negotiations on SRH issues to the young person.
Social selling will be used largely to make out to those out of school. Ads on wireless and telecasting will be done in common local linguistic communications for those who are illiterate. Studies will be done to place catchment countries for striplings where function dramas and picture shows will be organised on SRH issues for them.
In add-on to these, in service seminars will be organised for wellness workers in SRH clinics. In these seminars accent will be on schemes aimed at de-stigmatising cultural perceptual experiences about STDs. This is important as surveies carried out in Kenya and Zambia suggests that nurse accoucheuses working in sexual wellness clinics did non like go toing to adolescent with STDs because they see them as promiscuous ( Warenius et al 20060 ) .
Hospitals will besides be encouraged to put a twenty-four hours or half twenty-four hours for assignments for striplings and besides do information cusps on SRH available at clinics for patients to pick and read more on SRH issues.
In audience with young person leaders and SRH experts, young person Centres will be set up with clinical countries. This is to guarantee that locations of Centres are convenient for striplings. Services will include guidance, prophylactic services, STDs and relationships. The clinical country will supply diagnostic services such as research lab and scan services and clinics will be organised twice a hebdomad for those who need medical services to be seen by wellness professionals. To do these Centres youth-friendly, both striplings and SRH professional will run the Centres.
Finally, traditional therapists will be educated on SRH issues and encouraged to mention patients to wellness professionals for a item. Parents will besides be encouraged to discourse SRH issues with their kids to assist bridge the spread of striplings seeking information from their equals.
Evaluation
Evaluation of the programme will be ongoing at each stage of the programme to set and better on loopholes. Final rating will be carried out a twelvemonth after implementing the programme. To acquire a brooding image of the impact of the programme, random sampling of in and out of school striplings will be done to avoid choosing merely those exposed to the programme. Questionnaires will be used and inquiries will be asked on ; where striplings get information on SRH, barriers they face accessing SRH attention, handiness of young person Centres and service provided.
Indictors will be ;
10 % decrease in the Numberss of reported STDs instances among striplings.
Continuous usage of societal selling schemes in the programme.
SRH instruction being examinable in schools.
20 % addition in striplings accessing SRH services.
Result of the rating will be used to better on loopholes in the programme to accomplish the coveted result.
Decision
The SRH demands of striplings should non be over looked, as complications from these wellness issues can be significant for both persons and the authorities ( WHO, 2003 ) .
Adolescents in Nigeria are said to miss equal cognition about SRH issues, but perceptual experience of people about STDs and hapless wellness installations have all contributed to the high incidence of STDs among striplings. There is the demand for a countrywide arguments on how SRH information should be disseminated to striplings and besides diffuse the negative perceptual experiences about STDs and other SRH issues.
Existing SRH installations for striplings should be improved upon both in footings of substructure and forces. The authorities should besides make the atmosphere for private sector engagement in presenting SRH plans so people can do picks. It should nevertheless, be emphasised that the success or otherwise of any intercession will besides depend on the willingness of people to accept it.

GE 217 Against for profit prisons Prisons for profit have a different mission than public prisons, they must earn revenue. This means they have an inherent interest in ensuring prisons stay filled, even at the taxpayer’s expense. When a state government enters into a contract with a private prison company, it legally binds the taxpayer to pay the company a certain dollar amount per inmate per day. This has led to over incarceration and violence at private facilities nationwide. The relationship between prisons and private industry is not a recent innovation, but rather dates back to our nation’s origin.
In the colonial period, incarceration was a rarely utilized form of punishment. Newly formed governments, unequipped to house criminals, looked to private jailers to provide detention services. At the beginning of the nineteenth century, via legislation or private contracts, some states leased prison labor to private enterprises. In other states, private organizations exerted complete control over the prison function. (Robbins, 1989) Prison overcrowding has evolved into a critical social problem. Per capita the United States incarcerates more individuals than any other industrialized nation in the world.
Studies show that private facilities perform badly compared to public ones on almost every instance from prevention of intra-prison violence, jail conditions, and rehabilitation efforts—except reducing state budgets and adding to the corporate bottom line. To keep their gravy train rolling, private prison companies need a few things from state and local government. * Lots of people arrested and convicted (often of essentially victimless crimes) and given long sentences. This most heavily impacts young black males—about one in nine of whom is in prison, many for using or selling marijuana, or, to a lesser degree, harder drugs. Although whites have comparable drug use rates, their prosecution rates are dramatically lower. ) * Opposition to the decriminalization of drug use, which would cut sharply into prison industry profits. (As a result, it isn’t going to happen. ) * The continued criminalization and detention of undocumented foreigners. Louisiana is the world’s prison capital. The state imprisons more of its people, per head, than any of its U. S. counterparts. Which makes America first among the world? Louisiana’s incarceration rate is nearly triple Iran’s, seven times 论文帮助/论文写作服务/负担得起我及时提交我最好的质量 – China’s and 10 times Germany’s.

One in 86 adult Louisianans is doing time, nearly double the national average. And for African – Americans from New Orleans, 1 in 14 is in prison, parole or on probation. (Baker, 2012) The hidden engine behind the state’s well-oiled prison machine is cold, hard cash. A majority of Louisiana inmates are housed in for-profit facilities, which must be supplied with a constant influx of human beings or a $182 million industry will go bankrupt. Several homegrown private prison companies command a slice of the market. But in a uniquely Louisiana twist, most prison entrepreneurs are rural sheriffs, who hold tremendous sway in remote parishes.
A good portion of Louisiana law enforcement is financed with dollars legally skimmed off the top of prison operations. If the inmate count dips, sheriffs bleed money. Their constituents lose jobs. The prison lobby ensures this does not happen by thwarting nearly every reform that could result in fewer people behind bars. Meanwhile, inmates subsist in bare-bones conditions with few programs to give them a better shot at becoming productive citizens. Each inmate is worth $24. 39 a day in state money, and sheriffs trade them like horses, unloading a few extras on a colleague who has openings.
A prison system that leased its convicts as plantation labor in the 1800s has come full circle and is again a nexus for profit. In Louisiana, a two-time car burglar can get 24 years without parole. A trio of drug convictions can be enough to land you at the Louisiana State Penitentiary at Angola for the rest of your life. (Chang, 2012) For profit prisons often try to economize, but even the best run companies have come to recognize that operating with too small or poorly trained staff can spell trouble, and experts say state officials must pay close attention to the level of services being provided.
Even if private – prison corporations succeed in cutting costs, there is unlikely to be sufficient competition in any given community to ensure that the savings result in diminished government budgets for corrections. There is a substantial likelihood that government contracts with prison corporations will fully protect neither the interests of the public nor the prison inmates. (Hogan, 2006) Studies show that private facilities perform badly as compared to public ones on almost every instance from the prevention of intra-prison violence, jail conditions, and rehabilitation fforts—except reducing state budgets and adding to the corporate bottom line. A 2004 report found that private prisons had 50 percent more inmate on inmate assaults and almost 50 percent more inmate on staff assaults. Private prison companies cut costs by hiring cheaper, lower skilled staff and fewer of them. The result is a vicious cycle where poorly trained and poorly disciplined corrections officers are incapibable of adequately responding to prison emergencies. Prison safety conditions deteriorate, and more staff quit, increasing the turnover rate.
There is also less than adequate medical care for inmates, in some extreme cases infirmaries are often closed certain times due to shortage of guards. Other areas to suffer in private prisons are psychiatric care, educational, and meals in order for the prison to earn a profit; these programs seem to get cut before other many others. It is my opinion that privatization undermines sentencing reforms, cost the taxpayer more money, and endanger the lives of prison staff and inmates alike.
Offenders are incarcerated for reasons of their own making; I feel that having their freedom taken away should be punishment enough. They should not have to suffer anymore beyond that, especially for corporate greed. I strongly feel that prisons should be left in the hands of the public sector, which can operate them in a safe and true manner for which they were intended. Works Cited Baker, R. (2012, May 1). Briefing: For Profit Prisons.
Retrieved from Who, What, Why, Forensic Journalism: Thinking Hard, Digging Deeper: Http:whowhatwhy. com brinkerhoff, N. (2012, May 17). Retrieved from Info wars: http://www. inforwars. com Chang, C. (2012, May 13). Louisana is the worlds capital. Retrieved from Nola. com: http://www. nola. com Hogan, M. (2006, June 2). Correction Corp. Breaks Out,. Retrieved from BUS. WK. ONLINE,: htpp://www. businessweek. com/investor/content/jun2006/pi20060602_072092. htm23id Robbins, I. P. (1989). The Legal Dimensions of Private Incarceeration.

I need a response to this assignment
2 references
zero plagiarism

Work and Social Adjustment Scale
            The Work and Social Adjustment Scale (WSAS) is an assessment completed by the client to measure the degree of functional impairment perceived related to a diagnosed health problem (Thandi & et al., 2017). The WSAS addresses different areas of the client’s life where an impairment would be evident (Pederson & et al., 2017). This assessment is a simple five item scale that is easily administered. “The WSAS assesses the impact of a person’s mental health difficulties on their ability to function in terms of work, home management, social leisure, private leisure and personal or family relationships” (Mundt & et al., 2002). It can be administered to adults in treatment for mental health disorders and can be modified to evaluate psychosocial impairments in the youth population (De Los Reyes & et al., 2019).   
Psychometric Properties
            The assessment has been used widely for adults with mental health disorders, the psychometric properties have been proven to be accurate and consistent across different forms of psychopathology and unexplained medical symptoms (Jassi & et al., 2020). Disorders include obsessive-compulsive disorder (OCD), bipolar disorder, phobic disorders, anxiety and depression, chronic fatigue syndrome, and personality disorders.  “The WSAS is a simple, reliable, and valid measure of impaired functioning; it is a sensitive and useful outcome measure offering the potential for readily interpretable comparisons across studies and disorders” (Mundt & et al., 2002). Studies have proven that the test is reliable and sensitive to treatment related changes, which can evaluate the efficacy of psychotherapy and psychopharmacological approaches.
References
De Los Reyes, A., Makol, B. A., Racz, S. J., Youngstrom, E. A., Lerner, M. D., & Keeley, L. M. (2019). The work and social adjustment scale for youth: A measure for assessing youth psychosocial impairment regardless of mental health status. Journal of Child and Family Studies, 28(1), 1-16.
Jassi, A., Lenhard, F., Krebs, G., Gumpert, M., Jolstedt, M., Andrén, P., … & Mataix-Cols, D. (2020). The work and social adjustment scale, youth and parent versions: psychometric evaluation of a brief measure of functional impairment in young people. Child Psychiatry & Human Development, 1-8.
Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. H. (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. The British journal of psychiatry : the journal of mental science, 180, 461–464. https://doi.org/10.1192/bjp.180.5.461
Pedersen, G., Kvarstein, E. H., & Wilberg, T. (2017). The Work and Social Adjustment Scale: Psychometric properties and validity among males and females, and outpatients with and without personality disorders. Personality and mental health, 11(4), 215-228.
Thandi, G., Fear, N. T., & Chalder, T. (2017). A comparison of the Work and Social Adjustment Scale (WSAS) across different patient populations using Rasch analysis and exploratory factor analysis. Journal of Psychosomatic Research, 92, 45–48. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jpsychores.2016.11.009

 
The case study should consist of a 12-15-slide presentation, including slide notes. Make sure to include: at least 6 peer review reference in 6th edition apa style.  All slides most include comprehensive speaker notes.

Appropriate demographic factors, such as age, gender, and ethnicity.
The reason the patient was seen.
Description of the pathophysiology of the disease process/processes observed.
Past medical history of the patient and the pathophysiology of the disease process/processes, if they are different from the current concern. Determine whether the patient’s past medical history has had an impact on any of the disease processes observed.
Diagnostic findings, such as lab values or imaging results. Include an explanation of how diagnostic findings may relate to the disease process/processes.
Differential diagnoses applicable to the patient, as well as rationale for why the differential diagnoses would or would not pertain to the patient.

 A 42-year-old Black male presented by ambulance to the emergency department with several hours of severe substernal chest pain at rest. Prior to presentation, he was physically active, had no history of cardiovascular disease, and took no medications he smoke 1 packs of cigarette a day and drinks social. Family history Father died of a heart attack at age 57 and he has an imediate family of high blood pressure. At the time of arrival, the patient had received aspirin 325 mg and several doses of sublingual nitroglycerin without pain relief. His initial vital signs showed a heart rate of 64 bpm, blood pressure of 196/104 mmHg, respiratory rate of 18 breaths per minute, and oxygen saturation of 95% on room air. Physical examination was unremarkable. The patient’s electrocardiogram showed sinus rhythm with small Q waves in leads III and aVF with T-wave inversions in leads II, III, and aVF and ST depressions in V5 and  The basic metabolic panel and complete blood count were within normal limits. A point-of-care troponin I level was elevated at 1.5 ng/mL (normal ≤ 0.06 ng/mL) 

How do we decide what parts of an emergency reaction plan should be made public vs. kept a secret to avoid giving too much information to terrorist groups?
REPLY TO MY CLASSMATE RESPONSE TO THE ABOVE QUESTIONS AND EXPLAIN WHY YOU AGREE? (A MINIMUM OF 200 WORDS or MORE)
                                                    CLASSMATE’S RESPONSE
When determining to share an emergency plan with the public we must provide generic information with very limited details. With the previous terrorists’ attacks that have been done, we must study their plans of attack to have knowledge of the avenues they would be looking for to make a successful attack on our cities. For example, the following information would be kept secret: 
a) Response Process – this information would allow terrorist to know exactly who would be responding to the scene and their duties (Florida Comprehensive Emergency Management Plan, 2014). 
b) Concept of Operations – this information would allow terrorist to know what that personnel are being deployed, our threat classification, and the process in which we respond (Florida Comprehensive Emergency Management Plan, 2014). 
c) Roles and Responsibilities – terrorist would have knowledge of local, state and regional roles and responsibilities (Florida Comprehensive Emergency Management Plan, 2014). 
d) Training and Exercise – terrorist would have knowledge of our training program development, implementation, and exercise the schedule would be (Florida Comprehensive Emergency Management Plan, 2014). 
If any of this information was available to terrorist, it would make it easier for them to attack law enforcement, medical response personnel, assisting agencies, and all of the personnel that would be in place to attempt to destroy their plan of attack. Any information that would assist them in committing a terrorist act should be kept a secret. Information to water supply, safety facilities, and exit routes should be announced only at the time of an event. Citizens that we believe to be normal often times work for or support terrorist groups and can’t be trusted. However, any information that is made public is also accessible by the terrorist organizations that will, in turn, modify their plans to counter the strategies designed to minimize chaos and destruction. This creates a dilemma regarding how much information related to emergency planning for a terrorist attack should be made public versus what should be maintained on a “need to know” the basis to avoid giving the enemy the opportunity to adjust their plans accordingly (Spindlove & Simenson, 2013).
References:
Florida Comprehensive Emergency Management Plan. (2014). The state of florida terrorism incident response annex Retrieved from https://www.floridadisaster.org
Spindlove, J. & Simenson, C. (2013). Terrorism today: The past, the players, the future (5th ed.). Upper Saddle River, NJ: Prentice