LISTS, TUPLES, STRINGS, DICTIONARIES, AND BUILT-IN FUNCTIONS

LISTS, TUPLES, STRINGS, DICTIONARIES, AND BUILT-IN FUNCTIONS

Kindy, M. (2008). Chapter 15: Programmer-defines Functions. Python 2: For Beginners Only. Edition1.0. Retrieved from https://cs118.kindy.net/p2fbo_20131230.pdf

Kindy, M. (2008). Chapter 16: Fruitful functions. Python 2: For Beginners Only. Edition1.0. Retrieved from https://cs118.kindy.net/p2fbo_20131230.pdf

Kindy, M. (2008). Chapter 17: Files. Python 2: For Beginners Only. Edition1.0. Retrieved from https://cs118.kindy.net/p2fbo_20131230.pdf

our SLP 3 assignment is about using files for persistent data:

Read Chapter 17, in the online book of “Python 2: For Beginners Only” and run all the examples and and collect all the running results from output by copying and pasting into a file named as “ITM205-SLP3-Examples-YourFirstnameLastName”
Finish the following exercises from “Python 2: For Beginners Only”:
Exercise 17.1, Exercise 17.2
Exercise-A: modify the examples code in Chapter 17.6 in “Python 2: For Beginners Only” to define a function as make_contact(file name) that generates a file named as “EmergencyContacts” using module anydbm and include 5 pair of name and phone number. And then define another function as print_contacts(file name) to print out all the contact in the given “file name”. Test them with your own data.

Exercise-B:

Put both function make_contacts(file name) and print_contacts(file name) into a file and create a module named as “contacts.py. Write another test program test.py that import your contacts.py as a module and use the functions inside and test them.

Create a submission file named as “ITM205-SLP3-Exercises-YourFirstNameLastName “ which contains source code and running results marked with exercise number.

Write a summary document in Microsoft Word format named as “ITM205-SLP3-Summary-YourFirstNameLastName” to show what you have accomplished.

Managing Health Care Concerns of the Ageing Baby Boomer Generation

Health Care dissertation

Managing Health Care Concerns of the Ageing Baby Boomer Generation Surname/name: Name of the institution: Table of Contents Copyright…i Acknowledgementsii Table of contents…iii List of tables..iv List of figures.vi Abstract.vii 1.0.Introduction 1 1.1.Background 1 1.2.Statement of the Problem 2 1.3.Purpose Statement 2 1.4.Significance of the Study 3 1.5.Research Questions 3 1.6.Research objective 4 1.7.Identification of Variables 4 1.8.Assumption and Limitations 4 2.0.Literature Review 5 2.1.Introduction 5 2.2.Manuscript chapters 5 2.2.1.Portrait of a Boomer 7 2.2.2.Future Health Care Concerns of the Baby Boomer Generation 7 2.3.Others Chapters 9 2.4.Conclusion of literature review 11 3.0.Methodology 12 3.1.Design 12 3.2.Target population and participants 12 3.3.Procedure for Data Collection 13 4.1.Definition and measurement of variables 13 4.0.Data Analysis 14 4.1.Definition and measurement of variables 14 4.2.Data Analysis 14 5.0.Summary, Conclusion and Recommendations 20 5.1.Summary 20 5.2.Conclusion 21 5.3.Recommendations 23 References 25 Appendix 28 List of Figures Bar graph of those with health science intentions ..21 Pie chart of health sciences intentions …22 2000 census demographic chart ..24 2010 census demographic chart. 24 Correlation analysis of 2000 and 2010 populations ….25 Trend lines of 2000 and 2010 populations .26 Abstract The paper shows research on the baby boomer generation. The paper will consolidate research on their demographic make up, preferences and reasons why they are considered as one of the most important generations in the United States. The main aspect of the paper will be research into the expected challenges that the baby boomer generation will face as they age. It looks at the effect that they will have on healthcare. The research and analysis is based on whether the current health care system will be able to handle the increase in population of the aged. The research also looks at trends in health sciences in schools in order to see whether this the number of people interested in pursuing health sciences will be able to handle the anticipated increase in population of the elderly. The paper also gives recommendations on how the medical sector can anticipate the expected increase in elderly people who require healthcare services due to the aging baby boomer population. 1.0.Introduction Baby boomers are individuals who were born in the post world war era. This includes people born between 1946 and 1964. The baby boomers were predicted to have greater spending power than the prior generations. This is due to the sheer number of the cohort. Baby boomers grew up when government subsidies were widespread in education and post-war projects which made them get associated with privilege in Europe and North America. They were expected to be the wealthiest and most active group. They grew up with high expectations that the world would improve with time. Currently, as the baby boomer generation grows older, there is an increase in the need for health care services. This is because their numbers are large and there is a deficiency in the number of health workers who can handle their numbers (McIntyre & McDonald, 2013). 1.1.Background This report makes a presentation of the primary initiative research that was conducted by research organizations with the aim of understanding the baby boomer generation as they approach retirement. The baby boomer generation, which constitutes 77.5 million people, represents the largest population with sustained growth in the United States. As the older baby boomers approached old age, the organizations started to make investigations on ways which boomers would redefine and interpret retirement. One of the significant findings is the purported cohesiveness of the cohort. It was to elucidate the diversity which is related to their hopes, expectations and dreams of the retirement. The study is concerned with the health care of the baby boomers in their retirement age. 1.2.Statement of the Problem The study is concerned with the baby boomers demographics, health status and the impact it has on the health system in America. By making a combination of new research while analyzing the study of emerging approaches of health care and technologies, the report gives an illustration of how the field of health care is anticipating the revolution of the baby boomers and how they will leave a mark on the American health care for the coming generations. The U.S population has a significant portion of baby boomers. As the baby boomers progress in age, the percentage of the people above the age of 65 who use the health care resources will increase significantly. The study aims to show the methods in which we can reshape the health care system forever through the wave of the ageing baby boomers. It also shows the ways in which the society will have to deal with a greater population of people in their old age and the abilities to manage chronic conditions with the available health care services (Hudson, 2008). 1.3.Purpose Statement The objective of this study is to find out whether the medical system will be able to handle the aging baby boomer generation. One goal is to research why individuals are prone to diseases and to improve the health care system so as to enhance quality standards of living among baby boomers. Another goal is to ascertain the required transformation in the health care system which will be able to deal with the increasing number of people with chronic diseases in their old age. 1.4.Significance of the Study Even though the study encompasses only the cohort group of the baby boomers who were born from 1946-1965, it provides insight on how future population explosions are to be dealt with. It also gives answers to the research questions while contributing to the knowledge base in previous discussions on the subject matter. Information from this study can be beneficial to other areas such as career development and economic development. This will help institutions of learning to anticipate deficiencies in the fields that are important to human development such as healthcare. This research will also help the government to anticipate any other population explosions by creating robust healthcare policies which will be able to handle increases in people managing chronic illnesses. The findings from this research also aim at helping the young baby boomers understand themselves and prepare adequately for any expected changes that may occur as they approach retirement age. Not doing such research means that society will not understand the health issues facing the baby boomers (Condrey, 2010). 1.5.Research Questions The following questions on research are to accomplish the goals of the research study 1. Which generation do the baby boomers belong to? 2. What are the future health care concerns that arise due to the baby boomer generation? 3. What are the current health care concerns regarding the generation of the baby boomers? 4. How healthcare occupations will be promoted to fill future healthcare needs? 5. How many high school students are interested in pursuing a career in healthcare? 1.6.Research objective 1. To investigate which age bracket forms the generation of baby boomers. 2. To evaluate the future health care concerns of society due to the baby boomer generation. 3. To establish the current health care concerns regarding the generation of the baby boomers. 4. To find out how healthcare occupations will be promoted to fill future healthcare needs. 5. To find out how many high school students are interested in pursuing a career in healthcare 1.7.Identification of Variables Baby boomer refers to the people who were born during the population increase which came about in the post world war two era between 1946 to 1964 (Collins, 2009) Early baby boomer- the earliest baby boomer that was born between 1946 and 1954 Late baby boomer is a person born between 1955 and 1964. Individuation- it is the process of development through which an individual becomes unique (Condrey, 2010). A life cycle is a series of developmental tasks which must be undertaken by an individual throughout the course of their lives. (Thomas, 2012). Middle age- it is the juxtaposition between young and older adults. 1.8.Assumption and Limitations Some design elements of this research study did create some limitations. The facts that all individuals who participated were from the Tulsa, Oklahoma and other metropolitan areas brought limitations on the results. This is mainly because there might be a lack of generalization since these groups represent urban centers but assuming that baby boomers in urban areas are not different from those in rural areas. Therefore, it is possible to use the sample selected to represent the whole population in terms of age, gender and location. 2.0.Literature Review 2.1.Introduction The literature review will consider studies from different researchers who have investigated the same topic. It will review the empirical literature together with the theoretical one. The study involves finding out which age brackets the baby boomers belong to and the ways in which the current society is considering their health care. The paper is also going to focus on ways in which a country can improve the health care system. According to McDonald (2013), the generation of the boom is divided into two primary groups. The early group which born from 1946 after the 2nd world war and ended in 1954 after the war in Korea and the later boomers born from 1955 until the boom ended officially in 1964. The reason for this division is because they face different issues (Halkitis, 2013). 2.2.Manuscript chapters The Baby Boomer Generation This group has influenced the lifestyle changes and culture. They drove housing and labor markets, and they will eventually impact health care with the increase of people who need medical assistance. With no doubt that this group has a high impact in the society due to its sheer size as compared to other generations (Mangino, 1996). It was the boomers themselves who carried out the profile of psycho graphic and demographic research in the fields of; marketing, social science, politics and finance. Therefore, there is enough information on the baby boom generation. They have managed to gather data in great quantity, breadth and depth with the study of all cohorts including their own. Even though the findings have specifications on only one country, the consensus is that the trends which in North America is the same as that of Europe, New Zealand and to a small extent, Australia, and South America. The term baby boomer is not a misnomer because 78 million people were born between 1946 and 1963 in the U.S alone. Australia also saw a similar boom that led to a birth rate of more than 4 million. This meant that the population stood at 7 million at the end of the 2nd world war. The United Kingdom also had the same population explosion together with other European nations and Asian countries. The life expectancy of the U.S baby boomers is 8 years longer than that of the current senior citizens and is set to increase. Moreover, the health consciousness of the boomers and access to higher standards of medical care will be more active during the middle age and beyond compared to any other cohort (Albert, Johnson, Gasperino, & Tokatli, 2004). The baby boomer generation is also characterized by its high investment tendencies. The baby boomers have revolutionized all forms of business and innovation. Their period leads to the development of massive corporations. They have also heavily invested in real estate as well as stocks. Consumer good businesses have flourished due to the generation?s sheer number. The baby boomer generation accounts for more than 40% of consumer spending in the market. Health wise the baby boomers have seen health increase due to technological advancement. The population has used vast amounts of money on healthcare. They demand plastic surgery, as well as health surgeries such as artery reinforcement, has helped elongate their lives. The pre-baby boomers had a life expectancy that was half of what the baby boomers have. This means that they will live longer. Some people believe that this will strain healthcare and the government spending on medical benefits for the aging. 2.2.1.Portrait of a Boomer The Lion?s Clubs designed a program for recruiting the baby boom generation. The first tool is an informative summary of recent research concerning the baby boom generation and more so the habits and attitudes. The second tool provided is a series of communication materials. The last is the technique which is suggested to involve approaching the baby boomers and aligning the practices of the club, and procedures based on their expectations and aspirations. It has been believed for many years that wherever the baby boomers go, they return home with a chance. Thus, the purpose of this recruitment program is to help clubs make changes on their own with a good description and the kind that will help them to gain and retain people who will benefit them in shaping their future (White, 2006). 2.2.2.Future Health Care Concerns of the Baby Boomer Generation Knowing the preferences and habits of the baby boomers plans can be made in health care. Baby boomers do not share the same likes. It is necessary to understand how baby boomer?s mind processes given information which is important for effective communication. The researcher can consider how possible it is to make an emotional connection with your particular audience who is a baby boomer. A male who is 50 year old could be a parent or a grandparent, senior staff or just an entrepreneur (Chicago, Crain Communications, 2003). The researcher should think of methods in which information can be gathered about the particular audience in order to give priorities in segments and also present them in meaningful ways. Baby boomers normally have an average of two major life changes e.g. birth, living situations and also deaths in each year. It is necessary to address these life changes more often than any other generation group so as to be effective in reaching these baby boomers. Baby boomers are highly interested in what to can do about their health. The researcher should consider those messages which are framed and also provoke a sense of self efficacy together with empowerment. Baby boomers are over 50 years of age and are marketers to a large extent. Targeting images and messages directly to them which includes the larger issues they are with can have a high impact to their life either mentally or physically (Erin E Sudheimer Affiliation: University of Missouri-St. Louis, St. Louis, MO, 2009). The risks of developing Alzheimer?s disease are significantly increasing as the first group of baby boomers is turning 65. Age is the biggest disease risk factor in Alzheimer?s. This means that boomers are targeted to be the next victims with the first of the two waves turning 65. Most new families will contend with having at least one of their family members having Alzheimer?s. The symptoms of the disease are a fatal. It is a progressive disorder of the brain which causes memory problems and major behavior changes. The disease kills eventually after taking everything from the patient. It steals the memory of the patient, independence and judgment. It is a horrible disease that steals loved one?s character and eventually their lives. Management of the disease by family members is expensive and leaves the family finances in shambles. The cost to both government and individuals is quite high. Until a cure for the treatment of Alzheimer?s, it will become the disease for defining the baby boom generation (Chicago, Crain Communications, 2003). There are also expectations that 10 million baby boomers will develop heart diseases. Among those who attain the age of 85, more than half of them will suffer from some form of heart disease. Due to the difficulty of prevention, as well as detection, it is predicted that almost 10 million people from the baby boomer generation will die from heart disease. Caregivers of these patients are negatively affected in terms of employment income and financial security at large. However, nothing can be compared to the human cost consideration it takes to watch loved ones slowly being taken by death (Lee & Skinner, 1999). Another major consideration is that people over the age of 65 are expected to have more than one chronic illness. Current research shows that the population of baby boomers between 45 and 70 years of age already has chronic illnesses that they are managing, and this will only get worse with time. The percentage distribution of chronic disease in people over 65 years in the United States is as follows; 50% suffer from arthritis, 31% suffer from heart disease, 70% suffer from hypertension, 24% suffer from cancer while 21 % suffer from diabetes. This accounts for almost half of the medical spending in the United States. This is expected to rise to almost three quarters by the year 2030 as the bulk of the baby boom population will be beyond retirement. 2.3.Others Chapters According to the 2001 U.S census, every seven seconds, an American turns 50. This will be the same trend from 2014 as this age group will be turning 65. This shows that the population demographic of the United States will have more senior citizens. The census also showed that, three quarters of the wealth in America will be held by people who will be above the age of 60. This will mean that American spending will shift to healthcare since the population that holds the most wealth will be the senior citizens. There is growing concern that healthcare providers will not be able to meet this requirement. This is mainly due to the fact that soon over 70 million people will have passed retirement age (Mangino, 1996). The government will face a daunting task of providing retirement benefits in such a large scale. Wealth distribution of the baby boomers is 55 percent more than post baby boomer population. This means that the old baby boomer population will not be able to rely on the younger generation as the latter does not have the financial capability of supporting the baby boomer population. For the first time, The United States will have a situation where the current population will not be able to support the senior citizen populations (Albert, Johnson, Gasperino, & Tokatli, 2004). Baby boomers also pose the greatest consumer spending in the past decade. This will mean that, industries will have to change with the demographics of the population. In 2009, the US government expenditure survey showed that baby boomer population consumption doubles the young population consumer spending. This shows that industries currently rely on the baby boomer population. This means that as they grow older the demographic consumption will change. This means that businesses will have to prepare for reduced profits as the next generation cannot come close to matching baby boomer consumption. The other option available is changing business structures to accommodate the changing demographics and wealth distribution (Lee & Skinner, 1999). Baby boomers are also considered as one of the most experienced workers in the history of the labor force. The fact that they are retiring is worrying as companies seem to be losing their top employees and employing new inexperienced ones. There needs to be a way of transitioning from the baby boomer population. This can be done by mentorship. Mentorship is important as it allows inexperienced employees to learn from the experienced ones. There also needs to be a certain hierarchy in employment. This hierarchy involves having experienced and highly qualified management who offer guidance to the organization. This way by the time they are retiring the new generation will have learnt how to manage the organization and the work rate required. 2.4.Conclusion of literature review Barely ten years from now, the baby boom generation leading edge going to turn 65 which will usher in a sustained ageing of the U.S population? According to many, the federal government has staggering pressure from the baby boomers. The number of ageing baby boomers increases the number of people receiving medication, retirement and other disability benefits. This has led to the rapid growth the number nursing home residents. Some long-term forecasts suggest that nearly a third of GDP will have to be encountered for by health care in 2030. The fiscal impact of this demographic change is expected to be quite big. A more optimistic view is that the average retirement age will rise, and the gains from productivity and increase of tax revenue will offset the demands put on the federal budget by the ageing baby boomers. There is a projection which suggests that the percentage of those who are over the age of 65 and also require medical coverage for long term care will reduce in the coming century (Wilson, 2012). As the first wave of boomers is approaching retirement age, the health care system predictions have been nothing short of apocalyptic. Some predict that the surge in demand for medical care associated the old population strain the scarce resources and that future generations face economic instabilities due higher inflation and rising taxes. Some suggest that the increasing costs of medical care and the federal insurance plan for those who are older make the national debt increase to the point of no return. The oldest of the boomers at 78 million strong who existed between 1946 and 1964 are already working hard to make unsustainable demands on entitlement programs in Medicare Medicaid (Jones, 2008). In this paper, the objective is to ascertain the current and future healthcare demands that are brought about by the baby boomer cohort, and whether healthcare givers will adequately meet these demands. 3.0.Methodology 3.1.Design The study paper made the proper utilization of a descriptive research design. Descriptive research methods involve the use of collected test hypothesis or able approach questions concerning the prevailing status of the subject research. The design is based on naturalistic inquiry concepts which are flexible and do not involve the investigator in the manipulation of the conditions of the research. Naturalistic conditions are a subjective approach whose aim is to discover, understand and interpret the research. The descriptive study made an exploration of the baby boomers that have changed or are changing the health care system. 3.2.Target population and participants This is a group of interest to the researcher carrying out investigations. The population was the baby boomers who lived and worked around urban areas and seeking health care attention and change the formal learning. A sample is the population subset. The sample consisted of 970 participants. To ensure that the study included a wide variety of backgrounds and choices, the study involved choosing from the following direct learning organizations; private universities, technical schools and community colleges Participants from these institutions provided a wide variety of educational levels and socioeconomic status. To find a sample which is most likely to help in achieving the objectives of research, a variation is used. This is stratified sampling. The aim of this method of sampling was to find those who represent the greatest possible characteristics for the diverse research and potential patterns that span different cases. Using maximum differences is essential for discovering categories and making properties which are essential in the development of the theory. 3.3.Procedure for Data Collection When it becomes difficult to observe behaviors, interactions and feelings of individuals then interviews become the best solution. The use of interviews is the best solution in researches involving only a few participants. The data collected from the population can be used in the determination of the current status of the existing population with respect to many variables. The questions, in the interview, are open ended giving the interviewer an opportunity to ask the participants for all facts pertaining to the matter as well as the participant?s opinion on particular events. This is important for gaining crucial insights concerning the various phenomenon. On the other hand, a formal interview involves participants responding to a given set of questions and these methods are highly consistent as compared to a formal interview. While carrying out the interview, we made use of a tape recorder to record the interview whose primary purpose was to back up the data and also a way of data storage. The interviewer had a notebook which is to write a summary of the 4.1.Definition and measurement of variables The analysis here will be mostly descriptive statistics and correlation analysis. The data collected procedure and also record any actions which he noted. With immediate following of each interview, it was the task of the researcher to write short field notes from the interview and typed them down into a word processor after each interview. There were procedures in which data is, and they are for the comparative method which was constant for analysis and collection of data. 4.0.Data Analysis 4.1.Definition and measurement of variables The analysis here is mostly descriptive statistics and correlation analysis. The data collected is presented in graphical form and compared with previous trends. Data from the United States Census Bureau was used to analyzed baby boomers and their population bracket as well as getting demographic data. 4.2.Data Analysis According to ?The American Freshman: Forty year trends, highest point of interest in majoring in health sciences in the recent past was in 1993 the ratio of interest for men and women was 8.9% and 12.8% respectively. This is a combined average of 21.7% of the student population who want to major in health sciences. The highest period was in 1976 where the combined average was 28.7% (Pryor, Higher Education Research Institute (Los Angeles, & (U.S.), 2007). Figure 4.1.1 bar graph of those with health science intentions (source: self-made) The table below shows the interest in health sciences compared to the total number of students in eight school districts. The table clearly shows that the interest in venturing into the health sciences field is not very high. The health sciences field is made up of doctors, nurses and other healthcare professions like dentistry and orthopedics (Project Coordinator, 2013). Figure 4.1.2 pie chart of health sciences intentions (Source: self) The data collected showed that 224 out of the 970 students wanted to pursue a major in health sciences. This indicated a 23.09% interest in health sciences by students. In comparison to the data from ?The American Freshman: Forty year trends, this indicated a slight rise in the number even though it has yet to reach the highest levels of 1976. This data was compared with that of the number of baby boomers who are approaching retirement to see if this will be able to handle the increased need for healthcare (Project Coordinator, 2013). Table 4.1.1 Population number in age brackets (source: US census bureau) The table above compares the population distribution and the percentage increase in each age bracket. In 2010 there was a 30.4% increase in the number of people who were between 65 to 69 years of age. This indicates that there was a 30.4% increase in retirees within the 10 year period. This increase is attributed to the baby boomer population. The number between 60 to 64 years and 55-59 has also increased by 55.6% and 46.0% respectively. This is the same increase that is anticipated in people over retirement age in each five year interval. This is the predicted to be the greatest increase in people over retirement age in the history of the United States. At the same time there is a decrease in the number of people between the 30 to 34 years and 35-39 years age bracket. This is an indication that the next generation after the baby boomers is a lot less than that of the baby boomers. This means that once the baby boomers retire the new population will not be able to satisfy the healthcare requirements (Howden & Meyer, 2011). The two tables above show that the demographic distribution according to age. A comparison shows that the largest population in 2000 that made up the workforce is approaching retirement in 2010. It is expected by 2020 that part of the population will be above retirement. This means that in a few years? time, the largest ever proportion of the population will be in retirement (Howden & Meyer, 2011). The table below is a correlation analysis between the population in 2000 and that in 2010. The Pearson?s correlation analysis shows a 0.962 correlation. This means that the two populations are highly correlated with only slight differences due to death and birth differences. We can therefore conclude that the population in 2000 accurately showed what trends are expected in 2010. The main difference is that the age brackets are progressing. This is clearly seen in the graph below (Howden & Meyer, 2011). There is a peak in the population that is approaching the post retirement age. This peak represents the baby boomer population who were the largest population explosion in history. Just behind them there is the post baby boom generation which had very less births and consequently one of the smallest populations. The table shows that the population structure remains relatively the same except for progression in the years. What was the main age bracket in 35 to 54 years is now the age bracket in 45 to 64 years. This can then be predicted that in 2010 this same population will occupy 55 to 74 which means that the bulk of the population will be in retirement age (Howden & Meyer, 2011). 5.0.Summary, Conclusion and Recommendations 5.1.Summary The research above shows that there is a looming shortage in the healthcare industry due to the approaching retirement of the baby boomer generation. The specific research questions have been answered using various research data that was either obtained from the census data of 2000 and that of 2010 as well that of the sample taken of students who are interested in taking health sciences. The data showed that the baby boomer population has already started retiring and by 2030 they will all have retired. This presents is a shown clearly by the 45 to 70 year age bracket in the 2010 census (Hudson, 2008). More than 10,000 baby boomers are retiring per day. This has seen a great increase currently as the number of people over 65 has increased by 30.4 percent. This means that more than 30.4 percent has already retired. Considering that baby boomers are also employees in the health service means that they are no working. This brings a deficiency in two ways. One way is that they are retiring reducing the number of health workers in the medical field. The second way is that they themselves are becoming patients who need healthcare from the chronic illnesses they suffer (Hay & Diehl, 2009). The future expectation of the healthcare sector is that the number of retirees who require medical care for their chronic illnes

What is the relationship between alcohol and breast cancer?

What is the relationship between alcohol and breast cancer?

 

Research nursing questions

Order Description

Review the following research questions.

1. What is the relationship between alcohol and breast cancer?

2. What is the difference between self-efficacy scores in older adults who exercise and the scores of those who do not?

3. What is the difference in attitudes of male and female college students toward condoms?

Address the following as per rubric:

• Identify an appropriate research design.

• Discuss the strengths and weaknesses of the design.

• Provide a rationale for the design you selected

Does UR constitute “practicing medicine” and if so should UR be limited to only those medical professionals licensed to practice medicine?

Does UR constitute “practicing medicine” and if so should UR be limited to only those medical professionals licensed to practice medicine?

Does UR constitute “practicing medicine” and if so should UR be limited to only those medical professionals licensed to practice medicine?
Discuss who you think should head the utilization review program and justify your answer.

Does Work Overload Justify Negligence


  • Muhammad Qasim


I


ntroduction

According World Health Organization (WHO), Pakistan is one of the 57 countries with acute deficiency of healthcare workforce and with no well-defined human resource development policy in place. The country is facing dual burden of communicable and non-communicable diseases with Doctor to patient ratio of as high as one doctor per 1254 population (WHO, 2013). The health care’s facilities remain overcrowded by patients, specially the public sector, which result in work overload and stress among the healthcare professionals. Medical officers (MOs) and Post graduate trainees have duty hours as long as 90 hours per week. Healthcare professionals under stressful condition and work overload are more prone to commit negligence and medical errors. The consequences of medical negligence range from a minor harm to loss of human life. This paper will discuss medical negligence, malpractice in relation to work overload in the light of ethical principles and theories. Moreover, some recommendation will be put forward to minimize negligence, establish proper reporting system and minimize work overload among healthcare provider.


Scenario

A 27 years old male was admitted to the general surgery ward with gunshot injury. He was on injection Nalbuphine10 mg as per need. This patient was constantly complaining of severe pain. The assigned nurse assessed his pain and informed the doctor about his condition. She also informed that the patient has already received Nalbuphine up to its maximum limit i.e. four doses in the last 8 hours. The doctor was overwhelmed with the workload of ward and emergency unit as well. He told the nurse that the patient and his family are exaggerating the condition. Meanwhile, the doctor visited the patient and informed the nurse that he has reassured the patient and his family. After one hour, the patient developed breathing difficulty and went into respiratory arrest. Patient was resuscitated promptly for twenty minutes, but he did not revive, and hence expired. The family showed a strip of tablets Lorazepam 2mg, and added that two tablets are given to the patient on the advice of the duty doctor. It was found that the drug was neither mentioned in patient’s file nor was it verbally ordered to the nurse. The doctor requested not to report the incidence. Later on inquiry revealed that consequences occurred due to additive effect of concurrent CNS depressants.


Issue Analysis

In the above scenario, the patient was in acute pain, the family was worried about his restless condition. His cries and complaints were disturbing other patients in the units. Doctor was burdened with too many responsibilities and had to manage the patients in ward, recovery room, and emergency department at the same time. Being overwhelmed with too many responsibilities he advised two tablet of Lorazepam 2 mg per oral without mentioning in patient file without considering the prior high deses of Nelbuphine. Consequently, due to the additive effect of the concurrent CNS depressants patient collapsed, and after an attempt of unsuccessful cardio-pulmonary resuscitation (CPR) patient expired. This was violation of ethical principles of beneficence and non-maleficence.

Moreover, the doctor’s intention was not to harm the patient however, he bypassed the nurse, did not indicate the order in patient’s file, and handed over written prescription to the father of the patient. The poor father brought the medicine and gave to the patient, which resulted in fatal consequences. It was breach in his duty toward his patient and violation of Hippocratic Oath (Cruess & Cruess, 2014). It is also evident from the scenario that doctor wanted to just keep the patient calm and get rid of his pain complain. So, he prescribed a high dose of another sedative medicine for the sake of his ease. Though his intentions was not to harm the patient and was also over loaded with too many responsibilities but, my question is, does work overload justify negligence which cost a human life?


Discussion

Malpractice is negligence on part of an individual within a professional capacity. According to Beauchamp and Childress (2001) negligence is the absence of due care either intentionally imposing risk of harm or unintentionally but, carelessly in a given situation.

Principle of beneficence is central to healthcare and healthcare professionals are expected to be beneficent toward their patients in any circumstances. According to Mustafa (2013) “Beneficence refers to the promotion of welfare, denoting acts of mercy, unstinting love and selfless humanity” (p.2). However, in this case the doctor not only failed to be beneficent but also committed such an act which resulted in sentinel event. He prescribed the CNS depressant beside he knew that the patient had already received 40 mg of nelbuphine since morning. It was the commission of a maleficent act on his part which, resulted in loss of a precious human life (Beauchamp & Childress, 2001). Being in the professional boundary of a doctor, he was trusted upon by the patient and family and was expected to be beneficent toward patient in any case.

On contrary, it could be argued that, his intention was not to harm the patient. He just wanted to keep the patient in rest and pain free. In Addition, doctor was overburdened with other responsibilities. He had to take care of other patients so, on the bases of utilitarian theory he was justified to take into consideration the care of other patients as professional obligation. Additionally, it was not only the patient but also the worried family members and other patients in the ward who were disturbed due to his cries and complains. So his decision of prescribing sedative pills was for the benefit of large number of people (Beauchamp & Childress, 2001).

Though, his workload was more than usual, and he had to fulfill too many responsibilities at a time. However, it neither allows him to be negligent in patient care, nor permit him to violate Hippocratic Oath in which, he had promised that “he will lead his life and practice his art with integrity and honor by using his power wisely” (Zafar, 2006). His action was deficient as compared to a reasonable and prudent professional under given circumstances (Burkhardt and Nathaniel). Moreover his act was a serious carelessness and maleficent in nature for the client which cost his life. Such negligence is not justifiable on the basis of any legal or moral grounds.

Secondly, he bypassed on duty nurse who was responsible for the administration of the medication. It was breach of duty on his part to fail to enter the order in patient’s file. Being responsible for patient’s care, and employ of the institute, he was supposed to follow due course of actions of patient care. Moreover, the concurrence of opiates and sedatives would not have occurred if the doctor had followed proper procedure of prescription.

On other hand, it could be claimed that, the ultimate goal of his decision was to relieve suffering of patient. Violating proper procedure of prescription and administration was probably intended to provide prompt relief. However, the nurse could have moved with the doctor in his visit to the patient to argue on the dosage about concurrence. Furthermore, the doctor might have thought about giving prescription to the patient’s attendant will take less time and so prompt relief; he therefore broke the chain of flow of proper protocol.

The society expects professionally and morally sound decisions from the doctors. As a part of healthcare team, they are supposed to follow the policies and abide by the rules of the institute they work in. furthermore, “patients have the right to a quality of care which is marked both by high technical standards and by a humane relationship between the patient and health care providers” (Exter, 2009). In the scenario, the doctor’s noncompliance regarding proper procedure of prescription was below the acceptable standards and violation of his professional obligation. According to American medical association the doctor’s responsibilities include to be ever vigilant for the benefit of patient, and to bear their part in sustaining its institutions and burdens” (Cruess & Cruess, 2014). A large number of doctors’ misjudgments and medication errors are corrected by dispensing pharmacist or medication nurse if proper protocols are followed (Al-shara, 2011).

Finally, his request to the nurse about covering the incidence was a professional misconduct as this was a sentinel event. However, the nurse properly followed the virtue of veracity and dared to report the incident. Resultantly, the inquiry revealed that the additive effect of the concurrent CNS depressants was due to negligence in clinical judgment and careless behavior of the doctor.

It could be argued that the incidence occurred unintentionally, and its reporting could endanger the doctor’s carrier. In addition, reporting of the incidence could have cost his job and even his license of practice. Is it acceptable to take such risks in a country like Pakistan where there is already shortage of doctors?

The negligent behavior of the doctor cost a precious human life, even though he requested the nurse not to uncover the incident. This could be measured a serious misconduct and makes his trustworthiness and moral integrity questionable. According Pakistan medical and dental council the physicians need to attempt highest level of competence and all necessary skills and knowledge, and they will be responsible for their actions (Zafar, 2006).Considering the nature of the event, it was the moral and professional obligation of the nurse to report the incidence promptly. Proper reporting system could prevent future mishaps. Nurse was right in her decision to report the incident on the basis of utilitarian theory for benefit of long number of prospective patients (Burkhardt and Nathaniel, 2008).


Recommendation

Healthcare providers need to be competent, skillful, and vigilant to provide efficient care to the patients. They should comply with the Hippocratic Oath and trust and expectations of the society. Sound knowledge of bioethics and Islamic ethics can make a difference and should be the part of curricula across the disciplines of healthcare. Proper policies, procedures and protocols need to be implemented and monitored for compliance at institutional, provincial and country level. The government must consider the establishment of new institutions and policy for staffing and scheduling of healthcare professional to cater the needs of growing population and minimize work overload. The proper reporting and analysis should be carried out following an incidence.


Conclusion

In the conclusion, malpractice on the basis of work overload could not be justified on any moral or legal grounds. Healthcare professionals should comply with the entrusted expectations of patients and society. They are expected to demonstrated optimal level of clinical and professional competencies and skills to meet challenges of the respective professions. Human life is precious and should always be respected.


References

Al-Shara, M. (2011). Factors contributing to medication errors in Jordan: a nursing perspective. Iranian journal of nursing and midwifery research, 16(2), 158.

Barach, P., & Moss, F. (2001). Delivering safe health care: safety is a patient’s right and the obligation of all health professionals.

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Beauchamp, T. L., & Childress, J. F. (2001).

Principles of biomedical ethics.

(5th ed.). New York: Oxford University Press.

Burkhardt, M. &Nathaniel, A. (2008).

Ethics and Issues in Contemporary


Nursing

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ed.) Australia: Delmar

Cruess, R., & Cruess, S. (2014). Updating the Hippocratic Oath to include medicine’s social contract. Medical education, 48(1), 95-100.

Exter, A. (Ed.). (2009). International Health Law and Ethics: Basic Documents. Maklu.

Scheffler, R. M., Liu, J. X., Kinfu, Y., & Dal Poz, M. R. (2008). Forecasting the global shortage of physicians: an economic-and needs-based approach. Bulletin of the World Health Organization, 86(7), 516-523B.

WHO (2007).

Global Health Observatory Data Repository

. Retrieved from World Health Organization website:

http://apps.who.int/gho/data/node.main.A1444?lang=en

Zafar , M. H. (2006). Pakistan Medical & Dental Council: Code of Ethics. Retrieved April 8, 2014, from

http://www.pmdc.org.pk/Ethics/tabid/101/Default.aspx#6

Describe the relationship of sodium and potassium in the ICF and ECF.

Describe the relationship of sodium and potassium in the ICF and ECF.

IDENTIFY AND SELECT APPROPRIATE INTERVENTIONS INCLUDING DIAGNOSTIC TESTS AND NURSING INTERVENTIONS

Identify and select appropriate interventions including diagnostic tests and nursing interventions. Analyze physiological and psychological responses to illness and treatment modalities
Purpose: Examine case studies related to renal and urologic systems and fluid and electrolytes. Answer the assigned questions. This assignment should help refine your clinical/critical thinking skills.
Assignment Description: Answer the questions in the grading criteria related to each of the patients provided. Your answer must follow APA 6th edition format. Submit the answer in the assignment area of your course. This assignment is worth 50 points.
Patient 1 – A 52 year old female patient with a long-standing history of COPD and heart failure is being seen for recent onset of headache, muscle cramps, bilateral lower extremity edema, and nervousness. She also reports a 5-day history of watery diarrhea. Her medications include diuretics and long-acting and short-acting beta-2 agonists. The results of a Basic Metabolic Profile (BMP) reveal abnormally low serum sodium, potassium, and chloride levels. Her anion gap is normal.
a. Describe the relationship of sodium and potassium in the ICF and ECF.
b. Identify the acid-base imbalances for which this patient is at risk and why she is at risk for them.
b. Define “anion gap” and the significance of the anion gap being normal in this patient.

Patient 2-You are asked to see a 20 year old woman who has white blood cells present in her urinalysis results. How would you determine whether she has cystitis or pyelonephritis?
a. Differentiate between cystitis and pyelonephritis. Consider history, possible presenting symptoms, and urinalysis results,.
b. Provide specific patient education for this patient regarding possible treatments and behaviors to prevent this condition in the future.

Pregnancy and Advanced Maternal Age

As more women focus on their careers, more women are getting pregnant and having children after the age of 35 years old, which means in the medical field that they are placed in a group of mothers that are classified as being of advanced maternal age. Not that many years ago most of the women if they were able to conceive, would not carry the child to term or would die before the baby was born, but because of advances in medical technology most of these women easily get pregnant and have normal pregnancies; however there are some issues and risks involved when having a baby during your later childbearing years.

As women age, they become less fertile and the ovaries do not always release an egg each month during the menstrual cycle which can be a cause of infertility. As you age there is also an increased risk that the baby will have a genetic disorder, like Downs Syndrome. There are always concerns for the mother and fetus during pregnancy, but for the woman who has hit advanced maternal age she will be specially monitored for problems related to her age. The risk of miscarriage increases to about 1 in 4 at the age of 35 and 1 in 3 after the age of 45, with the majority of these caused by a genetic problem with the baby. The advanced maternal age mother is more then twice as likely to develop high blood pressure or diabetes during her pregnancy as a younger woman under 35 years of age. There is also an increased risk of placental abruption and placenta previa in older mothers. Regular checkups during the pregnancy are always important, but with the mother of advanced maternal age checkups should be started earlier and more tests will be provided to monitor the fetus. Common tests offered to mothers over the age of 35 are blood test called AFP, triple screen, quad screen and/or integrated tests, which is done between 15 to 18 weeks pregnant and measures several different substances in your blood to look for a problem in the babies spine or signal a possible genetic problem. Another more invasive test called Amniocentesis and Chorionic villi sampling are tests used to check for genetic problems with the baby. Amniocentesis is done by drawing away a volume of amniotic fluid by inserting a needle, usually guided with ultrasound, through the mother’s skin where it crosses the uterine wall into then amniotic sac where the baby and fluid reside. It is most often done in the third trimester to test for lung maturity when there is a danger in allowing a high-risk pregnancy to continue and at 15 weeks to do genetic testing. Chorionic Villous Sampling (CVS) is a technique that uses a needle through the cervix (a vaginal approach) to biopsy some chorionic tissue (placental tissue). The cells retrieved can be tested for genetic abnormalities, yielding the same information that amniocentesis provides, but over a month earlier. With all tests there comes increased risks and worrying for the patient and family, teaching is especially important during these times. With the more invasive testing there comes an increased risk of miscarriage and then waiting for the results can also cause anxiety

Not all is negative for the mother who is of advanced maternal age, these women are usually more educated, financially stable and have good healthcare, and they are usually in good relationships with extended family support. Most women of advanced maternal age are encouraged to have genetic counseling prior to pregnancy to determine if they are at risk of having a baby with a genetic disorder such as Down syndrome and so therefore are more educated regarding these issues and better able to make decisions that might effect themselves or the future of the baby. Women of advanced maternal age should be provided the same instructions for prenatal care as a younger mother, such as to see her provider before getting pregnant and continue with checkups as scheduled. Like any other pregnant mother she should take a multivitamin everyday, eat a variety of healthy foods, plenty of rest and exercise. Teaching should be done when to call the doctor, such as having bleeding with or without pain, severe headache, problems with eyesight, severe swelling of the face, hands, ankles and feet, any fluid leaking from the vagina and having contractions before her due date. Because of all medical advances that have been made, mothers of advanced maternal age can safely get pregnant and carry the baby to term, these mothers are really just like any other pregnant women, but because of their age will need to be monitored a little more carefully for risks that could affect any pregnant women.

Provide a detailed description of implementation logistics (When and how will the change be integrated into the current organizational structure, culture, and workflow? Who will be responsible for initiating the change, educating staff, and overseeing the implementation process?)

Provide a detailed description of implementation logistics (When and how will the change be integrated into the current organizational structure, culture, and workflow? Who will be responsible for initiating the change, educating staff, and overseeing the implementation process?)

 

Developing an Implementation Plan

Order Description

Read the instructions and requirements thoroughly and make sure to answer each part.
Developing an Implementation Plan
This is a capstone project and this is the 4th part of my research paper. The topic or, as it is called in research, PICOT question is:Are the patients in acute care settings (P) who have limited mobility (I) compared with those in long term care facility (C) at higher or lower risk of developing pressure ulcer (O) during their stay (T)?
I will provide you with the previous parts because all the parts must correlate. In addition, I will provide you with the 15 articles that must be used as references. These are the only 15 references to use for the assignment. Remember, the research paper must be written from the nursing point of view. I have been encountering too many problems with the previous orders on this paper, hence, if you have questions or do not understand the requirements completely, please let me know ahead of time, so we both can avoid extra work.
Also, you can upload some part of the paper as you write for me see if you are going in the right direction.
Instructions:
Consider the population in which the solution is intended, the staff that will participate, and the key contributors that must provide approval and/or support for your project to be implemented. These stakeholders are considered your audience.
Develop an implementation plan (1,500-2,000 words) using this checklist. The elements that should be included in your plan are listed below:
1. Explainsmethod of obtaining necessary approval(s) and securing support from your organization’s leadership and fellow staff.
2. Provide description of current problem, issue, or deficit requiring a change. Hint: If you are proposing a change in current policy, process, or procedure(s) when delivering patient care, describe first the current policy, process, or procedure as a baseline for comparison.
3. Provide detailed explanation of proposed solution (new policy, process, procedure, or education to address the problem/deficit).
4. Discuss rationale for selecting proposed solution.
5. Incorporate evidence from your Review of Literature in Topic 2 to support your proposed solution and reason for change. (I will upload it for you separately)
6. Provide a detailed description of implementation logistics (When and how will the change be integrated into the current organizational structure, culture, and workflow? Who will be responsible for initiating the change, educating staff, and overseeing the implementation process?)
7. Identify resources required for implementation: staff; educational materials (pamphlets, handouts, posters, and PowerPoint presentations); assessment tools (questionnaires, surveys, pre- and post-tests to assess knowledge of participants at baseline and after intervention); technology (technology or software needs); funds (cost of educating staff, printing or producing educational materials, gathering and analyzing data before, during, and following implementation), and staff to initiate, oversee, and evaluate change.
Prepare this assignment according to the APA guidelines.

, Christine Narvaez drove her automobile onto the parking lot of a busy supermarket. Narvaez had her 2-year-old grandchild with her. The youngster was riding, unconstrained, in a booster seat. Narvaez saw a friend and decided to stop for a brief chat.

, Christine Narvaez drove her automobile onto the parking lot of a busy supermarket. Narvaez had her 2-year-old grandchild with her. The youngster was riding, unconstrained, in a booster seat. Narvaez saw a friend and decided to stop for a brief chat.

She parked the car and exited the car, leaving the keys in the ignition and the motor running. The youngster crawled behind the wheel, slipped the car into gear, and set it in motion. The car struck Marguerite ONeill, a woman in her 80s, pinned her between the Narvaez car and another car and slowly crushed the womans trapped body. ONeill suffered a crushed hip, a broken arm, and four cracked ribs, and she lost more than 40 percent of her blood supply as a result of internal bleeding. She spent one month in a hospitals intensive care unit and had to be placed in a nursing home and was deprived of the ability to live independently.Narvaez carried the $ 20,000 minimum amount of liability insurance allowed by law. She was insured by Gallant Insurance Company. ONeills medical bills totaled $105,000. ONeill sued Narvaez and her insurance company, Gallant. ONeills attorney demanded the policy limit of $20,000 from Gallant in settlement of ONeills claim and offered a complete release from liability for Narvaez. Three Gallant insurance adjusters, its claims manager, and the lawyer of the law firm representing Gallant for the case all stated to John Moss, Gallants executive vice president, that Gallant should accept the settlement offer. Moss rejected their advice and refused to settle the case.One year later, on the eve of trial, Moss offered to settle for the $20,000 policy limit, but ONeill then refused. The case went to trial, and the jury returned a verdict against Narvaez of $731,063. Gallant paid $20,000 of this amount, closed its file, and left Narvaez liable for the $711,063 excess judgment. To settle her debt to ONeill, Narvaez assigned her claims against Gallant to ONeill. ONeill then sued Gallant for a bad faith tort for breaching the implied covenant of good faith and fair dealing that Gallant owed to Narvaez to settle the case.Question:Is Gallant Insurance Company liable for a bad faith tort?Did Gallant act unethically?On Halloween Day, Christine Narvaez drove her automobile onto the parking lot of a busy supermarket. Narvaez had her 2-year-old grandchild with her. The youngster was riding, unconstrained, in a booster seat. Narvaez saw a friend and decided to stop for a brief chat. She parked the car and exited the car, leaving the keys in the ignition and the motor running. The youngster crawled behind the wheel, slipped the car into gear, and set it in motion. The car struck Marguerite ONeill, a woman in her 80s, pinned her between the Narvaez car and another car and slowly crushed the womans trapped body. ONeill suffered a crushed hip, a broken arm, and four cracked ribs, and she lost more than 40 percent of her blood supply as a result of internal bleeding. She spent one month in a hospitals intensive care unit and had to be placed in a nursing home and was deprived of the ability to live independently.Narvaez carried the $ 20,000 minimum amount of liability insurance allowed by law. She was insured by Gallant Insurance Company. ONeills medical bills totaled $105,000. ONeill sued Narvaez and her insurance company, Gallant. ONeills attorney demanded the policy limit of $20,000 from Gallant in settlement of ONeills claim and offered a complete release from liability for Narvaez. Three Gallant insurance adjusters, its claims manager, and the lawyer of the law firm representing Gallant for the case all stated to John Moss, Gallants executive vice president, that Gallant should accept the settlement offer. Moss rejected their advice and refused to settle the case.One year later, on the eve of trial, Moss offered to settle for the $20,000 policy limit, but ONeill then refused. The case went to trial, and the jury returned a verdict against Narvaez of $731,063. Gallant paid $20,000 of this amount, closed its file, and left Narvaez liable for the $711,063 excess judgment. To settle her debt to ONeill, Narvaez assigned her claims against Gallant to ONeill. ONeill then sued Gallant for a bad faith tort for breaching the implied covenant of good faith and fair dealing that Gallant owed to Narvaez to settle the case.Question:

Educate nurses about how the practice of nursing is expected to grow and shift

Educate nurses about how the practice of nursing is expected to grow and shift

As the country focuses on the restructure of the U.S. health care delivery system, nurses will continue to play an important role. It is expected that more and more nursing jobs will become available out in the community, and less will be available in acute care hospitals.

Write a speech of 500 words to educate nurses about how the practice of nursing is expected to grow and shift. Include the concepts of continuity or continuum of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics.

While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines. These can be found in the APA Style Guide, which is located in the Student Success Center.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. Reference also.

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