Health Disparities And The Disproportionality Of Access...

Health Disparities and the Disproportionality of Access to Care for African Americans Health disparities endure tenacious issues in the United States of America, setting certain groups at higher risk of being uninsured, limited access to care, facing a poorer quality of care, and overall negative health outcomes. The high incidence of health disparities reflects the range of individual, social, economic, racial/ethnic and environmental magnitudes. Among the minority groups, African-Americans disproportionately access health care and the health disparities clearly glow in the nationwide. Purpose of the Study The purpose of this research is to identify and measure the most common health disparities that cause African-Americans poor health outcomes, assesses the solutions, and provides alternative suggestions in order to reduce or eliminate the main health disparities. Racial discrimination Racial classification has a possibility to expose an individual to racism and health disparities by influencing access to care, scope and quality of care, and overall health outcomes. In the United States of America, the secret codes of socioeconomic status are deeply spotted by race, causing the racial differences in socioeconomic status and becomes the main element to racial differences in health and health care (Kennedy, 2013). Many studies have indicated that African-Americans distrust medical practices and medical professionals due to a long history tied to the unethical treatmentShow MoreRelatedRacial Discrimination And The Health Of African Americans911 Words   |  4 Pagesdiscrimination is the ground root of disparities letting African Americans to low socioeconomic status and poor health outcomes. Why disproportionality in health is so high among African Americans in the United States? Disparities limit the continuity of improvement in overall quality of care and population health and result in poor health outcomes as well as unnecessary costs. Despite an upsurge focus on reducing disparities and increasing a set of advantages to address disparities in the federal, state, community

Drug Abuse ( Polysubstance ) Essay - 1052 Words

On the 10/05/2016, I took care of a 29 year old female who has been on admission since 09/24/2016. EMS found her in a ditch intubated her (ETT), mechanical ventilated, and brought her to the hospital. The patient informed me that police tried to stop her and her boyfriend but her boyfriend refused to stop, so she decided to jump out of a moving vehicle. Later she informed me that her boyfriend is in jail. However, her story about her incident is unclear. Her admission record shows that she started drugs at the age of 12. In addition, she is homeless, and her mom died when she was very young. Furthermore, her past medical and surgical histories are type 1 diabetes, ADHD, depression, anxiety, history of MRSA, TB ( latent TB per history from patient’s mother), history of drug abuse( polysubstance abuse) and hysterectomy. She has no known allergies. The following list of her home medications are Seroquel, Neurontin, Celexa, Remeron, Ativan, Klonipin, and Xanax. Patient was place d on contact isolation because of MRSA TB. The admitting diagnosis is rib fracture, lung contusion, sternum fracture, femur fracture, right occipital condyle fracture, spine fractures, pelvic fractures, and right hand fractures. Due to her multiple orthopedic injuries, she was placed on morphine Dilaudid for pain relief because she rated her pain 7-10 during my shift. She was extubated on 10/04/2016 but still on 3liters of Oxygen via nasal cannula. In addition, she has a lot of stitches due to herShow MoreRelatedThe Purpose Of This Paper Seeks To Analyze The Effects1208 Words   |  5 Pagespaper seeks to analyze the effects of prescription drug abuse. In the first article identified the author seeks to identify the differences between peer and parent influence on the misuse of prescription drug as it relates to ethnicity. The second article to be investigation into prescription drug use misuse and drug problems as it pertains to motivational context. The third and final article seeks to education young adults on medical p rescription drug use. A parent’s attitudes regarding substance useRead MoreProblem Statement For African American Youth1355 Words   |  6 PagesProblem Statement African American youth today appear to be one of the highest grossing substance users in the United States. According to SAMHSA (2016) â€Å"The rate of illegal drug use in the last month among African Americans ages 12 and up in 2014 was 12.4%, compared to the national average of 10.2% (p.1). In today’s society, at- risk youth are usually at the top of every conversation. As the impoverished communities continue to diminish, substance use continues to progress. In these socioeconomicRead MoreWhy Is Illicit Drug Abuse Most Frequently Associated With Poor Oral Health?1825 Words   |  8 PagesWhy is illicit drug abuse most often associated with poor oral health? Trevor Zlatnik University of Saskatchewan Abstract This paper reviews eight published articles that all look at oral health and some form of drug use. The articles vary in how they describe drug use. The articles may refer to drug use as drug abuse, substance use, drug addiction, or drug-dependency. The articles look at various drugs including methamphetamine, cocaine, morphine, heroin, ecstasy, and cannabis.Read MoreThe Cost Of Substance Abuse In Canada Case Study966 Words   |  4 PagesThe cost of substance abuse in Canada is astronomical. According to the Canadian Centre on Substance Abuse (CCSA), in 2002 alcohol accounted for about $14.6 billion and illegal drugs for about $8.2 billion in social cost (Single, Robertson, Rehm, Xie, 2002). This cost was measured in terms of the burden on health care and law enforcement, and productivity in the workplace or home. Arguably, the greatest cost may be immeasurable: human suffering and tragic loss of lives. 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Substance abuse and substance dependence which are the former terms that were used to define one with the disorder has been grouped into a set category of substance use disorder by the 2013 Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (APA, 2013). Furthermore, there is a certain number of diagnostic criteria as well as severity that must be met to best guide care services of the patient with a substance u se or polysubstance use disorder. IdentificationRead MoreLindsay Lohan818 Words   |  4 Pagesaddiction to alcohol and multiple illicit drugs including, OxyContin, a very potent painkiller, and cocaine. She stayed there for 45 days after completing her program. According to Meaghan Murphy (2007) article on FoxNews.com, after her first time in rehab, it was promising that she would no longer abuse and use narcotics, she had no intentions of using drugs, but the people she was around were using them. 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Advance Care Planning for Palliative Care †MyAssignmenthelp.com

Question: Discuss about the Advance Care Planning for Palliative Care. Answer: Introduction: This essay centers on the case study of Anthony Vella, aged 46. Six months ago, Anthony diagnosed with stage four pancreatic cancer. Anthony has been going for a chemotherapy since he was diagnosed with cancer, until two weeks ago, when his oncologist told him that chemotherapy is no longer effective against his condition. A few days later, he experienced severe abdominal and nausea, where he was admitted to the oncology ward. With the help of the palliative team care, Anthony significantly improved and he decided to return home. A week later, Anthony collapsed and was non-responsive. An ambulance took him to a major hospital, where he was taken to the emergency department. The remaining part of the essay explains advanced care plan (ACP) and how it could have been of benefit in the case study of Anthony Vella. This paper is structured into six parts. The first part is to define advance care planning and its possible benefits for Anthony. Explaining the point at which ACP discussion should be initiated then follows. The section that follows clarifies who should take part in the ACP discussion. The information that should be included in the ACP is the next section. The advance care plan is that is inclined to changes over time. Therefore, the part that follows is when the ACP can be reviewed. The last part of this essay discusses when the ACP should be activated. As a final point, a summary of all the points discussed is wrapped up in the conclusion part. Definition and benefits of Advanced Care Planning Advance care planning is a procedure that enables people to plan for their future medical treatment and care when they can make a rational decision (Rizzalli, 2010). It is a platform that allows individuals to express their wishes, objectives, beliefs, and values to their friends, family, and caregiver before any health crisis occur. The purpose of ACP is to ensure that a patient's wishes are known, understood and upheld as described by Holley (2005). ACP also helps by making things easier for family and caregivers as they will understand what the patient wants when he or she is too ill or unable to speak. Advance care planning is typical in context of life-limiting condition or a terminal illness. There are numerous benefits attached to ACP that include less aggressive medical care, taken care of as per according to the patient's wishes, reduced rate of hospital admission, mostly in the care home residents and reduced hospital bills as explained by Heale Noble (2017). Research shows that 57% of patients who have completed ACP spent reduced time in the hospital when nearing the end of death (Detering, Hancock, Reade, Silvester, 2010).Advance care planning is also crucial in enabling family and friends to prepare for the passing of a loved one. It also helps in resolving family conflict and with bereavement as described by Curtis (2008). In the case of Anthony Vella, ACP could have assisted in knowing what his final wishes were and how to address them. This was helpful especially when he became non-responsive and could not speak. He could have undergone ACP two weeks ago when his doctor indicated that chemotherapy is no longer effective. Since stage four pancreatic cancer is considered a terminal disease with only 1% survival rate of five years (American Cancer Society, 2016), ACP could have worked perfectly in the case of Anthony. Advance care planning helps individuals decide on the future care which is taken into consideration the moment the person loses capacity. It also increases the chances of the patient to set up for other documents such as advance directives (AD), which explains the kinds of intervention they would like to undergo (Spruit et al., 2013). Having both AD and ACP documentation minimizes family conflict while increasing likelihood of respecting patient's will as Detering, Hancock, Reade, Silvester (2010) explains. Initiating advance care discussion Different indicators can make a person go through ACP discussion. It can be due to a life-changing event such as the death of a spouse, following diagnosis of life-limiting conditions, a substantial shift in clinical focus, assessment of individual needs and multiple hospital admissions, just to mention a few. ACP discussion should be an agreement among the patient, caregivers, and families. The discussion should not be as a result of outside pressure, for instance from family members. Adams, Kabcenel, Little, Sokol-Hessner, (2015) outlined a sequential step that healthcare organization could take into consideration while preparing ACP discussions: engage, steward, respect, exemplify and connect. The first step is to engage with both the patient and family members to understand what matters to most of them. This is followed by stewardship which entails documenting the healthcare delegation and what is relevant to the patient regarding his health care (Adams, Kabcenel, Little, Sokol-Hessner, 2015). The exemplify step involves making the patient understand how ACP could be of benefit to them by showing examples of healthcare staffs that have undergone through ACP discussions. The final step is to connect with the patient in a respectful way both physically and culturally. A patient should discuss ACP when he or she is physically and mentally well enough for the patient to participate in the discussion fully and subsequently make a sound decision. The discussion should focus on their goals, cultural and religious beliefs, and values instead of other conditions such as dementia (Fried, Bullock, Iannone, O'leary, 2009). In the case of Anthony Vella, ACP discussions should have been initiated when the oncologist told him that chemotherapy has stopped to be effective. This is the time when healthcare provider could have convinced him to undergo the ACP discussion when he was still of sound mind (Fried, Bullock, Iannone, O'leary, 2009). According to the case study, it can it is to acknowledge that what matters to Anthony was spending time with his wife. However, there were no records of the religious and cultural background of Anthony, neither was there any medical care of his preferences to be applied once he became non-responsive. The participants of Advance Plan Discussion The ACP discussion involves some people, key among them are the healthcare providers, the patient, and the family members. Concerning our case study of Mr. Anthony, the participants should include his wife and his two children, professionals from his cancer team, preferably the oncologist, among many other people (Bakitas et al., 2009). If the patient has been accessed and found to be lacking the capacity to decide by himself, a reliable individual can present the patient's best interest. For example, when the patient is admitted to an emergency department, and is unconscious and requires immediate treatment. A person who is acutely aware of the patient's wishes, preferences and values can step in to make the decision needed (Bakitas et al., 2009).This is the case of Mr. Anthony since he was admitted to the emergency department and did not have ACP at hand. Information in Advanced Care Plan Unlike Advance Decisions, Advance Statements and Powers of Attorney which a person can make at any convenient time, Advance Care plan is made when a patient nears the end of life. It mainly contains the patient's care and treatment wishes. These records are attached to the medical notes where they can be of use in cases of emergency. If the patient has already made Advance Decision, Advance Statement or Powers of Attorney, the information should be part of the Advanced Care Plan (Adams, Kabcenel, Little, Sokol-Hessner, 2015). Preferred Priorities for Care (PPC) document contains some questions that are used to prompt the patient. The questions mainly revolve around "what matters to you?" (Adams, Kabcenel, Little, Sokol-Hessner, 2015). Doctors and other healthcare providers use this document when deciding what is in the patient's best interest. PPC contain questions such as where you want to receive care, where you want to be cared for when you are dying and where you prefer to die, who you want to be next to you, values such as cultural and religious beliefs, and any dietary requirements you will need (Fried et al., 2013). These questions help caregivers to understand what is crucial to the patient and subsequently, their quality of life. According to the research done by Sudore and Fried (2010) on what sort of information should be included in the APC, recommended that AD forms, what matters to the patient and the Powers of Attorney. The document should ensure that the proxy understands their role, taking into account whether the surrogates should be given liberty or adhere strictly to the patient's wishes. The Proxy is also responsible for informing friends and families of the wishes of the patient (Heale Noble, 2017). For the patient to make ideal decisions or choices, they should consult with the healthcare providers. The nurses are in a position to explain different types of treatment and options and how the choices will affect the patient and whether the patient's decision is realistic or not. ACP document should be written in a simple language that all parties involved can easily understand it (Heale Noble, 2017). This makes it much easier for those who are not much conversant with legal terms and technicalities to comprehend the information contained therein to implement the wishes of the patient entirely. This also reduces the occurrence of misunderstanding between proxy's decisions and wishes of the patient (Robinson et al., 2009). Regarding the case of Mr. Anthony, his ACP information on who takes over the power of making decisions when he was non-responsive. This could have been his wife or any other unbiased individual. His wife should have stepped in and helped in making decisions that are of the best interest of the patient. His wife or any other person taking the role of the proxy should have been reasonably ascertainable, is aware of Mr. Anthony's past and present wishes, as well as his feelings. Mr. Anthony should have appointed his health lasting power of attorney to take charge when he is incapacitated (Robinson et al., 2009). When to review Advanced Care Plan Murray and McLoughlin (2012) explained that chronic illnesses could take place in any of these three forms, acute illness signified by immense decline in physical health, for instance, cancer, long-term sickness that a person becomes ill for long duration marked with periodic occurrence of severe ill-health and a prolonged decline of physical health like in cases of dementia or aging. Healthcare providers help in observing the patient for a given period and subsequently categorize the patient into one of the three mentioned classes. This information is important as it creates awareness to both the patient and family members. The information gathered is used to come up with an ideal ACP and how to handle end of life issues Holley (2005). No specific recommendations or evidence point out to when to review ACP. Mostly, the decision to consider the ACP is based on the patient's personal experiences. Some factors can also lead to the review of ACP such as if the individual circumstances of the patient changes, for instance, place of residence or discernment of quality of life. Also, a new therapeutic approach may become available, and therefore, the possibility of the patient recovering. As the condition of the patient progresses, goals and values may change, which can affect the earlier decided on the ACP Holley (2005). Advance care planning should regularly be reviewed either to uphold or to amend something while the patient is still in a capacity to do so. This ensures that the ACP is a reflection of the patient's current wishes and also to increase its likelihood to be regarded as relevant and up to date when the opportune time Michael et al. (2013). Most cancer patients find ACP as a very dynamic document instead of a rigid one. As the illness progresses, the person's views may change Michael et al. (2013). Mr. Anthony being in stage four of pancreatic cancer might have felt the same. That is why he decided to spend the last few days of his life with his family rather than in hospital. If he could have already had a standby ACP, he could have changed his wishes. Mr. Anthony's ACP should have been addressed during the early periods of his cancer treatment. This could have given him time to adjust his ACP at different stages of the disease process. The ACP could have been reviewed the moment he was informed that the chemotherapy is no longer effective. Activating the advanced care plan The decision of when to activate the ACP is based on the patient's condition. If the formulation of ACP is per according Michael et al. (2013), then the activation of the document can take place either immediately or over a given period. When the ACP is activated, the proxy took over the role of a patient and now become in charge of the healthcare decision. Proxy only makes a decision when the patient is incapacitated, and therefore, unable to make a sound decision. The proxy temporarily takes over the role of making a decision that is of best interest to the patient until the patient regain knowledge, skills, abilities, and willingness to manage his or her ACP (Adams, Kabcenel, Little, Sokol-Hessner, 2015). The activation of the Advanced Care plan can only move forward if all the stewards agree with the wishes of the patient. All the parties should comply with the five conversation-ready principles Michael et al. (2013). In the case of Mr. Anthony, if the ACP could have been ready, then it could have been activated the time he collapsed in the marketplace and later become non-responsive. His proxy would have made the decision regarding his healthcare based on his wishes on the ACP. Conclusion The essay addressed the matters regarding advance care planning with Mr. Anthony, a cancer patient with stage four of pancreatic cancer being the reference point. Mr. Anthony situation helps in understanding why it is important to prepare Advance Care Plan that can be easily followed when a patient becomes incapacitated. ACP contains the patient's wishes concerning the treatment and care, where to receive care, who they want to be with, their preferred diet, where to receive care, among other things. AD, lasting healthcare power of attorney and other relevant documents should be attached to the document should be attached to the ACP. The reviewing of the ACP should be done from time to time to have an up to date report. In cases where the patient cannot make sound decisions, activation of the ACP should be contemplated. References Adams, K. M, Kabcenel, A., Little, K. Sokol-Hessner, L. (2015). "Conversation ready": A framework for improving end-of-life care. IHI White Paper, Cambridge, MA: Institute for Healthcare Improvement. Available from: https://ihi.org American Cancer Society (ACS).(2016). Pancreatic survival rates, by stage.American Cancer Society.Available from https://www.cancer.org Bakitas, M., Lyons, K. D., Hegel, M. T., Balan, S., Brokaw, F. C., Seville, J., ... Ahles, T. A. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. Jama, 302(7), 741-749. Curtis, J. R. (2008). Palliative and end-of-life care for patients with severe COPD. European Respiratory Journal, 32(3), 796-803. Detering, K. M., Hancock, A. D., Reade, M. C., Silvester, W. (2010). The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. Bmj, 340, c1345. Fried, T. R., Bullock, K., Iannone, L., O'leary, J. R. (2009). Understanding advance care planning as a process of health behavior change. Journal of the American Geriatrics Society, 57(9), 1547-1555. Hartle, G. A., Thimons, D. G., Angelelli, J. (2014). Physician orders for life sustaining treatment in U.S. nursing homes: A case study of CRNP engagement in the care planning process. Nursing Research Practice, 2014, 7 pp. DOI: 10.1155/2014/761784 Heale, R., Noble, H. (2017). Advance care planning and palliative care. Evidence-based nursing, 20(1), 5-6. Holley, J. L. (2005, March). PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: Palliative Care in End?Stage Renal Disease: Focus on Advance Care Planning, Hospice Referral, and Bereavement. In Seminars in dialysis (Vol. 18, No. 2, pp. 154-156). Blackwell Science Inc. Michael, N., O'Callaghan, C., Clayton, J., Pollard, A., Stepanov, N., Spruyt, O., Michael, M., Ball, D. (2013). Understanding how cancer patients actualise, relinquih, and reject advance care planning: Implications for practice. Support Care Cancer, 21, 2195-2205. DOI: 10.1007/s00520-013-1779-6 Murray, S. A. McLoughlin.(2012). Illness trajectories and palliative care. In L. Sallnow, S. Kumar A. Kellehear, International Perspectives on Public Health and Palliative Care, pp. 30-51. London: Routledge Rizzalli, C. (2010). Advanced Care Planning and Palliative Care. Health Voices, (6), 16. Robinson, L., Dickinson, C., Rousseau, N., Beyer, F., Clark, A., Hughes, J., Howel, D. Exley, C. (2012).A systematic review of the effectiveness of advanced care planning interventions for people with cognitive impairment and dementia.Age and Ageing, 41(2), 263-269. DOI: 10.1093/ageing/afr148 Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., ... Pitta, F. (2013). An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. American journal of respiratory and critical care medicine, 188(8), e13-e64. Sudore, R. L., Fried, T. R. (2010). Redefining the "planning" in advance care planning: preparing for end-of-life decision making. Annals of internal medicine, 153(4), 256.