NR 503 Week 3 Discussion 2019/2020 – Chamberlain College of nursing | NR503 Week 3 Discussion 2019/2020 - €10,31   In winkelwagen

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NR 503 Week 3 Discussion 2019/2020 – Chamberlain College of nursing | NR503 Week 3 Discussion 2019/2020

NR 503 Week 3 Discussion 2019/2020 – Chamberlain College of nursing Professor & class, Does the study design specify a question, goal, of the study?  Why is this important? I think the questions here are "can the effectiveness of a combination of cognitive behavioral therapy (CBT) and task-oriented balance training (TOBT) when compared with general health education (GHE) and TOBT reduce the fear of falling in patients with chronic stroke?" and "How does demographic and environmental factors affects mental health among the general population?" It is important to create the "question" as it sets the framework for the research topic in question. Through evidence-based study, that knowledge gained is then translated into practice.  Explain the methodology (Randomized Control Trial, & Cross-sectional Study). Liu,  Ng, & Ng (2018) did a randomized control trial that evaluated the effectiveness of combined cognitive behavioral therapy (CBT) and task-oriented balance training (TOBT) to develop confidence in balance thus reducing fear and improve balancing to decrease the risk of falling, promote independence and quality of life for patients suffering with stroke. Kim & Kim (2017) conducted a cross-sectional study to determine whether demographic and environmental factors are associated with mental health. They wanted to understand the demographic and environmental factors in order to create policies that are suitable to aid the problem. 
Describe the participant information, include recruitment. Is selection bias present? Participants for the randomized controlled study were randomly selected and placed into an experimental and a control group with two groups both received 45 min of TOBT two times per week over an eight week session, while the experimental group will receive 45 min CBT intervention, and control group 45 min of general health education (GHE) lasting over the same time period. Some of the participants criteria includes  adults age 55 to 85 with diagnosis of unilateral ischemic brain injury noted on magnetic resonance imaging (MRI) or computed tomography (CT) within 1–6 years post-stroke, discharged from all rehabilitation services at least 6 months prior to program initiation, ability to walk independently for at least 10 m with or without assistance, .........and the ability to follow instructions sign an informed consent (Liu,  Ng, & Ng, 2018). In the cross-sectional study with Kim & Kim (2017), the study was restricted to residents living in Seoul and was limited to 25 communities with a sample size of 23,139 participants, with 900 from each community. The authors attempt to defend themselves in regard to any biases due to the limitation of the design but asserted that other researchers reported similar results using longitudinal cohort studies. How is data collected?  With the use of a computerized system, in the cross-sectional study, data was contracted using trained interviewers based on the protocol and questionnaires that include personal questions about health behaviors and chronic illnesses in 2013 through a community health survey.  
In the randomized controlled study, through advertisement participants were drafted from a local self-help group, screened for eligibility, and was given an appointment to obtain informed consent. 
 Are the variables identified? If yes, discuss. If no, how does this impact your interpretation of the study? 
The variables were identified using demographical factors that include sex, age, education, labor market participation, co-morbidity, sleep hours, physical activity, smoking, chronic illnesses, and drinking; for mental health status, the applicable part of the shared questionnaires was used by the researchers. With the use of this data, the prevalence of the condition in the population can be easily assessed, even though Liu,  Ng, & Ng (2018) admits that there were some missing values for some variables (education, labor market participation, smoking, and drinking). How was the data analyzed, what statistics are provided? What are potential errors related to the study design?
The cross-sectional trial looks at the entire population over a period of time that allows for the conclusion about the phenomena to be drawn across a wider group of peope. Statistical data was provided by the Seoul Metropolitan government about the total space of the greenness area, the total number of green facilities, general park area and city park area, and residence area park per capita (Kim & Kim, 2017, p. 4). Using values of variables from an analysis in 2004 to make the comparison in the reliability of the greenness data, the researchers detected the number of green facilities and greenness area that was gradually increasing (Kim & Kim, 2017, p. 4). According to Curley & Vitale (2016, p. 69) cross-sectional is a quick and easy way to obtain descriptive data but is at a disadvantage due to the powerlessness to control or recognize the significance of relevant variables. The data was analyzed by using a Kolmogrov-Smirnov test that is used to compare the cumulative distributions of two data sets in the randomized control study with simple descriptive statistics. Curley & Vitale (2016, p. 99-100), states that if randomization is not performed in a truly random way there may be some inconsistency thus creating errors that may lead to the wrong assumptions. 
What are the weaknesses of the type of study design/method? 
One of the limitations of the randomized control trial is not collecting data on actual falls and thus, not doing so may cause a long, expensive, and extensive study even though Curley & Vitale (2016, p. 99) deem it as strong with the ability to limit bias.  According to Curly & Vitale (2016, p. 99) in the cross-sectional study, it is difficult to control or identify the significance of potentially important variables, where the current study has detected a weak relationship between mental health outcomes and environmental factors. Discuss the outcomes and the implications for implementation.
Generally, the outcomes of the cross-sectional study define the vulnerability of the populations based on demographical factors such as “biological information, health behaviors, and socio-economic status, and provided supportive evidence of the importance of demographic characteristics on mental health” (Kim & Kim, 2017, p.13) In the randomized control trial, data shows that including CBT with regular physical exercise will aid in breaking the tiresome cycle of the fear of falling (FoF) and actual falls. Therefore, creating better outcomes on the rehabilitation measures for chronically ill patients with stroke (Liu, Ng, & Ng, 2018).  Curley, L. A. & Vitale, A. P. (2016). Population-Based Nursing, Concepts and Competencies for Advanced Practice (2nd ed.). New York; NY, Springer Publishing Company. Kim, J., & Kim, H. (2017). Demographic and environmental factors associated with mental health: A Cross-sectional study. International Journal Of Environmental Research And Public Health, 14(4).  Liu, T. W., Ng, G. Y. F., & Ng, S. S. M. (2018). Effectiveness of a combination of cognitive behavioral therapy and task-oriented balance training in reducing the fear of falling in patients with chronic stroke: study protocol for a randomized controlled trial. Trials, 19(1), 168.  placebo-controlled single-blind parallel-group randomized controlled trial in which patients are assessed immediately, at 3 months, and at 12 months. Data was retrieved in the cross-sectional study through a community health survey in 2013 from 25 communities in Seoul that would examine the correlation between mental health and the factors associated with the community. statistical data provided by the Seoul Metropolitan government Although the outcome may be biased due to limitations of the study design, such as being a cross-sectional study, several longitudinal cohort studies have reported similar results. For instance, James et al. [26] examined the prospective association between residential greenness (Normalized Difference Vegetation Index (NDVI)) and mortality using data from the US-based Nurses’ Health Study prospective cohort.  Although our study only detected a weak relationship between mental health outcomes and environmental factors, increasing accessibility to greenness and decreasing levels of particulate matter on a community basis are beneficial and are important components in improving mental health conditions among urban citizens. Therefore, to improve the mental health of urban citizens, both policy approaches—giving more care to sensitive or vulnerable groups and making the environment better for citizens overall —need to be taken simultaneously because improved environments may bring more opportunities for physical activity, increase social engagement, and improve mental health. pg13 Relatively quick and easy to conduct (no long periods of follow-up). Data on all variables is only collected once. It is indeed heartbreaking that many healthcare workers who were taught to be non-judgmental when providing clinical care to patients are oftentimes not. From the introduction of the human immunodeficiency virus (HIV) era, the virus that can typically lead to the acquired immune deficiency syndrome (AIDS), there has always been a stigma attached to the way how this population is viewed. Once one is infected with HIV, he or she is permanently infected. As cited in the Chamerlain College (2019) reading, Giger & Davidhizar (2002, p. 186) explained the significance of cultural competence when applying care based on cultural values and awareness, and the ability to understand, communicate and interact effectively with people from different cultures, with different medical needs. The AIDS Education and Training Center National Multicultural Center (AETC-NMC) at Howard University College of Medicine provides insightful information on cultural awareness and dealing with the HIV/AIDS population. One of their goals is to strengthen provider’s cultural competence skills and how to manage patient care based on cultural demands without stereotyping (AETC-NMC, n. d.). As patient centered care is a priority in healthcare organizations, it is imperative to implement culturally sensitive approaches when caring for a diverse population. Even though according to Ansuya, 2012) that it may be challenging for some nurses to provide care to a culturally diverse population, educating staff to become culturally competent can facilitate better communication and understanding between patients and health care providers. Becoming knowledgeable about patients' cultural care values builds a foundation for meaningful care. - - - - - - - - - -- - - - - - - - - - - - - - - - - - GDPH. (n. d.). Office of telehealth & telemedicine. Retrieved at In the early 1980’s, dreadful stories began to stack up about “patient dumping,” the practice of refusing treatment due to a patient’s lack of insurance or ability to pay. Some hospital emergency departments and physicians were refusing to treat patients in the throes of an emergency. Some only perfunctorily examined patients before transferring them (in medically unstable conditions) to public hospitals. Congress responded to patient dumping in 1986 by enacting The Emergency Medical Treatment and Active Labor Act (EMTALA). While EMTALA did not address the causative issue of uncompensated care, it did guarantee universal emergency access for all. Through its financing powers under the Medicare Act, Congress required health care providers to assume fiscal responsibility for the emergency care of the indigent and the uninsured. Refusing treatment based on payment status could result in punitive fines, civil liability, or loss of participation in the Medicare and Medicaid programs.
Essentially, the law created a federal right to emergency care for anyone in the United States. Some of these initiatives seek to increase the focus on health in non-health sectors, while others focus on having the health care system address broader social and environmental factors that influence health. There are also emerging efforts to address non-medical, social determinants of health within the context of the health care delivery system. These include multi-payer federal and state initiatives, Medicaid initiatives led by states or by health plans, as well as provider-level activities focused on identifying and addressing the non-medical, social needs of their patients. The Trump Administration is pursuing policies that may limit individuals’ access to assistance programs to address health and other needs and reduce resources to address social determinants of health. T Velveth I found your post intersting as I had lacked the knowledge in the variation of treatments for patients who are tested positive for AIDS/HIV. It is then infact true that the availability health insurance determines the care one receives. Nursing care should be standard across the platform as this is important for the welfare of society as a whole. Though may face with challenges, Artiga & Hinton (2018) explore some of initiatives such as “multi-payer federal and state initiatives, Medicaid initiatives led by states or by health plans, ………” that focus on the health system that addresses the broader social and environmental factors that influence health, they also expressed that it is imperative to address social determinants of health, thus aid in the improvement of health and the reduction of health disparities in the healthcare system for better patients’ outcomes. Artiga, S., & Hinton, E. (2018). Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Retrieved from

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