Section D: Change Model

Roger’s Diffusion of Innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students may also choose to use change models, such as Duck’s Change Curve Model or the Transtheoretical Model of Behavioral Change. Other conceptual models presented such as a utilization model (Stetler’s model) and EBP models (the Iowa Model and ARCC Model) can also be used as a framework for applying your evidence-based intervention in a health care setting.

In 500-750 words (not including the title page and reference page), apply a change model to the implementation plan.

1. Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.
2. In addition, create a conceptual model of the project. The conceptual model should be placed in the appendices for the final paper.

Paper topic is Healthcare burnout and it’s affect on patient care and preventing/alleviating burnout.  See attached introduction to paper and literature support. Please build off of those.

The occurrence of cancer around the world is receiving increased attention by the medical establishment and the community. Numerous charities, universities, and non-profit organizations expend vast amounts of money and research to eliminate this disease in all of its forms. Unfortunately, not all types of cancer receive the same amount of attention in the media spotlight.  Whether it is due to embarrassment, ignorance, or fear, conversations about cancers involving the sexual reproduction systems are not as freely discussed in the United States or any other societies. 

While penile cancer is rare in the United States, it accounts for approximately 10% of cancers in African and South American men (Huether, McCance, Brashers, and Rote, 2017). A lack of social understanding, as well as the fear and ignorance that accompany diseases associated with sexual subjects, make delays a compounding problem. A specific diagnosis of penile cancer generally comes after a patient has noted a tumor or lesion. Further diagnosis, if it is not delayed, is done through an examination of the size, location, and fixation of the lesion. A biopsy is then performed along with imaging to determine if any metastasis has occurred in the surrounding lymph nodes. Treatment of this condition is usually completed with surgery although multimodal chemotherapy options are also being studied.  

Vaginal or cervical cancer is often discovered by females who experience vaginal bleeding or discomfort. These symptoms, again if not delayed, likely are followed by a physical including a bimanual pelvic examination and a Pap test. Additional testing for suspected cancerous growth includes an HPV test, colposcopy, and biopsy test to look for abnormal cellular growth or signs of cancer. Lastly, imaging, including MRI scans, computerized tomography, and positron emission tomography may be employed to identify and plan for the treatment of abnormal cellular growths. Treatment for cancer in the female reproductive organs is similar to that of men as surgery and chemotherapy, including radiation is often employed. 

Another similarity among men and women developing penile or cervical/vulvar cancer is the acquisition of the Human Papilloma Virus (HPV). Douglawi and Masterson (2019) note that nearly 40% of cases in France have been linked to this virus, which is most often acquired through unprotected sexual contact. Abramowitz et al. (2018) indicate an incidence of 7.5 per 100,000 women in the United States. Recent campaigns to vaccinate young adults, teens, and those in early adulthood has shown positive results in preventing transmission of this disease Joura, et al. (2019) agree that proper vaccination combined with screening can reduce recurrent or subsequent HPV disease transmission. 

A difference in the ability to recognize the presence of cancer includes visibility to the patient. Male sexual organs present an additional chance to catch the presence of a lesion by existing outside the body. Men that use good hygiene and self-examination practices are more likely to note a sore or lump on the penis than a female who must contend with pelvic pain or vaginal bleeding as a warning sign. 

Many of the same behavioral factors that cause cancer in other areas of the body are believed to be linked to the development of cancer within the reproductive organs. Factors such as smoking, poor personal hygiene, and HPV infection from unprotected sexual contact are associated with higher instances of penile or cervical/vulvar cancer (Emilio, Luigi, Riccardo, and Carlo, 2019). Additional factors such as diet and physical activity levels, remain a modifiable risk that can be adjusted with the appropriate education and effort. 

 Continued education of low-risk areas, as well as increased education of high-risk areas in Africa and South America, is the best way to reduce these debilitating illnesses. Information about the risk factors and best practices for maintaining a healthy lifestyle allow uneducated populations to realize access to treatment. The most effective avenue of treatment will include vaccines for males and females, to prevent acquiring HPV and information that stresses a healthier lifestyle, including physical activity and a low-fat diet.

References

Abramowitz, L., Lacau Saint Guily, J., Moyal-Barracco, M., Bergeron, C., Borne, H., Dahlab, A., Bresse, X., Uhart, M., Cancalon, C., Catella, L., and Bénard, S. (2018). Epidemiological and economic burden of potentially HPV-related cancers in France. Plos One, 13(9), e0202564. doi:10.1371/journal.pone.0202564

Emilio, S., Luigi, V., Riccardo, B., & Carlo, G. (2019). Lifestyle in urology: Cancer. Urologia, 86(3), 105–114. doi:10.1177/0391560319846012

Douglawi, A., & Masterson, T. A. (2019). Penile cancer epidemiology and risk factors: a contemporary review. Current Opinion In Urology, 29(2), 145–149. doi:10.1097/MOU.0000000000000581

Joura, E., Kyrgiou, M., Bosch, F., Kesic, V., Niemenen, P., Redman, C. W., & Gultekin, M. (2019). Human papillomavirus vaccination: The ESGO–EFC position paper of the European society of Gynaecologic Oncology and the European Federation for colposcopy. European Journal of Cancer, 116, 21–26. doi:10.1016/j.ejca.2019.04.032

• Type of paperTerm Paper
• SubjectMedicine and Health
• Number of pages6
• Format of citationAPA
• Number of cited resources4
• Type of serviceWriting

By completing this 7-10 page paper, students will analyze the connection of social determinants of health for a vulnerable population across the lifespan and propose an opportunity for advancing health equity and general health and wellness. Students should • Select and describe a vulnerable population front the list below: o LGBTQ • Explain the social determinants of health most commonly experience by the selected population and the impact to health across the lifespan. • Identify and discuss the social and public issues contributing to the diminished overall health of the population. • Propose a possible strategy for increasing health equity/equality for increase health and wellness outcomes of the population.

If you talk about a possible poor health outcome, do you believe that outcome will occur? Do you believe eye contact and personal contact should be avoided?

You would have a difficult time practicing as a nurse if you believed these to be true. But they are very real beliefs in some cultures. 

Differences in cultural beliefs, subcultures, religion, ethnic customs, dietary customs, language, and a host of other factors contribute to the complex environment that surrounds global healthcare issues. Failure to understand and account for these differences can create a gulf between practitioners and the public they serve.

In this Assignment, you will examine a global health issue and consider the approach to this issue by the United States and by one other country.

To Prepare:

• Review the World Health Organization’s (WHO) global health agenda and select one global health issue to focus on for this Assignment.
• Select at least one additional country to compare to the U.S. for this Assignment.
• Reflect on how the global health issue you selected is approached in the U.S. and in the additional country you selected.
• Review and download the Global Health Comparison Matrix provided in the Resources.

The Assignment: (1- to 2-page Global Health Comparison Matrix; 1-page Plan for Social Change)

Part 1: Global Health Comparison Matrix

Focusing on the country you selected and the U.S., complete the Global Health Comparison Matrix. Be sure to address the following:

• Consider the U.S. national/federal health policies that have been adapted for the global health issue you selected from the WHO global health agenda. Compare these policies to the additional country you selected for study.
• Explain the strengths and weaknesses of each policy.
• Explain how the social determinants of health may impact the global health issue you selected. Be specific and provide examples.
• Using the WHO’s Organization’s global health agenda as well as the results of your own research, analyze how each country’s government addresses cost, quality, and access to the global health issue selected. 
• Explain how the health policy you selected might impact the health of the global population. Be specific and provide examples.
• Explain how the health policy you selected might impact the role of the nurse in each country.
• Explain how global health issues impact local healthcare organizations and policies in both countries. Be specific and provide examples.

Part 2: A Plan for Social Change

Reflect on the global health policy comparison and analysis you conducted in Part 1 of the Assignment and the impact that global health issues may have on the world, the U.S., your community, as well as your practice as a nurse leader. 

In a 1-page response, create a plan for social change that incorporates a global perspective or lens into your local practice and role as a nurse leader. 

• Explain how you would advocate for the incorporation of a global perspective or lens into your local practice and role as a nurse leader. 
• Explain how the incorporation of a global perspective or lens might impact your local practice and role as a nurse leader. 
• Explain how the incorporation of a global perspective or lens into your local practice as a nurse leader represents and contributes to social change. Be specific and provide examples.

Gastro instestinal  Case Study

Chief complaint: “I have recurrent H. Pylori infection”. 

HPI: M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. 

PMH: 

H. Pylori infection gastritis

Diabetes Mellitus, type 2

Surgeries: None

Allergies: NKDA

Vaccination History: Up-to-date

Social history:

High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. 

ROS:

Constitutional: Negative for fever. Negative for chills. 

Respiratory: No Shortness of breath. No Orthopnea. 

Cardiovascular: No edema. No palpitations. 

Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal

Assessment:

Primary Diagnosis: Recurrent H. Pylori infection gastritis

Secondary Diagnoses: Dyspepsia

Differential Diagnosis: Peptic Ulcer Disease

Previous medication plan: two months ago and failed.

1. Clarithromycin      500 mg po BID for 2 weeks
2. Omeprazole      40 mg po BID for 2 weeks and then po daily.
3. Cipro      500 mg po BID for 2 weeks

Plan: Tests

Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results. 

Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test. 

Labs: No new labs are needed.  

Referrals: may refer based on effect of medication therapy given for 2 weeks.

Follow up: return to office in 8 weeks to reevaluate symptoms.

As a future nurse practitioner, it is important that you determine the medications used for recurrent H. Pylori infection. 

Please discuss new therapy guidelines for H. Pylori treatment, and provide patient education.

Below is the website for the American Academy of Gastroenterology Clinical Guidelines (ACG) for the updated H. Pylori therapy. Feel free to consult other peer-reviewed articles within 5 years of publication.

http://gi.org/wp-content/uploads/2017/02/ACGManagementofHpyloriGuideline2017.pdf

           0              0