Read the following case study and answer the reflective questions. Please provide rationales for your answers. Make sure to provide a citation for your answers. . 

CASE STUDY: An Older Immigrant Couple: Mr. and Mrs. Arahan Mr. and Mrs. Arahan, an older couple in their seventies, have been living with their oldest daughter, her husband of 15 years, and their two children, ages 12 and 14. They all live in a middle-income neighborhood in a suburb of a metropolitan city. Mr. and Mrs. Arahan are both college educated and worked full-time while they were in their native country. In addition, Mr. Arahan, the only offspring of wealthy parents, inherited a substantial amount of money and real estate. Their daughter came to the United States as a registered nurse and met her husband, a drug company representative. The older couple moved to the United States when their daughter became a U.S. citizen and petitioned them as immigrants. Since the couple was facing retirement, they welcomed the opportunity to come to the United States. The Arahans found life in the United States different from that in their home country, but their adjustment was not as difficult because both were healthy and spoke English fluently. Most of their time was spent taking care of their two grandchildren and the house. As the grandchildren grew older, the older couple found that they had more spare time. The daughter and her husband advanced in their careers and spent a great deal more time at their jobs. There were few family dinners during the week. On weekends, the daughter, her husband, and their children socialized with their own friends. The couple began to feel isolated and longed for a more active life. Mr. and Mrs. Arahan began to think that perhaps they should return to the home country, where they still had relatives and friends. However, political and economic issues would have made it difficult for them to live there. Besides, they had become accustomed to the way of life in the United States with all the modern conveniences and abundance of goods that were difficult to obtain in their country. However, they also became concerned that they might not be able to tolerate the winter months and that minor health problems might worsen as they aged. They wondered who would take care of them if they became very frail and where they would live, knowing that their daughter had only saved money for their grandchildren’s college education. They expressed their sentiments to their daughter, who became very concerned about how her parents were feeling. This older couple had been attending church on a regular basis, but had never been active in other church-related activities. The church bulletin announced the establishment of parish nursing with two retired registered nurses as volunteers. The couple attended the first opening of the parish clinic. Here, they met one of the registered nurses, who had a short discussion with them about the services offered. The registered nurse had spent a great deal of her working years as a community health  nurse. She informed Mr. and Mrs. Arahan of her availability to help them resolve any health-related issues.

 Reflective Questions 1. What strategies could be suggested for this older adult couple to enhance their quality of life? 2. What community resources can they utilize? 3. What can the daughter and her family do to address the feelings of isolation of the older couple? 4. What health promotion activities can ensure a healthy lifestyle for them? 

 

Epidemiologic Principles and Measures Used to Address the Practice Problem

     Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death on a global scale and in the United States (U.S.) (National Heart, Lung, and Blood Institute, 2021; Alwashmi et al., 2020; Bhansali et al., 2020; Ammary-Risch et al., 2019).  Between 2016 – 2017, the global prevalence of COPD was approximately 300 million (Ferguson et al., 2020; World Health Organization, 2017).  Identified as the fourth leading cause of death in the U.S., COPD claims the lives of 150,000 people every year (National Heart, Lung, and Blood Institute, 2021; Ammary-Risch et al., 2019).  Additionally, women are now found to be equally or more afflicted than their male counterparts and also make up almost 60% of COPD cases (National Heart, Lung, and Blood Institute, 2021; Centers for Disease Control and Prevention, 2018d; World Health Organization, 2017).  A significant risk factor often associated with COPD is smoking.  Cigarette smoking has been noted as the greatest factor in the development of COPD (Duan et al., 2020).  Air pollution has been noted as the second biggest contributor to COPD development (Duan et al., 2020). 

Use of Descriptive and/or Analytic Epidemiology to Address the Practice Problem

     The research consensus reveals that millions of people suffer from COPD in the U.S. and that number is expected to rise as many more suspected COPD sufferers remain undiagnosed, as well as those with continued exposure to toxins, an aging population, and others with long-term respiratory ailments (Ferguson et al., 2020; Ammary-Risch et al., 2019; Centers for Disease Control and Prevention, 2018d; World Health Organization, 2017). Age-adjusted death rates in women living in the U.S. have not changed greatly between 1999 and 2014 and are 35.6/100,000 from 35.3/100,000 (Center for Disease Control and Prevention, 2018b). Whereas the age-adjusted death rates in men living in the U.S. have decreased between 1999 and 2014, and are estimated at 44.3/100,000 from 57.0/100,000 (Center for Disease Control and Prevention, 2018b).

     Florida was ranked 33rd in the nation for the number of deaths caused by COPD in 2017 (National Center for Health Statistics, 2018).  Florida Department of Health’s Bureau of Tobacco Free Florida (TFF) program has made considerable improvements in reducing tobacco use rates from 21% in 2006 to 14.8% in 2019 (About Us | Tobacco Free Florida, 2020). As a result, there have been almost $18 billion saved in health care costs related to smoking during the years 2007 to 2015 (About Us | Tobacco Free Florida, 2020).  It is unfortunate to report that it has been estimated that with the current smoking rate, the children in Florida who are less than 18 years of age will die prematurely due to tobacco use (About Us | Tobacco Free Florida, 2020). To that end, in children between ages 11 and 17, there has been a reduction in cigarette smoking from 10.6% in 2006 to 2.2% in 2018; an estimated reduction greater than 75% since 2007 (About Us | Tobacco Free Florida, 2020). 

     The prevalence of global warming affects the COPD patient population. Damage to the human systems and body organs can be caused by exposure to pollution in ambient air (Duan et al., 2020). Respiratory tracts are particularly vulnerable to air pollution as exposure to external surroundings is direct (Duan et al., 2020). The complex mix of gases, vapors, and particles from synthetic and natural sources creates air pollution (Duan et al., 2020). Particulate matters (PM) form industrial emissions and aerosols in the atmosphere that when inhaled, can accumulate in the upper and lower respiratory tracts, therefore, affecting persons with COPD (Duan et al., 2020). Primary non-infectious elements include air pollution contributing to the increased COPD-related rate in mortality (Duan et al., 2020). 

     A comprehensive understanding of local barriers and challenges allows providers to understand and identify ways to prevent, diagnose, treat, and manage COPD (Ammary-Risch et al., 2019).  Some research has focused on the care of rural residents with chronic obstructive pulmonary disease (COPD).  The research discussed the difficulty in accessing care due to the unavailability of services, financial expenses, cultural perceptions, and distance of travel to seek specialty services (Croft et al., 2018).  The reported plans aimed to remove barriers and/or improve access to treatments such as oxygen therapy, pulmonary rehabilitation, and effective comprehensive self-care programs (Croft et al., 2018).

Recommend additional measures required to integrate proposed changes into practice

     Upon examination and review of several research articles, various interventions and prevention recommendations were revealed to manage and treat COPD.  Shared recommendations consisted of education regarding the prevention of exacerbations, prioritizing COPD management efforts to slow declining lung function, and increasing access to the appropriate treatments (National Heart, Lung, and Blood Institute, 2021; Ammary-Risch et al., 2019; Jang et al., 2019; Etminan et al., 2018; World Health Organization, 2017).  Current research assents that specific recommendations and policies to reduce exacerbation events and mortality are important and the use of predictive tests, statistical methodologies that aim to reveal the association between the severe COPD exacerbation occurrences and risk of subsequent severe COPD exacerbations; the use of various technological applications, and the use of pharmacological treatments will provide improvement of COPD exacerbation awareness, implementation of adept and integrated programs/policies, data collection and objective analysis necessary for a positive impact (National Heart, Lung, and Blood Institute, 2021; Alwashmi et al., 2020; Bhansali et al., 2020; Jang et al., 2019; Etminan et al., 2018; Centers for Disease Control and Prevention, 2018e; World Health Organization, 2017).

     Community partners and health care providers can promote collaboration and participation in positive interventions by encouraging the use of The COPD National Action Plan (Croft et al., 2018). The focus of this plan is on research to improve accessibility in limited geographical areas. Another focus is the development of clinical decision tools for providers who serve residents who live in rural areas (Croft et al., 2018).  Additionally, online community accessibility is also a focus of research as access to the internet in some areas is difficult (Croft et al., 2018).  The COPD National Action plan is attempting to overcome those barriers (Croft et al., 2018).  Plans aimed to remove barriers and/or improve access to treatments such as oxygen therapy, pulmonary rehabilitation, and effective comprehensive self-care programs (Croft et al., 2018).  Coordinated and collaborative efforts promoted by federal agencies are seeking to educate health care providers, patients, and the public about the importance of the prevention, treatment, and diagnosis of COPD (Croft et al., 2018). 

Share your professional experience related to the topic

     In my professional experience over the years, I have had many experiences in caring for patients with COPD.  Aside from patients experiencing typical COPD exacerbations, many patients also experience anxiety related to dyspnea, access to treatments, and managing oxygen therapy.  Depression is also an issue I have seen in patients who experience years of COPD burdens and negatively affects their quality of life.  These patients can become terse and seek to control what they can.  I have cared for patients who have passed from end-stage COPD and supported their families through the process.  It is an insidious disease that has become too common.  Based on the symptoms, the goals are to recommend strategies necessary to manage and monitor treatments to improve long-term outcomes (Bhansali et al., 2020). Many factors involve providing quality care and outcomes are affected by various aspects.  As COPD continues to play a significant role in the healthcare industry, accessible and integrative strategies must remain a top concern for the best outcome.      

-Isabel 

References

About Us | Tobacco Free Florida. (2020). About Us. https://tobaccofreeflorida.com/about-us/

Ammary-Risch, N., Atkins, G., Cramb, S., Croft, J., Davis, L., Dolor, R., Doyle, D., Elehwany, M., James, C., Johnson, L., Kiley, J., Knudson, A., Linnell, J., Mannino, D., Moore, P., Punturieri, P., Rommes, J., Sood, A., Stockton, E., . . . Yawn, B. (2019). COPD and Rural Health: A dialogue on the national action plan. The Journal of Rural Health, 35(4), 424-428. https://doi.org/10.1111/jrh.12346

Bhansali, A., Lee-Chiong, T., Peyerl, F., Riley, D., & Trout, D. (2020). A quality improvement initiative for COPD patients: A cost analysis. Public Library of Science, 15(7), 1-14. https://doi.org/10.1371/journal.pone.0235040

Center for Disease Control and Prevention. (2018b). COPD death rates in the United States. https://www.cdc.gov/copd/data.html

Croft, J., Cunningham, T., Holt, J., Liu, Y., Lu, H., Matthews, K., Wang, Y., Wheaton, A., & Lu, H. (2018, February 23). The Centers for Disease Control and Prevention. Morbidity and mortality weekly report: Urban-rural county and state differences in chronic obstructive pulmonary disease – United States, from 2015., 67(7), 205-211. http://dx.doi.org/10.15585/mmwr.mm6707a1

Duan, R.-R., Hao, K., & Yang, T. (2020). Air Pollution and Chronic Obstructive Pulmonary Disease. Chronic Diseases and Translational Medicine, 1-10. https://doi.org/10.1016/j.cdtm.2020.05.004

Ferguson, G., Han, M., Rodríguez-Roisin, R., Román-Rodríguez, M., Singh, D., & Vogelmeier, C. (2020). Goals of COPD treatment: Focus on symptoms and exacerbations. Respiratory Medicine, (166). https://doi.org/10.1016/j.rmed.2020.105938  

National Center for Health Statistics. (2018, April 13). Stats of the State of Florida. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/pressroom/states/florida/florida.htm

I NEED A COMMENT FOR THIS DISCUSSION BOARD WITH AT LEAST 2 PARAGRAPHS AND 3 SOURCES NO LATER THAN 5 YEARS.

Module 2 – SLP

INPATIENT, OUTPATIENT, AND ANCILLARY SERVICES

Cultural competency is extremely important in health care, as the consumers we serve come from diverse backgrounds. Inpatient and outpatient services account for the largest sector of health care services; however, cultural competency extends to all health care sectors. It is vital that as a health care professional, we are culturally competent to provide our consumers with high-quality health care.

Test your cultural competency on all three of the test below:

Health Inclusion. (2020). Cultural competence quiz. Retrieved from https://healthinclusion.com/cultural-competence-quiz/

SUNY Downstate Health Sciences University. (2020). Cultural competency in nursing homes: Test your knowledge on cultural competence. Retrieved from https://www.downstate.edu/cultural-competency/test.html

The London School of International Communication. (2020). Part 1 – Cultural knowledge. Retrieved from https://www.londonschool.com/lsic/resources/intercultural-quiz/

Based on your results and research, answer the following questions in a 2- to 3-page paper:

1. On a scale of 1 to 5, with 1 being needs improvement and 5 being exceeds expectations, rate yourself on the answers to each test, you should have three (3) ratings in total. (Note: Your personal rating does not affect your grade).
2. Describe how you would improve upon your rating.
3. Explain the importance of cultural competency in the U.S. health care system.
4. Rationalize in detail why health care leaders play a vital role in embracing and implementing cultural competency.

In your scholarly paper, you should include an introduction and conclusion paragraph. 

SLP Assignment Expectations

1. Conduct additional research to gather sufficient information to justify/support your responses.
2. Limit your response to a maximum of 3 pages.
3. Support your report with peer-reviewed articles, with at least 3 references. Use the following link for additional information on how to recognize peer-reviewed journals. Angelo State University Library (n.d.) Library guide: How to recognize peer reviewed (refereed journals). Retrieved from: https://www.angelo.edu/services/library/handouts/peerrev.php
4. You may use the following source to assist in formatting your assignment. Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from: https://owl.english.purdue.edu/owl/resource/560/01/.
5. For additional information on reliability of sources review the following source. Georgetown University Library (n.d.) Evaluating internet resources. Retrieved from https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content

To assess own leadership skills.

Content Requirements: 

1. Analysis of leadership’s skills using Foundation of Nursing Leadership – What is your leadership style (Links to an external site.).
2. Identification of strengths and opportunities for improvement based on self-assessment.
3. Action plan to address self-assessment capitalizing on strengths and addressing opportunities for improvement.

Submission Instructions:

• The paper is to be clear and concise, and students will lose points for improper grammar, punctuation and misspelling.
• The paper is to be 2 – 3 pages in length, excluding the title, abstract and references page.
• Incorporate a minimum of 2 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.
• Journal articles and books should be referenced according to current APA style (the library has a copy of the APA Manual).
• Your paper should be formatted per current APA and references should be current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions)