1-The nursing shortage imapacts the healthcare system and as well as the community. Nurses are the faces of healthcare. they are the managers of care for patients. At the community level we would see it being harder for a patient to recieve care. Without the proper staffing of nurses the community may be forced with longer waiting times to actually be seen. This could also make the cost of care go up for the community. ON the nursing profession side, nurses are constantly faced with being out of ratio. I have never worked at a hospital were ratios were not an issue. It is a very difficult problem and it mainly comes from the nursing shortage. You see more nurses going out of ration which the hospital ends up paying for. You also see nurses who have to pick up extra shifts just to help out the company to ensure that a unit is properly staffed. I do feel like this will always be an issue. Simply because there are so many people in the world and not enough nurses. I see more hospitals starting new graduate programs. This is a great way to help the nursing shortage. When you graduate from nursing school it can be hard to find your first job in an acute care setting. Many places want experience. So they pass up on these new nurses who are ready to work simply because the are not experienced. But a better solution would be to train them , which many facilities have caught on to. Training the nurses and having them sign a contract for 2 years for the cost of training them has help many facilities with their nursing shortage. 

Concern over nursing shortage grows. (2018). ACCN Bold Voices. Volume 10, Issue 8: 17-17

2-What is the impact to the nursing profession and to the public related to the projected nursing shortage? Discuss at least one way that the nursing profession is working toward a resolution of this problem.

The nursing profession shortage affects the community drastically. There are many nurses that with each year retire and facilities end up with a nursing shortage. Just like there are many colleges and schools that have nursing graduates, there will always be a need for nurses. “In the United States, the largest group of nurses is expected to retire by the year 2020, pushing health care facilities’ resources beyond their limits.” (Springer Publishing Company, 2015)Nursing shortages not only affect the nurses by overwhelming the nurses but can affect patients completely. A nurse that has been running around like chicken without a head and tending to more than 20 patients will not be able to perform all her nursing duties to the best of her ability. Patients safety is also at risk as nurses will be tired and might have medication or treatment errors due to the fatigue and tiredness. Also, it is important to remember that for specialty areas such as colonoscopy, endoscopy, ER, OR and neonate care many hospitals require experience, a new nurse unless properly trained for months will not be able to attain that position. Many nurses will also retire in these specialty areas and hospitals should implement a way to have a secure education and on-site training for a specific time to train new nurses for these specialties. “Just over a decade ago, in 2000, the estimated pool of registered nurses in the United States was 1.89 million, while the demand was two million—a deficit of only 110,000, or 6%. Yet the gap continues to widen. In 2008, there were approximately 2.6 million working RNs, but it is predicted that by 2020 the shortage will be approximately 808,400 nurses, or 29%.” (Springer Publishing Company, 2015)The nursing profession should consider all this and create a way in which the hospitals can work with the nurses to provide better training for these specialties. It is also imperative that nurses be appreciated, feel connected to their organization and the organization focuses on not only retaining the nurses but making them happy. “Nurses report higher job satisfaction if they perceive they are part of a team and feel a sense of belonging, though age is another variable in retention and job satisfaction.” (Springer Publishing Company, 2015)

Reference:

Springer Publishing Company. (2015, November 04). The Nursing Shortage: Exploring the Situation and Solutions. Retrieved from https://minoritynurse.com/the-nursing-shortage-exploring-the-situation-and-solutions/

3-By the year 2024, there are projected to be over one million nursing vacancies alone (Weiss et al 2014).

The nurses that are from the baby boomer generation will be exiting the workforce creating a huge amount of vacant positions.  The AACN reports that every year the rate of vacant positions go up 2-3% each. The question then is what do when do to change this trajectory? The answers lie in partnering with schools of nursing  to assist in graduating more competent nurses. There also appears to be a shortage of qualified nursing faculty to teach in the nursing schools. The AACN suggest perhaps the government and private sector subsidizing faculty salaries. One of the thing that many hospital are doing in a effort to minimize the problem, encourage continuing education. Hospital are encouraging nurses to advance their education and they give monetary compensation. In return, the nurse agree to work for a stated time after degree is complete. This serves as a win-win situation for the facility and the nurse.

Impact on nursing shortage, increased wait times, in every health care entity. Primary care, secondary care, tertiary care all will feel the impact. The other is quality of care will be compromised. Less nurses mean short cuts, shorts cuts equal errors. The abilty to deliver great patient care will be compromised. finacial aspect will be felt by all consumers, less supply/ more demand means increased price for healthcare.

Reeference

www.AACNNursing.org

Weiss, D., Tilin, F., Morgan, M (2014) The Interprofessional healthcare Team: Leadership & Development.

Review your state public health department and environmental quality departments online to identify vector-related diseases affecting your community.(NYS}

In a report format of 1,250-1,500 words, address the following:

1. Describe the health concerns of the community.
2. Identify current environmental risk assessment methods which apply to public health issues.
3. Suggest a modifier or new prevention or intervention program based on your research.
4. Create a sample program budget.
5. Complete a SWOT analysis of the proposed program.

APA format is not required, but solid academic writing is expected.

 Reply to Gina 

  Question 1- Gestational Diabetes Mellitus (GDM)

During pregnancy, around the 24th week, many women develop gestational diabetes. But what is gestational diabetes and how this medical condition may impact a pregnant woman? 

In 2014, the U.S. Preventive Services Task Force updated its 2008 statement to recommend that asymptomatic pregnant women be screened for GDM after 24 weeks of gestation. This recommendation applies to pregnant women who have not been previously diagnosed with type 1 or 2 diabetes mellitus (Hartline, 2013). Screening for and detecting GDM provides a potential opportunity to prevent adverse outcomes such as preeclampsia, fetal macrosomia which can cause shoulder dystocia and birth injury, and neonatal hypoglycemia (Hartline, 2013).

 Most clinicians in the United States use a two-step approach, first administering a 50-g non-fasting oral glucose challenge test at 24 to 28 weeks, followed by a 100-g fasting test for women who have a positive screening result. Gestational Diabetes is screened for in pregnancy by drinking a solution containing 50-g of glucose and testing blood glucose level one hour after drinking it. If the screening threshold is met or exceeded 130 mg/dL, 135 mg/dl, or 140 mg/dL blood sugar level, the patient is subjected to another test involving drinking a solution containing a higher amount of glucose (100g). In this case, the blood glucose should be checked first before administering the 100g glucose and then three more times such as 1 hour after drinking the solution, 2 hours after drinking the solution and the last check after three hours after drinking the solution. Cut off values will be: 1 hour 180 mg/dl, 2 hours 155 mg/dl, 3 hours 140 mg/dl, fasting 95mg/dl. Two abnormal values will meet the diagnosis of gestational diabetes (Hartline, 2013).

Alternatively, clinicians may use a one-step approach and administer only a 75-g two-hour fasting oral glucose tolerance test. The one-step approach may be cost-effective in high-risk patients or populations (Hartline, 2013).  A diagnosis of GDM is made when two or more glucose values fall at or above the specified glucose thresholds (Hartline, 2013).

The frequency of screening is based on the presence of risk factors: family history, pre-pregnancy BMI, or need for insulin or OAD medications during pregnancy. Woman with risk factors for type 2 diabetes, such as obesity, family history of type 2 diabetes, or previous fetal macrosomia may be screened earlier than 24 weeks of gestation (Hartline, 2013).

        Describe how this information will impact your care and monitoring of a pregnant woman?

The patient diagnosed with GDM require frequent evaluations and monitoring (Hartline, 2013). After receiving a diagnosis of GDM, patients should begin monitoring their blood glucose, initially with fasting levels and one or two-hour postprandial levels. Fasting glucose levels should be less than or equal to 95 mg per dL, one-hour postprandial levels less than or equal to 140 mg per dL, and two-hour postprandial levels less than or equal to 120 mg per dL. (Hartline, 2013).

As a healthcare provider, it would be my responsibility to encourage the patient to attain moderate gestational weight gain, based on their prepregnancy BMI, and to participate in a physical activity based on their clinician’s recommendations. Attention to maternal weight gain is important in minimizing the risk of fetal macrosomia. Maternal obesity, excess gestational weight gain, and GDM are independent and additive risk factors for macrosomia (Black, 2013).

Treatment of GDM results in a statistically significant decrease in the incidence of preeclampsia, shoulder dystocia, and macrosomia. Initial management includes glucose monitoring and lifestyle modifications. Antenatal testing is customary for women requiring medications. Induction of labor should not occur before 39 weeks in women with GDM unless glycemic control is poor or another indication for delivery is present. In women with an estimated fetal weight greater than 4,500 g a scheduled cesarean delivery should be considered (Black, 2013).

                                                                 Higher Level of Care

All women with GDM should receive nutritional counseling, by a registered dietitian when possible, consistent with the recommendations by the American Diabetes Association, and in some difficult cases, the patient may be referred to an endocrinologist (Black, 2013).

Women with a history of GDM are at high risk of subsequently developing diabetes. These patients should be screened six to 12 weeks postpartum for persistently abnormal glucose metabolism and should undergo screening for diabetes every three years after that (Black, 2013).

                                                                        References

Hartline, L. Dryden, D. Guthrie, A., Muise, M. Vandermeer, B., and Donovan, L. (2013). Benefits and harms of treating gestational diabetes mellitus. Annals of Internal Medicine.

Moyer VA (2014). U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. ;160(6):414–420.

Black MH, Sacks DA, Xiang AH, Lawrence JM. (2013).  The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth. Diabetes Care.36(1):56–62

Reply to Hollie

Pregnancy-related conditions necessitating referral

 Pre-eclampsia and gestational diabetes are two conditions that may need a higher level of obstetrical management. Pre-eclampsia is multi-system disorder that includes hypertension, proteinuria and possibly end-organ dysfunction (August & Sabai, 2019). Although the condition resolves after delivery, during pregnancy it can cause significant problems for both the mother and the baby (August & Sabai, 2019). Among many other things, women can have grand mal seizures as part of the condition (August & Sabai, 2019).

            Gestational diabetes (GDM) can cause hypertensive disorders in pregnancy as well as pre-eclampsia, premature delivery, c-section, macrosomia, large for gestational age infants, neo-natal jaundice, and stillbirth (Sweeting et al., 2015). The prevalence of GDM is increasing due to obesity and advanced maternal age (Sweeting et al., 2015).

Resources

 In my community there are a number of resources at my disposal. First are certified nurse midwife colleagues with home birth experience. The vast knowledge developed by these colleagues has given me the confidence to call on them when a situation with a pregnant mother is questionable. For pre-eclampsia, if a pregnant woman with no previous hypertension presented with a consistent blood pressure over 140/90, it would be a red flag. She would then be checked for protein in her urine which may or may not be present. Other signs and symptoms to look out for are visual disturbances such as flashes of light, incapacitating headaches, altered mental status or severe right upper quadrant pain with no obvious cause (August & Sabai, 2019).

For pregnant women with GDM, she would be referred to a registered dietician in the community. Our local Kaiser clinic has one as well as at least two of our community clinics. The goals of care for a mom with GDM would be to achieve a normal blood sugar level, prevent ketosis from occurring, achieve normal weight gain in pregnancy and to contribute to the well being of the fetus.

References

August,P., & Sabai, B. (2019). Preeclampsia: Clinical features and diagnosis. Retrieved from https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis#H1039781115

Durnwald, C. (2019). Gestational diabetes mellitus: Glycemic control and maternal prognosis. Retrieved from https://www.uptodate.com/contents/gestational-diabetes-mellitus-glycemic-control-and-maternal-prognosis?search=gestational diabetes&source=search_result&selectedTitle=1~88&usage_type=default&display_rank=1

Sweeting, A. N., Ross, G. P., Hyett, J., Molyneaux, L., Constantino, M., Harding, A. J., & Wong, J. (2015). Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment. Diabetes Care, 39(1), 75-81. doi:10.2337/dc15-0433

 Details:

Based on the summary of research findings identified from the Evidence-Based Project—Paper on Diabetes that describes a new diagnostic tool or intervention for the treatment of diabetes in adults or children, complete the following components of this assignment:

Develop a PowerPoint presentation (a title slide, 6-12 slides, and a reference slide; no larger than 2 MB) that includes the following:

1. A brief summary of the research conducted in the Evidence-Based Project – Paper on Diabetes.
2. A descriptive and reflective discussion of how the new tool or intervention may be integrated into practice that is supported by sound research.

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, which can be found in the APA Style Guide, located in the Student Success Center.

You are not required to submit this assignment to LopesWrite, unless otherwise directed by your instructor. If so directed, refer to the Student Success Center for directions. Only Word documents can be submitted to LopesWrite.