Sample Cours work #1
Pro Nursing Angela Batista
Spring 2017 3/8/17
Wit Reflection Paper
The movie Wit is an excellent movie that shines light on a patients perspective of being hospitalized. I believe that the film was designed to evoke sympathy for Vivian the patient, with the use of extreme circumstances, which was a brilliant strategy.
Vivian was a highly-educated woman with no living family willing to endure intense treatment with the slim chance of staying alive. As I suffered with Vivian watching how the staff treated her and the deterioration of her health progressed, I couldn’t help but to come to terms with the fact that the staff’s inhuman behavior is in fact common practice. I have a vivid memory of “the grand rounds” when the doctors were around Vivian’s bed discussing her treatment and its effect on her in medical terms, examining her as if she was a “dummy”. (FYI my tears really came down.)
As a professor with a PHD, Vivian didn’t allow herself to become enraged with the staff. Vivian even identified within herself similar tendencies, in her own pursuit for greater knowledge and understanding. But human life is very valuable, it deserves respect dignity and appreciation. We are human being with complex brains living in a complicated world enduring an array of circumstances, unfortunately Vivian herself, having no partner, no children and no family, only fully understood this on her death bed. Humans on average possess five senses the sense of touch, taste, sight ,smell and hearing, all of them have to be taken into account at all times. Patients should not be viewed as bed numbers or medical records. They should always be viewed as human beings with at very least common sense, and if the common sense is lacking we, as health care providers, must be sensitive to that as well.
I recommend every healthcare professional take the time to view content like this movie Wit periodical during their career. It serves as a helpful reminder that true patient centered care can only be achieved if the patients is treated as a respected team member. Not a crash dummy.
Sample Course Work#2
Nutritional Challenges Among Urban Children: Combating Childhood Obesity
by Angela Batista
Good nutrition is important for children. Children need adequate intake of key nutrients while their brains and bodies are developing. Healthy eating habits begin in these formative years. Unhealthy eating habits leads to childhood obesity.
What dose it mean to be obese? Adults with a BMI of 30% or higher are considered obese. Childhood obesity is a condition in which a child is significantly overweight for his or her age and height. Obesity essentially is too much body fat.
The impact of childhood obesity
Obesity is too common, very serious and extremely costly. Obese children tend to grow up and become obese adults and are at a risk of obesity related health complications that can be detrimental. Combating child hood obesity is essential for the health and well being for the children of today which will become the adults of tomorrow.
According to the CDC an estimated 112,000 excess deaths per year are associated with obesity. There are in fact more then 30 chronic health conditions associated with obesity, Type 2 Diabetes, high cholesterol, hypertension, heart disease and numerous cancers just to name a few.
Overweight and obesity in childhood is associated with $14.1 billion in additional prescription drug, emergency room and outpatient visit healthcare costs annually. An obese 10-year-old child who continues to gain weight throughout adulthood has lifetime medical costs that are $19,000 higher compared to a healthy-weight 10-year-old who maintains a normal weight throughout life.1
Obese children become obese adults, who raise obese children, who become obese adults, it is a vicious cycle that wont end without intervention.
Challenges in tackling childhood obesity
12.7 million children and adolescents are consider obese in the U.S.A.. The prevalence of obesity was 9.8% among 2-5 year old’s compared with 17.5 % of 6-11 year old’s and the highest level of prevalence went to the adolescents at 20.5 % of 12-19 year olds.2 Further more, from 1999 to 2014 national Health and nutrition Examination Survey revealed a steady increase trend in childhood obesity prevalance from 13.9 in 1999-2000 to 17.2 from 2013-2014 and a steady increase in adult obesity from 30.5 in 1999-2000 to 37.7 in 2013-2014. More then one third of adults were obese in the USA from 2011-2014.3
One of the challenges in tackling childhood obesity is access to affordable healthy food. Less nutritious, calorie-dense foods tend to be less expensive. More than 15 million U.S. children live in “food-insecure” households — having limited access to adequate food and nutrition due to cost, proximity and/or other resources.4 Low income individuals are at increased risk for both food insecurity and obesity.5 One study suggest your zip code matter more then your genetic code, experts in the field are saying urban design is making people obese.6 Foods with large shelf life and high profit margin are the most accessible in the low income urban neighborhood.
Food deserts are also prevalent in low income neighborhoods. Limited access to safe places to be physically active can contribute to building habits of a stagnant in active lifestyle, which can contribute to obesity.
Toxic stress occurs when children are exposed to repeated and ongoing traumas, such as physical, sexual or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, repeated exposure to violence in the home or in their neighborhood and/or the accumulated burden and stress of family economic hardship. More than half of U.S. public school students live in poverty, which can contribute to toxic stress as well as to obesity.7
The racial inequalities with regards to obesity is significant. Obesity is a major health problem for Black And Hispanic Americans.
Search of the Literature
Despite culturally sensitive obesity preventive interventions, obesity rates are increasing with in the African American adolescent population. This well documented known fact is supported with surveys conducted by the CDC In 2014 the CDC reported that the obesity rate among African American adolescents (20.2%) was second only to the rates of Hispanics youth (22.4%). Almost 9 percent of Black, 7.6 percent of Latino, 4.4 percent of White and 1.3 percent of Asian children are extremely obese (ages 2 to 19).3
Eliminating health inequalities could reduce medical expenditures by $54 billion to $61 billion per year, and recover $13 billion annually because of work missed due to illness and about $250 billion per year due to premature deaths, according to a study of data from 2003 to 2006.8
Youth ages 10 to 17 who have experienced two or more adverse family experiences have an 80 percent higher chance of obesity than children who do not experience such events, according to an analysis of the 2011–2012 National Survey of Children’s Health (NSCH).9
The prevalence of obesity among African American teens has been attributed to low level of physical activity and unhealthy eating habits. So exactly why are African American adolescent having an increased prevalence of obesity? One descriptive correlation study concluded that adolescents social economic status (SES), gender, and residential status were statistically significant predictors of eating behaviors, physical activity, BMI and body fat. Furthermore the studies revealed that adolescence with a low ses consumed foods higher in fat and calories than did adolescents of higher SES.10
Furthermore, there was a meta synthesis of a parental disconnect between perceived and actual weight status of children. Universally parents were more likely to misperceive their child’s weight and this was especially true for parents who themselves were overweight.11
A cross-sectional sample of 576 parent-child dyads with children aging from 5 to 12 were involved in the study. A comparison of parent’s classification of their child’s weight was compared to the classification of their child’s weight status based on BMI age-gender percentile. The results revealed that all the parents of children with a BMI greater than or equal to the 95th percentile classified their child in categories other than extremely overweight, and 75% of the children with BMI from 85th to less than the 95th percentile were misclassified as about right or underweight. The conclusion of the study revealed that most overweight children’s parents underestimate their children’s weight.12
In order to recognize that overweight children need treatment, parents must first identify their children are overweight or obese, understand their association of health risks, and have the ability to change their child’s weight status (Uzark, Becker, Dielmah, Rocehini, & Katoh, 1998).
Studies also show that motivational interviewing (MI) elicits internal motivation for behavior change while addressing the ambivalence and discrepancies between a person’s a current values and behaviors (e.g., “Heavy is healthy”) and their future goals (e.g., “I don’t want my child to get diabetes.”).13
In recent year numerous efforts have been made to combat the growing global problem of obesity among children. One such intervention stemmed from the American Academy of pediatric saying primary care pediatricians need to take on a central role with trying to prevent childhood obesity.
The Steps to growing up healthy is a primary care based obesity prevention program that utilized a motivational interventions (MI) Frame work and selected behavior strategies to reduce obesogenic behavior in Latino and black children 2-4 years old. Community health workers (CHW) were utilized to bridged the gap between the clinical setting and the home.
MI using patient centered strategies such as open ended questions, positive affirmations and reflective listing was delivered in brief dose during regular well visits which only lasted a total of 20 minuets ,studies called this brief motivational counseling or (BMC). Key behavioral strategies incorporated into the BMC targeted reducing or eliminating sugar sweetened beverages consumption, changing the type or amount of milk consumed, decreasing screen time like tv watching to less then 2 hours a day, and increasing physical activity to at least 60 minuets per day. The CHW reinforced behavior strategies with regular phone calls and home visits.
The utilization of a program like the Step to growing up healthy have proven to be effective with the prevention of children becoming obese. In addition to being a proven primary prevention strategy The Steps to Growing up Healthy lends it self to a growing body of evidence and research needed to combat early childhood obesity before the children become an obese adults. The study was innovative in its focus on very young children, the use of routine clinic visits to address obesity management, and the testing of two different types of contact with CHWs in prevention/reversal of obesity.14
Non-profit organizations like the Boys and Girls Club is an excellent facility that serves underprivileged children for little to no cost. The Boys and Girls organization has an excellent program called Healthy Habits. This program is a publicly funded organization that is helping to combat childhood obesity.
Engaging the entire community in obese prevention strategies is necessary to combat the growing epidemic of child hood obesity. Communities service sectors must collaboratively join the effort to combat child hood obesity. The key stake holder in the fight against childhood obesity would include parents, primary health care providers early education care schools like pre k program directores the WIC program and the parks department just to name a few.
It goes without saying that effective parent participation in childhood obesity would contribute significantly to the reduction of childhood obesity, decrease the likely hood of family turmoil related perhaps the lose of a child due to obesity and reduce the likelihood of toxic stress in the family due to the prevalence of a chronic condition associated with obesity like diabetes and respiratory illness.
As mentioned earlier Primary care provides have been called upon to take on a central role with trying to prevent childhood obesity. It is the duty of all healthcare providers to participate in the improvement of the health within the community in which he/she serves. A reduction of childhood obesity would mean a reduction in chronic complication requiring treatment in the acute care setting ultimately reduce the health insurance cost toward obesity, having the added benefit of contribute to making healthcare a more profitable business for health care providers.
Pre k programs would benefit from a well constructed obesity prevention program which they would be able to integrate and implement into the curriculum. The newly integrated pre k program would benefit from the recognition of being a program which benefit the health and well-being of the public with evidence based proven obesity reduction interventions and ultimately contributing to effectively combating a global epidemic like childhood obesity.
The WIC program has a special interest with regards childhood obesity, There program is designed to help the lower income mother and children and facilitate in the improvement of the health and well being of the public. The lower income mother and child have been identify as the same group of people who suffer the most with obesity. The wic program is a great government funded program which can facilitate in the battle against obesity in light of the fact that the population the wic serves is the same population that is at the highest risk of becoming obese.
Having safe sufficient useful recreational space is directly related to the reduction of a obesogenic environment. The parks department involvement in the creation, maintenance safety of the public recreational space is proven to be a vital component to the reduction of obesity with in then community.
The old cliche “It Takes a Village to Raise a Child” still stands strong and it couldn’t be more true in the fight agents childhood obesity. With the collaboration of parent health care workers schools and agencies like the parks department the epidemic of child hood can cant reach record lows.
Policy change is a powerful tool to effect social change. The passage of one piece of legislation can achieve widespread, lasting results that can surpass individual efforts in communities across the country. Enacting new policies can also help institutionalize these changes so that they become permanent practice1.
A policy I would recommend be adapted nation wide would be for schools to make breakfast a part of the school day. “Breakfast after the bell” is one such program that has proven to work. In 2013 Colorado mandated the policy which required schools with 70 percent or more students eligible for free or reduced-price school lunch in 2015-2016 school year to serve breakfast in the class room, after first or second period, during an early recess, or from carts offering grad-and go- breakfast out side the cafeteria. Reports suggest that schools offering breakfast in the classroom can see their participation increase from 30% to 80%.15
Providing school age children with well balanced nutritional meals in a class room setting is one way to combat obesity. School age children siting in a structured environment supervised by teachers would increase the likely hood that the children would eat the healthier food choices provide by the school and get accustomed to eating food they wold have otherwise never tried to eat at home.
Another policy which would help to eliminate childhood obesity would be to incorporate BMI screenings in schools. Incorporating BMI screening in school would help reinforce the importance of addressing healthy weight outside of the clinical setting, it also lends its hand to early detection with perhaps some intervention like hand outs being sent home from school.
A band on junk food in schools would reduce the likely hood of creating a obesoginc environment for high risk children. A band on junk food with replacements of healthy food choices would increase the likely hood that children would consume unhealthy foods during the school day. Essentially the school day is a significant portion of a child’s life.
Childhood obesity is a growing global problem. Threw researcher evidence base practice and cooperation from the community at lager the epidemic of childhood obesity can be fought and won. Obese children tend to grow up and become obese adults and are at a risk of obesity related health complications that can be detrimental. Combating child hood obesity would mean that the children of today will become the healthy adults of tomorrow.
1News & Media. (n.d.). Retrieved April 07, 2017, from https://corporate.dukehealth.org/content/over-lifetime-childhood-obesity-costs-19000-child
2Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. Jama, 311(8), 806. doi:10.1001/jama.2014.732
3Prevalence of Obesity Among Adults and Youth: United States, 2011–2014. (2015, October 28). Retrieved April 07, 2017, from https://www.cdc.gov/nchs/products/databriefs/db219.htm
4Key Statistics & Graphics. (n.d.). Retrieved April 07, 2017, from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statistics-graphics.aspx
6H. (2012, May 14). Does Zip Code Matter More Than Genetic Code? (HBO: The Weight of the Nation). Retrieved April 07, 2017, from https://www.youtube.com/watch?v=-8jNJsAeSFY
8Obesity and African Americans. In U.S. Department of Health and Human Services Office of Minority Health
9Mathew DB and Radel LF. Adverse family experiences among children in nonparental care, 2011-2012. National Health Statistics Reports, 74. 2014
10Tate, N. H., Dillaway, H. E., Yarandi, H. N., Jones, L. M., & Wilson, F. L. (2015). An Examination of Eating Behaviors, Physical Activity, and Obesity in African American Adolescents: Gender, Socioeconomic Status, and Residential Status Differences. Journal of Pediatric Health Care, 29(3), 243-254. doi:10.1016/j.pedhc.2014.11.005
11Doolen, J., Alpert, P. T., & Miller, S. K. (2009). Parental disconnect between perceived and actual weight status of children: A metasynthesis of the current research. Journal of the American Academy of Nurse Practitioners, 21(3), 160-166. doi:10.1111/j.1745-7599.2008.00382.x
12De, A., Jordan, K. C., Ortiz, K., Moyer-Mileur, L. J., Stoddard, G., Friedrichs, M., . . . Mihalopoulos, N. L. (n.d.). Do parents accurately perceive their child’s weight status? Retrieved April 07, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/19559989
13DiLillo V, West DS: Motivational interviewing for weight loss. Psychiatr Clin North Am 2011, 34(4):861-869.
14Gorin, A. A., Wiley, J., Ohannessian, C. M., Hernandez, D., Grant, A., & Cloutier, M. M. (2014). Steps to Growing Up Healthy: a pediatric primary care based obesity prevention program for young children. BMC Public Health, 14(1). doi:10.1186/1471-2458-14-72
15USDA Program Helps Schools Feed More Students for Free. (n.d.). Retrieved April 07, 2017, from http://www.foodservicedirector.com/ideas-innovation/health-wellness/articles/usda-program-helps-schools-feed-more-students-free