Discussion Board Entries from BSN Program
1.
This was an informative video on healthy habits that people need to develop. The healthy habit that I am going to focus on is more physical activity. One of things that this lecture focused on urban sprawl which are populations that have low populations, very residential and commonly car dependent. This is important to know because in areas where urban sprawl is prevalent, physical activity is decreased because of the dependence of cars. Cities also make it hard for people to regularly walk which is blatantly shown in the “National Never Walk” Campaign that was shown in the lecture. Some of the strategies in that campaign involve: “don’t build sidewalks”, “let sidewalks disintegrate” and “place mortal dangers where sidewalks go”. All of these are anti physical activity, or in this case walking which is the simplest form of physical activity that one can do. Non-walkable environments leads to sedentary lifestyles, which lead to people becoming overweight, which can cause adverse outcomes. These outcomes include increased mortality, heart disease, cancers, depression, osteoporosis, poor cholesterol and hypertension. There was a health research study that hypothesized that urban sprawl can lead to poor health outcomes. The independent variables were sprawl index in counties and metro areas. The dependent variables were physical activity, weight and health. The outcome of this study rendered mixed results. Less sprawl lead to increased walking, but not on other physical activity outcomes such as leisure time. Weight was mixed results. Only blood pressure was impacted by this study as diabetes and coronary heart disease were not impacted.
Other factors that affect physical activity included time spent biking which lead to more green space and recreational space. Living near footpaths also increased recreational walking. These two particular examples have to be used by planners when developing urban areas. Increased bike usage, recreational walking are activities that can be done to increase health of the populations. Walking was also more prevalent in higher density areas and taking mass transit equated to 30 minutes of walking time a day. This is particularly relevant in the NYC area as it is highly dense and the best way to get around is by the MTA. This is one of the positive areas where my clinical setting, First Steps, has set in place. It is in a very dense population and a lot of the kids, with parents, walk to school if they live close enough. Others take MTA, which has shown to be beneficial and others will drive. The neighborhood does suffer from some of the “National Never Walk” campaign like disintegrating sidewalks and obstructed sidewalks for example. These have to be fixed to provide safe walkways for the children to get to school.
Â2.
The program that I chose was the “Bright Bodies Weight Management Program”. It is a family based, intensive, lifestyle change for inner city youths that range ethnically and are obese. Lifestyle change is key here because if it was labeled a diet then that would mean that an end is in sight. With a lifestyle change that means that this is going to become part of who they are. There are three parts in this program, behavior modification, and exercise and nutrition education. Behavior Modification is done by using the “Smart Moves Workbook”, self-awareness training, cognitive behavior skills, coping and goal setting as tools. The caregiver of the participant also is involved and it is done once a week for 40 minutes for the first 6 months and then once every 2 weeks for the next 6 months. Exercise is done by exercise physiologists and they focus on high intensity aerobics, while the participants wear a heart monitor. This is done for 2 sessions a week for 50 minutes a session for the first 6 months followed by the same 2 50 minute sessions every 2 weeks. Nutrition education is taught by a registered dietician who also uses the “Smart Moves Workbook” and focuses on portion control. This is also done once a week for 40 minute sessions for the first 6 months followed by doing 40 minute sessions every 2 weeks for 6 months. The targeted population was ethnically diverse group of children from low socioeconomic neighborhoods. Differences between ethnic groups and sexes weren’t accounted for. Impediments for success of this program were that there was a high rate of children who dropped out, no measurements of specific changes made and the kids selected actively wanted to lose weight. The outcomes of those that remained were: minimal weight gain over a year while getting taller thus reducing BMI, 4% reduction in body fat, reductions in cholesterol and insulin sensitivity, a statistically significant decrease in glucose levels and kids went from prediabetic to normal. While not a perfect program, positive outcomes were attained.
3.
“Wit”
This movie was a very extreme form of what some medical professionals act like in hospitals. Emma Thompson portrayed a dying cancer patient role very well and her self-monologues about how she was feeling or what she wanted really added to the movie. As a viewer you were really able to get into her head about what her needs were. At the very beginning of the movie you can tell how smart Vivian Bearing is because of the back and forth banter she has with her doctor, Harvey Kelekian. She takes the news of insidious cancer relatively well and goes along with the experimental treatment seemingly right away. Throughout the movie you progressively see the toll that the cancer and treatment has on her. This is all compounded by the treatment she got from the majority of her health care team.
On her health care team was Dr. Harvey Kelekian, Dr. Jason, Nurse Susie and the radiology technician. The biggest issue with this health care team was that there was a huge lack of empathy and compassion from everyone except for Nurse Susie. I’m not entirely sure if this was done on purpose but Nurse Susie was the only one on the team who treated Vivian with any sort of dignity or even like a person. This could be because this is the nursing field in its finest, treating your and advocating for your patients to the best of your ability. From the very beginning Dr. Jason shows a lack of any feeling toward Vivian. It began when he started the pelvic exam and realized he needed a woman in the room, he left her in the stirrups to get Nurse Susie and when she arrived, she scolded him for leaving her up and exposed like that. This showed that Jason left her with no dignity, open like that. This was also the first incidence of advocacy shown by the nurse. Every time Vivian saw the radiology tech, he kept it very impersonal and was generally very cold with her. When Dr. Kelekian came in the room with the med students to discuss her disease and side effects and such, they ripped the sheet off of her and started touching her without even saying what they were doing. This wrong on multiple levels and although Kelekian wasn’t as cold as Jason, he still didn’t fully advocate for Vivian. The type of conversation about her side effects while she was sitting right there is another problem that the med students and Kelekian had. Throughout the movie, no doctor used lay terms with her and she had to fend for herself when it came to all these new medical terms she was hearing for the first time. At one point she was curled up in an immense amount of pain and the nurse wanted asked the doctor for a low dose but they kept insisting for the full dose. This showed that they just wanted to treat the disease with disregard to how the patient actually felt. Dr. Jason said “bedside manner is a colossal waste of time” right in front of her and this type of behavior is just horrible for a patients psyche. This cemented in her for the rest of the movie. At one point Jason went on and on about how cancer is amazing and how he wants to cure it, Vivian realized that he has no humanity. She also realized that she craves humanity and that she lacked it when she was teaching. The flashback that she thought of was that a student said that their grandmother died and she didn’t allow an extension on the paper.
Throughout her time in the hospital, the one constant was Nurse Susie. Susie advocated for Vivan at almost every juncture she could. I mentioned a couple of examples already but some more important ones were when Vivian was in pain and Susie wanted her to get a PCA as opposed to a morphine drip. I understood this as trying to keep Vivian’s independence. Susie pulled up a chair and shared a Popsicle with Vivian while also bringing up the option of the DNR…which Dr. Jason ended up ignoring at first. The little things like lotioning Vivian’s hands was another thing that nurses do to patients that they’ve been taking care of. I’ve done this for patients of mine as well.
Personally I’ve never had to deal with a health care team like this or at all but I have been part of one but to a much smaller extent. It was only for a student of mine when deciding what treatments he would need in the school. I spent the most amount of time with this student so I knew what would benefit him the most whereas the therapists would advocate for the convenience for themselves
