here is often the requirement to evaluate descriptive statistics for data within the organization or for health care information. Every year the National Cancer Institute collects and publishes data based on patient demographics. Understanding differences between the groups based upon the collected data often informs health care professionals towards research, treatment options, or patient education. Using the data on the “National Cancer Institute Data” Excel spreadsheet, calculate the descriptive statistics indicated below for each of the Race/Ethnicity groups. Refer to your textbook and the Topic Materials, as needed, for assistance in with creating Excel formulas. Provide the following descriptive statistics: Measures of Central Tendency: Mean, Median, and Mode Measures of Variation: Variance, Standard Deviation, and Range (a formula is not needed for Range). Once the data is calculated, provide a 150-250 word analysis of the descriptive statistics on the spreadsheet. This should include differences and health outcomes between groups. APA style is not required, but solid academic writing is expected. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are not required to submit this assignment to LopesWrite.

Sheet1

American Indian / Alaska Native (includes Hispanic)Asian / Pacific Islander (includes Hispanic)Black (includes Hispanic)Hispanic (any race)White (includes Hispanic)National Cancer Institute (2018) Lung and bronchus cancer. Retrieved from Janary 8, 2019 from https://seer.cancer.gov/explorer/application.php?site=47&data_type=1&graph_type=2&compareBy=race&chk_sex_1=1&chk_race_5=5&chk_race_4=4&chk_race_3=3&chk_race_6=6&chk_race_2=2&chk_age_range_1=1&chk_data_type_1=1&advopt_precision=1&advopt_display=1&showDataFor=sex_1_and_age_range_1_and_data_type_1
Year of DiagnosisRate per 100,000Rate per 100,000Rate per 100,000Rate per 100,000Rate per 100,000
200045.741.877.834.268.8
200147.9417934.168.7
200244.640.475.834.168
20035040.977.334.567.1
200451.740.575.13565.8
200548.740.273.733.865.9
200646.439.873.43265.8
200743.138.871.232.765.2
20084538.570.832.263.9
200940.13971.631.863.1
201042.43767.830.360.4
201139.636.664.129.458.5
201236.636.764.328.257.5
201339.936.660.528.856.3
2014323461.326.855.4
201538.734.457.42653.2
 
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Transcultural Perspectives in the Nursing Care Of Older Adult

Chapter 8: Transcultural Perspectives in the Nursing Care of Older Adults

Copyright © 2016 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2016 Wolters Kluwer • All Rights Reserved

1

Transcultural Perspectives in the Nursing Care of Older Adults #1

Longer life spans and the aging Baby Boomer generation will lead to a large population of older adults aged 65 years old and older who will seek health services.

Delivering culturally appropriate care to clients is set by how available and affordable national, state, and local health care resources are for older adults.

Copyright © 2016 Wolters Kluwer • All Rights Reserved

2

There are three areas of influences for older adults that guide their help-seeking behaviors:

Societal and economic factors; affordability and accessibility

Cultural values, practices, patterns of caregiving, and available community resources

Family, individual lifestyles, health, and coping behaviors

Transcultural Perspectives in the Nursing Care of Older Adults #2

Copyright © 2016 Wolters Kluwer • All Rights Reserved

3

The Older Adult in Contemporary Society: Factors Affecting Health Care

Societal level

Demographics: ethnicity and income level, low literacy

Socioeconomic status: fixed income, increased health-related expenses, delayed retirement

Theories of Aging: explain patterns of behavior

Copyright © 2016 Wolters Kluwer • All Rights Reserved

4

Question #1

Is the following statement true or false?

The health status of non-Hispanic Whites is typically better than other minority ethnicities.

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5

Answer to Question #1

True

Rationale: At all ages, the health status of Hispanics, Asian Americans, African Americans, Native Americans/Alaska Natives, and Native Hawaiians/Other Pacific Islanders has long lagged behind that of non-Hispanic Whites.

Also, approximately 40% of Hispanics and African Americans have no private savings for their retirement and will look to government-funded assistance.

Copyright © 2016 Wolters Kluwer • All Rights Reserved

6

The Older Adult in the Community: Cultural Influences #1

Cultural level

Differences in culture and ethnicity shape health and illness behaviors and actions.

Specifically:

Physical functioning: Mobility/exercise

Social and emotional well-being: Acculturation, family/peer support

Quality of life: Satisfaction and happiness

Beliefs and practices: Remedies, traditional healers, self-care

Copyright © 2016 Wolters Kluwer • All Rights Reserved

The Older Adult in the Community: Cultural Influences #2

Cultural level (cont.)

Culture change: relocating, migrating

Caregiving: willingness of family to offer support, responsibility to care for elders

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8

Question #2

Is the following statement true or false?

It is generally not recommended for older adults to utilize self-help strategies to maintain their health.

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9

Answer to Question #2

False

Rationale: Older adults who use self-help strategies to maintain their health generally report better psychological well-being and physical functioning than older adults who do not use these approaches.

Nurses who are aware of cultural variations can appreciate that older individuals will have different value orientations underlying their decisions to adopt health behaviors.

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10

The Older Adult in the Community: Cultural Influences #3

Cultural level (cont.)

Dimensions of Social Support:

Affective support: respect/love

Affirmational support: endorsement for one’s behavior/perceptions

Tangible support: aid or physical assistance

Complicated by separation from family members, loss of spouse/partner, declining physical abilities

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11

The Older Adult: Caring for Individual Clients #1

Older adults continue to meet developmental tasks:

Satisfaction of basic needs, such as safety, security, and dignity

Fulfillment of integrity and self-actualization

Maintaining self-esteem and choices about where he/she will live

Engaging in meaningful activity

May embrace increased religion/spirituality

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12

The Older Adult: Caring for Individual Clients #2

Continuum of care

Older adults generally require three types of care:

Intensive personal health services

Health maintenance and restorative care

Coordinated services

Nurses assess that values of independence and self-reliance may be very strong for some older clients; they may refuse any assistance; the nurse should evaluate clients’ behaviors relative to underlying values.

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13

The Older Adult: Caring for Individual Clients #3

Community-based services for older adults

In home care

Skilled nursing facility, assisted living

Community resources: home-delivered meals

Local or church-affiliated volunteer visitors

Day programs in communities and adult day care

Volunteering within the community and the educational system

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14

Question #3

Which criterion is among those used to determine the appropriate level of residential placement for an older adult who is reluctant to live alone?

Age

Gender

Financial resources

Risk for injury

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15

Answer to Question #3

D. Risk for injury

Rationale: Criteria that the nurse often considers to recommend the level of care or residential placement that would be most appropriate for an older client include mental orientation, physical mobility restrictions, degree of assistance needed to complete activities of daily living, frequency of incontinence, and level of risk for accident or injury if living independently.

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1

 
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Screening is an essential step as it helps clinical officers in the diagnosis of diseases. It helps to identify the cause of specific symptoms that a patient has. It is also helpful in the early detection and diagnosis of a disease, and therefore, it can be treated early. Many screening tools are normally used as the most important being population and risk assessment. When it comes to these two variables, the USPSTF recommends that the when it is screening for the women to check if they may be having diseases such as cancers, the care providers should screen all the population that have family members with that type of cancer. The example given is the case of breast cancer. In this case the whole population that is all women related to the one having breast cancer, ovarian, peritoneal or even tubal cancer should be screened. The screening should use one of the several tools that are designed for screening. This is aimed at ensuring that the increased risk of harmful mutation in breast cancer susceptibility genes is identified. The genes in question in this question are BRCA1 and BRCA2. Upon the screening, women with positive screening results should be given proper counselling on genetics in the event they are indeed confirmed to test positive for BRCA.

Answer to this discussion post with a minimum of 200 words. cited and references, APA style. 

__________________________________________________________________________________________

Screening is an essential step as it helps clinical officers in the diagnosis of diseases. It helps to identify the cause of specific symptoms that a patient has. It is also helpful in the early detection and diagnosis of a disease, and therefore, it can be treated early. Many screening tools are normally used as the most important being population and risk assessment. When it comes to these two variables, the USPSTF recommends that the when it is screening for the women to check if they may be having diseases such as cancers, the care providers should screen all the population that have family members with that type of cancer. The example given is the case of breast cancer. In this case the whole population that is all women related to the one having breast cancer, ovarian, peritoneal or even tubal cancer should be screened. The screening should use one of the several tools that are designed for screening. This is aimed at ensuring that the increased risk of harmful mutation in breast cancer susceptibility genes is identified. The genes in question in this question are BRCA1 and BRCA2. Upon the screening, women with positive screening results should be given proper counselling on genetics in the event they are indeed confirmed to test positive for BRCA. 

Moreover, it is also essential to assess the risks that might be associated with certain diseases or disorders. This is important because it helps to create awareness on the risks and to identify who is more at risk of contracting it (Moyer, 2014). Thus, the people who are more at risk can take necessary caution and care to manage the risk. For example, according to the guide to preventive services 2014, older people, African Americans, and people with a family history of glaucoma are more at risk of having glaucoma. Therefore, they should be screened regularly (Force, 2014).

References:

Force, U. P. T. (2014). Guide to clinical preventive services. Available from https://www.ahrq.gov/sites/default/files/publications/files/cpsguide.pdf  [accessed on 14/6/2019]

Moyer, V. A. (2014). Screening for lung cancer: US Preventive Services Task Force recommendation statement. Annals of internal medicine160(5), 330-338

 
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The U.S. Preventive Services Task Force is an independent panel of experts in primary care and prevention who Health Screenings are examinations and tests to look for a disease before patients develop any symptoms. It is important because from a medical perspective prevention is better than cure. It is also often easier to treat or indeed cure a condition in its early stages systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. The purpose of screening individuals or populations is to reduce the risk of death or future ill health from a specific condition by offering a test intended to help identify people who could benefit from treatment. Long and Colorectal cancer screening are tow among others recommendations from US preventing task force.


Report Issue

Please answer to this discussion post with a minimum of 200 words, cited, APA style. 

________________________________________________________________________________________

The U.S. Preventive Services Task Force is an independent panel of experts in primary care and prevention who Health Screenings are examinations and tests to look for a disease before patients develop any symptoms. It is important because from a medical perspective prevention is better than cure. It is also often easier to treat or indeed cure a condition in its early stages systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.  The purpose of screening individuals or populations is to reduce the risk of death or future ill health from a specific condition by offering a test intended to help identify people who could benefit from treatment.  Long and Colorectal cancer screening are tow among others recommendations from US preventing task force.

Lung Cancer (both small cell and non-small cell) is the second most common cancer in both men and women. The American Cancer Society’s estimates for lung cancer in the United States for 2019 are: About 228,150 new cases of lung cancer (116,440 in men and 111,710 in women) About 142,670 deaths from lung cancer (76,650 in men and 66,020 in women). (Society, 2019)

Summary of Recommendation and Evidence for lung Cancer 

Population: Adults Aged 55-80, with a History of Smoking. The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. The USPSTF updated its definition of and suggestions for practice for the grades A, B, C, D, and I. Lung Cancer Category B. It means that the screening is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

On the other hand, Colorectal Cancer is one of the most common cancers diagnosed in the United States. Excluding skin cancers, it is the third most common cancer in both men and women in the U.S.

Population: 

Adults aged 50 to 75 years. The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. The risks and benefits of different screening methods vary. Starting with a simple FBOT or FIT test at the office or sigmoidoscopy every 5 years and colonoscopy every 10 years. The recommendation for this group is category A (The USPSTF recommends the service. There is high certainty that the net benefit is substantial). 

Adults aged 76 to 85 years. The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history. Adults in this age group who have never been screened for colorectal cancer are more likely to benefit. Screening would be most appropriate among adults who 1) are healthy enough to undergo treatment if colorectal cancer is detected and 2) do not have comorbid conditions that would significantly limit their life expectancy. The recommendation for this group is category C (The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small). (Force, 2014)

References

Force, T. U. (2014, June 12). Recommendations for Primary Care Practice. Retrieved from The U.S. Preventice Services Task Force : https://www.uspreventiveservicestaskforce.org/Page/Name/recommendations

Society, A. C. (2019, May 17). Cancer Facts and Statistics. Retrieved from American Cancer Society: https://www.cancer.org/research/cancer-facts-statistics.html

 
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Using the recommendations for the US preventive task force “ the guide to preventive services 2014” please choose 2 screening tools and listed below you feel are the most importance in advanced clinical practice.

Using the recommendations for the US preventive task force “ the guide to preventive services 2014” please choose 2 screening tools and listed below you feel are the most importance in advanced clinical practice.

        . Population
        . Risk assessment

  • Screening test
  • Time of screening 
  • Intervention

This is a discussion post and needs to be done with citation, APA style 6th edition and with references. No less than 250 words. 

 
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Part I: HIV/AIDS has affected millions of people in the United States and the world since the 1980s. On a global scale, large numbers of people with HIV/AIDS are not receiving the needed treatment. Congress created The Ryan White Care Act of 1990 to assist public hospitals struggling financially from caring for uninsured men and women living with HIV/AIDS. There were four Titles written into The Ryan White Care Act of 1990. In recent years the Titles have moved into five Parts, Part A-F focusing on a variety of topics.

Part I: HIV/AIDS has affected millions of people in the United States and the world since the 1980s. On a global scale, large numbers of people with HIV/AIDS are not receiving the needed treatment. Congress created The Ryan White Care Act of 1990 to assist public hospitals struggling financially from caring for uninsured men and women living with HIV/AIDS. There were four Titles written into The Ryan White Care Act of 1990. In recent years the Titles have moved into five Parts, Part A-F focusing on a variety of topics.

In 2014, the Affordable Care Act gave insurance access to many of the uninsured population. Over the past few decades, countries like England and Canada have a lower percentage of HIV/AIDS cases. Is this due to their healthcare structure? In 4-5 pages, discuss the following.

  1. Explain the purpose of each of the five Parts in The Ryan White Care Act.
  2. Explain other viewpoints or opposing viewpoints of the Act.
  3. Describe your stance on if there is a need for the Ryan White Care Act with the Affordable Care Act. Think about other countries. 
  4. This portion of your assignment will require you to research and examine information from various sources. Use a minimum of three credible sources for your paper, with three being an academic source from the Rasmussen College Online Library (don’t forget to include in-text citations throughout your paper with paraphrasing or quoting)
  5. Make sure to include your APA formatted reference page.

Part II: Based on your research you decide which one of the previous communication tools would be most effective to communicate your findings. Keep in mind the position and facility you selected and create a memo, a PowerPoint, detailed meeting agenda, or an information sheet. In the first paragraph, slide, or bullet please justify the reason you picked communication format. 

  1. In the first paragraph, slide, or bullet please justify the reason you picked the particular communication format.
  2. Use feedback from your instructor to guide you through the communication tool you decided to use.
  3. Make sure to use audience specific language and tone.
 
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Does Chlorhexidine Bath In Total Joints Replacement Reduce Surgical Site Infection

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

· Identify and briefly describe your chosen clinical issue of interest.

· Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.

· Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

· Provide APA citations of the four peer-reviewed articles you selected.

· Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples

 
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Ethical Conduct Of Research

1. Prepare for Final Paper

Topic: Ethical Conduct of Research (Outcomes 1,6): 20 hours

  • Select a healthcare related research study. Identify      the sample population. Analyze and critique the study to identify if sampling      method reflects ethical principles including consent, conditions of the      participants, study approved by IRB, 
  • Minimum 20 pages excluding title and reference page. 
  • APA format

Final paper will be submitted through TURNIT in™.

Papers MAY NOT show evidence of similarity beyond 17% excluding reference pages!

Papers that reflect over 17% SIMILARITIES will be assigned a ZERO. There is NO opportunity for late or re-submitted work!

MINIMUN 6 REFERENCES, from 2014 to 2019

YOU WANT ADDED MORE CRITIQUE QUESTION IF YOU WANT TO COMPLET THE 20 PAGES 

FOLLOW THE TERM TEMPLATE APA PAPER TEMPLATE 6th

Title in Upper and Lower Case

Your Name

Miami Regional College

MSN 5300: Advanced Nursing Inquiry and Evidence Based Practice

Title of Paper in Upper and Lower Case (Centered, Not Bold)

Paragraph one is the introduction to the paper. It should begin with something that will grab the reader’s attention and provide a citation to support your opening sentence (Norwood, 2002). Next, support that opening sentence with discussion or explanation with one or multiple sentences which will make up the body of the introductory paragraph. The last sentence of the introduction should highlight areas to be covered in the paper. APA success requires knowledge of the format and skill in concise, clear written communication.

Research Study Overview

This section is where you provide a summary of the research study being critiqued? What were the goals of the research? What health care related issue was addressed? Is it a good/feasible study to apply in clinical practice? Was a practical study, from a financial aspect? Use as many paragraphs as needed to cover the content appropriately.

Ethical Issues in Research

Use this paragraph to provide feedback/history on ethical issues on research. 

Protection of Human Rights

What are the five human rights that must be protected during research/investigation? What do they stand for? How do they relate to this research study? Were any/all of the human rights protected in the duration of the research study in question? Use as many paragraphs as needed to cover the content appropriately. Ladkjfasdojfadfoasidfjaod. Aff fasdfjasod faosdijfaosdjfaodjfasdjdklfljkadf

Adpapsdufas dfoaidfoakds. Lijaofijasdijfalsd adifasdiufa osdifuaosdfaisdufad fjsdif asdoif. Poiofapdfiasdpfoi asdpf poifpadofiadf ;lskdm;vokmae ;obvkmse;rokmgageo sivjnseariun v;osdr g;I s;bnofnb;o aiermf ;sokdfmb;osiermg oskmfbopvsidfm b;mseoribgmseoribg nbsodfjbvs;ervjnnbs;odrkmfbv;oaerkmv sodbmsnoe;rif nvpsoeonvrsep.

Sampling Method

 What was the sampling method used, how did the researchers choose the subjects for participation? What other sampling methods could have worked better, provided better results? Does the sampling method used reflect ethical principles, was it a fair process? Is the population in question a vulnerable population, and if so were there special considerations taken? Use as many paragraphs as needed to cover the content appropriately.

Ina;osif;oaiwe mfasodifmaow vmoadifmgo ;aodifgi ;aodfvmao vma;o nvaoejjngfpsoinfv bnaeornfgvpesunfvpasjnvpadjfnvpajnvpoadf vpoasjdfnv[oiadsno[cv afnvpainfvpaw9unfvpasdj avmaojf;oaskdjfoaskdmv;lkamdsfovmewpoigfnasdock apovmaporingrpaio

Informed Consent

What is an informed consent? In regards to this research study, was it obtained, if appropriate? If a consent was part of the study, was it obtained properly? Did the participants assent? If participants unable to consent, were they not competent, did a caregiver consent? Were participants provided full/complete detailed information or was it a short version? What components did it include? Use as many paragraphs as needed to cover the content appropriately.

Mv;aoskdkjfngaogna;o aosngfva;osing; aodkfkngvo;sdjfnv ngvsoerphngea;oi aojgnjvspdofinv;sdjfvn;sdozjfvns; vnaoeriengpa9eru vnapesring[earoi vnaeroinmg[eaoirm vna[eroimgfaoskmf;szlkmf ngae[iorng[awekmf mvaoeor[imges’aripom d;mokgm ae

Ethical Scientific Integrity

What are the credentials of the researchers? Did the researchers fabricate data, publish errors/ publish correction? Is there evidence of plagiarism? Use as many paragraphs as needed to cover the content appropriately. Ifnagw;oeifnaw;eo vo;ianener;ai nvzodsianvaei;or nag;oekermf naipeieufn ;aoidfvim; ;aodkzkfnv;azdfskjvn.

IRB

This section is where you will discuss all the information available (or lack thereof) regarding the IRB. Was the research study approved by an institutional review board? If not, why not? Was a research proposal submitted for approval by an IRB? Use as many paragraphs as needed to cover the content appropriately Adkjfasdojfa dfoasidfjaod. Aff fasdfjasod faosdijfaosdjfaodjfasdjdklfljkadf.

Adpapsdufas dfoaidfoakds. Lijaofijasdijfalsd adifasdiufa osdifuaosdfaisdufad fjsdif asdoif. Poiofapdfiasdpfoi asdpf poifpadofiadf.

HIPPA

What is HIPPA and how does it apply to a research study? Was the research conducted using database information, and if so, was the health information protected? How was it protected? Was any data de-identified? Were participants provided pseudonyms or assigned numbers? Use as many paragraphs as needed to cover the content appropriately.

Benefit to Risk Ratio

Discuss if a benefit to risk ratio was calculated and how? Did it provide am honest estimation? What is your opinion about the outcome of the study and the potential benefits? Can it have a positive impact on the individual, how about in the community? Use as many paragraphs as needed to cover the content appropriately. Ladkjfasdojfadfoasidfjaod. Aff fasdfjasod faosdijfaosdjfaodjfasdjdklfljkadf

Adpapsdufas dfoaidfoakds. Lijaofijasdijfalsd adifasdiufa osdifuaosdfaisdufad fjsdif asdoif. Poiofapdfiasdpfoi asdpf poifpadofiadf.

Conclusion

Most papers should end with a conclusion or summary, which consists a short description of the key points of the paper. It should be concise and contain little or no detail. No matter how much space is left on the page, the References are always on the next page.

References (centered, not bold)

American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.

You next reference. 

Appendix A(centered, not bold)

This is the article to analyze, and critique 

Resilience of people living with HIV/AIDS in Indonesia: a phenomenological study Kumboyono Kumboyono, Cathrine T Sukotjo, Yulia C Lestari, Dini P Wijayanti Faculty of Medicine, Brawijaya University, Malang City, Indonesia

Abstract Background: HIV/AIDS is one of the most continuously developing communicable diseases in the world. The number of people diagnosed with HIV/AIDS is currently increasing worldwide, including in Indonesia. People living with HIV/AIDS (PLWHA) fall into a state of crisis, which signifies the difficulties of living with chronic pathological conditions. Resilience is one unique phenomenon observed among PLWHA in Indonesia, which further reveals the results of current health management and expectations of PLWHA for better health programmes. Objective: This study aims to explore the mechanism of resilience in Indonesian PLWHA and the factors affecting that particular mechanism. Method: This is a qualitative phenomenological study. Twenty-seven PLWHA were selected from a primary healthcare centre in Malang City, East Java, Indonesia. Participants were selected from various economic, social, and diverse sexual orientation backgrounds. Participants were informed about the conduct of the research and consented to take part in the interview. Results: Diagnosis of HIV/AIDS signifies the beginning of psychological and social distress, the spiritual reaction after being diagnosed is a state of crisis, and the coping mechanism and understanding of life by PLWHA is a definite sign of resilience. Conclusion: HIV/AIDS is a chronic progressive disease and induces the distinct mechanism of resilience in Indonesian society. Future healthcare and management of PLWHA will be required to support and motivate this mechanism to guide PLWHA into a more comfortable and healthy lifestyle.

Keywords: HIV/AIDS, healthcare, meaning of life, resilience, spiritual

Introduction HIV/AIDS is one of the most continuously developing communicable diseases in the world among other communicable diseases, such as tuberculosis, affecting people diagnosed with immunocompromised conditions. The number of people living with HIV/AIDS (PLWHA) worldwide is currently increasing with a significant incline among Asian countries, especially the Asia and Pacific region [1]. In Indonesia, the number of PLWHA is in synergy with the increasing pattern of an Asian epidemic, with 300,000 estimated new infections in 2015 [2]. Having been diagnosed HIV-positive, novel psychological and social disturbances are certainly experienced by PLWHA in general. As reported by Dahlui [3], PLWHA are a vulnerable community experiencing a psychosocial burden, together with physical discomforts. Another study from India also reported the effects of stress and the psychosocial burden suffered by people diagnosed with HIV/AIDS [4]. Although there is a mechanism of resilience to chronic diseases, this group of people are still under enormous pressure to survive the harmful pathological progress of HIV/AIDS and the opportunistic infections that follow. A lack of psychosocial support from family, for example, loss of parents and caregivers at an early age, adds to this pressure [5]. Biological mechanisms of survival under the duress of chronic diseases, such as HIV/AIDS or tuberculosis, can result in two outcomes. People living with the chronic disease will experience the entire physical

andpsychologicaldisturbancesafterperseveringunder similar clinical manifestations for a long period of time. One outcome results in depression and loss of spiritual motivation that may lead to mortality [6,7]. The other is the mechanism of resilience, the most distinct phenomenon will eventually lead to survival while experiencing deteriorations of physical and psychological well-being [8,9]. Qualitative phenomenological studies exploring the mechanism of resilience in PLWHA and its other factors have not been the focus of researches in Indonesia. The purpose of this study is to explore the nature of resilience amongpeoplediagnosedwithHIV/AIDS.Themeaning of experiencing an HIV/AIDS burden, physically and psychologically, and also the social responses of PLWHA were recorded and reported in this study. This research is important as it will allow health professionals to identify the support required by PLWHA.

Method Design of study This study is a classical phenomenological study with an analytic descriptive approach. This approach is used to understand the meaning of the patient’s life after being diagnosed with HIV/AIDS. This study obtained an ethical health licence from the Ethical, Health, and Research Commission of Medical Faculty, Brawijaya University, Malang City (Ref: 261/EC/KEPK/04/2014) and was upheld according to the Helsinki Declaration of 1975.

HIV Nursing; 2018: 18(1): 4–7 Research

4 © Mediscript Ltd 2018

Population and sample For this study 27 PLWHA were selected by snowball sampling from Malang City, Indonesia. Criteria for selection were that participants had been diagnosed with HIV/AIDS for at least 1 year and be aged 18–40 years. The benefit to participants in this research was anincreaseinawarenessoftheimportanceofaccepting a diagnosis of HIV/AIDS in order to remain productive. They were selected according to achieved saturation of data [10]. Participants consisted of 13 men and 14 womendiagnosedwithHIV/AIDSacquiredfromvarious modes of transmission, such as, multiple sexual partners: 17 participants; men who have sex with men: four participants; and injectable drug users: six participants. Participants were aged 25–34 years and lived in the areas of Malang city, Batu city, and Blitar municipality. The educational background of participants ranged from primary school, junior high school, senior high school, and vocational school. The marriagestatusofparticipantsvariedfrombeingsingle, married, and widowed. The occupational backgrounds of participants were freelancers, private-organisation workers, and homemakers.

Data collection Instrumentsusedtoanalysethedataweretheinterview process and the participative observation of researchers. Data were collected at the participants’ homes through private interviews and there were no repeat interviews. Data were recorded in the form of audio files (MP3) and the duration of interviews was 28–42 minutes. A community health nursing specialist who is a registered practitioner and a lecturer at Brawijaya University conducted the interviews

Data analysis Analysis of qualitative data was accomplished by creating a transcript of interview recordings and notes during the interview. Manual analysis of the data was carried out according to the Colaizzi method [11]. Analysing qualitative data manually provides more precise results because the data contain information on attitudes, values, and feelings that cannot be detected by software The procedure was as follows: 1. Read all transcribed verbatim to gain a whole sense of the resilience experience; 2. review each transcript and extract significant statements; 3. explain the meaning of each significant statement; 4. organise the formulated meanings into clusters of themes; 5. integrate results into an exhaustive description of the phenomenon under study; 6. formulate an exhaustive description of the phenomenon in uniquivocal statements of identification as far as possible; and 7. ask participants about the findings thus far as a final validating step. The results of the analysis were based on keywords, categories, and themes and subthemes of qualitative

variables of the study. There were two themes (phases) in this research and two subthemes from each.

Results According to the results of qualitative analysis of data, the mechanism of resilience of PLWHA in Malang city can be divided into two phases: crisis phase and survival phase. The crisis phase can be described by examining the psychological and social stresses of a lifestyle acquired by PLWHA. Meanwhile, the survival phase is explored by asking about the changes in the spiritual pattern and future arrangements of PLWHA. Each theme is discussed thoroughly and described qualitatively according to specific subthemes. Crisis phase of people living with HIV/AIDS The crisis phase of PLWHA is described through two subthemes: psychological and social stress. Psychological stress: the psychological response of PLWHA after being diagnosed with HIV/AIDS can be illustrated by anxiety and anger conditions. Anxiety aroseinparticipantsconsideringtheuncertaintyoftheir lives, which could end in morbidities and mortalities. Anger is also one of the psychological responses after participants pass the initial shock of being diagnosed with HIV/AIDS. Some of them accuse God for their sickness and acquire deep enmity against those who they perceive as responsible for transmitting the disease: Now I am afraid, anxious, worried that my sickness will result in me being sick all my whole life or I might die someday.IthinkGodnolongerlovesme,Ihadthisperiod of being angry with God, but now I realised and widely opened my heart … I’m open to taking the advantages of my situation …, God is the almighty, God will be the one who heals me. (Patient [P] 5, male, 25 years) Social stress: Feeling isolated from the social environment is perceived by participants to be due to social stigma. Social stigma arises as an impact of incorrect perceptions of society about PLWHA and HIV transmission, in the forms of societal embarrassment, labeling, prejudice, social isolation, fear of being isolated and being shunned by society. Whereas some participants suffered from discrimination, several others admitted that they also received acceptance from people living around them, depending on the openness and educational level of their communities: People gossip about me … both my own family and the society … many say that it’s the burden I have to bear alone as a consequence of what I did. If I want to work, Iwillmostsurelyberejectedbecauseofthedisease.But luckily, now there’s no pressure from society, in this area, it’s no longer a taboo subject. (P21, female, 28 years) Survival phase of life of people living with HIV/AIDS The survival phase of PLWHA can be divided into these following two subthemes: changes of spiritual pattern and future arrangements. Changes to spiritual pattern: changes of spiritual meaning experienced by participants occur in the form

Research HIV Nursing; 2018: 18(1): 4–7

5

of spiritual closeness to God through surrendering all to God, repentance, diligence of prayers, and worship: I don’t want to grief for too long … because everything that’shappeningrightnowisGod’swill,ifGodgivesme the disease, God will be the one giving me medicine. Now I’m diligently reciting prayers, before my illness, I rarely do it. I can now read the Quran which I was to unable before. (P16, female, 30 years). Futurearrangement: Planningforthefutureistheform ofPLWHA’sawarenessinlearninglifelessonsfromtheir personal experiences by maintaining health and future arrangements for their family. Maintaining health is a method used by participants to support their declining immune system through behaviour changes and beliefs leading to a more healthy lifestyle. I want to show that though I am diagnosed with HIV positive, I can live a healthy lifestyle without medical problems. I will change my lifestyle, change all of them. … All the bad behavior of my past I have left, such as drinking, doing drugs, multiple sex partners, I have left all of it. (P23, male, 32 years). Future hope for the family is a participants’ wishes for the security of their family, the future of their children, and happiness of their parents and relatives to redeem their previous deeds. This phenomenon can be observed through this following comment: What I fear is; it is acceptable if it is only me who suffer the disease … what about my kids, who will take care of them if I die … I have to stay healthy for my children. Besides, I want to get work again; I want to please my parents. … My parents need more attention now. (P25, female, 29 years).

Discussion The results of this study indicate that resilience is the participants’ ability to bounce back to psychological and social norms after facing adversity owing to a positive HIV/AIDS diagnosis. The nature of resilience among people diagnosed with chronic diseases can be categorised into the crisis and survival phase. The former is signified by the beginning of a psychological and physical struggle immediately after having been diagnosed with a certain critical disease, such as HIV/AIDS. Individuals acquiring one particular severe disease enter the crisis phase, which is also the beginning of their mental and physical experiences as people under the pathological burden of chronic and worsening physical manifestations [12]. Under the duress of discomfort and pain over a long period,togetherwiththeheavyburdenofpsychological and social pressures, individuals will finally arrive at certain destinations. One likely destination is morbidities and irreversibly deteriorating psychological conditions, which eventually lead to mortality. The other destination is an interesting phenomena to behold in itself, in which PLWHA and others suffering from chronic progressive disorders can persevere and acquire the physical resistance needed to counter the destructive progression of the disease. This phenomenon is called resilience and is a distinctive topic that may be discussed based on the results of this study.

According to the interview results, all the participants agree with the notion of having suffered great negative psychological changes regarding their diagnosis of HIV/AIDS. Participants admitted that some of them were hardly able to control the anger and hatred they had after first being informed about their actual clinical conditions. They perceived people in their close acquaintance as ones who were responsible for their clinical conditions, and this understanding led to justifying their motivation to harm innocent individuals and the perceived bad deeds of others in transmitting the virus. Other participants reacted in a different way by expressing great sadness, anxiety, and depression regarding their bleak future and low rate of survival under the rapid progressive manifestation of the disease. Based on these results of psychological and social reactions of the participants, it can be inferred that one significant negative event relating to their well-being can deflate the positive perceptions that participants’ acquire about themselves. The psychological and physical stress they receive after being diagnosed with HIV/AIDS signify the beginning of their long struggle andjourneyinreachingthecriticalphasethatallpeople with chronic disease will eventually reach. Those participants proceed both physically and mentally through the discomforts and the state of being constantly uncomfortable with themselves, which is specifically induced by the harmful particular stressor that is HIV/AIDS. Having been diagnosed with HIV/AIDS, initially, participants revealed a great distrust and absolutely blamed God and other spiritual systems of belief in their society, according to their upbringing. As most Indonesians consider that spiritual devotedness to God is the absolute duty in their private and public lifestyle, itisgenerallyperceivedasawrongdoingtoblameGod for the disease and discomfort the participants have to pass through in life. PLWHA in this study had a difficult time reconciling their sufferings with the goodness and righteousness of religious beliefs. This alsoaddedtotheirpsychologicalandphysicalburdens, whichfurtherledtoanxietyanddepression.Thismental stateofPLWHAisadistinctivepointinthecriticalphase of suffering from a chronic disease, and also has the role as a determining factor of the final destinations of the participants’ well-being. The final destinations of people with a chronic disease, as mentioned above, can manifest in mortalities owing to an individuals’ inability to cope with a long and strenuous psychological and physical burden. However, an interesting phenomenon called resilience to chronic disease can also exist and be presented in the final stages of an individuals’ struggle. According to this study, all participants reacted in a positive way regarding their experiences and meanings of life acquired by contracting HIV/AIDS. Most participants agreed to repent and improve their spiritual lifestyle by being more vigilant in prayers to God. Participants also admitted that they behaved more carefully after being diagnosed with HIV/AIDS to preserve their HIV Nursing; 2018: 18(1): 4–7 Research 6

remaining years and also to prepare economically and psychologically for their families. These are positive signs in the final destinations of PLWHA and can be further categorised into the resilience expected to be found in people with chronic disease. The resilience phenomena of PLWHA found in this study are in conjunction with the results of other previous studies of PLWHA. According to one study held in a Haitian children’s community diagnosed with HIV/AIDS [13], the participants admitted that they suffered great stress/depressive symptoms of being diagnosed with HIV/AIDS owing to a lack of social support, stigma, and discrimination; which agrees with the initial process of HIV/AIDS for participants of this study. Similarly, PLWHA in Brazil, Iran, and USA also revealedthepsychologicalandsocialstruggleofhaving negative social stigma from the environment, which is worsened with the struggle of coping with all the negative perceptions without their caregivers or family to support them [14,15,16]. AnHIV/AIDSdiagnosismaymakeanindividualstressed and impart a sense of grief. Therefore, a nurse has a veryimportantroleinhelpingpatientsthroughdisbelief of their fate and to be able to adapt to the condition oftheillness.Nursescanactascounsellorsbyproviding individual and group counselling and educators by providing accurate information about HIV/AIDS to the patient, family and community. The role of nurses as educators and counsellors is corroborated by research findings that reveal nurses have a role in providing access to knowledge and counselling for newly diagnosed HIV patients to help them in dealing with stigma and disclosure. The National HIV/AIDS Strategy of United States reveals that advanced and innovative education strategies are necessary to provide care that is free from stigma and discrimination [17,18]. An HIV/AIDS nursing education strategy involving PLHWA and experts in the field could help nurses reduce HIV/AIDS stigma in society. Conclusion PLWHAhaveachronicprogressivediseasethatinduces the distinct mechanism of resilience in Indonesian society. Future health care and management of PLWHA should socially support and motivate this mechanism to guide PLWHA into more comfortable and healthy lifestyles. The role of nurses as counsellors and educators can assist the adaptation of PLWHA in facing adversity after being diagnosed with HIV/AIDS.

Acknowledgements Conflicts of interests The authors declare there are no conflicts of interests regarding the funding and publication of this article. Funding The author is grateful for the support of the Directorate General of Higher Education, Ministry of Culture and Education, Republic of Indonesia in funding

this community health nursing research (Ref: 023.04.2.414989/2014). References 1. UNAIDS DATA 2017. Available at: www.unaids.org/sites/ default/files/media_asset/20170720_Data_book_2017_ en.pdf (accessed January 2018). 2. UNAIDS. Global AIDS update, 2016. Available at: www.unaids.org/en/resources/publications/all/ (accessed January 2018). 3. Dahlui M, Azahar N, Bulgiba A et al. HIV/AIDS related stigma and discrimination against PLWHA in Nigerian population. Plos One 2015; 10: e0143749. 4. Kumar S, Mohanraj R, Rao D et al. Positive coping strategiesandHIV-relatedstigmainSouthIndia. AIDSPatient Care STDS 2015; 29: 157–163. 5. Dejman M, Ardakani HM, Malekafzali B et al. Psychological, social, and familial problems of people living withHIV/AIDSinIran:aqualitativestudy. IntJPrevMed 2015; 6: 126. 6. SakiM,KermansashiSMK,MohammadiEetal.Perception ofpatientswithHIV/AIDSfromstigmaanddiscrimination. Iran Red Crescent Med J 2015; 17: e23638. 7. AmiyaRM,PoudelKC,Poudel-TandukarK etal. Perceived family support, depression, and suicidal ideation among people living with HIV/AIDS: a cross-sectional study in the Kathmandu Valley, Nepal. Plos One 2014: 9: e90959. 8. Kanez S. Depression and coping mechanism among HIV/AIDS patients under anti-retroviral therapy. Indian J Soc Psychiatry. 2016. 32: 149–153. 9. Sun W, Wu M, Qu P et al. Quality of life of people living withHIV/AIDSunderthenewepidemiccharacteristicsinChina and the associated factors. Plos One 2014; 8: e64562. 10. GentlesSJ,CharlesC,PloegJ,McKibbonKA.Sampling in qualitative research: Insights from an overview of the methods literature. Qualitative Report 2015; 20: 1772–1789. 11. Streubert HJ, Carpenter DR. Qualitative research in nursing: Advancing the humanistic imperative, 2nd edn. Philadelphia: Lipincott Williams & Wilkins, 1999. 12. Arrey AE, Bilsen J, Lacor P Deschepper R. Spirituality/ Religiosity: A cultural and psychological resource among sub-SaharanAfricanmigrantwomenwithHIV/AIDSinBelgium. Plos One 2016; 11: e0159488. 13. SurkanaPJ,MukherjeebJS,WilliamsdDRetal.Perceived discrimination and stigma toward children affected by HIV/AIDS and their HIV-positive caregivers in central Haiti. AIDS Care 2010; 22: 803–815. 14. daSilvaLMS,TavaresJSK.Thefamily’sroleasasupport network for people living with HIV/AIDS: a review of Brazilian research into the theme. Cien Saúde Colet 2015; 20: 1109– 1118. 15. Forouzan AS, Jorjoran Shustari Z et al. Social support networkamongpeoplelivingwithHIV/AIDSinIran. AIDSRes Treat 2013; 2013: 715381. 16. Peterson JL, Rintamaki LS, Brashers DE et al. The forms and functions of peer social support for people living with HIV. J Assoc Nurses AIDS Care 2012; 23: 294–305. 17. Wei-Ti C, Shiu CS, Simoni J et al. Optimizing HIV care by expanding the nursing role: patient and provider perspectives. J Adv Nurs 2009; 49: 1841–1850. 18. FrainJA.PreparingeverynursetobecomeanHIVnurse. Nurse Educ Today 2017; 48: 129–33.

Correspondence: Kumboyono Kumboyono Email: abu_hilmi.fk@ub.ac.id / publikasikoe@gmail.com

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Video Interaction: Aging client 6/14/2019 1:58:00 PM 3 hr 38 min 100%

Module Report The Communicator 2.0

Video Interaction: Aging client

Tutorial:

Module:

Stage 1 (2 of 2 Correct)

Scenario Case management nurse Darcy and student nurse Jamie are visiting with Mr. and Mrs. Silver.

Character Nina Stein

Selected Option/ Result “Tell me what is concerning you most.” Result: Correct

Rationale Open-ended questions are a therapeutic communication technique because they allow the client to direct the conversation and verbalize related thoughts and concerns.

Character Steve Silver

Selected Option/ Result “I will explain everything that is in the papers.” Result: Correct

Rationale

Reflection is a therapeutic communication technique because it directs questions and feelings back to the client in relation to what the nurse understood and heard, while encouraging the client to explore feelings and ideas about a situation.

Stage 2 (2 of 2 Correct)

Scenario Case management nurse Darcy is meeting with healthcare team members regarding Mr. and Mrs. Silver s transfer to the skilled unit.

Character AP Trudy

Selected Option/ Result “We need to involve their daughter in all decisions about their care, so could you go invite her to meet with us?”

Result: Correct

Report Created on: 6/14/2019 04:37 PM EDT REP_NTIndv_CommModuleReport_1_0

Page 1 of 3

Rationale Assertive communication is an effective style of interpersonal communication because the nurse uses a combination of honesty and tactfulness to ensure the rights of self and others.

Character Student nurse Jamie

Selected Option/ Result “We need to continue to remind Mrs. Silver of the move.” Result: Correct

Rationale Assertive communication is an effective style of interpersonal communication because the nurse uses a combination of honesty and tactfulness to ensure the rights of self and others.

Stage 3 (2 of 2 Correct)

Scenario Nurse Darcy is discussing Mr. Silver and Nina s concerns about the transfer.

Character Nina Stein

Selected Option/ Result “You re telling me that you feel your mother s behavior is a result of the transfer?” Result: Correct

Rationale Paraphrasing is a therapeutic communication technique because it allows the nurse to restate information provided by the client to determine whether or not the communication is mutually understood.

Character Steve Silver

Selected Option/ Result “When did she start acting differently?” Result: Correct

Rationale Focused questions are a therapeutic communication technique because they allow the nurse to clarify a message, collect data, encourage feedback, and confirm the client s ideas and beliefs.

Stage 4 (2 of 2 Correct)

Scenario Mr. and Mrs. Silver are not receiving the requested foods in the skilled facility.

Character Aide Tim

Selected Option/ Result “I ll meet with the dietitian to discuss this issue.” Result: Correct

Rationale Assertive communication is an effective style of interpersonal communication because the nurse uses a combination of honesty and tactfulness to ensure the rights of self and others.

Character Steve Silver

Selected Option/ Result “Tell us more about the foods that are appropriate for your diet.” Result: Correct

Report Created on: 6/14/2019 04:37 PM EDT REP_NTIndv_CommModuleReport_1_0

Page 2 of 3

Rationale Open-ended questions are a therapeutic communication technique because they allow the client to direct the conversation and verbalize related thoughts and concerns.

Stage 5 (2 of 2 Correct)

Scenario Nurse Darcy has a care conference to discuss Mrs. Silver s care.

Character Nina Stein

Selected Option/ Result “I hear you say that your father is tired and that you re concerned about your mother s safety, but you want to know about other options.”

Result: Correct

Rationale Exploration is a therapeutic communication technique because it encourages the client to delve deeper into a topic or issue of concern.

Character Steve Silver

Selected Option/ Result “Fifty-five years is a long time.” Result: Correct

Rationale Focused questions are a therapeutic communication technique because they allow the nurse to clarify a message, collect data, encourage feedback, and confirm the client s ideas and beliefs.

Report Created on: 6/14/2019 04:37 PM EDT REP_NTIndv_CommModuleReport_1_0

Page 3 of 3

 
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Research a health care organization or network that spans several states with in the United States (United Healthcare, Vanguard, Banner Health, etc.). Assess the readiness of the health care organization or network you chose in regard to meeting the health care needs of citizens in the next decade.


Research a health care organization or network that spans several states with in the United States (United Healthcare, Vanguard, Banner Health, etc.). Assess the readiness of the health care organization or network you chose in regard to meeting the health care needs of citizens in the next decade.

Prepare a 1,200-word paper that presents your assessment and proposes a strategic plan to ensure readiness. Include the following:

1. Describe the health care organization or network.

2. Describe the organization’s overall readiness based on your findings.

3. Prepare a strategic plan to address issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction.

4. Identify any current or potential issues within the organizational culture and discuss how these issues may affect aspects of the strategic plan.

5. Propose a theory or model that could be used to support implementation of the strategic plan for this organization. Explain why this theory or model is best.

Prepare this assignment according to the APA Style Guide, and abstract is required.

 
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