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Culturally Competent Nursing In a Microsoft Word document of 4-5 pages formatted in APA style, you will describe an interview of a person from a cultural background that is different from your own. Select a person from a cultural group different from your own. You may choose a patient, friend, or work colleague. For the sake of confidentiality, do not reveal the name of the person you interview; use only initials. In your paper, include the following: A complete cultural assessment using the 12 domains from the Purnell Model for Cultural Competence in your textbook, Transcultural Health Care: A Culturally Competent Approach. A description of implications for health practices. On a separate references page, cite all sources using APA format.

Describe two external stressors that are unique to adolescents. Discuss what risk-taking behaviors may result from the external stressors and what support or coping mechanism can be introduced. 

SHARON 

Re: Topic 3 DQ 2
 

External stressors that adolescence experience include peer pressure from from friends at school and body changes of puberty. Teens face peer pressure from their peers to look a certain way, engage in certain activities or act in a certain way. Failure to conform results in stress which leads to anxiety, withdrawal, aggression, poor coping mechanisms and sometimes engage in bad activities to please their friends or to try and fit in. Body changes of puberty which include development of breasts and hips in girls and broader chest and shoulders in boys results in confusion and the need to explore sexuality.They may also face challenges with their body image leading to starving themeslves or over eating. To deal with the stress they encounter teens may engage in risky sexual behavior which may result in sexually transmitted infections and unplanned pregnancy, experimenting,use or abuse of drugs or illegal substances and alcohol, cigarette smoking, they may steal in order to have items to show off to their friends, vandalism. or school violence, not attending school or classes.(CDC 2021). 

It is important for parents to identify problems early by listening carefully to teens, build trust, learn and model stress management skills and talk openly and give education about body changes and acceptance of these changes, implications of risky sexual bbehavior. . It is also important for parents to monitor television programs that the teens watch, support and promote involvement in sports and other social activities . When parents recognize that the problem may potentially get out of hand they may engage the help of a psychologist, psychiatrist, counselor or social worker. Teens may be encouraged to excercise and eat regularly, get enough sleep, avoid illegal drugs,alcohol and tobacco, develop assertiveness training skills and express how they feel politely and not aggressively. It is important to encourage teens to decrease negative self talk and challenge negative thoughts with alternative neutral or positive thoughts,builld a network of friends who help them cope in a positive way. (American academy of child and adolescent psychiatry 2019). 

References 

Center for disease prevention and control. 2021. Parent information: Risk behavior. www.cdc.gov/parent/teens/risk-behavior 

American Academyof child and adolescent psychiatry. 2019. Stress management and teens. www.aacap.org/AACAP/Families-and-youth 

Raising Children network Australia.2019.Risky behavior in pre-teens and teenagers:how to handle it. www.raisingchildren.net.au/teens/behavior 

Response 

Indeed, this is good work, Sharon. You have provided insightful post about external stressors that are unique to adolescents. I agree with you. According to American Psychological Association (2021), various coping mechanisms can be introduced to address stress among adolescents. For instance, the association recommends prioritization of sleep to check stress. Adequate sleep also helps in emotional and physical well-being. Teenagers need sleep for about 8 to ten hours a night (Pascoe et al., 2020). The other mechanism is the creation of time for fun. Teens need time to engage in activities that give them joy such as practicing music, listening to music, dancing, practicing art, or playing with building bricks. Exercise is another important coping mechanism. Physical activity is important in relieving stress and children aged between 6 and 17 years should engage in at least 60 minutes of exercise daily (Rodriguez-Ayllon et al., 2019). Importantly, teenagers should learn to talk about the stressors with a trusted adult to help them in putting their ideas in perspective and finding solutions (American Psychological Association, 2021).  

References 

American Psychological Association. (2021). How to help children and teens manage their stress. Retrieved  from https://www.apa.org/topics/child-development/stress 

Pascoe, M. C., Hetrick, S. E., & Parker, A. G. (2020). The impact of stress on students in secondary school and higher education. International Journal of Adolescence and Youth, 25(1), 104-112. https://doi.org/10.1080/02673843.2019.1596823 

Rodriguez-Ayllon, M., Cadenas-Sánchez, C., Estévez-López, F., Muñoz, N. E., Mora-Gonzalez, J., Migueles, J. H., … & Esteban-Cornejo, I. (2019). Role of physical activity and sedentary behavior in the mental health of preschoolers, children and adolescents: a systematic review and meta-analysis. Sports medicine, 49(9), 1383-1410. https://doi.org/10.1007/s40279-019-01099-5 

MIREILLE 

Re: Topic 3 DQ 2
 

There is evidence that many adolescents have mental health problems due to various stressors (Eisenstadt et al., 2020). The construct “stressor” has numerous definitions. A stressor is a chronic event or condition that endangers the physical or psychological health of persons of a certain age in a particular society (Eisenstadt et al., 2020). I will address two stressors that negatively affect adolescents: bullying and parental illness. 

Bullying is an issue for adolescents in many schools and social settings. Unequal power distribution may cause stress, low self-esteem, PTSD, depression, anxiety, and various health and psychological issues (Tenenbaum et al., 2011). This stressor may lead to a range of risk-taking behaviors in victims, such as aggressive and impulsive behaviors (Poon, 2016). There is mixed evidence of victims being more susceptible to addictive behaviors (Poon, 2016). Recommended coping strategies vary depending on the context. Sometimes controlling anger, finding support groups, and other forms of socialization can help (Tenenbaum et al., 2011). According to some studies, problem-focused strategies (understanding the problem and seeking solutions) are more effective than emotion-focused strategies associated with controlling emotions (Tenenbaum et al., 2011). However, some emotion-focused strategies are effective in dealing with bullying (Tenenbaum et al., 2011). 

Parental illness can be an impactful stressor for adolescents that affects their psychological and physical health. Studies show that adolescents whose parents are ill may experience depression, anxiety. They may also externalize parental symptoms (Pedersen & Revenson, 2005, p. 409). This stressor may lead to risk-taking behaviors such as substance abuse, sexual risk, and conduct problems (Pedersen & Revenson, 2005, p. 409). Some of these behaviors can be affected by other economic, sociological and cultural factors (Pedersen & Revenson, 2005, p. 409). The psychological and social support of relatives and friends may help as an effective coping strategy (Pedersen & Revenson, 2005, p. 414). Depending on the severity of the illness, modifying the adolescent’s subjective perception of the severity of the parent’s illness can reduce stress (Pedersen and Revenson, 2005, p. 411). 

The effectiveness of strategies that contribute to solving the problems of these stressors depends on many factors. As a result, their impact varies depending on psychological differences among adolescents, cultural, economic, and sociological variations. 

Eisenstadt/University College London, M. I., Stapley, E., Deighton/Anna Freud Centre, J., &Wolpert/University College London, M. (2020, December). Adolescent stressors and their perceived effects on mental well-being: A qualitative study. ResearchGate. https://www.researchgate.net/publication/346729988_Adolescent_Stressors_and_Their_Perceived_Effects_on_Mental_Well-Being_A_Qualitative_Study 

Pedersen, S., & Revenson, T. A. (2005). Parental illness, family functioning, and adolescent well-being: A family ecology framework to guide research. Journal of Family Psychology, 19(3), 404-419. https://doi.org/10.1037/0893-3200.19.3.404 

Poon, K. (2016). Understanding risk-taking behavior in bullies, victims, and bully victims using cognitive- and emotion-focused approaches. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.01838 

Tenenbaum, L. S., Varjas, K., Meyers, J., & Parris, L. (2011). Coping strategies and perceived effectiveness in fourth through eighth grade victims of bullying. School Psychology International, 32(3), 263-287. https://doi.org/10.1177/0143034311402309 

Response 

 Hello Mireille,  

Your focus on external stressors that are unique to adolescents is well done and detailed. In concurrence, many adolescents are at risk of experiencing several stressors that may lead to adverse affective experiences. Adolescence is a time of change and development for many young people across different domains. One of the coping mechanisms is the mindfulness-based cognitive therapy (MBCT). This approach is anchored on the principle that mediation is essential in effective application and regulation of attention to successfully manage and treat several psychological symptoms such as emotional response to depression, anxiety, and stress (Goldberg et al., 2019). Mindfulness approaches can be used to minimize adverse emotional reactions that emanate from or increase psychiatric complexities and exposure to stressors in teenagers and their parents (Perry-Parrish et al., 2016). Mindfulness approaches is more appropriate for adolescents with cognitive processes. Studies indicate that teenagers who practices mindfulness experience drastically less mental distress compared to their counterparts who do not practice mindfulness (Lindsey et al., 2018).  

References 

Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Kearney, D. J., & Simpson, T. L. (2019). Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: a meta-analysis. Cognitive behaviour therapy, 48(6), 445-462. https://doi.org/10.1080/16506073.2018.1556330 

Lindsey, L., Robertson, P., & Lindsey, B. (2018). Expressive arts and mindfulness: Aiding adolescents in understanding and managing their stress. Journal of Creativity in Mental Health, 13(3), 288-297. https://doi.org/10.1080/15401383.2018.1427167 

Perry-Parrish, C., Copeland-Linder, N., Webb, L., Shields, A. H., & Sibinga, E. M. (2016). Improving self-regulation in adolescents: current evidence for the role of mindfulness-based cognitive therapy. Adolescent health, medicine and therapeutics, 7, 101. doi: 10.2147/AHMT.S65820 

SIDONIE 

Re: Topic 3 DQ 2
 

Teens face numerous stressors through their life and often difficult to avoid. Two external stressors that affect teens and influence them to use risky behaviors are peer pressure and divorce of parents. Peer pressure continues to be a stressor that teens must deal in their everyday life. Teens feel they must think, act, and look a certain way, they look to their peers to understand social norms. They are longing for an increased need for social connection and peer acceptance, and a heightened sensitivity to peer influence (Andrews et al., 2020). They are always having to deal with pressure from their peers. Teens are more likely to experiment drugs, alcohol, or cigarettes when in presence other teens to fit in or look for approval. They may also engage in early sexual activity just because their friends are sexually active. 

Divorce of parents can impact teens’ life for years to come. Studies have shown that children who do not live with two original parents in the same household report poor mental health outcomes compared to their peers in nuclear families (Bohman et al., 2017). Parental separation can affect teens’ behavior significantly, as it can lead to residential moves which for teens may entail entering new school and having to make new friends in an already stressful situation. Changing schools has been associated with increased risk of adverse mental health (Bohman et al., 2017). Teens from divorced parents may suffer from depression, anxiety, and other mental illnesses. 

Teenagers may experience stress every day and can learn and benefit from stress management skills. Teens can decrease stress with following behaviors and techniques 

Exercise and eat regularly 
Get enough sleep and have a good sleep routine 
Avoid illegal drugs, alcohol, and tobacco 
Take a break from stressful situations. Engage to activities such as listening to music, talking to a friend, drawing, writing, or spending time with a pet (American Academy of Child & Adolescent Psychiatry, 2019) 

 References:  

American Academy of child & Adolescent Psychiatry (2019). Stress management and teens. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Helping-Teenagers-With-Stress-066.aspx 

 Andrews, J. L., Foulkes, L., & Blakemore, S.J. (2020). Peer influence in adolescence: Public health implications for COVID-19. Trends Cognitive Science, 24(8): 585-587. doi: 10.1016/j.tics.2020.05.001 

 Bohman, H., Laftman, S.B., Päären, A., & Johnson, U (2017). Parental separation in childhood as a risk factor for depression in adulthood: A community-based study of adolescents screened for depression and followed up after 15 years. BMC Psychiatry 17: 117. https://doi.org/10.1186/s12888-017-12522-z 

Response  

Hello Sidonie,  

This is an outstanding work. You have provided a thoughtful and detailed response about external stressors that are unique to adolescents. I agree with you. Essentially, other external stressors that are common among adolescents are academic demands and sexual orientation. To begin with academic demands, school results characterize key consideration in university acceptance and future careers. As such, academic demands are relatively high for teens leading to exam stress (Giota & Gustafsson, 2017). The high academic demands have considerable impact on the wellness of teenagers. In particular, more stress emanating from school work is linked to high psychological and psychosomatic concerns in teenagers. Regarding the sexual orientation, the social perception of sexual orientation is changing but the stress associated with it hardly changing, especially for young people. Teenagers in minority groups such as LGBTI are experiencing stress and how to cope with the stress (Feinstein, 2020). Research indicates high levels of stress, anxiety, and depression among LGBTI teenagers. These teenagers also record high utilization of maladaptive coping techniques such as blame and denial (Toomey et al., 2018).  

References 

Feinstein, B. A. (2020). The rejection sensitivity model as a framework for understanding sexual minority mental health. Archives of Sexual Behavior, 49(7), 2247-2258. https://doi.org/10.1007/s10508-019-1428-3 

Giota, J., & Gustafsson, J. E. (2017). Perceived demands of schooling, stress and mental health: Changes from grade 6 to grade 9 as a function of gender and cognitive ability. Stress and Health, 33(3), 253-266. doi: 10.1002/smi.2693  

Toomey, R. B., Ryan, C., Diaz, R. M., & Russell, S. T. (2018). Coping with sexual orientation–related minority stress. Journal of Homosexuality, 65(4), 484-500. https://doi.org/10.1080/00918369.2017.1321888 

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BUSI 3301 – Business Statistics

QUESTION 1

# 9 Temperature’s Effect on Chemical Process: application problem on the completely randomized design.

To study the effect of temperature on yield in a chemical process, five batches were produced at each of three temperature levels. The results follow. Construct an analysis of variance table. Use a .05 level of significance to test whether the temperature level has an effect on the mean yield of the process.

Temperature

50o C                                60o C                              700 C

34                                    30                                      23

24                                    31                                      28

36                                    34                                      28

39                                    23                                      30

32                                    27                                      31

Your Answer:

—————

QUESTION 2

#15 Testing Chemical Process: application problem on the multiple comparison procedures.

To test whether the mean time needed to mix a batch of material is the same for machines produced by three manufacturers, the Jacobs Chemical Company obtained the following data on the time (in minutes) needed to mix the material.

Manufacturer

1

2

3

20

28

20

26

26

19

24

31

23

22

27

22

1. Use these data to test whether the population mean times for mixing a batch of material differ for the three manufacturers. Use  a = .05.

2. At the a = .05  level of significance, use Fisher’s LSD procedure to test for the equality of the means for manufacturers 1 and 3. What conclusion can you draw after carrying out this test?

Your Answer:

QUESTION 3:

Gender Differences in Raise or Promotion Expectations. The Adecco Workplace Insights Survey sampled men and women workers and asked if they expected to get a raise or promotion this year. Suppose the survey sampled 200 men and 200 women. If 104 of the men replied Yes and 74 of the women replied Yes, are the results statistically significant in that you can conclude a greater proportion of men are expecting to get a raise or a promotion this year?

1.     State the hypothesis test in terms of the population proportion of men and the population proportion of women.

2.     What is the sample proportion for men? For women?

3.     Use a .01 level of significance. What is the p-value and what is your conclusion?

QUESTION 4

Q2: Given the following data.

xi:

3

12

6

20

14

yi:

55

40

55

10

15

The estimated regression equation for these data is ý = 68 – 3x.

1.     Compute SSE, SST, and SSR using equations (14.8), (14.9) and (14.10).

2.     Compute the coefficient of determination r2. Comment on the goodness of fit.

Adolescent pregnancy is viewed as a high-risk situation because it poses serious health risks for the mother and the baby. Describe various risk factors or precursors to adolescent pregnancy. Research community and state resources devoted in adolescent pregnancy and describe at least two of these resources. Research the teen pregnancy rates for the last 10 years for your state and community. Has this rate increased or decreased? Discuss possible reasons for an increase or decrease. 

MAKAFUI 

Re: Topic 3 DQ 1
 

According to the Centers for Disease Control and Prevention (CDC), roughly 22 per thousand births are born to teenage mothers (CDC, 2017). Risk factors to adolescent pregnancy include socioeconomic issues of poverty, low levels of literacy, low levels of education, single parent households, unemployment, incarceration, and living in crowded and poor neighborhoods (Falkner et al., 2018). Maryland State’s teenage birth rate has declined by 53% since 2001, and in 2017, the teenage birth rate in Maryland was 31.8 out of 1,000 births (Dumas et al., 2020). In Montgomery County in the state of Maryland, the teenage birth rate declined between 2008 and 2014 to 12.3 out of every 1,000 births with racial disparities showing Hispanic teens aged 15-19 having significantly higher birth rates at 20.9 per thousand births compared to 6.3 for White and 7.4 for Black teens in the same age category (Montgomery County Government: Department of Health and Human Services, 2016). 

The possible reasons for the decline in teenage pregnancy rates include increased access to school health services and school nurses, increased access to community health case management services, expansion of sex education in middle school and high school (which includes topics like pregnancy prevention strategies), and a proliferation of programs for prevention of adolescent pregnancy such as the Interagency Coalition on Adolescent Pregnancy (ICAP) (Feldman & Margolis, 2016; Jiang et al., 2017; Shifflet-Chila et al., 2016). The School health services and community health services are part of the interagency coalition that supports adolescent pregnancy prevention and parenting support programs through case management, education, and birth control support. 

Another resource dedicated to adolescent pregnancy prevention and support is the American Academy of Pediatrics (AAP), through its website that provides data, tools, resources, and educational materials on health promotion for pregnant teenagers (Shifflet-Chila et al., 2016). Similarly, the federally funded Teen Pregnancy Prevention Programs (TPP), which comprise sex education and sexually transmitted infections (STI) education also focus on adolescent pregnancy prevention and can be accessed through the U.S. Department of Health and Human Services website (Feldman & Margolis, 2016). The growth of these programs helps to slow down the rate of teenage pregnancy and births. 

References 

Centers for Disease Control and Prevention. (2017). About teen pregnancy. Retrieved from https://www.cdc.gov/teenpregnancy/about/index.htm 

Dumas, S. A., Chu, S., &Horswell, R. (2020). Analysis of Pregnancy and Birth Rates Among Black and White Medicaid-Enrolled Teens. The Journal of adolescent health: Official publication of the Society for Adolescent Medicine, 67(3), 409–415. https://doi.org/10.1016/j.jadohealth.2020.04.026 

Feldman Farb, A., & Margolis, A. L. (2016). The Teen Pregnancy Prevention Program (2010-2015): Synthesis of Impact Findings. American journal of public health, 106(S1), S9–S15. https://doi.org/10.2105/AJPH.2016.303367 

Jiang, Y., Granja, M. R., &Koball, H. (2017). Basic facts about low-income children: Children 12 through 17 years. Retrieved from http://www.nccp.org/publications/pdf/text_1174.pdf 

Montgomery County Government: Department of Health and Human Services. (2016). Teen Pregnancy trends. https://www.montgomerycountymd.gov/council/Resources/Files/agenda/cm/2016/160711/20160711_HHSED1.pdf 

Shifflet-Chila, E. D., Harold, R. D., Fitton, V. A., &Ahmedani, B. K. (2016). Adolescent and family development: Autonomy and identity in the digital age. Children and Youth Services Review, 70, 364-368. doi:10.1016/j.childyouth.2016.10.005 

Response 

This is excellent work, Makafui. The focus on adolescent pregnancies is well done. It is detailed and captures points about the topic. I agree with you that there is a steady decline in teenage pregnancy. According to CDC (2021), the teen birth rate in the US has been reducing since the year 1991. For instance, the teen birth rate declined from 17.4% per 1,000 teenage girls in 2018 to 16.4% per 1,000 teenage girls in 2019. Moreover, birth rates reduced by 7% for girls aged 15-17 years and 4% for females between 18 and 19 years. Although there are no precise reasons for the fall in teen pregnancy, evidence points that the declines can be attributed to sexual abstinence and increased utilization of birth control compared to the previous years (CDC, 2021). The decline in teen pregnancy is impressive, and there is a need to implement various initiatives to ensure the trend is maintained. Some of the initiatives include providing support programs and counseling to prevent teen pregnancy (Dowden et al., 2018). These groups can offer education on birth control and assist teens in understanding their sexual limits to avoid risky sexual behaviors (Leftwich & Alves, 2017). 

References 

CDC. (2021). About Teen Pregnancy. Retrieved from https://www.cdc.gov/teenpregnancy/about/index.htm 

Dowden, A. R., Gray, K., White, N., Ethridge, G., Spencer, N., & Boston, Q. (2018). A Phenomenological Analysis of the Impact of Teen Pregnancy on Education Attainment: Implications for School Counselors. Journal of School Counseling, 16(8), n8. https://eric.ed.gov/?id=EJ1184922 

Leftwich, H. K., & Alves, M. V. O. (2017). Adolescent pregnancy. Pediatric Clinics, 64(2), 381-388. https://doi.org/10.1016/j.pcl.2016.11.007 

GARDALA 

Adolescent pregnancy is linked to a number of negative consequences. Risk factors for teen pregnancy include
living in poverty, poor maternal academic education, and being a baby of a teen mother. Other factors
contributing to teen pregnancy are early sexual activity, abusive home situation, alcohol and drug
dependency, single-parent homes, and low self-esteem (Papri, Khanam, Ara, & Panna, 2016). Teen pregnancy is a
higher risk pregnancy, pregnancy tees are usually possible to develop gestational hypertension and anemia, and
have pre-term labor and delivery. Teens are also more likely not to know they have a sexually transmitted disease,
some that can cause harm to the baby (Araujo Silva et al., 2013). They are less likely to obtain prenatal care and
keep their appointments.
Comprehensive Adolescent Pregnancy Prevention (CAPP) is a New York state initiative with the purpose of decreasing
adolescent pregnancies. This is done through the establishment of a comprehensive approach that reduces initial
pregnancies and STDs among adolescents (" Comprehensive adolescent pregnancy prevention / CAPP," 2020). Family
Planning Benefit Program is also available for those who are not able to afford contraceptive services. It increases
accessibility to family planning services among individuals with an aim of reducing rates of unintentional
pregnancies especially among adolescents (Travers, O' Uhuru, Mueller, & Bedell, 2019). Access to birth control and
education on its importance can help in preventing teen pregnancy.
Travers et al (2019), notes that teenage birth rates in New York State had declined by 73% between 1991 and 2017.
This shift is due to efforts from health initiatives involving the government, schools, community groups, parents, and adolescents. Young people have been provided with the necessary resources that help them make informed
decisions about their sexual and reproductive health. Reality television shows, social media, and public health
campaigns have also incorporated pregnancy prevention information targeting adolescents. 

References
Araujo Silva, A. C., Santos Andrade, M., da Silva, R. S., Evangelista, T. J., Santos Bittencourt, I., & do Nascimento
Paixão, G. P. (2013). Risk Factors Contributing to the Occurrence of Adolescent Pregnancy: Integrative Review of
the Literature. RevistaCuidarte, 4(1), 531–539.
Comprehensive adolescent pregnancy prevention / CAPP. (2020, February 3). Retrieved from https://www.spcc-
roch.org/programs/comprehensive-adolescent-pregnancy-prevention/
Papri, F. S., Khanam, Z., Ara, S., & Panna, M. B. (2016). Adolescent Pregnancy: Risk Factors, Outcome and
Prevention. ChattagramMaa-O-Shishu Hospital Medical College Journal ,15(1), 53-56.
Travers, M., O'Uhuru, D., Mueller, T., & Bedell, J. (2019). Implementing Adolescent Sexual and Reproductive
Health Clinical Best Practice in the Bronx, New York. Journal of Adolescent Health ,64(3), 376-381. 

[Text Wrapping Break] 

Response 

This is an outstanding work, Gardala. You have provided thoughtful and insightful details about the topic. I agree with you. Teen pregnancy remains a key contributor to child and maternal mortality (Leftwich & Alves, 2017). Complications about teen pregnancy and childbirth are the primary reasons for death in girls aged between 15-19 years internationally. Pregnant girls and adolescents also experience various health risks and complications because of their immature bodies. Moreover, children born to adolescent mothers are equally at a higher risk. Unmarried pregnant teenagers also tend to face rejection or stigma by families, society, and peers. Teenage pregnancy also characterizes economic and social effects on teenage girls, families, and communities (Plan International, 2021). Therefore, there is a need to help adolescent girls by increasing awareness of their reproductive and sexual health rights, safeguarding them from abuse, and ensuring access to health services and education (Nkhoma et al., 2020). Adolescent pregnancy tends to increase when girls are barred from making decisions regarding their reproductive health and sexual choices. As such, it is important to help girls decide about their bodies and access health care services (Plan International, 2021). 

References 

Leftwich, H. K., & Alves, M. V. O. (2017). Adolescent pregnancy. Pediatric Clinics, 64(2), 381-388. https://doi.org/10.1016/j.pcl.2016.11.007 

Nkhoma, D. E., Lin, C. P., Katengeza, H. L., Soko, C. J., Estinfort, W., Wang, Y. C., … & Iqbal, U. (2020). Girls’ empowerment and adolescent pregnancy: A systematic review. International journal of environmental research and public health, 17(5), 1664. 10.3390/ijerph17051664 

Plan International. (2021). Teenage pregnancy. Retrieved from https://plan-international.org/sexual-health/teenage-pregnancy 

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The purpose of the paper is to relate the discoveries of science, your particular major, and the Christian ethic in a logical, coherent manner. Everyone on Earth has a worldview that shapes and directs the way they interact with the world, their neighbors and family, and how they view themselves. As we discussed in class, the atheistic/materialistic worldview describes the universe as a purposeless accident in which only the physical realm exists. Science, therefore, can only test things in the material world and has shown us that we are nothing more than “meat robots” with only an illusion of free will. The Christian ethic, however, understands the universe as an intentional, purposeful Creation, in 9 which we are all called to glorify the God who created us with all our mind, soul, and strength. We have inherent dignity as image-bearers of the Creator, and a slew of other attributes which we share with God, including creativity, love, and rationality.

NRNP 6675 Legal and Ethical Issues Related to Psychiatric Emergencies

Psychiatric emergencies entail severe disturbances in mood, thought, behavior, and social relationships and interactions that necessitate immediate intervention plans as defined by an individual, their family, or social unit. These immediate interventions are essential to save the patient and those close to them from possible or impending harm (including self-harm) and danger to themselves and others. Across many states in the U.S., psychiatric emergency holds laws and statutes, including in Illinois, permit involuntary admission of an individual with an acute mental illness to a healthcare facility under prescribed circumstances (Zakhari, 2021). The purpose of this paper is to explore legal and ethical issues concerning psychiatric emergencies and identify evidence-based suicide and violence risk assessments in Illinois.

Illinois State Laws for Involuntary Psychiatric Holds for Child & Adult Psychiatric Emergencies

In Illinois, an individual, either an adult or a child, can be admitted on psychiatric holds if there is a possibility of self-harming or posing danger to others. There are two types of involuntary admission in Illinois; by a court or through an application. Individuals who are involuntarily admitted to a psychiatric hold or are being treated for mental health and substance abuse and live in northern Illinois have more protections. In this case, admission by certification is the main process through which most individuals get admitted to a psychiatric hold in Illinois (Illinois Legal Aid Online, 2023). This can happen even without a court order as it entails filing a petition for immediate hospitalization of the affected person in the circuit court in their respective county.

The person filing the petition should be at least 18 years. The facility can release the individual after 24 hours of admission unless a certificate is filed upon which the person can be on hold for a further total of 72 hours that include the initial 24 hours. The emergency hold can only release an individual under involuntary hold to the guardian, or lawyer after 24 hours or process transportation to a mental health facility based on certification after examination by the physician (Zakhari, 2021). In the case of a child, the process provides that a child can be released or discharged if the current assessment shows that they no longer require emergency hospitalization. For adults, involuntary commitment applies to individuals with psychiatric disabilities and can cause harm to themselves or others or gravely disabled.

Differences: Emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient Commitment

In Illinois, emergency hospitalization for evaluation or psychiatric hold entails response to a crisis where one is admitted to a hospital’s emergency setting or treatment facility for providers to carry out a psychiatric assessment or examination. The admission time is usually 24 hours and can be extended through a court petition or application. Inpatient commitment entails a circuit court judge ordering the hospitalization of an individual who meets the state civil commitment criteria upon the emergency evaluation by at least two mental health providers. On its part, outpatient commitment occurs when one files a petition for involuntary admission in outpatient and presents it to a judge who determines if the individual in question should be committed to the described facility. The petition should be supported by at least two pieces of evidence called outpatient certificates from a psychiatrist and another clinician (Illinois Legal Aid Online, 2023b). The judge orders the qualifying individual presenting mental illness symptoms to adhere to a mental health treatment plan while outside the facility.

Differences Between Capacity and Competence in Mental Health

Capacity and competence are core aspects of mental health that affect the provision of care and interventions by psychiatric mental health nurse practitioners (PMHNPs). Capacity is the ability and cognitive functionality that allows one to make conscious and effective decisions based on the information offered. Competence on its part implies the ability to perform or execute actions required to effect the decisions and choices that one makes (Bipeta, 2019). Questions of capacity in mental health emanate from legal aspects while competence requires cognition to effect the decisions. Competence requires knowledge based on expertise and experience, skills or mental abilities and attitudes as well as personality traits that inform one’s perspective or worldview.

Legal and Ethical Issues of Confidentiality in Psychiatric Emergencies

Confidentiality is a core aspect that influences and affects the relationship between PMHNP and patients. Psychiatric nurses have a responsibility of keeping patients’ data and conditions confidential and never disclose such information. When a patient allows a nurse to disclose such information, the nurse should ensure that the process emanates from informed consent signed by the individual (Becker et al., 2020). The written authorization protects the nurse from any legal suits or redress that a patient may pursue and also lays the foundation for ethical practice by the nurse.

Despite the expected legal provision, ethical situations may compel nurses to disclose such information to third parties, especially in situations where non-disclosure can cause harm to others. The nurse may be compelled to give information during emergencies to protect other people who may be harmed because of the patient’s actions and situation (Bipeta 2019). Others include having infectious diseases and treating injuries that may lead to a criminal investigation or require directives from courts.

Evidence-Based Suicide Risk Assessment Tool

The Patient Health Questionnaire-9 (PHQ-9) is an evidence-based suicide risk assessment tool that contains questions that a provider can use in screening, diagnosing, and monitoring mental health conditions like depression and anxiety. The tool also evaluates the degree of severity of the mental issues. The tool contains one question that screens for the presence and duration of suicidal ideation (King et al., 2019). Screening patients for suicidal risks is essential as it allows the initiation of early treatment interventions and plans.

One Evidence-Based Violence Risk Assessment Tool

The Forensic Violence Oxford (FoVOx) is an evidence-based violence risk assessment tool that helps screen possible violent conduct of individuals in healthcare settings. The tool consists of 12 items that assist in determining the violence risks in mental health patients. The tool is not only feasible but also practical and easy to use (Cornish et al., 2019). It also assists in addressing the inconsistency at the time of discharge and may help clinicians to make better decisions if used routinely.

Conclusion

Mental health nurse practitioners like PMHNPs need to understand the different legal and ethical aspects that govern the treatment of patients in psychiatric emergencies, especially within their practice jurisdictions. Ensuring that they understand these provisions is critical to offering the best care and complying with the requirements. Assessment tools for suicide and violence are key to developing the right interventions to help patients get better outcomes.

References

Becker, S. H., & Forman, H. (2020). Implied Consent in Treating Psychiatric Emergencies.

            Frontiers in Psychiatry, 11, 127. DOI: 10.3389/fpsyt.2020.00127

Bipeta R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian Journal of

psychological medicine, 41(2), 108-112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th

            ed.). Wolters Kluwer.

Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones &

            Bartlett Learning.

Cornish, R., Lewis, A., Parry, O. C., Ciobanasu, O., Mallett, S., & Fazel, S. (2019). A clinical

feasibility study of the forensic psychiatry and violence Oxford (FoVOx) tool.

Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.0090

Illinois Legal Aid Online (2023). Being admitted to a mental health facility in an emergency.

Illinois Legal Aid Online (2023b). Getting an outpatient commitment order.

King, C. A., Horwitz, A., Czyz, E., & Lindsay, R. (2017). Suicide Risk Screening in Healthcare

Settings: Identifying Males and Females at Risk. Journal of clinical psychology in medical settings, 24(1), 8-20. https://doi.org/10.1007/s10880-017-9486-

Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual.

            Springer Publishing Company. Chapter 15, “Violence and Abuse”

Topic 2 DQ 2 

Compare the physical assessment of a child to that of an adult. In addition to describing the similar/different aspects of the physical assessment, explain how the nurse would offer instruction during the assessment, how communication would be adapted to offer explanations, and what strategies the nurse would use to encourage engagement. 

Tanveer 

Re: Topic 2 DQ 2
 

Medical assessment comparison between child and Adult 

There are numerous procedures for medical and physical assessment on a child patient which also correlates with the adult patient but still there are lot of differences. Adults have lot more complicated medical history then children. General and central nervous system anatomy and physiology in children is different to that of adults. Pediatric patients are at increased risk of lacking vital signs documentation during prehospital care. (Differences in Prehospital Patient Assessments for Pediatric Versus Adult Patients, 2018) 

The similar/different aspects of the physical assessment, instructions during the assessment, how communication would be adapted to offer explanations, and strategies the nurse would use to encourage engagement. 

Age is not just a number (Similar/difference aspects of assessment) 

Remember the names Erikson, Freud, and Piaget? Adult nurses reading this are cringing a little and feeling very relieved that those names are a distant nursing school memory. Pediatric nurses might not remember those exact theories on development, but treating patients based on age is a constant consideration in the pediatric population. The first major difference between adult and pediatric nursing is the role age plays in nursing care. 

As a pediatric nurse, you could have 3- 5 patients of entirely different ages. As a nurse, this means 3-5 different reasoning strategies to convince them to take medications, different coping abilities for traumatic or painful procedures, different physical skills based on motor development, different cognitive abilities, different lab value and vital sign normal ranges… the list goes on. That’s a love or hate aspect of pediatric nursing – such a wide variety in developmental stages. With adults, the majority fall within very consistent expected cognitive, emotional, physical, and clinical data ranges. When you discuss a procedure or a diagnosis to an adult patient, you can use logical explanations to help them understand what to expect. You can address everyone in the room at once, including other family and visitors. With children, you are explaining in one manner to the parents, and entirely differently to the pediatric patient. 

A 5 minute vs. 1-hour explanation of past medical history assessment 

It’s no surprise that adults generally have more complicated and extensive medical histories than children. Because of this, adult nurses are much more concerned with the interconnectedness of illnesses within the patient. It’s particularly important to get a thorough history for adult patients because comorbidities can explain seemingly unrelated presenting symptoms, or medication interactions to treat different conditions can be contraindicated. Adult nurses usually have a good understanding of disease pathophysiology, and how one body system affects another. 

Pediatric assessment is usually more straightforward. Children typically have fewer allergies, limited to no medical history, no surgical history, and a single medical problem with an associated etiology. But just because children tend to have less complex histories, does not mean they are any easier to care for medically. Pediatric patients actually crash quicker, they have less reserves, and can compensate normal vitals for extended periods of time before a sudden decline. Children don’t present the same way for sepsis, stroke, or heart conditions. And because some are too young to talk, it also requires keen assessment skills and reliance on intuition. (Hamstra, n.d.) 

Assessment differs for Neuropathic Pain 

The various screening and assessment tools available to clinicians for evaluating neuropathic pain. Despite the availability of the 15 tools discussed, a deficiency remains, particularly in the pediatric realm. To date, there is no well-validated neuropathic pain assessment tool for children younger than 5 years, no pediatric neuropathic pain screening tool that has been validated outside the domain of chemotherapy-induced peripheral neuropathy, and no consistent recommendation regarding the optimal tool to use with pediatric patients who have chronic pain. These areas, as well as others, would benefit from further research and development. (Kyle & Doralina, 2017) 

Difference between dealing family/visitors during treatment and assessment and instructions 

Adult patients have plenty of visitors throughout the day, but typically they are more self-sufficient. Their family and visitors will certainly fire tons of questions at you, but there is also usually a limit to their interference with your actual nursing duties. 

However, pediatric nurses must get used to parents breathing down their necks with every little thing. And it is totally understandable and acceptable – we are caring for their precious babies after all – but some nurses really don’t like the additional pressure that parents can add to already stressful situations. When you are starting an IV on a 1 week old, you’re praying that you don’t miss either. 

On the other end of the spectrum, sometimes parents have other children to care for or both parents work, and pediatric patients can be left alone often if they stay in the hospital for extended periods of time. That comes with other challenges as a nurse – doubling as the disciplinary, the caregiver, and the nurse. Sometimes it’s hard to know your place and to not overstep boundaries with families because your role is parental-like in some ways. 

Fluids 

Adults can be much easier in certain ways. They usually have larger veins for IVs, you can safely push medications and run blood products quickly. Everything in pediatric nursing is fragile and sensitive. Tiny doses of medications run slowly on pumps, small chest tubes, and even the slightest nursing errors can have big consequences. You need steady, careful, and gentle hands for pediatrics. Adults can withstand a lot more. 

Communication strategies by nurse for pediatric and adult patients 

When you discuss a procedure or a diagnosis to an adult patient, you can use logical explanations to help them understand what to expect. You can address everyone in the room at once, including other family and visitors. With children, you are explaining in one manner to the parents, and entirely differently to the pediatric patient. It’s like learning another language. BUT just because adult patients are older and supposedly more mature, don’t assume they’re more independent than children. I have seen plenty of adults that need more babysitting and reminders for baths and meds than pediatrics patients. 

Strategies to encourage engagement 

People often think of pediatrics as all play, and adults as all serious – but I challenge you (as an adult nurse) to break the mold if you don’t already. Even adults like to play sometimes. Who says adults wouldn’t enjoy a coloring book and a popsicle? And for the perception of pediatrics being all play, don’t forget about the tough moments that come along with caring for children – temper tantrums, infants crying, teenage mood swings, puberty…there are plenty of pros and cons for both nursing populations. (Hamstra, n.d.) 

References 

Differences in Prehospital Patient Assessments for Pediatric Versus Adult Patients. (2018, 8). Retrieved from Science Direct: https://www.sciencedirect.com/science/article/abs/pii/S0022347618304815 

Hamstra, B. (n.d.). 4 Major Differences Between Pediatrics And Adult Nurses. Retrieved from Nurse.org: https://nurse.org/articles/differences-between-pediatrics-adults/ 

Kyle, M. J., & Doralina, A. L. (2017, 11). A Review of Adult and Pediatric Neuropathic Pain Assessment Tools. Retrieved from Wolters Kluwer Health, Inc.: https://journals.lww.com/clinicalpain/Abstract/2017/09000/A_Review_of_Adult_and_Pediatric_Neuropathic_Pain.10.aspx 

Hello Tanveer, 

Thank you for this great discussion, you have integrated all the aspects of the question with the subtopics. From your discussion, it is true that there are numerous procedures for medical and physical assessment on a child patient, which also correlates with the adult patient, but still there are lot of differences (Wachs & Sheehan, 2018). The assessments need to be carefully undertaken on the basis of the medical history as well as the conditions that the patients may show. Nurses and other medical professionals should always identify the correct procedures on how to undertake the diagnosis and the assessment processes. In the processes of assessments for both the adults and children, there is always the need to interrogate family members on the possible complication which may lead to the diseases. Also, there is always the need to apply effective medical equipment so as to facilitate the assessment processes. 

References 

Wachs, T. D., & Sheehan, R. (2018). Assessment of Young Developmentally Disabled Children. Boston, MA: Springer US.       

The post NRS 434 Topic 2 DQ 2 appeared first on Nursing Assignment Crackers.

Week 9 Main Post

One of the most challenging conditions to treat in mental health is bipolar disorder. This complex disorder become even harder to treat in pregnant women. While there are risks to stopping the medication during pregnancy, there are also risks in continuing certain medications. Many of the mood stabilizers used to treat bipolar are known to have an increased risk of congenital defects if taken during pregnancy (Epstein et al., 2014). Zyprexa, Olanzapine, is an atypical antipsychotic medication that is frequently used to treat bipolar disorder. This medication has not been associated with an increased risk of miscarriage or congenital birth defects (Olanzapine (Zyprexa®), n.d.). Studies suggest that patients taking Zyprexa during pregnancy are at no larger risk of adverse effects than the normal population (Galbally et al., 2014).

This medication is ranked by the FDA as a level C pregnancy medication. This means risks cannot be ruled out. This ranking system is how the FDA presents guidelines on prescribing medications during pregnancy (Armstrong, 2008). Although it is not recommended to abruptly stop medications, many patients choose to use therapy instead of medication during pregnancy. CBT can help patients keep the depressive symptoms and mania at bay during pregnancy without having to use medication (Epstein et al., 2014). There are antidepressant medications that are deemed safer for use during pregnancy that could be used off label for bipolar disorder. One of those medications is Zoloft. Most SSRIs are considered safe options during pregnancy. Zoloft is considered one of the safest options for pregnant patients (What Is the Safest Antidepressant to Take When Pregnant?, 2021).

Resources

Armstrong, C. (2008). ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation. American Family Physician, 78(6), 772–778. https://www.aafp.org/pubs/afp/issues/2008/0915/p772.html

Epstein, R., Moore, K., & Bobo, W. (2014). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, Healthcare and Patient Safety, 7, 7. https://doi.org/10.2147/dhps.s50556

Links to an external site.

Galbally, M., Snellen, M., & Power, J. (2014). Antipsychotic drugs in pregnancy: a review of their maternal and fetal effects. Therapeutic Advances in Drug Safety, 5(2), 100–109. https://doi.org/10.1177/2042098614522682

Olanzapine (Zyprexa®). (n.d.). MotherToBaby. https://mothertobaby.org/fact-sheets/olanzapine/

Links to an external site.

What Is the Safest Antidepressant to Take When Pregnant? (2021, November 30). Psych Central. https://psychcentral.com/depression/safest-antidepressant-in-pregnancy#zoloft-vs-lexapro

Maternity is frequently seen as a duration of pleasure and psychological wellness for females. On the other hand, pregnancy and being a parent increase a female’s sensitivity to psychological disorders such as anxiety as well as anxiousness. According to a recent research, depression is a common problem in a lot of pregnant females. This problem is frequently misdiagnosed because they are attributed to variants in the mother’s mindset or physiology while pregnant. Furthermore, this ailment is frequently undiagnosed and neglected because of concerns concerning drug’s possible negative effects. Clinical depression adverse effects, consisting of modifications in sleep time, hunger, and energy degrees, are commonly hard to figure out during pregnancy from those connected with common expectant experiences. While as much as 75% of pregnant women experience signs of some depressive state of mind problems, the proportion of females satisfying the analysis requirements for major anxiety has actually been estimated to be between 12.6% at 31 weeks gestation and also 16% at 34 to 35 weeks of pregnancy(Shimada et al., 2021). There is a factor for hope. Clinical depression can now be dealt with medically or emotionally. Both are usually used. Pharmacists and also doctors usually recommend Sertraline to treat clinical depression in expecting females. Sertraline is an FDA-approved drug used to deal with depressive conditions as well as anxiety conditions, mainly suggested to pregnant females. This medication might enhance the state of mind, sleeping, hungers, and power level as well as help them uncover an interest in their everyday activities(Shimada et al., 2021). It has the possible to reduce concern, stress and anxiety, unfavorable feelings, and also the occurrence of panic occasions. It may likewise lessen the need to conduct repetitive tasks that disrupt daily life.

Reference

Shimada, B. M. O., Santos, M. D. S. O. M. D., Cabral, M. A., Silva, V. O., & Vagetti, G. C. (2021 ). Treatments amongst Expectant Females in the Field of Songs Treatment: An Organized Evaluation. Revista Brasileira de Ginecologia e Obstetrícia, 43, 403-413.

The Elderly Adult and Anxiety

            Anxiety disorders occur frequently in the elderly population. The disorder with the highest prevalence rate among the elderly is known as generalized anxiety disorder or GAD (Park, 2022, pp. 2649). There are however some treatment options that could be implemented for GAD, which could include FDA-approved medications, off-label medications, and nonpharmacological interventions. As an APRN is important that we consider each treatment option carefully due to the older adult having an increased risk of adverse effects, intolerability, and drug-drug interactions according to Crocco et al. (2017, pp. 2).

          One FDA-approved drug for treating anxiety in older adults is Escitalopram (Lexapro), which is considered a selective serotonin reuptake inhibitor (SSRI). SSRIs are known to be the first-line treatment for older adults with GAD. The reason for this is because SSRIs of safety profile and the fact that it has more tolerability within the elderly population. (Crocco et al., 2017, pp. 3). One benefit of using Lexapro is that it has been shown to assist with symptom reduction in older adults suffering from GAD. One risk indicated by Crocco et al. (2017) is the potential for “abnormal cardiac conductivity”, which recommends a maximum Lexapro dosage of 20 mg per day in the elderly population to reduce the possibility of this occurring (pp. 3). Therefore, elderly adults with cardiac conditions should be closely monitored while on this medication, including routine labs and examinations.

          An off-label drug that is used to treat older adults with anxiety disorders is Pregabalin or Lyrica, which is considered an anticonvulsant. Often times it has proven to effectively treat anxiety in elderly patients. Garakani et al. report that research studies have proven that the anticonvulsant medication most successful in treating GAD is Pregabalin. It is also mentioned that it is a very tolerable medication among the elderly population, which is a benefit of using this medication. There are several risk factors identified, including adverse side effects such as sedative effects, dizziness, and weight gain. (pp. 3). Another important consideration is that Pregabalin is a Schedule V, which means it has a high contingency for misuse and abuse. After initiating treatment with this occasional drug screening may be necessary to ensure it is being used by the elderly individual. Once deciding to discontinue this medication the APRN should remember Pregabalin must be tapered off to prevent withdrawal symptoms such as tremors, tics, or seizures in the elderly adult.

          Nonpharmacological treatment intervention for elderly adults with anxiety is known as “The Butterfly Hug”.  The Butterfly hug is done by “crossing both hands on the chest and then clapping both hands like the flapping wings of a butterfly” (Girianto, 2021, pp. 297), while simultaneously deep breathing.  This intervention is known as “direct bilateral stimulation” (pp. 297), which produces a calming effect and reduces anxiety. This could be taught to the elderly patient in psychotherapy sessions.

          There are multiple risk assessment tools used to assist with recognizing elderly adults who may require treatment for anxiety. The Generalized Anxiety Disorder scale-7 also known as GAD-7 is an “easy-to-use 7-item scale, based on Diagnostic and Statistical Manual of Mental Disorders-IV criteria, for identifying likely cases of GAD” (Sapra et al., 2020, pp. 2). Based on the score it will indicate the severity of the patient’s symptoms, classifying them as minimal, mild, moderate, or severe (pp. 3). This will assist the APRN with validating the necessity of treatment for GAD.

          According to Gautam et al. (2017), there are clinical practice guidelines that exist for generalized anxiety disorder. First, the diagnosis of GAD must be given by the provider after a thorough comprehensive assessment is completed. Then the provider must decide between psychotherapy, pharmacotherapies, or a combination of them both for the patient.  Therefore, I think that treating the patient with Lexapro and Pregabalin is the correct treatment option for an elderly patient with GAD. Initiating treatment with psychotherapy to assist with introducing healthy coping mechanisms for the patient when anxious is another great recommendation.

          Overall treating a special population such as the elderly is a complex process. Many things need to be taken into consideration for an elderly patient with GAD, such as other comorbid conditions like renal failure or cardiac conditions before initiating pharmacotherapy. Also, the cognition of an elderly patient is sometimes declined due to age or other comorbid conditions such as dementia, therefore one must consider if psychotherapy would even be effective due to their lack of understanding.

First, read “Case Study 15-8, Healthy Conflict Resolution”, on page 289-90 of Organizational Behavior in Health Care. Based on the information in Chapter 4 and your independent research, write a paper that addresses the following questions: What are the five conflict modes? What is the basis/cause of the conflict in the case described? What conflict style/handling-mode should be use to resolve the conflict? Why is the chosen approach preferable to other approaches? What are the advantages and disadvantages of your choice? Your well-written paper should meet the following requirements: Four-to-five pages in length, not including the cover sheet and reference page. Formatted according to APA 7th edition and Saudi Electronic University writing standards. Provide support for your statements with in-text citations from a minimum of four scholarly articles. Two of these sources may be from the class readings, textbook, or lectures, but the other two must be external. The Saudi Digital Library is a good place to find these references. You are strongly encouraged to submit all assignments to the Originality Check prior to submitting them to your instructor for grading.

Child abuse and maltreatment is not limited to a particular age—it can occur in the infant, toddler, preschool, and school-age years. Choose one of the four age groups and outline the types of abuse most commonly seen among children of that age. Describe warning signs and physical and emotional assessment findings the nurse may see that could indicate child abuse. Discuss cultural variations of health practices that can be misidentified as child abuse. Describe the reporting mechanism in your state and nurse responsibilities related to the reporting of suspected child abuse. 

MIREILLE 

Re: Topic 2 DQ 1
 

Child abuse is described as the intentional or unintentional damage (sexually, physically, or emotionally) of any child. Deprivation, ill-treatment, and neglect come under the umbrella of child abuse. Unexplained bruises and injuries, changes in behavior or dietary patterns, aggressive nature, or remaining silent are the signs of abuse. Unfortunately, child abuse is still prevalent across the world, especially in the United States. In 2019, there were approx 650000 documented occurrences of child abuse, with neglect being the most frequent kind of maltreatment in the United States. Child abuse knows no gender discrimination and the rates are almost similar between boys and girls. There is a positive relationship between official child abuse and environmental poverty in all racial/ethnic groups (Kim & Drake, 2018). 

Child abuse among toddlers is very common. They are prone to physical, emotional, and sexual abuse. The signs of physical abuse are children returning home with unexplained injuries, bruises, abrasions, cuts, bite marks, or other physical signs. Repeated injuries of any kind might be a red flag. If there are changes in their typical behavior, such as being very irritable, anxious, furious, or silent, child abuse can be suspected. The signs of sexual abuse are genital discomfort, bruising in the genital areas, itching, bleeding, frequent urinary tract infections, and trouble walking or sitting due to genital or anal discomfort. Emotional abuse can be identified when the child exhibits signs of behavioral issues or changes, such as avoiding a parent’s attention, becoming excessively angry or despondent. Abused children frequently exhibit extreme behavior. 

The nurse by taking a proper history from the child and parents and observing the signs as mentioned above can rule out abuse. 

Many cultural practices are prevalent in various countries and can be misidentified as abuse. Coining is practiced in South East Asian countries in which the kin that has been greased with oil is scraped with a ceramic spoon, a worn coin (Vitale & Prasad, 2017). Moxibustion is another traditional Chinese therapeutic technique that originated in Asian medicine and included burning rolled pieces of moxa plant (Killon, 2017). 

In my state (Florida), various abuse hotlines, toll-free numbers function 24 hours a day with the availability of counselors. The person reporting can contact and submit the details of the abuse. The complainant can register the complaint on https://reportabuse.dcf.state.fl.us/ also. 

Killion, C. M. (2017). Cultural healing practices that mimic child abuse. 

Kim, H., & Drake, B. (2018). Child maltreatment risk as a function of poverty and race/ethnicity
in the USA. International journal of epidemiology, 47(3), 780-787. 

Vitale, S. A., & Prashad, T. (2017). Cultural awareness: coining and cupping. Int Arch Nurs Health Care, 3(3), 080. 

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RESPOND HERE (150 WORDS, 3 REFERENCES) 

Hello Mireille, 

I do agree with you that child abuse is still prevalent in the US with approximately 4.4 million reported cases annually by the American Society for Positive Care of Children annually (Cooley & Taussig, 2021). However, some 3.5 million cases go unreported annually. Of the 4.4 million cases reported about 3.4 million received prevention and post response services. Socio-economic factors are the key indicators of such cases of child abuse happening. The cases are common in families of lower income and one or both parents abuse drugs (Tarantola, 2018). Addiction to use of prescription drugs or other hard drugs have been strongly linked to emotional instability and such parents have shown greater possibilities of mistreating their children from early age onwards. The cases of child abuse know no gender as both boys and girls are abused in equal measure. It is in the adolescent stage that the child strongly manifests the symptoms of child abuse (Li et al., 2021). At this age those abused may become extremely aggressive with high emotions that can be self-destructive is not well managed. However, girls are susceptible to forms of abuse related to either sexual exploitation or child sex-trafficking. From the year 2018, 29 states have reported about 900 unique cases of child sex trafficking. The majority of the victims, about 90 percent were girls.  

References 

Cooley, J. L., & Taussig, H. N. (2021). Anger and Attention Problems as Mechanisms Linking Maltreatment Subtypes and Witnessed Violence to Social Functioning Among Children in Out-of-Home Care. Child Maltreatment, 107755952110389. https://doi.org/10.1177/10775595211038926 

Li, W., Yang, J., Gao, L., & Wang, X. (2021). Childhood Maltreatment and Adolescents’ Aggression: A Moderated Mediation Model of Callous-Unemotional Traits and Friendship Quality. Child Maltreatment, 107755952110465. https://doi.org/10.1177/10775595211046550 

Tarantola, D. (2018). Child Maltreatment: Daunting and Universally Prevalent. American Journal of Public Health, 108(9), 1119–1120. https://doi.org/10.2105/AJPH.2018.304637 

EGLA 

Re: Topic 2 DQ 1
 

Infant and toddler abuse are very prevalent type of abuse that we see in children. Child abuse can include physical, sexual, or psychological abuse, or a combination of any of the three. It is important to access signs and symptoms of abuse in children because they might have effects later. Abuse might occur from home through caregivers or close family members. Risks associated with abuse of any kind include poverty, mental illness, and alcohol or substance abuse (Ho, Bettencourt & Gross, 2017). Toddlers who ae abused physically will have unexplained bruises, abrasions, burns, cuts, broken bones, black eyes, bite marks and other injuries that cannot be well accounted for 

Emotionally this child will be very withdrawn and scared of their caregiver. They will have behavioral problems like acting angry and depressed, they will sometimes act very aggressively and in a demanding manner. Behavioral signs that could be indicative of abuse may include fearfulness, inappropriate sexual behavior, abnormal or irrational fears, and social withdrawal. (Lee, Lindberg, Frasier, & Hymel,2021). Doing a thorough assessment will help in identifying any abuse suspicions. The victims and caregivers in this case will be very reluctant to provide any information therefore Nurses should be able to make a judgement of their assessments and follow the correct reporting mechanism of suspected child abuse according to their state laws. 

Cultures vary differently and what is acceptable in one culture might not be acceptable in another one. Some cultures spank their kids as a form of discipline and it is acceptable to them, other cultures will view that as abuse. Some cultures practice coining as a form of treating many illnesses but this could be mistaken for abuse. (Tan, & Mallika 2011). It is important to be culturally sensitive before making conclusions on about child abuse. It is our ethical duty as nurses to report child abuse, Ohio has a hotline that is confidential for reporting suspected child abuse. 

References, 

Ho, G. W. K., Bettencourt, A., & Gross, D. A. (2017). Reporting and identifying child physical abuse: How well are we doing? Research in Nursing and Health, 40(6), 519-527. doi:10.1002/nur.21818 

 Lee, G. S., Lindberg, D. M., Frasier, L. D., & Hymel, K. P. (2021). A changing history: When is it a red flag for child abuse? Child Abuse & Neglect, 117. https://doi-org.lopes.idm.oclc.org/10.1016/j.chiabu.2021.105077 

TAN AK, & MALLIKA PS. (2011). Coining: An Ancient Treatment Widely Practiced among Asians. Malaysian Family Physician, 6(2&3), 97–98. 

RESPOND HERE (150 WORDS, 3 REFERENCES) 

Hello ELA,  

I do agree with you that child abuse cases in the US occurs in many varied forms ranging from physical abuse to psychological one. Preventing child abuse and neglect can be accomplished through a variety of methods (Cirik et al., 2017). Primary care programs designed to identify high-risk patients and refer them to community resources, parent education to improve nurturing and increase the use of positive discipline strategies, and psychotherapy to improve caregivers’ coping skills and strengthen the parent-child relationship are examples of specific interventions (Curry et al., 2018). These interventions are provided in a variety of settings, including primary care clinics, schools, and the community. These programs typically entail a professional or paraprofessional (e.g., a peer educator or a community health worker) visiting a family’s home on a regular basis to provide counseling, educational services, or assistance (Molnar et al., 2021). Families are most frequently identified and referred by health care professionals during the prenatal and postpartum periods. Assessing family needs, giving information and referrals, providing clinical care, and strengthening family functioning and positive child-parent interactions are all part of these services. To assist families with young children, all states and the District of Columbia, as well as tribal and territorial governments, offer home visitation programs (Curry et al., 2018).  

References 

Cirik, V., Ciftcioglu, S., Efe, E., Cirik, V., Ciftcioglu, S., & Efe, E. (2017). Preventing child abuse and neglect. Archives of Nursing Practice and Care, 3(3), 064–067. https://www.peertechzpublications.com/articles/doi10.17352-2581-4265.000028-anpc.php 

Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Grossman, D. C., Kemper, A. R., Kubik, M., Landefeld, C. S., Mangione, C. M., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2018). Interventions to Prevent Child Maltreatment. JAMA, 320(20), 2122. https://doi.org/10.1001/jama.2018.17772 

Molnar, B. E., Scoglio, A. A. J., & Beardslee, W. R. (2021). Community-Level Prevention of Childhood Maltreatment: Next Steps in a World with COVID-19. International Journal on Child Maltreatment: Research, Policy and Practice, 3(4), 467–481. https://doi.org/10.1007/s42448-020-00064-4 

MAKAFUI 

Re: Topic 2 DQ 1 

Infants are particularly at a higher risk of child abuse and maltreatment due to their defencelessness and dependence on others as well as the intricate processes involved in their psychosocial, neurological, and cognitive development (GWIG, 2016). The most common types of abuse among infants include abusive head trauma from aggressive shaking (shaken baby syndrome), physical spanking (with bruises), burning, and falls from throwing or pushing (American Academy of Pediatrics, n.d.). Some of the infant abuses lead to fatalities, and in 78% of the cases, at least one parent is involved in the infant’s abuse (U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, & Children’s Bureau, 2018). 

Warning signs and emotional and physical assessment findings that may indicate child abuse in infants include: ominous watchfulness by the infant, looking away from parent/caregiver, passiveness, withdrawal, being overly compliant, developmental delays, and unaddressed bruises or injury marks in various stages of healing (Ho et al., 2017). In addition, signs of infant abuse may also be exhibited by the parent or adult caregiver, including denial or delay in seeking healthcare for infant injuries, blaming the infant for injuries or being burdensome, and little show of concern for the infant through touches or looks (GWIG, 2016). Some cultural practices that may be misidentified for abuse include the folk healing practice of cupping among some Chinese, Tibetian, and Middle Eastern cultural groups in which dry or wet cups are used for cupping therapy to suction the subcutaneous tissues underneath the skin (Lupariello et al., 2020). 

In the state of Maryland, it is mandatory for registered nurses to report suspected child abuse based on professional judgment, even without proof, and any report made in good faith is immune from civil or criminal liability or penalty (MDHS, 2021). The process involves filing a report (DHR/SSA 180), notifying the local Child Protection Services department, and law enforcement (in the jurisdiction where the incident occurred) within 48 hours following a verbal report to the nursing supervisor. A copy of the DHR/SSA 180 form must also be forwarded to the State Attorney’s office, and the form should contain the name, age, and address of the child and the nature and extent of the abuse or neglect of the child. 

References 

American Academy of Pediatrics. (n.d.). Abusive head trauma (shaken baby syndrome). Retrieved from https://www.aap.org/en-us/about-the-aap/aap-press-room/aap-press-room-media-center/Pages/Abusive-Head-Trauma-Fact-Sheet.aspx# 

Lupariello, F., Coppo, E., Cavecchia, I., Bosco, C., Bonaccurso, L., Urbino, A., Di Vella, G. (2020). Differential diagnosis between physical maltreatment and cupping practices in a suspected child abuse case. Forensic Sci Med Pathol. 16(1):188-190. doi: 10.1007/s12024-019-00155-w. 

Child Welfare Information Gateway [GWIG]. (2016). Mandatory reporters of child abuse and neglect. Retrieved from https://www.childwelfare.gov/pubs/issue-briefs/brain-development/ 

Ho, G. K., Gross, D. A., & Bettencourt, A. (2017). Universal mandatory reporting policies and the odds of identifying child physical abuse. American Journal of Public Health, 107(5), 709-716. doi:10.2105/AJPH.2017.303667 

Maryland Department of Human Services [MDHS]. (2021). Child protective services. https://dhs.maryland.gov/child-protective-services/reporting-suspected-child-abuse-or-neglect/mandated-reporters/ 

U.S. Department of Health & Human Services [USDHHS], Administration for Children and Families, Administration on Children, Youth and Families, & Children’s Bureau. (2018). Child maltreatment 2016. Washington, DC: Author. Retrieved from https://www.acf.hhs.gov/sites/default/files/cb/cm2016.pdf 

RESPOND HERE (150 WORDS, 3 REFERENCES) 

Hello Makafui, 

I do agree with you that infants are at a higher risk of child abuse that goes on undetected or unreported due to their inability to defend themselves. In the end if these cases go unreported and unaddressed, they have profound effects on the development of a child (Curry et al., 2018). This tremendously affects the child up to adult life and effects may persist throughout a lifetime. Maltreatment of children is prevalent, and it has serious health, educational, and behavioral effects (Mathews et al., 2020). It’s critical to know the frequency and features of child maltreatment across the country in order to create and evaluate programs to reduce it. However, it is well established that measuring child maltreatment is not widespread, and that when it is done, it has methodological obstacles. Child maltreatment, in all of its five recognized forms, is a major public health concern. Physical and mental illnesses are caused by proximal and distal pathways, respectively. Immediate physical injuries and conditions include brain injury and failure to thrive, as well as a wide range of psychological disorders such as anxiety, depression, and suicidality. Physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence all have serious consequences, according to research (Guyon et al., 2021). 

References 

Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Grossman, D. C., Kemper, A. R., Kubik, M., Landefeld, C. S., Mangione, C. M., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2018). Interventions to Prevent Child Maltreatment. JAMA, 320(20), 2122. https://doi.org/10.1001/jama.2018.17772 

Guyon, R., Fernet, M., Dussault, É., Gauthier-Duchesne, A., Cousineau, M.-M., Tardif, M., & Godbout, N. (2021). Experiences of Disclosure and Reactions of Close Ones from the Perspective of Child Sexual Abuse Survivors: A Qualitative Analysis of Gender Specificities. Journal of Child Sexual Abuse, 30(7), 806–827. https://doi.org/10.1080/10538712.2021.1942369 

Mathews, B., Pacella, R., Dunne, M. P., Simunovic, M., & Marston, C. (2020). Improving measurement of child abuse and neglect: A systematic review and analysis of national prevalence studies. PLOS ONE, 15(1), e0227884. https://doi.org/10.1371/journal.pone.0227884 

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