My paper is regarding pain management in advanced cancer. As with all pain management for all diseases, there is room for much improvement even though this was identified as a priority in 2003 by the IOM. While there have been many research studies regarding pain management using both pharmacologic and nonpharmacologic methods, both healthcare providers and patients still exhibit barriers in the treatment of pain.
Of particular interest to us as nursing students are the recommendations to provide additional education to cancer patients regarding pain medications, side effects, alternative treatments. Adequate education by healthcare providers was one way to overcome patient barriers to pain control. One technique that was interesting was teaching patients to use a pain diary in order to monitor pain over the long-term disease process and to assist healthcare providers in assessing effective pharmacologic and nonpharmacologic treatments. Teaching healthcare providers to utilize standardized pain assessment tools and utilizing better protocols for reassessing pain following treatment were also recommended. The use of advanced practice nurses to train staff nurses in assessment and reassessment was also recommended. As many as 60-90% of cancer patients experience pain, so using EBP tools would greatly benefit their care.
While the typical use of OTC pain medications and opioid-based medications was mainly discussed along with the use of radiation and chemotherapy, I was disappointed that for the most part nonpharmacologic interventions were not shown to greatly improve pain outcomes. While many are effective in reducing pain, most are used as adjuncts to traditional pharmacologic measures.
Few of us may treat cancer patients, however, all of us will treat patients who are in pain. The use of better standardized tools and use of better reassessment techniques will greatly improve our care of not only cancer patients, but all of our patients.
Wednesday, December 16, 2009
Childhood Obesity
One major problem our country faces is childhood obesity. Obesity is a major health risk for many chronic illnesses. In the past thirty years childhood obesity has doubled among children ages 2-5 and adolescents ages 12-19. It has tripled in children ages 6-11. It is estimated that more than 9 million children over the age of 6 are obese. (Committee on Progress in Preventing Childhood Obesity, 2006). Our youth are becoming more and more obese. What is going to happen if this is allowed to continue? What does obesity lead to? It is a risk factor for type II diabetes, heart disease, asthma, psychological and social problems, and many more. We need to step up and take action to combat this very real and dangerous problem.
What are we going to do about childhood obesity? The Committee on Progress in Preventing Childhood Obesity suggests many interventions to help fight childhood obesity. They include, empowering communities through education so they can become active in the fight and work towards change. Changing the physical environment and building communities so they facilitate more physical activity such as building more play places and parks. Create partnerships between local businesses, state and local governments, community based organizations, and industry to bring people together for a common goal of change. Gain political support to initiate measures to help prevent childhood obesity, such as requiring nutrition information on food from restaurants. Educate the public about the causes and effects of obesity and about proper nutrition so they can make informed decisions about their food choices. Identify leaders to serve as role models and teachers for children. Lastly we need to evaluate programs and interventions in order to see what is working. Once we know what works we can then make these changes to other communities (2006).
The longer we let this trend continue the more health disparities we will begin to see. The causes of childhood obesity are numerous and multifactorial. In order to reverse the trend of childhood obesity our interventions need to be on a large scale. We need to work with communities and state and local governments to bring about change and programs designed to fight childhood obesity. We must educate the public so they have the knowledge to obtain a healthy weight and lead a healthy lifestyle. We can serve as role models in our community. We must be leaders in the fight against childhood obesity.
What are we going to do about childhood obesity? The Committee on Progress in Preventing Childhood Obesity suggests many interventions to help fight childhood obesity. They include, empowering communities through education so they can become active in the fight and work towards change. Changing the physical environment and building communities so they facilitate more physical activity such as building more play places and parks. Create partnerships between local businesses, state and local governments, community based organizations, and industry to bring people together for a common goal of change. Gain political support to initiate measures to help prevent childhood obesity, such as requiring nutrition information on food from restaurants. Educate the public about the causes and effects of obesity and about proper nutrition so they can make informed decisions about their food choices. Identify leaders to serve as role models and teachers for children. Lastly we need to evaluate programs and interventions in order to see what is working. Once we know what works we can then make these changes to other communities (2006).
The longer we let this trend continue the more health disparities we will begin to see. The causes of childhood obesity are numerous and multifactorial. In order to reverse the trend of childhood obesity our interventions need to be on a large scale. We need to work with communities and state and local governments to bring about change and programs designed to fight childhood obesity. We must educate the public so they have the knowledge to obtain a healthy weight and lead a healthy lifestyle. We can serve as role models in our community. We must be leaders in the fight against childhood obesity.
Tobacco dependency
My report was about tobacco dependency. The article gave different ideas on how to prevent the use of tobacco problems and ways to help people that are already addicted to tobacco. One of the ways was to stop adolescents from starting to use. Most smokers start before they are at the age of 18. There are laws that should be followed, higher taxes raised, education, different ideas on how to stop smoking. As nurses, I think that it is very important to be able to follow up on the different sources to help people. We can turn around and educate and support our patients about them.
Cancer Biomarkers
I chose to discuss the importance about Cancer biomarkers. Biomarkers is any charactoristic that can be objectivley measured and evaluated as an indicator of normal biological or pathogenic processes, or of pharmacological response to therapeutic intervention. A well known example is the estrogen receptor. This paticular biomarker helps in the prognosis and predictor of response to endocrine therapies for breast cancer. The patient is tested for this particular biomarker and if the patient is positive for it 50-60% of the patients will respond to the therapy.
Biomarkers will play an increasingly important role in designing new drugs and improving the detection and treatment of cancer. Some other biomarkers that are widely used are the CA125 which help in the diagnosis of ovarian cancer, and prostate-specific antigen which helps to diagnosis prostate cancer. Since genetic and disease profiles differ from person to person this type of testing can help Doctors to tailor their treatment for that individual, and enhance the effectiveness and safety of cancer care.
Unfortunately progress for biomarkers has been slow. Most candidate biomarkers never advance beyond the discovery phase, and the number of biomarkers approved for clinical use is very small. Biomarkers will be clinincally valuable if they encourage appropriate selective use of treatments or identify cancers at a stage that is easier and less costly to treat. I think there needs to be more studies done to help find more biomarkers to help in the treatment of cancer.
Biomarkers will play an increasingly important role in designing new drugs and improving the detection and treatment of cancer. Some other biomarkers that are widely used are the CA125 which help in the diagnosis of ovarian cancer, and prostate-specific antigen which helps to diagnosis prostate cancer. Since genetic and disease profiles differ from person to person this type of testing can help Doctors to tailor their treatment for that individual, and enhance the effectiveness and safety of cancer care.
Unfortunately progress for biomarkers has been slow. Most candidate biomarkers never advance beyond the discovery phase, and the number of biomarkers approved for clinical use is very small. Biomarkers will be clinincally valuable if they encourage appropriate selective use of treatments or identify cancers at a stage that is easier and less costly to treat. I think there needs to be more studies done to help find more biomarkers to help in the treatment of cancer.
Putting an End to Childhood Obesity: Lost Cause?
I started this leadership assignment with the pre-conceived notion that doing some research and typing up a paper on how we can apply this finding of these reports to our nursing practice would be a piece of cake. As I read more and more articles regarding childhood obesity, the more daunting the topic became. We as nurses have been fighting this growing, epidemic if you will, for years and yet the number has more than tripled over the past 4 decades and currently stand approximately around 9 million with 15% of the rest of them at risk for becoming obese. So, hence the title, I researched a few different ways for us as nurses to approach this matter. Also while researching how we can help I came across some very interesting theories as to why the number of children who are obese is on the rise.
One theory pointed to food marketing to children and youth and how the majority of adds were found to promote foods that were high in sugar, calories, salt, fat and low in nutrients. Although kids are more inclined during this day and age to sit in front of the t.v. instead of go outside and play, these adds only contribute to the problem as they are promoting very unhealthy snacks. These articles also went in to much detail on how habits are learned from other family members and that children will tend to eat foods that are readily available to them and eat greater quantities of these foods when larger portions are provided. So for every caregiver that places a plate of these high calorie/sugar/salt/fat with low nutrient content out for them to grab, they are going to go for the food no questions asked.
So after reading all of the contributing factors and how many different people and things help to form the unhealthy habits in kids, I was pleased to read that there are many options for us as health care workers to intervene. One proposal was directed towards Social Marketing ( having the behavior you would like to see changed exchanged for another activity that is attractive and wanted by the family and the child). Since we as nurses are constantly teaching our patients and making/adjusting/ and implementing our plans of care, this is a easy approach that can be implemented. The road blocks come up when the rest of the family is not agreeing to make the change. "Do as I say, not as I do" is not the best way to promote change in young individuals as their family in their key socializing agent. So in hopes of decreasing morbidity/ mortality rates among individual that illness stems from their obesity, all sectors must work together to make the change and all members of the caregivers and family members must be on board!
PS: just another statistic- 80% of children who have 2 obese parents will become obese themselves, 40% with one obese parent, and only 7% when neither of their parents are obese.
One theory pointed to food marketing to children and youth and how the majority of adds were found to promote foods that were high in sugar, calories, salt, fat and low in nutrients. Although kids are more inclined during this day and age to sit in front of the t.v. instead of go outside and play, these adds only contribute to the problem as they are promoting very unhealthy snacks. These articles also went in to much detail on how habits are learned from other family members and that children will tend to eat foods that are readily available to them and eat greater quantities of these foods when larger portions are provided. So for every caregiver that places a plate of these high calorie/sugar/salt/fat with low nutrient content out for them to grab, they are going to go for the food no questions asked.
So after reading all of the contributing factors and how many different people and things help to form the unhealthy habits in kids, I was pleased to read that there are many options for us as health care workers to intervene. One proposal was directed towards Social Marketing ( having the behavior you would like to see changed exchanged for another activity that is attractive and wanted by the family and the child). Since we as nurses are constantly teaching our patients and making/adjusting/ and implementing our plans of care, this is a easy approach that can be implemented. The road blocks come up when the rest of the family is not agreeing to make the change. "Do as I say, not as I do" is not the best way to promote change in young individuals as their family in their key socializing agent. So in hopes of decreasing morbidity/ mortality rates among individual that illness stems from their obesity, all sectors must work together to make the change and all members of the caregivers and family members must be on board!
PS: just another statistic- 80% of children who have 2 obese parents will become obese themselves, 40% with one obese parent, and only 7% when neither of their parents are obese.
Children and PTSD
Hi!
Upon searching the IOM website for "the perfect" topic I found something mentioning Post Traumatic Stress Disorder (PTSD) in war veterans. We always hear about the war Vets and other adults experiencing stress but I thought, "What about children who experience PTSD?" So I used the brief from IOM and twisted it to something that not only completed the assignment, but caught my interest as well.
I remember being a kid myself and hearing from adults as I became older, "Children are resilient! Nothing effects them because they don't have life experience or understand what's going on around them." "Children are prone to develop PTSD if they are the vicitms of kidnapping or rape, school shootings, car accidents, child abuse, or are a friend or relative of someone who has committed suicide or has been killed" (Oliver, 2007). In fact, the younger the child is, the more likely they will experience PTSD. Unfortunately, children are underdiagnosed with the disorder because of false beliefs of resilience. I teach a 3-4yr old class in Sunday School. One child is in foster care and another child's mother is a recovering drug addict and has recently divorced an abusive husband. One child is hyperactive, aggressive, and has developmental delays. The other child is disruptive, disobedient, and refuses to participate in class. This is an example of the s/s children may display if they have experienced a traumatic event.
We have learned in previous classess that children can be best assessed by their behavior. They are less likely to explain in detail what's wrong, but can show us based on abrupt differences in their behavior. As nurses, it's important to know and understand appropriate developmental stages to be able to interrpret abnormalities in children's behavior. It's also important to perform body assessments as appropriate and VS. Nurses must develop trust in the child to help develop an effective plan of care.
With children, treatment includes cognitive and psychopharmacology therapies. We know children have difficulty sitting listening to adults speak and have a hard time expressing themselves in words. Children are able to express themselves best through play. According to Varcarolis, play therapy, dramatic play, therapeutic games, bibliotherapy, and therapeutic drawing can help children express their emotions. Pictures drawn, playing with toys, and telling stories all unconsciously reveal the child's perception and emotions of the traumatic event. Psychopharmacological medications used alongside with therapy can result in better outcomes. Studies are being done regarding the complete "recovery" of PTSD. It has been recommended that nurses and other mental health pros establish appropriate goals and outcomes rather than expecting a child to completely recover.
Upon searching the IOM website for "the perfect" topic I found something mentioning Post Traumatic Stress Disorder (PTSD) in war veterans. We always hear about the war Vets and other adults experiencing stress but I thought, "What about children who experience PTSD?" So I used the brief from IOM and twisted it to something that not only completed the assignment, but caught my interest as well.
I remember being a kid myself and hearing from adults as I became older, "Children are resilient! Nothing effects them because they don't have life experience or understand what's going on around them." "Children are prone to develop PTSD if they are the vicitms of kidnapping or rape, school shootings, car accidents, child abuse, or are a friend or relative of someone who has committed suicide or has been killed" (Oliver, 2007). In fact, the younger the child is, the more likely they will experience PTSD. Unfortunately, children are underdiagnosed with the disorder because of false beliefs of resilience. I teach a 3-4yr old class in Sunday School. One child is in foster care and another child's mother is a recovering drug addict and has recently divorced an abusive husband. One child is hyperactive, aggressive, and has developmental delays. The other child is disruptive, disobedient, and refuses to participate in class. This is an example of the s/s children may display if they have experienced a traumatic event.
We have learned in previous classess that children can be best assessed by their behavior. They are less likely to explain in detail what's wrong, but can show us based on abrupt differences in their behavior. As nurses, it's important to know and understand appropriate developmental stages to be able to interrpret abnormalities in children's behavior. It's also important to perform body assessments as appropriate and VS. Nurses must develop trust in the child to help develop an effective plan of care.
With children, treatment includes cognitive and psychopharmacology therapies. We know children have difficulty sitting listening to adults speak and have a hard time expressing themselves in words. Children are able to express themselves best through play. According to Varcarolis, play therapy, dramatic play, therapeutic games, bibliotherapy, and therapeutic drawing can help children express their emotions. Pictures drawn, playing with toys, and telling stories all unconsciously reveal the child's perception and emotions of the traumatic event. Psychopharmacological medications used alongside with therapy can result in better outcomes. Studies are being done regarding the complete "recovery" of PTSD. It has been recommended that nurses and other mental health pros establish appropriate goals and outcomes rather than expecting a child to completely recover.
Depressed adults and the effects on children
Hi everyone,
I wrote my paper about how having a depressed parent or parents is negatively impacting millions of childrens and adolescents and what needs to be done to to minimize some of these effects. Over 15 million children under the age of 18 will reside with a depressed parent each year. This results in these children having problems with growth and development, depression, behaviour, and socialization.
Currently there are several tools that screen for depression in adults, they don't however take the next step and pick out adults that have children at home. Implementing such a tool seems so easy, "Do you have children living in your household?" yes or no. If the answer is yes, additional intervention needs to be implemented to ensure that the kids are not being adversely affected.
Addtionally, I would like to see a simple questionaire for adults and children who are entering the healthcare system for other reasons. Doing this would allow for early intervention, and would open up treatment options for more people. Depression is such a huge problem, I feel as a nurse it is my personal responsibility to be on the look out for it, to provide education to patients about it, and to help people get the help that they need.
I wrote my paper about how having a depressed parent or parents is negatively impacting millions of childrens and adolescents and what needs to be done to to minimize some of these effects. Over 15 million children under the age of 18 will reside with a depressed parent each year. This results in these children having problems with growth and development, depression, behaviour, and socialization.
Currently there are several tools that screen for depression in adults, they don't however take the next step and pick out adults that have children at home. Implementing such a tool seems so easy, "Do you have children living in your household?" yes or no. If the answer is yes, additional intervention needs to be implemented to ensure that the kids are not being adversely affected.
Addtionally, I would like to see a simple questionaire for adults and children who are entering the healthcare system for other reasons. Doing this would allow for early intervention, and would open up treatment options for more people. Depression is such a huge problem, I feel as a nurse it is my personal responsibility to be on the look out for it, to provide education to patients about it, and to help people get the help that they need.
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