National Healthcare Issue/Stressor Essay
National Healthcare Issue/Stressor Essay
National Healthcare Issue/Stressor Essay
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National Healthcare Issue/Stressor Essay Assignment
To Prepare for National Healthcare Issue/Stressor Assignment:
- Select one current national healthcare issue/stressor to focus on.
- Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.
Healthcare issue=( Workforce injuries are much more frequent in healthcare )
Analyze , and explain how the healthcare issue/stressor above may impact your work setting.
Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.
APA format 250-280 words with references and in-text citations.
Format this assessment as a professional report. It may help to look at reports or other documents used within your organization and to follow that formatting. You must still follow APA guidelines for in-text citations and references, and include a title page and reference page.
Within the National Healthcare Issue/Stressor Essay Assignment report:
- Describe one critical health issue in your community or state that has grown larger or has the potential to become larger. Be sure to include any statistics available on the health issue. Tip: check your county and/or state health department Web site.
- Explain the factors that contribute to this health issue. Consider things such as access to health care services, economics, culture, attitude, education, health care policies, and so on.
- Describe any interventions your community or state has put in place to address the health care issue. Include information on how long the interventions have been in place, how the community was made aware of the interventions, and so on.
- Describe the scope and role of nursing and public health nursing in the interventions to reduce the health issue.
- Recommend evidence-based ways the scope of the interventions could be expanded to increase positive health outcomes. Think in terms of cost, efficiency and access, effectiveness, and the use of both conventional and unconventional interventions.
Additional Requirements for National Healthcare Issue/Stressor Essay Assignment
Complete your assessment using the following specifications:
- Title page and reference page.
- Number of pages: 3–4 (not including the title and reference pages).
- At least 3 current scholarly or professional resources.
- APA format for citations and references.
National Healthcare Issue/Stressor Essay Assignment
STRESS AND HEALTH: Psychological, Behavioral, and Biological Determinants
Abstract
Stressors have a major influence upon mood, our sense of well-being, behavior, and health. Acute stress responses in young, healthy individuals may be adaptive and typically do not impose a health burden. However, if the threat is unremitting, particularly in older or unhealthy individuals, the long-term effects of stressors can damage health. The relationship between psychosocial stressors and disease is affected by the nature, number, and persistence of the stressors as well as by the individual’s biological vulnerability (i.e., genetics, constitutional factors), psychosocial resources, and learned patterns of coping. Psychosocial interventions have proven useful for treating stress-related disorders and may influence the course of chronic diseases.
INTRODUCTION
Claude Bernard (1865/1961) noted that the maintenance of life is critically dependent on keeping our internal milieu constant in the face of a changing environment. Cannon (1929) called this “homeostasis.” Selye (1956) used the term “stress” to represent the effects of anything that seriously threatens homeostasis. The actual or perceived threat to an organism is referred to as the “stressor” and the response to the stressor is called the “stress response.” Although stress responses evolved as adaptive processes, Selye observed that severe, prolonged stress responses might lead to tissue damage and disease.
Based on the appraisal of perceived threat, humans and other animals invoke coping responses (Lazarus & Folkman 1984). Our central nervous system (CNS) tends to produce integrated coping responses rather than single, isolated response changes (Hilton 1975). Thus, when immediate fight-or-flight appears feasible, mammals tend to show increased autonomic and hormonal activities that maximize the possibilities for muscular exertion (Cannon 1929, Hess 1957). In contrast, during aversive situations in which an active coping response is not available, mammals may engage in a vigilance response that involves sympathetic nervous system (SNS) arousal accompanied by an active inhibition of movement and shunting of blood away from the periphery (Adams et al. 1968). The extent to which various situations elicit different patterns of biologic response is called “situational stereotypy” (Lacey 1967).
Although various situations tend to elicit different patterns of stress responses, there are also individual differences in stress responses to the same situation. This tendency to exhibit a particular pattern of stress responses across a variety of stressors is referred to as “response stereotypy” (Lacey & Lacey 1958). Across a variety of situations, some individuals tend to show stress responses associated with active coping, whereas others tend to show stress responses more associated with aversive vigilance (Kasprowicz et al. 1990, Llabre et al. 1998).
Although genetic inheritance undoubtedly plays a role in determining individual differences in response stereotypy, neonatal experiences in rats have been shown to produce long-term effects in cognitive-emotional responses (Levine 1957). For example, Meaney et al. (1993) showed that rats raised by nurturing mothers have increased levels of central serotonin activity compared with rats raised by less nurturing mothers. The increased serotonin activity leads to increased expression of a central glucocorticoid receptor gene. This, in turn, leads to higher numbers of glucocorticoid receptors in the limbic system and improved glucocorticoid feedback into the CNS throughout the rat’s life. Interestingly, female rats who receive a high level of nurturing in turn become highly nurturing mothers whose offspring also have high levels of glucocorticoid receptors. This example of behaviorally induced gene expression shows how highly nurtured rats develop into low-anxiety adults, who in turn become nurturing mothers with reduced stress responses.
In contrast to highly nurtured rats, pups separated from their mothers for several hours per day during early life have a highly active hypothalamic-pituitary adrenocortical axis and elevated SNS arousal (Ladd et al. 2000). These deprived rats tend to show larger and more frequent stress responses to the environment than do less deprived animals.
Because evolution has provided mammals with reasonably effective homeostatic mechanisms (e.g., baroreceptor reflex) for dealing with short-term stressors, acute stress responses in young, healthy individuals typically do not impose a health burden. However, if the threat is persistent, particularly in older or unhealthy individuals, the long-term effects of the response to stress may damage health (Schneiderman 1983). Adverse effects of chronic stressors are particularly common in humans, possibly because their high capacity for symbolic thought may elicit persistent stress responses to a broad range of adverse living and working conditions. The relationship between psychosocial stressors and chronic disease is complex. It is affected, for example, by the nature, number, and persistence of the stressors as well as by the individual’s biological vulnerability (i.e., genetics, constitutional factors) and learned patterns of coping. In this review, we focus on some of the psychological, behavioral, and biological effects of specific stressors, the mediating psychophysiological pathways, and the variables known to mediate these relationships. We conclude with a consideration of treatment implications.
PSYCHOLOGICAL ASPECTS OF STRESS
Stressors During Childhood and Adolescence and Their Psychological Sequelae
The most widely studied stressors in children and adolescents are exposure to violence, abuse (sexual, physical, emotional, or neglect), and divorce/marital conflict (see Cicchetti 2005). McMahon et al. (2003) also provide an excellent review of the psychological consequences of such stressors. Psychological effects of maltreatment/abuse include the dysregulation of affect, provocative behaviors, the avoidance of intimacy, and disturbances in attachment (Haviland et al. 1995, Lowenthal 1998). Survivors of childhood sexual abuse have higher levels of both general distress and major psychological disturbances including personality disorders (Polusny & Follett 1995). Childhood abuse is also associated with negative views toward learning and poor school performance (Lowenthal 1998). Children of divorced parents have more reported antisocial behavior, anxiety, and depression than their peers (Short 2002). Adult offspring of divorced parents report more current life stress, family conflict, and lack of friend support compared with those whose parents did not divorce (Short 2002). Exposure to nonresponsive environments has also been described as a stressor leading to learned helplessness (Peterson & Seligman 1984).
Studies have also addressed the psychological consequences of exposure to war and terrorism during childhood (Shaw 2003). A majority of children exposed to war experience significant psychological morbidity, including both post-traumatic stress disorder (PTSD) and depressive symptoms. For example, Nader et al. (1993) found that 70% of Kuwaiti children reported mild to severe PTSD symptoms after the Gulf War. Some effects are long lasting: Macksound & Aber (1996) found that 43% of Lebanese children continued to manifest post-traumatic stress symptoms 10 years after exposure to war-related trauma.
Exposure to intense and chronic stressors during the developmental years has long-lasting neurobiological effects and puts one at increased risk for anxiety and mood disorders, aggressive dyscontrol problems, hypo-immune dysfunction, medical morbidity, structural changes in the CNS, and early death (Shaw 2003).
Stressors During Adulthood and Their Psychological Sequelae
LIFE STRESS, ANXIETY, AND DEPRESSION
It is well known that first depressive episodes often develop following the occurrence of a major negative life event (Paykel 2001). Furthermore, there is evidence that stressful life events are causal for the onset of depression (see Hammen 2005, Kendler et al. 1999). A study of 13,006 patients in Denmark, with first psychiatric admissions diagnosed with depression, found more recent divorces, unemployment, and suicides by relatives compared with age- and gender-matched controls (Kessing et al. 2003). The diagnosis of a major medical illness often has been considered a severe life stressor and often is accompanied by high rates of depression (Cassem 1995). For example, a meta-analysis found that 24% of cancer patients are diagnosed with major depression (McDaniel et al. 1995).
Stressful life events often precede anxiety disorders as well (Faravelli & Pallanti 1989, Finlay-Jones & Brown 1981). Interestingly, long-term follow-up studies have shown that anxiety occurs more commonly before depression (Angst &Vollrath 1991, Breslau et al. 1995). In fact, in prospective studies, patients with anxiety are most likely to develop major depression after stressful life events occur (Brown et al. 1986).
DISORDERS RELATED TO TRAUMA
Lifetime exposure to traumatic events in the general population is high, with estimates ranging from 40% to 70% (Norris 1992). Of note, an estimated 13% of adult women in the United States have been exposed to sexual assault (Kilpatrick et al. 1992). The Diagnostic and Statistical Manual (DSM-IV-TR; American Psychiatric Association 2000) includes two primary diagnoses related to trauma: Acute Stress Disorder (ASD) and PTSD. Both these disorders have as prominent features a traumatic event involving actual or threatened death or serious injury and symptom clusters including re-experiencing of the traumatic event (e.g., intrusive thoughts), avoidance of reminders/numbing, and hyperarousal (e.g., difficulty falling or staying asleep). The time frame for ASD is shorter (lasting two days to four weeks), with diagnosis limited to within one month of the incident. ASD was introduced in 1994 to describe initial trauma reactions, but it has come under criticism (Harvey & Bryant 2002) for weak empirical and theoretical support. Most people who have symptoms of PTSD shortly after a traumatic event recover and do not develop PTSD. In a comprehensive review, Green (1994) estimates that approximately 25% of those exposed to traumatic events develop PTSD. Surveys of the general population indicate that PTSD affects 1 in 12 adults at some time in their life (Kessler et al. 1995). Trauma and disasters are related not only to PTSD, but also to concurrent depression, other anxiety disorders, cognitive impairment, and substance abuse (David et al. 1996, Schnurr et al. 2002, Shalev 2001).
Other consequences of stress that could provide linkages to health have been identified, such as increases in smoking, substance use, accidents, sleep problems, and eating disorders. Populations that live in more stressful environments (communities with higher divorce rates, business failures, natural disasters, etc.) smoke more heavily and experience higher mortality from lung cancer and chronic obstructive pulmonary disorder (Colby et al. 1994). A longitudinal study following seamen in a naval training center found that more cigarette smoking occurred on high-stress days (Conway et al. 1981). Life events stress and chronically stressful conditions have also been linked to higher consumption of alcohol (Linsky et al. 1985). In addition, the possibility that alcohol may be used as self-medication for stress-related disorders such as anxiety has been proposed. For example, a prospective community study of 3021 adolescents and young adults (Zimmerman et al. 2003) found that those with certain anxiety disorders (social phobia and panic attacks) were more likely to develop substance abuse or dependence prospectively over four years of follow-up. Life in stressful environments has also been linked to fatal accidents (Linsky & Strauss 1986) and to the onset of bulimia (Welch et al. 1997). Another variable related to stress that could provide a link to health is the increased sleep problems that have been reported after sychological trauma (Harvey et al. 2003). New onset of sleep problems mediated the relationship between post-traumatic stress symptoms and decreased natural killer (NK) cell cytotoxicity in Hurricane Andrew victims (Ironson et al. 1997).
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