Abstract
Heat is associated with high mortality rates in the United States. The main route of entry of heat is the skin. The study was conducted using data that were collected in 105 cities in the United States in the 1987-2005 period to assess the mortality rates that were correlated with heat. It was established that there was a decline in the number of deaths. However, it was established that the elderly in society were more affected.
Article summary
Bobb, J. F., Peng, R. D., Bell, M. L., & Dominici, F. (2014). Heat-related mortality and adaptation to heat in the United States. Environmental health perspectives, 23(12), 1-26.
The article focuses on the number of deaths that are caused by heat and how persons adapt to heat in the United States (Bobb, Peng, Bell & Dominici, 2014). The world is experiencing relatively high temperatures that are anticipated to have negative health impacts. The negative health impacts could be prevented if persons and communities are able to adapt to varying heat exposures.
However, the authors of the article argue that little is known with regard to the extent to which people across the world could be adapting (Bobb et al., 2014). The objective of the study was to assess the assumption that “if adaptation is occurring, then heat-related mortality would be decreasing over time” (Bobb et al., 2014, p. 2). The study utilized daily weather data, the number of deaths data that were grouped into ages and air pollution data. It is important to underscore that 105 cities in the US were studied for a period of 18 years (1987-2005). Regression models were used in the estimation of trends that were related to regions, cities and national statistics.
The results showed that “the number of deaths (per 1000 deaths) attributable to each 10oF increase in same-day temperature decreased from 51 (95% posterior interval: 42-61) in 1987 to 19 (12-27) in 2005” (Bobb et al., 2014, p. 18). It was noted that the biggest decline was among persons aged 75 and older. In addition, cities located in the northern parts of the United States were shown to have relatively high rates of mortality. The data correlate with those reported in the United States by other bodies (CDC Environmental Health, 2014; Environmental Health Perspectives, 2014). In fact, the National Center for Health Statistics (2014) contends that mortality rates vary among different ages.
The route of exposure
The route of exposure that was the focus of the study was the skin. The authors contend that relatively high temperatures result in heat that penetrates through the skin. In fact, the larger the skin surface area that is exposed to heat the higher the chances of suffering from heat-related illnesses.
The environmental agent
The environmental agent (heat) that is addressed in the study represents a physical factor. Heat is obtained from the sun and it only harms persons when it penetrates the skin in relatively large amounts over prolonged periods (Moeller, 2011). However, although heat is a physical agent, it is crucial to note that it causes chemical changes in the body.
An effective method of control
Behavioral control is an effective method of control that could be used to prevent persons from negative impacts of heat (Moeller, 2011). Another type of control is the use of protective materials (National Environmental Public Health Tracking, 2014). However, behavioral control is better than the use of physical means because more persons in society can adopt it without limitations based on their financial abilities (Moeller, 2011).
Conclusion
In conclusion, it is apparent that climate changes are leading to exposures to relatively high temperatures that harm people. Although the study findings demonstrate that there has been a reduction in the number of deaths caused by heat, more actions need to be taken to prevent deaths caused by the physical agent. Behavioral control is an effective approach that could be adopted by many persons in the United States.
References
Bobb, J. F., Peng, R. D., Bell, M. L., & Dominici, F. (2014). Heat-related mortality and adaptation to heat in the United States. Environmental health perspectives, 23(12), 1-26.
CDC Environmental Health. (2014). Data Resources. Web.
Environmental Health Perspectives. (2014). Learning to take the heat. Web.
Moeller, D. W. (2011). Environmental health (4th ed.). Cambridge, MA: Harvard University Press.
National Center for Health Statistics. (2014). Nation at a glance: Age-adjusted Death Rates by States. Web.
National Environmental Public Health Tracking. (2014). National Environmental Public Health Tracking Program Mini-Monograph in Environmental Health Perspectives On-line. Web.
Public Health Interventions And Economics: Malaria
The case study advocated for the use of treated mosquito nets as an effective intervention for preventing malaria-related maternal deaths. An independent cost-effectiveness analysis of the intervention reveals that using treated mosquito nets is an effective intervention for reducing maternal deaths. The cost of a mosquito net is low, compared to the cost of treating a sick mother or losing an unborn child to the disease. The incremental cost-effectiveness ratio is $41.46 per disability-adjusted life year (DALY) and the incremental cost-effectiveness ratio for the mother and the newborn is $1.02 per DALY averted. Similarly, the decrease in neonatal mortality is $1.08. These figures show that the cost of prevention is lower than treatment. In some African countries, expectant women get mosquito nets free. Well-wishers and international health agencies usually donate them. Since there is little or no cost associated with availing these nets to pregnant mothers, using treated mosquito nets is a cost-effective intervention for minimizing maternal deaths associated with malaria (Bhattacharya, 2013).
The proposed intervention would not work in my community because the incidence of maternal deaths, associated with malaria, is very low. Schantz-Dunn and Nour (2009) say the US has successfully eradicated malaria. Based on this background, it is difficult to convince expectant women in my community to sleep under a mosquito net if they do not see the need to do so in the first place. Therefore, this intervention would not work in my community. Nonetheless, since malaria-related neo-natal deaths in America are negligible, does it mean that the cost-effectiveness of the intervention is “0” (zero)?
References
Bhattacharya, D. (2013). Public Health Policy: Issues, Theories, and Advocacy. San Fransisco, CA: Jossey-Bass.
Schantz-Dunn, J., & Nour, N. (2009). Malaria and Pregnancy: A Global Health Perspective. Rev Obstet Gynecol, 2(3), 186–192.
National Database Of Nursing Quality Indicators
The National Database of Nursing Quality Indicators (NDNQI)
The NDNQI was founded to provide a reference point that could focus on processes, structures, and outcome indicators to assess the care provided by nurses at the setting level. The database has been used successfully to correlate the number of nurses in healthcare institutions with patient outcomes (Best & Neuhauser, 2006; Chu, Wang & Dai, 2009). The database was developed using indicators that were established using feasibility testing. The following list contains the indicators that pertain to my practice setting:
- Patient falls
- Nursing hours per patient per day
- RN education and/or certification
- The nurse vacancy rate
- Voluntary nurse turnover
Two nurse-sensitive indicators and influence of theories and philosophies
The RN education and nursing hours per patient are the two nurse-sensitive indicators in my setting. RN education correlates with the quality of nursing care offered to patients. Also, patient outcomes are determined by the number of hours that nursing care is provided to patients. The two indicators are based on King’s goal attainment theory, which emphasizes that patient goals are set by both the patient and healthcare provider. For a nurse to set and realize goals with a patient, he or she needs to have sufficient time to interact with the patient (Chu et al., 2009). Also, the nurse needs to have good training and/or education because setting and realizing patient goals requires a lengthy process that needs the application of specific knowledge gained through formal training (Chu et al., 2009).
Two scholarly research articles from Walden’s library
The articles by Gerritsen and van Beek (2010) and Davidson, Dunton, and Christopher (2009) best describe how quality indicators influence nursing care outcomes. Gerritsen and van Beek (2010) argue that nursing organizational culture determines the quality of patient outcomes. The study authors designed a study to determine the effect of organizational culture on the quality of care provided to dementia patients. The study was conducted using questionnaires and observations. The authors established that the two parameters correlated positively. The findings are important in my practice setting because the quality of nursing care is greatly determined by the organizational culture of nursing staff.
Davidson and colleagues (2009) conducted a study to assess the importance of nurses focusing on some parameters aimed to reduce medical errors. The authors contend that nurses can improve the quality of nursing care by reducing the number of medical errors experienced by patients in their settings. The article’s findings have implications for my setting. If nurses reduce injection errors, wound dressing, giving medications, and entry of records, among others, the quality of nursing care would be improved in my practice setting.
Quality as defined by a peer-reviewed source
Chaboyer, Johnson, Hardy, Gehrke, and Panuwatwanich (2010) give a definition of quality that resonates with my thinking. The authors assert that quality nursing care is characterized by the minimum number of medical errors and patient falls. This is a good definition because nursing settings that are marked by a high number of medical errors and patient falls usually provide low-quality nursing care. The definition of quality focuses on the safe and reliable environment of nursing settings (Chaboyer et al., 2010).
The metric selected from the NDNQI measure set
The measure set chosen from NDNQI focuses on the reduction of errors, a sufficient number of nursing hours per patient, and RN education. The three indicators could be used to give quality the best definition. Quality nursing can be improved through advanced RN education, reduction of practice setting errors, and increasing nurse-patient contact hours. In conclusion, quality nursing is an important aspect of the healthcare industry because it is used to improve patient outcomes.
References
Best, M., & Neuhauser, D. (2006). Joseph Juran: Overcoming resistance to organisational change. Quality and Safety in Health Care, 15(5), 380–382. Chaboyer, W., Johnson, J., Hardy, L., Gehrke, T., & Panuwatwanich, K. (2010).
Transforming care strategies and nursing-sensitive patient outcomes. Journal of Advanced Nursing, 66(5), 1111–1119.
Davidson, J., Dunton, N., & Christopher, A. (2009). Following the trail: Connecting unit characteristics with never events. Nursing Management, 40(2), 15–19.
Gerritsen, D.L., & van Beek, A. P. A. (2010). The relationship between organizational ulture of nursing staff and quality of care for residents with dementia: Questionnaire surveys and systematic observations in nursing homes. International Journal of Nursing Studies, 47(10), 1272–1282.
Chu, H., Wang, C., & Dai, Y. (2009). A study of a nursing department performance measurement system: Using the balanced scorecard and the analytic hierarchy process. Nursing Economics, 27(6), 401–407.