Clinical Case Reasononing

 

Author: Sana Rehman

A concussion is the most prevalent type of mild traumatic brain injury and might cause adverse consequences (Tator, 2013). Concussion occurs frequently in all age groups, and different settings as well, but contradiction for age groups has been seen in the literature (Abrahams et al.: 2014; Marar et al., 2012). The concussion is defined as a serious pathological process, adversely impact the brain functioning due to abnormal biomechanical factors (Sharp, & Jenkins, 2015). 

The epidemiological studies have demonstrated that the prevalence rate for concussion has increased twice with recent years and the situation is growing more alarming day by day — the current clinical case reasoning following the three component of cycle considering a case of a girl. The three components of the cycle include the situation of the patients, cues & information and process or information.

Current Situation of the Patient

A 12-year-old girl named Mia Roberts, studying in grade six came in hospital emergency mainly with the complaints of headache, nausea, loss of appetite and fatigue. Her playmate also noticed that she was not eating well during that day and found to be silent during most of the day. At night, behavioural changes and fluctuations in mood have also been noticed as she was crying without any particular reason and felt confused. It was reported that Mia had a head injury in that morning during the play of the basketball tournament. During play she got stuck and headed down in the left side of her frontal bone. Her reported symptoms depicted that she might be having a concussion. Mild traumatic brain injury that dislocates the brain functions to abnormal way is termed as a concussion.

In 2015, Coronado et al., surveyed on nearly 3.42 million emergency departments for studying the sport’s concussion and reported that 70% concussion occurred during playing football, soccer, basketball and ice-hockey like games by collisions of players who were between the age of 12 to 19 years (Coronado et al., 2015). A substantial body of researchers reported a significant number of cases for developing concussion due to football, basketball and hockey (Abrahams, Fie, Patricios, Posthumus, September 2014; Marar et al., 2012). 

Concussions symptoms such as dizziness, sleeplessness, headache, behavioural and emotional changes (McCrory et al., 2017) were similar to her symptoms. Some researches resulted that the majority of athletes experienced these symptoms within days that is due to the structural anatomical changes of the brain during the injury. Mia Roberts also had an injury in the left side of the frontal lobe that’s why she is feeling symptoms like a concussion.   

Cues and Information 

Risk factors related to the occurrence of concussion were also important to be in view. Gender plays an important role in playing games, and it is one of the major risk factors in concussion. Being a female player is a potential risk factor of the concussion, which indicated that Mia Robert might have a concussion during that play (Abrahams et al.: 2014; Marar et al., 2012). Comparatively, males found to be least on the risk of developing concussion while playing games. 

The place of the injury is another risk factor of the concussion. In 2016, Caccese & Kaminski studied that aerial collision of the athletes with injury in the left side of the brain is the major risk factor of the concussion. Researches on the age limits also conclude that with the increase of age concussion’s risk factor decreases that was also assimilated with her age as she was only 12 years old that was her major risk factor of being concussion (Marar et al., 2012). Currently, from the profile of the Mia Roberts, her gender, age and place of injury, all were the major risk factors of the occurrence on concussion.  

As far as with the concern of the patient’s diagnosis, it cannot be diagnosed only on the risk factors of the problems. The patient would be medically examined properly with the interview by the doctors. Mia Roberts interviewed by the doctor, and her initial notes were taken as objective data of the patient that were as blood pressure as 105/87, temperature 36.7°C, Pulse 81, Respiratory Rate 20 and SpO2 was 98%. In a clinical interview, patient subjectively reported that she had blurred feelings, experiencing dizziness, headache and did not feel well after injury. 

The ratings of the patient on the pain scale of headache are 4 out of 10. There would be a detailed examination of the patient would be suggested that contains many domains like injury mechanism, signs and symptoms, the neurological and cognitive functioning of the patient that includes balance testing (Caccese & Kaminski, 2016).

Besides the clinical interview, neurological tests like PET scan, MMRI, functional MRI or SCAT3 would also be implemented in the assessment so that the structural changes could be seen in that tests and with better understanding diagnosis could be made (Coronado et al., 2015). The sign and symptoms of the patient clearly indicated the concussion symptoms. Studies indicated that neurochemical changes linked with the concussion problem effectively detected by the magnetic resonance spectroscopy (MRS) rather than diffusion tensor imaging and positron emission tomography (PET) scanning (Abrahams, Fie, Patricios, Posthumus, September 2014; Marar et al., 2012). Functional MRI is also effective to see the functional changes of the concussion after two months of the injury (Finch, Clapperton & McCrory, 2013).

To give the concussion diagnosis is much more difficult due to the results of the neurological tests. It is more rely on the clinical interview and the behavioural and emotional functioning that can be seen in the case of Mia Robert as she had started emotional and behavioural problems like crying without any reason that was another sign of the concussion symptoms of the patient (Marar et al., 2013).

Process and Information

In the case of Mia Robert was a 12 years old girl, which is the developing age of the brain as well. Studies described that developing brain responded differently as compared to the adult brain to any traumatic injuries and are most prone to have a concussion and highly vulnerable to the damages (Caccese & Kaminski, 2016). Same happened in the case of Mia; she got an injury in her growing age. Therefore more risk and damages have been found to be associated with her condition. It was also assessed that Mia’s injury occurred at the frontal lobe of the brain and the frontal and temporal lobes were responsible to the sensory inputs that might be affected her in long term effects of the brain (Caccese & Kaminski, 2016).

Due to the frontal lobe injury, she had the problems related to the sleeplessness, dizziness and fatigue. Brain injuries alarmingly effects the learning of the children between age five to 18. The recent studies found that children who had a concussion during play had no significant difference in the learning performances with other peer mates (Finch, Clapperton & McCrory, 2013). In contrast, Mia experienced issues in multiple areas to function well. 

Age and gender were also found to be strong determinants for developing functional, emotional, behavioural, and sensory and health issues. More assessment and management are needed in the case to achieve desirable results. From the above case clinical case reasoning, it can be hypothesized that Mia might get recover soon with the proper assessment and regular treatment plan.

 

Suicide: A Huge Mental Health Issue in Nursing Practice

 

Author: Sana Rehman

In mental health studies, suicide is a significant issue that needs to be addressed with the help of the nursing staff in clinical settings. Researchers has focused on suicidal issues and the reasons are made known to avoid the future cases of suicide. Mostly, the reasons are hard to anticipate in advance but once a patient survives, it becomes the ethical duty of the nurses to take effective care of these patients (Sheehan, et al., 2019).  Nurse teachers can teach effective strategies to their student nurses about how to implement theories in the real work settings  to save the patients who tried to commit suicide (Sun, Long, Chiang & Chou, 2019). 

“In mental health, when depression exceeds the highest levels of endurance, people tend to commit suicide and a nurse is charged with the duty to develop effective strategies which can bring back the patients towards the normal course of life."Most of the people commit suicide to get rid of psychological pain and their mental weakness offers them a solution to end up their lives because they find no charm in a life with problems. This is a serious form of self-harm and many people die during the suicide attempt. Therapies used to help out the survivors is the need of the clinical best practices and nurses have to perform their role in making the patients hopeful about life. 

The negative thoughts must be removed from the mind of the patient and effective communication along with kind words of empathy will increase the chances of the speedy recovery of suicidal patients (Rudd & Roberts, 2019). Suicide has also become 10^th biggest reason of the deaths in the USA and in the past 15 years, this rate has increased rapidly because of the mental health issues and incapability of the people to face the realities of life with courage. To prevent the precious lives of people from the attempts of suicide, national suicide preventive policies have been developed. These policies will be implemented with the help of health care providers and nurses will take care of all those who are going through severe mental issues and have tried to commit suicide once (Hogan, 2020).

In the hospitals and clinical settings, dealing with emergency cases of suicide is an important task. Healthcare providers have to take special care of these cases. The standards and recovery measures need to be implemented immediately because the number of patients with suicide risks is increasing day by day (Zhou, et. al., 2019).   Most of the people are prone to suicidal attacks because they have low self-esteem, nurses can make efforts to engage these people in positive thoughts and can increase their self-esteem. 

Nurses can also provide social support and this will remove the disappointment and despair from the lives of depressed people (Matel-Anderson, Bekhet & Garnier-Villarreal, 2019). Nurses have to fulfill another ethical guideline in which trust is developed between the patient and the nurse. This trust is maintained through open communication and respect shown towards the patient. This strategy will not only offer help to the unique cases but can also be documented for further use in psychiatric nursing practices (Vandewalle, et. al., 2019).

In Australia, NMBA (Nursing and Midwifery Board of Australia) Standards define the ethical roles of nurses and midwives. These standards guide the nurses to deal with the patients and their families in an appropriate manner. Those patients who are brought unconscious in the hospitals, they need the support of the nurses because they cannot move their bodies. So, nurses need to take care of those patients with care and affection. The families of such patients need empathy and nurses need to treat the family members of the patients with empathy. To those patients, who have tried to commit suicide, nurses must take care for the usage of those technologies which are aimed to save the lives of such patients (Aitken, Marshall & Chaboyer, 2019). 

While most of the nurses are not aware of the strategies and interventions used in clinical practices when they are dealing with a patient prone to suicide. This must be learned through a formal platform where the senior nurses can train junior nurses on the matters to handle the people at risk of suicide. This learning will be used in treating theses patients but ethical aspects to treat them will be kept at the priority (Gilje, 2018).

One ethical duty of the nurses is to get training on how to handle patients with suicide risk. If they have not leaned the practices during their education, they need to show agreeableness to go through a training program because they can save a lot of lives this way if they learn practices to deal with the suicide patients. Nurses need to be quick and efficient while handling emergencies of suicidal patients because carelessness in that critical time may take the life of the patient. On the other hand, a careful and responsible attitude of a nurse can save the life of a patient. This will be helpful in the recovery of the patient when the nurse will be able to handle the patient according to the specific needs (Siau, 2019).

 One main goal of the nursing practices in mental health is to accept the reality and to positively view suicide to move towards solution finding. Nurses are ethically bound to understand the needs of the patients and to convert their negative feelings and depression into positive and productive thoughts with the help of effective communication (Flood, 2019).

Hence, it is concluded that due to increased depression in society, the rate of suicide has gone up. Nurses have to play their major role in the treatment of suicidal patients and their mental wellbeing can be improved if the nurses take care of these patients in an ethical manner according to the NMBA standards. Moral support provided by the positive behavior and treatment of a nurse will help the patients to combat the negative thoughts and to come out of depression. This can save a lot of lives by instilling positive thoughts and showing empathetic behavior towards suicidal patients.

Case Study of Structural and Functional Changes in Crohn's Disease

Author: Sana Rehman

Crohn's disease is a type of inflammatory bowel disease which refers to the intermittent episodes of abdominal cramping and diarrhea. It causes inflammation in the digestive tract and often leads to weight loss fatigue and vomiting and nausea. In the current case, Jordan is a 25 years old male diagnosed with Crohn's Disease.

Structural and Functional Changes 

The structural and functional wellbeing of digestive tracts is crucial for the health of the individual. The structural abnormalities often leads to functional decline, as a result human experience unhealthy life. The structural changes in inflammatory bowel disease mainly occur due to issue in digestive tract. Hence the distal ileum is the most prevalent issue in IBD. Furthermore, the inflammation or thickness of the intestine wall is also one of the kind of inflammatory bowel disease. In the current case, Jordan was experiencing diarrhea, abdominal cramp, and weight loss and diagnosed with Crohn's disease. 

The complete medical assessment of the Jorden’s reports suggest multiple changes in the structure of digestive tracts, which further leads to the weight loss. The structure changes of inflammatory disease were large patches of inflamed mucosa and submosca throughout his small bowel and colon. He was also diagnosed with the bowel obstruction in his terminal ileum. The dry and pale skin were the other symptoms due to the structural issues. The structural abnormalities were inhibiting the organs to function well. The relationship between structural and functions are consistent. The structural wellbeing of the digestive system promotes better functioning. In contrast, the structural abnormalities disturb the functional system as well (Nair et al., 2016).  

The functional changes which have been observed in Jordan’s case were dysfunction of food consumption and water intake. The digestive system was not processing appropriately to absorb the food. As a result, Jordan was experiencing nausea and vomiting. The inflamed digestive tract was not properly performing its function. Diarrhea or lack of food consumption and vomiting were reducing the weight of the Jordan. Due to Crohn's disease, the sleep cycle was also disturbed. Furthermore, Jordan was not able to appropriately walk and perform daily activities. The work-life was also reported to be disturbed. Apart from these, Jordan was experiencing multiple pain.

The functions of the entire body were disturbed due to structural issues. All these structural abnormalities were contributing to weight loss in Jordan’s case. Literature suggests that structural abnormalities in the digestive system not merely affect the function of that particular organ, but also disturbs the entire body functions (Nair et al., 2016).

Role of Morphine in determining the Pathways to alter the Conscious Perception of Pain

Morphine is a very effective painkiller for reducing pain in multiple body areas. In particular, it is effective in blocking the pain due to Crohn's disease. Morphine found to be more effective painkiller in contemporary medicines. The recent data suggested the effectivity of morphine in pain reduction and led to a better condition of the patients. It is effective because it directly effects on opioid receptors (GCPR), which regulates pain in the nervous system. Opioid receptors are widely distributed in the brain, spinal cord, digestive tract. These receptors respond to encephala, which control body pain.

Morphine mimics the compound to artificially block pain. Morphine binds the opioid receptors that generate the series of events, and GCPR activates g-protein. It also triggers more conduction through potassium channels and minimizes the conduction through calcium channels and adenylate cyclase. In this way, the nervous system controls the body’s signalling system that transmits pain. The robust evidence-based studies have been carried out on patients with Crohn's disease (Morrone et al., 2017). 

The results of the studies recommended the morphine three most effective medicine for blocking pain. A few contradictory studies also reported that morphine as a least effective painkiller due to its side effect (Long, Barnes, Herfarth, &Drossman, 2012), but the ratio of such studies were very limited. Therefore, it can be concluded that morphine is an effective medicine for relieving abdominal pain.

The Clinical Manifestation indicates the deterioration of Jordan’s Condition

The clinical manifestation that deteriorates the Jordan Crohns or inflammatory bowel is comprised of a cluster of symptoms. Such as diarrhea, abdominal pain, weight loss, nausea or billing vomiting, fatigue, mails, tenderness, abdominal gurgling & rumbling, and dark colour urine. The medical examination showed right lower abdominal quadrant and audible bowl sound, pale and dry skin, cool extremities, capillary and flat neck veins. Medical Officer reported bowel obstruction in terminal inflamed mucosa & submucosa throughout his small bowel and colon. The above symptoms have a history of gradual development.

 This early sign and symptoms of the Crohn's disease were observed in the age of 17. Currently, Jordan is 25 years old and still suffering from acute pain and Crohn's disease. Unfortunately, the lack of proper treatment by medical officers and surgeon lead to deteriorating the condition of Jordan. The issues needed medical attention but tried to manage by consulting doctors and nutrients. No improvement in Jordan's condition has been observed despite having invasive treatments. According to recent studies, the timely treatment for an early sign and symptoms for Crohn's disease must be taken (Ha, & Khalil, 2015). In some other studies, the delayed treatment and inappropriate treatments worsen the condition of the patients.

Characteristics of Intravenous Fluid and Rational for Administration

The intravenous fluid is a liquid substance used to fulfil the water, sugar and salt (Barkas, Liberopoulos, Kei &Elisaf, 2013). The intravenous fluid injected through a vein to those patients who cannot consume oral food. Intravenous food is available in many types and forms. In Jordan’s case, the 100 ml Hartman compound sodium was used to fulfil diet deficiency. The Hartman solution is a mixture of sodium lactate, sodium chloride, potassium, calcium and chloride. It is used for multiple purposes such as relapsing electrolytes & fluids among patients with low blood pressure, low blood volume and metabolic acidosis (Kammermeier, 2016). The fluid is injected through veins.

In the current case as Jorden was suffering from weight loss. He was not consuming many diets due to diarrhea and vomiting, as his intestine and bowel tract was not functioning correctly. To fulfil the diet deficiency, 100 ml Hartman compound solution was injected in his body. The literature is enriched with the evidence-based studies reflects the effectivities of intravenous fluid for the management of Crohn's disease affects (Barkas, Liberopoulos, Kei &Elisaf, 2013). The robust studies also indicate the effectiveness of intravenous fluid in weight gain among the patients of Crohn's disease (Kammermeier, 2016).

 

Environmental Cleaning and Mental Health

Author: Sana Rehman

Mental health is not only a matter of internal wellbeing, but it is found to be associated with the external environment. From a poorly-Lil office to a cluttered bedroom or a view from a window: everything affects our mental health. The surroundings directly impact our mood, feelings, behavior, and minds. The cold fresh breeze, rain, pleasant weather, seaside, beach sight, greenery, hills enchanting beauty, and northern area views, all impart a very positive impact on our mind and body. Not only beautiful sights improve the mental health of the people, but cleaning decontamination and waste management also reported to be associated with mental health. 

Air Pollution

According to the World Health Organization, every 10th Person inhales polluted air and encounters polluted air is accountable to seven billion death worldwide. Polluted air found to associate with physical illnesses such as cardiovascular disease, respiratory problems, and neurovascular disease. The polluted air is not only alarming for physical health but also reported to be a risk factor for developing depression (Ali & Khoja, 2019). 

Schor & Fabno (2015) recommended the relationship between polluted air and anxiety. Stress is the ultimate consequence of air pollution. Harvard School of public health carried out a study to investigate the impact of nitrogen oxide, black carbon, and other pollutants on stress. The finding of the study concluded that the perceived level of stress occurs when getting exposure to air pollution. Apart from all these, the mood swings have also been found to be dependent on climates. World Health Organization reports the connection between climates or extreme weather conditions, pollution

Exposure to Toxic Agents 

Only air pollution is not a single factor which is responsible for environmental cleaning. Exposure to a toxic agent is also an alarming aspect that leads to several mental health issues. Toxic agents cause many physical diseases, disabilities, and other mental health or medical issues. Exposure to metal (Aluminum & Mercury) leads to many psychiatric symptoms such as dementia confusion, depression, anxiety, poor concentration, memory loss, and insomnia. Children's exposure to leads is responsible for developing attention deficit hyperactivity disorder (ADHD), conduct disorder, and criminal behaviors. 

The exposure to lead in adolescence and young adulthood develops Alzheimer's disease and schizophrenia. Toxic substance and disease registry (TSDR) suggested that the source of leads is old house paints or plumbing systems, muddy shoes, auto exhaust, or industries. Regularly cleaning houses, paint, and children's hands are important to reduce the mental health effects of leads. Mercury poison among adults develops many psychiatric complications such as irritability, depression, anxiety, excessive embracement. 

The fetus and newborns are more susceptible to mercury exposure. According to TSDR the most common source of Mercury is waste products, fluorescent bulbs, and thermometers. Hence the careful handling of such waste products reduces the risk for mental health issues. Furthermore, the Aluminum, arsenic, Tin, Thallium, Magnesium, Pesticides, solvent, Toxic gases (Carbon dioxide, hydrogen sulfide), Polychlorinated biphenyls (PCBs), and Polybrominated biphenyls (PBBs) are associated with mental health issues, disabilities, and neuropsychiatric complications. 

Messy Home

Messy home always causes a feeling of distress and anxiety. Cluttering the house and housekeeping found to impart a positive impact on the mental health of the people. The University of California carried out a study on stress hormones. According to their study the messy home develop the increased level of steroids hormone, and cortisol, which produce stress. 

Similar studies have been conducted in Indiana university and the results indicated that the people with clean houses are mentally healthy compared to the people with messy homes. Furthermore, it has been reported that clutter home leads to a cluttered mind, which further develops unstable relationships. In short, it can be concluded that a clean house a clean bill of physical and mental health. 

Conclusion

The above facts depicted the strong connection between the environment and mental health. Hence, Environmental cleaning is very crucial for the mental health of the people. A pleasant environment is needed for the sound mind and body, but environmental cleaning can only be achieved through a cohesive contribution. A single person cannot help to keep the surroundings clean. The role of society, Government, policymakers, and social workers is very important to achieve the desired outcome.

 The awareness campaign through media and social media can be effective to motivate people for keeping their environment clean. Furthermore, documentary, short films, and skits for waste management and precautionary measures should be promoted for the healthy and clean society. 

 

 

 

Annotated Bibliography in Health Care

Author: Sana Rehman

The significance of the research question in evidence-based practice is very crucial. The research question provides statically proved information to avoid the chances of malpractices (Correa-de-Araujo, 2016). The lives of the human being are very crucial; therefore, the research question and its scientifically proved answer through primary and secondary sources are significant. In particular, the elderly age is very sensitive, and due to the ageing sign, the physical, psychological, and emotional decline occurs. Most specifically, the elderly population experience physical weakness; as a result, their physical activity reduced to some extent. 

Robust studies suggested that in a hospital setting, the most concerned issue of elderly people is restrained physical functioning (Rodrigues, 2014). Therefore to enhanced elderly people's physical functioning, their health status can be enhanced. The role of the nurse also plays a significant role in maintaining and promoting the health functions among the elderly (Rodrigues, 2014). According to evidence-based studies, they take care of nurses in health care centers can enhance the quality of life and health status of the elderly. Therefore, the significance of evidence-based research and identifying the answers to clinical reach questions are crucial for a nurse. 

The current study aims to investigate the effectiveness of an intervention based program to enhance the physical functioning of the elderly population. The research question has been a break down following the PICOT method.

PICOT

Following Table Shows the Question

P	Population, Patient, Problem, Setting	Elderly population, Physical Activity
I	Intervention	Physical Activity based Program
C	Comparison	Lack of physical activity at home and hospital
O	Outcome	Improved physical activity
T	Timing	Different times of the day

The above table shows the breakdown of the research question in the PICOT method. The breakdown of the research question makes the investigation process easier (Lobiondo-wood, & Haber, Cermon and Sing, 2018).

Article 1

Daher et al. (2019) conducted a study to investigate the impact of physical activity to enhance the quality of life and the health system. An intervention-based prospective survey was carried out among 100 participants with the age range of 60-69. The participants were divided into active and control, and the active group were indulge in daily exercise for 60 minutes. 

The result of the study indicates that the active group found to be physically active as they found to have the last visit to the hospital (0.0011), emergency room (0.0056), duration of hospital stay (0.0012), and subsidiary test (0.023). The study provided the evidence-based answer to the above question and recommended the intervention based program effective for elderly physical functioning.

Article 2

Nielsen et al. (2018) conducted a study to assess the effectiveness of the elderly activity-based intervention. For that purpose, the nonrandom Quasi-experimental trial was used. Around 144 elderly population was allocated the activity performance intervention and (n=231) usual practice. The intervention comprised of these steps (a) assessment, (b) referral to further rehabilitation and (c) follow up visits. 

The results of the study suggested that no significant difference in activity performance was observed between both groups. In other words, the study proposed that physical activity-based intervention does not reduce the risk of readmission in the hospital. This study contradicts the findings of the study mentioned above, but still provides the answer for our study.

Article 3

Thomas et al. (2019) conducted a systematic study review of the effectiveness of physical activity programs for the balanced life of the elderly. The Medline, PUBMED, and ScienceDirect databases were consulted to find out the relevant articles. The inclusion criteria for studies were controlled randomized trial, the elderly with the age range of 60-65, the sample size varied from 6 to 9, and the duration of the intervention falls between the 8 to 32 weeks. Finally, eight articles were considered for the final review. 

The articles investigated the effectiveness of aerobic exercise, T Bow, Balanced Training, wobble board training, Wii fit training, and adapted physical activity. The outcome of the study suggested that the physical functioning of elderly people improved by up to 16% to 46%. Thomas et al. (2019) study was highly relevant to the current study question and provided a clear picture that physical exercise significantly enhanced the physical activities of the elderly people.

All three included articles were highly relevant to the current study objective. The research question of the current study was to investigate the effectiveness of the physical intervention-based program to enhance the physical activity or functioning of elderly people. To find the answer to the questions, three relevant articles have been retrieved from PubMed databases. 

Two articles were found to be in support of physical activity-based intervention to enhance the physical functioning of elderly people. In contrast, one study contradicted the above two articles and suggested that physical activity-based interventions don’t enhance the physical functioning of elderly people.

 

Reflective Essay in Nursing Profession

Sample Reflective Essay in Nursing Profession

The current article provides an example of reflective essay as the reflective article samples or reflective article format are crucial to understand in nursing practices. The change in health needs and expectations has created the urge for the healthcare sector to recognise an unconventional service by nursing and medical professionals and government while enhancing the quality of primary care services to people. In future, the healthcare sector is focused on involving greater health promotion, chronic diseases monitoring the care of older patients while coping the increasing complexity in care standard. The process involves astute use of existing resources while cultivating work practices with an innovation used by other health professionals and practice nurses (Ion, et al., 2018). However, in Australia, the healthcare sector is facing a shortage of health workforce following the underlying need to develop a sustainable and responsive health workforce while maintaining the commitment to high quality and safe health outcomes. The examples of reflective essays can be seen in multiple theories. According to intersectionality theory, the process of clinical and health service inquiry is followed with research approach within the health service inquiry having a strong impact of people’s health (Mapedzahama, et al., 2018).

It is essential for nursing staff to follow up with a combination of philosophies under universal generalisability to develop understanding upon meeting health disparities to minimise the risk to complex aspects of a gendered power relationship, gender relationship, and other cultural relationship following the multiplicity of individual lives. By combining intersectionality theory, complexity theory, and social determinants, it is important for individuals to extrapolate broader social location in Australia contributing healthcare access and practices within areas of inequalities, confounding factors, structural relationship synergises with identification to produce health inequalities (Powell Sears, 2012). It is essential for nursing professionals to define the areas in which they are required to intersect identities within institutions within the hierarchies of power, gender, sexuality, and social relationship supporting illness and diseases. As a health care professional, I often meet people facing issues with a healthcare service provider having complex needs which often become challenging for us healthcare professionals to comply within the scope of our rights and responsibilities (Piller & Takahashi, 2010).

Our focus in health care operations is followed with the intersection of primary healthcare provider interconnecting with patients understanding their needs embodied with the process in space and time. We have learned about our roles and responsibilities under the Australian Practice Nurses Association of Australia following clinical care involving procedures and activities. It also considers practices needing management, coordination, and administration to support administrative practices as business entities (Clark, et al., 2015). It has followed us to develop the integration requiring effective communication channels with general practices following organisation and individuals. According to patient demographics, the practices are influenced by nursing play supporting families focused on immunisation and health issues. As a healthcare professional, I have focused on sustaining strong belief about having cultural identity following the components of the social and emotional wellbeing of patients under the Australian Framework of health as it is often cultivated and maintained while developing the connection to community and traditional lands (Morley & O’Connor, 2016).

As an individual, I am personally focused on fostering effective response following positive coping mechanism having life balance to protect individuals with adverse life experience facing issues having self-assessed health, educational, and wellbeing outcomes for greater life satisfaction. I believe that having a cultural impact on nursing practices are focused on the cultural identity of individuals to assess resources Australia Wide (Breckenridge & Hamer, 2014). While working in a professional setting, we have to follow with a positive attitude encouraging individuals to develop their own roles setting standards for education and role model guidelines, though there isa time when we face challenges. For example, in Australia, I think that the define health safety and quality standards are quite insufficient ensuring safe culture for patients achieving optimum care outcomes. Business with health care is disempowering boasting the likelihood of culturally safe clinical care contributing to health improvement. I think that it is followed with cultural safety within mandatory standards to offer safe, quality-assured clinical care strengthening inadequate gap within healthcare delivery (Keleher, et al., 2007).

Furthermore, throughout any career, I believe that while integrating cultural safety with healthcare practices reconfigure healthcare allowing the equity following the access to an appropriate intervention improving standards for individuals in professional work setting following a procedure based on conditions of Australian population irrespective on indigenous and non-indigenous people. As a healthcare worker, I have experienced cultural safety indigenous-lead care model limited, however, it has taken uptake from the inherent power imbalance with the healthcare service provider and patients (O'Connell, et al., 2014). Furthermore, I personally believe that having cultural safety, the care results often inadvertent disempowering of the recipients involving in decision making while maximising the care effectiveness. We are required to work on effective work practices by making sure that individuals in our work setting are aware of considering power relationship implementing reflective practices which further allow the individuals clarifying safety means. I was always focused on cultural safety and institutional care to deliver effective care identifying communication difficulties and barriers with intervention or procedures to overcoming these barriers (Currie, et al., 2007).

I think that as nurses, we are required to work on communal development having the discipline to incorporate evidence-based research to support science and approaches to improve healthcare practices taken into consideration to support cultural and socioeconomic background for people in need ensuring interaction and sensitivity to support effective care practices. The goal of the community role in supporting individual practices is focused on health nursing promoting, protecting, and preserving public health involving various scenario (Piller & Takahashi, 2010).For example, promoting healthy lifestyles, and preventing disease and health problem supporting direct care to the individual requiring it. I am currently looking forward to educating myself and others about making efficient decisions following people with chronic conditions so that they can make healthy decisions while supporting their roles under health and wellness programs. As a nation, I think that we are facing major issues such as infectious and sexually transmitted diseases, obesity, poor nutrition, substance abuse, smoking, teen pregnancy, and other (Clark, et al., 2015).

Currently, I am looking forward to improving my focus as community nursing work in healthcare institutions while giving importance to the healthcare practices in remote places supporting people facing issues such as chronic illness, and economic struggle looking forward to improving individual welfare. I was focused on bringing quality patient care in a vulnerable and underserved member of the society (Keleher, et al., 2007). From what I have experienced, nursing practices in Australia has followed in response to government initiatives to support the primacy care followed with current demographics and employment characteristics exploring the trends supporting their role in the recent time. Following my role in Australia general practices, I have followed with the expansion in the last decade following the changes in health policies, funding models, and nursing education are transforming the Australian primary care landscape (Morley & O’Connor, 2016).

To summarise, it can be said that nursing practices are evolving in this era continuously hence require us as nurses to continuously learn about new standards, regulations, and policies formulating perspectives. This I believe can support us meet the difficulties of this industry dynamics whole contributing our role in the social and communal background doing good for the people in Australia.