Doctor of Nursing Practice Issues and Concerns

Doctor of Nursing Practice: Advanced Nursing Practice Within Global Health Systems-Social Justice, Equity, and Ethics in Health Care
Topic 1:
Underdeveloped and developing nations have a range of health concerns to keep under consideration and that deserve attention from middle and wealthy nations for help and nurturing. Many of these nations don’t have proper sanitation or clean water, and this creates much of their illness and suffering. However, this paper will focus on the HIV/AIDS crisis in underdeveloped nations. This epidemic has been controlled in middle and high income nations, it is still widespread in underdeveloped countries, particularly those in sub-Saharan Africa. “The Worldwatch Institute has reported that in as many as 20 developing countries—nearly all in sub-Saharan Africa—more than 15 percent of the total military force is thought to be HIV-positive. And nearly 74 million workers worldwide could die from AIDS-related causes by 2015” (worldwatch.org, 2017). Actually, by the end of 2015 there were over 36 million individuals infected with HIV all over the world. Sub-Saharan Africa was one of the most prevalent areas with 1 person infected for every 25 people (gc.ca). In nations in this part of the world, females tend to be 80% of all HIV infections and are twice as likely to be infected than their male counterparts (gc.ca).
The DNP can play an instrumental role in eradicating this issue. So much of reigning in the spread of HIV/AIDS revolves around prevention and education. Organizing rigorous campaigns in these affected parts of the world to show what people can do to stop the spread of this disease would be very useful. Distributing things like condoms and drilling into the minds of the people there that the use of condoms is a necessity and an obligation in order to stop the spread of this epidemic, could be useful. The DNP could act as a health and disease prevention ambassador in this regard, and have a powerful impact on minimizing the spread of this disease.
Topic- 2:
The DNP has a potentially very powerful role in helping to shape the social determinants of health. According to the official website of the World Health Organization (WHO), “The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries” (2018). The DNP can work with local non-governmental organizations and local sectors of powerful organizations like the Red Cross to ensure that her patients have access to the supplies and health resources that are available. Health and medical supplies are sent to the developing world, but the people need to know about them and access them. The DNP can act as a human bridge between the larger chapters of health organizations that are stationed in developing countries, and the communities served. The DNP can also act as someone who can provide current intelligence about the needs of a particular community and communicate that to organizations like the Red Cross or Doctors without Borders. For example, if a community is in need of medication for urinary tract infections or has high rates of anemia, the DNP can act as someone who as “on the ground” intelligence and can convey the needs of a community to the organizations who can provide supplies and medicine. The DNP can also work with these greater organizations and discuss ways that social changes can be implemented in order to address the greater good so that these communities are more inclusive, balanced and healthier, with greater gender equity.
Topic- 3:
The official ANA position regarding human rights is inspiring as it can help to make societies and communities around the world more equitable and peaceful places. The ANA definition puts a spotlight on the necessity of individual dignity, worth and human rights as a definitive guiding principle. “Nurses establish relationships of trust and provide nursing services according to need, setting aside any bias or prejudice (ANA, 2015, p. 1). This statement on ethics and human rights provides the foundation and context for all other position statements related to the practice of nursing. The protection and promotion of human rights in health and health care are fundamental functions of the American Nurses Association” (ANA, 2016). According to this definition, this means that it is up to the nurse not just to promote health, but to engage in one’s due diligence to promote the elements of society that impact health and justice, such as dignity.
Hence, the job of the DNP is to stay educated and current on the host of social issues that can often be intertwined with health concerns within the developing world. It’s not enough for a DNP to simply treat conditions, hand out vitamins and antibiotics, and call it a day. The nurse needs to be the one who is willing to take a long hard look at how communities are run from the inside, and be able to pinpoint the social issues and mentalities that are contributing to an imbalanced way of life. For example, in some African communities, it is permissible for a village elder to be wed into marriage with an infant. For most people in the world, this is an egregious human rights abuse. In such cases, it can be quite useful for the DNP to act as a mediator in this regard, for the protection of the child.
Topic- 4:
If there’s one thing that the current political climate has demonstrated to me, is that it has caused much distress for many of my patients. More and more patients express uncertainty to me, and concerns about living in a society where their leader is viewed as mercurial and unpredictable. This has been a uniform reaction among so many of my clients. However, more acutely, I have found more psychological distress in patients of mine who identify as belonging to the LGBTQ community, particularly people who identify as transgender. For example, in Trump’s America, there have been numerous policies that have been notably not-inclusive to people of transgender background from preventing transgender people from using the bathrooms they’d like to use, to preventing them from serving in the military. Actions like these within Trump’s America are very worrisome, as many have argued that they “give the green light to anti-LGBTQ groups and hate groups in the US to discriminate and commit violence against the LGBTQ community. According to the Southern Poverty Law Center (SPLC), hate murders and violence against transgender people in 2016 hit an all-time high” (Flaskerrud & Lesser, 2017). With all these factors combined, it is clearly up to me as a DNP to be responsible for engaging in active advocacy work for members of this community. Members of the transgender community deserve to feel safe and not under any psychological distress. They need to feel like their voices are heard and prioritized by their governments. Forming an advocacy group that can protect these people and lobby on their behalf would be the utmost responsibility of the DNP, and something that needs to be done with great skill and organization at this time. A society isn’t healthy or balanced when minority members are marginalized.
Topic- 5:
In creating a new community-based health program, I would employ the CHANGE (Community Health Assessment and Group Evaluation) model. This model is “A tool created to guide a team of community leaders through the assessment process of identification and prioritization of health issues. With this information, the community team can create sustainable, community-based improvements to address the identified health issues” (Wargo, 2017). The CHANGE model is so effective and so useful because it forces members of a community to work together in an organized fashion so that they can create meaningful and specific change within their community, changes that definitively reflect their immediate needs. The CHANGE model is also so useful and has such a high rate of success because it does depend on gathering and evaluating data to determine how well things are progressing. This is a form of internal checks and balances within the model to ensure that it is successful. The CHANGE model also relies upon teamwork, which is another form of checks and balances that ensures the overall success of the model. By relying on teamwork, the CHANGE model ensures that there are a variety of perspectives at work, which can help pinpoint assumptions and mistakes. One recommendation that I would employ for making the development of the program successful, would be to have regular sessions of discussion where there would be a free-flow of ideas and everyone would have an opportunity to air out their concerns and grievances in a constructive manner. This would help shed light on any weaknesses, fears or concerns that could be weakening the entire process. It’s important to air out issues like these during the transformation process as this can often illuminate things that need to be better addressed or that require better solutions.
Topic- 6:
Large aggregated databases can be used to improve population health in concrete ways. Large aggregated databases represent a wealth of information about communities. A good clinician should be able to take that data and look for trends. A massive database such as that should be able to offer a look at the trends and health patterns within a community and show issues or weak spots that need more attention. For example, a large health database in the early 21st century demonstrated that there was a high incidence of ulcerative colitis and other such bowel diseases in parts of Northern Canada. Findings such as these, which can only be found when one has access to large amounts of data, can act as a springboard to subsequent research and to determining why and how such a health trend exists, along with what can be done to prevent it. Hence, this is why it’s so important for all clinicians to have relevant and timely training in the best usage of all electronic databases. It’s in the best interest of the clinician and of the patient communities that they serve. For example, a study conducted in the beginning of the 21st century found that when nurses had proper training on how to use and search through databases, forming conclusions, “The knowledge gained appeared to be of value in practice. Nurses spoke of being able to answer clients’ questions better. They also spoke of feeling more confident in their responses when patients developed symptoms and side?effects that they had read about” (Griffiths & Riddington, 2003). Confidence, authority, knowledge—these are all things that can be increased when one has access to large amounts of data and can create informed assumptions about them. This research emphasizes the importance of training when it comes to database usage and retrieval.

















References
ANA Board. (2016). Retrieved from https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/ethics-and-human-rights-protecting-and-promoting-final-formatted-20161130.pdf
Flaskerud, J. H., & Lesser, J. (2018). The Current Socio-Political Climate and Psychological Distress Among Transgender People. Issues in mental health nursing, 39(1), 93-96.
GC.ca. (2017, June 8). HIV/AIDS in developing countries. Retrieved from http://international.gc.ca/world-monde/issues_development-enjeux_developpement/global_health-sante_mondiale/hiv_aids-vih_sida.aspx?lang=eng
Griffiths, P., & Riddington, L. (2001). Nurses’ use of computer databases to identify evidence for practice—a cross?sectional questionnaire survey in a UK hospital. Health Information & Libraries Journal, 18(1), 2-9.
Wargo, K. (2017). Retrieved from http://www.archwaypartnership.uga.edu/wp-content/uploads/2014/09/Community-Wellness-Planning-Toolkit.pdf
WHO.int. (2018). Social determinants of health. Retrieved from http://www.who.int/social_determinants/en/
Worldwatch.org. (2014, 6). Study Highlights Four Key Health Challenges in Developing Countries; China Struggling With All | Worldwatch Institute. Retrieved from http://www.worldwatch.org/study-highlights-four-key-health-challenges-developing-countries-china-struggling-all