Our discussion last Thursday and Friday focused on the Impact of Disease on Health Care Delivery System and Health & Social Care. During that time our tutor Kate gave us an activity which we will cite examples have disease affected those areas of health.
Due to our disserted topic I learned that once a disease happen get through in a community many problems will appear and needs to be solve immediately before it will get worst. To prevent it to happen, many organisation like WHO, DOH, UNICEF etc. made actions to control it but unfortunately still many problems coming up which was all explained by the groups.
If you need assistance with writing your reflective nursing essay, our professional reflective nursing essay writing service is here to help!Find out more
Things like Financial Issues, Supply and Demands, Lack of Awareness and Knowledge, Skills Shortage and Poor compliance are the cited problems in all groups that occur in a community who are affected with any kinds of disease. We come up this idea of some reasons. Why Financial Issues? Because medicines and manpower are not free which means it needs funding to cope this problem especially when a large portion of individuals who are needed to be rendered with health services. Supply and Demands, still related to financial issues. Lack of Awareness and Knowledge, this contributes the problem because if a community is lack of awareness or knowledge about it health they are very vulnerable to illnesses or diseases. Skills Shortage this pertains to the members of health care system, it talks about how effective are they in rendering their services, are they professional and skilled to give services in an efficient and effective way??
Another topic we also considered last week was about case study of Philip, that study is very meaningful to us because its talks about Philips health and family problem. That case study gives us information that Health awareness is vital to a human life and we should take care of ourselves. It also
gives ideas to health practitioner on how to manage a case that has crucial situation and needs immediate attention.
Has this new knowledge changed my understanding? ( have I developed a whole new way of seeing things):
Knowing about the topic we tackled last week enlightened my mind on the importance of caring ourselves and a community as a health practitioner. Hearing those facts make me think that we should take care ourselves in many ways like having enough knowledge in health promotion and disease prevention, regular check up to assess our health status whether we are having illness or not, having healthy habit, diet and lifestyle.
On the other hand also as a health care provider it is our responsibility to provide health teaching on those individuals we know that needs it or even not because doing this promotes health and gives knowledge to them on avoiding any disease problems. In addition, we should be a role model of health to them because this is one of the effective way were they will believe our health teachings and apply it to their selves.
How will I apply this knowledge and understanding in my work situation?
In my situation, there are many cases where I can apply this facts and knowledge I gathered in our last week’s discussion. As we know, we can encounter different case of diseases in care homes both communicable and non-communicable disease and we are aware that we’re susceptible to have that diseases if we are not aware of it. Due to this point, precautions necessary to prevent getting and spread of one disease to another and we can do it by applying the things we discussed about public health in our workplace. In order to avoid ourselves and others from getting any disease we must maintain doing the basic things like hand washing after toileting/diapering, before preparing or eating food, after covering a sneeze or cough, after blowing the nose, before and after treating a sore or wound. Using of proper protective clothing as a first line of defence.
Learning a new topic leads to changes in our knowledge and understanding and should also lead to changes in ways of working.
Identify any new knowledge, facts or theories that I have learnt from this week’s teaching:
Last week, We discussed all the things that are related about public health and itself. I found out that public health is a very broad topic and correlates many components such as health sector, health organisations, etc.
I learned that Public Health is vital in helping people to be aware about their health because it promotes good health, prolongs life and prevents society in getting any kind of diseases. It is also a gathered deed for the health of the certain population.
In dissemination of all the information related to health, there are agencies that are responsible in data distribution. This agencies and sectors are the one who takes the promotion, prevention, planning, action, and implementation of all the goals in regarding health information dissemination.
One of the most common agencies here in United Kingdom is the National Health Service or commonly called NHS. This agency acts as a framework of local organisations responsible for the healthcare of the community and to work with the local community to improve our populations health and well being. There are more agencies that acts or has a role like the NHS in relation to Public Health.
On the other hand Health Organisation has a big role in terms of promoting people in health awareness of the community because they are the one who distribute the health information globally such as World Health Organisation. WHO is the organisation that coordinates and directs for health within the United Nations. WHO leads in providing information about global health matters. Every time there is a new case of disease they are the one that conducts the studies on it and share the information all over the globe. For example, last week we had disserted the topic about the different infectious disease ( Swine Flu, Salmonella, HIV/AIDS, Measles, Meningitis, Tuberculosis , and MRSA ) and Non-infectious Disease ( Cancer, Coronary Heart Disease, Cerebro-Vascular Accident, Obesity, Asthma ) which are the products of the studios of WHO. Without WHO we cant gain access or unknowledgeable about these diseases.
Has this new knowledge changed my understanding? (have I
developed a whole new way of seeing things)
The topic we discussed doesn’t change my understanding about Public Health. The lesson we take up last week adds information about what I know in public health and it makes me understand that it is very important in building healthy community not only in a certain place but globally.
It also reminds me that as a health practitioner, we have also the responsibility to share what we have learned about promoting health and preventing diseases. Through this way we can help achieved one of the Public Health goal, which is the Health Awareness.
How will I apply this new knowledge and understanding in my work situation?
Like what I have said before, we can apply this knowledge by sharing the information about public health and telling them how to prevent diseases.
In my situation as an Health Care Assistant in a Care Home, I can share what I have learned by telling to all my colleague’s the importance of using protective clothes whilst giving care to a service user and explaining them how to make care a service user who has infectious and non-infectious disease.
In this assignment, for Part 1, I am going to cite two agencies and named their roles in Public Health in terms of identifying level of health and disease in communities. I will name also epidemiology of two diseases and investigate a chart or graphical form of its incident rate. On other hand I will show the Statistical Data of the two diseases and interpret it base on facts and my understanding.
In every agency I will choose two different approaches and strategies in controlling disease and investigate its effectiveness and after that I will make surveillance on how it improves Public Health. In this activity too I need to inspect current priorities to the provision of one disease and gives example on how it relates between prevalence rate, its causes and the requirements for health and social care services. Explore
In Part 2, I will do a case study on a given data or on a workplace experience. Analyse its critical factors that affects individual’s health then after I am going to put its priorities and evaluate its effectiveness to individuals well being. I will proposed as well changes that can improve its health and set it in action like having implementing campaigns to encourage maximize their health.
In this part, I will explain the role of 2 different agencies in identifying levels of health and disease in communities
It is improving and safeguarding well-being. Public Health is in charge for health safety, health enhancement and health inequalities issues in England. It is responsible moreover for shaping policy, allocating resources, co-ordinating actions and supervising progress. Diagnose and investigate health hazards and health problems in the society. Assess accessibility, effectiveness, and quality of personal and population-based health services. In addition they are the one organised community efforts in aiming prevention of disease and promotion of health. In relation of this, I select two agencies that will partake the goals of public health.
There are many agencies that have important roles in the society. I chose two agencies which helps contribute health awareness and protection for any kind of diseases; it is the Department of Health (DOH) and National Health Services (NHS).
I will precisely relate this two agency to the two diseases I chose which is the Meningitis and Cerebrovascular Accident.
Department of Health has many roles for the society. This agency focuses on issues related to the general health of the citizenry. It also compiles statistics about health issues of their area. It assesses and assures risk management to human health from the environment properly. Promote and protect the health and wellness of the people within the society and community. Promote and protects the public health to prevent disease and illness. Provides research and information for the detection, reporting, prevention, and control of any diseases or health hazard that the department considers to be dangerous that likely affects the public health. Establish a uniform public health program throughout the community which includes continuous service, employment of qualified employees, and a basic program of disease control, vital and health statistics, sanitation, public health nursing, and other preventive heath programs necessary or desirable for the protection of public health. Gather and disseminate information on causes of injury, sickness, death, and disability and the risk factors that contribute to the causes of injury, sickness, death, and disability within the society for their awareness. Implement programs and campaigns necessary or desirable for the promotion or protection of the public health to reduce and control the disease. DOH develops strategic approaches for current health risks. Establish risk analysis framework and maintenance of risk standards.
National Health Services is a publicly funded healthcare systems in United Kingdom, this agency focus on maintaining people’s health and well-being. This agency is responsible for delivering quality and effective health service to humanity. They also contribute fair access to everyone in relation to people’s need. They are responsible for making payments to independent primary care contractors such as GPs, dentists, opticians and pharmacists in rendering their services to all people who needs it. It provides different caring services such as Emergency Respite Care, where care is provided if an individual; are unable to fulfil your caring responsibilities due to unforeseen circumstances, such as illness. Domiciliary Care, where somebody comes into your home and takes over some of your responsibilities for a few hours. Day care centre, where the person you care for spends time at a centre whilst you have a few spare hours to yourself. There are more services rendered by the NHS which develop societies health
In this part, I will investigate the epidemiology of two diseases in graph format and show my understanding and interpretation of the given data:
Meningitis is an infection of the meninges, protective membranes that surround the brain and spinal cord. Infection can cause the meninges to become inflamed and swell, which can damage the nerves and brain. This can cause symptoms such as a severe headache, vomiting, high fever, stiff neck and sensitivity to light. Many people (but not all) also develop a distinctive skin rash.
Symptoms can differ in young children and babies. See the “symptoms” section for more information.
Meningitis can be caused by:
bacteria, such as streptococcus pneumoniae, the bacteria also responsible for pneumonia, which usually live harmlessly in your mouth and throat, and
viruses, such as the herpes simplex virus.
Viral meningitis is the most common and less serious type of meningitis. There are approximately 3,000 cases of viral meningitis reported in England and Wales every year, but experts believe the true number is much higher. This is because in many cases of viral meningitis the symptoms are so mild that they can often be mistaken for flu.
Viral meningitis is most common in young children and babies, especially in babies less than one year old.
Viral meningitis usually gets better by itself within a couple of weeks, without the need for specific treatment.
Bacterial meningitis is extremely serious and should be treated as a medical emergency.
If the bacterial infection is left untreated, it can cause severe damage to the brain and infect the blood (septicaemia), leading to death.
Treatment requires a transfer to an intensive care unit so the body’s functions can be supported whilst antibiotics are used to fight the infection.
There are approximately 2,000 cases of bacterial meningitis in England and Wales every year. The number of cases has dropped sharply in recent years due to a successful vaccination programme that protects against many of the bacteria that can cause meningitis.
The treatment for bacterial meningitis has improved greatly. Several decades ago, almost all people with bacterial meningitis would die, even if they received prompt treatment. Now deaths occur in one in 10 cases, usually as a result of a delay in treatment.
Bacterial meningitis is most common in children and babies under the age of three, and in teenagers and young people aged 15-24.
The best way to prevent meningitis is to ensure that your family’s vaccinations are up to date.
Stroke (cerebrovascular accident)
A stroke happens when the blood supply to the brain is disturbed in some way. As a result, brain cells are starved of oxygen. This causes some cells to die and leaves other cells damaged.
Types of stroke
Most strokes happen when a blood clot blocks one of the arteries (blood vessels) that carries blood to the brain. This type of stroke is called an ischaemic stroke.
Transient ischemic attack (TIA) or ‘mini-stroke’ is a short-term stroke that lasts for less than 24 hours. The oxygen supply to the brain is quickly restored and symptoms disappear. A transient stroke needs prompt medical attention because it indicates a serious risk of a major stroke.
Cerebral thrombosis is when a blood clot (thrombus) forms in an artery that supplies blood to the brain. Blood vessels that are furred up with fatty deposits (atheroma) make a blockage more likely. The clot prevents blood flowing to the brain and cells are starved of oxygen.
Cerebral embolism is a blood clot that forms elsewhere in the body before travelling through the blood vessels and lodging in the brain. In the brain, it starve cells of oxygen. An irregular heartbeat or recent heart attack may make you prone to forming blood clots.
Cerebral haemorrhage is when a blood vessel bursts inside the brain and bleeds (haemorrhages). With a haemorrhage, blood seeps into the brain tissue and causes extra damage.
(2009) (Meningitis). Available from http://www.nhs.uk/conditions/Meningitis/Pages/Introduction.aspx. [Accessed Feb. 24, 2010]
These are the graphs showing the rates of Meningitis and Cardiovascular Accident here in United Kingdom.
Source: PHLS Meningococcal Reference Unit
Group B- unvaccinated Meningococcal serogroup C
Group C- vaccinated with Meningococcal serogroup C conjugate vaccine (MCC)
This graph table shows the effectiveness of meningococcal conjugate vaccine from 1998 – 2007. As we have seen in the figure, the case reduces every year especially to those who have taken the vaccine. It also shows the successful phased introduction of the meningococcal serogroup C conjugate vaccine (MCC) in 1999 into the National Immunisation Programme in the UK. This graph tells also that the immunity to Meningitis C has been identified in age groups who have not been vaccinated, as bacterium carriage rates are reduced across the population. We can see also in this table that those who didn’t take meningococcal vaccine were greatly affective by Meningitis.
Source: NOIDS England & Wales Final Midi Report for 2005 (Table 3 – Final totals for 2005 by sex and age-group)
Prevalence of Bacterial Meningitis and Septicaemia by Age Group
In this table, we could conclude that ages under 1-4 years old was greatly affected by meningitis as we have seen in the peaks of the graph and 0-11 months was greatly affected by the Pneumococcal and Meningococcal disease. And the same ‘peaks’ in the number of notifications for the ‘under 4 years’ and ’15-24′ age groups can also be seen with meningococcal septicaemia.
Source: NOIDS England & Wales Final Midi Report for 2005 (Table 3 – Final totals for 2005 by sex and age-group)
Prevalence of Bacterial Meningitis (without Septicaemia) by Age Group
This graph shows the high number of notifications of meningococcal and pneumococcal meningitis (without septicaemia) in England and Wales. Observing this graph will note us that the cases in 2005, age group that is 1 year of age are greatly affected with Meningococcal Meningitis and Pneumococcal Meningitis and 15 to 24 years of age were averagely affected with the certain disease. It also illustrates us that among the group cases ‘under 1 year of age’ gets the highest peak in having Pneumococcal disease. It is also interesting to note that the pneumococcal meningitis peaks again in the older age groups (45-64 and 65+).
Top of Form
Bottom of Form
This graph shows all the percentages of all six categories are experiencing stroke. Figures for males are in dark gray bars and data for females are in light gray bars, with the number of patients in each age category shown above each bar. All data are patients who are experiencing stroke or CVA. As we observed in the graph the age group from 30 to < 40 of males has the highest rate of experiencing stroke and in female is the age group whilst 50 to <60 is the utmost pace of age for females. 20 to <30 and 40 to <50 has the same rate in experiencing this disease. In female 30 to <40 and 50 to <60 is nearly same to each other having this disease.
Our nursing and healthcare experts are ready and waiting to assist with any writing project you may have, from simple essay plans, through to full nursing dissertations.View our services
This illustration shows the Incidence Rate of stroke in United States and United Kingdom. Details are articulated as person per year having stroke in 7 age categories. Individual experiencing strokes, person-years of follow-up was defined as the number of years from birth to the date for first recorded stroke. For individual without strokes, person-years of follow-up were defined as the last available follow-up date during the natural history period. Stroke incidence rates are revealed in data chart beneath the graph. As you see the data it’s very clear that a UK male has the highest incidence rates. UK Females, US Males and US Females are mostly like has the same incidence rate in occurrence of CVA.
In this part, I will choose at least two approaches and strategies that control the incidence of one disease and analyse its effectiveness:
As prevention of these diseases and to decrease its rate Department of Health and National Health Services make strategies and campaign to attain their goals. Department of Health formulate the ” Meningitis C Campaign ” the purpose of the this campaign was to immunise as many as possible of the country’s 15 million young people and children aged under the age of 18 years in as short a time as possible, immunising those most at risk of disease first.
Carrying out of the programme was made according to the risk of disease-those at utmost risk being immunised first. In November 1999, National Childhood Programme introduces the routine immunisation of vaccine at the ages of two, three and four months – alongside the DTP, Hib and polio vaccines and in December 1999 adolescent that ages 15 and 17 was also immunised.
As a result of the campaign there are around 13 million children have immunised during the first year through the help of general practitioners, nurses, immunisation coordinators and many other health professional.
This was pursuing by a widespread draw alongside programme to immunise all other children and adolescents up to the age of 18 years in 2000/2001. After that the vaccine was made accessible to anyone up to 25 years.
National Health Services contributed also a meningitis prevention program here in United Kingdom. The ” Campaign to promote new Vaccine against Meningitis”, this program encouraged all parents to immunised their children against pneumococcal disease which is the causative agent of meningitis. General Practitioners has the big role of this campaign because they are the who will catch-up the campaign for the children ages 0 – 2 years who is starting their immunisations. This program was imposed by Health Minister Dr. Brian Gibbons. He states that: “Immunisation is the best way to protect children from serious disease and the routine childhood programme has been extremely effective in achieving this. The changes will further improve the programme and benefit children. This new vaccine will help save lives and prevent hundreds more cases of serious illness such as meningitis and pneumonia.”
To maximise the defence against Meningitis C and Hib disease NHS made two changes in the routine program. The present three doses of Meningitis C vaccine will be respaced at three and four months of age with a booster shot at 12 months.
Most up-to-date proof shows that the protection offered by this vaccine declines one year after vaccination. To maximise the protection in the first two years of life when the risk of infection is high, we will recommend doses at three and four months of age and a booster dose at 12 months. A booster shot of Hib vaccine will be given at 12 months.
In 1992 Hib vaccine was introduced and is presently given to children at two, three and four months of age. Since 1999, there was a small but slow increase in the number of cases in older children being reported. Again, because of this Meningitis prevention program, the disease declined over time. There was a Hib booster campaign happened in 2003. This dose was given to older children to maximise their immunity. This upturned the small increase in infections that had started to occur. A booster dose of Hib vaccine is being added to the childhood immunisation programme as a routine at 12 months to extend protection against Hib disease.
The new routine vaccination schedule is as follows:
2 months DTaP/IPV/Hib + pneumococcal vaccine
3 months DTaP/IPV/Hib + MenC vaccine
4 months DTaP/IPV/Hib + MenC + pneumococcal vaccine
12 months Hib/Men C
13 months MMR + pneumococcal vaccine
DTaP/IPV/Hib is a single injection that protects against diphtheria, tetanus, pertussis, polio and Hib.
MenC protects against meningitis C
Hib/ MenC is a combined vaccine protecting against Hib and Meningitis C
(2009)( Campaign to promote new Vaccine against Meningitis ) available from www.immunisation.nhs.uk. [Accessed at February 24, 2010]
Due to this campaign the rate of meningococcal infection has fallen every year since, and the cases of laboratory-confirmed group C meningococcal disease across all age groups immunised has go down by 90% since the vaccine was implemented. In 2003/04, there were only 65 cases reported and 8 deaths.
There was even a good effect in those who were not immunised with a reduction of about 70%, recommending that the vaccine has had a community protection effect.
In fact the campaign has been so successful that meningitis C disease now accounts for less than 10% of meningococcal meningitis cases. Even though the campaign made a great success still the health officials and medical professionals need to remain cautious.
(2010) ( Meningitis C Campaign) available from http://webarchive.nationalarchives.gov.uk. [Accessed at February 24, 2010]
. For Cardiovascular Accident prevention, Department of Health formulated new strategies to fall its rate. They formulated the Stroke: Act F.A.S.T. awareness campaign; F.A.S.T means Face, Arm, Speech, and Time.
The Stroke: Act F.A.S.T. awareness campaign aims to teach all health related professionals and the community on the signs of stroke and that prompt emergency treatment can reduce the risk of death and disability.
The campaign will notify the community about F.A.S.T. to call 999. F.A.S.T is a simple examination to help people to identify the signs of stroke and be aware of the importance of fast emergency management.
Campaign adverts, on Television, radio, internet and flyers, illustrate stroke ‘spreading like fire in the brain’ to demonstrate that fast emergency action can limit damage and radically raise a person’s probability of surviving and of avoiding long-term disability.
(2010)( Stroke: Act F.A.S.T. awareness campaign ) available from http://www.dh.gov.uk/en/Publicationsandstatistics. [Accessed at February 24, 2010]
If Department of Health has its campaign towards CVA, National Health Services provide also a program to lessen its incidence rate; The National Stroke Awareness Campaign. This campaign is related to F.A.S.T were NHS implemented that all paramedics should know how to assess a person using F.A.S.T before sending them to hospital.
They also made a Stroke Association who will support this campaign. This kind of charity is exclusively concerned with fighting stroke towards people in all ages. The charity resources research into prevention, treatment, better methods of rehabilitation and facilitates stroke patients and their families directly through its Rehabilitation and Support Services which include Communication Support, Family and Carer Support, information services, welfare grants, publications and leaflets.
In this part, I will investigate current priorities and approaches to the provision of heath services for people with one disease:
Treating Meningitis is not easy thing to do because this disease has various types, viral and bacterial meningitis. There is no treatment for Viral Meningitis. The immune system, will create antibodies to annihilate the virus. Until it is known that a child has viral, not bacterial meningitis, he or she will be admitted to the hospital. But once the finding of viral meningitis is complete, antibiotics are stopped, and a child who is recuperating satisfactorily will be sent home.
Simply acetaminophen must be given to lessen fevers. Clear fluids and a bland diet including preferred foods should be offered. During recovery, a child desires rest in a gloomy, quiet room. Bright lights, noise and guests may irritate a child with meningitis. Increased anxiety on the brain from build-up of fluid in the meninges is a severe problem.
(2010)(Viral Meningitis) available from: http://www.healthscout.com. [Accessed at February 24, 2010)
For Bacterial Meningitis may prove fatal within hours. Patients with suspected acute bacterial meningitis should be immediately admitted to the hospital and assessed for whether LP (lichen planus) is clinically safe. Antimicrobials should be given quickly. If LP is late because a CT scan is essential, antibiotic action should be started before the scan and after blood samples have been attained for culture. When the exact organism is recognized and results of susceptibilities are known, treatment can be customized accordingly. After the diagnosis has been confirmed (generally within 12-48 hours of admission to the hospital), the patient’s antimicrobial therapy can be modified according to the causative organism and its susceptibilities. Supportive therapy, such as fluid replacement, should be continued. Dexamethasone should be continued for Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides.
S pneumoniae (duration of therapy 10-14 days)
Penicillin susceptible (minimum inhibitory concentration [MIC] <0.1 microgram/mL): ampicillin or benzylpenicillin
Penicillin intermediate (MIC = 0.1-1.0 microgram/mL): cefotaxime or ceftriaxone
Penicillin resistant (MIC â‰¥2.0 microgram/mL) or cephalosporin-resistant (MIC â‰¥1.0 microgram/mL): vancomycin AND cefotaxime or ceftriaxone.
H influenzae (duration of therapy 10-14 days)
Beta-lactamase-positive: cefotaxime or ceftriaxone.
Streptococcus agalactiae (group B streptococci) (duration of therapy 14-21 days)
Gentamicin AND ampicillin or benzylpenicillin.
Escherichia coli and other gram-negative Enterobacteriaceae: (duration of therapy 21-28 days)
Gentamicin AND cefotaxime or ceftriaxone.
Listeria monocytogenes (duration of therapy 21-28 days)
Gentamicin AND ampicillin or benzylpenicillin.
Staphylococcus aureus (duration of therapy depends on microbiological response of CSF and underlying illness of the patient)
Methicillin susceptible: nafcillin or oxacillin
Methicillin resistant: vancomycin.
Staphylococcus epidermidis (duration of therapy depends on microbiological response of CSF and underlying illness of the patient)
Pseudomonas aeruginosa (duration of therapy 21 days)
Ceftazidime and gentamicin.
Enterococcus species (duration of therapy 21 days)
Ampicillin and gentamicin.
Acinetobacter species (duration of therapy 21 days)
Gentamicin and meropenem.
N meningitides (duration of therapy 5-7 days)
Penicillin susceptible (MIC <0.1 microgram/mL): ampicillin or benzylpenicillin
Penicillin intermediate (MIC = 0.1-1.0 microgram/mL): cefotaxime or ceftriaxone.
(2010) (Bacterial Meningitis) available from: http://bestpractice.bmj.com. [Accessed February 24, 2010]
In this part, I will explain by giving examples, the relationship between the prevalence of one disease, its causes and the requirements fo
Cite This Work
To export a reference to this article please select a referencing stye below:
Related ServicesView all
Related ContentAll Tags
Content relating to: "reflective practice"
Reflective practice is as a medium for an individual’s reflective capacity to be communicated and examined both internally and externally. Self directed learning is emphasised through reflective writing as students engage in a more holistic approach which uncovers the reasons behind their actions.
Compassion in Medicine | Reflective Essay
Advancements in medical technology have given rise to medicalization, a process where ‘non-medical’ problems have become understood and treated as ‘medical’ issues.1 This potentially objectif...
Reflection on Communication Skills in Booking Issue
Reflection is a fundamental component of learning that we all practice unknowingly. Through reflective learning, we self-evaluate our decision with the aim of learning and self-improvement from past experiences. ...
DMCA / Removal Request
If you are the original writer of this reflective essay and no longer wish to have your work published on the NursingAnswers.net website then please: