Please change the verb tense to past tense for the project setting, project process, and project evaluation plan. Your project has been implemented. There are still some areas of your project process and evaluation plan that require a change in tense to the past.
Please do not accept if your not going to do it/ turn in time. pay is up for bid
You should respond to both discussions separately–with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts.
Minimum 150 words each reply with references under each reply.
Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual).
Discussion 1
List factors that predispose Eskimos to risk as a result of the consumption of large quantities of sugar
The traditional Eskimo diet was adapted to the harsh frigid conditions of the northern and southern regions of Alaska. The diet is reflective of the traditions of hunting, trapping, fishing and gathering of food necessary to survive the tundra. The dietary mainstay of the people traditionally consisted of wild meats, caribou seafood, fish, eggs, and whale (Ginger & Haddad, p. 282, 2021). This diet had low levels of simple carbohydrates, was very nutrient dense and included high proportions of protein and omega-3 containing fats. Diabetes and cardiovascular disease were uncommon (Ginger & Haddad, p. 294) Additionally the activities required for daily activities and survival required higher demands of physical activity. Dietary shifts and lifestyle changes most certainly predispose Eskimos to risks due to the consumption of large quantities of sugar. The shift away from traditional diet to a diet that includes consumption of highly processed and carbohydrate dense foods coupled with less physical activity certainly contributes to health risks.
Analyze different strategies useful in communicating with the Japanese American family.
Analyzing the nuances of communication within the Japanese culture can be very helpful in implementing strategies when caring for a Japanese American family. A great starting point is the initial assessment. During this phase it would be important to understand the “culture of anticipatory perception” and “empathetic identification”. The Japanese culture is a more high-context, nonverbal culture, relying on the value of sensitivity and responsiveness (Ginger& Haddad, p. 313, 2021). This would require the caretaker to be tuned into and actively observing for opportunities to provide care to the patient, rather than relying on the patient to verbalize needs or concerns. Though this may be perceived as subtle, indirect or passive, it is considered respectful within the culture. Rather than complain of pain, a patient may have a subtle change in facial expression or change in body positioning, as the Japanese concept of Gaman, values “enduring pain and discomfort with perseverance and dignity” (Ginger & Haddad, p 313, 2021). Other nonverbal communication should also be analyzed. Within Japanese culture norms around physical touch and eye contact differ. American norms that encourage therapeutic touch and consistent eye contact do not have the same meaning within Japanese culture which does not normalize casual touch between adults or eye contact when speaking to a superior person. Understanding the importance of social hierarchies and group harmony will also be central when communicating with the Japanese American family. So, understanding patient preferences regarding hierarchy within the family will be important when giving education and communication related to care.
When caring for a Russian American client, for the most part, at what distance would a Russian patient feel at most ease
Although it is not uncommon for Russians to stand close when speaking, even to strangers, nurses should be aware the Russians mostly prefer to remain at a social distance with caregivers (Ginger & Haddad, p. 365, 2021). Personal space is an important consideration when providing nursing care, this is generally true across all cultures. Ideally, we should maintain a distance that is therapeutic for the patient while still allowing care to be performed. We should look to “promoting dignity by increasing choice and giving patients control wherever possible.” (Stephen, Nyashanu, Ossey-Nweze & Serrant, 2021). If a task requires us to invade the personal distance, an explanation should be provided to help ease the stress and anxiety that may be created by the invasion of the patient’s space (Ginger, Haddad, 2021)
Discussion 2
The Eskimo population, known as Eskimos and also Inuit, live in cold areas such as Alaska, Canada, Greenland and Siberia. They have created a culture of living in community, using sustainable hunting as a means of support, but always with an enormous respect for nature, which has allowed them to adapt to extreme climatic conditions (Lewis et al., 2023). Their traditional dietary intake is based on animal proteins and fats, providing them with the energy necessary to guarantee their existence in an environment with little or no vegetation. However, with the arrival of processed and sugar-rich foods, the Eskimos have been affected by various metabolic diseases (Lewis et al., 2023).
The main causes that put the Eskimo population at risk of suffering health problems related to the consumption of high sugar in their diet are, mainly, their genetic predisposition, their change to Western diets and the scarce access to medical care. Genetically, Eskimos have adapted to metabolize animal fats as a source of energy, so for this population the immediate incorporation of large amounts of refined carbohydrates and sugars in their diet is a major problem that can lead to insulin resistance and increase the possibility of type 2 diabetes (Malyarchuk, 2024).
In addition, the geographic location of many Inuit communities is a factor that delays a visit for medical care and nutrition education, which hinders early detection of disease and promotion of healthy habits. The inability of this population to access fresh food, due to its high cost and scarcity, coupled with the dependence on processed foods that are more affordable, has contributed to the emergence of cardiovascular disease and obesity in this population (Malyarchuk, 2024).
Japanese American Families
As for Japanese-American families, communication with these families should be based on knowledge of their culture and a deep respect for their traditional values. In Japanese society, an appreciation for harmony and cordiality are paramount in all social interactions, so health care workers need to be aware of the rules of communication that govern this population group (Jang et al., 2021). The most important factors are the hierarchical family structure where elders enjoy a place of authority and respect. When interacting with these families the older members are the ones who represent the authority and should be allowed to take a very decisive position when it comes to making a medical decision in the family (Jang et al., 2021).
Also in interacting with Japanese-American families it is important to maintain indirect communication and subtle body language. Very different from Western cultures where direct eye contact is seen as a sign of commitment and honesty, in Japanese culture it can be interpreted as disrespectful or defiant. It is also common for the Japanese to avoid overly displaying emotions and often suppress personal concerns so as not to upset others (Jang et al., 2021).
As healthcare professionals, we must be observant and be able to perceive nonverbal cues, such as a different posture or facial expression, to better understand the true concerns in the patient and family (Sonoda et al., 2022). Maintain an appropriate tone of voice, without being too loud or flashy, and use polite and friendly language where patients are confronted, in order to contribute to the creation of a relationship of trust and respect with the patient and his or her family (Sonoda et al., 2022).
Russian Culture
In the case of Russian culture, it is important to know that it is characterized by a formal and respectful approach to social relations, which is reflected in the way Russian-American patients prefer to communicate in a health care environment. (Erugina et al., 2023). In general, Russians appreciate direct, simple, objective and well-ordered language in communication, without unnecessary detours or euphemisms. They are people who prefer concrete explanations about their health and the treatments they are given, since clarity and complete and total information foster the trust they will develop in the health professionals who care for them (Erugina et al., 2023).
In terms of physical proximity, Russian American patients tend to be comfortable with a personal space of approximately one to one and a half meters during a conversation. This way of preserving personal space is because excessive closeness is understood in Russian culture as an invasion of privacy (Erugina et al., 2023). But, in situations of trust, the professional can reduce this barrier, depending on the bond he or she manages to create with his or her patient. Moreover, kindness is highly valued in Russian culture, so acts of courtesy, respect and acceptance of the way you express yourself are essential in creating an effective therapeutic relationship. It is crucial for healthcare professionals to be respectful of these cultural norms, and simply recognize empathy in order to create timely communication and provide high quality care to Russian-American patients (Erugina et al., 2023).
You should respond to both discussions separately–with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts.
Minimum 150 words each reply with references under each reply.
Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual).
Discussion 1
Components of the Affordable Care Act (ACA) and Their Positive Effect on Health Care Outcomes and Cost Reduction
The health care reform has been a controversial discussion for a few years, with its main goals being, to improve patient access to health care while lowering costs. An initiative to the healthcare reform is the ACA which began in 2010 and continues to develop today (Neiman et al., 2021). Despite being frequently thought as a single policy, the Affordable Care Act is a collection of several laws that collaborate to achieve various objectives. Its primary means of making health care more accessible was through the expansion of public and private health insurance coverage (Neiman et al., 2021); these key elements which include, Medicaid expansions, subsidized Marketplace coverage, and individual mandates, went into effect in 2014 (Courtemanche et al., 2018). I believe that this aspect of the law may enhance patient outcomes by allowing more individuals to obtain health coverage at a more affordable rate in relation to their income.
Additionally, the ACA intertwines hospitals, health care providers, and physician income to the caliber of care they deliver, in order to raise standards. This is done by providing incentives for providers and organizations when care is delivered efficiently, and it is of quality. Incentives include different bonuses whether financial or occupational based (Moy et al., 2023). This can also be accomplished by implementing strategies such as the Bundled Payment Care Initiative (BPCI) and Accountable Care Organizations (ACOs) whose aim it to reduce unnecessary and costly services (Moy et al., 2023). Hospitals and physicians must meet standards that emphasize disease prevention, clsely manage patients with chronic illnesses, and maintaining patient health (Moy et al., 2023). This is beneficial for the patient’s as well, by making their care more cost friendly while receiving the best care possible for optimal outcomes.
Lastly, the ACA encourages preventative care, which can further reduce long-term healthcare costs. With these reforms, patients are more likely to receive timely care, preventing the escalation of health issues that can lead to expensive emergency interventions. Preventative care is offered by the ACA without additional costs such as copays and deductibles. This measures improves quality of life by reducing the risk of chronic illness and a reduced cost not only to healthcare, but also to patients (CMS.gov, n.d.).
Discussion 2
The Affordable Care Act and Health Care Outcomes and Costs
The 2010 Affordable Care Act (ACA) introduced numerous provisions that have aided and strengthened healthcare results and reduced spending. The most significant effects on the United States healthcare system have been the expansion of Medicaid coverage, the establishment of health insurance marketplaces, and the emphasis on preventive care. Collectively, they assist in ensuring better access to care, better health outcomes, and cost savings.
One of the most successful ACA provisions was the Medicaid expansion. The ACA provided for states to expand coverage to Medicaid-eligible individuals up to 138% of the federal poverty level. Research has demonstrated that Medicaid expansion has led to greater insurance coverage and improved health status in low-income populations. Levine et al. (2022) report that states that expanded Medicaid eligibility perceived reduced mortality, better chronic disease management, and greater availability of primary health care services. Moreover, Medicaid expansion has led to cost savings via the reduction of hospital expenses associated with uncompensated care (Levine et al., 2022). Since more individuals are covered, hospitals have had fewer financial losses due to treating individuals with no coverage who are unable to pay.
The second major provision of the ACA was establishing health insurance markets in which persons are able to shop and purchase insured plans with subsidies. The markets have made persons who are below the Medicaid eligibility limit but who are required to be supported financially in a position to purchase health insurance. Mellor et al. (2023) presented evidence that subsidies provided under ACA markets increased insurance coverage, as well as improved access to major health care. Additionally, by having insurance companies compete with each other, the markets helped contain premium increases, keeping all costs of the overall healthcare system in balance (Mellor et al., 2023).
Preventive care services mandated by ACA are instrumental in enhancing health outcomes and reducing expenses. The ACA compels health providers to provide preventive services such as vaccination, cancer screening, and check-ups without billing the patients directly. With early prevention and diagnosis, these policies correlate with reduced occurrences of long-term illnesses as well as healthcare expenditure on them. Ercia et al. (2021) add that increased availability of preventive care has helped with the achievement of early intervention and diagnosis, making patients not experience huge amounts associated with emergency care as well as hospital admission. The revolution of a reactive into a proactive health system, besides improving patient health, alleviates health schemes from financial burden too.
Furthermore, ACA has levied value-based models of care such as Accountable Care Organizations (ACOs), in which providers work with greater concentration towards the supply of quality care services instead of quantity. Such models compel providers to shift their focus to the delivery of better care, more integrated services, avoiding unnecessary services, and the establishment of meaningful patient performance measures. Ercia et al. (2021) argue that value-based payment models have ensured improved care and less expenditure, thus accruing benefits for both patients and providers.
In conclusion, the ACA has enhanced health care outcomes and contained expenses by increasing Medicaid, insurance markets, preventive services mandates, and value-based medical systems. Together, they have enhanced the treatment availability framework, healthier patients, and sustainable fiscal health care system.
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my culture and ethnicity is Hispanic
automatic thought record attached for reference
add psychotherapy note and patient with diagnosis of ADHD
