Challenges Faced Rural Healthcare Facilities Health And Social Care Essay

Challenges Faced Rural Healthcare Facilities Health And Social Care Essay Twenty-five percent of the total population in the United States are living in rural areas and compared with urban Americans and healthcare facilities in rural areas generally serve low-income, the elderly, and individuals who are less informed and armed with less knowledge concerning health care prevention measures. Moreover, rural individuals accessing healthcare in rural facilities face barriers to healthcare such as fewer doctors, hospitals and health resources in generation and face difficulty in accessing health services. Statement of the problem   Hospital closures and other market changes have adversely affected rural areas, leaving State and Federal policymakers, and others concerned about access to health care in rural America. Considerable changes in the health care delivery system over the past decade have intensified the need for new approaches to health care in rural areas. Managed care organizations, for example, may not be developed easily in rural areas, partly because of low population density. Research Questions          The primary research question in this study is the question of whether rural health care facilities overcome the ongoing challenges to provide quality medical care to their communities. Rationale of the Research The rationale of this research is based upon the following facts: 1.) Rural Healthcare and Barriers to Accessing Care: Many small rural hospitals have closed, while other health care supply of primary care physicians and other health care provider facilities are in financial straits. Unavailability of resources and transportation problems are barriers to access for rural populations. 2.). The supply of primary care practitioners and other health care providers in rural areas is decreasing. Some are leaving rural areas to join managed care organizations elsewhere. 3.) Barriers to Health Promotion and Disease Prevention. Goals for improving the Nations health over the next decade can be achieved only if rural populations are included in efforts to remove barriers to access and use of clinical preventive services. 4.) Barriers Related to Lack in Health Care Technology. Technologies including telemedicine offer promise of improved access to health care, but their most efficient and effective applications need further evaluation. 5.) Organizational Barriers of Service Provision to Vulnerable Rural Populations: Low population density in rural areas makes it inherently difficult to deliver services that target persons with special health needs. Groups at particular risk include: the elderly; the poor; people with HIV or AIDS; the homeless; mothers, children, and adolescents; racial or ethnic minorities; and persons with disabilities. 6.) Consumer choice and the rural hospital. Factors that drive changes in rural hospitals have a critical effect on consumer choice and access. Significance of the Study This study is significant in that individuals in rural areas are likely to continue to receive less healthcare as well as less effective healthcare if rural healthcare does not gain necessary knowledge, informed by research study as to what should be done to better deliver health care services to those in rural areas. This study is of significance to several groups including patients depending on rural healthcare services, the families of these patients, the rural communities at large and the insurance companies who provide insurance coverage for individuals in rural areas. Methodology The methodology of the proposed research is one of a qualitative nature in which data will be gathered through survey/questionnaires of individuals, physicians and business in the rural community at focus in the research in order to asses whether the needs of the community in terms of healthcare provision are being met. Data analysis will be both qualitative and quantitative in nature. After having administered and compiled data from the survey/questionnaires focus groups will be scheduled to gain further insight into the unmet needs of the community in health care services in needs assessment focus group discussions. Literature Review The California Healthcare Foundation, in its Rural Health Care Delivery: Connecting Communities through Technology report of December 2002 states : Challenges facing rural health care include scarcity of local medical resources and distance between patients, physicians and facilities. (Turisco and Metzger, 2002) Furthermore, it is related in this report that there are insufficient numbers of primary care practitioners in rural areas. (Turisco and Metzger, 2002; paraphrased) In the instance where a patient is forced to travel from home to another area for accessing health care services resulting is a range of difficulties including: (1) time away from work; (2) additional expenses; and (3) the complications of coordinating care in different locales. (Turisco and Metzger, 2002) This increases the chance the patient information will come up missing or incomplete and as well may result in care that is delayed or fragmented. (Turisco and Metzger, 2002) The physicians in rural areas as wel l as other health care providers experience negative impacts due to the low number of health care practitioners in rural areas as well as in the distance factor, which results in limitations on productivity, communication and ongoing education. (Turisco and Metzger, 2002) Research notes that there is more difficulty for the rural providers in communication with other providers of health care. There is much less in the way of opportunities to attend conferences and training due to the requirements of travel, which limits access to medical knowledge and research work. Lower efficiency results due to travel time involved in visiting patients in hospitals and nursing homes as well as in à ¢Ã¢â€š ¬Ã‚ ¦fewer face-to-face visits, and more time on the telephone with other providers and with patients. (Turisco and Metzger, 2002) In a recent report relating to healthcare in rural India stated is that: The number of patients is increasing exponentially each year, putting enormous pressure on healthcare delivery systems worldwide. Hospitals and specialists are concentrated in cities and are inaccessible to the rural poor. (Tata Consultancy Services and Microsoft Corporation, nd) This report relates that several physicians in India along with Tata Consultancy Services (TCS) and the largest IT company in India collaborated in the creation of WebHealthCentre.com which is stated to be: à ¢Ã¢â€š ¬Ã‚ ¦a comprehensive healthcare portal like no other. (Tata Consultancy Services and Microsoft Corporation, nd) Offered are abundant health-related reference material, online medical consultation, online appointment scheduling, and online lab results for physicians. (Tata Consultancy Services and Microsoft Corporation, nd) The WebHealthCentre.com website was stated to have been created with the Microsoft.NET Framework, Micr osoft Windows 2000 Advanced Server, Web services and Microsoft SQL Server 2000. The requirements set out by the physicians in rural areas included: Ease of use by a wide cross section of people; Cutting-edge yet cost-effective technologies; Simple log on by many different users and easy assignment of user rights; Tight security to keep medical records confidential; Structured data capture for future data mining; Scalable to handle millions of users; and Extensible to accommodate audio and video interface. (Tata Consultancy Services and Microsoft Corporation, nd) Benefits resulting from implementation of this healthcare service delivery Network include: Improved access to healthcare; Better use of doctors time; Rapid development, usability; Scalable to millions of patients; and Extensible to new technologies. (Tata Consultancy Services and Microsoft Corporation, nd) Key features of WebHealthCentre.com are stated to include the following: Online, real-time medical consultation with remote healthcare professionals. PC or mobile-phone access to regional directories for hospitals, specialists, blood banks, medical appliance suppliers, and welfare agencies. An online appointment scheduler that enables patients to make appointments with participating physicians. An online lab report tool that helps diagnostic centers automate the process of uploading lab reports to the Web. Access to test results through mobile devices. Online access to electronic health records. Medical image upload services. Online sonogram viewing. A medical student resource center. Healthcare job listings. Online shopping for healthcare supplies. (Tata Consultancy Services and Microsoft Corporation, nd) The Agency for Healthcare Research and Quality (AHRQ) held an expert panel meeting to provide guidance on its new health information technology on July 23-24 2003. The focus of AHRQ is the implementation and evaluation of technologies, which have been shown to be effective in small and rural communities. Secondly, the AHRQ has set its focus upon supporting advancement in the HIT field through implementation and evaluation support for innovation in technologies for use in diverse health care settings. (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003) The Meeting Summary reports that two general themes emerged from the discussion which are those of: (1) Bringing people together; and (2) Providing technical assistance. (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003) Activities recommended for achieving their goals are those as follows: Support demonstration projects that involve HIT implementation and will lead to the creation of learning networks comprised of providers from various types of rural health care organizations. Create learning communities that span geography; collect and analyze the outcomes associated with participation. Once factors that facilitate learning communities and HIT implementation have been identified, engage CMS and other purchasers to define an appropriate reimbursement strategy. Incorporate evidence-based primary care guidelines with rural relevance into technological templates. Clinicians are likely to accept clinical guidelines offered by the Federal Government at no cost. Support local capacity development for HIT, including barrier analysis, education and other activities. Provide sustained technical assistance (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003) Evaluation of the process in rural and small communities includes: (1) scope of the project; (2) goals; (3) critical success factors; and (4) technical assistance. (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003) Community grants have been focused on the provision of personal digital assistant (PDA) systems in assisting with the decision support role. The initiative is stated to include: (1) development of toolkits; (2) leveraging known tools; (3) developing capacity; and (4) disseminating best practices. (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003) Ormond, Wallin, and Goldenson report in the work entitled: Supporting the Rural Health Care Safety Net (2000) state: The policy and market-driven changes in the health care sector taking place across country are not confined to metropolitan areas. Rural communities are experiencing changes impelled by many of the same forces that are affecting urban areas. However, due to the demographical differences and other facts existent only in rural life the health care system can be differentiated from those in urban areas in various ways. According to Ormond, Wallin, and Goldenson, it is that difference that highlights the importance of giving consideration explicitly to the impact of competitive forces and public policy developments on rural health care systems and the patients and communities they serve. (2000) The changes that are occurring in the health care sectors are resulting in many providers being threatened in both rural and urban areas however, health care provider failures in a rural area is likely to a much greater impact as compared to health care provider failure in urban areas. Because alternative sources of care in the community or within reasonable proximity are scarce, each provider likely plays a critical part in maintaining access to health care in the community. For this reason, in most rural communities all providers should be considered part of the health care safety net if not directly through their care for vulnerable populations, then indirectly through their contribution to the stability of the communitys health care infrastructure. (Ormond, Wallin, and Goldenson, 2000) The study reported by Ormond, Wallin and Goldenson is based on case studies in rural communities in the states of Alabama, Minnesota, Mississippi, Texas, and Washington selected in representation of à ¢Ã¢â€š ¬Ã‚ ¦a broad range of pressures facing rural providers. (2000) A debate is stated to exist in terms of limited services models for hospitals who fear that more insure d patients or those who are wealthier will be reluctant to use this facilities. Challenges to full-service facilities in rural areas include recruitment and retention of health care professionals and of ensuring the financial viability of local hospitals. (Ormond, Wallin, and Goldenson, 2000) Also related is the fact that health care providers are very reluctant to locate in communities without a hospitalà ¢Ã¢â€š ¬Ã‚ ¦ while simultaneously when there is not a strong physician practice in an area, hospitals find it difficult to attract patients. (Ormond, Wallin, and Goldenson, 2000) Constraints upon a rural hospital of either a full or limited service hospital include its rural location. The population required to support given service, such as a hospital or particular physician practice is spread over a much greater area. Low volume can mean high average costs, a factor that rural health officials feel is not always taken into account in reimbursement. (Ormond, Wallin, and Goldenso n, 2000) Demographical and socioeconomic differences in rural areas places demands upon health care system providers in terms of the need for treatment for more elderly people which are those more likely to have chronic health care needs. (Ormond, Wallin, and Goldenson, 2000) Furthermore, due to the lack of access to mass and major media in rural areas, the individuals residing in these areas are much less likely than those in urban areas to be aware of the availability of health care and public programs. Insurance coverage in rural areas is also a factor because rural areas have higher self-employment than urban areas, and specifically relating to farming operations making it very likely the employer-sponsored insurance in minimal. Of those who are insured in rural areas, it is likely that many of these are under insured with high premiums and low benefits as compared to those insured in urban areas. The social structure of rural communities may make the stigma attached to particip ation in public programs greater, particularly in the case of Medicaid. (Ormond, Wallin, and Goldenson, 2000) The range of services offered in rural hospitals is limited by the size of the area it serves as compared to the population within that area. Many of the hospitals in the study reported by Ormond, Wallin and Goldenson relied on a local primary care physician for core servicesà ¢Ã¢â€š ¬Ã‚ ¦but augmented his or her capabilities by making arrangements with other, nonlocal providers. The core services each hospital offers depend primarily on the capabilities of their physicians. (2000) In order that a hospital be able to support a visiting specialist program it is a requirement that the hospital have the staff that is appropriate and qualified to assist in the various specialties and physicians be able to monitor recovery, as well as the necessary space and equipment for procedures. (Ormond, Wallin, and Goldenson, 2000) The rural hospital is not in the position to provision all the services needed within the community it serves and this makes a requirement of having a referral system of a reliable nature. Stated to be a mainstay of the safety net in rural areas just as is the case in urban areas is the community health center. (Ormond, Wallin, and Goldenson, 2000) Another important provider of care in rural areas is the local health department. Another problem in rural areas is transportation for patients in that in rural areas there is oftentimes no public transportation. Internal strategies reported to be used by rural health care providers are inclusive of: à ¢Ã¢â€š ¬Ã‚ ¦increasing the stock of physicians and other health professionals, tailoring facilities and services to the needs of the community, and expanding, downsizing, or diversifying as needed. (Ormond, Wallin, and Goldenson, 2000) Other stated strategies are inclusive of cooperation among rural providers and developing links with urban providers through mergers, management contracts, and joint projects. (Ormond, Wallin, and Goldenson, 2000) Initiatives have been developed for recruitment of physician s and other health professionals who are familiar with life and medical practice in rural areas. (Ormond, Wallin, and Goldenson, 2000) Those who are recruited for practice in rural areas are likely to remain after recruitment. All five states in this study report that they provide support: à ¢Ã¢â€š ¬Ã‚ ¦for the development of rural health professionals by requiring, facilitating, or funding training opportunities in rural areas so that students become familiar with the particular demands and satisfactions of rural medical practice, or by funding education either through scholarships for aspiring providers from rural areas or through loan forgiveness for providers agreeing to locate in rural areas. (Ormond, Wallin, and Goldenson, 2000) Only the state of Washing is stated by this report to have a formal residency program. Service expansion is reported to be utilized by rural hospitals and clinics for enabling them in meeting a broader range of health care needs in their communities. (Ormond, Wallin, and Goldenson, 2000) Areas of expansion included: (1) the construction or renovation of a physician plant; (2) the addition of new medical services; and (3) diversification beyond traditional acute services. (Ormond, Wallin, and Goldenson, 2000) In fact, growth and expansion as compared to downsizing appeared to be the more common, and seemingly more successful, route. (Ormond, Wallin, and Goldenson, 2000) Expansion is also noted in outpatient services offered by hospitals and clinics. Cooperative efforts among rural providers as these health care providers collaborate in order to ensure the capability of serving their communities will continue is noted in this report stating that cooperation with other rural providers is also a mainstay of rural hospitals strategy to ward off encroachment by urban health care systems. (Ormond, Wallin, and Goldenson, 2000) The work of Rygh and Hjortdahl entitled: Continuous and Integrated Health Care Services in Rural Areas: A Literature Study makes a review of literature that examines possible methods of improving healthcare services in rural areas. Stated by these authors is the fact that: Healthcare providers in rural areas face challenges in providing coherent and integrated services. (Rygh and Hjortdahl, 2007) This study proposes a need for greatly flexibility in traditional professional roles and responsibilities, such as nurse practitioners of community pharmacists managing common conditions. (Rygh and Hjortdahl, 2007) Further stated is that the substitution of health personnel with lay health workers or paraprofessionals often in combination with interdisciplinary teams, is among measures proposed to alleviate staff shortage and overcome cultural barriers. (Rygh and Hjortdahl, 2007) Other findings of this study include that for those working in rural areas called for is flexibility of roles and responsibilities, delegation of tasks, and cultural adjustments by the healthcare practitioners. (Rygh and Hjortdahl, 2007) This study states that rural case management is greatly dependent upon a locally based case manager and that the highest ranked skills for rural case managers are: the ability to be creative in the coordination of resources, multidimensional nursing skills, excellent communication skills, high-caliber computer skills and excellent driving skills. (Rygh and Hjortdahl, 2007) Stated is that: Case management in a rural environment requires a much broader and generalist knowledge base, it covers all levels of prevention and transverses all age groups. Rural case management is a distinct specialty area of practice, with a distinct knowledge base and skills level, and nurses should be prepared at the advanced practice level. (Rygh and Hjortdahl, 2007) This study further relates that evidence exists of the success of: à ¢Ã¢â€š ¬Ã‚ ¦collaboration at the interface betw een primary and secondary sectors may improve access, continuity of care and the quality of service delivery in rural areas. (Rygh and Hjortdahl, 2007) This study defines telemedicine as Medicine practiced at a distance therefore encompassing diagnosis, treatment and medical education. (Rygh and Hjortdahl, 2007) The state of Maine is stated to have a well-functioning telemedicine services system using telemedicine in a broad array of interactive videoconferencing applications, including mental health and psychiatry, diabetes management, primary care, pediatrics, genetics and dermatology. (Rygh and Hjortdahl, 2007) According to this review telemedicine has the potential to be a tool of a valuable nature in achievement of healthcare access in rural areas although the cost-effectiveness of telemedicine has yet to be documented. (Rygh and Hjortdahl, 2007; paraphrased) The work entitled: Providing Hospice and Palliative Care in Rural Frontier Areas states that the National Rural Health Association (NRHA) à ¢Ã¢â€š ¬Ã‚ ¦believes that all Americans are entitled to an equitable level of health and well-being established through health care services, regardless of where they live. An important but often overlooked aspect of health and well-being is assurance of appropriate care and support when people are experiencing chronic, progressive illness and/or approaching the end of their lives. (Providing Hospice and Palliative Care in Rural Frontier Areas, 2005) In order to study this area of service provision the method for defining and assessing needs is stated to be through a needs assessment to include recruitment of a group of members of the community for participation in identifying the needs and creating a method of assessing results. Data is gained from various sources an may include the following: Demographics of the community; disease statistics (county health department and state vital statistics division); List of health care organizations/agencies that provide related services; A definition of unmet or under-met service needs; Identification of the unique characteristics that differentiate palliative care and/or hospice services from other services in the community; Vital statistics, including cause of death, age at death and location of death; Loss data; Community residents satisfaction with current hospice and/or palliative care services, obtained through interviews; and Community members preferences about hospice and palliative care. (Providing Hospice and Palliative Care in Rural Frontier Areas, 2005) Recruitment of individuals in this type study are stated to include: Community residents; Representatives from other community service providers such as a librarian, store owners, chiropractor or dentist; The president of a fraternal organization, the Rotary Club, another service club or the Chamber of Commerce; Pastors or leaders of local faith communities; Someone involved with the local food pantry or other emergency relief organization; An influential local business person such as the feed store owner; A county extension staff person active in community events and volunteer work; Someone who organizes the towns annual parade, festival or other special events; Someone who works on civic clean-up and beautification; and Representatives from other small organizations and entities in each of the countries the provider serves. (Providing Hospice and Palliative Care in Rural Frontier Areas, 2005) This study speaks of the creation of capacity building in expansion of the service provision and in meeting unmet or undermet needs in rural areas. Capacity building strategies include education and training of staff for skills development needed in broadening the services provided. Community education in establishing a broader understanding of what services and opportunities are available for care is also stated to be a strategy for capacity building as service utilization will be increased as well. Capacity building strategies as well are stated to include outreach strategies for development and sustaining partnerships and collaborations as well as in sustaining and supporting growth of expectations related to hospice and palliative care services. (Providing Hospice and Palliative Care in Rural Frontier Areas, 2005; paraphrased) Stated as practical examples of the training and education of staff and the philosophy used by rural providers in the creation and sustaining of program ca pacity are those as follows: Development and adoption of service performance parameters; Education of the board and/or local leaders in national trends such as palliative care, open access, managed care, chronic care management and the nursing shortage; Establishment of an ethics committee comprised of community members, hospital representatives, palliative care and hospice program staff, and church members to review specific ethical considerations/cases and to address projects such as advance care planning and advance directives; Importing best practices in enhancing service definition and outreach; Offering support for local and offsite continuing staff education an subsidies for staff to pursue relevant credentials; Offering support for local and offsite continuing staff education and subsidies for staff to pursue relevant credentials; Appointing full-time or substantially part-time physicians and advanced practice nurses as soon as feasible and involving these individuals in professional and community outreach; Establishment of bridge programs and/or extended palliative home care; Improved/extended utilization of volunteers in meeting caregiving requirements. For hospices, this may include volunteer participation in providing continuous care as allowed by regulations; and As needed, referrals to other organizations. (Providing Hospice and Palliative Care in Rural Frontier Areas, 2005) The work entitled: Planting the Seeds for Improving Rural Health Care relates the Chronic Care Model which portrays the essential involvement of the community, the design and function of the health care system and effective interaction between patients/families and their team of caregivers, producing optimal clinical outcomes. (2005) The following figure labeled figure 1 shows the Chronic Care Model: Figure 1 Chronic Care Model Source: Planting the Seeds for Improving Rural Health Care (2005) Components of this program include the following: Use of a rapid-cycle method for implementing quality improvements; Use of a standard set of changes for teams to implement; Sharing a vision of the ideal system of care developed by clinical experts; Monthly reporting of process and outcome measurements; Three learning sessions; A final national forum during which teams attend sessions with expert faculty to share progress, best practices, and lessons learned. (Planting the Seeds for Improving Rural Health Care, 2005) The work entitled: Practical Tips and Information Resources for Developing Collaborative Relationships Between Rural Community Health Centers (CHCs) and Rural Hospitals asks the question of Why Collaborate? and answers this question by stating that collaboration strengthens community health infrastructure; improves efficiency levels; and provides joint economic advantage. Collaboration is stated to be a process through which parties who see different aspects of a problem can explore constructively their differences and search for (and implement) solutions that go beyond their limited vision of what is possible. (Taylor-Powell, et al., 1998) There are five levels of relationships in building collaborative interorgnaizational relationships around health issues in a rural community which are: (1) networking; (2) cooperating; (3) coordination; (4) coalitions; and (5) collaboration. These five levels of relationships according to purpose, structure and process are shown in the following C ommunity Linkages- Choices and Decisions matrix. Figure 2 Community Linkages Choices and Decisions Source: Practical Tips and Information Resources for Developing Collaborative Relationships Between Rural Community Health Centers (CHCs) and Rural Hospitals (2005) The following are examples of the ways that CHCs and hospital partnerships are able to collaborate. These initiatives may also be used by any rural hospital, CHC or primary care provider: Joint training, recruitment, human resources, and clinical direction; Shared case managers; Working together on disease collaboratives; Shared medical laboratory; Partnership establishment enables organizations in qualifying for funding through grants for which they would not otherwise have been eligible to receive; and Shared electronic patient medical records systems; (Practical Tips and Information Resources for Developing Collaborative Relationships Between Rural Community Health Centers (CHCs) and Rural Hospitals (2005) This study states findings that a number of activities specific to an individual site have the potential for wider replication. Those activities are stated to be as follows: Local foundations can support rural health-related activities; namely physician recruitment and retention. Collaboration of CHCs, hospitals, nursing homes, and assisted care facilities in the same location can serve a large rural area and make efficient use of scarce resources; namely physicians. Affiliation with a large regional hospital can be a positive experience that is supportive of community-based services. Collaboration may be a vehicle for expanding benefits to CHC patients; namely as a result of the collaborative, a hospital utilizes the CHCs sliding fee scale for laboratory services provided to CHC patients. Case management for discharge planning and care coordination between the CHC, home health care agency, and the hospital can improve patient care. Electronic patient medical records systems that integrated the CHC and the hospital medical records are the key to future collaboration and the development of a comprehensive model of a health care system for the rural community. (Practical Tips and Information Resources for Developing Collaborative Relationships Between Rural Community Health Centers (CHCs) and Rural Hospitals (2005) There are important factors identified for organizing a successful collaboration which include: (1)

Nutritional and Fitness Paper

My sthrongest dimensions after taking the self-test are intellectual health, social health and environmental health. I think that I am sthrongest in intellectual health because I don’t make rash decisions in my life without thinking about the consequences. When I was younger I seemed to get myself in trouble a few times and at one point it got so bad that I had to really look at myself and question the decisions that I was making. I learned from the mistakes that I made in my teen years and have helped me a lot when making decisions in work and with friends.In social health I scored sthrongest in this category I feel because I am able to listen to others problems without making it about myself. If a friend comes to me with a problem, I tend to listen to them more than give my own opinion or feedback unless I am asked. I always try to give people the benefit of doubt and don’t judge them when I first meet them. Social health also includes relationships with family and fr iend, I come from a close knit family and have a good relationship with my immediate family and can’t see myself not ever talking to any of them.My friendship also have the stayed the same tthroughout the years, I have the same friends I have had since high school and college. In environmental health I believe was one of many sthrongest because over the years I have become aware of global warming and the affect that is being done to our planet and resources. When I am brushing my teeth, I turn of the faucet until I need the water again; I also use energy saving light bulbs all around my house to save electricity. I have been recycling bottles, cans and paper and have even gotten some of my family members to do the same.I know that I can do more in regards to getting out there and spread the word little by little. The way that I can become sthronger in physical health is by exercising more, whether it be taking the stairs instead of the elevator or going for a walk around the block. I could also try to improve my physical health by eating healthier meals during the day and cutting out junk food and instead eat more vegetables and fruits. I can also try and improve my sleeping patterns and get more sleep during the night.The way that I can change my emotional health is by understanding me more, for example, if I am feeling mad or aggravated at some one, I can take time and compose myself and approach the situation differently. The way that I can change my spiritual health is by getting more involved in the community and do more charitable events. I have to involve myself more in nature, for example, if I go to the park I can sit on a bench and listen to the birds chirping, the wind blowing and connect with Mother Nature. Some personal choices that I can make to improve my health are; exercising, eating healthy and quit smoking.I have started to get back in the routine of exercising for at least an hour a day, I will be using the shaping technique so that I won’t overwhelm myself and quit within the first couple of days. In eating healthy I can learn to cut out junk and greasy food, it’s important that I learn this because I have a daughter myself and I don’t want her to suffer from any health issues, such as diabetes or child obesity. I have to make these choices so that I can be a good example to my daughter and she will be able to make better choices.A behavior change technique that could help me I shaping, which is when â€Å"to reach a goal, you may need to take several individual steps, each designed to change one small piece of a larger behavior† (Donatelle, 2010). This technique would help me in exercising, for example, I can begin to walk for 30 minutes a day and after my body becomes accustomed to the exercise I will add more minutes to it until I have become used to working out. Another behavior change is called visualization, which mearns â€Å"mentally practice can transform healthy behavior into healthy ones† (Donatelle, 2010).This technique could help also in my exercise, for example, if I am going up a hill I can mentally tell myself â€Å"you can do this†. This will prepare my mind so that my body will go. Another technquie I called modeling which mearns â€Å"learning behaviors by watching other perform them† (Donatelle, 2010). This would be helpful in exercising because I will have someone else who can go to the gym with me and be motivated by them just being there. Controlling the situation would mean â€Å"the right setting or the right group of people will positively influence your behavior† (Donatelle, 2010).

Teddy Roosevelt A Sick Kid - 808 Words

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A man who would inspire generations of outdoorsmen to protect their local and national wilderness for their own children, so that they might one day hunt, fish, and hike those the same hillsides. Roosevelt was born in 1858 into a wealthy family with good connections in New York City. Since Theodore was a sickly kid, he spent a great part of his childhood on his own, collectingRead MoreThe Affordable Care Act : A Critical Analysis Essay10519 Words   |  43 PagesTheodor Roosevelt â€Å"calling for health insurance for industry†, and upon Congress to increase more funding for government funding for the Public Health administration, also set the ball rolling for aggressive politicians in the future to stake their claim to protect the working class. (The Henry J. Kaiser Family Foundation, 2009, p. 01) He saw a need for a healthier society, especially one which accepts immigrants in vast numbers to fill at that time a growing industrialized nation. 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Besides, he says, our stream might not have Giardia. Ill take the first drink. Juanita winces. No, don’t do thatRead MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 PagesDallas Edward Hampton, University of Central Florida Vernard Harrington, Radford University Nell Hartley, Robert Morris University Barbara Hassell, Indiana University, Kelley School of Business Erin Hayes, George Washington University Tom Head, Roosevelt University Douglas Heeter, Ferris State University David Henderson, University of Illinois at Chicago Scott Henley, Oklahoma City University Ted Herbert, Rollins College Susan Herman, University of Alaska Fairbanks James Hess, Ivy Tech CommunityRead MoreProject Mgmt296381 Words   |  1186 Pagesinformal rules governs the basic issue of working hours. Developers are free to adopt whatever work schedule suits them. 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Pro Illegal Immigration - 1348 Words

Whether it’s due to personal reasons, economic reasons, or unemployment, sometimes people need the opportunity to leave their nation and move somewhere new. Either to build onto what they already have or start over completely, moving to another country provides a very appealing alternative to the state of their current lifestyle. Often times this ends up in illegal immigration, which has more positive effects than people are led to believe. At one point in time America relied on outsiders so much that they were willing to enslave them in order to. Like many other settler societies, the United States, before it achieved independence and afterward, relied on the flow of newcomers from abroad to occupy its unsettled lands. They had land and†¦show more content†¦However, it lasts for only 6 years and you will not be able to travel abroad for long periods of time. The current legislation states that a person can travel abroad up to 365 days in total for the entire 6 years under Conditional Permanent Residency. Those qualified will also be eligible for student loans and federal work-study programs, but will not be eligible for federal financial aid such as Pell Grants. The dream Act requires that you complete a college degree, or participate in two years of military service, a small price to pay for freedom. The dream act also provides support groups for illegal immigration, which you can find by simply typing in your area code on the website. Nathan Thornburgh, a senior editor of Time magazine, stated that â€Å"Whether you fine illegal aliens or stick them in English classes or make them say a hundred Hail Marys, at the end of the day, illegals would be allowed to stay and become citizens... That s amnesty. And that s a good thing for America. Amnesty won t depress wages - globalization has already done that. Amnesty will not undermine the rule of law. It sounds counterintuitive, but with immigration, forgiving a crime may be the best way to restore law and order† (Thornburgh, Nathan). This idea provides a new view on illegal immigration, promoting that sometimes it is okay to forgive and forget, and in this case amnesty could be theShow MoreRelatedPro-Illegal Immigration Paper916 Words   |  4 PagesLabrada 11/16/11 FYS 138 Professor Lodge The Melting Pot The debate of illegal immigration in the United States is one that is plagued with many details, and one that sparks a huge amount of controversy among politicians and citizens alike. While it is an issue that many argue about, few people are actually knowledgeable about the subject and have facts to back up their opinions. According the Center for Immigration Studies, the â€Å"unauthorized resident immigrant population is defined by allRead MorePro Illegal Immigration Speech1722 Words   |  7 PagesSara Rosas April15th, 2010 COM103 Persuasive Speech Topic: illegal immigration General Purpose: to persuade Specific Purpose: To persuade my audience to be pro illegal immigration. Central Idea: I will persuade you that illegal immigrants should be allowed to stay in the U.S. by sharing with you some information on the subject, arguments on the subject, and also some solutions to the problem. Introduction: Imagine a teenage girl, only seventeen years old having to go three statesRead MoreThe Pros And Cons Of Illegal Immigration1964 Words   |  8 PagesIf America is a supposed â€Å"melting pot† and â€Å"land of opportunity†, why does immigration happen to be one of the biggest issues circulating the news as well as the White House? According to the Migration Policy Institute there are approximately 11 million illegal immigrants living in the United States. These men, women and children enter the country illegally, with the purpose of living a better life. These people are willing to enter America in ghastly fashions, a perfect example are the undocumentedRead More The Pros and Cons of Illegal Immigration into the United States797 Words   |  4 PagesThe Pros and Cons of Illegal Immigration into the United States Illegal immigration has been an important and serious issue for decades; which affects everyone, both Americans and immigrants themselves. Illegal Immigration has three main purposes: first to find a better life in the ?promise land?, second: free healthcare, and third: for criminal activity. Most illegal immigrants come to America with the best intentions for themselves and/or their families, but many others have alternativeRead MoreThe Pros and Cons of Illegal Immigration in the USA1007 Words   |  5 Pages Immigration is an increasingly hot controversy in southern California; there have even been various rallies recently with many supporting a path to citizenship and others arguing that we need to close our boarders and prosecute violators. Immigration is the spotlight not due to money, but because it affects problems like race, the role of government, national identity and change. There are more advantages than disadvantages on supporting illegal immigratio n and supporting an amnestyRead MoreIllegal Immigration: Pros and Cons1128 Words   |  5 PagesIllegal immigration is a major problem which most of the developed countries face in the current economy, and it has been major political problem for the political parties in America (republicans and democrats) and over years each party has a different agenda to discuss the problem. Illegal immigration can be defined as a movement of people from a source country to the destination country without any legal documents and violates destination countries immigration laws. People have moved across landsRead MorePros and Cons of Illegal Immigration Essay example1493 Words   |  6 Pageshousing with abusive landlords, have few health cares options, and are victims of fraud and other crimes. The main controversy lies in the passing of a plethera of laws throughout the existence of the US regulating immigration and in the handling of illegal immigration. Modern immigration polocies have recieved less and less publicity as tolerance becomes more widespread, although each person is entitled to their own opinion about the issue (Conover 342). Immigrant problems are related to tradeRead MoreThe Pros and Cons of Illegal Immigration in America Essay718 Words   |  3 PagesMost of the time, I would complain about all the illegal immigration there is in the United States. Researching this topic has pretty much changed my mind on illegal immigration. Although there is much controversy over illegal immigration, it has many positive benefits. We Americans are never happy, always finding something to complain about. The more we complain and take it nowhere, the more time we waste. Illegal immigrants are usually, overall intelligent and hard workers. They bring theirRead MoreImmigration Is One Of The Most Popular Topics Today1591 Words   |  7 PagesProfessor James Leary English 101 [DR] 23 February 2016 Immigration is one of the most popular topics today. Over 4.4 million illegal aliens are on the waiting list to be documented. Many U.S. citizens have been in an outrage over legalizing immigrants. But what many people fail to realize is that immigration has several advantages that far exceeds the negative concerns. Immigration brings several economic advantages to the United States. Immigration also has a huge influence on American culture. DespiteRead MoreAnalysis Of Donald Trump s President Of The United States Essay970 Words   |  4 Pagesreasons. He is pro-life, against gun-control, and supports illegal immigrants returning to their countries (Project Vote Smart). These issues are important to me and my reasoning as to why I back Donald Trump. Donald Trump is against one of the biggest talked about issues in the United States; Abortion. Although Trump hasn’t always been pro-life. He was claiming to be pro-choice from what he wrote in his book The America We Deserve back in 2000 (Novielle). Donald Trump said he was pro-life except in