Dear Dr Chandler and Mr Erik MuiseI thank you so much for

Dear Dr. Chandler and Mr. Erik Muise,I thank you so much for taking your time to review my persuasive paper. I have a lot of strength when it comes to writing. I always give a detailed description of things so my readers can understand my point. I also make sure my sentences flow from paragraph to paragraph by using punctuations properly, so that my readers can get engaged without being bored. Beside checking for wrong spellings, I make sure that I use the right words to get my points across. I really know how to apply APA format when writing academic papers. Once I start writing, I cannot stop. I tend to write too much and find it very difficult to narrow down. Please I need feedback on how to narrow down ideas and how to stay focus on topic. I am interested in writing evidence-based research books and need advice on how to achieve that. Mastering courage is also a problem for me when it comes to writing. All your comments are appreciated,Theresa Nkrumah Persuasive ExerciseWhen my daughter came back from school to spend the summer vacation with me, I found out that she had gained a lot of weight. I knew, telling her straight that she had gained weight would have made her upset, so I decided to talk about myself first. One day, I was relaxing in the living area with a cup of tea, when she came and sat beside me. That was a great opportunity for me to talk about healthy lifestyle. I started telling my daughter that I had changed my lifestyle to incorporate healthy diet and routine exercises. She looked at me, giggled and said in a small voice, “you don’t need to lose any more weight. You look good for your age.” I replied, “I need to maintain my weight and also want to be healthy.” She was quiet for some time and said, “well I will lose all the pounds I have accumulated on me when I graduate next year. I eat too much fast food because I don’t have enough time to cook. Always on the run and stress, stress, stress makes me eat snicker bars all the time.” Hmmm, I found out what was making my daughter fat. I knew right then that she was not eating healthy at all. I turned and looked straight in her beautiful brown eyes and said, “that is not good, you need to treat yourself to healthy foods.” I also explained to her that I look small for my age because I always try to eat healthy. She agreed with me, but she still insisted that she has no time to exercise or cook healthy food. I knew she was going to argue so I told her that I would give her a present if she lost weight. I could tell that she was a little bit relaxed when I said that. Then I started telling her the risks of gaining weight, such as getting diabetes, hypertension and even stroke. She was so scared and told me that she would try to eat healthy and exercise. I bought her a book entitled, “Cooking with natural foods as you search for abundant health.” I went to the gym with her during the summer vacation and taught her how to cook easy and healthy foods. She stopped eating foods that are saturated with fats, sugar and salt. She lost 10 lbs. within two and a half months. As promised, I bought her nice Burke and Dooney handbag and she was so happy. Since then my daughter has maintained her ideal weight and living a healthier lifestyle. She has even convinced her friend to join the healthy lifestyle The Rise of Antimicrobial Resistance Among the Elderly in the Long-Term Care FacilitiesAnd Antimicrobial Stewardship ProgramTheresa Nkrumah, BSN, MSN/MPH, RNUniversity of Massachusetts-AmherstN 605 Scholarly Writing for Health ProfessionalsProfessor Genevieve E. ChandlerApril 6, 2019AbstractThe purpose of this paper is to illustrate that there is a world-wide problem concerning the increase of antimicrobial resistance. The author advocates for a change of culture that can eliminate or reduce antimicrobial resistance. Antimicrobial, especially antibiotics are included in the most frequently prescribed medications these days. Literature emphasizes that all healthcare facilities including Long-Term Care Facilities (LTCFs) should establish antimicrobial stewardship programs to minimize or prevent antimicrobial resistance. Studies also recommend that nurse practitioners and other healthcare providers should acquire extensive knowledge concerning antimicrobial use and the adverse effect.Key words: antibiotics, antimicrobials, drug resistance, infection, antimicrobial stewardship, Long-Term Care Facilities (LTCFs). IntroductionAntimicrobial resistance in the LTCFs across the US and the world at large is a very serious issue. Literature has revealed that, antimicrobial resistance and healthcare associated microbes cause greater than 2.5million infections in the United States alone each year, and unfortunately 2 percent of the infections results in mortality (Wilson et al., 2017). It is very urgent to find different health care practices in order to change the culture of infection treatment. This will eliminate or reduce the incidence of antimicrobial resistance. The purpose of this paper is to identify how antimicrobial stewardship can minimize antimicrobial resistance and prolong life among the elderly in the LTCFs. The plan of the paper is to point out the cause of antimicrobial resistance. Then discuss the negative impact of antimicrobial resistance in the LTCFs. Finally, the paper will incorporate evidence-based research that would encourage LTCFs to establish antimicrobial stewardship programs.Cause and impact of antimicrobial resistance The excessive use of antimicrobials in the LTCFs have created massive incidences of antimicrobial resistance with adverse effects such as, the occurrence of clostridium difficile among residents (Nicolle, 2014). Literature reveals that persistence of urinary tract infection (UTI) with serious complications are due to antimicrobial resistance among residents in the nursing home settings (Donk Van der, Schols, Driessen, Hagenouw & Meulendijks, 2013). There are numerous obstacles that should be considered in order to improve the effective use of antimicrobial in the LTCFs. Residents in LTCFs acquire high incidence of infections due to comorbidities, aging process, invasive procedures, invasive devices and exposure from healthcare institutions (Nicolle, 2014). The high incidences of asymptomatic bacteriuria, colonization of gram-negative organisms in the oropharyngeal, altered skin integrity such as feeding tubes sites or pressure ulcers with pathogenic organisms usually present positive culture but no infection (Nicolle, 2014). All the challenges mentioned illustrate that microbiological tests require careful evaluation and explanation. Research shows that providers usually prescribe antimicrobial therapy without the evidence of infection (Nicolle, 2014). This can result in false diagnosis of infections and unnecessary treatment of antimicrobial therapy that can lead to antimicrobial resistance. Antimicrobial stewardship program that will encourage good use of antimicrobial treatment will be discussed next.Antimicrobial stewardship programs The drive for antimicrobial stewardship programs (ASPs) is to improve the efficacy of antimicrobial treatment, decrease antimicrobial use and health cost by promoting sensible usage of antimicrobials (Nathwani, Varghese, Stephens, Ansari, Martin & Charbonneau, 2019). Studies prove that antimicrobial stewardship program has the most important influence on clinical and economic values. According to literature, implementation of ASPs can reduce antimicrobial resistance in healthcare facilities significantly (Nathwani, et al., 2019). Furthermore, Nathwani et al. (2019) verify in their studies that, length of stay (LOS) in the hospital decreased after establishing ASP. Amazingly, healthcare institutions have reported a decrease in death rate as a result of infection and a reduction in antimicrobial cost after ASP implementation (Nathwani, et al., 2019). All these show that ASPs not only provide quality care but also lower healthcare cost. Even though, establishing ASP can be expensive from the start the cost will be compensated from later savings. Conclusion Antimicrobials have great benefit for mankind in treating serious and otherwise deadly infections. Antibiotic stewardship is excellent program for all long-term care facilities to implement. There should be a mandatory antimicrobial stewardship in all healthcare facilities and intense education for all providers and nurses to reduce antimicrobial resistance. It is about time to take serious action in preventing excessive prescription of antimicrobials. All LTCFs should have the best plan of care to include minimum but effective dosage of antimicrobialsSummary of main points There is a great worldwide concern for needless use of antimicrobials in LTCFs due to excessive prescription by providers. Excessive antimicrobial use has resulted in antimicrobial resistance and increased infection that has serious adverse effect and also increased mortality not only in the United States but the whole world. Studies encourage health care facilities to implement antimicrobial stewardship programs and that should be a priority to minimize antimicrobial resistance. Furthermore, there should be antimicrobial course for physician extenders and nurses during school years and periodic training after school to understand antibiotic use and the effect.Personal commentHealthcare providers should take extra caution when prescribing antibiotics to the elderly residents. I understand and support the studies that encourage healthcare providers including nurses to stay abreast with current review of antibiotic resistance in the antibiotic treatment regulation. It should be a major priority for all healthcare facilities to establish antimicrobial stewardship program and enforce regular antimicrobial training classes for medical providers and nurses as well. It is necessary to establish a protocol for healthcare providers to always identify the reason for administering or prescribing antibiotics. I have gained a lot of knowledge concerning antimicrobials and would like to recommend that antibiotics should be handled as control drugs. This will greatly reduce antibiotic resistance, decrease infections and save lives.ReferencesAbbo, L., Smith, L., Pereyra, M., Wycloff, M., & Hooton, T.M. (2012). Nurse Practitioners’ attitude, perceptions, and knowledge about antimicrobial stewardship. The Journal for Nurse Practitioners, 8(5), 370-376. doi: doi.org/10.1016/j.nurpra.2012.01.023Donk Van der, C.F.M., Schols, J.M.G.A., Driessen, C.J., Hagenouw, R.G.P., & Meulendijks, A. (2013). Prevalence and spread of multidrug resistant Escherichia Coli isolates among nursing home residents in the Southern part of the Netherlands. Journal of the American Medical Directors, 14(3), 199-203. doi: 10.1016/j.jamda.2012.09.026 Echevarria, K., Groppi, J., Kelly, A.A., Morreale, A.P., Neuhauser, M.M. & Roselle, G.A. (2017). Development and application of an objective staffing calculator for antimicrobial stewardship program in the Veterans Health Administration. American J Health-Syst Pharm, 74(21), 1785-1790. doi: 10.2146/a/hp160825 Nathwani, D., Varghese, D., Stephens, J., Ansari, W., Martin, S., & Charbonneau, C. (2019). Value of hospital antimicrobial stewardship programs (ASPs): A systematic review. Antimicrobial Resistance and Infection Control Journal, 8(35), 1-13. doi: 10.1186/s13756- 019-0471-0Nicolle, L. E. (2014). Antimicrobial stewardship in the long-term care facilities: What is effective? Antimicrobial Resistance and Infection Control Journal, 3(6), 1-7. doi:10.1186/2047-2994-3-6Scales, K., Zimmermann, S., Reed, D., Beeber, A.S., Kistler, C.E., Preisser, J.S., Weiner, B.J., Ward, K., Fann, A., & Sloane, P.D. (2017). Nurse and medical provider perspective on antibiotic stewardship in nursing homes. The American geriatric Society, 65(1), 171.doi: 10.1111/jgs.14504Tandan, M., Burn, K., Murphy, H., Hennessy, S., Cormican, M., & Vellings, A. (2018). Antimicrobial prescribing and infections in long-term care facilities (LTCF): A multilevel analysis of the HALT 2016 study, Ireland, 2017. Europe’s Journal on Infectious disease surveillance, epidemiology, prevention and control, 23(46), 1-11. doi: doi.org/10.2807/1560-7917. E.S.2018.24.46.1800278Wilson, M.B., Shick, S., Carter, R.R., Heath, B., Higgins, P.A., Sychia, B., Olds, D.M., & Jump, R.L.P. (2017). An online course improves nurses’ awareness of their role as antimicrobial stewards in nursing homes. American Journal of Infection Control, 45, 466-70. doi: doi.org/10.16/j.ajic.2017.01.002

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