E-structor Response Form (Your marked-up essay is below this form.)

Your tutor has written overview comments about your essay in the form below. Your tutor has also embedded comments [in bold and in brackets] throughout your essay. Thank you for choosing Smarthinking to help you improve your writing.

Hi Carla! My name is Darleen and I look forward to working with you on this Health Sciences and Nursing Essay Review to improve your writing today. Let’s get started!

Writer’s Name: Carla 11578420

Institution: Regis College Nursing (MA)

Course Level/Title: NU-629-06-20PCS3 Adv Hlth.Promotion&Disease Prevention

Essay Title: Transgendar

Assignment Description: Needs to be APA format, grammar and APA refernces , check for page numbering , header

*Strengths of the essay: This is an interesting and very important topic and you have included some very good discussion points in your essay. It was a pleasure to review your submission.

Introduction/Conclusion: Consider revising your introductory paragraph to eliminate details and citations that do not belong in the very first paragraph. Also be sure to include a clearly identified purpose statement to help your reader understand what your essay will discuss. For example, “The purpose of this essay is to …..”

Consider writing and including a well written conclusion. If you include a purpose statement in your introduction, refer back to this in your conclusion. A strong conclusion will clearly indicate a summary of your main topic.

See The Smarthinking Writer’s Handbook Chapter 3: Drafting Your Essay Lessons 1 and 2, “Writing effective Introductions and Strong Conclusions.” It can be accessed by clicking the Academic resources Icon on your Smarthinking Homepage or at the following link:

Grammar & Mechanics: There are a lot of typographical, punctuation and grammatical errors throughout your essay so be sure to proofread carefully and correct all errors. Read each sentence out loud to make sure it sounds “right.”

Avoid all use of slang words and phrases and only utilize professional terminology at all times. Be sure to always identify who or what you mean by terms such as “they” or “it.”

Eliminate unnecessary words. Make your sentences very clear and very concise.

Content Development: You include a lot of very good information and data in your essay. Be sure you define every key concept so that your reader knows exactly what you are talking about. Consider defining what the term “transgender” means. Also, this seems to be a major topic for your paper but you spend very little time really talking about it. Consider including more detail, more statistics, and more definition to support this concept.

Be sure that you clearly identify all abbreviations the first time they are used in an essay.

Organization: The introduction should not have a heading. APA manual p. 27.

Be sure to include a properly formatted title page.

Running head is too long. Consider shortening it. Do we “promote “disease?

Using headings helps to organize your paper. Please check your resources for correct APA format and proper heading formats.

Good use of headings that really help to organize your paper.

Use of Resources:  Please review your APA resources carefully regarding formatting of the references, citing and quoting and consider using the Smarthinking Writer’s Handbook and choose Chapter 2: Section 3, Lesson 9. Be sure to remove all blue hyperlinks and underlines from your reference list. Writing: Nursing/Allied Health tutors are Content Specialists and are not authorized as Writing Specialists. For specific questions about grammar, mechanics, and APA format, please submit your essay to our Grammar and Documentation review service in The Smarthinking Writing Center.

Summary of Next Steps:

· Revise your introductory paragraph and include the purpose of your essay at the end of your introductory paragraph.

· Consider more definition and detailed discussion on the transgender population.

· Write a conclusion that summarizes all the main points and answers all of the questions and predictions made in the introduction.

· Be sure to carefully proofread your essay, sometimes you have to read it aloud to catch spelling errors that the computer spell check overlooked. For additional ideas about proof reading use link Chapter 4: Revising and Editing Your Essay, lessons 1,2, and 3

· Read embedded comments and suggestions and consider revising as needed.

· After you reviewed the APA manual and applied the APA style and you still have questions, submit a clean draft of your essay to the Writing/Essay Center for assistance with Grammar, Mechanics, and APA.

· Use your APA manual Ch.7 and the Smarthinking Writer’s Handbook.

· And here are additional resources that may be helpful

· Good luck with your studies

Thank you for submitting your essay for review. I enjoyed helping you with this step in the revision process.

You can find more information about writing, grammar, and usage in Smarthinking’s student handbooks. You can visit the  Smarthinking Writer’s Handbook  or the  Smarthinking ESOL (English for speakers of other languages) Writer’s Handbook .


Please look for more comments [in bold brackets] in your essay below. Thank you for visiting Smarthinking. We hope to see you again soon.


Section one (introduction)

According to the World Health organization, [All three words are capitalized. They are all part of the proper name of this organization.] having merely the absence of diseases does not mean that one is healthy. Therefore the [ A more precise…] precise definition of an individual’s health is having a complete status of physical, social, and mental wellbeing (Constitution, 2020). The concept of health involves understanding several factors such as it is a valuable factor to everybody regardless of ethnicity, religion, race, or social difference. With this in mind, therefore, every individual right access a high standard of health, and if there is unequal development, this may result in discrimination or unfair treatment in health promotion programs. It is also essential it notes that health is not just a responsibility of the government, but every person has a responsibility in promoting health as much as we all aim to benefits from proper medical and healthcare services. When a particular group is unable to cope up with risk or anticipate the impact of a specific disaster, the particular population can be classified as a vulnerable group. Example of people who are considered to have high vulnerability includes children, immune-compromised persons, pregnant women, and elderly. Some of the contributing factor to vulnerability includes malnutrition, poverty, poor housing, and homelessness. [You have include a lot of great information in this introductory paragraph. However, introductions should be just that, a brief introduction to your topic and why it is important. It should not include details such as contributing factors and citations. Those belong in the body of your essay. You should also write and include a purpose statement to help guide your reader into the intent of your paper. [Eliminate unnecessary wording such as “therefore.” There are several major grammatical and sentence structure errors so be sure to proofread carefully and correct all errors.]

Health changes as the environment [What environment? Be specific.] continue to change, and as this change continue to evolve or emerge human being have been implementing different ideas, developing a science-based approach, innovating new technology and epidemiology for generations. In most cases, the diseases that emerge are finally dealt with, and this involves endless effort to get the solution. For example, Before Edward Jenner’s 1796 discovery of the smallpox vaccine, the disease had wiped out [Consider using more professional terminology here.] thousands of individuals. However, soon after, he discovers that knowledge is still one of the modern science applied in medicine today [?] (Tulchinsky & Varavikova, 2014). It is, therefore, evident the historical records of heath have the potential to help in understanding health-related issues and making it quicker to develop ways that can help in dealing with current or new situations. Tulchinsky & Varavikova (2014) states that public health a [?] history that has knowledge that shows approaches that have been implemented in the human era to improve health and protect the public against infections. [Good info but a little challenging to read. Several of the sentences do not make sense as written. Be sure to proofread carefully and correct all errors.]

Current different government or countries implements various initiatives to deal with health issues, and the US, in particular, has a Healthy People initiative that takes one decade. [What?] In every period of this specific time, the country focuses on twelve health-related issues and gives way forward towards addressing each on the matter appropriately. The objective set in every decade helps to assess the progress in terms of public health at the national level and motives individuals to work toward achieving each of the goals set. The initiative also promotes collaboration of the healthcare sector with both internal and external environments. The Healthy People initiative goals include attaining high-quality in healthcare, improving a long life that is free from diseases, and enhancing public health equity. The program is also designed to develop a social and physical environment that eliminates disparities. However, this is not the limit because the Health People Initiative has a general focus on health and address a dynamic aspect related to health issues, including education. [Consider clarifying the above info. Eliminate unnecessary words. The ending of this paragraph is much better than the beginning.

But if one of the objectives of Healthy People 2020 is to prevent diseases, why not get to understand the levels of prevention? According to Kisling & Das (2019), the level of prevention strategy includes primordial, primary, secondary, tertiary, and quaternary preventions, and each approach helps to address the five-stage of a disease. For instance, primordial prevention is an early strategy that focuses on reducing the risk factors in a community using regulation and national policy measures. The approach is focused on identifying social and environmental condition that contributes to the onset of diseases, especially to children. The primary prevention strategy focuses on the susceptible population to ensure that disease never occurs. One of [?] how this works is by improving individual immunity to suppress the infection and prevent it from progressing to subclinical disease. In case one [one what?] is already at the subclinical stage, and the secondary prevention strategy comes in handy. The approach uses screening to assess pathologic changes for individuals on how to tend to look healthy, but they are not. [What do you mean by this? Consider clarifying.] Kisling & Das (2019) suggest that Papanicolaou (Pap) smear as one of the best examples of secondary prevention used to diagnose cervical cancer at the subclinical stage. The third stage is known as tertiary prevention used for symptomatic patients. It combines the clinical stage with the outcome stage to identify measures that can help to reduce the disease severity. Quaternary is the last prevention stage preferred by ARPN nurses and healthcare providers, and its purpose as the best approach for identifying the possibility of overmedication to prevent the patient from medical invasion. The core aim at this stage is to ensure that the medical therapy prescribed to the patient does not cause more harm but rather help as intended. [Interesting. Consider including an example to help illustrate what you mean here. Be sure to always identify abbreviations that are used for the first time in an essay.]

APRN nurses are an essential part of the healthcare facility, and they play a crucial role in disease prevention and health promotion. Some of the roles include providing general education to the patient through various areas like the importance of nutrition as well as physical exercises. It is also the role of an APRN nurse to monitor the patient and report any possibility of a high-risk situation of a different illness. [?] [Report to whom?] For example, if monitoring patients with heart disease historical records, [?] the nurse should encourage the patient to take regular cholesterol tests while advising the patient about a healthy lifestyle (Bryant-Lukosius et al., 2017). APRN nurse act as a patient advocate for adequate health as well as educate them on what to expect in case of an unprepared incident. This role helps to both promote prevention strategies and support health promotion. [True.The APRN has a more complex role than educating and advocating, right? What other important elements are expected of the APRN?]

Section two

The term vulnerability in the definition [What definition?] refers to an individual, population, or organization’s degree of exposure to a disaster that they unable to recover from due to different limiting factors such as poverty, malnutrition, and destitution. [Whose definition is this? What was your resource here?] On the other hand,[Consider eliminating these four words. They are unnecessary. Also, if you have an “other hand” then you must have a “one hand.” Does that make sense?] health disparity refers to the difference between or among population groups in terms of attaining health under situation such as prevalence, mortality, adverse condition, and disease burden (Baciu et al., 2017). The two factors [vulnerability and disparity?] have negative affection [Incorrect word use here.] on health promotion, and cultural competence is one of the strategies used to minimize the impact they have on health promotion efforts. [?] Since a few individuals may not understand that cultural competence, it is worth mentioning that this is the provider’s or organization’s ability to implement strategies that promote effective delivery healthcare services that meet the diverse patients’ needs. [It’s ood that you defined cultural competence but remember to keep it professional. Considers eliminating “Since a few individuals may not understand…” Just state the term and define it.] Through this approach, healthcare provider improves their ability to communicate, understand and interact with patients in a manner that meets their needs in every aspect related to health (Saha, Beach & Cooper, 2008). [Good info. Be sure you proofread carefully and make sure that your content flows logically and professionally.]

If then, [?] healthcare providers can improve this approach to a vulnerable population group such as transgender [Define?] it the issues of discrimination and mistreatment in the health care sector will be a long-gone issue. [?] Vermeir, Jackson & Marshall (2018), states that cultural competence component such as understanding about gender identity helps healthcare providers to effectively interact and acknowledge the needs and eliminate the healthcare barrier for the transgender group. It would also promote nurses’ role as a patient advocate to support justices for their patients with discrimination or violation of the law. [?] Davoodvand, Abbaszadeh & Ahmadi (2016) suggest that every patient is vulnerable because they have experienced some degree of damages. With this in mind, I would say that combining both patient advocacy and cultural competence is even better. In this case, it would help transgender [transgender persons?] to receive better and non-discriminative services in the healthcare sector. This would change the negative view some of the healthcare providers have about the transgender group.

Section three

Mirza & Rooney (2019) suggests that despite that, [Despite…what?] is it the right of every individual to access healthcare services in any sector the issues of mistreatment, denial to services and harassment is still of essential concern in our society. [?] According to the Center for American Progress, a significant number of the transgender population always complain of discrimination and denial of services. [Need a citation and date] One factor that may contribute to this high rate of mistreatment of the transgender group includes lack of awareness and low literacy on the social and cultural aspects of this group among healthcare providers. This is why I continued to insist on implementing training to healthcare providers and cultural competence and patient advocacy. [Avoid referring to self in an academic essay.] Healthy-People (2020) reveals that one of the goals of the Healthy People 2020 Initiative is to improve the health, wellbeing, and safety of the transgender and LGB people. Discrimination and mistreatment is the core contributing factor to inadequate access to healthcare services for the transgender population. [How do you know this is true? Can you support this statement with citation to professional literature?] Therefore the preventive measures essential for mitigating these issues should include implementing legal discrimination laws in healthcare and other organizations such as the workplace. [Such as? Consider being more specific here.] It is also vital to implement social programs and training approaches [Such as?] that will help to create awareness and promote cultural competence and positive interaction.

The ResearcherGate webpage reveals several pieces of evidence of uses of Community-Based Participatory Research (CBPR) to study the transgender community. First, CBPR promotes collaboration with the community and professional approach throughout every step in the research procedure. Wright et al. (2017) include that they study developed a [?] strong partnership that enables the participants to learn from each other and gain skills as well as gain more understanding of the importance of safe, respectful, and supporting cultural competence environment. The National Center for Transgender Equality provides different types of resources for this group, such as health care, insurance, and additional mental health resources, legal resources, and domestic violence resources (Additional help, 2019). Additionally, the USAID also has a program that supports vulnerable populations, which includes displaced children and orphan fund programs, Leahy War victims fund, victims of the torture program, wheelchair program, and disability program (“Vulnerable populations programs,” 2016). [Incomplete sentence.]

The following links provide farther information:


Health involves having a complete status of physical, social, and mental wellbeing. Health changes continuously as the environment changes, and to ensure we come up with the changes, we apply approaches such as trial and error, scientific methods, and implementation of technology techniques. Healthy People 2020 is one of the current initiatives that demonstrate different programs, such as prevention strategies that are used for health promotion and disease prevention. Every ARPN nurse has a role in healthcare to act as a patient advocate, develop public awareness, and promote the implementation of CBPR and cultural competence. The vulnerable populations have equal rights as anybody else. The nation has made a significant effort in promoting and preventing diseases. There is much that is yet to be done to ensure that the quality of life of every resident is improved.


Additional help. (2019, April 23). Retrieved from

Baciu, A., Negussie, Y., Geller, A., Weinstein, J. N., & National Academies of Sciences, Engineering, and Medicine. (2017). The state of health disparities in the United States. In Communities in Action: Pathways to Health Equity. National Academies Press (US).

Bryant-Lukosius, D., Valaitis, R., Martin-Misener, R., Donald, F., Peña, L. M., & Brousseau, L. (2017). Advanced practice nursing: a strategy for achieving universal health coverage and universal access to health. Revista Latino-Americana de enfermagem, 25.

Constitution. (2020). Retrieved from

Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses’ viewpoint: a qualitative study. Journal of medical ethics and the history of medicine, 9.

HealthyPeople. (2020). Lesbian, gay, bisexual, and transgender health | Healthy people 2020. Retrieved from

Kisling, L. A., & Das, J. M. (2019). Prevention Strategies.

Mirza A. S., & Rooney C. (2019, August 13). Discrimination prevents LGBTQ people from accessing health care. Retrieved from

Rosen, G. (2015). A history of public health. JHU Press.

Tulchinsky, T. H., & Varavikova, E. A. (2014). A history of public health. The New Public Health, 1.

Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient centeredness, cultural competence, and healthcare quality. Journal of the National Medical Association, 100(11), 1275-1285.

Vermeir, E., Jackson, L. A., & Marshall, E. G. (2018). Improving Healthcare Providers’ Interactions with Trans Patients: Recommendations to Promote Cultural Competence. Healthcare Policy, 14(1), 11.

Vulnerable populations programs. (2016, February 26). Retrieved from

Wright, L. A., King, D. K., Retrum, J. H., Helander, K., Wilkins, S., Boggs, J. M., … & Gozansky, W. S. (2017). Lessons learned from community-based participatory research: establishing a partnership to support lesbian, gay, bisexual, and transgender aging in place. Family practice, 34(3), 330-335.

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