Critically Discuss the Effectiveness of Nurse Leadership Order Instructions: Using current literature critically discuss the effectiveness of nurse leaders use of the five major conflict resolution/management strategies (ie compromising, avoidance, collaboration, competition, accommodation) in terms of evidenced patient, staff and organizational outcome in a range of contemporary clinical practice context including new graduate practice context.
Critically Discuss the Effectiveness of Nurse Leadership Sample Answer
Nurse leadership
Leadership competencies are some of the most basic competencies that an individual in any profession or organization must possess, whether at the individual or at the group level. Effective and efficient leadership in a healthcare setting is very necessary. Research on leadership reveals that good leadership in a hospital environment contributes directly to patient outcomes (Curtis, Vries & Sheerin, 2011). Leadership in nursing is one of the very foundations of a nurse because of the great duties of interacting with the patients are more on the nurses than any other professionals in a healthcare setting. Good leadership, health work environment, job satisfaction, lower worker turnover rates, positive outcomes for the patient and healthcare providers greatly rely on effective leadership (Curtis, Vries & Sheerin, 2011).
Several researchers have come up with different leadership theories. Spector (2006, as cited in Curtis, Vries & Sheerin, 2011) classifies these theories into four approaches:
The trait approach, which focuses on the individual characteristics of a person and how these characteristics affect leadership
The behavior approach, which just like the trait approach looks at leadership from the perspective of the leader, the way the leader behaves, and how it contributes to effectiveness in leadership
The contingency approach focuses on leadership as the way a person applies leadership skills according to the situation that they face within their environment.
The leader-member exchange approach, also called charismatic or transformational leadership looks at leadership from the perspective in which the leaders and supervisors engage in the coordination and delivery of the organization’s objectives.
While all these leadership theories are crucial in helping nurses lead, transformational leadership is the most suitable choice for advancing nursing leadership. This type of leadership is all about vision and the ability to influence others, sharing a bond with followers, trust and being able to empower others (Wagner, et. al., 2010). Nursing leadership differs from all the other types of leadership because the nurse assumes and emphasizes more on nursing assuming responsibility and improving the practice environment (AANAC, 2014). This assumption differs from Lorber, Brigita and Savic (2011) findings in which they concluded that all leaders in whatever position they were in a combined sphere of nursing practice. In this sense, nursing knowledge derived from nursing leadership influences their leadership. In their definition they defined nursing leadership as the ability to empower others, facilitating learning, developing nursing knowledge and working with and through others in order to achieve success ( Lorber, Brigita and Savic, 2011). This definition clarifies further that a nurse leader is any nurse who can assist or help others. In this sense, it means a nurse student who provides medical assistance to patients is a nurse leader just like a practicing nurse offering a medical prescription to the patients in a ward. A ward manager is a leader to all team members. From this definition we can derive that every nurse is a leader, the only difference is the area under which they practice or the authority that they practice.
Conflicts are very common in any working environment where people differ in terms of ideas and ideologies. Conflict resolution competencies are very essential for nurses in a healthcare setting. In their research, Khanaki and Hassanzadeh (2010) came up with the conclusion that conflicts among individuals have proved to have a negative impact in on organizational efficiency and efficacy. This gives us a reason why we should manage conflicts effectively in a work environment. The manner in which the conflict is managed whenever it occurs can determine the effectiveness of the organizations activities. There are several causes of conflicts some of which include poor communication among individuals, a dissatisfaction which may result out poor management style, desire to obtain power, ineffective leadership and lack of openness. Khanaki and Hassanzadeh ( 2010) classify the causes of conflict into three major categories, these are the power, value and economy. Power conflict results when one party demands more power so that to influence the other lesser party. Value conflict results out of inconsistence in people’s culture and way of life. This type of conflict results mostly when individuals from different backgrounds are not ready to adjust to other peoples opinion because to them they feel their opinion is the best. This may be caused by differences in cultural beliefs, religious beliefs and political alignment. Economic conflicts results out of the competition for human basic needs, which are ever limited in nature.
In nursing, conflicts occur in many circumstances. In the first circumstance is the nurse-client conflict. Good nurse client relationship is the foundation of the clients well being (Akerjordet & Severinsson, 2010). The main aim of the nurse in the nurse-client relationship is to help achieve the client’s health goals (College of Nurses of Ontario, 2009). Existence of a conflict can be a hindrance to the achievement of this goal. This conflict may escalate if the client is constrained for instance not smoking, fatigued or over stimulated, tense anxious, worried disoriented or afraid. In this case, the avoiding strategy will not help in such a conflict.
Critically Discuss the Effectiveness of Nurse Leadership
The conflict must be brought to an end in order to help achieve the health goals of the client. In this case, the compromising strategy will help solve the problem partially. The nurse needs to find out the medical history of the client by seeking to understand the healthcare needs of the client and the client’s perspective. Acknowledging the clients concerns and addresses them calmly. Anticipate the conflict in situations in which it has previously occurred and create a care plan to prevent its escalation.
Conflicts among colleagues at the workplace are also very common among individuals, and nurses are no exceptional. Poor relationship among members of the healthcare team directly affects the delivery of care to the patients (Henry & Ginn, 2010). For instance, workplace bullying can interfere with the nurse’s confidence and the ability to foster therapeutic relationships with the clients. Struggle and the desire for power can result to a conflict in a workplace. it’s not only the struggle but also misuse of power can also result to the conflict in a workplace where individuals do not feel comfortable with the manner in which they are lead by their nurse leaders. Other major causes of conflicts in nurse leadership include differences in practice perspectives where individuals feel their way of doing things is best based on experience, education level and culture of practice. Bullying of junior staff such as the student nurse on placement and age differences result to conflicts among colleagues (Royal College of Nurses, 2011). It is very important to note that before seeking for a solution to a conflict one must understand its root cause by interacting with the individuals conflicting in order to find out the real cause of the conflict. Collaborating and compromising strategy can help resolve such a conflict. The collaborating strategy requires that the concerns of both conflicting parties must be analyzed and a middle solution that can help solve the conflict is arrived at which satisfies both parties. This strategy is very assertive and cooperative in nature. In compromising strategy, it requires that a solution is arrived at by looking at the concerns of both parties and addressing them while neglecting others as much as necessary and finding a middle-ground position. This strategy is moderately assertive and moderately cooperative (AANAC, 2014).
The other form of conflict that can occur in the nurse work environment is the conflict between workers and the management. This may result out of several factors and this will affect quality service delivery to the clients. Poor management skills applied by the managers can result to the conflict between the managers. For instance, supervision is a very common activity in any work environment, however, the way the supervision is carried out will determine the attitude that the nurses will develop towards the work. Thorough supervision will result to the poor relationship between the management and the workers because the workers will feel that the management does not have trust on them that they can deliver the expectation of the management. Another very common cause of conflict between them management and the workers is equality. All workers are equal as long as they are under one supervisor; none of them is more superior that the other and therefore they should all receive the same treatment (Porter-O’Grady, 2012). Accommodating is one of the strategies that can help solve such a conflict. Lack of engagement of staff workers in managing them and taking care of their concerns can cause conflicts between the management and the staff. if the management cannot manage such conflicts there are very high chances of soldering by workers. This requires that individuals overlook their own concerns to satisfy the concerns of the others. This strategy basically relies on generosity and selfless that is followed by choosing to do what one could not have preferred to do under normal circumstances. Another strategy that can help deal with such conflicts is the competing strategy one seeks for own concerns at the expense of others by using appropriate power to win the position and defend something that is believed to be correct (College of Nurses of Ontario, 2009). It is assertive and uncooperative.
Nurse leadership is purely responsible for the management and resolution of conflicts in a work environment. Subordination of individual needs for the best interest of the client’s health should be a driving force for conflict resolution in a working environment. Nurse leadership requires proper inquiry to the cause of the conflict that comes out of the client’s behavior in client-nurse conflict. The nurse needs to assess the cause of the conflict and design the appropriate solution for the conflict. Nurses are required in their professional practice to promote a respectful work environment, mentor, and support and integrate new staff members into the practice setting. In order to function effectively as a team nurses need to have a positive collegial relationship (College of Nurses of Ontario, 2009). This relationship can result from good communication, mutual acceptance and understanding, use persuasion pother than coercion and balance of personal emotions in a work environment. The management is purely responsible for soldiering of workers and therefore they have a fully responsibility of preventing the occurrence of such conflicts in a work environment. Management can promote quality practice by establishing good communication networks between the management and the staff and among the staff workers. A fair and efficient reporting system will help the nurses report their dissatisfaction before it results into a conflict. Open communication will promote an atmosphere in which individuals share freely identify the cause of the conflict and finding an appropriate solution before it escalates.
Critically Discuss the Effectiveness of Nurse Leadership References
Nurse Practitioner Soap Notes and Genital Infection
SUBJECTIVE DATA
Chief Complaint (CC): “I have been having vaginal itching, burning and discharge for the past five days now”
History of Present Illness (HPI): Ms. T. A is a 35-year-old African American female who presents to the clinic stating that she has been having vaginal itching, burning and discharges for the past five days now. A patient described that her discharge is thick cottage cheese without any odor. She reported itching and burning with urination. She denies any blood in her urine. She reported itching and burning sensation when urination. She reported pain, burning, and discomfort during sexual intercourse. She rated her pain during urination as 4 and pain during sexual intercourse as 5 on a scale of 1 to 10. She denies using any medications to relieve her symptoms. She denies fever, chills, back pain costovertebral tenderness and suprapubic pain. She denies nausea and vomiting. She denies using a condom for sexual intercourse because is in a monogamous marriage with her husband. She also came to the clinic to have pap/ pelvic examination done. Her last pap was March 2012. The patient said her menstrual period is regular. Her last menstrual period was April 20th, 2014. She used about 4 pads a day during her periods. She denies using tampons for her period or douching. Patient’s age of onset of menarche was 12-years-old. She is sexually active. She denies the history of any sexually transmitted disease.
Medications: She is currently taking women’s multivitamin once a day.
Allergies: No known allergies to medications, foods, insects and the environment.
Past Medical History (PMH): No history of past medical history,
Past Surgical History (PSH): No history of past surgical history.
OB/GYN History:
Obstetric History: G2, P0, T2, A0, and L2. She has her two children full term their weights range from 7lbs 8lbs. she has spontaneous vaginal delivery no complications on April, 15th, 2009 and July 5th, 2011.
Her menstrual period is regular and lasts for about 3 days. Method of contraception is ParaGard IUD (10years) which was inserted November 14th, 2011.
Menstrual History: Age of onset of menarche was12-years-old. Her last menstrual period was
April 20th, 2014. Her menstrual period is regular and last for about for 4 days. No spotting or bleeding since her last menstrual period. Her last previous pap examination was March 2012 and no history of the previous mammogram. No history of sexual of sexually transmitted diseases. She denies using douching.
Method of Contraception: Method of contraception is ParaGard IUD (10years) which was inserted September 14th, 2010.
Sexual function: She is sexually active with her husband. Her last sexual activity with her husband was three days ago.
Personal/Social History: She is married and lives in a single-family house with her husband and children. She graduated with a bachelor of science in biology. She is currently working in a laboratory company as a manager. She denies exposure any to smoke at home. She does not smoke, drinks alcohol or use illicit drugs. She sleeps for about 7 hours at night. She has a good family support system. She has one regular sex partner (her husband) and three-lifetime partners. She is sexually active and her form of contraception is ParaGard IUD. She eats healthy food. Her favorite’s foods are baked fish, beans and vegetables. She walks about 2 miles a day. Her hobbies are jogging, cooking and watching movies.
Immunizations: Flu vaccine January 2014, Varicella April 2003, Hep B July 2009, Tdap February 2010, MMR, May 2007 and pneumonia: Never received.
Family History: Grandparents on both sides are deceased with no medical problem.
Her mother is 55 years alive with no medical problem.
Father: Her father 57 years alive with no medical problem.
Brother: Her brother is 30 years alive with no medical problems.
Sister: Her sister is 32 years alive with no medical problem.
Nurse Practitioner Soap Notes and Genital Infection Review of Systems
General: She denies any chills or fever, change in appetite, fatigue, and weakness. No recent weight changes.
Skin: She denies any rashes, sores, lumps, lesions, acne, itching and dryness or changes.
HEENT: She denies dizziness, headache, and syncope. She denies any problem with her hair. No history of alopecia. She denies ear pain, difficulty hearing/ changes in hearing and denies tinnitus. She denies changes or problems in vision. She denies eyes pain, blurred vision, seeing spots, burning, edema and discharge. She denies epistaxis, runny nose, and sinus pain.
Neck: She denies pain or stiffness in moving her neck.
Breast: She denies breast tenderness, lumps, discharge, and nipples darkening.
Respiratory: She denies any wheezing, coughing or shortness of breath.
Cardiovascular: She denies any chest pain or shortness of breath. She denies any irregular heartbeat.
Gastrointestinal: She denies any abdominal tenderness and pain. Her last bowel movement was yesterday. She denies any changes in bowel or bladder habits. She denies constipation, diarrhea, and blood in the stool.
Peripheral vascular: Pulses are palpable in all extremities. No edema.
Urinary: She reported the frequency with urination, pain and burning upon urination and she rated her pain as 6 on a scale of 1-10.
Genital: She reported cottage cheese-like discharge from the vaginal and burning sensation and frequency with urination. She denies douching or odor from the vagina. She denies any history of abnormal pap or sexually transmitted diseases. She reported soreness and redness to the outer area of the vaginal.
Musculoskeletal: She denies having any muscle weakness and joint pain.
Psychiatric: She denies having any present/past psychiatric problems. No depression, mood changes or anxiety.
Neurological: She is alert and oriented to place, time and person. She denies any recent change in memory or forgetfulness. She denies any tingling, numbness or paresthesia.
Hematologic: She denies any history of blood disorder and easy bruising. She has regular menstrual bleeding.
Endocrine: She denies any history of diabetes or thyroid disorders. No excessive thirst, polyuria, polydipsia, and polyphagia.
OBJECTIVE DATA:
Vital Signs: BP 120/66, T 98.7, P 80, R 18, and oxygen saturation 98 % on room air. Height 65 inches, weight 145 lbs. and BMI- 23.4.
General: Ms. T. A is a 35-year-old African American woman and she is appearing well. She is awake, alert and oriented times three. She is in no acute distress. She is in good health. She dresses appropriately and hair is well groomed. She smiles appropriately and seems happy. Her posture is good, gait is steady and she walks very well. No mouth or body odor noted. She speaks very good English. She is very friendly, well behave and very polite.
SKIN: No rashes, lesions, sores, acne, lumps, itching and dryness or changes noted. Good skin turgor.
HEENT: Pupils equal, round, reactive to light and accommodation. Extraocular muscles are intact. Head is normocephalic. Hair distributions are normal. No ear discharge noted. Nares are patent. Her oral mucosa is normal and appearing well, mucous membranes are moist and pink and good dental hygiene. No teeth missing.
Neck: No thyroid nodules or thyromegaly noted. No jugular vein distention noted.
Breasts: Breasts are bilateral, non-tender to palpation, areolas are light pink and, no palpable nodes and no discharge noted. No masses, tenderness or lumps noted. Present of hair around the chest and nipple.
Chest/Lungs: Chest is symmetrical. Lungs are clear to auscultation in all lobes and percussion bilaterally. No wheezing, rales, rhonchi, or rubs noted.
Heart/Peripheral Vascular: Rhythm and rate are regular. S1 and S2 heard on auscultation and are normal. No S3 or S4 sounds. No murmurs. No edema and pulses are palpable in all extremities. Point of maximum impulse noted at fifth intercostal space. Pulse + 1 in upper and lower extremities. No jugular vein distention noted clubbing, no edema or cyanosis.
Abdomen: Abdomen is flat no abdominal tenderness and no hepatosplenomegaly on palpation. Bowel sounds were present in all four quadrants.
Genital: Pubic hairs are well distributed on the outer vaginal area. Her cervix is intact and closed os. No lesion or cysts note. Her uterus is smooth and within normal limits. Both ovaries are not palpable. Rectal sphincter muscle was normal. No mass or lesion was noted. Vaginal was reddened and swollen. There was present of the copious amount of cottage cheese like discharge noted from the vaginal canal with no odor.
Musculoskeletal: Present of adequate muscle tone. Full active range of motion, no edema noted, capillary refills are less than 2 seconds. Gaits steady, symmetrical and no edema noted bilaterally. Good muscle tone and bulk are normal. Upper and lower extremities strength are equal throughout bilaterally. Full hip flexion and knee flexion. No involuntary movement noted.
Neurological: She is alert and oriented to place time and person. She follows command and responds appropriately.
ASSESSMENT:
1) Yeast Infection
Differential Diagnosis: Chlamydia, Trichomoniasis and bacteria vaginosis
3) Overactive Bladder – UTI, Sphincteric incontinence and neurogenic bladder
EXPLANATION
A) Yeast Infections a type of vaginitis that is inflammation of the vagina which is characterized by vaginal irritation, intense itchiness and vaginal discharge. It is caused by fungus candida. A vaginal yeast infection is also called vaginal candidiasis which is very common among women. Three out of 4 women will experience a yeast infection at some point in their lifetimes (Mayo Clinic, 2014). The symptoms of yeast infection can be mild to moderate and include : Thick, white, odor-free vaginal discharge with a cottage cheese appearance, Itching and irritation in the vagina and at the entrance to the vagina (vulva), a burning sensation usually during intercourse or while urinating , redness and swelling of the vulva and vaginal pain and soreness (Mayo Clinic, 2014). This is my primary diagnosis for this patient based on her physical examination and present illness. T. A complained of complain of cottage cheese like discharge, burning sensation during urination, discomfort and pain during sexual intercourse. During speculum examination, there was present of the copious amount of cottage cheese like discharge noted from vaginal canal and vulva. These are all defining characteristics of yeast infection.
B) Urinary Tract Infection: Urinary infection continues to be a major health problem for women worldwide. Bacteria ascend from the colonized urethra into the bladder and continue to ascend into the kidney. If left untreated can cause lasting damage to the kidneys, severe morbidity and even mortality (Shuiling & Likis, 2013). Women are afflicted with UTIs much more often than men because of women’s pelvic anatomy and shorter urethras. The female urethra is short; there is a distance between the urethra and the anus; and the perineal environment is moist, encouraging migration of bacteria from the rectum to the urethra. Women whose mothers have had frequent UTIs also seem to be more susceptible to these infections (Shuiling & Likis, 2013). UTI can be divided in two general classifications: cystitis, a relatively simple infection involving only the urinary bladder and upper tract infection or pyelonephritis, an infection involving one or both kidneys (Shuiling & Likis, 2013). Some women with simple UTI have suprapubic tenderness. Flank pain may be present but usually is not with simple UTI. Its presence would raise the index suspicious for pyelonephritis. Typically, women with pyelonephritis fells acutely ill may have fever, chills or nausea, vomiting and costevertebrate angle tenderness as well as symptoms of cystitis which are dysuria, frequency, urgency and suprapubic pain (Shuiling & Likis, 2013). This patient does not have upper tract infections (pyelonephritis) because she does not have these symptoms. Some of the symptoms of UTI include frequency, burning sensation during urination and cloudy urine. Urine culture is the reference diagnosis of a UTI. A urine dipstick that is positive for leukocyte esterase or nitrite is 75% sensitive and 82% specific for UTI (Shuiling & Likis, 2013). This is my secondary diagnosis for this patient. Based on patient complained of frequency and burning sensation during urination, also her urine dipstick was positive for nitrites, and leukocyte esterase, these are signs and symptoms of urinary tract infection.
C) Overactive Bladder: The symptoms of overactive bladder in women include urinary urgency and frequency (Mayo Clinic, 2014). This patient also complained of the frequency with urinary with are symptoms of overactive bladder.
Plan
Labs: Urine culture (Mid- stream) was collected and sent to the laboratory. Urine dipstick showed no ketones in urine. There were present of protein, small bilirubin, large nitrites and leukocyte esterase which confirmed that she has urinary tract infection. Pap/pelvic examination- Cervix was swab for HPV, Chlamydia and gonorrhea. She was also screen for cervical cancer. Patient was advised to follow if her symptoms of yeast infections returns or worsens after completion of the prescribed medication because indicate she might need long term treatment regime.
Medications: She was prescribed nitrofuratoin100mg orally twice daily for 7 days and for yeast infection, she was prescribed Diflucan 150mg orally one dose and dose may be repeat if necessary.
Health Promotion: The important of completing the treatment regimen even if symptoms resolve before all medications are taken should be emphasized to avoid development of resistant organisms. Most importantly, a woman who has been diagnosed with a UTI should be advised to contact the clinician if her symptoms persist after 48 hours of antibiotic treatment (Shuiling & Likis, 2013). Patient should be advised to increase fluids intake and avoid delayed in urination. Advised patient to wipe front to back, urinate after sexual intercourse, to wear cotton panties or liners, avoid close fitting clothes, avoid douching both in general and during treatment. Teach patient the important of completing the course of medication. Patient should avoid alcohol consumption when taking metronidazole and for 48 hours after completing the treatment (Tharpe, Farley & Jordan, 2013). Patient was informed that metronidazole can cause nausea, vomiting and cramps even if alcohol is not consumed. In addition, the patient was counselled to avoid intercourse until her symptoms cease and then to use condoms until she completes her treatment (Shuiling & Likis, 2013). Patient should be encouraged to continue to practice safe sex practice and monogamous relationship, but refrain from sex until symptoms subside. Patient should be advised that if her partner has symptoms of yeast infection, it is important that the partner get treated to prevent reinfecting each other (Shuiling & Likis, 2013).
Disease Prevention: For this patient, Pap smear should be performs according to the recommended guidelines. Patient should be tested for all sexually transmitted diseases based on her history.
REFLECTION: I learned more about yeast infection. The doctor ordered urine culture (Mid- stream) was collected and sent to the laboratory. Urine dipstick showed no ketones in urine. There were present of protein, small bilirubin, large nitrites and leukocyte esterase which confirmed that she has urinary tract infection. Pap/pelvic examination- Cervix was swab for HPV, Chlamydia and gonorrhea. She was also screen for cervical cancer. She was prescribed nitrofuratoin100mg orally twice daily for 7 days and for yeast infection, she was prescribed Diflucan 150mg orally one dose. Patient was advised to follow if her symptoms of yeast infections returns or worsens after completion of the prescribed medication because indicate she might need long term treatment regime. I agree with Dr. Youssefi treatment plans. In a similar patient evaluation, I would not have anything differently. After the clinical rotation, for that day, my preceptor gave me an assignment to read more about yeast infection and urinary tract infection. . I realized that patient teaching is very important for patient with both yeast infection and urinary tract infection. This is a very interesting clinical experience for me because the patient was diagnosed with both yeast infection and urinary tract infection. Based on my research, I found out that women in professions where frequent urination is impeded have higher rates of UTIs. Nurses, teachers and factory workers where voiding on demand is restricted or difficult are all susceptible to such infections, for example. Education about the need for voiding when the urge is present can decrease the incidence of UTIs in these women. They should also be cautioned against limiting fluids to decrease the need to urinate. Some who have worked under these conditions for a long time will no longer feel a need to urinate until the bladder is already overdistended. For them, timed voiding may be helpful in reestablishing normal bladder responsivity (Shuiling & Likis, 2013).
Nurse Practitioner Soap Notes and Genital Infection Sample Answer
Nurse Practitioner SOAP Notes
Chief Complaint (CC): “In the past 7 days, I have had a very severe pain when urinating and a continuous feeling of scratching my private parts.”
History of present illness (HPI): A 25 year old female by the name Topyster of Hispania origin comes to the hospital with her hands clinging on her pubic parts as a sign of severe pain. She claims that she has been feeling pain whenever she visits the toilet for a short call and this has been going on for the past one week. The lady reports severe pain while urinating and a feeling of itchiness in her pubic part every minute. She reports that she feels a lot of pain during sexual intercourse and this has caused a lot of discomfort to her partner. Asked whether she has ever used any medication to relieve this pain, she denies, saying that she does not know what type of medicine could help. She reported the pain extending to her periods and it became even worse when using the tampons and pads. The patient reported that she has never used a condom during sexual intercourse because they trust one another. The last menstrual period she received was in September 15th and during that time, the periods were accompanied with a lot of pain and the blood flow was more than usual. The patient confirmed that she has never vomited nor felt nausea since the pain started.
Onset
The pain started a week ago, on Wednesday
Location
At the vagina
Duration
When the pain started, it was not very severe; it used to occur after urination. As time went by, it became very severe and a feeling of scratching the vagina ensued.
Medications: the patient confirmed that she has been taking family planning pills.
Allergies: the patient has never experienced any allergy since her childhood, neither food nor environmental allergies reported.
Past Medical History (PMH): The patient confirmed that she has never been to the hospital in the recent past.
Past surgical history: the patient has never undergone any surgery
OB/GYN history:
Obstetric history: she has one kid of 8lbs who she gave birth to on May, 2013 without any complications. The method of the conception of the pregnancy was through sexual intercourse.
Menstrual history: she started receiving her menstruations while she was 13 years old and the last period she received was on September 15, which lasted for 4 days. She has never used douching.
Sexual function: she is sexually active and the last sexual intercourse was 2 days ago.
Social/ personal history: she is married and they are staying happily together with her husband and their one kid. She graduated from college 3 years ago with a bachelors’ degree in business management. She runs a personal transport business. Her favorite foods are the locally prepared vegetables and sausages. She likes jogging every evening after work. She has one sex partner and has had two sex partners in her lifetime. She has never smoked but she reported taking alcohol when in college, but after marriage, she has never used alcohol.
Immunizations: pneumonia vaccine, January 2013; flu vaccine,e march 2014.
Family history
Grandparents are deceased with a fatal road accident.
Her mother is 47 with no medical problem
Her father deceased in a landslide
Her brother aged 18 is alive and with no medical problem
Her sister is 12 with no medical problem
Review systems:
General: she denies any chills or change in fever and no change in appetite
Skin: she denies skin rashes and skin dryness
HEENT: she denied ear pain, headache, dizziness, blurred vision and seeing spots
Neck: she denies neck pains and difficulty in moving the neck
Breast: she denies breast pain and nipple darkening.
Respiratory: she denies any wheezing and shortness of breath.
Gastrointestinal: she denies of any abdominal pain, constipation, and diarrhea.
Urinary: she reported pain when passing urine, and rated it as 5 in a scale of 1-10
Endocrine: She denies any history of diabetes or thyroid disorders. No excessive thirst, polyuria, polydipsia and polyphagia.
OBJECTIVE DATA:
Vital signs: BP 115/77, T 92, P 60, and oxygen saturation on room air was 96%. Height 54 inches, weight 135 lbs. and BMI- 22.
General: Topyster is a 25 year old Hispania woman who appears physically well. She is in good health and her hair is well groomed. She smiles appropriately and no odor in mouth or body noted. She speaks very fluent English, polite and well behaved.
SKIN: she has no skin rashes, lesions, nor dryness. In general, she has good skin turgor.
HEENT: the pupils are equal, round and very reactive to light and accommodation. Hair distribution is normal. Nares are patent, moist nose and good dental hygiene.
Breasts: the breasts were steady and no palpable nodes and no discharge noted.
Neck: no thyroid nodules or thyromegaly noted.
Chest/lungs: the chest is symmetrical and lungs are very clear and no wheezing.
Heart/ peripheral vascular: rhythm and arte are regular. No murmors or edema.
Genitals: pubic hair well distributed and her cervix is intact.
Musculoskeletal: the presence of enough muscle tone and no edema noted. Good muscle tone and bulk is normal.
ASSESSMENT:
diagnosis
positives
negatives
Rationale & reference
Yeast infection
Itching in the vaginal area and around the vulva.
Burning sensation in the vaginal area
Swelling of the vulva
White/gray vaginal discharge
Pain during sexual intercourse
No headaches
No vomiting
No fever
No chills
Most yeast infections are caused by a type of yeast called candida albicanas (Dupont, et. al., 2009). The bacteria accumulate around the vagina resulting to the multiplicity of the yeast. The symptoms of the yeast infection include: itching in the vagina, burning sensation especially during urination and sexual intercourse, thick white discharge with cheese cottage appearance and swelling of the vulva (Mukherjee, Sheehan & Ghannoum, 2005).
These symptoms were confirmed in Topyster and it was made the primary diagnosis.
Genital herpes
Burning sensation during urination
No fever
No muscle aches
No blister on the vagina
No appetite loss
It is a sexually transmitted infection caused by the herpes simplex virus (Barton & Sen, 2007). The general symptoms include fever, muscle aches in the back, buttocks and thighs. In women, blisters may be around the vagina, cervix or the anus. In men, blisters may be around the pennies, scrotum and around the anus. Pain during urination is common in both genders. (Wald, 2006)
In the examination of Topyster, these symptoms were not confirmed and the patient did not complain of any of these.
endometriosis
Pain during urination and sexual intercourse
No abdominal pain or pelvic pain
Endometriosis is the abnormal growth of endometrial cells similar to those that form in the uterus.
Its symptoms include painful periods, painful sex, pain in the lower abdomen and pelvic area (Ferrero, et. al, 2011).
The patient confirmed pain during sex and urination.
Lab test
Patient results
rationale
Urine culture (mid-stream)
No ketones in urine
Presence of protein, bilirubin, large nitrites and leucocyte esterase.
Urinary tract infection is an infection that happens anywhere along the urinary tract. Its symptoms include a strong and urgent feeling if urination every time and burning sensation.
The patient was advised to visit back the hospital if her symptoms worsened.
condition
pharmacological
test
Follow up
rationale
Yeast infection
Nitrofuration in 100mg orally, twice daily for 7 days
Diflucan 150mg one dose
Urine test was positive
If symptoms persist patient to visit the hospital after two weeks
The use of nitrofurationin the treatment of yeast prevents other additional infections that may result out of fungal infections.
Health promotion: the yeast infection is a fungal disease, which results out of bacterial infection (Mukherjee, Sheehan & Ghannoum, 2005). It is very important that the patient completes her medication even if she feele relieved. This will help prevent the development of other resistant microorganism. The patient is advised to forgo sexual intercourse until after her health has completely improved (Dupont, et. al., 2009). The patients should be advised to ask her husband to visit the hospital because he both has got the yeast infection.
Disease prevention: Pap smear should be performed according to the set standard procedures. Testing should be carried out on the patient based on his medical history.
Reflection: I have learnt a lot from this study about yeast infection. From the study, it is very evident that observing cleanliness is the very best option of avoiding such medical complications. In order to avoid the yeast infection and other sexually transmitted diseases, it is very important that one observes cleanliness especially on their underpants. There is an urgent need to carry out public education about this sexually transmitted disease in order to avoid the spread of the disease and deal with the disease amicably. If we can carry out public education, then we can reduce the spread of the disease by a very high percentage. Not all disease symptoms can be confirmed just by asking patient questions. Thorough examination of the patient is very necessary before commencing any treatment. Prescription of antibiotics in the patient’s medication is very necessary as it helps the patient fight against other additional diseases that may arise out of the bacteria that may attack the pubic parts (Soong & Einarson, 2009). Completion of the dose is very necessary as this will help prevent other medical complications that may result out of the same disease.
I feel much touched by the level at which the sexually transmitted diseases are attacking women. In fact, three quarters of the people who report to the hospital about sexually transmitted diseases are women. This shows that there is a very crucial need to help our young ladies in schools and those out of schools by educating them on hygiene best practices.
Nurse Practitioner Soap Notes and Genital Infection References
Barton, S. & Sen, P., 2007. Genital herpes and its management. BMJ. May 19, 2007; 334(7602):
Dupont, F, Lortholary, o., Ostrosky-Zeichner3, L., et. al., (2009).Treatment of candidemia and
invasive candidiasis in the intensive care unit: post hoc analysis of a randomized,
controlled trial comparing micafungin and liposomal amphotericin B. Critical Care 2009,
13 (5):R159 (doi:10.1186/cc8117)
Ferrero, S., Camerini, G., et. al (2011). Bowel endometriosis: Recent insights and unsolved
problems. World Journal of Gastrointestinal Surgery . Mar 27, 2011; 3(3): 31–38. Published online Mar 27, 2011. doi: 10.4240/wjgs.v3.i3.31
Mukherjee, P., Sheehan, D.& Ghannoum, M., (2005). Combination Treatment of Invasive
Fungal Infections. American Society for Microbiology: New York.
Soong, D. & Einarson, A., 2009. Vaginal yeast infections during pregnancy. Canadian Family
Physician. Mar 2009; 55(3): 255–256. College of Family Physicians of Canada. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654841/#__ffn_sectitle
Wald, A., 2006. Genital HSV‐1 infections. Sex transmission infection v. 82(3); 2006 June.
Nursing Profession Pursuing Career Path Order Instructions: This is an essay paper for entry to a nursing school. It need not have any references/source.
Nursing Profession Pursuing Career Path Sample Answer
Nursing profession
People pursue different careers due to various reasons such as passion, interest, hobby, financial benefits, work gratification, achievement of status among many other reasons.
Nursing Profession Pursuing Career Path
I decided to pursue a career in nursing because of the passion and the desire to impact positively on people’s lives. I believe I have the motivation and the will to contribute significantly to the nursing profession by pursuing this career path.
As stated earlier, I opted to study this career due to passion and desire to contribute to change in lives of many people. While growing up, I came across a nurse when I accompanied my parents at a health facility. The presentation of the nurses at the facility motivated me and triggered in me a desire in the field, which I endeavored to accomplish. The first impression at the facility played a critical role in making a decision to pursue the career. Furthermore, the fact that nurses contributed to the quick recovery of my father at that time made me like and desire the profession just to save other patients and help them manage their illness in a good way.
Granting me an opportunity in your institution is a privilege, as it will enable me to achieve my personal as well as career goals. I do believe that I have the potential to help in the transformation of the nursing profession. My vision is to ensure that nursing becomes a respectful profession in society for its positive contribution. As a nurse, I will be at the forefront of ensuring that patients access quality services. Patients require better treatment from the time they step in a health facility to the time they depart from it. I will be at the forefront of championing the rights of the patients as well as those of nurses. I do believe that if patients are treated well, they feel good and recover quickly. Likewise, nurses require conducive working conditions to render quality care to the patients. Striking the balance between the rights of nurses and patients will, therefore, be one of my major contributions to the profession.
To render quality care, nurses require to adhere to professionalism and codes of ethics. They must be respectful, honest, have integrity, be independent, and be autonomous among other values to help patients in their recovery process. As a nurse, I do believe that I will be able to abide by these principles and help those that go against these codes to ensure that we render the best services to our patients.
As a nurse professional, I also hope to formulate various programs in the society to ensure that people live healthy lifestyles. I will champion training programs to encourage community members to adhere to healthy living. This will help to improve health standards in the community. Furthermore, as a nurse profession, I will also participate in the policy-making whereby I will agitate for the adoption of various technologies and other innovations in helping improve service delivery.
I am motivated to pursue this career and I do not intend to retract from achieving that which I desire. Granting me this opportunity at your institution will enable me to realize this noble dream. As a nurse, I believe that I can contribute to a greater level in restoring the profession just to see that all the people access quality healthcare. My desire is to impact the lives of patients regardless of their age, race, nationality, or religion.
Select one of the following ethical issues in healthcare:
Foregoing curative medical treatment due to religious beliefs
Use the CSU Global Library and select Internet sources to conduct research on your chosen topic. Based on your research, provide the history of the issue from a legal, ethical, and moral perspective. In your paper address the following questions:
Do the consequences of actions always direct what is morally required?
What should happen when two principles come into conflict? For example, should patient autonomy be considered more important than beneficence? Defend your position.
Are moral and ethically rules always binding, or are they only guidelines to be assessed in each case? Defend your position.
Your paper should be 10-12 pages in length, well-written, and formatted per CSU-Global specifications for APA Style. Support your analysis by referencing and citing at least six (6) credible, peer-reviewed sources other than the course textbook (Ethics in Health Administration: A Practical Approach for Decision Makers, 2nd ed, by Eileen E. Morrison).
SAMPLE ANSWER
Foregoing Curative Medical Treatment Due to Religious Beliefs
Introduction
Healthcare professionals frequently find themselves in dilemmas as they undertake their chores at the workplace, with some directly confronting the ethical issues while others turning away. Usually, the moral courage that one possesses is what matters most as it, more often than not, helps the practitioners in addressing the various ethical issues that may present themselves; which could even involve doing something otherwise considered wrong. Inasmuch as there usually are predetermined courses of action considered ethically moral or otherwise, the consequences of the course of the action taken is what really matters (Stewart, Adams, Stewart, & Nelson, 2013). Because of this, an action that is otherwise not acceptable may have to be carried out in order to get to achieve a desirable consequence; for instance, according to most religious doctrines, abortion is not acceptable, even the conscience of the individual that may be involved may not allow it. However, if done for the sake of good will remains morally binding, for instance, the case of complications in pregnancy.
In order for us to get to understand the implications of the ethical issues pertinent with the health care practice, there is the need to understand the definition of nursing by the International Council of Nurses (ICN). Under it, the profession is defined as: “Nursing encompasses autonomous and collaborative care and communities of all ages, groups, families and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention f illness and the care of ill, disabled, and the dying people. Advocacy, promotion of safe environment, research, participation in shaping the health policy and in patient and health systems management, and education are also key nursing roles.” (ICN, 2011). As outlined by Morrison (2011), the definition incorporates the three fundamental components of bioethics. It is, thus, conceivable to say that the health practitioners have the obligation of developing a well-founded ground of ethical understanding with regards to the protection of the people; which is their sole duty.
Moral Courage
The ability of one to make the right decisions in such situations that involve moral and ethical issues is what is called moral courage. According to Day (2007), moral courage is “a trait displayed by individuals, who, despite adversity and personal risks, decide to act upon their ethical values to help others during difficult ethical dilemmas. As Hall (2014) asserts, such individuals tend to strive to see to it that the only do what is right, even in cases whereby most are expected to choose least ethical behavior, which could even be not taking any action.
Conflict of Principles
Religious, spiritual and cultural beliefs and practices remain very crucial in the lives of most patients, yet most health practitioners usually find themselves at the dilemma of whether to, how and when to address such issues when dealing with patients. In the past, the physicians were basically trained on the various ways of diagnosing and treating the various diseases, but with very little or no training on the spiritual approach to the ordeal. Besides, the professional ethics allows the professionals no chance of impinging their personal beliefs on their patients who are usually very vulnerable (Brierley, Linthicum, & Petros, 2013). The matter is even complicated further by the characteristic nature of most nations of religious pluralism, having a wide range of systems of beliefs: agnosticism, atheism to the very many religious assortments. Because of this, it tends to be very difficult getting to fully understand the religious beliefs of all the patients from all walks of life.
The very first temptation that would prove worthwhile in this case is for the professionals to fully avoid the doctor patient interactions with respect to their spiritual or religious beliefs. This simplest solution may never be the best as several studies have shown that the spiritual and cultural beliefs f various patients have been proved to be very important factors for the patients to be in a position of coping with relatively serious illnesses (McCormick et al, 2012). McCormick et al (2012), assert that the engagement of the spiritual beliefs of the patients in their healing process may be devised by the health practitioners through comparison of their own beliefs against those of the patients.
Case Scenario: Foregoing Curative Drugs due to Religious Beliefs
In some communities, there is too much belief in the traditional practices that accepting the modern medicines becomes very difficult. Such communities have a belief system in which they believe and may recognize the move towards accepting the western medicine as evil. In such a case, the patient may never be taken to the hospital, or worse still, after getting to the hospital refuse to take the prescribed medicine on the belief that it is against the doctrines of their religion. The most common cases, include, but not limited to; blood transfusion, abortion, taking of family planning pills and even the normal tablets.
Conflict in Principles
In case of the principles coming into conflict, there usually is the need to be very flexible as there are so many ways in which the situations may present themselves. For effective resolution of such conflicts, the ethical and professional principles, rather than the personal preconceived ideas, should always form the pillar for the effective decision making when it comes to ethics (ANA, 2011). The ethical behavior of nurses is usually guided by a set of principles contained in the American Nurses Association (ANA) Code of Ethics of Nurses (2001). It is expected of all the nurses that they uphold all the principles in the course of their practice of professional nursing, while, at the same time, the Cord of Ethics for Nurses encourages them to ensure consistency with their personal values. There is also emphasis on the need to hold open discussion with regards to conflicting ethical principles in such a manner that all the principles are placed at the same level and treated equally.
Autonomy versus Beneficence
Autonomy
Autonomy refers to the personal self-rule that is both free from controlling such interferences that may result from others and the personal imitations that my put meaningful choices at jeopardy. In the health care, autonomy forms one of the key guidelines for the clinical ethics. A point that must be noted is that when speaking of autonomy, it does not merely imply leaving the patients the freedom of making their own choices. Rather, the health practitioners are under an obligation to see to it that they create the conditions that provide room for the independent choices, thought under some guidance. The respects for autonomy scenarios include giving room for autonomous choices as well as respecting the right to self-determination of an individual.
It must be noted that the doctors are usually visited by the people because they may not be equipped with the necessary information or background necessary for the making of informed choices. Hence, it is the physicians that educate the patients in order for them to adequately understand the situations, including; addressing the fears and emotions that may interfere with the decision making ability of the patients. Confidentiality is another form of autonomy very crucial in administering the treatment to the patients.
Beneficence
Usually, this is an action done purely for the benefit of others through either removing harm or simply by improving their situations. Apart from being refrained from causing harm, the health practitioners are expected to see to it that they help the patients. Due to the nature of the relationship inherent between the patients and the physicians, the doctors have the obligation removing or preventing harm and balancing and weighing the possible risks against the possible benefits of any action.
Balancing of autonomy and beneficence
Amongst the most difficult and common ethical issues to tackle comes in when the patient’s autonomous decision comes into conflict with the beneficent duty of the physician, which is mainly looking after the best interest of the patient. For instance, a patient who has very strict religious background may refuse to take medicine, simply because they believe in spiritual healing. This may be so challenging, especially when the physician has successfully diagnosed the ailment and knows its cause well, hence, its prescription (ANA, 2011). At such a point, the physician may be under the challenge of whether to maintain the autonomy of the patient or take a beneficence action, which will violate the autonomous requirement of the patient. More often than not, the two are equally important, however, beneficence comes first as it is a matter of life and death.
Basically, the modern biomedical ethics are grounded on four principles, which balance categorical Imperative of Emmanuel Kant: you must always do the right thing no matter what it takes, and Utilitarianism of John Stuart Mill and Jeremy: make the best decision for everyone all around. When in combination, the principles are usually called Principalism.
Respect for autonomy: giving priority to the informed choices of the patient. This theory asserts that the practitioners need to see to it that the wishes of the patients are taken into consideration. As such, the wish by a patient to have a kind of special attention with regards to choice of the health care services administered should solely depend on the patient’s wish.
Non-malfeasance: do no harm
Beneficence: do what is best for the patient, regardless of their consent. This principle asserts that the consent of the patient may be overlooked in order to see to it that the course of action is for their own good. With this, the health care practitioners are expected to ensure the good of the patients even if it means doing what they don’t wish for. The ultimate consideration of the morality will lie in the consequences, and at times, even if a patient requested for the end not to have blood transfusion due to religious beliefs, they may eventually end up thanking the physician, rather than suing them (Morrison, 2011).
Justice: always balancing the social and individual costs, risks and benefits. The physician has the obligation of seeing to it that they properly advise the patients with respect to the possible risks involved to ensure they are well informed before getting to a medical ordeal.
Morals and Ethics
Most of the moral dilemmas that tend to arise in medicine are usually analyzed using the four aforementioned principles but with some consideration given to the resultant consequences, though the frameworks may have limitations. The judgment of the best consequences is not always clear, and din case the principles conflict, the ease of deciding on the best dominant is always very hard. Virtue ethics usually focuses on the nature of the moral agent rather than how right the course of action taken is. Usually, as a practitioner, the ethical principles, which guide what action to be taken do not usually take into account the moral agent’s nature (Cordella, 2012). To look into how binding the morals usually are, the “standard” Jehovah’s Witness case may be used.
A very competent adult believer loses too much blood due to bleeding in a vessel in an acute duodenal ulcer, and the only best chances of saving his life is by having a blood transfusion together with some operation done on him. In exercising his autonomous decision, the patient requests for surgery and treatment with the best non-blood products available, and refuses blood transfusion. He even accepts the risks that are pertinent with surgery without blood transfusion.
It is very important for the health practitioners to get to distinguish between morality and legally binding courses of actions as an action may be legal but not moral and vice versa. For instance, the resuscitation of a dying patient may be considered legal, but not moral. On the other hand, when a patient falls too sick at home, it may be moral to over speed to the hospital but illegal. Also, the physicians have the obligation of distinguishing between religion and morality. From instance, some of the religions believe in circumcising women while others recognize it as a sin.
Moral Frameworks
However, the moral theories tend to provide different frameworks upon which the nurses may be able to get clarification as well as view the patients’ disturbing situations. Widely used and applicable are three frameworks that may guide the physicians. The three basic broad categories of the moral frameworks are: virtue theory, deontological and utilitarianism theory.
Virtue theory
This theory exclusively probes the human morality. It gives very little attention to the regulations that people need to adhere to; rather, it puts more emphasis on what is deemed necessary in development of human characteristics considered as good, just like living a generous and kind life.
Deontological ethics
These are usually associated with the ethical and moral standards in the execution of the professional duties by the health professionals.
Utilitarianism theory
This is the belief that any form of action is considered as being right as long as it leads to the greatest good for larger number of people. As such, there usually is a calculation on the outcome of any particular action. As such, if a health practitioner considers an action as having high propensity of bringing good and happiness to larger number of people; it definitely is the right thing to do (Morrison, 2011). In other words, the utilitarianism tends to base its reasoning on the usefulness of the action that may make it be considered as moral or immoral; for the course of action to be considered as moral, the good outcomes have t outweigh the bad ones.
Moral principles
They are the broad and general statements of philosophical concepts that provide the foundations upon which the moral rules are founded.
The health practices usually come with too many challenges which leave the practitioners at a dilemma in more often situations than not. For instance; the debate n abortion, organ transplant, end-of-life issues, management of personal health information and the allocation of the scarce health resources. Looking into each of the aforementioned issues, it usually leaves the platform very open for the practitioner to decide what they deem right course of action to take. As put across by Elliot (2011), “Culture provides the rules or framework that guides us as we negotiate our way through our daily activities of life.” Through the assessment of the heritage of any particular patient helps the nurses to understand well how such a person relates to their surroundings, how they view health and wellness, their various ways of gaining and applying knowledge as well as any other area that may be of interest in health care provision.
Most of the nations of the world, for instance, in America, the populations are characterized by people of vast diversification in the religious, ethnic, sexual orientation and nationality. As such, the patients that visit the health centers present with themselves varied symptoms requiring medical attention, some based on illness while others grounded on the cultural and religious backgrounds of the patients.
As the patients are guided through any healthcare facilities of the dialysis unit, it is very recommended that the practitioners not only concentrate on the clinical needs, but also see to it that they identify the patient’s demographics and religious orientations amongst others. The problem very common is the avoidance of the common mistakes that greatly impact safety and quality and instead, pay too much attention on the nature of the illness and how the patient may be treated. In doing this, they are not really identifying with the patient in order to attend to them as an individual. A point that must be noted is that all patients have diversified characteristics and needs, both the clinical and non-clinical, which affects the manner in which they participate, receive and view their treatment (Morrison, 2011).
Unlike in the past when health provision was mainly limited to a particular community, mostly, where one came from, there have increasingly arisen changes due to the cultural and religious diversity. There is need for the healthcare providers to see to it that they are well conversed with all the possible cultural and religious traditions inherent in the societies within which they work. It is based on this challenge that the terminology ‘cultural competence’ came to be, whereby all the practitioners are expected to be able to work in the various cultural and geographical regions without much trouble (Cordella, 2012). This may only be so through getting to first and foremost understand the various cultures to help learn their beliefs.
A fact that all health care practitioners must come to terms with is the diversity in the religious beliefs inherent in the various cultures and people from different walks of life. The beliefs of the various patients tend to be aligned to their religious backgrounds, which may never be easy to change. Due to this, it is in order that all the professionals fully understand the possible challenges that they may expect, however, they should never let the various beliefs by such patients waver their conscious mind of making the right decisions to do good. Once a person believes in the consequence o the course f action they are about to take, they should do so without any fear.
Conclusion
In conclusion, we as health practitioners are faced everyday with caring for patients of different faiths, cultures and religions. It is important to always keep an open mind and allow yourself to try to understand the faith that our patients believe. Understanding other cultures and beliefs are critical in the healing process. In healthcare today as physicians, we need to keep an open and unbiased mind, treating everyone as equal. Through the development of proper cultural competence, we may help our patients by accepting their beliefs without abandoning our own personal customs. As health practitioners, we may not be able to change the beliefs of the various patients from the different walks of life as the populations continually get diversified, rather, there is need to remain open minded in order to accommodate the diverse beliefs. In addition, as long as we believe that the course of action that we are taking will lead to more good than bad, then the autonomous stake of the patients should always be put at stake. After all, they will eventually appreciate the results.
Brierley, J., Linthicum, J., &Petros, A. (2013). Should religious beliefs be allowed to stonewall a secular approach to withdrawing and withholding treatment in children?. Journal of Medical Ethics, (9). 573. doi:10.1136/medethics-2011-100104.
Conflicts between religious or spiritual beliefs and pediatric care: informed refusal, exemptions, and public funding.(2013). Pediatrics, (5), 962.
Cordella, M. (2012).Negotiating Religious Beliefs in a Medical Setting. Journal Of Religion & Health, 51(3), 837-853.
Elliot G. (2011). Cracking the cultural competency code. Canadian Nursing Home, 22(1), 27-30.
Hall, H. (2014). Faith healing: religious freedom vs. child protection: the medical ethics principle of autonomy justifies letting competent adults reject lifesaving medical care for themselves because of their religious beliefs, but it does not extend to rejecting medical care for children. Skeptical Inquirer, (4). 42.
International council of nurses, (ICN). (2011). Nursing and health professions. 2011.
Krohn E. (2013). Recovering health through Cultural Traditions. Forth World Journal, 12.
Lamparello, A. (2001). Taking God Out of the Hospital: Requiring Parents to Seek Medical Care For Their Children Regardless of Religious Belief. Texas Forum On Civil Liberties & Civil Rights, 647.
Morrison, E. E. (2011). Ethics in health administration : a practical approach for decision makers / Eileen E. Morrison. Sudbury, Mass. : Jones and Bartlett Publishers, c2011.
Stewart, W., Adams, M., Stewart, J., & Nelson, L. (2013).Review of Clinical Medicine and Religious Practice. Journal Of Religion & Health, 52(1), 91-106.
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summarize your strategy for disseminating the results of the project to key stakeholders and to the greater nursing community.
SAMPLE ANSWER
Dissemination Strategies
Dissemination is a process where deliverables and outcomes of projects are made available to stakeholders and to the clinical practice audience. Its main intention is to make knowledge and its associated evidence-based interventions widely spread (Gellis, Solomon, Lukens & Huz, 2014). Dissemination evidence has several goals; first, to increase the evidence reach. Second, it increases people’s motivation of using and applying evidence. Lastly, it increases people’s ability of using and applying evidence.
The aim of the dissemination strategies is to spread knowledge and the evidence-based interventions across or within the geographical locations, the settings of practice, or other networks of end users such as health care providers and patients. The results of the project outcome are disseminated to key stakeholders. The main purpose for this is to inform the development of project, to allow feedback receipt and to ensure that the practice and the outcome are maintained after project implementation (Cleary & Hunt, 2013).
Passive dissemination strategies are not as effective as the active strategies. Interventions that solely rely on transfer of passive information are comparatively ineffective. Despite the effects of the active knowledge translation strategies being modest, they are usually very effective. The interventions that are multifaceted (i.e. one that incorporates two or more distinct strategies) are more likely to work than the interventions that are single (Cleary & Hunt, 2013).
Dissemination need to be considered early in the stage of project planning. It requires a period of time for dissemination at the end of the project work. The audit committees are required to strengthen the research findings implementation and the evaluation of winning implementation put into practice making use of the necessary outcome measures.
References
Cleary, M., Happell, B., Walter, G., & Hunt, G. (2013). Obtaining higher research degree qualifications: Key strategies to consider. Contemporary Nurse: A Journal For The Australian Nursing Profession, 44(2), 196-203.
Gellis, Z. D., Solomon, P., Cullen, S., Lukens, J., Gleba, J., Zalucki, D., & Huz, S. (2014). Dissemination of Evidence-Based Depression Care for Community-Dwelling Older Adults. Best Practice In Mental Health, 10(1), 1-15.
Riesch, S. K., Ngui, E. M., Ehlert, C., Miller, M., Cronk, C. A., Leuthner, S., & … Durkin, M. S. (2013). Community Outreach and Engagement Strategies from the Wisconsin Study Center of the National Children’s Study. Public Health Nursing, 30(3), 254-265.
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discuss methods to evaluate the effectiveness of your proposed solution and variables to be assessed when evaluating project outcomes.
Example: If you are proposing a new staffing matrix that is intended to reduce nurse turnover, improve nursing staff satisfaction, and positively impact overall delivery of care, you may decide the following methods and variables are necessary to evaluate the effectiveness of your proposed solution:
Methods:
Survey of staff attitudes and contributors to job satisfaction and dissatisfaction before and after initiating change.
Obtain turnover rates before and after initiating change.
Compare patient discharge surveys before change and after initiation of change.
Variables:
Staff attitudes and perceptions.
Patient attitudes and perceptions.
Rate of nursing staff turnover.
Develop the tools necessary to educate project participants and to evaluate project outcomes (surveys, questionnaires, teaching materials, PowerPoint slides, etc.).
SAMPLE ANSWER
Developing an Evaluation Plan
Project outcomes need to be evaluated to see how effective the applied solutions were or whether they carry any potential. The solutions and variables applied are evaluated resulting to some findings. The greatest contributors to job dissatisfaction with the staff are found to be in relation to the organizational climate, nurse turnover, their health benefits and working conditions. Nurses express satisfaction with the provision of essential drugs. The staff have a negative attitude towards working as they are not put into consideration as individuals whose needs are also to be attended to for the better of the patients and themselves (Needleman, 2006). All these will be analyzed before the initiation of change. The survey will be done and solutions derived. A strong line management and support from it will be found to have improved the staff’s attitude and led to a reduction in job satisfaction (Lankshear, 2005). Support from the management and good communication improve the working state. Essential working instruments like gloves will also be administered to change the working condition.
The rate of nurse turnover is a great concern for healthcare organizations and is likely to become worse. It costs a lot in terms of hiring, orientation and training, compromised quality of care and the lack of organizational knowledge. It can be especially problematic: directly or indirectly. It may be considered direct when the costs are clearly attributable to a specific activity or are more obvious like advertising costs. Those that cannot be attached to a particular activity and may be inappreciable like loss of organizational knowledge are indirect (Finkler et al., 2007). After coming up with solutions like increasing compensation and benefits for nurses, supporting flexible scheduling and job sharing, recognizing and rewarding superior performance, the rate of nurse turnover will reduce remarkably and improve the concerned areas.
A great comparison between patient discharge surveys before change and after initiation of change is a great step to be used in this evaluation. Initially, patients express with great satisfaction their thoughts on clinical service and the public health services but may be less satisfied with the provision of essential drugs and health insurance schemes. Those greatly affected are the elderly, retired, and those with low income. After coming up with ways to solve the issue with the help of the government, a program will be enacted with the sole responsibility of providing supplement support to the disadvantaged by paying health premiums and covering all extra costs. Primary care facilities will also not be allowed to earn any profits on essential drugs thus reducing the prices of essential drugs.
The attitudes and perception of staff in their work place are full of tension as they are not provided with everything they need for job satisfaction in the various departments. They perceive the administration or management to be one that does not care about their wellbeing as individuals and as employees. Recognition is not administered to them for their work done. A positive attitude towards the provision of drugs was registered but with issues like working conditions and organizational climate, a negative attitude was registered. The patients’ perception about the staff, management and activities to be carried out will be of great standard. To them, everything to do with healthcare ought to be of great value and lots of care considered for healthy lives and good working force. The rate of nurse turnover is viewed as an aspect to be considered for the success of flow of activities. The administering of proper measures to resolve the issue save time and efforts that would be highly costly at a later time (Aiken 2007).
To successfully educate project participants and evaluate project outcomes, questionnaires will used. The questionnaires will structured in a way that provides the name of the employer, allowing us to aggregate responses by hospital for the analysis of nurses’ reports and patient satisfaction. They shall also include questions about the work environment, job satisfaction, and experience of nurse turnover.
Finkler, S.A., Kovner, C.T., & Jones, C.B. (2007). Financial management for nurse managers and executives.
Lankshear, A.J., Sheldon, T.A., & Maynard, A. (2005). Nurse staffing and healthcare outcomes: A systematic review of the international research evidence.
Needleman, J., Buerhaus, P.I., Stewart, M., Zelevinsky, K., & Mattke, S. (2006). Nurse staffing in hospitals: Is there a business case for quality? Health Affairs, 25(1), 204-211.
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As mentioned below , this is a continuation of 111490 SECTION B, basically in section B the writer wrote the introduction of the paper, and now the writer will have to write the entire paper. The paper will have 4 pages minimum excluding the introduction which is already written in 11490 SECTION B. follow the instructions below and also note that this is a fact-based assignment that will not include your opinion.
• This will require research and support for what is written.
• The assignment should be paraphrased without quotations from scholarly and fact-based publications.
Case Study Ethical Legal Dilemma Advanced Practice Nursing
Description.
This paper is a continuation of 111490 SECTION B, in that section, the introduction was written and for this paper the writer will take the introduction and continue by responding to the questions below base on the instructions giving hear below. Basically SECTION B of 111490 is the introduction of this paper, as you will realized if you read through it, so the writer will continue written the entire paper from where the introduction ended.
Also it is very important to note that this is a fact-based assignment that will not include your opinion.
• This will require research and support for what is written.
• The assignment should be paraphrased without quotations from scholarly and fact-based publications.
The paper should have a minimum of 7 citations and some of these should be case law or applicable statutes. The APA Manual and the textbook have instructions on legal formatting.
Directions:
1. Create an ethical legal decision-making dilemma involving an advanced practice nurse in the field of education, informatics, administration, or a nurse practitioner.
2. Include one ethical principle and one law that could be violated and whether the violation would constitute a civil or criminal act based on facts in the law.
3. Construct a decision that would prevent violation of the ethical principle and prevent the law from being violated.
4. Describe the legal principles and laws that apply to the ethical dilemma.
5. Support the legal issues with prior legal cases or state or federal statutes.
6. Analyze the differences between ethical and legal reasoning and apply an ethical-legal reasoning model in the case study to create a basis for a solution to the ethical-legal dilemma.
7. List three recommendations that will resolve advanced practice nurses moral distress in the dilemma you have presented.
8. Based on the issue you presented, the rules of law apply the laws to you case and come up with a conclusion.
Note:
• This is a fact-based assignment that will not include your opinion.
• This will require research and support for what is written.
• The assignment should be paraphrased without quotations from scholarly and fact-based publications.
SAMPLE ANSWER
Ethical Legal Dilemma Advanced Practice Nursing
In a case on the night of April 15, 1975, a patient by the name Quinlan ceased breathing for two intervals of 15 minutes. The parents decided to transport the patient to hospital where it was determined that her pupils were not moving and she failed to respond to deep pain (Karen Ann Quinlan Memorial Foundation, 2010). The patient was placed on a ventilator at the hospital and received a tracheotomy. The parents watched the condition of their daughter and observed that as days went by their daughters’ condition was deteriorating continuously. After much discussion and counseling, the family decided that it was at their best interest to remove the ventilator. The nurse attending the patient went to remove the ventilator but as she was about to start removing it the patient asked her to stop removing it. The nurse was in a dilemma not knowing what to do and who to listen to. This forced the hospital top disagree with the parents decision and later filed a case in court.
The principle of autonomy could be violated in this case if the nurse had done as by the parents’ wishes. Autonomy is essentially independence, the ability of an individual to choose his or her own actions (Fowler & American Nurses Association, 2008). According to this principle patients have a right both morally and legally to decide what type of treatment should be offered to them. The patient’s decision should be upheld and respected by all those involved in attending to the patient (Milton, 2003). Violating an ethical principle is a civil wrong.
The self-determination act could be violated if the nurse acted according to the demands of the family. The law provides that the parents are part of the patients family and that they have a right to call off the treatment or a do not resuscitate order for their patient (Bandman & Bandman, 2002). The 1990 act of self-determination provides that all the paternal relatives of the patient have a right to determine the treatment of their patient. The law further says that in case of life determination and maintenance the patient has a last decision on the same if at they can speak. Violation of this act is a criminal act punishable before a court of law.
When presented with the same case as above the nurse could choose to do what any reasonable and profession al person in the nursing field could do when faced with such a situation. The beneficence principle is based on the provision of bringing good to the patient (Purtilo, 2005). Every day of work is a day of nursing reflection; every day that a nurse is working is making decisions that are very crucial to the life of the patient (Furlong, 2007). In consideration to the beneficence principle, I could not remove the ventilator and instead ask the hospital administration to take the case to a court of law.
Another similar case to this was the case of Terri as described by Bratcher, Farrel, Stevens, & Wanderground (2007). The case was about the right to remove a feeding tube from the patient who had been using the tube for feeding for so long. Terri suffered a cardiac arrest in 1990. Her husband took her to hospital to seek for medical attention with the hope that Terri could recover. As time went by, the husband lost hope that the patient could not recover band therefore sought the ethical committee to take off the tubes. Terri’s parents refused that the tube should not be taken away from their only daughter. This brought a very serious battle between the two families. When they presented the case before a court of law, the court ruled in favor of Terri’s husband. However, the parents using their political power influence they did not heed to the court order and instead asked to pay the costs of the hospital as long as their daughter is arrive. First in this case, the court arrived at the decision after proving beyond reasonable doubt that the patient could not survive any longer on the tube after they were presented the facts about the situation of the patient by the nurse in charge of Terri.
Legal reasoning is the kind of thinking that comes from law, which consists mainly in legislation and the courts decisions (Rantmeester, 2013). The law is produced in relationships among the federal and state government and the governed. Law is very flexible and is subject to challenge depending on individual’s way of reasoning. Legal reasons suggest what is to be done from a legal point of view and suggest legal consequences for not doing what there are legal reasons to do (Lir & BJumtschkc, 2001). Ethical reasoning on the other hand emphasizes on the obligations, relationships, virtues, duties, responsibilities and personal character. Ethical reasoning focuses on practices of deliberation, argumentation and justification in which individuals try to make their moral lives in their line of professional communities. Ethical reasoning suggests what should be done and why it is right to do so. Whereas legal reasoning is a process of a legal expert giving advice to non experts, ethical reasoning is a process of reasoning among several different parties who are acting in the best interest of their loved one or patient, or who cares deeply about the rights of others (Rantmeester, 2013).
Savage & Milton (1989) came up with a decision making model for nurses. This framework is arranged into 9 steps that a nurse can follow in making a decision on the action to take when in a dilemma. The first steps require the nurse to use their professional and reflection practice in order to identify the health problem that the patient is suffering from. Once the health professional has discovered the health problem of the patient then they should identify the ethical problem or the ethical principle that is in the dilemma. Step there the practitioner should identify all the stakeholders who are involved in the decision. The fourth step the practitioner should identify their role as stated by the duties and responsibilities guidelines. The fifth step is to identify as many alternative solutions as they are available. These decisions should be based on reflective practice and application of past experience and also the use of evidence based practices (Sims, 1994). The sixth step is to consider the long-term and short-term consequences of each alternative solution that the practitioner has identified. The seventh step requires the practitioner to make a decision based on the best considered option. The eight steps is consideration on how the decision fits in with the general philosophy of practice care. The last step requires the practitioner follow the situation until they can see the actual results of the decision and use this information to help in making future decisions.
In the case presented in this paper, I could recommend the following when the advanced nursing practitioners are faced with a similar case. Never bring personal sympathy and feelings when dealing with such a case. When one brings their personal emotions and feelings in such a case, they may not act according to the will of the patients paternal relatives of family. This will b e very contrary to the patients will and families will. Secondly, the practitioner should listen to the two parties before they act, before removing any measures to resuscitate the patient’s life sustaining services first find out whether the patient is able to speak and think on their behalf. Thirdly, never act against the patients will. If at all the case is in such a way that the parents or relatives of the patient have refused the decision of the patient then take the matter to court for determination on the issue.
The ethical legal dilemma of the advanced nursing practice is basically solved through the application of the code of ethics principle and the law. Respect to the ethics of practice and the law will help one deal with the ethical legal dilemma effectively. Therefore, there is a dire need for masterly of the law in relation to nursing practice and the masterly and implementation of the code of ethics.
References
Bandman, E. & Bandman, B. (2002). Nursing Ethics Through the Life Span. (4th ed.). Upper Saddle River, NJ: Prentice Hall
Bratcher, R., Farrel, J., Stevens, K., & Wanderground, K. (2007). Ethical and Legal issues. Jones &Barllet Learning, chapter 25; 387-400.
Fowler, M. D. M., & American Nurses Association. (2008). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association
Furlong, E. (2007). Right or wrong: legal and ethical issues and decision-making. Jones and Bartlett Publishers, chapter 3: 29-45
Karen Ann Quinlan Memorial Foundation, (2010). Karen Ann Quinlan: she changed the way people looked at life and death. Retrieved September, 27, 2014. From www.karenannquinlanhospice.org/history.htm
Lir&J. Jumtschkc,(2001). Ethical Dilemmas and the Nurse Practitioner in the NICU. Neonatal Network, 20 (1): 33-38
McLean, D. J., & Yoder, D. G. (2005). Issues in recreation and leisure: Ethical decision making. Champaign,Ill:HumanKinetics
Milton, C. (2003). The American Nurse Association Code of Ethics: a reflection on the Ethics of Respect and Human Dignity With Nurse as Expert. Nurse Science Quarterly, 16(4), 301-304
Purtilo, R.(2005). Ethical dimensions in the health professional (4th ed.). Philadelphia: Elsevier Saunders.
Rantmeester, C. (2013 ). What’s legal? What’s moral? What’s the difference? A guide for teaching residents. American journal of bioethics, volume 6(4). Creighton University Medical Center.
Savage TA, and Milton CB. 1989. Ethical decision-making models for nurses. Chart 86(4): 2-5.
Sims, R. R. (1994). Ethics and organizational decision making: A call for renewal. Westport, Conn., u.a: Quorum Books.
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This is a essay question to be written for entry into a nursing school…
SAMPLE ANSWER
Patient Care Influence on Career and Decision to Continue Education
In life, it is important to set goals and have ambitions. These goals and visions act as a catalyst and a sense of direction towards attainment of one’s ambitions. I have an ambition of becoming the best healthcare provider in the years to come, attested to by my desire and determination to attain higher levels of education in this field. My background and patient care have motivated me to continue with my education.
I am highly esteemed that in the near future, I will be joining your college to pursue higher education in nursing. It has been long since I made the decision of pursuing a career in nursing. I always wanted to help people overcome their health problems and restore them to their normal life. This dream was born in me when I was in my adolescent. I experienced a sad episode when my grandparent lost his life because of negligence by the health practitioners. My grandparent was one of my best and closest friends. This incidence hurt me and I developed an interest in the field hoping that I will one day come to help many people that go through what I went. I always wanted to be the person that will help provide the best patient care to patients regardless of their age, status in society, race or even religion. I did not know what it would take me to become the person I wanted to be at this early stage, however as I continued with my studies, I sort advice from the teachers who advised me on the areas that I was required to concentrate to make my dream a reality.
The education I gained enabled me to serve in various health facilities and I appreciate the opportunities as I have managed to acquire enough experience. Working with different calibers of patients is not a simple task. Patients have different needs and as a care provider, I have done my best to ensure that they receive the best quality care to my best of my knowledge. Some of the patients are cooperative while others are demanding and do not understand. However, I am thankful that I managed to do my best to ensure that they recover well. These opportunities have enabled to learn a lot. I have managed to understand the psychology of the patients and the best way to respond to them. Patient requires motivation, caring, and love. This makes them feel a sense of belong and they as well feel encouraged. Furthermore, patients require constant interactions and assessment. This ensures that, their health is closely monitored and in case of an emergency, they receive immediate care to manage their ailments. I have also gained more skills on socialization and importance of respect when working with other people.
Regardless of these, I always felt that I could do better to enhance patience care. I was, therefore, motivated to pursue further education to acquire more skills and knowledge in the area to improve my services. Education is one of the platforms that would help me understand the patient care in detail, hence, impact on my service delivery. I want to be the best decision maker and problem solver in healthcare to improve the lives of the patients. I also want to acquire more skills to improve on nursing research. Nursing has grown of age and it requires application of evidence-based research to render superb services (Fawcett & McCulloch, 2014). Therefore, to me, I want to build on my experience to improve my skills and knowledge to render high quality care. I want to be able to deal with challenges in patient care in a professional way to enhance quality care.
I will appreciate if this opportunity to further my studies in your college is accepted. As indicated earlier, I am a dedicated and a determined individual who has high ambitions. The institution is the best for me in imparting in me requisite skills to enable me achieve my goals.
Legal Aspects in Nursing Order Instructions: This paper is part of some other papers that you guys have already written for me such as 111549. Hear the writer will be working on building a case and so he will have to discuss some legal steps to hear.
Legal Aspects in Nursing
The writer should first in one paragraph elaborate on the legal components of this case below which is “informed consent and risk versus benefit” and then he will go ahead and use the point listed below as subheadings and them respond to them in detail citing court cases and using peer review articles to supports the facts.
In one paragraph discuss the legal components of this case below which is “informed consent and risk versus benefit”. Also Base on the Case Study 1: Malpractice Action brought by Yolanda Pinnelas, construct a 2 page paper about the legal constructs involved in the cases. Support the paper with peer-reviewed articles and case law where applicable. You may have an appendix that has samples of documents that support your positions or expands on the facts of the case. The paper should discuss the following issues. Discuss the following 3 points using each point as a subheading for the paper.
– Standards of care
– Duty, breach, damages and proximate cause
– Preparation for the court of the parties
Case Study 1: Malpractice Action Brought by Yolanda Pinnelas People Involved in Case: Yolanda Pinnelas-patient Betty DePalma, RN, MS-nursing supervisor Elizabeth Adelman, RN, recovery room nurse William Brady, M.D., plastic surgeon Mary Jones, RN-IV insertion Carol Price, LPN Jeffery Chambers, RN-staff nurse Patricia Peters, PharmD-pharmacy Diana Smith, RN Susan Post, JD-Risk Manager Amy Green-Quality Assurance Michael Parks, RN, MS, CNS-Education coordinator SAFE-INFUSE-pump Brand X infusion pump Caring Memorial Hospital
Facts: The patient, Yolanda Pinellas is a 21-year-old female admitted to Caring Memorial Hospital for chemotherapy. Caring Memorial is a hospital in Upstate New York. Yolanda was a student at Ithaca College and studying to be a music conductor. Yolanda was diagnosed with anal cancer and was to receive Mitomycin for her chemotherapy. Mary Jones, RN inserted the IV on the day shift around 1300, and the patient, Yolanda, was to have Mitomycin administered through the IV. An infusion machine was used for the delivery. The Mitomycin was hung by Jeffrey Chambers, RN and he was assigned to Yolanda. The unit had several very sick patients and was short staffed. Jeffery had worked a double shift the day before and had to double back to cover the evening shift. He was able to go home between shift and had about 6 hours of sleep before returning. The pharmacy was late in delivering the drug so it was not hung until the evening shift. Patricia Peters, PharmD brought the chemotherapy to the unit. On the evening shift, Carol Price, LPN heard the infusion pump beep several times. She had ignored it as she thought someone else was caring for the patient. Diana Smith, RN was also working the shift and had heard the pump beep several times. She mentioned it to Jeffery. She did not go into the room until about forty-five minutes later. The patient testified that a nurse came in and pressed some buttons and the pump stopped beeping. She was groggy and not sure who the nurse was or what was done. Diana Smith responded to the patient’s call bell and found the IV had dislodged for the patient’s vein. There was no evidence that the Mitomycin had gone into the patient’s tissue. Diana immediately stopped the IV, notified the physician, and provided care to the hand. The documentation in the medical record indicates that there was an infiltration to the IV. The hospital was testing a new IV Infusion pump called SAFE-INFUSE. The supervisory nurse was Betty DePalma, RN. Betty took the pump off the unit. No one made note of the pump’s serial number as there were 6 in the hospital being used. There was also another brand of pumps being used in the hospital. It was called Brand X infusion pump. Betty did not note the name of the pump or serial number. The pump was not isolated or sent to maintenance and eventually the hospital decided not to use SAFE-INFUSE so the loaners were sent back to the company. Betty and Dr. William Brady are the only ones that carry malpractice insurance. The hospital also has malpractice insurance. Two weeks after the event, the patient developed necrosis of the hand and required multiple surgical procedures, skin grafting, and reconstruction. She had permanent loss of function and deformity in her third, fourth, and fifth fingers. The Claimant is alleging that, because of this, she is no longer able to perform as a conductor, for which she was studying. During the procedure for the skin grafting, the plastic surgeon, Dr. William Brady, used a dermatome that resulted in uneven harvesting of tissue and further scarring in the patient’s thigh area where the skin was harvested. The Risk Manger is Susan Post, J.D. who works in collaboration with the Quality Assurance director Amy Green. Amy had noted when doing chart reviews over the last three months prior to this incident that there were issues of short staffing and that many nurses were working double shifts, evenings and nights then coming back and working the evening shift. She was in the process of collecting data from the different units on this observation. She also noted a pattern of using float nurses to several units. Prior to this incident the clinical nurse specialist, Michael Parks, RN, MS, CNS, was consulting with Susan Post and Amy Green about the status of staff education on this unit and what types of resources and training was needed.
Legal Aspects in Nursing Sample Answer
Legal Aspects
Introduction
In their practice, nurses encounter various ethical and legal aspects that may implicate them in legal tussles. When new treatments are used, issues of informed consent to treatment and balancing between benefits and risks tend to be challenge in resolving them. Understanding aspects concerning informed consent is, therefore, important as patients are assisted on how to ask questions and to understand the information they need to fully and truly be aware of the treatment choices available to them (Moffett & Moore, 2011). Similarly, assessing aspects to do with benefits and risks of any experiment treatment option is critical for long term health of the patients. This paper, therefore, deliberates on the various aspects relating to informed consent and risks versus benefits as well as legal constructs involved. The paper adopts a case study on Malpractice action brought by Yolanda Pinellas.
Standard of care
Under the law, any individual under the duty of care is required to have a degree of prudence and caution when undertaking their duties. Nurses and any clinical officers are under duty of care to provide medical treatment based on the scientific evidence and to collaborate with other medics involved in the treatment of any health condition (Moffett & Moore, 2011). Practitioners have a duty to inform the patient about any fiduciary interests or material risks of the physician that may make the patient to reconsider the procedure (Moses & Feld, 2008). Failure to do this means that the physicians will be liable for any risks that the client or patient may suffer. In the case of Yolanda’s, the medical practitioners attending to her failed to inform her about the dangers inherent in using Mitomycin in her chemotherapy. Furthermore, the medical officer failed to inform her that the hospital was testing a new IV infusion pump by the name SAFE-INFUSE. This was, therefore, a mistake on the side of the medics and the ordeals and sufferings that Yolanda went through were as a result of lack of informed consent. This caused her to be exposed to the risks. The medics are, therefore, liable for breaching the standard of duty.
Duty, breach, damages and proximate cause
Duty, which is the obligation of one person to another, is something that unifies a society. In medical field, the nurses have a duty to provide quality care to the patients’ failure to which it amounts to negligence (Owen, 2007). Breach is another element of negligence and misconduct such as omission and improper act towards another person. Proximate cause ensures that there is logical act and fairness in judgment. A defendant in proximate cause is liable for failing to foresee a problem or harm in his or her course (Find Law, 2014). Damage, on the other hand, is when the defendant fails to take necessary precautions leading to harm on the patient or plaintiff. In this case, of Yolanda, it is evident that there was breach of duty, damage and proximate course. The medical practitioners had a duty to ensure that Yolanda is well treated and always check the progress of the medication something that the hospital failed. They did not mind checking the beeping sound; they also failed to record the serial number of the pump. They knew that they were carrying out an experiment of the safe-infuse PUMP but went ahead to use it on Yolanda. They also knew that the nurses were not enough and lacked enough training and went ahead to admit the patient. Therefore, they could have avoided all these mistakes and taken their responsibility to provide quality care these problems could not have occurred.
Preparation for court of the parties
Yolanda has a right to take the matter in the court to be compensated for these breaches. The medical practitioners and the hospital breached his rights to informed consent on the risks and benefits of the treatment. They failed to inform her of any risks and benefits about the treatment. This information could have enabled her to make an informed decision of whether to attend the procedure at the facility or not. She needs to note main points and issues in the case, prepare a detailed outline of important aspects that the judge will need to know, and then back it up (International Court of Justice, (2014). She should also get a good witness to provide factual evidence against the medics and the hospital (Family law, 2012). When presenting the facts, she should stick to the facts she prepared to ensure that she explains clearly to win the case.
Take note that this paper comes in two sections and each section is suppose to have its reference list at the end of that section. For section A, you will have to paste the link to the article used for the critique, and also any references used in the paper. and for section you will provide 4 minimum references from credible pear review sources. remember to follow proper rules on how to critique an article.
SECTION A (1 page)
Health Reform Shaped by Nursing Research
Critique a reliable internet source that describes a health reform-related public policy that was shaped or influenced by the application of nursing research in the U.S and should not be more than 5 years old. Also post the link to the internet source at the end of your paper.
Paste the link at the end of this section, which will directly link the reader to the article use for the critique.
SECTION B (1 page) ( 4 references minimum)
For this section, refer to 111521 and 111489 to better understand this section as those sections will have some reasonable information to the writer a better understanding of the amendment we are working on.
Compare two ethical principles and three measurable goals that would support passage by Congress of your amendment hear below.
The public policy problem is that section 2713 requires organizations to provide their workers with birth control as part of their insurance coverage. The public policy question is: should the federal government mandate that organizations can choose whether or not to provide contraceptive services to employees as part of their insurance coverage? The public policy resolution is an amendment to section 2713(a) (4) of PL 111-148 that would say: organizations – both for-profit and non-profit organizations – have the option of either offering their employees birth control as part of their insurance coverage or not to offer contraceptive services (Cauchi, 2014).
The reforms in the health sector have been researched by various researchers in the nursing field. One of the highly recognized researchers that came up with a series of reforms in the health sector is the IOM report as by the committee of Robert Wood Foundation. Their research methodology was very efficient given the breadth of the area of study. Survey was used in observing the practitioners in the field and the use of questionnaires in collecting the data was very recommendable in their study.
The findings came were analyzed and the researchers recommended the changes that were to be effected in the field so that the field could be running effectively and smoothly. The first finding according to the researchers is that nurses in the U.S do not practice their nursing fully due to a variety of historical, regulatory and policy barriers which have limited the ability and scope of practice of the nurses (IOM, 2011, chapter 3). In regard to this barrier the researchers recommended that there is need for standardization of policies of practice by the nurses in all over the states of America. Once the rules have been standardized then the staff turnover will be reduced and any nurse can work at any hospital within the United States (Montgomery & Keegan, 2013, p. 59). All nurses should be allowed fully to the degree of their knowledge without limitations. Secondly the researchers found out that the education levels of the nurses were never advanced and therefore recommended that nurses should achieve higher education training through an improved education system that promotes seamless academic progression (IOM, 2011, chapter 4). Thirdly they found out that the nurses were not cooperating fully with the physicians. They recommended that nurses should be full partners with physicians and other health professionals in redesigning the healthcare system in United States (IOM, 2011, chapter 5). Laureate &Grey (2010, p.4) refer to this as the change in the practice model for the better achievement of results and effective flow of work in the working environment. Fourthly, the researchers’ findings revealed a lapse in the patient management of information. The researchers recommended effective workforce planning and policy making require better data collection and an improved information structure (IOM, 2011, chapter 6).
Reference
IOM (Institute of Medicine). 2011. The Future of Nursing: Leading Change, Advancing Health.
Washington, DC: The National Academies Press. Retrieved from
One of the ethical principles is the principle of autonomy. This principle stands for independence and the ability to be self directed. According to this principle everyone has a right to self-determination and arte entitled to decide what happens to the life. Adults have the ability to think and capacity to consent to or refuse the treatment. This amendment will provide that everyone’s wishes are respected even if they do not agree to them. Mandating that the insurance companies cover the contraceptives, sterilizations and drugs or devices that are meant to induce the expulsion of human embryo would violate the consciences of many Americans which shall be against the promises made by president Obama (Centre for Medicare and Medical Services, 2011).
The other ethical principle is justice to all. This requires that all clients be treated equally irrespective of the origin, race or occupation. This principle stands to equalize those who are in the job market and those who are not. The bill is unfair because it concentrates on providing the contraceptives to those people who are in working in organizations or companies. Those who work in the private sector or who do not work will have not been affected by this bill. According to the National Catholic Bioethics Center (2010) pregnancy is not a disease and therefore contraceptives, sterilizations and abortifications should not be included as mandated preventive services. Therefore amending t he bill will ensure that both the workers and those who are not working are all treated equally.
One of the measurable goals is public education in regard to the use of the contraceptives their side effects and other better birth control methods. Another measurable goal is workers engagement in understanding the need for the amendment. The amendment should be expressed fully to the workers explaining to them why we need the amendments. Once they have understood then the need for the amendment then they can be the first ones to campaign for the amendment. The third measurable goal is engage organizations and groups that stand against the bill. for instance the religious group[s such as the Catholics are on record for opposing this bill, therefore engaging them in the amendment process will give more support to the amendment. The amendment should have the support of as many people as possible and one of the ways is to use such organizations.
