Monthly Archives: May 2023

HA3300D – Healthcare Policy and Ethics

Discussion 07: Tuskegee Experiment

In Week 1, you learned about the 1932-1972 Tuskegee Experiment, in which 399 black men were subject to medical research by the U.S. Public Health Services without their consent. Use what you’ve learned about this experiment, and your textbook, to answer these questions:

.Researchers used utilitarian ethics to support their actions. Do their actions make sense when viewed from a utilitarian perspective? Why or why not?

.Explain why and how Kantian ethics might have changed the researchers’ behavior.

.Propose a second ethical theory that might have saved these men from abuse.

Your initial post should be a minimum of 8 – 10 sentences and include an APA-style references list to ensure full credit. Respond to two other students in a minimum of 4 – 6 sentences, being sure to cite course material in APA format in your work.

As a nurse in a healthcare organization, it has become evident that patient outcome data have been consistently declining in some patient care settings. Some of the outcomes under inspection include patient Hospital acquired pressure injury (HAPI), (4 % increase in the last 6 months) .

You have investigated contributing factors to the declining outcomes and participated with a team approach to developing an evidence-based practice project. After reading this article Aiken Article titled “The effects of nurse staffing and nurse education on patent deaths in hospital with different nurse work environment”, PICO: In a healthcare setting, what is the effect of nursing staffing in reducing patient outcomes in HAPI cases? Was developed.

In this assignment, you will complete this evidence-based practice (EBP) proposal using the categories below

• Conceptual and theoretical frameworks (an example of a conceptual model for an EBP project would be the Iowa Model). An example of a theoretical framework (this will support the phenomenon of interest) and if caring was an integral part of the project then Watson’s Model of caring might be a consideration). If a theoretical framework is selected, be sure that the purpose of the framework is discussed in detail, and explain specifically how the framework supports the evidence-based practice project. Do not select a theoretical framework just for the sake of selecting one.
• Methodology
• Evaluation and Analysis.
• Significance and/or implications for practice
• References
• Appendices

Mainpost

Case study:

JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has a hx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter.”

Discussion: Diversity and Health Assessments

Introduction

            Health care providers should exhibit knowledge of population diversity and treat all patients with respect regardless of their culture and belief system. This is essential in understanding patient’s lifestyle, and behavior which may affect their health care. Accepting patient’s culture in a nonjudgmental manner creates a unique relationship between the patient and the healthcare provider. Therefore, APRN’s should be cognizant of patient’s culture, beliefs, lifestyle, and socioeconomic status as it relates to healthcare. A culturally competent healthcare provider accustoms his/herself to the exclusive needs of patients with cultures that are different from his or her own. Being accustomed to the belief’s and values of a patient lays the foundation for a trusting patient-provider relationship (Ball et al., 2019).

Socioeconomic, Spiritual, Lifestyle, and Cultural Factors Associated with the Patient

            The case study presents an 86-year-old Asian male that is physically and financially dependent on his daughter who is a single mother with little money to care for the patient’s healthcare needs.  Understanding the Asian culture is relevant to providing care to this elderly patient.  I will verify patient’s preferred language, ask about patient’s preference with a healthcare provider regarding race or ethnicity, gender, and age. Ensuring respect for this patient despite his financial and physical dependency will encourage a trusting relationship between the patient and the health care provider. Asian culture is known to teach respect for parents and family is a priority over self. Additionally, in Asian culture adult children are required to make financial, physical, and social sacrifices for their parents that are aging (Miyawaki, 2015). As a healthcare provider, I will welcome this patient, show respect by avoiding eye contact as some Asian countries consider making eye contact as rude. Maintaining eye contact is not done with individuals of East Asian cultural backgrounds. Also, the Japanese culture, teaches against maintaining   eye contact with others as it is believed to disrespectful (Uono & Hietanen, 2015).

            I will make the patient understand that I am familiar with culture of adult children caring for their aged parents. I will explain to the patient that he should not consider himself a burden to his daughter as the daughter is maintaining the requirement of their culture. This will encourage a relaxing environment that will enable the patient to feel accepted and ready to relate with the health care provider. Respect for the patient’s spiritual and religious belief is also vital. The patient should be asked about any spiritual belief that may affect his healthcare when sick or dying. Also, the APRN should inquire about spiritual or religious groups that the patient may belong that could be supportive in providing some assistance to his healthcare. Spirituality and faith help Asian-Americans manage the turmoil of adapting to a new country, by providing a safe environment where immigrants can socialize and be of assistance to one another (Lee & Eun-Kyoung, 2017).

Sensitive Issues

            I will inquire if the patient is compliant with taking his medications as prescribed and access for the use of over the counter, herbal, or traditional medications. This is especially important as the patient takes lisinopril 10mg QD, prilosec 20mg QD, B12 injections monthly, and cipro 100mg QD. To avoid drug interactions, it is important to ask about additional medications that the patient may be taking. Examples of Chinese herbal medicine include astragalus, ginger, licorice, panax ginseng, and schizandra. Traditional medicine is used across Asian societies for daily health maintenance, and treatment of certain medical conditions. Also, in China, Japan, and Korea, traditional medicine has become almost or equivalent to conventional medicine (Mu et al., 2020).

            Furthermore, the functionality of the patient will be accessed to determine the level of dependency on the daughter. Activities of daily living like feeding, bathing, wearing clothes, grooming will be accessed. Asking about financial assistance with purchasing medications, proper feeding and housing is vital to ensure the overall needs of the patient are catered for. Due to socioeconomic status and financial constraint of the patient and his caregiver (daughter), I will recommend the help of a social worker to provide the services of a home health nurse and home health nursing assistant. This will ensure that patients’ needs are met, and the patient takes his medications in a timely manner thereby relieving the responsibility on the patient’s daughter.  In addition, the services of physical and occupational therapy will be sorted to help strengthen any weak muscles or extremities to ensure some dependence with physical activities. I will explain to the patient that my recommendation for a social worker is to help him meet his daily needs and not to disrespect him. This will maintain patients pride and ego.

Targeted questions to assess health risks

1. Do you have health insurance, or do you pay out of pocket for your medications?
2. Do you take your medications as prescribed?
3. Do you check your blood pressure at home?
4. Would you want to receive help with feeding, clothing, bathing, or moving around your home?
5. Do you experience any pain or difficulty in urinating?
6. In the las two weeks have you experienced sleep disturbances, decreased appetite, feeling of sadness, hopelessness, or guilt, thoughts of committing suicide and poor concentration.
7. In what way do you think you are a burden to your daughter?
8. How often do you eat and what type of food do you eat?
9. Do you take any herbal, traditional or over the counter medications?

            The questions above are used to access the patient’s access to his medications and if he is compliant with taking his medications. The need to access for patient’s knowledge about checking his blood pressure due to his history of hypertension. Accessing patient’s willingness to receive outside resources like home health assistance is essential to providing the needed healthcare. Question about urinating accesses the history of prostatitis. Accessing for depression in the elderly is crucial to determine the patient’s mental state. Elderly Asian immigrants in the US are at risk of depression (Seungah & Eun-Kyoung, 2017). Evaluating the patients feeding habits and if the patient takes any medication outside his prescribed medications determines the patient’s health risk.

References

Ball, J., Dains, J., Flynn, J., Solomon, B., Stewart, R. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Lee, R., Eun-Kyoung, O. (2017). Faith, spirituality, and values among Asian-American older adults: An exploratory factor analysis of the multidimensional measures of religion and spirituality. Mental Health, Religion & Culture, 19 (8), 920–931.    doi:10.1080/13674676.2017.1290593

Miyawaki, C. (2015). A review of ethnicity, culture, and acculturation among Asian caregivers of older adults. SAGE Journals. https://doi.org/10.1177/2158244014566365

 https://journals.sagepub.com/doi/full/10.1177/2158244014566365

Ryu, S., & Lee, O. E.-K. (2016). Faith, spirituality, and values among Asian-American older adults: An exploratory factor analysis of the multidimensional measures of religion and spirituality. Mental Health, Religion & Culture, 19 (8), 920-931. https://doi- org.ezp.waldenulibrary.org/10.1080/13674676.2017.1290593

Uono, S., Hietanen, J. (2015). Eye contact perception in the West and East: A cross-cultural study. Plus One. https://doi.org/10.1371/journal.pone.0118094

Xin, B., Mu, S., Tan, T., Yeung, A., Gu, D., Feng, Q. (2020).  Belief in and use of traditional Chinese medicine in Shanghai older adults: A cross-sectional study. BMC Complement Medicine and Therapies 20 (128). https://doi.org/10.1186/s12906-020-02910-x. https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-020-  02910-x

Directions: End of Life
• An 80, year old woman was admitted to the hospital with pneumonia and weakness. She lives alone. Her children are supportive and help her around the house but do not live with her. Her husband of 51 years died within the last 6 months. She is grieving the loss, but she is relieved and feels guilty as he was an abusive spouse.

Question:
• How do you assist her in coping with her loss?

Look for 2 different articles, a qualitative and a quantitative research and compare them.

Critique quality of the literature reviews conducted for both articles.

Identify and discuss the research questions, sampling and sampling sizes, research designs (qualitative vs. quantitative), hypothesis, data collection methods, and research findings.

Discuss the credibility of the sources and the research/researchers findings.

400-word minimum/550-word maximum without the references (2 pages).

Minimum of 3 references in APA format, must have been published within last 3-5 years.

Responses to at least two classmates’ postings should be approximately 200 words and should be thoughtful, substantial, polite and more extensive than a simple “well done” phrase or “I agree.” Consider points of agreement, disagreement, assumptions, and value judgments. You will be able to respond to others after you submit your initial post. Your grade will be affected by how thoughtful your replies and initial questions are answered.

2 pages of Define and describe the disease/condition, symptoms, causes, treatment, living with the disease/condition.

Mr. B is a 75-year-old, white, male

Source: Self, reliable source

Subjective:

Chief complaint: “I feel winded.”  

HPI:  Patient states he has been feeling short of breath with exertion for years now. However, over the past year he feels he has been worsening. He decided to come in today as he experienced shortness of breath mowing his lawn yesterday and had to take two breaks. He has a cough, generally productive. He denies any chills or fever. He denies any chest pain or lower extremity swelling. He denies any nausea or vomiting. He has not taken anything OTC for his symptoms.

Allergies: NKA

Current Mediations:

Lisinopril, 20 mg, daily

Propranolol ER, 120 mg, daily

Simvastatin, 40 mg, daily

Aspirin, 81 mg, daily

Tamsulosin, 0.4 mg, daily

Sertraline, 100 mg, daily

Omeprazole, 20 mg, daily

Metformin, 1000 mg, BID

Glimepiride, 4 mg, daily

Insulin glargine, 10 units, nightly                                                                                                                      

Pertinent History: Hypertension, hyperlipidemia, diabetes mellitus, benign prostatic hyperplasia, anxiety, gastritis, obesity, nicotine dependence

Health Maintenance. Immunizations: Immunizations up to date, to include PPSV-23. He has refused recommended yearly low dose CT screens (candidate given at least 30 pack-year-smoking history).

Family History:

            Father – Congestive heart failure, hypertension, hyperlipidemia (deceased age 81)

            Mother – atrial fibrillation (deceased age 79)

Social History: Patient lives with his wife. He smokes 1ppd (40 pack year history). He drinks “a beer or two a day” and denies drug use.

ROS: Incorporated into HPI

Objective:

VS – BP: 118/68, HR: 86, RR: 16, Temp 97.6, oxygenation 100%, weight: 340 lbs, height: 64 inches.

Mr. B is alert, awake, oriented x 3.  Patient is clean and dressed appropriate for age.

Cardiac: No cardiomegaly or thrills; regular rate and rhythm, no murmur or gallop. No peripheral edema or jugular vein distention

Respiratory: Clear to auscultation, but decreased breath sounds

Chest x-ray shows no consolidation or masses

ECG shows sinus rhythm

Spirometry shows FEV1/FVC < 0.7 and FEV1 of 65% predicted

Assessment:

Diagnosis: Moderate chronic obstructive pulmonary disorder, ICD-10: J44.9

Please answer the following:

1. Utilizing the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines mentioned in your lecture, what is your prescribed treatment plan (include specific dosage, frequency)? Why did you choose this treatment plan? In your answer, please describe, briefly, the pharmacodynamics (1 point) and pharmacokinetics (1 point) of your treatment choice and how they influenced your choice. Please describe how the patient comorbidities influenced your choice as well (1 point).  Are there any medical interactions to your choice (1 point)? 
2. Document the education you would provide for this patient, specific to the prescribed medication(s). Please include information pertinent to the patient (2 points) and common potential adverse effects for each prescribed medication (2 points)

 Goal:

Identify the process for decision making regarding technology. Discuss nursing role in identifying appropriate technology for practice.

Your paper should include the following:

1. One technology application used in health care to facilitate decision making.
2. The application’s impact on quality of decision making.
3. The process for selecting and implementing the application.
4. The costs associated with the application.
5. Nurses’ role(s) in selecting and evaluating the application.

Your assignment will be graded according to the grading rubric.

Final Essay/Paper RubricCriteriaRatingsPoints

Identification of Main Issues/Problems

10 points
Distinguished

Identify and demonstrate a sophisticated understanding of the issues/problems.

8 points
Excellent

Identifies and demonstrate an accomplished understanding of most of issues/problems.

6 points
Fair

Identifies and demonstrate an acceptable understanding of most of issues/problems.

4 points
Poor

Identifies and demonstrate an unacceptable understanding of most of issues/problems.

10 points

Analysis and Evaluation of Issues/Problems

10 points
Distinguished

Presents an insightful, thorough analysis and evaluation of issues/problems.

8 points
Excellent

Presents a thorough analysis and evaluation of most of the issues/problems.

6 points
Fair

Presents a superficial or incomplete analysis and evaluation of issues/problems.

4 points
Poor

Presents unacceptable analysis and evaluation of issues/problems.

10 points

Demonstrates a Conceptual Understanding

10 points
Distinguished

Provides a thorough, competent and interpretive responses to all issues/problems, and shows a high level of conceptual understanding.

8 points
Excellent

Provides a competent and interpretive responses to all issues/problems, and shows a moderate level of conceptual understanding.

6 points
Fair

Provides a competent responses to all issues/problems, but lacks interpretation and a moderate level of conceptual understanding.

4 points
Poor

Provides an unacceptable response to all issues/problems, and lacks interpretation and a moderate level of conceptual understanding.

10 points

Use of Citations to Course Readings and Additional Research/Literature

10 points
Distinguished

Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing.

8 points
Excellent

Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.

6 points
Fair

Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.

4 points
Poor

Ineffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing.

10 points

Writing Mechanics and APA Formatting Guidelines

10 points
Distinguished

Demonstrate a high level of clarity, precision, and attention to detail. APA style is correct and writing is free of grammar and spelling errors.

8 points
Excellent

Demonstrate a high level of clarity. APA style and writing mechanics need more precision and attention to detail.

6 points
Fair

Demonstrate a moderate level of clarity. APA style and writing mechanics need more precision and attention to detail.

4 points
Poor

Demonstrates issues in writing and communicating clearly. APA style and writing mechanics need serious attention.

10 points

Research paper on Niurka 300 words minimum APA format. please use sources within the las 5 years.