ethical dilemmas.

Working in an emergency room gives rise to ethical dilemmas. Due to time restraints and the patient’s cognitive impairment and lack of medical history, complications can and do occur. The nurse has very little time to get detailed patient information. He or she must make a quick assessment and take action based on hospital protocol. The organized chaos of the emergency room presents unique ethical challenge, which is why nurses are required to have knowledge of ethical concepts and principles.Create a 15-minute oral presentation (3–4 pages) that examines the moral and ethical issues related to triaging patients in an emergency room.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

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Competency 1: Explain the effect of health care policies, legislation, and legal issues on health care delivery and patient outcomes.
Explain the health care policies that can affect emergency care.
Recommend evidence-based decision-making strategies nurses can use during triage.
Competency 3: Apply professional nursing ethical standards and principles to the decision-making process.
Describe the moral and ethical challenges nurses can face when following hospital policies and protocols.
Explain how health care disparities impact treatment decisions.
Competency 4: Communicate in a manner that is consistent with expectations of nursing professionals.
Write content clearly and logically, with correct use of grammar, punctuation, and mechanics.
Correctly format citations and references using APA style.
To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community.

How does a triage nurse decide which patient gets seen first?
How does health disparity affect the triage nurse’s decision making?
What ethical and moral issues does the triage nurse take into account when making a decision?
What are triage-level designations?

Association of Critical Care Nurses,

Required Readings

Brooks, P., Spillane, J.J., Dick, K., & Stuart-Shor, E. (2014). Developing a strategy to identify and treat older patients with postoperative delirium. AORN Journal, 99(2), 256-276. (see attached file).

Jarden, R.J. & Sutton, L.J. (2014). A practice change initiative to improve the provision of enteral nutrition to intensive care patients. British Association of Critical Care Nurses, 20(5), 242-254.

McCluskey, A. & Middleton, S. (2010). Delivering an evidence-based outdoor journey intervention to people with stroke: Barriers and enablers experienced by community rehabilitation teams. BMC Health Services Research, 10(18). doi: 10.1186/1472-6962-10-18. Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-10-18. (see attached file).

Murfet, G.O., Allen, P., & Hingston, T.J. (2014). Maternal and neonatal health outcomes following the implementation of an innovative model of nursepractitioner-led care for diabetes in pregnancy. Journal of Advanced Nursing, 70(5), 1150-1163 (see attached file).

PIICOT Question

In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?

P: Adult patients

I: in extended intensive care within an urban acute care facility

I: increased mobilization of the patients

C: minimal mobilization of the patients

O: early transfers of the patients from intensive care

T: 6 months

Patient Safety Initiatives

uality Improvement and Patient Safety Initiatives

The vice president of nursing, Dr. Sasha Mendez, has had a lot of complaints from patients and their families about the difficulties they experience navigating the system at her organization; e.g., going from the E.R. to admissions. Dr. Mendez’s nursing specialty area is psych/mental health. As such, she is very concerned about the stress this is causing the patients.

What are the macro systems that are affecting patient satisfaction at Dr. Mendez’s facility? What micro systems should she also analyze to look at how the patient moves through—from entry, to possible admission, to possible discharge? How do these systems relate? What impacts each system?

The concepts presented in Week 8 serve as a foundation for this week as you continue to look at factors within an organization’s environment that are barriers and facilitators for implementing change. In this Discussion, you examine the macro and micro systems within the organization (of your practicum setting) and identify changes that may need to take place to facilitate quality improvement and achievement of patient safety outcomes.

To prepare:

Reflect on the issue you have been addressing through your EBP Project.
Identify the macro and micro systems that influence the issue. Review the McClusky and Middleton (2010) article for an example of this process (See attached file).
Determine the desired outcomes of resolving the EBP Project issue and how resolving it will improve quality and patient safety. (Note: Next week you will evaluate these outcomes. You may want to view the Week 10 Discussion as you prepare.)
What procedures/processes would need to be modified to achieve the desired outcomes?

Post your PowerPoint presentation

By tomorrow Tuesday 10/23/18, in APA format and include 3 scholarly references from the list of required readings below, develop a 5-slide Microsoft PowerPoint presentation for the business unit team and leadership within the organization, sharing your issue, strategies for resolving the issue, and how it will improve quality and patient safety.

Note: The purpose of the presentation is to persuade the business unit team and leadership to accept your recommendations.

interdisciplinary teams

Details:

The field of nursing has changed over time. In a 750-1,000 word paper, discuss nursing practice today by addressing the following:

Explain how nursing practice has changed over time and how this evolution has changed the scope of practice and the approach to treating the individual.
Compare and contrast the differentiated practice competencies between an associate and baccalaureate education in nursing. Explain how scope of practice changes between an associate and baccalaureate nurse.
Identify a patient care situation and describe how nursing care, or approaches to decision-making, differ between the BSN-prepared nurse and the ADN nurse.
Discuss the significance of applying evidence-based practice to nursing care and explain how the academic preparation of the RN-BSN nurse supports its application.
Discuss how nurses today communicate and collaborate with interdisciplinary teams and how this supports safer and more effective patient outcomes.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.c

Anthony Medical Center’s Labor

Learning from the Past

Considering your analysis of St. Anthony Medical Center’s Labor and Delivery service strengths and opportunities, propose a list of features, advantages, and benefits for the current service offering. With reference to the previous plan, explain your reasoning for the new list.

Response Guidelines

Respond to your fellow learners according to the Faculty Expectations Response Guidelines. Focus on your proposal in relation to that of your colleague: Where do your lists align? Where do they differ? Support your thoughts with your own analysis.

Resources

Discussion Participation Scoring Guide.

[u03d2] Unit 3 Discussion 2 Options Menu: Forum

Competitive Analyses

Review the presentation given by the marketing director in the media piece, Vila Health: Market Analysis. Then construct a competitive analysis focused on social media use for St. Anthony Medical Center’s Labor and Delivery service line versus the two other competitor organizations. Post your document in the discussion space. This completes step three of Kotler’s Marketing Plan format, presented in Health Care Marketing.

Response Guidelines

Review and respond to your fellow learners according to the Faculty Expectations Response Guidelines. Focus your response on a comparison with your own analysis–do you see any emerging patterns? Support your response with reference to your texts and to the information gleaned from St. Anthony Medical Center itself.

Resources

Discussion Participation Scoring Guide.
Vila Health: Market Analysis | Transcript.
DQ 4

High-Level Marketing Objectives
Revisit the vision, mission, values and strategic plan summary for St. Anthony Medical Center. Given the directional strategy, analyze the current versus desired status of the Labor and Delivery service line. Propose conceptual-level marketing objectives, including performance indicators and proposed measurement units for each indicator. Explain your thinking for each objective.

Response Guidelines
Respond to your fellow learners according to the Faculty Expectations Response Guidelines, focusing on the similarities and differences between your two plans. Where do you see the biggest difference? Explain how you think will affect overall outcomes.

Disaster Management

Topic 2: Disaster Management

Contact your local public health department to learn about its role in a local disaster, including the role of the nurses who work there.
I called the ……… county health department and spoke with a Mr. ………… He explained to me that he has a list of local nurses that he sends out an email to in order to ask for assistance when there is a need. Currently he is working out at the panhandle and stated that he does have a few volunteers from here who are helping to wrap things up at some of the shelters from the last hurricane. It’s nice that all the countries that have help available come in and help when there is a need. He said that sometimes they need nurses to help with flu shots and such and so he sends out an email and if you are available you just show up. He asked me if I knew anything about the Medical Reserve Corps (MRC). I had only just read about it in our material this week. As you guys may already know the MRC is a government organization comprised of a large network of volunteers that come together to improve the welfare and safety of a community (HHS, 2016). Mr. ………asked if I was interested in being a part of it.

Would you be a good candidate to serve on a disaster team?
I do believe that I have something to offer the community, we all do. According to the information that Mr. …….. gave me, I have the opportunity to decline when I am needed if I have other obligations. So of course my job and my family come 1st. I did sign up to be part of the e-mailing group and Mr. ……. will be forwarding my information to another colleague in order to set up membership to the MRC.
Would your current employer be flexible in allowing you to participate in a disaster situation?
I am already part of the disaster team for work, so they would take priority. If I were PRN, I am sure they would be accommodating, but I am a full time staff member, and since being part of the MRC is voluntary, they would not be a priority for me at this time.
What is your personal preparedness to face a disaster?
We have a hurricane/disaster box prepared that has everything needed to help sustain us for 1 week. I have lived in FL for so long that I grew up with a family plan and so I carry that with me now that I have my own family. I have only ever evacuated once and having our preparedness box made that process a lot less stressful.

diagnose pyloric stenosis?

Mother states that infant has not had fever or diarrhea
Mother states that infant has had 8 wet diapers in the past 24 hours
Objective Data

Weight 4.8 kg (birth weight 3.5 kg)
Vital signs: T 37.1° C (rectal), P 130, R 30, BP 92/52
Mucous membranes moist, anterior fontanel flat and soft
Awake and alert, lusty cry
Good muscle tone
Olive-sized mass palpated at epigastrium
10. Question 1
What test will be used to diagnose pyloric stenosis?

11. Question 2
What should the nurse do in this clinical situation? Using the case study above, the first prioritization step the nurse would take is ____.

12. Question 3
The second prioritization step the nurse would take is ____.

13. Question 4
The third prioritization step the nurse would take is ____.

14. Question 5
The fourth prioritization step the nurse would take is ____.

15. Question 6
The fifth prioritization step the nurse would take is ____.

16. Question 7
The sixth prioritization step the nurse would take is ____.

17. Question 8
The seventh prioritization step the nurse would take is ____.

18. Question 9
The eighth prioritization step the nurse would take is ____.

V- Case Study: Pediatric Cardiovascular System
Michael is a 7-week-old breastfed infant who presents with a 2-day history of irritability and poor feeding.

Subjective Data

Mom states patient has been “fussy” for past 2 days
Only feeds for a “few” minutes at a time
Breathing heavily and fast for 2 days
Objective Data

Weight: 4.8 kg
Vital Signs: T 36.8° C, P 250, R 65, BP 84/58
Breath sounds clear to auscultation
Oxygen Saturation 95%
Central capillary refill 4 sec
19. Question 1
What is the treatment for an unstable patient with SVT?

20. Question 2
Decreased cardiac output from prolonged SVT will produce what complication?

21. Question 3
In this clinical situation what should the nurse do? Prioritize actions.

VI- Case Study: Hematologic System
Liam is an 8-year-old male with a history of hemophilia. Liam presents today with a 1-day history of right elbow pain.

Subjective Data

Right elbow pain for 1 day
Patient states he hit his right elbow on desk yesterday
Patient complains that he cannot move his elbow
Objective Data

Weight 31.6 kg
Vital sighs: T 37.4° C, P 82, R 20, BP 108/68
Rates pain 6 on scale of 10
22. Question 1
How should the nurse respond when Liam’s father explains that they watched and waited to see if Liam needed treatment after his injury?

23. Question 2
Why are neuro checks an important part of Liam’s physical exam?

24. Question 3
What should the nurse do in this clinical situation? Prioritize actions.

VII- Case Study: Common Disorders of the Red Blood Cells
Susan is a 26-year-old G1P0 at 6 weeks of gestation with type 2 diabetes. Her BMI is 32. Her hemoglobin A1C is 9. She uses glyburide 10 mg PO daily. The physician has switched her to insulin at this time.

1. Question 1
What is the nursing priority at this time?

2. Question 2
What should Susan be taught about insulin needs during pregnancy?

3. Question 3
What additional risk factor does Susan have?

4. Question 4
How should Susan be counseled regarding weight gain in pregnancy?

5. Question 5
What advice can be given to Susan regarding exercise?

VIII- Case Study: Pediatric Genitourinary System
Lilly is a 3-year-old female who presents with complaints of abdominal pain and fever since yesterday.

Subjective Data

Complains of lower abdominal pain
Fever for 24 hours
Lilly has ‘wet her pants’ despite being recently potty trained
Objective Data

Vital signs: T38.5° C, P 114, R 32, BP 104/62
Urine positive for WBCs, nitrites, blood
6. Question 1
What risk factors does Lilly have for UTI?

7. Question 2
What might prevent Lilly from a recurring UTI?

8. Question 3
What should the nurse do in this situation? Prioritize actions.

IX- Case Study: Pediatric Neurologic System
Abby is a 1-year-old female who presents after a reported seizure at day care.

Subjective Data

Fever for 1 hour
Eating and drinking normally per mother
Objective Data

Vital signs: T 40° C, HR 160, R 44, BP 104/68
Awake and alert
Skin hot to touch, otherwise normal physical examination
9. Question 1
How should the nurse respond to Abby’s mother when she asks if Abby has epilepsy?

10. Question 2
How should the nurse respond to Abby’s mothers question about brain damage?

11. Question 3
In this clinical situation what should the nurse do?

the Child in Inpatient

CASE STUDIES

I- Case Study: Care of the Child in Inpatient and Outpatient Settings

Jordan is 9-year-old male who is a direct admit for observation. He has a history of vomiting and diarrhea for 48 hours.

Subjective Data

  • Nausea and vomiting for 24 hours
  • Has not voided today
  • Unable to tolerate oral fluids

Objective Data

  • Vital signs: T 37.8° C, P 120, R24, BP 110/60
  • Weight: 34 kg
  • Hyperactive bowel sounds to auscultation

1. Question 1

When should the discharge teaching begin for Jordan and his family?

2. Question 2

What is the best way to approach Jordan regarding the IV that has been ordered.

3. Question 3

What would be good distractions for a child of Jordan’s age?

II- Case Study: Pediatric Cancer

Mario is a 7-year-old male who presents with a 1-week history of body aches and pallor. He has a 2-day history of fever to 103° F and a 1-day history of bruising and lethargy.

Subjective Data

  • Complains of hurting all over
  • States he feels very tired
  • States he feels dizzy when he stands up

Objective Data

  • Weight 26.1 kg
  • Vital signs: T 38.9° C, P 140, R 40, BP 108/54, O2 sat 100%
  • Purpural rash on extremities
  • WBC 0.7
  • HGB 3.1
  • Hct 8.5
  • Plt .08
  • ANC 0.1

4. Question 1

Which of Mario’s presenting symptoms must be treated and stabilized before chemotherapy induction?

5. Question 2

What testing is required for a definitive diagnosis of meningitis?

6. Question 3

What should the nurse do in this clinical situation? Prioritize actions.

III-  Case Study: Pediatric Respiratory System

Will is a 4-month-old infant born at 34 weeks of gestation. Will’s mother states that he has not been able to go to day care because he has been coughing with a fever for the past 3 days. She states today he is unable to feed well from the bottle because of nasal secretions.

Subjective Data

  • Mother complains that infant has had cough for 3 days
  • Mother states that infant is having trouble sleeping
  • Not voided in past 6 hours

Objective Data

  • Birth Weight: 1.9 kg
  • Today’s Weight: 5.5 kg
  • Vital Signs: T 38° C, P 186, R 60, BP 90/52, Pulse Oximetry 93%
  • Thick yellow nasal secretions
  • Nasal flaring with moderate intercostal retractions
  • Breath sounds decreased with crackles bilaterally to auscultation

7. Question 1

What risk factors does Will have for contracting bronchiolitis?

8. Question 2

What is the first priority for Will’s treatment?

9. Question 3

What should the nurse do in this clinical situation? Prioritize actions.

IV-  Case Study: Pediatric Gastrointestinal System

Lucy is a 44-day-old formula-fed infant who presents with a 4-day history of vomiting.

Subjective Data

assessing their self-identified:

Assignment:

Identify an older adult age 65 +, use a 1st and last initial. Execute a therapeutic assessment interview with them for at least two interview sessions assessing their self-identified:

Demographics, life time education and career/employment
Two most significant (positive) times in their lives
What past hardship or loss has the client successfully negotiated in the past?
Two personal strengths
Engage them in identifying what is healthy versus non-healthy coping skills
Inquire of 2 healthy coping skills they have used in the past and/or now
Three (3) pieces of advice they would give to their younger self if they could?
Support the client in taking the Geriatric Depression Scale.pdf
Support the client in taking the Fulmer SPICES Assessment.pdf
Perform a Mini Mental State Exam.pdf and Patient_Stress_Questionnaire.pdf (attach here)
Perform a Hall, Ryan, Hall, Richard, and Chapman Article.pdf
Report the findings from the Geriatric Depression Scale, Fulmer Spices, Patient stress questionnaire and the mini mental status exam
Discuss your older adult’s level of ego integrity vs. despair as described by psychoanalyst Erik Erikson. If you had to rate them on a scale of 1-10, with 1 representing a full state of despair and 10 representing full ego integrity, what rating would you give your older adult?
Describe at least two nursing diagnoses for this client.
Create a plan of care for the client to include at least three nursing goals with two nursing interventions each.
The assignment should be written in an APA-formatted essay. DO NOT COPY OR PLACE THE ASSESSMENTS INTO YOUR PAPER- JUST SUMMARIZE THEM IN PARAGRAPH FORMAT. The essay should be at least 1500 words in length and include at least two scholarly sources other than provided materials. Don’t forget the format of an APA essay paper includes the title page, intro, assignments, conclusion, and references. Note that in this assignment when you interview the older adult, it is ok to just denote their responses- you do not have to quote them or use personal communication citations- I know that you are interviewing them. Please do not give full names of your interviewees, just give their initials or say, Mrs. S. or something like that.

he current health care environment

comment2

Nurse legislatures can represent the nursing profession because they understand the challenges that nurses face in the current health care environment. Nurse legislatures are in the unique position of representing the interests of nurses and the health care needs of the public. Mary Ann Dailey, RN, DNSc, a member of the Pennsylvania House of Representatives approaches the job from the perspective of a nurse and says that nurse legislators can represent the interests of the nursing profession in ways that no one else can. They understand the challenges that nurses face in today’s health care environment in a world in which hospitals desperately need more nurses and nurses agonize about being overworked (Larson, 2016).

Daley has been involved in efforts to pass a bill allowing prescriptive privileges for nurse practitioners in Pennsylvania and a bill that affects the usage and education of unlicensed assistive personnel. She is currently working on a bill to give whistleblower protection to nurses and other health care professionals who are concerned about issues that have happened in their hospital and may be too afraid of repercussions to speak up. Daily and other nurses serving in state and federal levels agree that more nurses should get involved in politics and encourage volunteering for others who are in office. She further states that it could be running for office, contacting their representatives with concerns, voting regularly, or volunteering for others who are in office and could even mean paying closer attention to issues that involve nursing