Category: Nursing

Marcia W is a 40-year-old female with multiple myeloma, who upon diagnosis shows great interest in having all the information necessary to make a decision about further treatment.  Dr. C tells her that the response rates for chemotherapy with this disease are very good and that recent research has shown that 50 percent of all patients can hope for long-term survival rates, which are tantamount to cure. The other 50 percent of patients die within a year or two.  What Dr. C neglects to tell her is that preliminary studies are showing that, over a 20-year period subsequent to chemotherapy, 10 percent of those who survive the myeloma will contract a form of leukemia that is highly resistant to treatment. When her treatment is discussed in a staff meeting, Dr. C says he does not want to tell Marcia W about the 10 percent because he is afraid that it might unduly alarm her and cause her not to take treatment, thereby spoiling her chances for long-term survival. Moreover, he states (1) that the research is not conclusive enough to suit him and (2) that 10 percent is such a low figure that he is not morally required to communicate the risk.  After all, he suggests, one cannot inform a patient of  every risk.
(a) To what extent is Dr. C being paternalistic if he withholds the risk of leukemia?
(b) If Dr. C withholds the risk of leukemia from Marcia, is he trying to deceive her? Is it always deception in cases where one withholds information that is considered unreliable?
(c) Would withholding the risk of leukemia from Marcia be justified under either of the exceptions to disclosure outlined in Canterbury v. Spence? Why or why not?
(d) What should Dr. C do in this case?  Would withholding the risk of leukemia be justified from either a utilitarian or deontological perspective? Be sure to explain either the hedonic calculus or the categorical imperative in your answer. 

Give examples of how cross-contamination of articles could occur if clinical staff is not aware of proper evidence collection procedures. How could cross-contamination of evidence be detrimental to an investigation?

Patient Safety (Links to Websites Available Below)
Read the Institute of Medicine’s To Err is Human ( https://nap.nationalacademies.org/resource/9728/To-Err-is-Human-1999–report-brief.pdf )
Review The Joint Commission’s Core Measures (https://www.jointcommission.org/measurement/measures/ )
Review The Joint Commission’s 2024 Hospital National Patient Safety Goals ( https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2024/hap-npsg-simple-2024-v2.pdf )
Review Florida’s Nurse  Practice Act ( http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0464/0464.html )
After reading and reviewing the above sources, please answer all the following questions:
In To Err Is Human, the summary of the report published in 1999 stated that between 44,000 and 98,000 patient dies in hospitals each year.  Were you alarmed by this number?  
Per the report, what is the cause of these deaths?
Do all hospitals have to follow the Joint Commissions’ Core Measures and National Patient Safety Goals?  Support your yes or no answer with evidence.
Using the Joint Commission’s Core Measure, what guidelines can a nurse check for in a patient’s chart to determine if the attending physician is following the Core Measures for Cardiac Care? Please list the measures that should appear in the patient’s chart?
Using the Joint Commission’s National Patient Safety Goals, what steps can a nurse take to ensure that he or she does not commit a medication error?  Please list the steps.
According to Florida’s Nurse Practice Act, what would happen to a RN who witnessed another nurse committing a medication error but did not report the infraction?
Guidelines:
Initial post: Respond to the discussion questions posted in Discussion board,  must be at least 200 words in length to earn credit for the assignment
The initial and response posts must each have a minimum of two (2) outside references (i.e., textbook, medical/nursing resources, etc.) to earn credit for assignment
Use the standard English grammar and spelling
Be substantial and add to the conversation
Do not answer question(s) by just listing answer(s) in bullet points. Answers must be written in paragraph form to earn credit.
Do not make personal comments such as “I agree”, “Good point”, etc.  These comments will not count towards your minimum word requirement.
Must cite references using APA 7th edition format

Students will choose from one of the predetermined topics for this assignment.  Using the literature, national/international organizations, and .org/.gov websites, students will draft a White Paper including a problem statement, proposed solution, and a relevant Change Model to assist with implementation. The problem should be explained in detail using the literature.  The proposed solution should also be described in detail as a rationale for implementation.  Given that change can be difficult, students will then explain the change model they have selected from the list and provide information on how it will facilitate the implementation of the proposed solution.  Papers should be APA formatted & 5-7 pages long, excluding title and references. Turnitin must be under 35% compatibility.
White Paper Topic List:
Section A: Problem (choose one)
Solution B: Solution (choose one)
Section C: Change Model (choose one)
Nurse Satisfaction
Shared Governance
Lewin’s Change Management Model
Patient Safety
Magnet Pursuit
McKinsey 7 S Model
Nursing Shortage
Self-Scheduling
Kotter’s change management theory
Continuity of Care
Formal Preceptor Training
Nudge Theory
Patient/Family Satisfaction
Mandated Staffing Ratios
ADKAR model
Staff Turnover
Flexible Scheduling
Kübler-Ross Five Stage Model
Grading Rubric for Leadership White Paper
Nursing Problem – explain the scope of the problem broadly (15), use literature to provide relevant statistics, facts, and overall impact of the issue (15).
30 points
Proposed Solution – explain the proposed solution in detail (20).  Is the proposed solution evidence-based?  Provide a few examples from the literature detailing how the solution has been successfully integrated (20).
40 points
Change Model – explain the proposed change model in detail (10), then tell the reader how the model will be used to assist with buy-in and implementation (10).
20 points
APA formatting, grammar, punctuation, flow
10 points
TOTAL
100 points

Diabetes (priority disease). Describe the Miami community following the worksheet paper. See photo attached

The answers must be in your own words with reference to the journal or book where you found the evidence to your answer. 
All answers to case studies must-have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites)  per case Study
Less than 10% of turnitin similarity

Application of Course Knowledge: 
Describe a fictional ethical dilemma or a dilemma you have encountered in your nursing practice. 
Identify the key stakeholders. 
Describe how the situation impacts the key stakeholders.  
*Note: Peer responses should provide suggestions for how to address the ethical dilemma. 

Assignment Instructions: Complete the following steps to begin your Policy Advocacy Letter for this week’s checkpoint assignment. You will submit your responses in an APA-formatted paper (approximately 200 words in length) with in-text citations and references for any cited resources used to support your proposal.
Identify a pending healthcare bill that needs improvement or propose a new bill recommendation relevant to your current practice, community health needs, or personal interests. Submit a link or a PDF of the bill with your paper for this assignment. Note: Navigate to Congress.gov and view the following video on how to search for legislation.
Explain why that bill or recommendation is important. You must specify the exact piece of legislation in your paper and refer to its appropriate title – e.g., “Title VIII funding, H. R. 952”.
Identify a leader or change agent (local, state, and national leader/legislator) who is appropriate to advocate for this policy change or adoption. Briefly justify why that leader is an appropriate choice for this policy change or adoption. Note: To determine your representatives, navigate to org.
Identify the official mailing or email address of this leader. Note: Your elected officials’ email and physical addresses are available on their websites. You can find out who represents you on the House and Senate Additional notes:
You are advocating for pending legislation. You cannot choose something that has already passed because if that is the case, no advocacy is necessary.
Always refer to your selected piece of legislation by its appropriate title – e.g., “Title VIII funding, H. R. 952”.
The elected official you contact must have the authority to vote for the proposed legislation. The mayor, governor, or assemblyman (woman) of a city would have no legislative authority and therefore would not be appropriate. You are most likely going to contact a state or federal member of Congress (House or Senate).

Develop a disaster recovery plan to reduce health disparities and improve access to community services after a disaster. speaker notes for the local system, city officials, and the disaster relief team.

Discussion 4
Gastrointestinal Function:
R.H. is a 74-year-old black woman, who presents to the family practice clinic for a scheduled appointment. She complains of feeling bloated and constipated for the past month, some-times going an entire week with only one bowel movement. Until this episode, she has been very regular all of her life, having a bowel movement every day or every other day. She reports straining most of the time and it often takes her 10 minutes at a minimum to initiate a bowel movement. Stools have been extremely hard. She denies pain during straining. A recent colonoscopy was negative for tumors or other lesions. She has not yet taken any medications to provide relief for her constipation. Furthermore, she reports frequent heartburn (3–4 times each week), most often occur-ring soon after retiring to bed. She uses three pillows to keep herself in a more upright position during sleep. On a friend’s advice, she purchased a package of over-the-counter aluminum hydroxide tablets to help relieve the heartburn. She has had some improvement since she began taking the medicine. She reports using naproxen as needed for arthritic pain her hands and knees. She states that her hands and knees are extremely stiff when she rises in the morning. Because her arthritis has been getting worse, she has stopped taking her daily walks and now gets very little exercise.
Case Study Questions
In your own words define constipation and name the risk factors that might lead to develop constipation. List recommendations you would give to a patient who is suffering from constipation. You might use a previous experience you might have.
Based on the clinical manifestations on R.H. case study, name and explain signs and symptoms presented that are compatible with the constipation diagnosis. Complement your list with signs and symptoms not present on the case study.
Sometimes as an associate diagnosis and a complication, patients with constipation could have anemia. Would you consider that possibility based on the information provided on the case study?
Endocrine Function:
C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford any more medications. Except for a number of “female infections,” she has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.
Case Study Questions
In which race and ethnic groups is DM more prevalent? Based on C.B. clinical manifestations, please compile the signs and symptoms that she is exhibiting that are compatible with the Diabetes Mellitus Type 2 diagnosis.
If C.B. develop a bacterial pneumonia on her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.
What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?
Submission Instructions:
You must complete both case studies.
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.