Conduct an external environmental assessment for the organization along the lines described in chapter 5 of your textbook. You can get this information from the company’s Web site, other Web sites, journal articles, and other sources.

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Conduct an external environmental assessment for the organization along the lines described in chapter 5 of your textbook. You can get this information from the company’s Web site, other Web sites, journal articles, and other sources.

 

Create a strategic group map showing the interrelationship between the environmental forces and the organization.

Assignment 2: Analyze the external environment

Select a health care provider organization in the local community (or nationally), preferably a hospital, a physician group practice, or even a nursing home chain. Conduct an external environmental assessment for the organization along the lines described in chapter 5 of your textbook. You can get this information from the company’s Web site, other Web sites, journal articles, and other sources. Be sure to cover all the basic categories of environmental factors. Draw a diagram showing the environmental forces you have identified and the interrelationships among them and with the organization.

For this assignment, your report should be at least four pages in length, in current APA edition format and should include the following information:

The steps to externally evaluate the firm
Description of two environmental forces that may have some impact – positive or negative – on the organization or business.
Create a strategic group map showing the interrelationship between the environmental forces and the organization
Description of two critical issues specific to the organization, its industry and its customers

Nursing Theorist Analysis: The Environment Theory

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Abstract

The Environment Theory, as discovered by the founder of modern nursing, Florence Nightingale, places great emphasis on the individual needs of patients as it pertains to their surrounding environment. It establishes the nurse’s role in providing an environment suitable for optimal patient recovery and allowing the body to self-heal. This places a great emphasis on a holistic approach to patient-centered care. Nightingale’s theory addresses each of the aspects of the nursing metaparadigm as well as outlines how it is utilized in every day clinical practice. Many of the techniques developed by Nightingale were adopted by modern nursing and continue to be crucial practices throughout the healthcare field. The Environment Theory also aligns with integrative nursing principles one and three: human beings are whole systems inseparable from their environments and nature has healing and restorative properties that contribute to health and well-being, respectively. Altering the environment of the patient reinforces the natural laws in which promote recovery from illness.


Nursing Theorist Analysis



Introduction

Florence Nightingale (1820-1910) served as a nurse during the Crimean War when she became the founder of the Environment Theory of nursing. This theory was based on the idea that in order to allow the natural laws to implement healing, the environment in which a patient resides must be altered in a way that allows for optimal recovery. These speculations were established when Nightingale noticed a relationship between the death of the soldiers she was caring for and the conditions of the environment they were placed. These conditions included “inadequate nutrition, dirty water, and inappropriate sewage disposal” (Selanders, 2010, p. 84). The theory strictly focuses on patient care and emphasizes the need to take into account how some factors may affect individuals differently. So having the capacity to alter these situations the best way possible in order to provide the necessary care for that individual patient’s needs and reach his or her desired health outcomes. Nightingale later concluded that there are internal and external components of the environment. Concerning aspects include elements like “food, water, and medications— as those that directly [affect] the external being, such as ventilation, light, noise control, stimulation, and room temperature” (Selanders, 2010, pg. 84). The presence of unsanitary environments greatly impacts the health status of an individual which has evolved through evidence-based research and become a huge practice and safety concern in modern nursing.


Nursing Metaparadigm

The nursing metaparadigm is a nursing discipline that includes four concepts that address the holistic approach of caring for patients. Nightingale’s theory of nursing places most of the focus and emphasis on the environment component of the metaparadigm. Nurses are to provide a clean setting for rehabilitation in order to restore complete health. This is an aspect of patient care that is implemented in every day clinical practices. For example, ensuring the patient is entering a clean room with clean sheets and blankets, proper ventilation, and controllable temperatures. The healthcare staff is also following all patient safety protocols including hand hygiene, maintaining sterile fields and changing soiled linens when appropriate. All to provide the best possible environment to promote recovery for the patient, which is what Nightingale was striving to do through the development of her theory.

The next component of the metaparadigm is the client. Nightingale viewed individuals as being multidimensional and composed of “biological, psychological, social, and spiritual components” (Selanders, 2010, p. 85). She mainly addressed the psychological component which consisted of feelings and intellect being able to directly cause illness amongst individuals. The third component is health, which Nightingale perceived as being at the best state of health possible at any specific point in time. She considered health as a relative state. For a person to be healthy, they do not have to be free of disease or illness, just “maximize optimal potential to be in a healthy state” (Selanders, 2010, p. 85).

The final component is the nursing practice. Nightingale outlines the role of the nurse as being responsible for placing the patient in the most suitable conditions in which allow nature to act on. This promotes a very patient-centered relationship. The health status of the patient is maintained through the proper preservation of the environment and relationship built by the nurse. An example of this aspect performed in everyday practice performing hourly rounds on patients and making sure the nurse call light is within reach of each patient at all times so if anything is needed to improve the comfort of the patient, the nurse is accessible at all times.


Integrative Nursing Principles

Per Nightingale’s theory, poor health results from poor environments (Selanders, 2010, p. 84). The first integrative nursing principle states that human beings are whole systems inseparable from their environment. The general definition of environment, which Nightingale used to form her theory reveals “environment is anything that through manipulation, assists in putting the individual in the best possible condition for nature to act” (Selanders, 2010, p. 84). This addresses crucial aspects of everyday nursing practices including hand hygiene, providing proper nutrition and fluids, cleansing the patient, etc. These are all important skills that are now required of nurses to obtain prior to licensing in order to ensure the safety of the patient and assisting staff as well as prevent the spread of infection.

Nightingale’s theory includes thirteen canons, a few of which specifically pertain to nature itself. She placed emphasis on the idea that natural elements could aid in the restoration of health. This concept coincides with the third integrative principle which states nature has healing and restorative properties that contribute to health and well-being. The canons that directly correspond are ventilation, temperature, light, and noise. Nightingale believed that the absence of fresh air would eventually lead to sickness and the patient would stay that way, hindering the healing process. Also, becoming ill could be promoted by whether an individual is too hot or cold, lack of exposure to direct sunlight, and disruption of sleep by any kind of noise. All of these components are considered natural healing interventions.

Florence Nightingale made huge contributions to modern-day nursing. The observations she made in the mid-Victorian era were quickly adopted by the healthcare field and have continued to evolve to shape the nursing profession as we know it today.

References

  • Selanders, L. (2010). The Power of Environmental Adaptation: Florence Nightingale’s Original Theory for Nursing Practice.

    Journal of Holistic Nursing 18

    (1), 81-88. doi: 10.1177/0898010109360257

Legal- Ethical and Professional Issues in Nursing

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Critically analyse how ethical, professional and legal issues underpin nursing practice.

1. Introduction

Ethics regards standards of moral judgement and professional conduct. Nurses are highly accountable to patients, the public, employers, and the entire profession. It is imperative they have a sound understanding of various ethical, legal and professional issues they will face during their careers. There are three primary duties for nurses, among many others, which are the duty of autonomy, confidentiality, and duty of care to all patients.

i

These duties are supplemented by the principles of beneficence, meaning promoting or doing good and acting in patients’ best interests, and non-maleficence, meaning to avoid harm.

ii

These are professional duties which become legal duties if any legislation or policies are breached during practice. In 2001 a study found that there was a perceived need for more advice on ethical dilemmas within the health profession, after increasing legal cases and public inquiries.

iii

As a result, various Clinical Ethics Committees (CECs) and Research Ethics Committees (RECs) were established within the UK to provide comprehensive ethics support. Constantly changing values in health, behavioural science, and society mean that medical practitioners must be aware of new ethical issues for the medical sector, and learn how to respond appropriately.

2. Regulatory Bodies

The nursing practice upholds its own

code of ethics

and this is regulated by strict disciplinary guidelines, with the governing body having more influenceover its member than legislative entities in medical matters. The Department of Health issued a Health Service Circular 219.99, which mandated some requirements of a new nursing education programme. In the Nursing and Midwifery Order 2001, the Nursing and Midwifery Council (NMC) must establish minimum standards and requirements for nursing education in professional and ethical issues.

iv

The NMC is an organisation established by parliament to protect the public and regulates the medical and nursing professional standards using the Register of Medical Practitioners (RMP). The Register acts to allow the GMC to monitor entry to the profession only by achieving the standards required to become an RMP, and also by monitoring ‘fitness to practice’ proceedings to ensure all practitioners maintain consistently high standards of conduct. The NMC contains guidelines regarding the expectations of particular duties such as confidentiality, medical research obligations, consent rights, and autonomy. The nursing practice is expected to comply at an individual level with these guidelines on a daily basis. The NMC’s ‘Code of Professional Conduct: Standards for conduct, performance and ethics’ is widely adhered to in the profession. To be registered, it is a general rule that nurses must undergo education in addition to personally indicating through performance and training that they intend to follow ethical standards to retain a licence for nursing.

v

The General Medical Council (GMC) is a statutory entity with the role of protecting the public by maintaining a register of medical practitioners fit to practice, while also monitoring complaints about practitioners. There are fourteen key concepts which outline the ethical standards and responsibilities expected of a doctor. The GMC has also provided guidance on particular areas such as consent, confidentiality, and withholding or withdrawing treatment.

vi

This guidance is not mandatory, but is recognised at law, and in the case of

W v Egdell

, the court referred to the GMC guidelines on confidentiality.

vii

The British Medical Association (BMA) is the national association of practising doctors, with its own medical ethics unit which deals with individual ethical queries from doctors and nurses, and provides guidelines on ethical issues. Together, the GMC and BMA act to provide guidance for nurses and other practitioners to assist in ethical decisions, however it should be noted that these decisions are highly personalised, dependent on the patient and situation, and often subjective therefore unable to be entirely answered by these guidelines.

Given that the duty of confidentiality is a combined public interest and individual interest assessment, the judicial system does not provide ample guidance. This creates a problem for nurses and the ethical questions about who to protect. The GMC acts to protect practitioners who breach confidentiality rules if it was in the public interest, although this depends on the circumstances. The GMC will be unable to protect nurses if disclosure amounts to a significant breach towards the particular individual, despite assessment of legal and ethical questions.

viii

While case law often determines the ‘public interest’ query, individual practitioners and nurses must still exercise professional judgment and are personally accountable for any decisions which may breach ethical standards.

ix

However, the ethical guidelines are not entirely subjective, and the NMC regulates the code of ethics which enforces all disciplinary processes for practitioners. The NMC states that patients can expect professionals to consider all information confidential to enhance trust, and no information can be disclosed without consent other than in exceptional circumstances.

x

Nurses are also under instruction from doctors and employers, required to exercise their own judgment as well as following directions and adhering to the ethics of the team and the Code of Professional Conduct for Nurses.

xi

This can lead to some conflict, where they may be instructed to act contrary to their own personal beliefs, hence a balance of opinions must be applied by the individual to ensure they continue to act in the patient’s best interests while following ethical obligations. Additionally, nurses are expected to work together with other health practitioners and care professionals or agencies, service users, carers and communities, and extended families, to ensure decisions made about patient care adhere to shared values.

xii

3. Legal Issues in Nursing

The current legal framework in the UK includes statute law and case law. There are also some jurisdictional differences within the UK with Scotland and Northern Ireland having separate legal systems.

xiii

For instance, in Scotland a person can appoint an attorney of welfare to make medical treatment decisions if that person becomes incompetent, under the

Adults with Incapacity (Scotland) Act 2000

, yet this is not an option in England. There is a range of statutes impacting health care in the UK, as well as international standards. These include the

Abortion Act 1967,

the

Mental Health Act 1983,

the

Data Protection Act 1998, The Children Act 1989,

various Acts relevant only in Scotland, and guidance such as the

Guidance for Access to Health Records Requests

provided by the Department of Health. Particular examples of these acts include the strict control of disclosure of personal information under the

Data Protection Act,

and the concurrent use of the

Public Interest Disclosure Act 1998

if nurses are concerned about confidentiality decisions made at executive levels in organisations. The

Human Rights Act,

Article 8, also allows people to take action against public authorities who have no upheld their right to a private life.

xiv

When read with Article 3, it can be implied that there is a fundamental right for all individuals to determine their own lives, without interference from the government, including the right to choose medical treatment – treatment must be either consensual, or if the patient is in fact incapable of consent, it must be therapeutically necessary.

xv

Case law is the second branch monitoring ethical standards in nursing and the medical profession. Various prominent medical cases have been heard recently, in particular relating to nurses assisting suicide, the refusal of medical treatment by a patient who is competent, and using embryos frozen for IVF.

xvi

In England, nobody can consent to treatment for an incompetent adult, so the Court must make a declaration in the best interests of the patients and the overall medical practice. However, before reaching litigation, it is often expected that nurses are competent in making these decisions and informing their supervisors and subsequently the court regarding patient consent.

xvii

Nurses require a sound understanding of the associated ethical and legal principles in order to make such a judgment, and this is best understood by implementing stringent teaching and education procedures prior to practicing in a health clinic to ensure they can apply principles of health care and ethics.

In England, a patient is considered a minor if he or she is under 18 years of age, although in Scotland the required age is lower at 16. In England and Wales, the

Family Law Reform Act 1969

states that a person who is 16 or 17 years old has a statutory right to consent to treatment, under section 8, a minor aged 16 or over is considered an adult and has the legal rights which flow from this categorisation. The consent must be effective, and then no consent is required from a parent, except in specific procedures such as organ donation and nontherapeutic research.

xviii

The consent is valid if the minor is of ‘sufficient intelligence and understanding to appreciate the information and advice about the treatment and what it involves,’ for instance if a teenage girl consent in receiving contraceptive advice without her parents’ knowledge or consent.

xix

As the law enforces a duty of confidentiality by nurses to adults, the law then extends the duty to children who are competent in consenting to treatment. Knowledge of these circumstances is integral in enabling nurses to perform their roles following ethical standards.

The most common reaction to a perceived breach of ethical standards in the health profession is an action in negligence and malpractice, being the act or omission or commission made by the nurse or doctor.

xx

It requires four elements: duty, being a legal obligation owed to the patient – nurses must provide the degree of care reasonably exercised by other nurses in that practice area. Second, a breach of that duty by not meeting the required standard. Third, causation, which is a factual connection between the action of the nurse and the harm suffered by the patient. Finally, damages, being monetary payment intended to compensate the patient for the detriment.

xxi

The patient must have suffered bodily, economic, or emotional injury. The breach of duty test refers to the reasonable judgments of ‘responsible bodies of medical opinion,’ where those of special skills or competence are judged at a higher standard for that profession, rather than the ordinary person test.

xxii

The standard of care is also higher for professionals, and while the primary duty is with the doctor, nurses can also be held liable even when acting under direction from her employer.

xxiii

The nurse, even when supervised, must exercise her own skill and competence as expected of a nurse of the same level and experience.

xxiv

4. Confidentiality



The principle that a patient who understands relevant information regarding his or her medical problem should be able to make a decision about treatment extends to the duty conferred on doctors and nurses. This is a duty of confidentiality, to not give information about the patient to others without consent. The patient must be considered competent to make the decision, as in other circumstances a breach of confidence may be permitted.

xxv

The principle of autonomy for competent individuals then implies that confidentiality must be respected. In some circumstances, complying with requests for confidentiality may be detrimental to the patient – which is the best interest principle and nonmaleficence conflicting with the right to autonomy.

xxvi

The nurses must carefully assess the possible consequences of breaching confidentiality, considering the risk of harm of not breaching which must be significant to justify ignoring the concept of autonomy. The GMC guideline for confidentiality allows disclosure under Paragraph 27 where: ‘disclosure of personal information without consent may be justified in the public interest where failure to do so may expose the patient or others to risk of death or serious harm.’

xxvii

Discussion regarding confidentiality must be informed by ethical principles following case law and legislation, in addition to guidance policies, and any on-job learning which may be applied to independent cases.

Confidentiality is further governed by the

Health Insurance Portability and Accountability Act 1996,

which outlines the requirement to protect distribution of confidential information on patients.

xxviii

This mandates the need to reduce online systems tracking, monitoring login systems and monitoring confidential information distribution. Password systems are tracked to ensure hospital employees cannot access patient files without consent. A recent example is the event at the Moffitt Cancer Centre, after it came to light that a research study falsified patient consent.

xxix

Hundreds of documents were fraudulently produced during a cancer research study, which breaches the duty of a nurse to obtain an informed consent signature before conducting a procedure.

xxx

The signature implies that the patient is aware of the procedure, its alternatives, and possible risks, so when a nurse does not obtain the signature and falsifies it, the employer and the nurse are both accountable for damages.

xxxi

The right to confidentiality has been supported judicially in several prominent cases, including

Hunter v Mann

[1974] QB 767,

W v Edgell

[1990] Ch 359, and in

X v Y

[1988]. In the latter case, the court stated that ‘the doctor has a duty not to voluntarily disclose without the consent of his patient information which he has obtained in his professional capacity, save in exceptional circumstances’ (at [23]). These circumstances are when there is a competing public interest, and the case went on to outline: ‘cases may arise in which disclosure in the public interest may be justified, such as a situation in which the failure to disclosure appropriate information would expose the patient, or someone else, to a risk of death or serious harm’ (at [25]). In that case, Justice Rose reiterated that an AIDs case involved a significant public interest, but also a fundamental right to individual confidentiality. While the public had an interest in publication of the matter, it was held that it did not outweigh the right to confidentiality in the medical context, in particular regarding an AIDs patient. Justice Rose stated: ‘the public in general and patients in particular are entitled to expect hospital records to be confidential, and it is not for any individual to take it upon himself or herself to breach that confidence whether induced by a journalist or otherwise’ (at [35]).

5. Autonomy

Nursing ethics revolves around the concept that nursing is collaborative, hence patients have an inherent right to bodily autonomy wherever possible, and this includes a human rights component and the need to allow informed consent, or the withholding of this consent. The law of informed consent underlies the ethical notion of autonomy, outlining the minimum standard of behaviour accepted by the community.

xxxii

Compliance with legislation is mandatory, whereas compliance with the ethical notions of autonomy must be applied at a personal level within the nursing practice. For example, in the UK, the evolution of the

Mental Capacity Bill

highlights the public’s belief that patients have the right to make their own treatment decisions. Contrastingly, the

Human Fertilisation and Embryology Act 1990

is applied by the courts strictly, for instance in the interpretation of the word ‘embryo’, which limits the autonomy on a legislative basis. There are also conflicts within ethics and autonomy, for instance the issue of parental choice in the ‘saviour sibling’ debate may not adhere to overall societal benefits, including the ethical duty to act beneficentlymtowards all children, including future children.

xxxiii

These are particularly sensitive issues which require subjective personal judgment of nurses involved. Generally, nurses must comply with patient request even if they do not personally agree, and ensure that in the nature of justice, all clients are treated fairly and equally, for instance regarding distribution of hospital resources and time spent per patient.

xxxiv

Autonomy, and by extension consent, can be both legally and ethically ‘effective’, depending on context and the patient circumstances. From a health sector perspective, autonomy may or may not be practical for the purposes of precluding liability from litigation and avoiding ethical criticism, weighed against the best interests of the patient.

xxxv

It may also be that the patient does not have the requisite decision-making capacity, in which case nurses may treat the patient without consent. This is usually grounded on the principle of necessity, and the circumstances in which it is permitted are limited.

xxxvi

It must be proven as necessary to treat the patient, and in addition the necessity to act was coupled with it being impractical to communicate with the patient, and the action taken was that which a reasonable person in the same circumstances would take if acting in the patient’s best interests.

xxxvii

Further, when acting under necessity, the nurse must prove she did no more than was immediately necessary and in the patient’s best interests.

xxxviii

The question of what is immediately necessary, not acting further and in breach of patient autonomy, is not legislated and remains an ethical dilemma in the nursing practice.

6. Conclusion

Legal and ethical issues are prevalent in the health care industry, and in particular for the nursing practice, where nurses have daily individual contact with patients. Ethical issues are wide-ranging, from organ donation, genetic engineering, assisted suicide, withholding treatment in end-of-life care, or simple procedures requiring consent. Many nurses do not have formal education in legal and ethical issues, and as such as often unqualified to address these questions when they arise in the medical environment.

xxxix

While there are legal, ethical and professional guidelines which mandate the conduct of professionals, it does require education in the area and an ability to be aware of the risks of any personal decision made regarding a patient. Nurses must be guided in learning about ethics within their profession to ensure mistakes to do not occur. As nurses have contact with patients on a daily basis in dynamic environments, ethical issues vary based on patient profiles, medical technology development, and healthcare specialties. Awareness of ethical problems involves rational reflection of what action should be taken in particular scenarios, and adhering to principles guiding this behaviour. Nurses are influenced by professional, personal, cultural, social, and political factors. The fundamental responsibilities of all medical practitioners remains constant, being to promote health, act in the best interests of the patient, prevent illness, remove suffering, and extend services beyond the individual to their family and the community.

7. References


i

Edwards, S. (2009).

Nursing Ethics: A Principle-Based Approach.

2nd edition. Palgrave MacMillan: London, p. 31.


ii

Gordon, J., Rauprich, O. & Vollmann., J. (2009). ‘Applying the Four-Principle Approach’.

Bioethics.

Vol 25. Issue 6, p. 13.


iii

Slowther A, Bunch C, Woolnough B, Hope T. (2001).

Clinical Ethics Support in the UK: A review of the current position and likely development

. London: The Nuffield Trust, p. 22.


iv

Nursing and Midwifery Council (2010) Standards for pre-registration nursing education. Nursing and Midwifery Council, London, p. 17.


v

Nursing and Midwifery Council 2010, p. 18.


vi

General Medical Council. (2013).

Standards and ethics guidance.

Available at: http://www.gmc-uk.org/publications/standards_guidance_for_doctors.asp [1November 2014]


vii


W v Egdell

[1990] Ch 359


viii

GMC 2013.


ix

Griffith, R. (2013).

Law and Professional Issues in Nursing.

Transforming Nursing Practice Series. Edition 3. SAGE Publications, p. 9.


x

Nursing and Midwifery Council 2010, p. 15.


xi

United Kingdom Central Council for Nursing, Midwifery, and Health Visiting (UKCC) (1992).

Code of professional conduct for the nurse, midwife and health visitor

. London: UKCC.


xii

Nursing and Midwifery Council 2010, p. 13.


xiii

Griffith 2013, p. 10.


xiv


Campbell v MGN

[2004] UKHL 22


xv

Griffith 2013, p. 11.


xvi


R (on the application of Pretty) v DPP

[2001] UKHL 61;

Re B (Consent to Treatment: Capacity)

[2002] EWHC 429;

Evans v Amicus Healthcare Ltd & Ors

[2004] EWCA (Civ) 727.


xvii

Griffith 2013, p. 15.


xviii

Griffith 2013, p. 16.


xix


Gillick v West Norfolk and Wisbech AHA

[1985] 3 All ER 402.


xx

Edwards 2009, p. 59.


xxi

Griffith 2013, p. 22.


xxii


Bolam v Friern Harnet HMC

[1957] 2 All ER 118.


xxiii


Whitehouse v Jordon

[1981] 1 WLR 246.


xxiv


Maynard v West Midlands Health Authority

[1984] 1 WLR 634).


xxv

Edwards 2009, p. 59.


xxvi

Edwards 2009, p. 63.


xxvii

GMC 2013.


xxviii

Lachman, V. (2006).

Applied ethics in nursing

. New York: Springer, p. 102.


xxix

Martin, R. (2010, August 26). ‘Moffitt Cancer Centre discovers patient consent was falsified

.

’

St. Petersburg Times.

Available on:

http://www.tampabay.com/news/health/research/moffitt-cancer-center-discoverspatient-consent-was-falsified-for-study/1117483

[1 November 2014]


xxx

Martin 2010.


xxxi

Lachman 2006, p. 103.


xxxii

Griffith 2013, p. 21.


xxxiii

Kleiman, S. (2007). Revitalizing the humanistic imperative in nursing education.

Nursing Education Perspectives.

Issue 8, p. 36.


xxxiv

Kleiman 2007, p. 37.


xxxv

Kleiman 2007, p. 49.


xxxvi

Edwards 2009, p. 77.


xxxvii


Lord Goff in Re F (Mental Patient: Sterilisation)

[1990] AC 1.


xxxviii


Marshall v Curry

[1933] 3 DLR 260;

Murray v McMurchy

[1949] 2 DLR 442.


xxxix

Kleiman 2007, p. 50.

Culturally sensitive End of life care for Chinese culture

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Culturally sensitive End of life care for Chinese culture

admin | October 7, 2015
Step 2- Find 3 EBP articles that pertain to the topic. Step 3- For each article include paragraphs that describe: Paragraph 1- History of article, author’s credentials and history and summary of article Paragraph 2- Describe what evidence was derived from this study. Paragraph 3- Nursing Practice Application.. CULTURALLY SENSITIVE END OF LIFE CARE.

An 11 year old boy who has played baseball (pitcher) for the last 7 years is seen by an orthopedist. The athlete complains of intense pain in the shoulder joint that worsens when his arm is raised.

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An 11 year old boy who has played baseball (pitcher) for the last 7 years is seen by an orthopedist. The athlete complains of intense pain in the shoulder joint that worsens when his arm is raised.

Sleeping on his back or stomach is painful as is any type of throwing motion. The doctor suspects an injury to the rotator cuff. Range of motion exercises performed by the doctor elicit pain when the arm is raised away from the midline.

The rotator cuff is a group of tendons that function to hold the arm in its socket and to stabilize the shoulder. Four muscles merge into tendons and attach the humerus to the shoulder blade. Repetitive motions can aggravate the cuff and lead to chronic inflammation. Tears of the cuff often necessitate arthroscopic surgery. Rotator cuff injuries are common in athletes whose sport involves repetitive motions such as tennis players, golfers, and baseball players (“Rotator Cuff Injuries”, 2016).

The doctor ordered X-rays and an MRI to assess the extent of the injury (Eajazi et al. 2015). She prescribed rest, ice compresses, and the use of anti-inflammatories (Williams et al 2000). The MRI results indicate a partial tear. The plan is to rest the shoulder for 6 weeks and see if the pain improves before opting for surgery. A follow-up appointment is scheduled for 6 weeks.

Rotator Cuff Injuries. (n.d.) Retrieved February 23, 2016, fromhttps://www.nlm.nih.gov/medlineplus/rotatorcuffinjuries.html

Eajazi, A.,Kussman, S.,LeBedis, C.,Guermazi, A.,Kompel, A.,Jawa, A., &Murakami A.M. (2015). Rotator cuff tear arthropathy: Pathophysiology, imaging characteristics, and treatment options.AJR Am J Roentgenol.205(5), 502-511.

Williams, Jr, G.R. &Kelley, M. (2000). Management of rotator cuff and impingement injuries in the athlete. J Athl Train. 35(3), 300-315.

ASSIGNMENT

Musculoskeletal Disorders

Select one of the musculoskeletal disorders from the text and describe it to the class.

Explain how it is diagnosed, what muscles are involved, the treatment, and the prognosis.

Objective: List the muscles of the body and understand basic muscle types.

Pop Culture

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No plaglarism 

300 words

I need this assignment in 48 hours

Topic

1. Do you think that pop culture will survive as it is, or will it morph into something different?   Provide examples

Write an essay describing the usefulness of theory to nursing research.

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Write an essay describing the usefulness of theory to nursing research.

Write an essay describing the usefulness of theory to nursing research. Theory is a set of related statements that describes or explains phenomena in a systematic way. Theories explain why one event is associate with another event or what causes an event to occur.

Write an essay describing the usefulness of theory to nursing research. Theory is a set of related statements that describes or explains phenomena in a systematic way. Theories explain why one event is associate with another event or what causes an event to occur.Write an essay describing the usefulness of theory to nursing research. Theory is a set of related statements that describes or explains phenomena in a systematic way. Theories explain why one event is associate with another event or what causes an event to occur.

Write an essay describing the usefulness of theory to nursing research. Theory is a set of related statements that describes or explains phenomena in a systematic way. Theories explain why one event is associate with another event or what causes an event to occur.Write an essay describing the usefulness of theory to nursing research. Theory is a set of related statements that describes or explains phenomena in a systematic way. Theories explain why one event is associate with another event or what causes an event to occur.

HIPAA PRIVACY RULE

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HIPAA PRIVACY RULE

HIPAA Privacy Rule
Order Description
I will attach the annotated bibliography that was just done for your references: Hope these help.
Scenario No. 1: HIPAA Privacy Rule
Case Study: Imagine that you are the privacy officer for a small town hospital. You receive a report that there is a breach of privacy. You are informed that a 15-year-old girl is received at the emergency with an emergency labor. The baby is delivered in the emergency room as there is no time to move the patient to the obstetrics (OB) department. In addition to the emergency delivery, the baby is born with multiple medical problems. Once the mother and baby are moved to obstetrics and neonate, care is given to both.

The OB nurse who took care of the mother and baby completes her shift, and she goes home to her own daughter to have a talk with her. She sits her daughter down and pleads with the girl to tell her if she ever has any problems, especially when it comes to pregnancy. The nurse tells her daughter the story about the young patient who delivered that evening, and she accidentally mentions the patient’s name. The patient’s name is one of those odd names that immediately triggers the nurse’s daughter to relay that she knows the patient. The mother/nurse, realizing that she made a big mistake by mentioning the patient’s name, pleads with her daughter not to say anything. Needless to say, word shoots through the four high schools in the town the next day.

The nurse returns to work the following evening, and she contacts you to hand in her badge and keys, stating that she knows she made a mistake by breaching the young patient’s privacy and she knows she is going to be fired. In addition to the breach of the obstetrics nurse, you learn that the patient hid her pregnancy from her family, and to make matters worse, her aunt and mother are both nurses at the hospital. You know both of these nurses on a professional and personal level.

Scenario No. 1 HIPAA Privacy Rule Project Assignment:
Research the HIPAA Privacy Rule here:

U.S. Department of Health and Human Services. (2013). Health Information Privacy. Retrieved from https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/introduction/index.html

Then, perform additional research regarding the HIPAA Privacy Rule and prepare your Final Paper by analyzing the issues through these questions in regards to the above scenario: •Analyze the specific requirements needed to perform this investigation.
•Identify whether this incident was an actual breach of privacy according to the HIPAA law.
•Examine the differences and similarities between the hospital’s stance and HIPAA as to whether the nurse should be fired from her job.
•Explain why you would fire or not fire the nurse immediately or whether you would put her on administrative leave awaiting the details of the investigation.
The Final Paper:
•Must be eight to ten double-spaced pages in length, excluding title and reference pates, and formatted according to APA style as outlined in the Ashford Writing Center.
•Must include a title page with the following:
?Title of paper
?Student’s name
?Course name and number
?Instructor’s name
?Date submitted
•Must begin with an introductory paragraph that has a succinct thesis statement.
•Must address the topic of the paper with critical thought.
•Must end with a conclusion that reaffirms your thesis.
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•Must use at least eight scholarly sources that were published within the past five years, including a minimum of four from academic journals found in the Ashford University Library.
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•Must document all sources in APA style, as outlined in the Ashford Writing Center.
•Must include a separate reference page, formatted according to APA style as outlined in the Ashford Writing Center.

RESOURCES:

Jackson, D., Cleary, M., and Mannix, J. (2013). Ethical sensitivity: Shaping the everyday work environment. Contemporary Nurse: A Journal for the Australian Nursing Profession, 44(1), 2-4. Retrieved from the EBSCOhost database.
McCullough, L. B. (2005). Practicing preventive ethics – the keys to avoiding ethical conflicts in health care. Physician Executive, 31(2), 18-21. Retrieved from the ProQuest database.
U.S. Department of Health and Human Services. (2003). Health Information Privacy. Retrieved from https://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/generaloverview.html

Vernillo, A. (2008). Preventive ethics and rural healthcare: Addressing issues on a systems level. American Journal of Bioethics, 8(4), 61-62. Retrieved from the EBSCOhost database.

Apply the framework developed by Corey (2005) to a fictional case, using a person-centred framework. For the purposes of this assignment, you are to choose one of the characters in the movie below and adapt the client’s role to meet the requirements of the assignment:

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Apply the framework developed by Corey (2005) to a fictional case, using a person-centred framework. For the purposes of this assignment, you are to choose one of the characters in the movie below and adapt the client’s role to meet the requirements of the assignment:

 

Psychology
This question requires you to apply the framework developed by Corey (2005) to a fictional case, using a person-centred framework. For the purposes of this assignment, you are to choose one of the characters in the movie below and adapt the client’s role to meet the requirements of the assignment:
American Beauty (1999) movie, directed by Sam Mendes and starring Kevin Spacey as Lester Burnham, an office worker who has a midlife crisis when he becomes infatuated with his teenage daughter’s best friend. If you choose option 1, you can pretend that any member of the Burnham family has been referred to you for counselling by their GP:
 Dad ‘Lester’ (Kevin Spacey)
 Mom ‘Carolyn’ (Annette Bening)
 Daughter ‘Jane’ (Thora Birch)
The framework for your case study should include the following:
 An introduction to the client you have chosen
 Your basic assumptions about using a person-centred approach for this particular fictional client
 Your ‘assessment’ or understanding of the case from a person-centred perspective
 The goal(s) of therapy with this client
 A description of fictional key moments of the therapeutic process, preferably demonstrated with the use of ‘verbatim’ interaction between therapist and client.
Refer to Module 5 for an outline of Corey’s (2005) framework (Ch 1 & 5 of Case Approach to Counselling & Psychotherapy) and the example of “Ruth” to guide you on how to approach this case study assignment. When writing up a case study, you may use a loose report structure with decimal notation, or an essay structure with headings. However, full sentences and descriptive prose is required, not dot points or lists. In text and end text referencing are both essential for academic work.
Suggested length:
Maximum 2,500 words (excluding references) Penalty for word count 10% above applies. Please record your word final count (excluding reference list & cover page) on the cover page.
Assignment Presentation & Submission

How you would develop a nursing plan of care for this patient based Virginia Hendersons theory

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Virginia Hendersons theory

Based on the case scenario attached that is found in this weeks content folder answer how you would develop a nursing plan of care for this patient based Virginia Hendersons theory. Post your answer the following question in a 300 word count with 3 references including the following: https://www.nursing-theory.org/theories-and-models/henderson-need-theory.php What would Virginia Henderson do? Please preface your discussion with the theorist you are using to answer the question.