A university medical center urology group was interested in the asso Show more Data Description and Background A university medical center urology group was interested in the association between prostate specific antigen (PSA) and a number of prognostic clinical measurements in men with advanced prostate cancer.

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A university medical center urology group was interested in the asso Show more Data Description and Background A university medical center urology group was interested in the association between prostate specific antigen (PSA) and a number of prognostic clinical measurements in men with advanced prostate cancer.

Data were collected on 97 men who were about to undergo radical prostectomies. Each line of data set provides information on 8 other variables for each person. Variable Name Variable Description Information cavol Cancer Volume Estimate of prostate cancer volume (cc) weight Weight Prostate weight (gm) age Age Age of patient (years) bph Benign Prostatic Hyperplasia Amount of benign prostatic hyperplasia (cm2) hyperplasia svi Seminal Vesicle Invasion Presence or absence of seminal vesicle invasion: 1 if yes; 0 if no cp Capsular Penetration Degree of capsular penetration (cm) gleason Gleason Score Pathologically determined grade of disease (678). Note a higher Gleason score indicates worse prognosis. psa PSA Level Serum prostate-specific antigen level (mg/ml) PSA is commonly used as a screening mechanism for detecting prostate cancer. However to be an efficient screening tool it is important that we understand how PSA levels relate to factors that may determine prognosis and outcome. The PSA test measures the blood level of prostate-specific antigen an enzyme produced by the prostate. PSA levels under 4 ng/mL (nanograms per milliliter) are generally considered normal while levels over 4 ng/mL are considered abnormal (although in men over 65 levels up to 6.5 ng/mL may be acceptable depending upon each laboratorys reference ranges). PSA levels between 4 and 10 ng/mL indicate a risk of prostate cancer higher than normal but the risk does not seem to rise within this six-point range. When the PSA level is above 10 ng/mL the association with cancer becomes stronger. However PSA is not a perfect test. Some men with prostate cancer do not have an elevated PSA and most men with an elevated PSA do not have prostate cancer. PSA levels can change for many reasons other than cancer. Two common causes of high PSA levels are enlargement of the prostate (benign prostatic hypertrophy (BPH)) and infection in the prostate (prostatitis). Some of the variable names may look unfamiliar to you please use resources on the web if you feel unsure as to what these variables measure. The section above is based on excerpts from Wikipedia.org and you can also find variable definitions at http://www.prostate-cancer.org/resource/glossary.html. For example a large tumor may invade surrounding tissue and penetrate the wall of the prostate (variable svi and cp). Also benign hyperplasia is associated with higher PSA levels but is non-cancerous (variable bph). The goal of the analysis is to develop a model for PSA to be used for inferential purposes. Your model should be parsimonious that is a model that balances both explanatory power with simplicity. To this end you may employ any of the methods learned in class. Write up a report (5-7 pages) describing how you obtained this model. Below is a list of things to address in the report. Are all the assumptions needed to fit the model satisfied? Do any transformations need to be applied to the response and/or explanatory variables in order to correct for any model deviations? Are there any outliers in the dataset? Are they adversely affecting the estimates obtained using the least squares method? Recall that the goal of model building is not to build the model that best fits your particular dataset but rather a model that can generalize. Consequently what is the method you will employ to select a model? How many variables will you use? How did you model them (aka via polynomial terms interactions or transformations)? Show less

Are there religious issues that might influence clinical decisions?

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Are there religious issues that might influence clinical decisions?

Let’s have a debate!!! Is nursing theory important to the nursing profession? If you believe that it is important, explain why it is useful. If you do not believe that it is useful, explain why nursing theory is not necessary to the profession? Be sure to provide an example that demonstrates your opinion and a scholarly reference (not using the required textbook or lesson) which supports your opinion.

The diversity movement suggests that there is strength in our differences and that our differences enhance each other. At the same time, the movement insists that our differences should not have economic, social, or political consequences. We are entitled to the same access to resources and opportunities regardless of our differences. The human suffering from Hurricane Katrina and the images of victims has stimulated the debate about differential access to resources.
Read the report Women in the Wake of the Storm: Examining the Post-Katrina Realities of the Women of New Orleans and the Gulf Coast. On the basis of your reading, create a report, answering the following:
• Discuss the prominent dimensions of diversity revealed as a result of the Hurricane Katrina disaster.
• Discuss factors that specifically influenced women’s vulnerability to Hurricane Katrina. While answering, consider the primary dimensions mentioned in the lectures as well as the secondary dimensions such as parental and marital status, income, educational level, military experience, geographic location, work background, and religious beliefs.
• Describe the implications for healthcare organizations as a result of the disaster.
• Discuss at least of two of the policy implications that are outlined in the report. If you were given the task to add another policy recommendation what would it be and why?

Medical Indications: The Principles of Beneficence and Nonmaleficence
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of various treatment options?
5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Patient Preferences: The Principle of Respect for Autonomy
1. Has the patient been informed of benefits and risks, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
6. What are plans and rationale to forgo life-sustaining treatment?
7. What is the legal and ethical status of suicide?
Contextual Features: The Principles of Justice and Fairness
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
6. Are there religious issues that might influence clinical decisions?
7. What are the legal issues that might affect clinical decisions?
8. Are there considerations of clinical research and education that might affect clinical decisions?
9. Are there issues of public health and safety that affect clinical decisions?
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?

Nursing DB

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Nursing DB

Paper , Order, or Assignment Requirements

200 words 2 references within 5 years (prefer nursing journals or peer reviewed only)
Henrietta Lacks was an African American woman whose cancer cells were the source of the HeLa cell line, one of the most important cell lines in medical research. HeLa cells are “immortalized cells.” Immortalized cells lines are important because they will reproduce indefinitely under specific conditions. The HeLa immortal cell line was vital for creating the polio vaccine, cloning (i.e., Dolly the sheep), gene mapping (i.e., the Human Genome Project) and more.
Mrs. Lacks was the unwitting source of these cells when her tumor was biopsied in 1951 during treatment for cervical cancer at Johns Hopkins Hospital in Maryland. Her cells were then cultured by George Otto Gey, who created the cell line known as “HeLa” (i.e., Henrietta Lacks). Consent was NOT obtained to culture her cells, nor was she (or her family) ever compensated for the use of the cells despite the fact that the HeLa cell line revolutionized modern medicine!
As we examine ethics for nursing research and evidence-based practice, please consider and present examples of human experimentation that have occurred during the history of medical research. Have these projects resulted in beneficial outcomes for society? Can human experimentation be justified when the greater good of society is at stake?

Essay On Ethical Principles Particularly Autonomy In Nursing Nursing Essay

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The aim of this essay is to explore the ethical principles, mainly looking at the principle of autonomy; Ethical principles are used for staff to meet the requirements of others to an appropriate standard of social and professional behaviour, General Medical Council. (2009). The purpose and status of this guidance. Available: http://www.gmc-uk.org/education/undergraduate/professional_behaviour.asp#The_purpose_and_status_of_this_guidance. Last accessed 16 December 2009). For this assignment the student will explore an ethical problem that they have been faced with on the ward. The ethical problem involves a stroke patient refusing a peg feed, and wishes to have their normal diet. Keeping in line with the Nursing and Midwifery Council (2008) the student will maintain the confidentiality of the patient who will be referred to as Mr P.

Scene

The ethical dilemma that the student has encountered is with a patient that is refusing a peg feed, after he had his swallowing reflexes affected after having a stroke. “A person that rules themselves, is free from the interference of others and free from personal limitations that can obstruct individuals choice.” R Gillon (1986). here for respect of a patient’s autonomy is the most basic rule of ethics. The effects of the stroke left him with speech impediments along with significant swallowing difficulties, resulting in this having an effect on his diet.

McLaren (1998) suggests that stroke patients often experience swallowing difficulties. Correspondingly as well, patients who have been affected by a stroke can have their ability to eat affected Williams & Wilkins, (2007). Impairments range in a variety of different effects from a stroke. In Mr P’s case this was evident that he did have this problem and that Mr P. needed to have an assessment done by the speech and language therapist (SALT).

Problem

Mr P. had his speech impaired along with other effects resulting from the stroke, so needed to have a swallowing assessment done, which was performed by a SALT, patients who have been effected by the stroke have different ways of coping. (http://www.manchester.gov.uk/egov_downloads/report02_25_.pdf.)

After the assessment had be done and had clarified that Mr P. need to have a peg tube to be put in place for the time being so Mr P. would get his adequate diet. But Mr. P. refused insertion of the peg feed because of the way it needed to go in through his stomach, so was making gestures towards the solid food on the tables which was his normal diet by mouth. As Mr P. had his swallowing mechanism affected it was decide for his best interest that he should have a peg feed.

Mr P did refused the peg feeding tube as he felt he could still have a normal diet of solid food, he showed that he did not want the peg tube food by his gestures towards other patients food, at food times. After the refusal a mental capacity test was needed for Mr P. to see if the refusal was made from sound mind. The 2005 Act addresses this perceived imbalance by setting

out a statutory framework for determining decision

making capacity and introducing a checklist of factors for

determining a person’s best interests (Mental Capacity Act

2005, sections 2,3 and 4).

Reason

Complications may occur if Mr P. was to continue with his normal diet by month, because of his swallowing reflex he could end up chocking with his dysphasia. (NIDCD, 1998)

With Mr P. refusing the feeding tube it caused an ethical problem requiring a meeting between the multi disciplinary team, patients and Health Care staff to help maintain a high quality of health care for the patient), house officer and a nurse’s. This is so that they can discuss and to resolve the issue of this problem with the best interests of Mr P. A. Atwal., M. Jones . (2007). The nurse and the house officer knew that Mr P was dysphasic and at risk for aspiration, and they knew that it could lead on to serious complications such as choking and possibly would not survive with a normal diet. The house officer and the nurses recommend the continuation of a feeding tube as it was the best for the benefit and safety of the Mr P. Through hard work and explain the situation to Mr P. and family. It was then decide from Mr P. with conisation from his family that he would try the feeding tube, with the trail of soft food on to normal food in the long run.

Ethical principle/ Discuss

With this ethical dilemma affecting Mr P. it is a struggle between patient autonomy and the principle of beneficence and non-malfeasance. S Fry, M J Johnston (2008).

The student will now explore the ethical principles and theories that link to the case of Mr. P. The ethical problem is the decision for him to have refused a feeding tube.

There are four main ethical principles that are important to nurses to use on the wards and these can be integrated for Mr P. and are used in everyday use. These are autonomy (the right to make choices), beneficence (to do good), non-malfeasance (to do no harm) and justice (fair treatment). (Beauchamp & Childress 2001). To have Respect for patients’ autonomy it requires us, not to deceive patients, for example, not to lie or tell white lies about their diagnosed of their illness unless they clearly wish not to be told. Hunt (1994)

The principle of autonomy is the individuals have to be permitted personal liberty to determine their own actions to (Beauchamp & Childress 2001). This means to respect an individual as self-controlled choosers (Johnstone 1999a). With in health care respecting people’s autonomy requires us to consult people and obtain their agreement before we do medical procedures on them as in the case with Mr P., hence the obligation to obtain informed consent from patients before we do any medical procedures to help them.

With in autonomy patients make there own chooses basis on thoughts of their own mind. To respect persons as autonomous their chooses as an individual must be acknowledge that they make their own choices which come from personal values and beliefs with no interference from others. Fry & Johnstone (2003)

The decision from Mr. P. not to have the peg feed, but to have his normal diet is an expression of his own autonomy. He his choosing what he wants for himself and therefore is to be respected for his autonomous diecon. As it is was not safe for Mr P. this is why non-malfeasance would come into this situation. Autonomy is a big part of the values in life. There is no such thing as complete autonomy, only maximized autonomy. This involves a person/patient being autonomous in all situation they are in. It is important for nurses to remember that patients have a right to their own bodies and lives and are free from interference.

Non-maleficence means to ‘do no harm’ and is considered to be an dominant principle for everyone who undertakes the care of a patient (Munson 2004).

A nurse has a duty to act in the best interest of the patient and prevent them from causing harm to themselves or others. This could be achieved through acting as an advocate to patient’s needs and thoughts. If a patient frequently finds it difficult to fully express their needs and fears (cited in Burnard and Chapman 2000). Mr. P. was aware of the imprecations and with the Medical staff explains how they would slowly move onto his normal diet, but for now for his safety he will need the peg feed inserted. Before he gave consent his family (acting as the advocates) and nurse explained the procedure with the peg feed.

According to Staunton and Chiarella (2004), justice is the idea of treating people equally and giving them what they deserve. It means that all people, regardless of wealth, status or religion, that the patients are entitled to fair access to service.

Beneficence addresses actions of ‘mercy, kindness, and charity.’ It means to promote the welfare of other people (Beauchamp & Childress 2001). Sometimes there are limits to the good nurses can do, but nurses are directed in the Code of Ethics for Nurses with Interpretive Statements to always place there patient’s interests and well-being as their primary interest. Doing good toward and facilitating the well-being of one’s patient is an integral part of being a moral nurse. (Cited in Butts & Rich 2008).

Ethical principles fall under ethical theories they represent the ideas on which guiding principles are based up on. They attempt to be coherent and systematic.

The utilitarian theories follow reasoning that can suggest that an act is morally good or bad based on its outcome. Fry & Johnstone, (2002) Under this way of looking at the situation it can brings the most good to the numbers of people, it is known to be a good or morally correct act. This method is know as a consequence based approach to moral reasoning and is often used to make decisions on how health care is delivered. Fry & Johnstone, (2002)

The deontological theories highlight the rightness of an action based on the ideas that some principles must be upheld.

When trying to come up with the most moral action to take it is not the nature of the outcome that will be judged it is the action itself that is judged right or wrong. It is deemed as an action that is ethically correct(Hawley, 1997c). (ethics in clinical practice, georgina Hawley,harlow,2007)

Teleology or consequentialism is known as “right” in terms of good produced as consequence of an action. It a calculation of the results from performing various tasks relevant to a situation and to choose one that will maximise the ratio of benefit over harm. (candee and puka 1984)

(Ethics in nursing 2nd ed, verena teschudin, 1992, oxford)

These theories bring an entirely new outlook to the process of moral reasoning for ethical issues in nursing practise. Actions are not judged on the outcome, but rather to a view of the caring and responsibility will be used to determine what might be a morally correct as an act. A morally good act is the one that shows caring and concern for other people and what might be important to them. Hunt, (1994)

http://www.encyclopedia.com/doc/1O62-NMCcdfprfssnlcndctstndrdT.html

ilimpacting

Ethical codes are there for everybody in life and with in the hospital wards, there are boundaries to the roles most of the codes can be used with in. The expectation of what an ethical code can do changes depending on how ethical code in general is understood. The difficulties encountered when ethical values are applied reactively to an objective world can be avoided by seeing them as a more integral part of our understanding. It is concluded that an ethical code can establish important values and describe a common ethical background for health care but is of limited use with solving new ethical problems.

The NMC Code of Conduct (NMC, 2005) set out professional codes preparation for practice (NMC, 2005) explained that autonomous practitioners are exercise increasing clinical discretion and accept greater professional responsibility by making their own decisions.

ww.nursingtimes.net/nursing-practice-clinical-research/part-51-accountability-autonomy-and-standards/200972.article, these where the the codes of conduct that was in use before the NMC came into existence in 2002, replacing the UKCC (United Kingdom Central Council for Nursing and Midwifery).

According to the NMC, autonomy implies that that one should respect patients’ and clients’ choices concerning their own lives. Here it becomes imperative for nurses and other health care professionals to respect the values, thoughts and actions of patients and not let their own values or morals influence treatment decisions.

http://www.issuesinmedicalethics.org/093di082.html

Conclusion

In conclusion the student understands the difficulty ethical problems that can have on a patient and staff. The decision making falls down to the patient in a lot of the situation that arise. The causes of the problem can question the decision making of the nurse to whether they believe it to be morally correct. As a professional the nurse has to maintain the respect for patients’ views and continue to practice in a adequate way without prejudice to anyone. The patients going into hospital surroundings expect their rights to be upheld and be involved in the process of their care.

The student will carry on their future of learning to contain with ethics and will be better equipped to deal with a situation if one was to occur in the future while on the wards.

Atwal., M. Jones . (2007). The importance of the multidisciplinary team . British Journal of Healthcare Assistants. 9 (1), 425 – 428.

Beauchamp., Childress. (2001). Principles of Biomedical Ethics. 5th ed. oxford: Oxford University press. 395.

Benner, Partricia A.; Tanner, Christine A. & Chesla, Catherine A. (1996). Expertise in Nursing Practise: Caring, clinical judgment, and ethics. . New york: Springer. 410 -412.

Buka. (2008). Patients rights, law and ethics for nurses . London: Hodder Arnold. 45 .

C Tengnah R Griffith . (2008). Mental Capacity Act 2005: statutory principles and key concepts. British Journal of Community Nursing . 13 (5), 233 – 235.

C. Hodge.. (1990). Value for money?. Nursing times. 14 (5), 20.

Edgar, A. (2004). In W. Tadd (Ed.), Ethical and professional issues in nursing: Perspectives from Europe.

Edwards, S, D. (1996). Nursing ethics a principle based approach. Great Britain: palgrave macmillan.

Fry, S., Johnston. M, J. (2008). Every day nurses are required to make ethical decisions in the course of caring for their patients. Chichester: John Wiley & Sons. 32.

G. Hunt., (1994). Ethical issues in nursing. London: Routledge. 148 – 154.

General Medical Counci. (2009). The purpose and status of this guidance. Available: http://www.gmc-uk.org/education/undergraduate/professional_behaviour.asp#The_purpose_and_status_of_this_guidance. Last accessed 16 December 2009 .

Gillon, R. (1986). Philosophical medical ethics. Chichester: John Wiley & Sons. 60 -61.

Hawley, G. (2007). Ethics In Clinical Practice: An Interprofessional Approach. harlow: Pearson Education. 21.

Thompson, K. Melia, K. Boyd, & D. Horsburgh . (2006). Nursing Ethics. united Kindom: Elseviers Limited. 178 – 190.

Limentani, A. E. (1999). The role of ethical principles in health care and the implications for ethical codes, J. Med Ethics. 25: (5), 394-398 .

Manchester Primary Care Trust. (2006). Stroke: Prevention, treatment, care and support. Available: http://www.manchester.gov.uk/egov_downloads/report02_25_.pdf. Last accessed 14 January 2010

McLaren, S. (1997). Eating disabilities following a stroke . British Journal of Community Nursing. 2 (1), 9-18.

NIDCD. (1998). Dysphagia. Available: http://www.nidcd.nih.gov/health/voice/dysph.asp. Last accessed 15 Jan 2010.

P. Staunton., M. Chiarella (2004). Nursing and the law. Austrlia : Elsevier. 35 -68.

Professional and ethical issues in nursing By Philip Burnard, Christine M. Chapman, Suzan Smallman, 2005, London.

Tschudin, V. (1992). Ethics in nursing, the caring relationship. 2nd ed. oxfford: butterworth-heinennann.

Williams, Wilkins. (2007). nervous system Professional guide to pathophysiology. In: J munden Professional guide to pathophysiology . 2nd ed. Ambler: lippincott williams. 279 -352.

Exp19-access-ch01-cap – loan lending management 1.0

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In the following project, you will open a database containing the records of small loans from a lending firm, work with a form in which to store loan officer information, add records, and sort tables. You add a record using a form and print a report. You apply a filter by selection to a query and a filter by form to a table and save the results for both filters.

Start   Access. Open the downloaded Access file named   Exp19_Access_Ch01_Cap_Loan_Lending_Management.accdb. Grader has automatically added   your last name to the beginning of the filename.

You update a table to contain the data for the Loan Officers,   so that each of the loans processed can be associated with a staff member.

Open the Loan Officers table in Datasheet view. Add the following records to   the Loan Officers table:

FirstName

LastName

EmailAddress

PhoneExtension

Title

John

Badman

[email protected]

x1757

Loan Officer

Stan

Dupp

[email protected]

x6720

Senior Loan Officer

Herb

Avore

[email protected]

x2487

Loan Officer

Polly

Esther

[email protected]

x8116

Senior Loan Officer

Strawberry

Fields

[email protected]

x3219

Loan Officer

Ann

Cerdifone

[email protected]

x5962

Managing Loan Officer

Close the table.

You’ll now add information to   the Loans table for the most recent loan that the firm processed.

OfficerID: 5  MemberID: 15  LoanAmount: 7000  Term: 36   months  InterestRate: 15.41  Payment: 244.07  Grade: D  IssueDate: 12/15/2018  LoanStatus: Late (31-120 days)

You would prefer for the Loan data be presented in order of issue   date with the most recent loans listed first.

Sort the records in the   Loans table by the IssueDate field in descending order (newest to oldest).   Save and close the table.

Next you will use the Maintain   Members form to add another loan that was processed for one of the firm’s   members.

Open the Maintain Members form. In record 3 (for Brynn Anderson, MemberID 13), add a new loan to the subform:

OfficerID: 5  LoanAmount: 17000  Term: 36   months  InterestRate: 4.35  Payment: 300.45  Grade: B  IssueDate: 9/1/2018  LoanStatus: Fully Paid

When you need to navigate to a   record quickly, without a large number of clicks with your mouse, you can   search specific information in the Search field of the Navigation bar at the   bottom of the window. In this case, you are interested in adjusting   information for the author with an MemberID of 16 (Tyler Fletcher).

Use the Navigation bar to search for MemberID 16, and then edit the subform so that the   InterestRate is 12.54 instead of .1899 for   the loan with LoanID 47. Close the Maintain Members form.

Reports are   used to neatly organize table data or query results into a document for   presentation to co-workers and/or supervisors. In this case, you are   interested in confirming that the report you created based on the Loans,   Officers, and Members query is reflecting the appropriate information before   sending it to your supervisor.

Open the Loans, Officers, and Members report and check that the report shows   five loans listing Fully Paid as   Loan Status. View the layout of the report in Print Preview. Close the Loans,   Officers, and Members report. Open the Loans, Officers, and Members query.   Sort the query by LoanOfficer field in ascending order.

You are interested in quickly   filtering the data in the Loans, Officers, and Members query based on loan   officer. Filtering by selection allows you to select your filtering criteria   and apply it to the data. In this case, you would like to see only the loans   managed by John Badman.

Use filter by selection to show only the loans managed by the loan officer   whose name is John Badman.

Sorting allows you to display   data in various ways including alphabetically (A-Z & Z-A), in ascending   order, in descending order, newest to oldest etc. You want to display the   query results alphabetically by LoanStatus.

Sort the query by LoanStatus in alphabetical order. Save and close the query.

Now, you are interested in   quickly filtering the data in the Loans table based on two different fields.   Filtering by form allows you to enter your filtering criteria into a form   that is then applied to the data.

Open the Loans table. Use Filter by Form to create a filter that will   identify all loans with a term of 36   months that also have an interest rate less than .11. Apply the filter and preview   the filtered table. Close the table and save the changes.

Close all database objects.   Close the database and then exit Access. Submit the database as directed.

A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis

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A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis

Assessing the Abdomen-Get Nursing Paper Help-Assessing the Abdomen
A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CAT scan. The CAT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.
Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time-consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.
In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.
Abdominal Assessment
SUBJECTIVE:
CC: “My stomach hurts, I have diarrhea and nothing seems to help.”
HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards.
PMH: HTN, Diabetes, hx of GI bleed 4 years ago
Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs
Allergies: NKDA
FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD
Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)
OBJECTIVE:
VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs
Heart: RRR, no murmurs
Lungs: CTA, chest wall symmetrical
Skin: Intact without lesions, no urticaria
Abd: soft, hyperctive bowel sounds, pos pain in the LLQ
Diagnostics: None
ASSESSMENT:
Left lower quadrant pain
Gastroenteritis
PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
To prepare:
With regard to the SOAP note case study provided:
Review this week’s Learning Resources, and consider the insights they provide about the case study.
Consider what history would be necessary to collect from the patient in the case study.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
To complete:
Analyze the subjective portion of the note. List additional information that should be included in the documentation.
Analyze the objective portion of the note. List additional information that should be included in the documentation.
Is the assessment supported by the subjective and objective information? Why or Why not?
What diagnostic tests would be appropriate for this case and how would the results be used to make a diagnosis?
Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature.
TEXTBOOKS TO USE IF NEEDED ARE AS FOLLOWS
1. Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.
• Chapter 5, “SOAP Notes” (pp. 91–118)
2. Dains, J. E., Baumann, L. C., Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
3. J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Analyze the subjective portion of the note. List additional information that should be included in the documentation.
Analyze the objective portion of the note. List additional information that should be included in the documentation.
Is the assessment supported by the subjective and objective information? Why or Why not?
What diagnostic tests would be appropriate for this case and how would the results be used to make a diagnosis?
Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature.

Reflection on Incident: Care of Drug Overdose Patient

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Critical Incident Report

Critical reflection is an essential skill for nursing practice, reflection can be used as a method that connects knowledge and experiences and it can be argued that nurses who use reflection can be better positioned to provide excellent patient care (Japan Journal of Nursing, 2013, 170-179). This report will focus on values and a range of influences that affect them, styles of leadership and the benefits or disadvantages of them and the importance of quality assurance and of reporting incidents. In this report I am going to critically reflect on an incident that occurred on my placement on a specialist medical ward. During this placement I encountered a patient who had been transferred from Intensive Care following a drug overdose and query suicide attempt, the patient was a known intravenous drug user and was HIV positive and Hepatitis C positive. As a patient on the ward she experienced some discriminatory behaviour and experienced dehumanisation from members of staff due to her diagnoses of HIV and Hepatitis C, this was predominantly through staff gossiping and unprofessional conduct. This eventually led to the patient getting quite upset and agitated causing her to lash out at members of staff. I was part of the care team working alongside the patient from when she was transferred up until she left the ward, during this time I had to report the staff behaviours to the ward leader.

There were multiple influences and factors that led up to the incident, many of these revolved around values. Values are deep-seated beliefs about what is right or wrong and about what is important or unimportant, they are considered as principles, standards or qualities that people care about and that contribute to behaviour. Personal values are supported by a set of unwritten rules or norms regarding what is socially acceptable. Values are a part to professional identity and many professionals have shared sets of values through their regulatory bodies and trust values (Baillie and Black, 2018, 12-14). It is essential to be able to understand and integrate these values into practice, giving consideration to organisational, social and political factors and how they influence health and social care. Social factors could be considered as one of the largest influences leading up to the incident. As mentioned, the patient experienced some discriminatory attitudes and labelling from members of staff during her stay on the ward, certain staff members refused to treat the patient and others made comments about her. The discrimination may be a result of the stigma around intravenous drug users and the belief that all those who inject drugs are HIV positive. This stigma could have developed from the increased risks of HIV in those who take drugs intravenously, this is noted by Avert (2018) who state “people who inject drugs are 22 times more at risk of HIV compared with the general population.” The discriminatory behaviour came from a range of staff including doctors and staff nurses, both of which have set codes of conduct that contain organisational values. The General Medical Council (GMC) code of conduct sets out guidelines and expectations that should be followed by those registered. Principle three discusses ‘objectivity’ and states that ‘holders of public office must act and take decisions impartially, fairly and on merit, using the best evidence and without discrimination or bias” (GMC, 2018). I found it concerning that there was a great lack in compassion for the patient, particularly as our organisational values with the National Health Service promote the Compassion in Care strategy using the 6C’s. The 6C’s are a way of articulating the values which need to underpin the culture and practise of organisations delivering care and support and underpin quality social care provision too (NHS England, 2019).

It is also important to look into the political influences on both personal and

professional values

and how they may have influenced the behaviour during the incident. Political factors such as government policies like the Equality Act (2010) and the Human Rights Act (1998) have indirect influences on our behaviours and values as professionals but also members of society. The discrimination experienced by the patient can be considered as unmoral but also unlawful as The Equality Act (2010) makes discrimination of any kind unlawful, and anyone diagnosed with HIV has the same protections as disabled people, regardless of their health status.

Leadership is essential for a variety of reasons in health and social care settings, particularly for the safety of patients and the management of incidents and elicit effective performance from staff. The Hay Group (2006) found that where nurses demonstrated and used their transformational leadership skills, wards experienced fewer safety incidents. The NHS Leadership Academy (2013) has developed a Healthcare Leadership model in order to describe what should be seen in leaders and how an individual could develop their role, the model is made up of nine leadership dimensions which include ‘Leading with Care’ and ‘holding to account’, this is important to recognise as it shows the NHS taking steps to ensure that their leaders are of the highest standard. Initially there was no leader that was managing the incident, the ward leader in the environment had adopted a ‘laissez-faire’ style of leadership. Laissez-faire leadership is a laid back approach in which the leader has little control or direction over the staff and what they are doing (Royal College of Nursing, 2013), however this leadership style is generally noted as ineffective and although it is recognised as a distant form of leadership it does not mean that team members may take any action they choose, but rather that they stay within certain guidelines and boundaries. The deputy sister on the ward adopted the leadership role for the management of the incident, she used a situational leadership approach, which is where effective leaders adapt their leadership style to manage situations. For the incident she used an autocratic approach to the situation. Autocratic leadership is a form of transactional leadership and uses good structure in order to determine what needs to be done. This was effective for the management of the situation as it meant a resolve could be met and the staff involved were managed in a suitable manner. Through the use of autocratic leadership, the deputy sister spoke to all members of staff, and made it clear that it was unacceptable for any type of discrimination to be present on the ward and reminded them of the NHS and local Trust values. Furthermore, over the course of a week the deputy sister created learning packs around HIV in order to improve staff understanding and remove the stigma around the condition, which had the potential to result in changes in personal values.

Critical incident reporting is essential in proving patient safety and care standards (British Journal of Anaesthesia, 2010) and is key to maintaining quality assurance. When errors are being made repeatedly, it is a gross failure of care, and through the use of incident reporting, these mistakes can be minimised (Journal of General Internal Medicine, 2005, 1063-1067). The term ‘quality assurance’ refers to maintaining a high quality of health care by constantly measuring the effectiveness of the organisations that provide this (WHO, 2018). Reporting incidents is paramount to ensuring that situations do not reoccur and that we learn from the incidents in order to improve the quality of care provided. The incident that I experienced was reported through the trusts internal systems, this was investigated by the ward staff and also more senior members of staff. This is beneficial to improving healthcare standards as it gives an insight into situations that should not be occurring, and it allows senior management to investigate into the reasoning behind the occurrence. Organisations such as the Nursing and Midwifery Council (NMC) have clear guidelines about our role in quality assurance, for example, in the Code of Conduct the section ‘Promote Professionalism and Trust’  clearly highlights the importance of nurses ‘continuing professional development’ and also upholding the values set out in the code of conduct (NMC, 2018). The lack of understanding and compassion that led to the discrimination could suggest that the staff involved may require more training to gain a better understanding of conditions such as HIV, thus allowing them to be more objective and evidenced based with the care that they provide. It is essential that reporting of incidents should be used in order to learn and develop care standards and used for the evaluation of care in order to help improve the systems and practice seen within the National Health Service.

To conclude, through this critical incident report I have considered the significance of reflective reporting and discussed the importance of integrating values within practice giving consideration to organisational, social and political influences on health and social care whilst reflecting on an incident that I have experienced in practice. From the incident that I have reflected on it is clear to see the difference that personal values can have on professional practice, however it is important to consider that organisation’s have their own set of values that should be followed, regardless of personal values. The report has also considered the importance of political influences such as the Equality Act (2010) and how they affect incidents and values. Furthermore, I have looked into a variety of leadership styles including the transactional and laissez-faire methods that were used by different leaders during the incident. Finally, through reflecting on the incident I have been able to discuss the importance of monitoring quality assurance and evaluation of healthcare both in general and also throughout the incident, this has allowed me to consider what was learnt from the incident and how to prevent situations such as this from happening again.


Reference List

  • Avert. (2019).

    People who inject drugs, HIV and AIDS

    . Available from: https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/people-inject-drugs [Accessed 3 January 2020].
  • Baillie, L. and Black, S. (2015). Professional Values in Nursing. Boca Raton: CRC Press, Taylor & Francis Group, 12-14.
  • Branch, W. (2005). Use of critical incident reports in medical education.

    Journal of General Internal Medicine

    , 20(11), 1063-1067. [Accessed 19 January 2020]
  • General Medical Council (2019).

    Code of conduct for Council members

    . London: General Medical Council. Available from: https://www.gmc-uk.org/about/how-we-work/governance/council/code-of-conduct [Accessed 11 January 2020].
  • Hay Group (2006)

    Nurse Leadership: Being Nice is Not Enough.

    London: Hay Group. Available from: tinyurl.com/ Haygroup-frontline-care Health Foundation [Accessed 13 January 2020].
  • Mahajan, R. (2010). Critical incident reporting and learning.

    British Journal of Anaesthesia

    , 105(1), 69-75. [Accessed 19 January 2020]
  • NHS England (2019).

    The 6C’s

    . London: NHS England. Available from: https://www.england.nhs.uk/6cs/wp-content/uploads/sites/25/2015/03/introducing-the-6cs.pdf [Accessed 19 January 2020].
  • NHS Leadership Academy. (2013).

    Healthcare Leadership Model – NHS Leadership Academy

    . London: NHS England. Available from: https://www.leadershipacademy.nhs.uk/resources/healthcare-leadership-model/ [Accessed 19 January 2020].
  • Nursing and Midwifery Council (2018)

    The Code for nurses and midwives

    . London: Nursing and Midwifery Council. Available from: https://www.nmc.org.uk/standards/code/read-the-code-online/#fifth [accessed 07 January 2020]
  • Royal College of Nursing. (2013) Leadership Models.

    Royal College of Nursing: RCNi,

    Available from: https://rcni.com/hosted-content/rcn/first-steps/non-verbal-communication [Accessed 19 January 2020].
  • Tashiro, J., Shimpuku, Y., Naruse, K., Maftuhah and Matsutani, M. (2013). Concept analysis of reflection in nursing professional development.

    Japan Journal of Nursing Science

    , 10(2), 170-179. [Accessed 13 January 2020].
  • The Equality Act 2010 (c.15). London:TSO Available from: http://www.legislation.gov.uk/ukpga/2010/15/contents [Accessed 19 January 2020].
  • World Health Organisation (2018)

    Management of quality care: quality assurance

    . WHO. Available from: https://www.who.int/management/quality/assurance/en [Accessed on 17 January 2020]

Physical and Psychological Domains of Palliative Care

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PHYSICAL AND PSYCHOLOGICAL DOMAINS OF PALLIATIVE CARE

Taking care of critically ill patients is challenging task and it needs proficiency. It’s very difficult to handle a family and terminally ill patient without any proper knowledge. To solve the problems and handle the difficult situation during palliative care is proper training and knowledge about palliative care. It also needs proper training and experience for caring terminally ill patient. According to Kaasa & Loge, (2003) in palliative care quality of life is the basic and central concept. Quality of life is has been used in vast concept which includes physical, psychological, spiritual, and social life of a patient.it is an approach to improve the quality of life of patient who come across life threatening illness for example cancer. The main

purpose of palliative care

is relief from suffering or to early identification of symptoms as early as possible. During my palliative clinical rotation I have encountered a 60 years old, female patient who was diagnosed with liver cancer stage III. Patient was only on palliative care she had not received any chemotherapy or radiation. Now she was admitted in hospital for draining ascetic fluid and for pain management. When I was taking history of patient I came to know that patient was worried about her condition and she was unaware about her diagnosis and prognosis. She was very depressed and anxious about her health. She was unable to do her daily routines due to abdominal distention, pain and tenderness. Furthermore she was physically very weak.

While taking care of patient I found all four domains of palliative care in my patient which includes physical, psychological, emotional, spiritual and sociocultural. But physical and psychological domains were the most effected domains in my patient. In this paper I will

focus on physical and psychological domain of palliative care. In literature it is stated that“Palliative care is aimed at improving the quality of life for patients and their families who are confronted with life-threatening illness by providing support and care for pain, physical symptoms, psychological and social stress, and spirituality.”(Weiner et al, 2013). While taking care of patient I realized that patient was suffering from pain. Some other physical symptoms which are present in patient are abdominal distention, general weakness, shortness of breath, fatigue, and loss of appetite. According to Skevington & Lofty (2003) pain, fatigue, general weakness, loss of appetite, nausea, vomiting are the common symptoms in cancer patients. Furthermoreit is stated inClinical practice guidelines for quality palliative care (2008) regular, ongoing assessment of pain, nonpain symptoms (including but not limited to shortness of breath, nausea, fatigue and weakness, anorexia, insomnia, anxiety, depression, confusion, and constipation), treatment side effects, and functional capacities should be documented through a systematic process.in case of my patient due to abdominal distention she had pain, feeling fullness and shortness of breath. To relief from pain first I encouraged patient to take deep breathing and staff inserted drain to drain out ascetic fluid. After draining 1000 ml fluid she felt relief from pain. In addition in mypatient due to nausea and anorexia she has low appetite. Due to poor intake she felt lethargic and unable to do her daily activities. Therefore I encouraged patient to eat frequently but in small amount and I also educate her attendant about the importance of proper nutrition.

The second important domain affected in my patient was psychological domain. Due to physical deterioration mostly patient become frustrated of their life and do not want to live

furtherand end up with sadness, loneliness, anxiety due to hospitalization and they worried about the prognosis of disease. My patient also faced above mentioned problems as she did not know about her prognosis and she was worried about progressive symptoms likeabdominal distention, pain, fatigue and general weakness.Furthermore in case of my patient she was worried because she was unaware of her diagnosis.When I was taking history her attendant said that we did not disclose the diagnosis to the patient because she already worried about disease. As every patient has right to know about their diagnosis and their disease process. According to Jhordy et al (2007) physical weakness and impairment disturb most aspects of life like psychological, social, sexual, spiritualand other daily activities of life. Due to limitations in activities patients at the high risk of psychological problems. Therefore most of terminal patients think that they are dependent on family and they burden on their children and spouse. In literature it is stated that mood disorder, anxiety, and depression are coexist with advanced illness. Psychological distress with terminal ill patient is very common in palliative care setting. Patient’s response in different ways to show the depression, for example sadness, fear and grief in different stages of their progressive disease.35 to 50 % of cancer patient experience psychological problems. The experience of psychological problems effect on an individual coping mechanism with illness, physical symptoms and on their treatment. (Kelly,Chonchinov &McClement, 2006).Therefore it’s very important to assess the psychological problems of patient to give a quality care and is as important as to assess physical condition of patient. It is also stated in above mention article. That we should educate patient about different psychologist, social groups who support them. To relief from stress I also encourage patient to verbalize her feelings and encouraged her to take deep breathing. We also arrange an activity that we gathered same diagnose patient and encourage them to verbalize their feelings and I also provide a paper to express her feelings on paper. After activity patient mentioned that she felt better and it effects positively on patients.In addition I spend most of the time with patient to encourage her to express her feelings and I also educate her attendant to support her and spend time with her.

The challenges that I faced during clinical were to communicate the prognosis of disease. Because patient was unaware of her diagnosis and their family did not want to tell the patient bout her diagnosis. Therefore due to this reason I was unable to communicate the disease process properly and it hinders me to apply the concept of palliative care. Furthermore due to lack of resources I was unable to give holistic care.

As a nursing student I want to recommend that palliative course should be compulsory in the nursing school and medical, so they can provide knowledge about end of life.There should be proper training for students so they can easily handle the difficulties while taking care of terminal ill patient. It’s not important to give palliative care to only terminal patient but it’s our responsibility that from the diagnosis we have to taking care of patient. On institutional level different seminar should be arrange to give awareness about the palliative care. In addition we can arrange different sessions for patients and families to give awareness about palliative care and disclosure of life threatening diagnosis.it also important to give proper training to the staff of health care system so they can give comfort and help the patient to end up with a peaceful death. There should be a separate bereavement room for families so they express and spend last time with their patients. Moreover there should be a palliative care team so they give proper training to staff ongoing basis to achieve competency in palliative care.According to Ramjan et al (2010) palliative approach can improve comfort and dignity of patient through the early identification and assessment as well as knowing the patients psychological, emotional, social and spiritual concerns. Furthermore we can give awareness through social media, that everyone can approach aware about the importance of palliative care.Mostly patients want to die in home in the presence and support of family. One of article it is mention that health care provider need to support and give education to the family members on symptom management so they can easily continue care at home also(Luckett et al, 2013).

In conclusion, palliative care is very important part of health profession. The basic theme of palliative care is not the treatment of the disease but it is all about to decrease the sufferings of patient.There are different domains in palliative care which are affected due any of progressive disease, such as physical, psychological, spiritual, socio-cultural and sexual domains of life. The most important is physical which disturb other domains of life.Moreover when I reflect back I realized that overall clinical and palliative care is very beneficial and productive. Now I can easily integrate theoretical knowledge in a hospital setting. Furthermore now we can educate patients and their family members abut palliative care and be able to assess all domains of health.

Discuss the principles of holistic care and the four principles of the holistic caring process

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Discuss the principles of holistic care and the four principles of the holistic caring process

•Discuss the principles of holistic care and the four principles of the holistic caring process
•Discuss the differences in patient needs when developing a holistic plan of care
•Discuss the similarities and differences between complementary and alternative medicine and western medicine
•Describe the role of nutrition, exercise, humor and music therapy in complementary and alternative medicine
•Discuss three main barriers to changing our current healthcare system to a more integrative system of care
•Create a short summary of the case file (age, sex, diagnosis)
•Complete a comprehensive, review of needs or problems discovered, and provide rationales and interventions to address the needs
•Discuss implementation and evaluation of complementary and alternative modalities within the plan of care
•Write a short summary in 2–3 paragraphs about the highlights of what this course added to your professional practice and the way you will practice nursing in the future

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Assignment: History about the evolution of nursing

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Assignment: History about the evolution of nursing




ORDER HERE FOR ORIGINAL, PLAGIARISM-FREE PAPERS ON Assignment: History about the evolution of nursing

I need a paper in APA is my personal evolution as student in the mental health class is my own opinion about the class.I attach the rubric for the paper. you need to reed it carefully because need to be cover all those expectation.

Is not history about the evolution of nursing is about me and my own experience as a student and all that i learn in this class following the rubric


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Nursing Evolution Rubric CRITERIA 1. Reflects on current theory and clinical class with concepts and theories using the Program Learning Outcomes and BSN Essentials listed in the syllabus. 2. Develops an effective communication style for interacting with current patients, families, and the interdisciplinary health team when providing holistic, patient centered nursing care to populations encountered in this course. 3. Models leadership when providing safe, quality nursing care; coordinating the healthcare team; and when tasked with oversight and accountability for care delivery. Meets Expectations 3 1. Reflects on current theory class and clinical and how courses support each other (transfer of knowledge to apply to clinical)- Focused to Current Term. 2. Synthesizes theories and concepts from liberal education to build an understanding of the human experience. 3. Uses skills of inquiry and analysis to address practice issues 4. Applies knowledge of social and cultural factors in the care of populations encountered in this course. 1. Reflects on providing holistic patient care to populations encountered in this course. Approaching Expectations 2 1. Limited reflection on current theory class and clinical and how courses support each other (transfer of knowledge to apply to clinical)- Focused to Current Term. Not Meeting Expectations 0-1 1.No reflection on current theory class and clinical and how courses support each other 2. Limited synthesis of theories and concepts from liberal education to build an understanding of the human experience 3. Use limited skills of inquiry and analysis to address practice issues 4. Applies limited knowledge of social and cultural factors in the care of populations encountered in this course. 2. Does not synthesize theories and concepts from liberal education to build an understanding of the human experience 3. Does not use skills of inquiry and analysis to address practice issues 4. Does not apply knowledge of social and cultural factors in the care of populations encountered in this course. 1. A limited reflection on providing holistic patient care to populations encountered in this course. 1. No reflection on providing holistic patient care to populations encountered in this course. 2. Describes inter-collaborative involvement (i.e. Interprofessional rounds; consultations and interaction with PT/OT; Respiratory Therapy, Pharmacist consultation—describe their role/ contribution.) 2. Describes limited inter-collaborative involvement 2. Does not describes inter-collaborative involvement 1. Describe an event that demonstrates: • application of leadership concepts, skills and decision making in the provision of high quality nursing care, • healthcare team coordination • the oversight and accountability for care delivery 2. Describe an event that demonstrates leadership, appropriate teambuilding and collaborative 1. Describes limited • leadership concepts, skills and decision making in the provision of high quality nursing care, • healthcare team coordination and the oversight and accountability for care delivery Gives no examples of leadership concepts, skills and decision making in the provision of high quality nursing care, healthcare team coordination and the oversight and accountability for care delivery in a variety of settings 2. Limited description of an event that demonstrates leadership, appropriate teambuilding and collaborative strategies to effectively implement patient safety and 2. Does not describe an event that demonstrates leadership, appropriate teambuilding and collaborative strategies to effectively implement patient safety Score 2 0 0 Nursing Evolution Rubric strategies to effectively implement patient safety and quality improvement initiatives within the context of the interprofessional team quality improvement initiatives within the context of the interprofessional team and quality improvement initiatives within the context of the interprofessional team …

Assignment: History about the evolution of nursing