REPORT ON RESPONSE TO NURSING

The VA is always so way ahead, but yet so far behind the times. The VA has been one of the forerunners in some topics in the medical field such as changing completely to electric charting. Though the VA may be way ahead at times in technology treatment availability for our veterans, where it matters the most, the ball has been dropped and many suffer. The VA is a nice resource in that it provides quality free care for our veterans. Though it may be quality care is it really free? The time it takes to make appointments and wait for healthcare services through the VA sometimes costs you the window in were treatment is lifesaving. Many veterans have no access to treatment in a timely fashion. As a result many veterans’ disease processes reach a point of no return. If the veteran did not have to wait so long for certain treatments they would not have cancer metastasized so far or worse caught cancer before it had the chance to metastasize. The reason for the delay in care is due to the fact that there are not enough healthcare providers to help the influx of veterans that need primary treatment. REPORT ON RESPONSE TO NURSING

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Publishing of the VA Final Rule allows for advance practice registered nurses to practice without the oversight of medical physicians with the exclusions of CRNAs. Allowing APRNs to practice without a physician is extremely helpful in reducing and ultimately eliminating the delays in accessing healthcare treatments. Though they are allowing APRNs to practice without a physician they excluded CRNAs. Excluding CRNAs I feel will ultimately congest the system up more. You have the same influx of people now being able to see primary care practioners, but now there will be a higher demand for advance therapies and procedures requiring anesthesia. The VA will have practioners to perform the procedure but not enough anesthesiologists. As a result the veterans will still have to wait for treatments therefore delaying their care. In one article the former president of the American Anesthesiologists Dr. Jane Fitch states, “When you have a veteran on the operating table with multiple medical conditions, seconds count. All those years of education and training can make the difference between life and death” (Mckelway, 2016). I do agree with Dr. Fitch’s statement that years of experience may make the difference between life and death, but CRNAs have two years of training and a majority of it is hands on. CRNAs are extremely qualified candidates. It has been proven that the mortality rate does not change when CRNAs are supervised versus unsupervised by a physician. Medicaid and Medicare have allowed some states to “opt out” of supervision because of this finding. Opt out Allows CRNAs to practice without supervision of a physician because there have been multiple studies showing that there was no higher rate of mortality without supervision. I think excluding CRNAs in this Final rule will not fix the problem of delay in care in the VA.  I agree that CRNAs should continue to fight for the right to practice without supervision of a physician in order to help solve this problem making so many veterans suffer. REPORT ON RESPONSE TO NURSING

PRINCIPALISM

Principalism, especially in the context of bioethics in the United States, has often been critiqued for raising the principle of autonomy to the highest place, such that it trumps all other principles or values. How would you rank the importance of each of the four principles? How do you believe they would be ordered in the context of the Christian biblical narrative? PRINCIPALISM

First, I must address what each of the four principles are.

 1. Autonomy—agreement to respect another’s right to self-determine a course of action;

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support of independent decision making (Beauchamp & Childress. 2009).

2. Beneficence- compassion; taking positive action to help others; desire to do good; core

principle of our patient advocacy (Beauchamp & Childress. 2009).

3. Nonmaleficence- avoidance of harm or hurt; core of medical oath and nursing ethics (Beauchamp & Childress. 2009)

4. Justice- refers to an equal and fair distribution of resources, based on analysis of benefits and burdens of decision. Justice implies that all citizens have an equal right to the goods distributed, regardless of what they have contributed or who they are. (Butts &Rich, 2008).PRINCIPALISM 

                In my opinion, Beneficence is the most important principle.  Most ethical theories have embraced various aspects of beneficence, and utilitarian theorists see beneficence as the foundation for causing the greatest benefit for all. If one is to take a positive action to help others and has the core principle to advocate what is good and just for others then the other principles seem to fall into place. Beneficence strives for the best care while embracing not doing anything harmful (Enright & Miyamoto, 2008).  If one acts in beneficence then it stands to reason that they would respect the persons autonomy, they would do no harm and justice would be maintained.  How would I rank each? beneficence, followed by autonomy, nonmaleficence and finally justice.

                In biblical terms, I feel that beneficence would again, be the most important principle. The reason I feel this way is because God gave his only son, for our benefit. Jesus died on the cross for our benefit. Everything that God and Jesus has done has been for the benefit of mankind. It is well known that in the bible, Matthew 25:36, states, I was naked, and you clothed me. I was sick, and you visited me. I was in prison, and you came to me.’ I feel that God wants how we live to benefit others. Everything we do in our lives affects another person one way or the other. It is up to us to have it be a positive benefit to others. PRINCIPALISM

PATIENT RECORD ANALYSIS

Your final project for this course will be a patient record analysis. You will apply the knowledge of anatomy, physiology, and pharmacology that you have developed during this course in a thorough review of existing patient information. Specifically, you will review a patient’s history and a discharge chart from a recent physician visit, explaining the reasons behind diagnosis

or (diagnoses) based on documented symptoms. You will also cite any inconsistencies or concerns and discuss potential and current treatments, all in preparation for your future coding practices. It may seem unnecessary to learn so much about pathophysiology and pharmacology for a career in health information management, but such knowledge is essential in ensuring the accuracy of patient records, coding, and billing.

The project is divided into two milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules Three and Five. The final product will be submitted in Module Seven. PATIENT RECORD ANALYSIS

In this assignment, you will demonstrate your mastery of the following course outcomes:

·Analyze the pathophysiology of commonly diagnosed health conditions for anticipating the pharmacological needs of patients

·Differentiate between common health conditions that present similar symptoms using evidence – based resources for ensuring accurate patient health records

·Analyze standard pharmacological groupings and their specific drugs for their uses in treating patient symptoms and diseases

·Integrate foundational concepts of anatomy, physiology, and medical terminology into the analysis of symptoms, diagnosis, and treatment options for informing accurate coding practices

Prompt

Your patient analysis should answer the following prompt Using the provided Final Project Patient File (attached), critically analyze the patient’s medical and family history and dissect the discharge chart from the patient’s recent visit. There are several inaccuracies and inconsistencies in this patient file; the pages of the file that contain issues are marked in the upper right – hand corner with red bookmarks. You must identify a total of three true issues with the patient file, explain what makes each identified issue a true issue, and discuss how you would approach addressing each issue in a real professional setting. Specifically, the following critical elements must be addressed:

I. Patient History Analysis

a) Summarize the patient history, explaining key patient demographics and family history that could be risk factors for common diseases.

b) Identify the past diagnosis (or diagnoses, if more than one exists in the file) and explain how the diagnosis was made. Specifically, what tests were done?

c) Discuss the symptoms the patient showed according to the file. Why and how did these symptoms lead the doctors to order certain tests?

d) What alternate diagnosis (or diagnoses) could these symptoms have indicated? Explain using evidence – based resources to support your conclusions. PATIENT RECORD ANALYSIS

e) Using supportive details from peer – reviewed resources, explain the pathophysiology of the diagnosis. In other words, how does the diagnosed disease develop and progress in the body?

f) Identify the past prescribed medications the patient is taking and explain the purposes of their larger

pharmacological groupings.

g) Explain what symptoms the specific medications are meant to treat, using resources to support your claims about the impact of the medication on the symptoms.

h) Illustrate how these medications impact the body and its functions. Use examples to support your explanations.

II. Recent Visit Analysis

a) Explain why the patient has returned to the doctor’s office. What symptoms and signs is the patient experiencing?

b) Analyze the new symptoms and signs to determine whether the past diagnosis is still a reasonable conclusion or could have been a

misdiagnosis. Use specific information from both the recent visit and the patient history to inform your analysis.

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c) Based on the new signs, symptoms, and potential diagnosis (if the doctor has made a new diagnosis), discuss what new or potential

treatments would be appropriate. Why?

III. Identification of Record Inaccuracies

a) The patient file contains several inaccuracies and inconsistencies. Using your knowledge of medical terminology, anatomy, and physiology, articulate three issues you’ve identified.

b) Explain in detail what makes the identified issues a problem in terms of patient health and recordkeeping. Be sure to use appropriate medical terminology, references to anatomy, and concepts of normal physiology, where appropriate.

c) Discuss the impact of the issues on the patient, the coding system, and the billing system if they had not been caught, using the appropriate terminology.

d) Illustrate how you would work to address each issue, with specific detail regarding who you would pull into the discussion and who would be responsible for the particular details of each issue in a real medical setting.

In this Module, you will complete your record inaccuracies identification and submit your completed patient record analysis. It should be a complete, polished artifact containing all of the critical elements of the final product. It should reflect the incorporation of feedback gained throughout the course. PATIENT RECORD ANALYSIS

The length of your patient record analysis will depend on the issues you find in the file, but it will likely be 8–10 pages with an

additional page for references. All citations should be made according to the latest version of APA guidelines.

FINAL PROJECT CHECKLIST

Your final project should discuss the following critical elements. Make sure you review your final project before you submit it, and make sure it discusses all the critical elements and answers the questions.

I. Patient History Analysis

a) Did you summarize the patient history, explaining key patient demographics and family history that could be risk factors for common diseases?

b) Have you identified the past diagnosis (or diagnoses, if more than one exists in the file) and explained how the diagnosis was made? Specifically, what tests were done?

c) Did you discuss the symptoms the patient showed according to the file? Did you discuss why an d how these symptoms led the doctors to order certain tests?

d) Did you include what alternate diagnosis (or diagnoses) these symptoms could have indicated? Did you use evidence – based resources to support your conclusions?

e) Using supportive details from peer – reviewed resources, did you explain the pathophysiology of the diagnosis? In other words, how does the diagnosed disease develop and progress in the body?

f) Have you identified the past prescribed medications the patient is taking and explained the purposes of their larger pharmacological groupings?

g) Did you explain what symptoms the specific medications are meant to treat, using resources to support your claims about the impact of the medication on the symptoms?

h) Did you illustrate how these medications impact the body and its functions? Did you include examples to support your explanations?

II. Recent Visit Analysis

a) Did you explain why the patient has returned to the doctor’s office? Did you discuss what symptoms and signs the patient is

experiencing?

b) Did you analyze the new symptoms and signs to determine whether the past diagnosis is still a reasonable conclusion or could have been a misdiagnosis? Did you use specific information from both the recent visit and the patient history to inform your analysis?

c) Based on the new signs, symptoms, and potential diagnosis (if the doctor has made a new diagnosis), did you discuss what new or potential treatments would be appropriate? Why? PATIENT RECORD ANALYSIS

III. Identification of Record Inaccuracies

a) The patient file contains several inaccuracies and inconsistencies. Using your knowledge of medical terminology, anatomy, and physiology, did you articulate three issues you have identified?

b) Did you explain in detail what makes the identified issues a problem in terms of patient health and record keeping? Did you use appropriate medical terminology, references to anatomy, and concepts of normal physiology, where appropriate?

c) Did you discuss the impact of the issues on the patient, the coding system, and the billing system if they had not been caught, using the appropriate terminology?

d) Did you illustrate how you would work to address each issue, with specific detail regarding who you would pull into the

discussion and who would be responsible for the particular details of each issue in a real medical setting? PATIENT RECORD ANALYSIS

REPORTS ON SCIENTISM

Write an 800-1,000 word essay on your personal worldview. Briefly discuss the various possible meanings of the term “spirituality,” and your understanding of the concepts of pluralism, scientism, and postmodernism. Primarily, address the following seven basic worldview questions: REPORTS ON SCIENTISM

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1. What is prime reality?
2. What is the nature of the world around you?
3. What is a human being?
4. What happens to a person at death?
5. Why is it possible to know anything at all?
6. How do people know what is right or wrong?
7. What is the meaning of human history?

Prepare this assignment according to the APA guidelines found in the APA Style Guide

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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Personal Worldview Inventory

	1 Unsatisfactory 0.00%	2 Less than Satisfactory 65.00% REPORTS ON SCIENTISM	3 Satisfactory 75.00%	4 Good 85.00%	5 Excellent 100.00%
70.0 %Content
25.0 % Comprehension of Pertinent Terms	The concept of spirituality is not analyzed clearly, and no distinctions are made among possible meanings of the term. Only one meaning for the term spirituality is assumed. There is no discussion or discernible grasp of the concepts of pluralism, scientism, and postmodernism.	There is surface coverage of the concept of spirituality, with some distinctions, but demonstrating poor or unclear grasp of these distinctions. There is a poor grasp and application of scientism and postmodernism to the concept of spirituality. REPORTS ON SCIENTISM	At least two senses of spirituality are distinguished, though the grasp of that distinction may be shallow. Grasp of scientism and postmodernism is limited to its definition, with some demonstration that its full application and significance is grasped, even if minimally.	At least two senses of spirituality, including from the text, are distinguished. Description of how spirituality is broadly defined in the context of scientism and postmodernism is provided and sufficiently demonstrates a grasp of the meaning of these concepts.	Several possible definitions of the term spirituality, including from the text, are clearly articulated and distinguished. Description of how spirituality is broadly defined in the context of scientism and postmodernism is provided and clearly demonstrates a grasp of the meaning of these concepts.
45.0 % Personal Worldview Analysis	The analysis does not answer all seven questions and there is no discussion of the interconnection of the questions and their implications.	The analysis answers all seven questions but with minimal thought and any attempt at interconnection of the questions has little to no relevance.	The analysis answers all seven questions thoughtfully and in a detailed manner. The analysis hints at the interconnection of the questions and their implications.	The analysis answers all seven questions thoughtfully and in a detailed manner. The analysis recognizes the interconnection of the questions and their implications.	The analysis answers all seven questions thoughtfully and in a detailed manner. The analysis thoroughly explains the interconnection of the questions and their implications.
20.0 %Organization and Effectiveness
7.0 % Thesis Development and Purpose	Paper lacks any discernible overall purpose or organizing claim.	Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.	Thesis and/or main claim are apparent and appropriate to purpose.	Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.	Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.
8.0 % Argument Logic and Construction	Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.	Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.	Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.	Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.	Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
5.0 % Mechanics of Writing (includes spelling, punctuation, grammar, language use)	Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.	Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.	Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.	Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.	Writer is clearly in command of standard, written, academic English.
10.0 %Format
5.0 % Paper Format (use of appropriate style for the major and assignment)	Template is not used appropriately, or documentation format is rarely followed correctly.	Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. REPORTS ON SCIENTISM	Appropriate template is used. Formatting is correct, although some minor errors may be present.	Appropriate template is fully used. There are virtually no errors in formatting style.	All format elements are correct.
5.0 % Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)	Sources are not documented.	Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. REPORTS ON SCIENTISM	Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.	Sources are documented, as appropriate to assignment and style, and format is mostly correct.	Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
100 % Total Weightage