Scenario:

Mark, a 35-year-old, was brought via ambulance to the emergency department after collapsing on the street. He was diagnosed with appendicitis and the surgical team was alerted to the potential surgery. The physician prepared to obtain informed consent and began discussing the simple effective surgery and the treatment with the patient. The RN was present at the bedside. The patient stated he did not want surgery. Based upon his beliefs as a Christian Scientist, it is against his practices. He requested a Christian Science practitioner. The patient rated his pain as 9 on 0-10 verbal pain scale so the RN prepared the narcotic analgesic to relieve the patient’s pain. The patient declined the medication. The RN believes the patient should accept the pain medication and have the surgery thinking “If it were me I would proceed with the surgery and treatments proposed by the surgeon.” The surgeon can be heard speaking to a fellow surgeon about how to go about changing the patient’s decision.

Initial Discussion Post:

Address the following:

1. State and discuss the legal and ethical considerations occurring in this scenario. Include supporting citations.
2. How can RNs support the patient’s decision when the beliefs of the patient are contrary to their own? List three (3) interventions, with supporting rationales, the RN would perform to ensure the delivery of culturally sensitive care.
3. Identify one (1) additional major religion, in which the same circumstances might also require the RN to advocate for the patient’s refusal of surgery. Describe the beliefs behind why the identified religion could pose a moral conflict for a similar patient.

Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.

Discussion 2: Diversity and Health Assessments

In May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the health care field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and health care professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds.

Case 1

Subjective Data

CC: “I came for my annual physical exam, but do not want to be a burden to my daughter.”

History of Present Illness (HPI): At-risk 86-year-old Asian male – who is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs.

PMH: hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis

PSH: S/P cholecystectomy

Drug Hx:

Current Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and cipro 100mg daily.

Review of Systems (ROS)

General: + weight loss of 25 lbs over the past year; no recent fatigue, fever or chills.

Head, eyes, ears, nose & throat (HEENT): no changes in vision or hearing, no difficulty chewing or swallowing.

Neck: no pain or injury

Respiratory:

CV:

GI:

GU: no urinary hesitancy or change in urine stream

Integument: multiple bruises on his upper arms and back.

MS/Neuro: + falls x 2 within the last 6 months; no syncopal episodes or dizziness

Psych:

Objective Data

PE: B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, ornasopharynx clear, edentulous.

Lungs: CTA AP&L

Cor: S1S2 without rub or gallop

Abd: benign, normoactive bowel sounds x 4

Ext: no cyanosis, clubbing or edema

Integument: multiple bruises in different stages of healing – on his upper arms and back.

Neuro: No obvious deformities, CN grossly intact II-XII

Case 2

Subjective Data

CC: “I am here for my annual physical exam and have been having vaginal discharge.”

History of Present Illness (HPI): 32-year-old pregnant lesbian – her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank.

Drug Hx:

Current Medications: prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion

Family Hx: She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.

Review of Systems (ROS)

General: no fatigue, fever or chills.

Head, eyes, ears, nose & throat (HEENT):

Neck: no pain or injury

Respiratory:

CV:

GI:

GU:

Integument: multiple piercings, and tattoos. Old scars related to “cutting”.

Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements

Objective Data

PE: B/P 128/76; Pulse 83; RR 16; Temp 99.0; Ht 5,6; wt 128; BMI 20.98

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, ornasopharynx clear, good dentition. Piercing in her right nostril and lower lip.

Lungs: CTA AP&L

Cor: S1S2 without rub or gallop

Abd: benign, normoactive bowel sounds x 4

GU: external genitalia intact, no lesions or masses. White copious discharge with an amine odor; no cervical motion tenderness; adenxa intact.

Ext: no cyanosis, clubbing or edema

Integument: intact without lesions masses or rashes.

Neuro: No obvious deficits and CN grossly intact II-XII

Case 3

Subjective Data

CC: “Annual physical exam”

History of Present Illness (HPI): 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle.

Drug Hx:

Current medication – denied

Allergies: no allergies to food or medications.

Family history: is very positive for diabetes, hypertension, and alcoholism.

Review of Systems (ROS)

General: no recent weight gains of losses, fatigue, fever or chills. Head, eyes, ears, nose & throat (HEENT):

Neck:

Respiratory:

CV: no chest discomfort or palpitations

GI:

GU:

Integument: history of eczema – not active

MS/Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements

Psych:

Objective Data

PE: B/P 158/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt 208; BMI 32.6

General: 23 year old male appears well developed and well nourished. He is anxious – pacing in the room and fidgeting, but in no acute distress.

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, ornasopharynx clear, poor dentition – multiple carries.

Lungs: CTA AP&L

Cor: S1S2, +II/VI holosystolic murmur; without rub or gallop

Abd: benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin.

Ext: no cyanosis, clubbing or edema

Integument: intact without lesions masses or rashes.

Neuro: No obvious deficits and CN grossly intact II-XII

To prepare:

• Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
• Select one of the three case studies. Reflect on the provided patient information.
• Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
• Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
• Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 3

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Assignment Practicum Journal Entry: Pediatrics

1). Reflect on a PEDIATRIC Patient (CHILD or ADOLESCENSE)  who presented with gastrointestinal disordersduring your Practicum experience.

2). Describe your experience in assessing and managing the patient and his or her family.

3). Include details of your “aha” moment in identifying the patient’s disorder.

4). Then, explain how the experience connected your classroom studies to the real-world clinical setting.

NOTE:  If you did not have an opportunity to evaluate a patient with this background during the last 9 weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.

NOTE: This paper is on a child; not an ADULT patient.

WRITE a 1 (one) PAGE PAPER.

–Due Saturday 4/28/17; before Midnight

—Must have Nursing background to take this job.

–Deliver scholarly written material not high school stuff I saw.

—APA format with at least 3-4 references on your topic of choice.

—All references cited on paper and must be within 5 years old.

— Must be original and FREE OF PLAGIARISM.

NOTE: Each paper is run through Turn-it- in

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ApplicationPLEASE MAKE SURE IT’S IN APA STYLE FORMAT. CITE ACCURATELY.

The Nurse’s Role in Supporting the Organization’s Strategic Agenda

As hospitals seek to reduce the incidence of Never Events and improve the overall quality of health care provided, it is apparent that ultimate success will require the effort of the entire medical staff. Consider the nurse’s role in supporting the organization’s strategic agenda as it relates to improving clinical outcomes. For this application you are asked to interview a quality manager in an acute care or long-term care agency of your choice. Your goal is to determine the manager’s view regarding the impact of the direct care nurse’s role in clinical outcomes for the organization. How does this influence the ability of the organization to achieve its strategic agenda? Before you attend the interview, create a list of relevant questions that will help you better understand the effect a nurse can have on the successful treatment of the patient. Write a 3-page paper discussing what you learned from this interview. How will what you learned impact how you approach your nursing responsibilities?

Assignment Option 1: The U.S. Healthcare System: Analysis of a Healthcare Sector

Your portfolio assignment focuses on a specific sector of healthcare and its relation to the current U.S. healthcare system. Choose one of the healthcare sectors listed below for your portfolio assignment:

•    Hospitals

•    Long-term Care

•    Mental and Behavioral Health

•    Ambulatory Care

•    For-Profit/Public Health Care.

Write a ten to twelve page paper where you address the following:

·       Describe of the sector’s historical development and current role in healthcare delivery.

·       Explain how the political influence in the U.S. healthcare system impacts how this sector provides healthcare to specific communities.

·       Evaluate how quality, safety, and competition within this healthcare sector impact patient care.

·       Examine what major challenges exist for this sector for the system over the next decade from healthcare reform and other factors. Discuss a minimum of three challenges and offer your recommendations on how healthcare leaders and administrators can manage them.

·       Provide a conclusion summary of your findings and of the project experience.

Your paper should meet the following requirements:

·       Be ten to twelve pages in length, not including the cover or reference pages

·       Be formatted according to the CSU-Global Guide to Writing and APA Requirements 

·       Provide support for your statements with in-text citations from a minimum of eight scholarly references – four of these references must be from outside sources and four may be from course readings, lectures, and textbooks. The CSU-Global Library is a good place to find these references.

Utilize the following headings to organize the content in your work.

•    Introduction

•    Historical Development and Current Role in Healthcare Delivery

•    Political Influence

•    Quality, Safety, and Competition

•    Future Challenges and Issues

•    Recommendations

•    Conclusion