WHY A NURSING HOME SHOULD HAVE AN ETHICS COMMITTEE

In Chapter 8 of your textbook Moody (1996) discusses ethics committees in nursing homes and states that federal regulation may soon require that nursing homes move in the direction of establishing ethics committees (pp 172-174).
 
As of 2011 there were only a handful of state laws and no federal laws mandating the existence of ethics committees. However, there was a mandate for ethics committee made in the private, although influential, accreditation standards of the Joint Commission, an independent, not-for-profit organization, that is seen as the nation’s predominant standards-setting and accrediting body in healthcare (Pope, 2011).
 
In addition to Joint Commission the American Medical Director Association (AMDA) recommends that each facility should have an ethics “mechanism” to assist in managing decisions such as do-not-resuscitate and other end-of-life issues (AMDA).
 
Research nursing home ethics committees and write a 2 – 3 page paper on why a nursing home should have an ethics committee and what the responsibilities of the committee are.
 
Support your statements with evidence from the Required Studies and your research. Cite and reference your sources in APA style.

Benner identifies Virginia Henderson as a significant early influence on her nursing career (Benner & Wrubel, 1989). Benner’s earlier work relating to expert nursing practice investigated the progression of skill acquisition for nurses based on the skill acquisition theory developed by philosopher Hubert Dreyfus and his brother, mathematician and systems analyst Stuart Dreyfus (Dreyfus & Dreyfus, 1980). It is important to clarify that Benner has consistently referred to this model as the “Dreyfus Model of Skill Acquisition.” Benner, rather than developing a model of skill acquisition, merely validated and extended the existing Dreyfus model to exemplify the process of skill acquisition in nursing. In addition, much of Benner’s writing is the result of collegial effort. For the sake of preventing redundancy, general references contained in this chapter to Benner’s work must be assumed to refer to Benner and colleagues.
Benner served as project director for the Achieving Methods of Intrapersonal Consensus, Assessment and Evaluation project from 1979 through 1981. This project was designed to identify differences between beginning and expert nurses’ clinical performance and situational appraisals (Benner, 1984/2001). A sample of 21 pairs of nurses in a preceptor relationship (newly graduated nurse and expert) was examined using an interpretive phenomenological method and structured using the Dreyfus Skill Acquisition Model (Dreyfus & Dreyfus, 1980). The pairs were interviewed separately and asked to describe a clinical incident that they had in common to determine if there were differences in the descriptions, indicating differing perceptions and approaches. In addition to the 21 pairs, 51 experienced nurses selected by administrators as being highly skilled, 11 new graduates, and five senior nursing students were interviewed (individual and small group) and/or observed to identify characteristics of performance in other skill levels of nurses. Six hospitals were represented. The results of this study are reported in From Novice to Expert: Excellence and Power in Clinical Nursing Practice (FNE). Findings indicated discernable differences in skill level between novices, advanced beginners, and competent, proficient, and expert nurses. Narrative descriptions were interpreted, and 31 nursing competencies were identified. These competencies were further examined and classified into seven domains of nursing practice. The information presented in FNE regarding skill acquisition domains of nursing practice provides a structure for later works in that frequent reference is made to the differences between inexperienced and expert nursing in terms of concepts such as critical thinking, intuition, and ethical agency.
While the levels of skill acquisition along with the related competencies and domains of nursing practice identified in FNE are frequently used as a framework for practice and education, Benner did not state an intent to develop an interpretive theory until the publication of Primacy of Caring (Benner & Wrubel, 1989). Here, Benner and Wrubel comment on the limitations of existing nursing theories in capturing the essential human issues that are central to nursing. They state, “A theory is needed that describes, interprets, and explains not an imagined ideal of nursing, but actual expert nursing as it is practiced day by day” (p. 5) with a goal to “make visible the hidden significant work of nursing as a caring practice” (p. xi). Benner and Wrubel note, “This book is devoted to an interpretive theory of nursing practice as it is concerned with helping people to cope with the stress of illness” (p. 7).
Primacy of Caring (Benner & Wrubel, 1989) contains further development of the distinguishing features of expert nurses begun in FNE as well as a description of the primary role of caring in nursing practice. Expert nursing practice, as presented in that work, is based on caring at multiple levels of practice. Caring is defined as a “basic way of being in the world” (p. xi) and nursing as a “caring practice whose science is guided by the moral art and ethics of care and responsibility” (p. xi). The descriptions contained in Primacy of Caring relate to the primacy of caring as a significant factor in stress and coping, nursing practice, and illness outcome. Expert nursing care is described related to specific situations such as chronic illness, cancer, and neurological illness. In addition, Benner discusses caregiving from a feminist perspective in her chapter on coping with caregiving.
Benner, Tanner, and Chesla (1996) present the findings of a study conducted between 1990 and 1996 in Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics (ENP). This work extended the original data of earlier studies. An additional 130 critical care nurses representing eight hospitals were interviewed in small groups, with 48 of those nurses individually interviewed and observed in practice. Benner states, “From this original study, we developed an ethnography of the practice of critical care nurses” (Benner, Hooper-Kyriakides, & Stannard, 1999, p. 6). ENP devotes several chapters to application of this information for improvement of nurse–physician relationships and implications for nursing education and administration.
Benner et al. (1999) published Clinical Wisdom and Interventions in Critical Care: A Thinking-in-Action Approach (CWICC) based on the findings of Phase 2 of the previously described study. Conducted between 1996 and 1997, Phase 2 extended the critical care focus to an additional 75 nurses working in a wide variety of critical care areas as well as advanced practice nurses. This book gives insight into the development of expert critical care nurses’ ability to grasp a problem intuitively and plan ahead when in familiar clinical situations as well as excellent examples of Benner’s nonlinear concept of nursing process. The work identified two habits of thought and actions of expert critical care nurses: (a) clinical grasp and clinical inquiry and (b) clinical forethought. In addition, nine domains of critical care nursing practice with nursing competencies specific to the critical care setting were delineated. Implications for the educational strategies to foster development of expertise are presented in CWICC.

THE U.S.DETERMINE THE AVERAGE DAILY COST OF NURSING HOME CARE IN YOUR STATE.

Week 4 DiscussionLong-Term Care in the U.S.Determine the average daily cost of nursing home care in your state. Discuss the funding options (public and private) that exist to pay for long-term care. What policy and financing recommendations would you make to ensure that long-term care is available for everyone who needs the services in the U.S.? Please justify your answer.Rationing of Healthcare ServicesHealthcare services can be rationed by governmental rationing or by allowing those who can afford the services to purchase the services. If you were the chairperson of a medical ethics committee faced with the decision concerning which of the following patients would receive a heart transplant what decision would you make and what justification would you give to the families of each of the patients for making that decision?Patient 2: A forty-six-year-old unemployed auto worker with a history of alcohol use and smoking suffered a heart attack and will die within one month if he does not receive a heart transplant. The patient does not have health insurance nor does he have the resources to pay for the procedure.
Please do the following in its entirety: 
Answer all question please. 
Please  sure to use a cover sheet and please submit a reference page with  your assignment. Late assignments will not be accepted. NO EXCEPTIONS PLEASE!!!!
1.Apatient is having cardiac enzymes drawn to rule out a Myocardial Infarction.
a) What are the clinical indication and nursing implications for the following enzymes and their importance as a marker for Myocardial Infarction?
CK 
    CK-MB 
     Myoglobin and Troponin 1.
2.A patient has chest pains and is worried of having a second Myocardial Infarction.
a) What are the discriminating differences between chest pains from angina pectoris  versus the pain associated with Myocardial Infarction.

Question Description

CASE STUDY

You are caring for an 82-year-old woman who has been hospitalized for several weeks for burns that she sustained on her lower legs during a cooking accident. Before the time of her admission, she lived alone in a small apartment. The patient reported on admission that she has no surviving family. Her support system appears to be other elders who live in her neighborhood. Because of transportation difficulties, most of them are unable to visit frequently. One of her neighbors has reported that she is caring for the patient’s dog, a Yorkshire terrier. As you care for this woman, she begs you to let her friend bring her dog to the hospital. She says that none of the other nurses have listened to her about such a visit. As she asks you about this, she begins to cry and tells you that they have never been separated. You recall that the staff discussed their concern about this woman’s well-being during report that morning. They said that she has been eating very little and seems to be depressed.

1. Based on Nightingale’s work, identify specific interventions that you would provide in caring for this patient.

2. Describe what action, if any, you would take regarding the patient’s request to see her dog. Discuss the theoretical basis of your decision and action based on your understanding of Nightingale’s work.

3. Describe and discuss what nursing diagnoses you would make and what interventions you would initiate to address the patient’s nutritional status and emotional well-being.

4. As the patient’s primary nurse, identify and discuss the planning you would undertake regarding her discharge from the hospital. Identify members of the discharge team and their roles in this process. Describe how you would advocate for the patient based on Nightingale’s observations and descriptions of the role of the nurse.

Critical thinking activities

1. Your community is at risk for a specific type of natural disaster (e.g., tornado, flood, hurricane, earthquake). Use Nightingale’s principles and observations to develop an emergency plan for one of these events. Outline the items you would include in the plan.

2. Using Nightingale’s concepts of ventilation, light, noise, and cleanliness, analyze the setting in which you are practicing nursing as an employee or student.

Instructions: Write an essay (about 500 words) in response to the topic. Give your essay a title.
(Underline the thesis of your essay.  If you submit an essay in which the thesis is not underlined, five points will be subtracted from the grade you receive for the essay.)
TV talk shows present us with an almost endless array of celebrities who tell us that greatest good in life is personal fulfillment.  Many of us get the impression that wanting something or wanting to do something makes it right and that we have a right to pursue whatever we want regardless of the consequences for ourselves or others.
In an entitled essay explain why you believe that this notion of personal fulfillment is good or bad for both individuals and society.
 
Commentary

Are we obligated to think about how our pursuit of happiness affects others?  Do people overindulge in their wants and desires and ignore the consequences to themselves and others?  Before you can address this topic, you must determine the meaning of the term “personal fulfillment.”  You may find that there are many ways to define this term, a term that is often misunderstood by most people. The famous Greek philosopher, Aristotle, would probably urge us to observe the “golden mean” when we search for personal fulfillment.  Some spend most of their lives seeking personal fulfillment only in material things and are never happy, whereas others seem to be completely happy with possessions.

Assessing and Planning Care for an Elderly Person

In order to gain an insight into the world of elder adults, it is important to understand how they view themselves and the values they hold. Additionally it is important to assess and determine his/her needs and establish appropriate interventions for this individual.
By the due date assigned, choose an older adult to interview. This cannot be a patient in your clinical setting. You can use a friend, family member, or co-worker. The older adult should be 65 years or older. Use the format provided to record the responses. A list of questions is available for you to start with. Include 2–3 questions of your own to get a complete picture of the older adult. Summarize your findings and also contrast the responses with findings in your readings and other current literature.
Download a patient questionnaire. This form should be used as an example.
After gaining permission, conduct a physical and mental functional assessment of the older adult you have chosen. Review your readings for the process of functional assessment.
Make use of the tools discussed this week to complete a comprehensive assessment of your patient. Search the Internet for resources on these tools.

  1. Tinetti Balance and Gait Evaluation
  2. Katz Index of Activities of Daily Living
  3. Assessment of Home Safety
  4. The Barthel Index

Make sure the older adult is clearly identified on the tools. Do not include their name, but do include professional or other designation, and age. Your name should also be identified on the tool. (This should be a part of your Appendix.)
Compare and contrast the age-related changes of the older person you interviewed and assessed with those identified in this week’s reading assignment. During this data analysis process provide at least 4–6 preliminary issues that you have identified. Identify three alterations in health that you would propose and describe them. Identify a minimum of three comprehensive interventions for each problem.
Make sure that you integrate personal cultural awareness and cultural competency.
Paper should be 5–6 pages, not including the questionnaire or tools used. These should be attached as an Appendix. Remember to use headings to identify the different sections in your paper.
On a separate references page, cite all sources using APA format.

  • Use this APA Citation Helper as a convenient reference for properly citing resources.
  • This handout will provide you the details of formatting your essay using APA style.
  • You may create your essay in this APA-formatted template.
  • Attached Files:
    • File SOC-220_SOCIAL PROBLEMS PRESENTATION_Sample.pptx SOC-220_SOCIAL PROBLEMS PRESENTATION_Sample.pptx – Alternative Formats (1.525 MB)
    • File SOC 220 common presentation assignment rurbic.docx SOC 220 common presentation assignment rurbic.docx – Alternative Formats (18.424 KB)
    • Power Point Assignment Rubric and List of Social Problems are attached:
      Social Problems Presentation Instructions
      Introduction
      This assignment will investigate the concepts covered in this course and allow you to use policy evaluation, cultural values, and political outlook to discuss it.
      This assignment fulfills/supports
    • Module Outcome: You will define how prejudice, stereotypes, and racism help to perpetuate disadvantage for less powerful groups.
    • Course Outcome #2: You will identify and describe key social problems and proposed solutions.
    • General Education Competency #1: You will use critical thinking skills that support cultural awareness and a global perspective.
    • The Project Assignment:
      As a journalist or researcher, create a 1-2 minute commercial OR 15-22 Power Point Presentation on an international (I ask that you limit your topics to non-American social problems) social problem to be shown during the news. This information should be compiled into a commercial presentation using power point slides, Flipgrid, Animoto, or Powtoon.
      You must answer the following questions by also providing a typed summary in MSWord format answering the following questions if you are providing a 1-2 min. commercial. If choosing a power point presentation, please make sure theses questions are included in your presentation with answers- detailed and comprehensive, using 3 academic sources (min.) or more if needed:
    1. Topic selection and explanation for choosing the topic. Select a problem in another country. Since there are literally hundreds of topics to choose from, I ask that you limit your topics to non-American social problems. Identify the problem. Provide some background and/or information concerning why you choose this particular topic. Be sure to discuss who is involved. (0-15 points)
    2. Explain why the social problem is considered a serious issue. Provide research within the past 5 years. Is the problem increasing, and if so, how and/or why? (0-25 points)
    3. Acknowledge how this problem can be addressed from a journalist perspective. What path would you take to bring light to the problem if you were a journalist for this story? For example, you may choose to focus on a specific region or topic. If you want to focus on a specific topic, some ideas for you to consider might be youth (toy soldiers, child labor), gender, rape, health, illness (AIDS), drug use (additional topics may be found under helpful information). Since there are literally hundreds of topics to choose from, I ask that you limit your topics to non-American social problems. (0-20 points)
    4. Identify at least four sociological concepts related to this social problem. You must demonstrate your understanding by including one sociological perspective. You may select three other concepts and explain how it helps us better understand the nature of the social problem you selected? (i.e. socialization, norms, gender, deviance, dehumanization, cultural universal, alienation, role expectations, life span, etc.) (0-15 points)
    5. What might be one important way in which the social issue is currently being addressed in society?  Examine examples from mainstream media that address the issue. Provide at least two examples of a current event, news report, or a media outlet that addresses the social problem. (0-15 points)
    6. American Solution. If this problem were in America, how would the problem be solved? (0-10 points)
    7. Your commercial presentation should be critical and analytical (solely not opinion)
      Any evidence of plagiarism to include self-plagiarism will result in zero for this assignment.
      Resources:
      Social Problems: Community, Policy, and Social Action. Leon-Guerrero, A. Canada: Sage.
      FTCC Library
      Public Library
      http://lib.guides.umd.edu/c.php?g=326995&p=2194601 (Link of examples of social problems)
      Acceptable Length:
      1-2 minutes or fifteen slides
      Formatting Requirements
    • Put your name, course and section number, and assignment title on the title slide.
    • References should be in MLA Citation Style
    • Submit through SafeAssign.
    • Grading Criteria
      You must address the problem with:
      ¬    At least 3 references for this assignment; Wikipedia may not be used as a reference.
      ¬    Academic writing is recognized by a well-edited clear and concise paper.
      ¬    Any evidence of plagiarism to include self-plagiarism will result in zero for this assignment.
      Also our FTCC Library databases can be very helpful in finding information: some of them are:
      Opposing Viewpoints
      SIRS
      CQ Researcher
      Films on Demand
      Issue and Controversies
      Pop Culture Collection
      You may also use .edu, .gov. .org sites. Please do not use Wikipedia as a primary source or .com sites. Also for each slide, please include your research you found for each source in the comments/notes  area of the power point slide and a reference slide/or include your references in your MSWord summary submission.
  • ItemReminders for the power point presentation or commercial- Also samples/examples
    Reminders for the power point presentation or commercial- Also samples/examples
    Attached you will find the instructions and grading rubric for the Social Problems Presentation: SOC 220 common presentation Update_2_ _2_.docx
    (For this assignment, you have the choice of developing a 2-3 minute commercial or a 15 min, slide power point presentation, based upon a social problem/issue in society).
    You may use some of these ideas for topics:(Please email me if you want to use a different social problem that is not from the list
    Human trafficking
    Child Marriage
    Kafala Domestic Workers
    Exploitation of young boys
    Cartels
    Slavery
    Sex trafficking/prostitution
    Skin bleaching
    Unemployment
    Gender inequality
    Food and water availability
    Political freedom/instability
    Education
    Safety, security, and well-being
    Government accountability/corruption
    Poverty
    Religious conflicts
    War
    Climate change
    Animal cruelty
    Destruction of natural resources
    Domestic Violence
    Homelessness
    Health care/Global health
    Here are some (optional) sample video- commercials to view:
    https://www.youtube.com/watch?v=zsu-RjsUPB0
    https://www.youtube.com/watch?v=Vc_VNvD9B3c&feature=youtu.be
    https://www.youtube.com/watch?v=9gspElv1yvc
    https://www.youtube.com/watch?v=GXZ7ubFoV1I
    Please also view the sample power point presentation in the : “Power Point Presentation” link in Black Board
Article 1 for 200-300  words
Select an article that touches on the ethical concepts you learned from this week.  Post a summary of your article for discussion with your classmates, and answer the following question:
What ethical dilemmas did you notice in your article review for this week? Provide examples and incorporate concepts you learned from the textbook (include reference).
this week we will be learning about Defining and Prioritizing Stakeholders, and Society, The Environment, and Government. The materials presented this week provide opportunities will allow you to:

  1. Assess the role of ethics in a business environment.
  2. Select key types of business stakeholder relationships that are important to advances business ethics in the workplace.

Article 2 300-350 words
Read the What Would You Do scenario on page 81 of your textbook as provided below and answer the questions that follow:
Malaysia Airlines
Malaysia Airlines is owned by individual investors and the Malaysian government, which took over the
company in 2014 after two mysterious jet crashes. The airline has lost money and struggled since that
time, going through three CEOs. The current CEO, Peter Bellew, is experienced in tourism and travel and
has been asked to cut costs and increase revenues. His strategy is to maximize the number of Malaysian
Muslims (who make up more than 60 percent of the population) flying to Mecca for hajj, the annual holy
pilgrimage and an obligation for all Muslims who are well enough to travel and can afford the trip. Bellew
plans to provide charter flights to make the pilgrimage easier on travelers.
Critical Thinking
• Describe the passenger stakeholder claims on Malaysia Airlines.
• Describe the government stakeholder claims on Malaysia Airlines.

Interprofessional practice requires that health care practitioners recognize that patient outcomes are better when there is a collaborative team approach in addressing patient health issues. Also there are barriers to interprofessional practice that must be addressed among health care practitioners. The Interprofessional Education Collaborative (IPEC) is an initiative including multiple professions designed to advance interprofessional education so that students entering health care professions are able to view collaboration as the norm and seek collaborative relationships with other providers (IPEC 2011).This week your Discussion will focus on interprofessional practice. This Discussion is an opportunity for you to examine your perspective and experiences with interprofessional collaborative practice and to apply your knowledge to managing patient care.Identify a professional nursing organization and review their position on interprofessional practiceReview the following case study:Case Study:Ms. Tuckerno has been diagnosed with multiple sclerosis (MS). The patient receives care at an internal medicine clinic. Her internist is not in the office today and she is being treated by the nurse practitioner. The patient is on two medications for her MS three different blood pressure medications one medication for thyroid disease one diabetic pill daily insulin injections twice a day she uses medical cannabis and uses eye drops for glaucoma. Upon assessing the patient the nurse practitioner (NP) decides her treatment plan should be adjusted. The NP discontinues some of the patients meds and discontinues medical cannabis. She orders the patient to follow up in two weeks.The patient returns and is seen by her internist. The internist speaks with the patient and reviews her medical chart. The internist states to the patient I am dissatisfied with the care you received from the nurse practitioner. The internist places the patient back on originally prescribed medications and medical cannabis.Post at least 250 words (no introduction or conclusion)an explanation of your understanding of interprofessional practice.2. Also explain the position on interprofessional practice for (The American Association of College of Nursing)3 Then explain what you think is the best collaborative approach to manage Ms. Tuckernos care.ResourcesBankston K. Glazer G. (November 4 2013) Legislative: Interprofessional Collaboration: Whats Taking So Long? OJIN: The Online Journal of Issues in Nursing Vol. 19 No. 1.DOI: 10.3912/OJIN.Vol18No01LegCol01Hain D. Fleck L. (May 31 2014) Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign OJIN: The Online Journal of Issues in Nursing Vol. 19 No. 2 Manuscript 2.DOI: 10.3912/OJIN.Vol19No02Man02Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington D.C.: Interprofessional Education CollaborativeBuppert C. (2015). Appendix 11-D: Sample Professional Services Agreement. In Nurse Practitioners Business Practice and Legal Guide (5th ed.) (417-422). Burlington MA: Jones & Bartlett.Buppert C. (2015). Legal Scope of Nurse Practitioner Practice. In Nurse Practitioners Business Practice and Legal Guide (5th ed.) (37-78). Burlington MA: Jones & Bartlett.