Response to peer discussion board-150 words-1 reference within 5 years-NURSING JOURNALS ONLY.There is a large push for evidence-based practice to become the main foundation of all clinicalpractices and clinical decision making. In order to provide the best up to date quality careevidence-based practice must be used. By the year 2020 90% of clinical decisions will besupported by accurate timely and up-to-date clinical information and will reflect the bestavailable evidence (Boswell& Cannon 2017). Though it is ideal to have evidence-base practicedriving health care practices there are many obstacles in the way of changing the culture ofhealth care practices. There are many obstacles to change such as resistance to change fromstaff available resources to support changes lack of support and training from mentors andresearch findings incompatible with the realities of their practice (Johnston Coole Feakes Whitworth Tyrell & Hardy 2016 p. 392).Working at Shands Hospital in Gainesville Florida there is most definitely a strong push forthe best quality of care through evidence-based practice. Each unit throughout the hospital hasa clinical leader. The units clinical leaders main job description is to assure the unit is clinicallyusing practices that are evidence-based. The main obstacle that I have found on my unit hasbeen research findings incompatible with the realities of their practice (Johnston et al. 2016 p.392 ). Working on such a high acuity unit in the cardiovascular intensive care unit a lot ofevidence-based hospital driven policies and practices have had to be adjusted specially to fit ourunit. Hospital wide practices have had to be adapted because certain practices do not apply tothe realities and acuity of our unit. One main example is the MEWS assessment. The modifiedearly warning score (MEWS) is an example of a physiological track and trigger system designedto identify patients at risk of clinical deterioration in order to provide a timely response torequest appropriately-trained nursing or medical staff to assess the patient and provide anyinterventions required (Harris 2013 p.432). MEWS is an extremely useful tool on floor units but on my particular unit a majority of our patient population have such a high baseline MEWScore. If following our hospital protocol for our patients MEWS we would be constantly callingphysicians and bringing them to the bedside. Our patients have extremely high acuity which isone of the reasons they are in the intensive care unit. Our physicians are aware of the acuity ofour patients and therefore the hospital wide MEW score does not really apply to our unit. Wehad to adjust the triggers of the MEW Scores of when to notify a physician. On the floor aMEWS of 4 a physician is notified and needs to come assess the patient but in the CICU thescore for when a physician has to come to bedside was adjusted to a 6. MEWS is just one ofthe many obstacles present in implementing evidence-based practices on our unit. There aremany obstacles to implementing evidence-based practices in our clinical practices but it isimperative that we adjust or policies and practices to reflect the research found in order toprovide the best quality care.Answer rating (rated one time)

Directions: Carefully read each scenario describing an ethical dilemma in health care. SelectTWOscenarios for which you will write a thorough response to not exceedONEcomplete paragraph for each. Responses will vary based on an individuals cultural upbringing ideology and educational knowledge; however you must support your position with appropriate theory and principle.In Clinical Ethics three clinical ethicists (a philosopher -Jonsen a physician -Siegler and a lawyer -Winslade) developed a method to work through difficult cases. The process can be thought of as the ethics workup similar to the History and Physical skills that all medical students use when learning how to workup a patient’s primary complaints. While this method has deep philosophical roots clinicians who use this method like the way it parallels the way they think through tough medical cases.Medical Indications- All clinical encounters include a diagnosis prognosis and treatment options and include an assessment of goals of carePatient Preferences- The patients preferences and values are central in determining the best and most respectful course of treatment.Quality of Life- The objective of all clinical encounters is to improve or at least address quality of life for the patient as experienced by the patient.Contextual Features- All clinical encounters occur in a wider social context beyond physician and patient to include family the law culture hospital policy insurance companies and other financial issues and so forth.Scenario 1At your last office staff meeting the rising cost of rent and overhead was discussed. One of your partners mentioned that he had been approached by a large pharmacy chain with an offer of space adjacent to their new pharmacy that is only one block from your current offices. The cost per square foot is half of what you are currently paying and there was a suggestion that the rent could be lowered if the volume of prescriptions from your office were substantial. Although this offer is very tempting you have reservations about the potential conflict of interest. One of your partners is pushing to explore this option. You are wondering if you could manage the conflict by refusing to engage in any reduction in rent based on prescription volume but still take the space at the reduced lease costs. Another partner feels that this arrangement will compromise her autonomy and feels that it will look as if the office is associated with the pharmacy even if it is not. Everyone agrees that the overhead costs need to be reduced. What is the right thing to do?Scenario 2You are the training director for a residency program. Recently several residents have come to you reporting that a physician frequently makes disparaging comments to residents and to patients about the work of other physicians. The physicians latest comment was to a patient in which he said he would not allow a particular physician to treat his pets. Other comments attributed to this physician involved telling the residents that a surgeon is a butcher and a psychiatrist a mindless twit. The residents have attempted to speak to him about this practice to which the physician responded by saying he only speaks the truth adding that patients and residents have a right to know. The residents report the comments appear to be unwarranted and they seem to be scaring the patients. Is this physician behaving unethically? Should physicians question the work of their colleagues? How should this be done?Scenario 3You are nearing the end of your practice career and many of your patients are older. Several of them have developed mild dementia and youve been discussing their wishes should they continue to lose mental capacity. The other day an elderly gentleman arrived for his appointment with his middle-aged son who reported that his father is becoming increasingly forgetful. The son would like to have his father moved to a facility rather than continue to live on his own. While examining your patient you note he has multiple bruises on his upper arms that suggest he has been grabbed by someones hand. When you discuss with him the idea of moving to an assisted living facility he becomes very upset and says his son wants to get his hands on his money and that is why he wants him to move from his own home. The patients Mini Mental Status examination is within the normal limits and he reports that his multiple bruises are the result of a friend grabbing his arm while they were out walking. You would like to respect your patients autonomy to make his own decisions but have some concerns that he may be at risk. You are not sure what the ethical principles are and approach your colleague for advice. What advice would you give to this colleague if you were approached?Scenario 4You have been treating a 24-year-old man for many years in your family practice. He has an anxiety disorder and had some trouble with substance abuse in his teens but has been doing well and attending university. After his last visit for a minor injury you noted that a prescription pad was missing. A few weeks later you received a call from a pharmacy asking you to verify a prescription for Lorazepam 1mg bid 300 tablets and acetaminophen with codeine 300 tabs written for this patient. You report that this is a forgery and ask the pharmacy not to fill it. Your colleague urges you to report this to the police and states this is allowed under the Health Information Act. You are very angry with the betrayal of trust with your patient but you have never reported a patient to the police and wonder what you should do. The CMA code of ethics advises you to keep patients personal health information private and only consent to release to a third party with consent or as provided for by the law such as when the maintenance of confidentiality would result in a significant risk of substantial harm. You are wondering if your patient has a substance abuse problem and whether he could be selling this medication. You have called the patient to come in for an appointment but he has refused. Should you notify the police?Scenario 5A patient has rheumatoid arthritis for which she should be taking drugs to control the disease and prevent further joint damage. However she tells the doctor that she has stopped because she does not like the look of the side effects listed on the leaflet in the packet and would like a treatment she found on the internet. The doctor disagrees with her preferred treatment. What issues does this raise? How should the doctor handle this scenario?Scenario 6A newly hired nurse is being given orientation and training in the hospital by a senior member of the nursing staff. Assigned to a medical -surgical unit the nurse receives instructions on procedures. The nurse is instructed to push Heparin IV through a tube in the person’s arm. The nurse when being trained in nursing program was instructed not to do so such a thing as it could have serious consequences. When the newly hired questioned the procedure that nurse was told by the senior nurse: Look that is how we do it here missy. We are understaffed and do not have the time to do it intravenously. If you want to work here that is how you will do it too. What should the response of the new nurse be to this situation? Why?Scenario 7John a 32 year-old lawyer had worried for several years about developing Huntington’s chorea a neurological disorder that appears in a person’s 30s or 40s resulting in uncontrollable twitching and contractions and progressive irreversible dementia. It typically leads to death in about 10 years. John’s mother died from this disease. Huntington’s is autosomal dominant and children of an affected person have a 50% chance of inheriting the condition. John had indicated to many people that he would prefer to die rather than endure the progression of the illness. He was anxious drank heavily and had intermittent depression for which he saw a psychiatrist. Nevertheless he was a productive lawyer. John first noticed facial twitching 3 months ago and 2 neurologists independently confirmed a diagnosis of Huntington’s. He explained his situation to his psychiatrist and requested help committing suicide. When the psychiatrist refused John reassured him that he did not plan to attempt suicide any time soon. But when he went home he ingested all his antidepressant medicine after pinning a note to his shirt to explain his actions and to refuse any medical assistance that might be offered. His wife who did not yet know about his diagnosis found him unconscious and rushed him to the emergency room without removing the note. How much weight should Johns preferences (especially his attempt to end his life) carry in managing his emergency and subsequent clinical care? Scenario 8Mrs. Jones has signed a donor card indicating that she is willing to donate her body to science without notifying her husband and son. She gets into an accident and it is determined she is brain dead. The family doctor who is on call that afternoon reviews the chart and determines that she would be perfect for medical students to practice the removal of organs for transplantation purposes. The doctor then talks to the family to discuss the procedure and to confirm their consent. They both oppose the procedure and refuse to allow their doctor to move forward. The doctor points out that Mrs. Jones could be helping hundreds of people by educating the medical students and that technically consent has already been provided. The husband understands how beneficial the educational experience is but is too emotional to allow them to continue. The son a medical student refuses because he knows the bodies are not treated with dignity. If you were the doctor how would you proceed? Why?

Assignment: International Comparison of Data
 
The World Health Organization’s “Statistical Information System” is an interactive database that allows you to compare health indicators for multiple countries. For this Assignment, you will compare the country you selected for the Discussion with the United States in terms of healthcare (i.e., please compare the same country in both the Discussion and Assignment.)
 
To prepare for this Assignment:
• Consider the value of using standardized quantitative health measures or indicators to compare information internationally.
• Examine the definitions of indicators presented in the Resources, including pages 65–72 of the Shi and Singh (2019) course text.
• Use the WHO website to examine country statistics and profiles.
• Create a table to record data related to three health indicators for the two countries you are comparing, as illustrated in the example Indicators Chart on this page.
• Once your table is complete, compare the data and analyze it in light of the information presented in this week’s Resources and the research you conducted for the Discussion. What insights does this comparison give you about health and disease within the U.S. healthcare delivery system and the system of the other country you selected?
• Review the resources in the Writing and Library Skills Resource Guide page
 
By Day 5
The Assignment
 
Write a 1- to 2-page paper in which you:
• Identify the country that you are comparing with the United States.
• Define the three health indicators you have selected for your analysis and explain why you chose them.
• Include the table you created to record and compare your data.
• Summarize the results of your comparison, sharing at least two insights that you gained through this analysis of health and disease in the United States and your selected country.
 
Your Assignment must be written in standard edited English. Be sure to support your work with specific citations from this week’s Learning Resources and additional scholarly sources as appropriate. See the rubric for additional requirements related to research and scholarly writing.
Required websites:
 
http://www.oecd.org
 
https://www.who.int/countries/

Question Description

I need the second half of my paper fixed I have to turn it in by tomorrow afternoon I will provide an article and the format it needs to be in and will provide the paper that was turned in PART B DID NOT PASS!!! Here are the instructions AND notes from the teacher:

B. Evaluate a primary qualitative research peer-reviewed journal article (suggested length of 3–5 pages) that has healthcare implications by doing the following:

1. Identify how the researcher addresses the five following areas of the selected journal article, using the attached “Evidence Table”:

• background or introduction

• review of the literature

• discussion of methodology

• data analysis

• researcher’s conclusion

2. Critique whether the evidence presented in each section of the journal article supports the researcher’s conclusion.

3. Explain the protection of human subjects and cultural considerations of the journal article.

4. Identify strengths and limitations of the study.

5. Describe how the evidence informs nursing practice.

C. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

Qualitative- and also subtypes- most often case study, others are grounded theory, phenomenology, and also descriptive subtypes.

Use the readings in module 3, chapter 6, to help you understand different methodologies researchers use.  Read your article as the researchers should tell you the methods they used to research their questions. Identifying research types and subtypes is a big concept.
 

Data Analysis
 
How did the researchers analyze the data collected?  Did they explain it enough for you to evaluate for external or internal validity? What statistical testing was used?  What analysis was discussed?  For quantitative studies examples include T-Test, ANOVA, Logistic Regression, Linear Regression, Chi-Square or descriptive statistics like frequencies, prevalence, and rates or incidence.  For qualitative studies the data is interviews or focus groups and the data is coded for themes and then analyzed based on the subtype.  If it is qualitative descriptive the sample is small and the subjective responses of the participants are usually reported without coding or analyses.
 

Conclusion
 
What are the conclusions of the researchers; do they make sense to you as a clinician?
 

A & B 2

Based on your analysis of the five areas in the table, assess whether the evidence presented in the research report supports the conclusion.

Begin by paraphrasing the author’s conclusion in a sentence; then, discuss how each of the first four sections of the research report described in the table (1 sentence each) supports the author’s conclusion (section 5).  Approximately 5 – 7 sentences total should be enough.

Hints:

Can these researchers make the conclusions that they made? Would anything else explain their results? Are there any other plausible explanations for their conclusions? Remember, you will want to justify your answer. Give a full paragraph on why or why not the evidence in the first four areas of the research paper supported the conclusion in section 5.

B 3

Identify the ethical principles that the researcher should have addressed prior to the study.  For example, what considerations should the researchers have addressed regarding informed consent, privacy, confidentiality, etc. for the specific subjects in the studies you chose to critique.  (1 – 2 paragraphs)

B 4

The strengths and limitations refer to the study design, not to the procedures or interventions being studied in the articles.  Consider things like sample size, level of research, quality of research, sampling strategy, and study design.  Also, consider what the author has stated in the last few sections of the research report regarding strengths and limitations.  (1 – 2 paragraphs)

B 5

Please discuss how the results of the study you selected impacts nursing practice.  (1 – 2 paragraphs)

Include a reference page and in-text citations where appropriate.