NURS 521 WCU Healthcare Ethics and Law Discussions

For each Discussion use 250-300 words and 1 reference. Submit discussion answer by parts ( part 1, discussion 1 and discussion 2, part 2, discussion 1 and discussion 2, part 3 discussion 1 and discussion 2)

Part 1 NURS 521

Please respond to the following survey, the following discussion is about it.

Survey

Question 10 pts

Physician assisted suicide (PAS) remains a controversial practice in terminal illness cases, and has been railroaded in most states. Only three states allow PAS at this time. Consider your role in counseling a patient seeking PAS services. Your patient is under 30 years old and believes that quality of life comes first over compromising medical treatments. The patient has therefore made a clear decision to forgo traditional medical treatment due to poor prognosis and the likelihood that medical treatment will only give an additional three to six months to live. Do you remain supportive of the patient’s decision to pursue PAS? 

Group of answer choices

Completely Agree

Somewhat Agree

Somewhat Disagree

Completely Disagree

Question 20 pts

Although cases of eugenic sterilization are now relatively rare, sterilization without consent was performed with some regularity decades ago amongst state institutionalized patients with extreme cases of mental illness or retardation. Sterilizations were also performed on patients who were poor, of color, or who signed consents for sterilization procedures when they did not understand what they were signing. In unethical situations such as these, does the nurse have the responsibility to be the whistleblower, even if it means personal scrutiny or loss of livelihood?

Group of answer choices

Completely Agree

Somewhat Agree

Somewhat Disagree

Completely Disagree

Question 30 pts

A police officer brings an intoxicated patient to your addiction recovery center. As a nurse at the detox unit, you are used to dealing with belligerent and intoxicated patients. In this case you are concerned because of the length of time it took for the police officer to bring the patient into detox relative to the time the person was picked up, per the police report. In examining the patient, you see a number of bruises and lacerations over the person’s arms, neck, and trunk, but when you question the patient about how the injuries occurred, the patient says he doesn’t remember. You suspect that the police officer may have assaulted and abused the person. You are unsure how to pursue your suspicions, and you regularly interface with this particular officer. You decide that you don’t have enough evidence to make a report and say nothing about your suspicions to your supervisor or coworkers. Have you violated the ANA Code of Ethics by remaining silent?

Group of answer choices

Completely Agree

Somewhat Agree

Somewhat Disagree

Completely Disagree

Question 40 pts

You are a nurse in an OR and have noticed that patients are not achieving adequate pain relief intraoperatively and postoperatively. You are very concerned. Procedurally, you can see nothing different in how the anesthesia or narcotics are being administered. However, time and again, patients are complaining of inadequate pain relief. You know the certified nurse anesthetist (CRNA) almost lost his license last year when it was suspected that he was abusing fentanyl, and you worry that he may be stealing fentanyl and covering it up, but you cannot be sure since the ampules of fentanyl that are pulled from the Pyxis appear to be intact. You speak with your supervisor and it comes to light that the employee under investigation is someone other than the CRNA. Are you obligated to share your concerns about the CRNA with the state board of nursing?

Group of answer choices

Completely Agree

Somewhat Agree

Somewhat Disagree

Completely Disagree

Question 50 pts

The payroll director of your hospital was recently sued for embezzlement. He was caught when a fired employee called the hospital to say that her W-2 tax form showed more payment than she had actually received. An investigation determined that the director had deposited the employee’s additional pay into his bank account and had done this multiple times with other employees. You discover that one of the directors of nursing who you work closely with, and who is a friend of the payroll director, is also under investigation for aiding and abetting the embezzlement scheme. The circumstances have generated a lot of fear and distrust amongst hospital staff and it has fallen to you to provide support to your nursing staff. Are you legally obligated to discuss specifics regarding the case with those staff directly affected by the embezzlement?

Group of answer choices

Completely Agree

Somewhat Agree

Somewhat Disagree

Completely Disagree

Question 60 pts

The mother of your pediatric patient in the emergency room is a Jehovah’s Witness and she has informed you that her daughter cannot get the blood transfusion needed to save her life. The matter is taken before the ethics committee of the hospital in an attempt to negotiate with the child’s mother for the life-saving transfusion that her child needs. In the end, the physician’s right to administer emergency medical treatment over the parent’s objections was allowed, but the physician was also protected from liability in the event he had chosen to honor the parent’s refusal of treatment. In general, the law does not dictate the physician’s action, and the physician’s decision is ultimately a moral one.

Group of answer choices

Completely Agree

Somewhat Agree

Somewhat Disagree

Completely Disagree

Question 70 pts

You are a pediatric nurse and you have noticed a growing trend in the last five years of children who are identifying as transgender. The physician you work with has begun offering administration of cross-sex hormones to children identifying as transgender who wish to transition. You feel some internal conflict in certain cases about the decision to offer puberty-blocking cross-sex hormones to children who are not of legal age to make the decision, but who have lived with the stigma of expressing in the opposite sex their whole lives. In spite of your internal conflict, you have a moral obligation to remain supportive to these patients.

Group of answer choices

Completely Agree

Somewhat Agree

Somewhat Disagree

Completly Disagree

Question 80 pts

You are working in an infertility clinic as a nurse and are aware that the physician you work with chose to transfer more than five embryos into your patient when normally the physician transfers only two. When you read the patient’s chart, you discover that part of the justification is that the embryos were not all of the best quality when graded; there was a quality issue amongst the embryos in general, but the patient insisted they be transferred regardless of their quality. The woman ends up with a quintuplet pregnancy and sues the physician. Was the patient within her rights to sue the physician when she had expressly requested the embryo transfer even though their quality contradicted the usual transfer criteria and protocol?

Group of answer choices

Completely Agree

Somewhat Agree

Somewhat Disagree

Completely Disagree

Question 90 pts

A nurse that was working as a health care worker in a camp for Ebola victims developed a low-grade fever the day of her flight but did not develop other Ebola symptoms, such as nausea and vomiting, until she had landed in the United States. Was she negligent to other passengers and airline personnel for flying with a low-grade fever?

Group of answer choices

Completely Agree

Somewhat Agree

Somewhat Disagree

Completely Disagree

Question 100 pts

You are a nurse practitioner providing prenatal care in a community health center. A patient who regularly receives medication for chronic pain and who is a known opioid addict presents as a prenatal patient on your schedule. It is early in her pregnancy and you decide that weaning her from the pain medication now would be the best option. The patient herself is in agreement and goes home with your plan of tapering the dose over the next month, but instead abruptly stops all pain medication without your knowledge. You receive a hospital report three weeks later that the patient was admitted to the hospital for opioid withdrawal and miscarriage. The patient states you told her to stop the pain medications and you are now under investigation for medical malpractice. When patients do not follow medical advice and end up with a poor outcome, providers are always protected as long as their plan is well documented in the patient’s chart.

Group of answer choices

Completely Agree

Somewhat Agree

Somewhat Disagree

Completely Disagree

Discussion 1

Reflect upon the survey you took. In your initial response, address some of the following questions. Explain your answers.

Did you find it easy to make confident and decisive      decisions with several strongly agree or strongly disagree answers, or did      you select mostly moderate responses?

Did any subject areas trigger personal emotions or      issues?  If so, do you feel you were able to remain objective? 

Were any of the decisions especially difficult to      make?

Did you employ any critical thinking or resolution      strategies to determine a response?

Did you rely on policy or legal parameters to make      your decisions? 

Would you be comfortable making your answers to the      survey public, or do you prefer anonymity?

Have you dealt with similar situations and could you      perceive similar situations occurring in your clinical practice?

How might a moral inventory such as this survey      impact your clinical practice?

Please share additional thoughts as well.

Discussion 2

Identify examples of active and latent errors. Provide examples from your clinical experience, if possible. How can such errors be avoided to support better patient care?

Part 2 NURS561 

Discussion 1: 

After participating in the Pathways to Safer Opioid Use simulation exercise, reflect on the following.

Have you empowered a patient to believe they could make needed lifestyle modifications irrespective of the barriers that exist in their environment? Please provide examples. If so, you were engaged in health promotion activities as part of your nursing role.

Were there any strategies used in this simulation exercise that you use to improve patient health literacy? Are there any that you use that were not mentioned here? In your experience, how effective are these strategies?

What are some of the biggest challenges you encounter when trying to improve health literacy? What solutions can you offer to manage these challenges?

HERE IS PART OF THE SCRIPT OF THE SIMULATION EXERCISE

Safe opioid use and the prevention of adverse drug events (ADEs) are critical tasks for health care providers.

Chronic pain is reported by over 100 million Americans annually1, with pain affecting more Americans than diabetes, heart disease, and cancer combined. There is a general consensus from experts that the under treatment of pain is a major problem.

Yet, growth in the amount of pain medication dispensed in our society is correlated with increases in prescription misuse and abuse. Opioid overdose deaths have recently surpassed motor vehicle deaths2, making it the single most common cause of accidental death. Health care providers don’t have to choose between successfully treating pain and stopping ADEs. With education and training, health care providers can reduce opioid-related ADEs.

Dr: I know that you finished the primary care nurse pain management training a few months ago and you haven’t had any opportunities to practice your new expertise, but with Jane gone, we’re really going to have to work hard to grow your skills to work with pain patients.

RN: Do you need to do this another time?

Dr: no, Our absolute priority is patient safety. Adverse Drug Events…they’re a real concern with opioids, and the risks increase with benzos, muscle relaxers, etc. and some patients are taking all of them at the same time. Adverse drug events and misuse…They are real threats to our patients’ lives and to our practice. But you have to watch out because – under treatment is a big problem too. there is a patient waiting for medication reconciliation and counseling.

This program provides basic guidance on pain management and the prevention of ADEs for nursing professionals.

The nurse’s role in pain management is critical. You have a unique responsibility within the team to:

Counsel and listen to patients;

• Assist in the coordination of care;

Monitor the proper use of medications;

• In addition, no one has access to the information that you do. No one can observe a patient’s situation quite like you do.

Narrator: So, first patient, Mrs. Jackson, 38, ongoing pain from a rotator cuff injury sustained while rock climbing. Her pain management plan includes ice packs, and physical therapy, but she will require surgery which she’s been delaying until her toddler goes to kindergarten in the fall.Overall excellent health. After trying NSAIDs, she became more functional on a lose dose of opioids. The dose is being dialed up as she builds a tolerance. You need to make sure she’s taking her medications properly and counsel her on a new dose. For some reason the PDMP web site is down. Can’t check to see if she’s received other medications from other providers.

• The Prescription Drug Monitoring Program (PDMP)1 provides a record of Schedule II through IV controlled substance prescription and dispensation information. The PDMP attempts to reduce non-medical abuse, diversion, and duplication of prescriptions while preserving the professional practice of health care providers and legitimate patient access to optimal pharmaceutical-assisted care. 

Health care providers are given electronic access to PDMP data in real-time, at the point-of-care to improve their ability to screen for substance use disorders, reduce pharmaceutical drug diversion, and assist legitimate medical practice and patient care. 

• Almost every state in the country has a PDMP, though programs differ greatly from state to state and sharing of information among states is not always optimal.

RN; Well we want to make sure your pain is under control safely until the surgery. Did you bring your medicine with you?

• Pt: yeah

Narrator: And because the PDMP site was down, you say…

• RN: I just want to make sure that, according to the opioid agreement we have, you’re not receiving any other pain medicine from any other provider?

Pt: No

• RN: Are you taking any other prescription medicines besides these?

Pt: Nope, just what Dr. Bright prescribes.

• RN: Great!

HEALTH LITERACY STRATEGIES

Warm greeting: Greet patients with a smile and a welcoming attitude.

Eye contact: Make appropriate eye contact throughout the interaction.

Plain, non-medical language: Use common words when speaking to patients. Take note of what words they use to describe their illness and use them in your conversation.

Slow down: Speak clearly and at a moderate pace.

Limit content: Prioritize what needs to be discussed and limit information to 3-5 key points.

Repeat key points: Be specific and concrete in your conversation and repeat key points.

Graphics: Draw pictures, use illustrations, or demonstrate with 3-D models.

Patient participation: Encourage patients to ask questions and be involved in the conversation during visits and to be proactive in their health care.

Teach back: Confirm patients understand what they need to know and do by asking them to teach back directions.

Narrator: So the pill count is where it should be, and her regimen is fairly simple and free from tricky interactions.
She’s switching to hydrocodone at this visit and you’re responsible for counseling her on correct use.

RN Uh there’s actually little difference in how you take the new medication from how you took it before, but I want to review to make sure we’re doing everything correctly…

 Narrator: You quickly run through how many and when. 

RN Um. What questions do you have? can you tell me in your own words how you’ll be taking the new medication?

narrator: you engage in teach back and patient starts reading the instructions. Reading is not teach back so you ask questions to have the patient frame how she’d take the medication in her words and in her real life.

RN: What’ll you do if you have break through pain?

PT: I’d take a second one if the pain gets real bad, but I’d have to four hours before I take another.

Rn: What if that same 24-hour period, you have a really bad night?

Pt: If I have a really bad night and I’m up, I’d take one every four hours and then I’d have an extra.

Narrator: And you discover a miscommunication.

RN I’m so glad we went over this, because I didn’t explain things clearly. While you can take a pill every four hours, you can’t do that continuously if you’ve doubled up earlier in the day. Usually people can get by with fewer pills during the night. But either way, don’t take more than six in a 24 hour period, Otherwise you run the risk of an overdose. Tell me, how would you take your medication if you were having a bad day?

Pt: I’d take one first thing, 6 AM. Then at 10 or 10:30. Then, I’d probably wait until 4 to take the next one, because usually midday isn’t so bad. Then at eight. And that would leave me two for the night if I have trouble sleeping.

RN: Now don’t forget the other ways to reduce break through pain. Um. So tell me, are there any times when you shouldn’t take that extra pill?

PT: I take a sleeping pill?

Narrator: And your teach back even gives you new information.

I was going to talk about driving, but… Do you take sleeping pills?

• PT: No, but my husband has some. I take it Maybe once every two weeks.

Rn: Well, we should review your opioid agreement, and talk about sharing medications. 

• Narrator: And by having the patient teach back what she understood in the context of her life, you had the opportunity to correct misunderstandings and gained insight into her use.

Narrator: As you wrap up, you give Mrs. Jackson a handout that summarizes what she needs to know to manage her medication use.

• NURS561 Discussion 2

Choose two emerging populations, such as Latino/Hispanic Americans, Asian Americans/Pacific Islanders, or Black/African Americans. How do health issues differ between the two populations?

PART 3 NURS535 

Discussion 1 The diversity of both students and faculty poses important considerations for teaching and learning. Reflect on the characteristic differences in gender, race, and culture, as well as the differences among the diverse generations in today’s nursing education classroom. When considering your personal philosophy of teaching, discuss how you might use these characteristic differences and diverse backgrounds and experiences of today’s nursing students as a teaching tool to connect students to nursing content and increase their understanding. In other words, how might you incorporate the background and experiences of your students into your teaching methods to enhance the ability of all students in your classroom to think critically and problem solve patient-care issues? 

Discussion 2

Nursing faculty is responsible for creating an environment that is conducive to learning and accommodates the multiple learning styles and abilities of students. As a nurse educator, how might you design learning experiences for class and clinical environments to promote positive and effective learning for all students? Do you think students should use their preferred learning styles and perhaps risk becoming rigid and unable to learn in different ways (should a situation demand a different learning style)? Or should educators encourage students to be open to different methods of learning, moving them away from their comfort zones?