The following case for discussion is from the eText, chapter 18, page 527:

Steven and Marisol are a young married couple who are concerned about passing genetic diseases to their children.  Members of Steven’s family have been diagnosed with Huntington’s disease, an incurable genetic disorder that causes cognitive problems, difficulties with movement that ultimately require full-time nursing care, and reduced life expectancy.  Members of Marisol’s family have tested positive for a mutation of the BRCA genes that are strongly associated with breast and ovarian cancer.

At a family reunion, they are discussing their decision to use in vitro fertilization and preimplantation genetic screening of embryos.  Seven’s cousin, Valerie, is appalled.  She is opposed to the idea of in vitro fertilization and to the entire idea of genetic screening. 

Valerie says, “You can’t just choose the babies you want to have.  God will only give you the challenges He knows you can handle.  And if a child is born with a disease, your job is to love that child, no matter what.” 

Steven is speechless.  But Marisol is not.  “But if we can guarantee that our child is healthy and will live a happy life, shouldn’t we do that?  We don’t want to raise a child who is doomed to genetic diseases.” 

Valerie shakes her head.  “There is no way to know,” she says.  “Kids get sick and die.  Some who have diseases get better.  You can’t control everything.  And besides, that test-tube baby stuff is really expensive.  How can you afford it?” 

Now Steven replies, “We want to invest in this procedure now because it might save money in the long run.  I’ve seen how much Huntington’s costs a family – so have you.  I’d rather pay to prevent it now than have to deal with the costs later.”

Valerie responds, “That sounds really rude.  It sounds like you resent people who get sick and need your help.  The whole thing is very selfish.”

Questions for discussion – Answer any two of the following questions:

With whom do you agree here: Steven and Marisol or Steven’s cousin, Valerie?  Explain.

Is it wrong to want to prevent genetic disease through use of IVF and preimplantation genetic screening?   Is it a wise investment?  Should it be covered by health insurance?

Is it selfish to want to control your child’s genes?  Explain your answer.

What about using IVF for selecting the gender of the baby you want to have?  Explain your reasoning.

These options are available to couples today: LINK

Response for each one is 200 words.

1) 

At the start of this course, I did not think I would appreciate the community health nurse as much as I do now. When signing up for this course I really did not know what to expect, but by judging by the name I figured that it would consist of busy work rather than important education for the development of my career, and now that it is nearing the end, boy was I wrong! This course has been able to teach me so much important information, not just of my community, but the importance of community education, community risks, diseases that affect the community, and even made me realize of many things I experienced growing up in the community that happened, but was not aware of its importance. The community health course has been able to expand my knowledge and mentality of the healthcare process and those that are involved in it, outside of the healthcare setting. 

            Course goals and personal goals were attained during this course. The course goals specified in our syllabus included the nurse role in meeting emergent needs, exploring history, legality, social aspects, and nursing practice of the healthcare setting, predict, plan, analyze, implement public health surveillance, etc. These goals were met mostly because of the research the course would prompt us to explain. The prompted course work would set the foundation of the research, but the actual research part would open the doors of endless information on the subject and would lead up to different topics that were different, yet relatable to the information of the foundation. This method was able to help me build on top of information already known or learned and expand the knowledge previously acquired and was able to continue expanding my knowledge on the subject. The relevance of the topics with today’s modern concerns and realistic factors made it interesting to continue the research, making this course a breeze for me. 

            The information gained in this community health nursing course will be always an influence in the day to day living and career practice. I’m now able to evaluate my community and the people included in it, such as senior citizens, LGBT, and communicable diseases, and have an understanding of the amount of work, research, and planning that went behind some of the simplest situation. With a greater understanding of the community, I could impact those around me with basic facts and knowledge with the hopes of one day preventing a disease or reducing the risk of contracting a communicable disease in my community. 

2) The objectives for this course are:  1) to examine nursing roles to meet the health needs of individuals, families, communities, and populations.  I learned how to evaluate and anticipate the needs of people, families, and communities and to develop a plan of care to help meet their needs.  As it related to my current practice I am aware of the needs of patients and their families once they are discharged from the hospital post operatively.  2) To explore historical, legal, social, cultural, political, and economic forces that influence care.  I learned that it is sometimes out of the hands of patients and their families.  Patients and their families are sometimes forced to live lifestyles that leave them more prone to certain health risks.  During this course I was able to see certain lifestyles are at higher risk for healthcare issues than others and ways the community health nurse can assist in prevention and treatment.  3) Predict lifestyle trends that effect healthcare and future challenges of nurses.  Although it is still frustrating that some illnesses and lifestyles can be prevented easily and patients choose to continue to expose themselves to certain lifestyles it is not always the patient choice.  The public health nurse can provide education needed to those who are willing to change to promote a healthier living environment and lifestyle.  5) Plan, analyze, implement, and evaluate public health monitoring and outbreak investigation.  I learned the importance of the community health nurse and their role during infectious disease outbreaks and how their involvement can have a positive impact on those affected by the disease and disease prevention in others. 6) Develop strategies to deliver nursing care during disaster management.  I think this was my favorite assignment was the week we developed the plan for disaster management.  I do not know if it because of the time I spent working as an emergency room nurse or because my husband is involved in emergency management.  I guess deep down I am an adrenaline junky and being involved in the preparation triggered that.  I have enjoyed these last few weeks with everyone, good luck to you all on your future endeavors.  Best wishes!  Florence Nightingale was a consummate advocate for population health (Clark, 2015).  Which to me means community health nurses has been a part of nursing since the beginning. 
 

 Students need and want opportunities to learn and participate as part of the healthcare team. If ignored or not included in inpatient care, they become frustrated and feel cheated by the clinical experience. The nursing faculty should guide the clinical learning process, assist students with administering medications and treatments when needed and ensure that students are learning. Students view the RN preceptor as the clinical expert and role model, as well as the person nursing students look up to. 

 Identify the problems and challenges and discuss how you would respond to and handle the problems and challenges from 1) the faculty role 2) the RN preceptor role, and 3) the student role.  

1page 

Introduction
Each person owes a duty to himself or herself and to the world to study ethics and to engage in thoughtful debate about what is right, and what is wrong. It is this habit of thinking about and reflecting on ethics that will help you determine the right choices when faced with an ethical dilemma.

Initial Post Instructions
Articulate a moral dilemma wherein one has to show a specific virtue or virtues (it can be any virtue or virtues including honesty, courage, charity/generosity, compassion, etc.)

• What is the moral dilemma about?
• What virtue or virtues should be shown? (You are here selecting the best course of action)
• Why is that virtue or those virtues to be shown?
• How should the virtue or virtues be expressed, and why in that manner?
• Apply Aristotle’s golden mean to the dilemma.
• Tell us how the dilemma involves conflict moral duties (loyalty to community versus to self, professional versus familial duties, national or personal obligations).

The dilemma must be a situation in which a choice has to be made.

Be sure you told us why your chosen course of action was best.

Writing Requirements

• Minimum of 2 sources cited (assigned readings/online lessons and an outside scholarly source)
• APA format for in-text citations and list of references

 My personal philosophy of teaching patients and families is extremely important. First, the cost of healthcare is expensive. Educating our patients can reduce the number of emergency room or office visits. Many ER visits are not necessary and could have been avoided or seen in the doctor´s office with a smaller co-pay then the ER. The goal of education efforts is to improve the quality of care delivered by the nurses. Nurses play a key role in improving the nation´s health and recognize the importance of lifelong learning to keep their knowledge and skills current (DeSilets,1995).

 Nurses are faced with issues when it comes to teaching. Time is a big problem because patients are being discharged at a faster rate and it becomes challenging to teach the patient before discharge. In the cancer center where I work first time patients receiving chemotherapy are so overwhelmed and anxious it is a real struggle for them to understand. I try to have family in on the teaching, so we are all on the same page. Next, there is a percentage of the country who have literacy problems. When teaching keep it simple with out big or technical words. Ask them to repeat what was just said. Also writing simple instructions down helps. Emphasizing on staying healthy while receiving chemotherapy is an on-going process, checking labs and accessing the patient weekly. We do have a lot in interaction with our chemotherapy patients as we have five nurses and it is a small center with twelve chairs.