Question A

QSEN  Reflective Practice: Cultivating QSEN Competencies CHALLENGE TO ETHICAL AND LEGAL SKILLS 

While in a clinical rotation in my junior year, I was assigned the dreaded Jack Camp (I still remember his name). He was a middle-aged single man receiving care for a compound fracture of his left lower extremity being treated with an external fixator. He had a bad case of diabetes, and an even worse sweet tooth. Before I even met him, the nurses on the floor were saying things like “good luck,” which made this junior nursing student extra paranoid (although I was grateful for the warning). The patient was known for voicing loud complaints about his room, the food, and the hospital routine. He also was using his call light very frequently. The nurses called him names and discussed their dislike of him in the nurses’ station, which was in the center of the unit. As the day progressed, I found out that all this patient wanted was some attention, because he was used to running things in his business. I actually found him entertaining. Thinking Outside the Box: Possible Courses of Action Ignore the comments of the other nurses on the floor, hoping that no one else hears them. Report the nurses to my clinical instructor, possibly causing tension on the floor. Politely tell the nurses to keep it down and refrain from talking about the patient, risking my own comfort level; after all, I am only a visiting student—what do I know? Evaluating a Good Outcome: How Do I Define Success? Act as a patient advocate despite my limited power, which means correcting unethical behaviors as cordially as possible. Have the courage to go to the next level if the nurses’ behavior is not corrected. Inform the patient politely to modify his behavior. Personal Learning: Here’s to the Future! My response was to ignore the nurses’ comments and hope no one else heard them either. I was not courageous enough to be the patient advocate that we had been taught to be. I knew my response should have been to ask them to keep it down, which would allow them to maintain their personal opinions while at the same time keeping the comments from jeopardizing patient confidentiality. From this experience, I learned that you have to be a leader, speak up, and take the risk. Part of that means being able to go against the group, risking being ostracized. In doing so, others may follow your lead, but if they choose not to follow, at least you know you advocated for your patient. Since this experience, I have not been in a situation that has challenged my personal ethics, but I have the self-confidence to believe that I can be the leader that I spoke so passionately about.

Then, answer the following questions:

1) How do you think you would respond in a similar situation? Why?

2) How do you think the nursing staff would have reacted had the nursing student approached them regarding their comments about Mr. Camp?

3) How could the nursing student initiate improved communication between Mr. Camp and the nurses working on his unit?

Question B

Nursing Advocacy in Action 

Patient Scenario Everybody loves Sarah. Mature for her 9 years, Sarah has advanced leukemia, and her only medical hope now is to transfer to a hospital 3,000 miles from home that has the bone marrow that she needs. There are, however, several problems. Sarah’s family is homeless and visits rarely. She makes excuses for them—saying how hard it is to be on the street and always trying to find shelter—but she couldn’t hide her disappointment when no one visited on Christmas and her birthday. You have met the parents and were struck by their immaturity. Sarah’s health care provider is working passionately to get Sarah to the transplant center; the latest hurdle is ensuring that they will accept her given the fact that the family has no insurance or finances. Many of Sarah’s professional caregivers aren’t sure that the bone marrow transplant is a good idea. It is doubtful the funds would be found to send any of her family with her, and the possibility exists that, if unsuccessful, she could die at the transplant center surrounded by strangers. You mention these concerns to Sarah’s doctor, who replies, “But this is her only hope for cure!” Implications for Nursing Advocacy How will you respond if you are Sarah’s nurse? Talk with your classmates and experienced nurses about the questions that follow. If you elect to advocate for Sarah, what practical steps can you take to ensure better health outcomes? What is it reasonable to expect of a student nurse, a graduate nurse, and an experienced nurse in this situation? What advocacy skills are needed to effectively respond to this challenge?

Answer these questions

1) If you elect to advocate for Sarah, what practical steps can you take to ensure better health outcomes?

2) What is reasonable to expect of a graduate nurse in this situation?

3) What advocacy skills are needed to effectively respond to this challenge?

One page with intext citation reference from the resources provided 

Step 1: Read attached article entitled, Advance Directives and Health Care Planning-Are all the pieces in place.pdf 

Step 2: Read the following article: Effect of Living wills on End of Life Care.pdf

Step 3: Watch the video, “Advanced Directives: Important Healthcare Tools for Supporting You and Your Family”https://www.youtube.com/watch?v=GOIrnjqP5_M (Links to an external site.)

Step 4: Watch the video, “How to Have an End of Life Discussion”https://www.youtube.com/watch?v=JtkgTzCSzqk (Links to an external site.)

An Advanced Directive is a document in which a client who is competent is able to express wishes regarding future acceptable health care. The document may include decisions including the desire for extraordinary lifesaving measures, such as resuscitation, intubation, and artificial hydration, and nutrition. The advanced directive may also be used to designate another person to make decisions when the client becomes physically or mentally unable to do so. The Patient-Determination Act requires all clients admitted to a health care facility be asked if they have advanced directives.

Planning guides for seriously ill clients includes:

1. Living will: Legal document that instructs health care providers and family members about what, if any, life-sustaining treatment an individual wants if at some time the individual is unable to make decisions.
2. Durable power of attorney for health care: Legal document that designates another person to make health care decisions for the client when the client becomes unable to make decisions independently.

Nursing intervention in these types of situations is to ensure to communicate to the interdisciplinary health care team that the client has provided and advanced directive and that it has been placed in the client’s medical record. Clients who do not have advanced directives must be given written information outlining rights related to health care decisions.

Initial Discussion scenario:

Mr. Gomez is a 73-year-old man who is estranged from his wife. Since he prefers that she doesn’t make any medical decisions for him should the need arise, he has filled out an advance directive naming his daughter Elena as his health care proxy. He has suffered from diabetes for many years and is adamant that he does not want dialysis, even if it would sustain his life. He does, however, wish to have tube feeding for however long it will sustain him.

One evening while at home with his daughter, Mr. Suarez has a seizure. He is taken to the hospital immediately, but never regains consciousness and doctors do not expect him to do so. Elena contacts her mother Mr. Gomez’s estranged wife and she quickly joins her daughter at the hospital. They want to put him on dialysis (as his diabetes is worsening) and a feeding tube (as there is no other way for him to receive nutrients). His daughter informs the doctors of her father’s end-of-life wishes. The doctors warn her that without dialysis her father will pass away more quickly, even with the feeding tube. Mr. Gomez’s estranged wife informs Elena that she needs to follow the advice received from the doctors in order to save her father’s life. Elena says that although she is aware of the consequences, she wants them to carry out her father’s wishes.

The clients estranged wife immediately has her attorney file an order to stop Elena from following her father’s wishes that are in his advanced directive. She feels that even though they are estranged, she still should have the right to make decisions regarding Mr. Gomez’s care. This action delays Elena’s ability to honor her father’s wishes and the doctors feel that it is necessary to inform the hospital’s ethics committee about the ongoing issue.

Assignment: Discuss the following questions

1. What is the role of the doctors in deciding whether or not to respect Mr. Gomez’s advanced directive?
2. Does Mr. Gomez’s estranged wife have the authority to step in and ignore Mr. Gomez’s advanced directive. Explain your reasoning while providing evidence-based solutions in your conclusion.
3. Gomez’s estranged wife has filed temporary order to ignore the advanced directive. If you were Elena, how would you handle this dilemma? What rights does Elena have that allow her to honor her father’s wishes?
4. What is the role of the ethics committee and how can they best support the client and his family?

In this writing assignment, you will write a one- to two-page paper in which you analyze the importance of user-friendly informatics systems.

Step 1 Reflect on your encounters with healthcare informatics systems that you have used in the clinical setting (either as a practicing nurse or as a student in the clinical setting).

Step 2 Answer the following questions as you write your paper:

• Why is it important that informatics systems be user friendly? In your encounters with informatics systems, have the systems been user friendly? Explain.
• What does learnability refer to and what was your experience with learning this healthcare informatics system?
• What does efficiency refer to and, in your experience, how did the healthcare informatics systems affect your efficiency?
• What does memorability refer to and, in your experience, how easy was it to use the healthcare informatics system after being away from it?
• Did you encounter any errors while using the healthcare informatics system? How can errors affect the usability of a healthcare informatics system?
• What was your overall satisfaction with the healthcare informatics system?

Cite any sources in APA format.

The nursing process is a tool that puts knowledge into practice. By utilizing this systematic problem-solving method, nurses can determine the health care needs of an individual and provide personalized care.

Write a paper (1,750-2,000 words) on cancer and approach to care based on the utilization of the nursing process. Include the following in your paper:

1. Describe the diagnosis and staging of cancer.

2. Describe at least three complications of cancer, the side effects of treatment, and methods to lessen physical and psychological effects.

3. Discuss what factors contribute to the yearly incidence and mortality rates of various cancers in Americans.

4. Explain how the American Cancer Society (ACS) might provide education and support. What ACS services would you recommend and why?

5. Explain how the nursing process is utilized to provide safe and effective care for cancer patients across the life span. Your explanation should include each of the five phases and demonstrate the delivery of holistic and patient-focused care.

6. Discuss how undergraduate education in liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process. Consider mathematics, social and physical sciences, and science studies as an interdisciplinary research area.

You are required to cite to a minimum of four sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Rubric:

A detailed description of the diagnosis and staging of cancer presented. The description is informative and well-developed.

Three or more complications of cancer are detailed. The side effects of treatment and methods to lessen the physical and psychological effects are thoroughly described.

The discussion is accurate, detailed, and presents all significant factors contributing to the yearly incidence and mortality rates of various cancers in Americans. Strong rationale and evidence support the discussion.

A detailed explanation for how the ACS might provide education and support is presented. The role and function of the ACS are clear and informative. ACS services to be recommended are discussed and rationale is provided for the recommendation.

A well-developed explanation of how the nursing process is utilized to provide safe and effective care for cancer patients across the life span is presented. The explanation clearly describes how the process provides safe and effective care for patients across the life span. Strong rationale or evidence is provided for support. Insight into the nursing process and its utilization to provide safe and effective care for patients across the life span is demonstrated.

A thorough discussion on how undergraduate education in the liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process is presented. A strong correlation for how undergraduate education contributed to nursing knowledge and prepares nurses to work with patients utilizing the nursing process is clearly established. Insight into the contribution of liberal arts and science studies to nursing practice is demonstrated.