A 17 year old male client in an inpatient psychiatric unit is being uncooperative. The client is standing in front of the nursing station, where the nurse answers incoming phone calls and discusses patient care with the treatment team. The nurse kindly asks the client to return to the dayroom and join the rest of patients for group. However the client says, “No, I am perfectly fine where I am.” A staff member observes the situation and steps in and states, “you need to go to group now, or we will have to escort you to the quietroom.” The client looks at the staff member and says in a calm tone, “you can’t make me move, I am not doing anything wrong.” The nurse realizes this situation is escalating and is stuck between a rock and a hard place. Please consider all the details provided above and answer the following questions:

1. What does the principle of the least restrictive environment have to do with this situation?
2. What role does HIPAA play in this scenario and why does it make the situation more complicated?
3. Which nurse would be more likely to initiate a restrictive intervention for this client, a nurse with a utilitarianism view of ethics or a deontological view of ethics? And why?
4. Finally, how would you resolve this situation?

REQUIRES;

SCHOLAR ARTICLES>>>APA FORMAT>>>NO PLAGIARISM 

QUESTION 1 Describe the nurse’s role and responsibility as a health educator. What strategies, besides the use of learning styles, can a nurse educator consider when developing tailored individual care plans, or for educational programs in health promotion? When should behavioral objectives be utilized in a care plan or health promotion?                                                                                                                                                     QUESTION 2 A. Describe a health promotion model used to initiate behavioral changes. B.How does this model help in teaching behavioral changes? C. What are some of the barriers that affect a patient’s ability to learn? D. How does a patient’s readiness to learn, or readiness to change, affect learning outcomes?

Objectives:

Define  Consanguinity 

Identify global prevalence of consanguinity

Describe impact on population health risks

Discuss the cultural and ethical considerations of consanguineous unions. (Links to an external site.)

Note: Remember to check calendar or syllabus’s course summary for Response due date.

Background

As migrants move into western societies, long-held cultural beliefs arrive with them in their new communities, and are often misunderstood. Consanguineous marriage is one such cultural practice.  This social institution of marriage has been common across the globe throughout human history.  Today, it’s rate varies significantly from one population to another, depending on religion, public attitude, culture, legislation, socio-economic condition and geography.  

Over the past 5-10 years, the mapping of the Genome has vastly increased our knowledge of consanguinity’s heredity (autosomal-recessive) risks.  In western cultures, the rate of consanguinity is very low, compared to developing countries where in certain ethnic groups, may account for more than 50% of marriages. (M. Islam. 2017. Consanguineous marriage in Oman:  understanding the community awareness about congenital effects of and attitude towards consanguineous marriage.Annals of Human Biology, Vol 44(3), 273-286.)

For an overview of the health-related risks, review the following 2016 Australian public health Fact Sheet 18 | WHEN PARENTS ARE RELATED – CONSANGUINITY.pdf

Link here for Emory University Department of Human Genetics factsheet of Parents’ Reproductive options: Emory U_Reproductive Options for Carriers of Genetic Diseases_Pt flyer.pdf

 Read the below 2019 review article on cultures who practice consanguineous unions:Link to this article: 2019_A review of the reproductive consequences of consanguinity.pdf(FYI when reading a scholarly article read the sections in this order:

1. Title, abstract
2. Introduction
3. Discussion
4. View tables
5. Conclusion
6. Methods and findings (if you need to know the specific stats.) 

To do:

Primary post: write a 400 word essay using APA discussion qualities (excellent organization, grammar, spelling, citations, introduction, body and conclusion, 3 (or more) references). 

You are a PHN assigned to a district that has a large ethnic population with a high incidence of consanguineous marriages.  The local community health clinic provides primary care to this population.  You are planning a pre-conception genetic education class that respects the users’ rights to informed consent and privacy. The education provided must be culturally sensitive, accurate, and respectful to long-held beliefs. To be informed, you review the 2019 evidence (article linked above).

1. Introduce and define Consanguinity (i.e., consanguineous marriages).  
2. Specify the genetic risks of consanguineous marriages.   
3. Identify global prevalence of consanguinity.  What are the five countries with the highest incidence of consanguineous marriages ( list percentages, too)?  
4. Identify two (2) U.S. communities that are at risk.
5. Discuss three (3) of the social/cultural beliefs that are predisposing or perpetuating factors for these consanguineous practices.
6. Discuss two factors that have reduced consanguinity in some populations.  
7. Discuss confidentiality issues:  Link to the following American Journal of Nursing website: (Links to an external site.) Discuss ethical and privacy issues you, as a PHN, must consider if/whether to disclose genetic information to
   
   •  a spouse or
   •  to relatives.

8. Conclude with your opinion of weighing the cultural issues and ethical obligations to inform the at-risk party of genetic risks, and, legal requirements to respect and protect the patient’s privacy.

(FYI Here is link to GINA (Genetic Information Nondiscrimination Act) passed in 2008) (Links to an external site.)

(Link here for GINA in pdf for laypersons’ literacy level)

 

Tell your story of a personal experience with moral courage. Explain a situation or circumstance where you observed or participated in a situation when moral courage was displayed.

Review the module notes and readings, and reflect upon why you think more people do not engage in moral courage when experiencing a conflicting situation. Relate the importance of where one is situated along the stages of moral reasoning and if one is too many stages beyond another individual, what may be the underlying issues of understanding another’s perspective?

• Provide 1 exemplar of a time when you experienced a conflict and the action(s) you took in response to the conflict. Explain those action(s) from the perspective of Kohlberg’s and Gilligan’s stages of moral reasoning and levels of caring, respectively. Reflect upon this experience and identify what you have learned (new knowledge) and what challenged your assumptions and resulted in you engaging in unlearning or understanding something from a different perspective.
• Discuss why you identified yourself as being at that stage and how this aligns with your beliefs and assumptions as a professional nurse. Think about your emerging identify as a BS prepared registered nurse and describe what you might do now, at this moment in time, to change or reinforce the action you took when faced with conflict. How does this support becoming the professional nurse you want to be?
• Talk out loud with your peers and articulate 2 solutions you as a nurse can endorse and implement within a healthcare environment or community setting that promotes moral courage, mutual respect, authenticity, and integrity as a professional.
• Integrate text/article readings, module notes, and one other scholarly article that support your responses to the discussion questions and solutions for enhancing moral courage.

The Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, has dramatically improved the quality of care in the nursing home over the last twenty years by setting forth federal standards of how care should be provided to residents. 

This Act is interpreted with the U.S. Code of Federal Regulations (42 CFR Part 483). Such improvements include less use of antipsychotic drugs, a reduction in chemical and physical restraint use, and a reduction in inappropriate use of indwelling urinary catheters.

Mandates

The quality of care mandates contained within OBRA, and the regulations, require that a nursing home must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care. 

In order to participate in Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for nursing homes.

The mandates of OBRA are regarded in the nursing home setting to represent minimum accepted standards of care. The failure of a nursing home to comply with the OBRA quality of care mandates in caring for a resident represents a failure to exercise the degree of reasonable care and skill that should be expected.

Penalties

The Indiana State Department of Health is responsible for ensuring that nursing homes follow these mandates through the state survey process. The Department of Health and Human Services (DHHS) and the states may apply penalties against nursing homes for failure to meet the minimum standard of care as defined in the OBRA regulations. 

Such penalties may include fines, appointment of administrative consultants to run the nursing home while deficiencies are remedied, and even closure of a nursing home.

• Residents must be assessed to identify their medical problems and their abilities to perform basic self-care activities. The DHHS established a uniform data set, referred to as the minimum data set (MDS), to document this assessment.
• The nursing home is responsible for the safety of each resident. This includes being responsible for orders written by the resident’s primary physician or other medical provider. If the physician writes an order that does not comply with the federal regulations, the nursing home is responsible for making sure the physician changes such order. The mere presence of a physician’s inappropriately written order does not absolve the nursing home of responsibility in providing safe care.
• Provide services that will enhance each resident’s quality of life to its fullest (42 CFR §483.15).
• Maintain the dignity and respect of each resident (42 CFR §483.15).
• Develop a comprehensive care plan for each resident (42 CFR §483.20).
• Conduct a comprehensive and accurate assessment of each resident’s overall health upon admission and at each required interval (42 CFR §483.20).
• Prevent a decline in activity of daily living (ADL) activities, including the ability to eat, toilet, bathe and walk. Staff must provide for ADL care when necessary (42 CFR §483.25).
• Prevent the development of pressure sores, and if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing (42 CFR §483.25).
• Provide appropriate care to those who have urinary incontinence and restore bladder function if possible. This also includes only using urinary catheters when appropriate as outlined in the regulations to prevent adverse consequences related to such use (42 CFR §483.25).
• Prevent accidents, including falls, accidental poisonings and other incidents that could cause injuries (42 CFR §483.25).
• Maintain adequate nutrition to prevent unnecessary weight loss (42 CFR §483.25).
• Provide each resident with sufficient fluid intake to prevent dehydration (42 CFR §483.25).
• Ensure that residents are free from significant medication errors (42 CFR §483.25).
• Have sufficient nursing staff (42 CFR §483.30).
• Ensure that each resident’s rights to choose activities, schedules, and health care are maintained (42 CFR §483.40).
• Provide pharmaceutical (medication) services to appropriately meet the physical and psychological needs of each resident (42 CFR §483.60).
• Maintain accurate, complete, and easily accessible clinical records for each resident (42 CFR §483.75).

CASE STUDY: Mrs. J is repeatedly asking for a nurse; other patients are complaining, and you simply cannot be available to Mrs. J for long periods.  Considering the setting and the OBRA guidelines, what would you do to manage the situation?