Assessment 5 Instructions: Tonya’s Case: Ethics and Professional Codes

• Write a 2-3 page paper that examines end-of-life issues in relationship to hospitals, professional ethics, and accrediting bodies.
  How Institutional Conceptual Frameworks Influence Ethical Decision Making
  We wrap things up by exploring institutions and groups designed to help ensure that hospital staff at all levels think and act ethically in caring for patients. Accrediting bodies are oversight agencies charged with performing accreditation of hospitals and helping to establish standards for health care delivery. Their aim is to keep the quality of care as high as possible and to make sure the care is delivered ethically. Ethics committees are groups of individuals within hospitals that meet regularly to advise staff on ethically difficult cases and to promote an ethical institutional culture.
  Demonstration of Proficiency
  By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
  • Competency 2: Apply sound ethical thinking related to a health care issue.
    • Demonstrate sound ethical thinking in applying ethical principles and moral theories to a specific case.
  • Competency 3: Analyze ethical issues associated with patient care from the perspectives of various health care professionals.
    • Explain professional codes of ethics and apply them in to a specific case.
  • Competency 4: Explain the conceptual framework that health care leaders use to make ethical decisions.
    • Explain organizational documents like mission and value statements and use them to analyze a case study.
    • Explain the role of accrediting bodies and applies this understanding in analyzing a case study.
  • Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals.
    • Provides validation and support within written communications by including relevant examples and supporting evidence using APA citations.
    • Produce writing with minimal errors in grammar, usage, spelling, and mechanics.
  • Preparation
    Complete the Case Study: Tonya Archer media activity, which is linked later in this assessment.
    Before you begin creating your submission for this assessment, make sure you have worked through the Tonya Archer case study. This will provide the foundational context for the assessment, for which you will be carrying out independent research by using the Internet to complete the following:
  • Identify the professional code of ethics for your professional specialty or a specialty that you are interested in.
  • With a local hospital in mind (perhaps one you work for), locate the mission, vision, and values statement of that hospital.
  • After you identify the professional ethics code and the hospital mission, vision, and values statements relevant to your work and interests, it may be useful to complete the following:
  • Identify which item in the ethical code you believe is the most important and explain why.
  • Name something in the code you would like to see addressed in more depth. Why?
  • Which item in the code do you think would be the most challenging to follow and why?
  • Does your code make an explicit distinction between what is legal and what is ethical? That is, is the code clear that, while an action may be legal, it may not be ethical?
  • Finally, how well does your professional code of ethics align with the mission and values statement of your hospital? Can you imagine a situation in which following one would make it challenging to follow the other?
  • Instructions
    For this assessment you will apply some concepts we have learned in the course, particularly those relating to the basic principles of health care ethics, professional codes of ethics, and values of health care institutions.
    Write a paper that answers the following questions as it relates to the Tonya Archer Case Study:
  • What are the most relevant end-of-life issues in health care ethics as they relate to this case?
  • What should the hospital do? Should doctors simply keep Tonya on life support, as the parents want? Or, since all medical evidence indicates that Tonya’s brain damage is permanent, should life support be removed?
  • Support your answer with the following considerations in mind:
  • Explain which principles of health care ethics and which moral theory are the best philosophical foundations for your view.
  • Is your view supported by your professional code of ethics? If so, explain how. If not, explain what your code gets wrong about a case like this.
  • Is your view consistent with the mission statement and values of the hospital you identified in your independent research you conducted to prepare to complete this assessment?
  • Would an accrediting body, like the Joint Commission, support your choice? Why or why not?
  • Submission Requirements
    Your paper should meet the following requirements:
  • Written communication: Written communication is free of errors that detract from the overall message.
  • APA formatting: Resources and citations are formatted according to current APA style and formatting guidelines.
  • Length: 2–3 typed, double-spaced pages.
  • Font and font size: Times New Roman, 12 point.
• SCORING GUIDE
  Use the scoring guide to understand how your assessment will be evaluated.

First

Comparison of Virginia, Maryland and District of Columbia APRN Regulations

     The region of Virginia in which I live is locally known as “the DMV” (the abbreviation for District/Maryland/Virginia). It is common for many practitioners to live in one jurisdiction and practice in another. For this reason, I chose to compare the three jurisdictions.

     According to the American Association of Nurse Practitioners, an APRN’s practice is restricted in Virginia. However, in the District and Maryland, APRNs may practice to their full scope of education and experience. Two differences I noted were in regulating agencies and in prescriptive authority. In Virginia, APRNs are regulated jointly by the Board of Nursing and the Board of Medicine. In contrast, in the District and Maryland, the respective Boards of Nursing are the only regulatory agencies.

     Regarding prescriptive authority, in Virginia, in order for a nurse practitioner (other than a nurse anesthetist or midwife) to have autonomy in practice, one must have practiced in a restricted capacity for at least five years (9000 hours). Also, nurse practitioners may only prescribe Schedule II – V medications in partnership with a physician. In the District, APRNs have full prescriptive authority (DC Health), and in Maryland, full prescriptive authority includes prescribing medical marijuana (Maryland Board of Nursing).

     Loversidge (2019), in addressing the regulation of Advanced Practice Registered Nurses (APRNs), proffered that it “has been inconsistent because…states [have] the right to establish laws governing professions and occupations” (p. 65). As a note of interest regarding practicing

RNs, the District does not participate in the Nursing Licensure Compact either, and an RN that wants to practice in DC must obtain a separate DC-specific license. In a region as geographically close as the DMV, especially during health-related crises, collaboration among the three regions Boards of Nursing could allow for scope expansion of a Virginia-licensed APRN. In the meantime, it is essential for APRNs crossing borders into other jurisdictions to familiarize themselves with the regulations of each in order to adhere to both prescriptive authority and other regulations.

References

American Association of Nurse Practitioners. Retrieved September 28, 2020, from https://www.aanp.org/advocacy/state/state-practice-environment

DC Health, Nursing Regulations, Nurse Practitioners. Retrieved September 28, 2020, from

https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Chapter%2059%20Nurse-Practitioners.pdf

Loversidge, J.M. (2019). Government response: regulation. In J. A.Milstead, & N. M. Short (Eds.), Health policy and politics: A nurse’s guide (6th ed., pp 57-86). Burlington, MA: Jones & Bartlett Learning

Maryland Board of Nursing Scope and Standards of Practice. Retrieved September 28, 2020, from http://www.dsd.state.md.us/comar/comarhtml/10/10.27.07.03.htm

Virginia Department of Health Professions Board of Nursing. Retrieved September 28, 2020, from https://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/NursePractitioners.pdf

Second 

 APRN Board of Nursing Regulations in Texas and Florida.

Most states in the U.S of America have similar and different regulations to govern APRN in their practice acts because of the complexity of the health care system. According to Milstead & Short (2019), “Regulation means to control over something by rule or restriction, and health professions regulation is needed as a mechanism to protect the interest of the public safety (p. 60). Each states Board of Nursing in the U.S put in place regulations to protect the public of interest because of the potential risk for harm so that APRN can be held accountable and responsible of any rules that are outline in the practice acts. In Texas, to renew APRN license, applicant must completed an APRN educational program, attest to having a minimum of 400 hours of current practice within the preceding biennium, and attest to being in compliance of continuing competency and APRN with prescriptive authority (Office of the Secretary of States, n.d). In Texas, APRN with full valid prescription authorization number can obtain authority to order or prescribe control substance in Schedule II, III through V. Prescription for controlled substance in Scheduled III through V including refill of the prescription shall not exceed 90 days’ supply, beyond the initial 90 days the refill prescription cannot be authorized, and prescription of the controlled substance in Schedule III through V for child less than two years of age can not be authorize prior to consultation with delegating physician and notation of consultation in the patient’s chart (Office of the Secretary of States, n.d). This regulation enables the APRN to follow the guidelines when prescribing certain categories of control substance.

In Florida, to renew APRN license, the applicant must prescribe up to 30 hours of continuing education biennially as a condition for renewal of a license or certificate, must complete at least 3 hours of continuing education on the safe and effective prescription of controlled substances, and complete a 2-hour continuing education course on human trafficking. In Florida, APRN has been granted legal authority to prescribed drugs listed as controlled substance subject to approval by their supervising Practioner, will need mid-level Practioner DEA registration, APRN cannot prescribe more than 7-day supply of Schedule II control substance except the APRN is a psychiatric nurse who only can prescribe 7-day supply of Schedule II controlled substance that is mental health drugs, and ARNPs who are not psychiatric nurses cannot prescribe psychiatric mental health controlled substances for children younger than 18 years of age (Akerman LLP – Health Law Rx, 2016).

Regulations for Advance Practice Registered Nurse (APRNs): Legal Authority to      Practice

American Health care delivery system is face with so many complex issues which requires adequate access to health care for positive health outcome. There is a barrier to health delivery because of shortage of health care providers in the U.S and these are affecting millions of Americans to seek health care at their convenient time. Every year, foreign immigrants, people living in rural areas, lower-middle class citizen find it difficult to access health care due to race, color, ethnicity, nationality, sexual orientation or socioeconomic status. Granting APRN full legal authority to practice without limitation can help resolve the issue of the barriers facing health care delivery system in the U.S. Some states allow APRNs to practice independent without physician supervision to lessen the high demands of their health care delivery system while other states are still deliberately on the issue. In 2017, 15 states report that NPs are regulated solely by a BON and have independent scope of practice and prescriptive authority without physician supervision, delegation, consultation, or collaboration… (Milstead & Short, 2019 p.63). If an APRN with full legal right to practice moved to another states with limitation, the APRN must abide to the regulations of the new states when it comes to renewal of license and prescription of some categories of control substance. For example, Texas regulation requires APRN to obtain authority to prescribe control substance in Schedule II, III through V, the APRN with legal right to practice independently must abide to the rules of Texas with no exception to the law because the APRN is within the jurisdiction of the new states.

                                                References

Akerman LLP – Health Law Rx. (2016). Deciphering Florida’s New Laws on ARNP and PA Controlled Substance Prescribing. Retrieve from: https://www.jdsupra.com/legalnews/deciphering-florida-s-new-laws-on-arnp-25553.

Milstead, J & Short, N. (2019). Health Policy and Politics: A Nurse’s Guide. Government Response: Regulation. p. 60, 63, 6th edition. Burlington. MA. Jones & Bartlett Learning.

Office of Secretary of States. (n.d). Texas Administrative Code. Retrieve from: https://texreg.sos.state.tx.us/public/readta1c$ext.ViewTAC?tac_view=3&ti=22&pt=11

Treatment of Psychiatric Emergencies in Children Versus Adults

The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations.

In this Discussion, you compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients.

Learning Objectives

Students will:

· Compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients

· Analyze legal and ethical issues concerning treatment of child or adolescent psychiatric emergency clients

To Prepare:

· Review the Learning Resources concerning emergency psychiatric medicine.

· Consider a case where an adult client had a psychiatric emergency. If you have not had a personal experience with an adult client who had a psychiatric emergency, you can conduct an internet or library search to identify.

Post:

· Briefly describe the case you selected.

· Explain how you would treat the client differently if he or she were a child or adolescent.

· Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case.

 Required Readings ( Need 3 references)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Bipolar and Related      Disorders”

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 23, “Emergency Psychiatric Medicine”      (pp. 785–790)
• Chapter 31, “Child Psychiatry” (pp. 1226–1253)

Optional Resources

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell. 

• Chapter 50, “Provision of Intensive Treatment:      Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)
• Chapter 64, “Suicidal Behavior and Self-Harm”      (pp. 893–912)

 In the realm of marketing, a successful branding strategy is one of the most important contributors to organizational success. A solid branding strategy can help add visibility and credibility to a company’s products.

Similarly, nurse-scholars can build a personal brand to add visibility and credibility to their work. You can begin building your brand by developing and maintaining an academic portfolio. Such activity can help share the results of your efforts and contribute to your success. This Module’s Discussion asks you to consider and share strategies for building your portfolio.

To Prepare:

• Reflect on strategies that you can pursue in developing portfolios or portfolio elements that focus on academic achievements.
• Review one or more samples from your own research of resources focused on portfolio development.

Post 6-8 paragraph an explanation of at least two strategies for including academic activities and accomplishments into your professional development goals. Then, explain how those goals may align with the University’s emphasis on social change. Be specific and provide examples.

Burns, M. K. (2018). Creating a nursing portfolio. Ohio Nurses Review, 93(3), 16–17.

Note: You will access this article from the Walden Library databases.

Casey, D. & Egan, D. (2013). The use of professional portfolios for career enhancement. British Journal of Nursing, 15(11), 547–552. doi:10.12968/bjcn.2010.15.11.79625

Note: You will access this article from the Walden Library databases.

East, R. (2015). Developing a nurse practitioner portfolio. ACORN: The Journal of Perioperative Nursing in Australia, 28(4), 35.

Note: You will access this article from the Walden Library databases.

Hannans, J. & Olivo, Y. (2017). Craft a positive nursing digital identity with an ePortfolio. American Nurse Today, 12(11), 48–49. Retrieved November 14, 2018, from https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Digital-Identity-1017a-1.pdf

Leahy, R., & Filiatrault, A. (2017). Employers’ perceptions of the benefits of employment electronic portfolios. International Journal of ePortfolio, 7(2), 217–223.

Note: You will access this article from the Walden Library databases.

McMillan, L. R., Parker, F., & Sport, A. (2014). Decisions, decisions! E-portfolio as an effective hiring assessment tool. Nursing Management, 45em>(4), 52–54.

Note: You will access this article from the Walden Library databases.

Walden University. (n.d.). Walden University catalog. Retrieved October 4, 2019, from https://catalog.waldenu.edu
Select College of Health Sciences, then Master of Science in Nursing (MSN). Review the MSN Learning Outcomes on this page.

Select an ethnic minority group that is represented in the United States (American Indian/Alaskan Native, Asian American, Black/African American, Hispanic/Latino, Native Hawaiian, or Pacific Islander). Using health information available from Healthy People, the CDC, and other relevant government websites, analyze the health status for this group.

In a paper of 1,000-1,250 words, compare and contrast the health status of your selected minority group to the national average. Include the following:

1. Describe the ethnic minority group selected. Describe the current health status of this group. How do race and ethnicity influence health for this group?
2. What are the health disparities that exist for this group? What are the nutritional challenges for this group?
3. Discuss the barriers to health for this group resulting from culture, socioeconomics, education, and sociopolitical factors.
4. What health promotion activities are often practiced by this group?
5. Describe at least one approach using the three levels of health promotion prevention (primary, secondary, and tertiary) that is likely to be the most effective in a care plan given the unique needs of the minority group you have selected. Provide an explanation of why it might be the most effective choice.
6. What cultural beliefs or practices must be considered when creating a care plan? What cultural theory or model would be best to support culturally competent health promotion for this population? Why?

Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.