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?

Mood disorders can impact every facet of a human being’s life, making the most basic activities difficult for patients and their families. This was the case for 13-year-old Jeanette, who was struggling at home and at school. For more than 8 years, Jeanette suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. 

As a PNP working with pediatric patients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies. 

This week, as you examine antidepressant therapies, you explore the assessment and treatment of three populations: pediatrics, adults, and geriatrics. The focus of your assessment tool, a decision tree, will specifically center on one of the most vulnerable populations, pediatrics. Please remember, you must also consider the ethical and legal implications of these therapies. You will also complete a Quiz on the concepts addressed throughout this module. 

Assignment- Decision tree 

Required: media file within classroom  (https://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_02/index.html) 

You will write a formal (APA formatted) paper no more than 5-6 pages long addressing the media file as directed in the classroom directions

Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

When pediatric patients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult patients with the same disorders, they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders.

To prepare for this Assignment:

· Review this week’s Learning Resources, including the Medication Resources indicated for this week.

· Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy.

The Assignment: 5 pages

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature..

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

 Your friend Bruce calls in a panic. He has just come from the doctor and been diagnosed with a bacterial infection. The doctor told him not to worry; his B cells will take care of it in no time! Knowing that you are studying the immune response, he is calling to ask you to explain this statement. Is the doctor correct? Is there more to the story? 

Newman pointed out that, “nurse client relationships often begin during periods of disruption, uncertainty, and unpredictability in patient’s lives” (Smith & Parker, 2015, p. 288). Explore what she means by this statement. Then, reflect on a patient that you cared for that you could apply her theory to. Provide details of the interaction and outcomes.