case study – 2025 Meet the Client John Mathis John Mathis a 73 year old male is treated in the emergency department ED

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case study – 2025

Meet the Client: John Mathis
John Mathis, a 73-year-old male, is treated in the emergency department (ED) for an infected wound on his right foot. John states he was walking barefoot and stepped on something sharp that cut his foot. He treated it with topical antibiotics, but it appears red and inflamed, with purulent drainage. John is admitted to the medical-surgical unit for inpatient wound care treatment.

As part of the admission interview, the nurse asks Mr. Mathis and his wife how they would like to be addressed by the staff. They reply that until they are more comfortable, they prefer to be called “Mr. and Mrs. Mathis.” As the interview continues, Mr. Mathis tells the nurse he has never been hospitalized. He appears anxious and frequently turns to his wife for reassurance.
Mr. Mathis states his pain level is 8/10 and that he has been staying in bed due to his foot pain.

  1. What is your patient’s primary (priority) nursing diagnosis? (Must place all three components of a nursing diagnosis for full points.) Why does this take priority?
  2. What nursing actions will you take in providing care to your patient? (Please think about the patient holistically. This should be a fairly comprehensive list. Include all necessary interventions related to the primary diagnosis, must be measurable and specific.)
  3. What interventions can the nurse implement to prevent venous thromboembolism in Mr. Mathis’ legs?
  4. What action should the nurse implement to reduce Mr. Mathis’ anxiety during the admission process?

nursing multidimensional care – 2025 Module 03 Assignment Interventions to Promote an Environment of Safety Purpose of

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nursing multidimensional care – 2025

  

Module 03 Assignment- Interventions to Promote an Environment of Safety

Purpose of the Assignment

Identify strategies to reduce the risk for injury to clients in various environments.

Course Competencies

· Select appropriate nursing interventions when providing multidimensional care to clients experiencing alterations in mobility.

· Strategies for safe effective multidimensional nursing practice when providing care for clients experiencing sensory and perception disorders.

Instructions

In a one page Word Document, plan interventions with rationale which will promote an environment of safety for the described client below. Consider the client’s medical history and medications.

Mr. Joe Smith, 75-year old man, recently suffered a left cerebrovascular accident. He has right visual field deficits and residual weakness in this right arm and leg. He uses a walker for mobility. He takes Metoprolol for his blood pressure and the physician started him on Coumadin because he has recently been diagnosed with atrial fibrillation. 

Use at least two scholarly sources to support your interventions and rationale. Be sure to cite your sources in-text and on a reference page using APA format.

You can find useful reference materials for this assignment in the School of Nursing Guide  

Introduction to ethics – 2025 Follow the web links to Bob Dylan s song Highway 61 Revisited for both the song and then the lyrics

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Introduction to ethics – 2025

 

Follow the web links to Bob Dylan’s song “Highway 61 Revisited” for both the song and then the lyrics. Dylan begins with a retelling of a story from the Bible to fit the song.  The other song that actually quotes from Plato’s Euthyphro is listed in question two “No Church in the Wild” by Jay-Z and Kanye West.

In light of that song and our course readings so far, please answer any two of the following  questions:

1) What connection does that Bible story and Dylan’s song have with ethics and the so-called “Divine Command Theory” as espoused by Euthyphro? If we take the song, as some do with the first stanza especially, as a war protest song, how does the interpretation of the Abe story in the song change?  Here is the Dylan song “Highway 61 Revisited” by Karen O (click on small arrow after “link”): LINK (Links to an external site.)
And here is the story of Abraham called by God to kill his own son (Dylan’s first line in his song refers to this story): LINK (Links to an external site.).

Here are Dylan’s lyrics in the first stanza of “Highway 61 Revisited” that relate to our topic for this week:

Oh, God said to Abraham, “Kill me a son”
Abe said, “Man, you must be puttin’ me on”
God said, “No” Abe say, “What?”
God say, “You can do what you want, Abe, but
The next time you see me comin’, you better run”
Well, Abe said, “Where d’you want this killin’ done?”
God said, “Out on Highway 61”

assignment 1 – 2025 ACCT 361 Assignment 1 30 points Business Process Modeling Prototyping an Event Driven IT Application Give yourself enough

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assignment 1 – 2025

    

ACCT-361: Assignment #1 – 30 points
Business Process Modeling: Prototyping an Event-Driven IT Application 

Give yourself enough time to complete this assignment. It is estimated to be about four hours to complete this assignment. In order to do well on the midterm, you must think this through on your own. 

Formula One 

Formula one sells auto parts at fourteen stores in Northern Virginia and Washington, DC. The following describes the business processes Formula One uses for the acquisition of inventory items. 

Formula One has a purchasing department centrally located at company headquarters in Burke, VA. The acquisition/payment process begins when a store manager determines a need for inventory at his/her location. The manager enters the requested items directly into the ERP system to generate a purchase requisition form. 

A purchasing clerk at corporate headquarters checks the system for open requests. Based on the system’s purchase requisitions, the purchasing clerk prepares each purchase order using the ERP system. A request may need to be split into more than one order as not all vendors supply every item. To obtain volume discounts, the clerk combines all requests for similar items into one purchase order. Each purchase order instructs the vendor to ship the inventory items directly to the appropriate stores. The computer process accesses the vendor and inventory master files and updates the purchase order transaction file. One copy of the purchase order is subsequently printed and forwarded to receiving. 

Each store location has a receiving dock manned by warehouse workers. When a delivery comes in from a vendor, a warehouse worker inspects the items and manually creates a receiving report. The employee compares each receiving report to the corresponding purchase order for quantity or item differences. If there is a difference, the employee works with a store manager to resolve the discrepancy. The employee subsequently signs the receiving report and purchase order and keys the data into the system to update the receive goods transaction file. The signed receiving report and purchase order are then filed in the department numerically. 

Formula One has good relationships with their vendors who allow installment payments for all deliveries within the last 60 days. All payments are handled by the cashier in the payments department. 

The following business rules apply:
• Inventory items can be backordered
• Vendors accept returns from the warehouse worker • Inventory items are not unique 

Required:
1. Cover page with full name, section, and Assignment title, 2. A page with the REA model –hand drawn, 

Conceptual Model: Draw an REA model with cardinalities for the operating events, resources and agents in the Formula One inventory acquisition/payment process. The REA model must be hand drawn, scanned/photographed, and submitted to the Assignment 1 link in Blackboard under the Assignment tab. 

 

* The files that i attached is an example of how to do this assignment.

Clinical systems – 2025 Select two diverse clinical settings for example ED versus ICU PeriOp versus Med Surg Pediatrics versus Adults or Sports Medicine vs

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Clinical systems – 2025

Select two diverse clinical settings; for example: ED versus ICU, PeriOp versus Med-Surg, Pediatrics versus Adults, or Sports Medicine vs. Nursing Home, etc. For your two selected clinical settings, compare and contrast the content, features, need, and value of data, information, knowledge, and decision support to clinical practitioners in those settings.

Justify the clinical elements necessary for each clinical setting and create a recommendation of necessary elements for a shared clinical system.  

Make sure that you include the four expanding rings of information (EMR, warehouse, regional, NHIN/PHIN) in your analysis. Describe how the differences would alter the design or features of a clinical system. Support your statements where you claim either similarities or differences between your two settings.

Construct a justification for the shared clinical system from ethical, legal, social, and public policy viewpoints. Formulate a plan for implementation and create the necessary workflow for a successful implementation. Evaluate the role of the master’s prepared informatics nurse after implementation.

ATI written assignment – 2025 Complete the ATI Learning System PN Fundamentals 2 Practice Quiz Under Tutorials Simulations

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ATI written assignment – 2025

Complete the ATI Learning System PN Fundamentals 2 Practice Quiz (Under Tutorials, Simulations, and Quiz Banks).

2. Using your Individual Performance Profile from your first attempt only, complete a remediation of the Topics to Review. In a Word document:

  • Type the list of topics and subtopics under Topics to Review.
  • For each subtopic, write a paragraph discussing the content.
  • Include strategies for answering questions on the content.
  • Use your textbooks and other professional resources, citing as applicable.

Format:

  • Standard American English (correct grammar, punctuation, etc.)
  • Logical, original and insightful
  • Professional organization, style, and mechanics in APA format
  • Submit document through Grammarly to correct errors before submission

Case study – 2025 Using the attached aquifer case present the case and support evidence in a power point presentation with the following

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Case study – 2025

Using the attached aquifer case, present the case and support evidence in a power point presentation with the following components.

  • Slide 1: Title, Student Name, Course, Date
  • Slide 2: Summary or synopsis of Judy Pham’s case
  • Slide 3: HPI
  • Slide 4: Medical History
  • Slide 5: Family History
  • Slide 6: Social History
  • Slide 7: ROS
  • Slide 8: Examination
  • Slide 9: Labs (In-house)
  • Slide 10: Primary Diagnosis and 3 Differential Diagnoses – ranked in priority

Primary Diagnosis should be supported by data in the patient’s history, exam, and lab results.

  • Slide 11: Management Plan: medication (dose, route, frequency), non-medication treatment, tests ordered, education, follow-up/referral.
  • Slide 12-16: An evaluation of 5 evidence-based articles applicable to Ms. Pham’s case: evaluate 1 article per slide.
  1. Include title, author, and year of article
  2. Brief summary/purpose of the study
  3. How did the study support Ms. Pham’s case?

Course texts will not count as a scholarly source. If using data from websites you must go back to the literature source for the information; no secondary sources are allowed, e.g. Medscape, UptoDate, etc. 

  • Slide 17: Reference List                                                              

DNP – 2025 T1 After viewing the video discuss how you plan to protect your patient s

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DNP – 2025

  

T1 After viewing the video, discuss how you plan to protect your patient’s privacy within your project.

https://videocast.nih.gov/summary.asp?Live=33360&start=182&duration=8224&bhcp=1

T2 How would you define and imply causal inference relative to your quasi-experimental designed project and separate it from bias and other factors that may influence it?

https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=hch&AN=116288407&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1

 

 T3 Using your project proposal on improving self-management skills of diabetic patient to effectively control their blood glucose level , provide an example of each of the types of errors described in the article.

https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsdoj&AN=edsdoj.b1da50f685f4486d809494257f7e7181&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1

T4 Examine your process of data collection and how you will maintain patient privacy during your intervention. How can the Christian worldview of carrying out work within the public arena with compassion, justice, and concern for the common good affect data collection and patient privacy?

T5 Provide examples of how you addressed feasibility and statistical versus clinical significance in your proposal. For example, why did you select a four-week time frame for your project versus a power analysis? Did you select this because it was feasible? Why or why not and explain.

T6 What is the difference between clinical and statistical significance and why are both important to the patient improvement outcomes of your project?

https://doi.org/10.1016/j.prrv.2017.02.002

class3w2a1 – 2025 The purpose of this assignment is to develop a a leadership strength to strategy plan b a

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class3w2a1 – 2025

 

The purpose of this assignment is to develop (a) a leadership strength-to-strategy plan, (b) a professional curriculum vitae (CV), and (c) an action plan for leadership formation. The strengths-to-strategy plan (from the Week 1 interactive) formulates a plan to guide leadership development. The CV provides the professional foundation for the DNP portfolio through documentation of professional and academic accomplishments. The action plan addresses gaps or developmental opportunities in the CV while applying strategies from the strength-to-strategy plan. The strengths-to-strategy plan, professional CV, and developmental action plan contribute to the student’s professional development of skills and competencies relevant to the DNP scholar as a leader.

NR703 Professional CV Template (Links to an external site.)  (Links to an external site.)

Course Outcomes

This assignment enables the student to meet the following course outcomes:

CO3: Differentiate attributes of effective leaders and followers in influencing healthcare (PO6)

CO5: Formulate selected strategies for leadership and influence across healthcare systems (PO8)

Due Date

The Late Assignment Policy applies to this assignment.

The assignment title is due by Sunday 11:59 p.m. MT at the end of Week 2.

TOTAL POSSIBLE POINTS: 150

PREPARING THE ASSIGNMENT:

Follow these guidelines when completing each component of this assignment. Contact your course faculty if you have questions. It is each student’s responsibility to save and maintain all artifacts required in the e-Portfolio (Links to an external site.)  (Links to an external site.) . (Links to an external site.)  (Links to an external site.)

  1. The assignment will include the following components:
    1. One title page
      1. Title: Strengths-to-Strategy, Curriculum Vitae, and Action Plan
      2. Format the title page as shown in the APA Paper Template in the Resources tab of Canvas and as demonstrated below:

Strengths-to-Strategy, Curriculum Vitae, and Action Plan

Name

Chamberlain College of Nursing

NR703: Applied Organizational & Leadership Concepts

September Session [or applicable Session] 2020

  1. Include an introduction and a conclusion paragraph.
  2. Use the following required level 1 headings:
    1. Strengths-to-Strategy Plan
    2. Professional Curriculum Vitae
    3. Action Plan for Leadership Formation
    4. Conclusion
  3. Introduction (10 points)
    1. Note: Do not use “Introduction” as a heading. Place the paper’s title on the first line.
    2. Present a clear purpose statement.
    3. Introduce the sections of the paper in a mini-outline in sentence format.
    4. Establish the significance of the paper to you as a future practice scholar and DNP leader.
  4. Strength-to-Strategy Plan (40 points): Complete the Week 1 Strength-to-Strategy Plan interactive exercise located in the Explore section of Week 1.
    1. Use the Strength-to-Strategy Plan interactive to provide the rough information for this section of the paper, written in a Microsoft Word document
    2. Create four (4) Level 2 headings that reflect the Week 1 interactive results
      1. Leadership Strengths
        1. Describe in a paragraph 3 strengths you discovered in the interactive in complete sentences.
        2. Briefly explain the importance of each to your leadership development.
      2. Leadership Opportunities
        1. Describe in a paragraph 3 opportunities you discovered in the interactive in complete sentences.
        2. Briefly explain the importance of each to your leadership development.
      3. Strategies for Turning Opportunities into Strengths
        1. Describe in a paragraph 3 strategies for turning opportunities into strengths you discovered in the interactive in complete sentences.
        2. Briefly explain the importance of each to your leadership development.
      4. Strategies for Leveraging Others’ Strengths
        1. Describe in a paragraph 2 strategies for leveraging others’ strengths you discovered in the interactive in complete sentences.
        2. Briefly explain the importance of each to your leadership development.
  5. Professional Curriculum Vitae (40 points):
  6. Use the required NR703 Professional CV Template  (Links to an external site.) attached as an Appendix after the paper. This section of the body of the paper should introduce your CV, explain your impressions as you constructed it in the template, and note any insights or surprises you discovered. In this section, include the instructions to the reader to see the Appendix, either in the sentence or within parentheses.
  7. The professional CV should include the following (NOTE: If there are no entries in a section, enter “None” or “N/A” but do not remove the section):
    1. Name and Contact Information
    2. Education
      1. List all educational institutions attended in reverse chronological order.
      2. Include date degree conferred, degree earned, institution, and location.
      3. Include your DNP with the anticipated graduate date .
    3. Professional Licensure: RN licensure and APRN/Other Licenses
      1. List state(s) of licensure.
      2. Do not list license numbers.
    4. National Professional Certifications
      1. Include the date(s) of certification, the certification name, and certifying organization.
    5. Professional Work History
      1. List all employment in reverse chronological order.
      2. Include ONLY dates of employment, position, institution, and location of the position held.
    6. Professional Associations and Activities
      1. List dates, role, and organization.
    7. Awards and Honors
      1. List dates, awards, and granting organizations.
    8. Research and Grants*
      1. List dates, role, title, sponsor, and monetary award.
    9. Publication: Books, Book Chapters, and Journal Articles*
      1. Provide complete reference in APA format
      2. Bold your name
    10. Presentations*: International, National, Regional, or Local
      1. Include date, title, conference, sponsor, and city.
    11. Volunteer activities
      1. Include dates, role, and organization.
    12. References Available Upon Request

*There may be items in the CV that you have not done yet in your development, but it is appropriate to leave the headings and enter “None” or “N/A.”

  1. Action Plan (50 points) : Include 3 Level Two Headings with 1 paragraph each that support your leadership formation. The action plan should include the following three sections:
    1. Analysis of Current CV : An analysis of your current CV, including your greatest accomplishments and what you are most proud of in your career journey.
    2. Plan of Action for Strengthening CV : A plan of action for strengthening your CV by adding accomplishments to areas in which you may not have entries or have limited entries.
    3. Plan of Action to Turn Opportunities into Strengths: A plan of action for using the strategies for turning your developmental opportunities into strengths noted on the Strength-to-Strategy Plan.
  2. Conclusion (10 points):
    1. Recaps the paper’s purpose statement and mini-outline criteria.
    2. Draws major conclusions from the body of your paper.
    3. Summarize the importance of professional development to you as a future practice scholar and DNP leader.
  3. Writing Organization and Mechanics (10 points)
    1. One document is created using the four Level 1 headings prescribed.
    2. The standard Chamberlain CV Template is used for the CV section and placed as an Appendix.
    3. Grammar and mechanics are free of errors. (Grammarly.com)
    4. APA style and standard English language are used & abbreviations/ acronyms are explained.
  4. You will submit one document with all sections included in the following organization:
    1. Title Page
    2. Introduction
    3. Strengths-to-Strategy Plan
    4. Professional Curriculum Vitae
    5.  Action Plan for Leadership Formation
    6. Conclusion
    7. References (if used)
    8. Appendix*

*(NOTE: If more than one Appendix is used, they are labeled Appendix A, Appendix B, etc.)

IF YOU NEED ADDITIONAL INFORMATION FROM ME TO BE INCLUDED IN THE ASSIGNMENT PLEASE NOTIFY ME BEFORE FINALIZING THE ASSIGNMENT.  PERSONAL INFO FOR ASSIGNMENT.

medical ethics – 2025 Develop a solution to a specific ethical dilemma faced by a health care professional by applying

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medical ethics – 2025

 

Develop a solution to a specific ethical dilemma faced by a health care professional by applying ethical principles. Describe the issues and a possible solution in a 3-5-page paper.

Introduction

Whether you are a nurse, a public health professional, a health care administrator, or in another role in the health care field, you must base your decisions on a set of ethical principles and values. Your decisions must be fair, equitable, and defensible. Each discipline has established a professional code of ethics to guide ethical behavior. In this assessment, you will practice working through an ethical dilemma as described in a case study. Your practice will help you develop a method for formulating ethical decisions.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

  • Competency 1: Apply information literacy and library research skills to obtain scholarly information in the field of health care.
    • Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.
  • Competency 3: Apply ethical principles and academic standards to the study of health care.
    • Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.
    • Discuss the effectiveness of the communication approaches present in a case study.
    • Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.
    • Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.
  • Competency 4: Write for a specific audience, in appropriate tone and style, in accordance with Capella’s writing standards.
    • Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
    • Write following APA style for in-text citations, quotes, and references.

Instructions

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed.

For this assessment, develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:

  1. Access the Ethical Case Studies media piece to review the case studies you will be using for this assessment.
    • Select the case most closely related to your area of interest and use it to complete the assessment.
      • Note: The case study may not supply all of the information you need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.
    • Include the selected case study in your reference list, using proper APA Style and Format.
  2. Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.
    • Identify which case study you selected and briefly summarize the facts surrounding it. Identify the problem or issue that presents an ethical dilemma or challenge and describe that dilemma or challenge.
    • Identify who is involved or affected by the ethical problem or issue.
    • Access the Ethical Decision-Making Model media piece and use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) to analyze the ethical issues.
      • Apply the three components outlined in the Ethical Decision-Making Model media.
    • Analyze the factors that contributed to the ethical problem or issue identified in the case study.
      • Describe the factors that contributed to the problem or issue and explain how they contributed.
  3. Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.
    • In addition to the readings provided, use the Capella library to locate at least one academic peer-reviewed journal article relevant to the problem or issue that you can use to support your analysis of the situation. The How Do I Find Peer-Reviewed Articles? library guide will help you locate appropriate references.
      • Cite and apply key principles from the journal article as evidence to support your critical thinking and analysis of the ethical problem or issue.
      • Review the Think Critically About Source Quality resource.
        • Assess the credibility of the information source.
        • Assess the relevance of the information source.
  4. Discuss the effectiveness of the communication approaches present in a case study.
    • Describe how the health care professional in the case study communicated with others.
    • Assess instances where the professional communicated effectively or ineffectively.
    • Explain which communication approaches should be used and which ones should be avoided.
    • Describe the consequences of using effective and non-effective communication approaches.
  5. Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.
    • Describe the actions taken in response to the ethical dilemma or issue presented in the case study.
    • Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.
    • Discuss the key lessons this case provides for health care professionals.
  6. Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.
    • Describe the proposed solution.
    • Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.
    • Discuss how likely it is the proposed solution will foster professional collaboration.
  7. Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
    • Apply the principles of effective composition.
    • Determine the proper application of the rules of grammar and mechanics.
  8. Write using APA style for in-text citations, quotes, and references.
    • Determine the proper application of APA formatting requirements and scholarly writing standards.
    • Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Additional Requirements

Your assessment should also meet the following requirements:

  • Length: 3–5 typed, double-spaced pages, not including the title page and reference page.
  • Font and font size: Times New Roman, 12 point.
  • APA template: Use the APA Style Paper Template [DOCX] as the paper format and use the APA Style Paper Tutorial [DOCX] for guidance.
  • Written communication: Use correct spelling, grammar, and punctuation.
  • References: Integrate information from outside sources to include at least two references (the case study and an academic peer-reviewed journal article) and three in-text citations within the paper.
  • APA format: Follow current APA guidelines for in-text citation of outside sources in the body of your paper and also on the reference page.

If you would like assistance in organizing your assessment, or if you simply have a question about your assessment, do not hesitate to ask faculty or the teaching assistants in the NHS Learner Success Lab for guidance and suggestions.

case study

 

Jenna and Chris Smith are the proud parents of Ana, a 5–day–old baby girl born without complications at Community Hospital. Since delivery, the parents have bonded well with Ana and express their desire to raise her as naturally as possible. For the Smiths, this means breastfeeding exclusively for the first six months, making their own baby food using pureed organic foods, and not allowing Ana to be vaccinated.

The Smiths are college educated and explain they have researched vaccines and decided the potential harms caused by them far outweigh any benefits. They point to the rise in autism rates as proof of the unforeseen risk of vaccines. Their new pediatrician, Dr. Angela Kerr, listens intently to the Smiths’ description of their research, including online mommy–blogs that detail how vaccines may have caused autism in many children. The Smiths conclude by resolutely stating they’ve decided not to vaccinate Ana, despite the recommendations of the medical community.

Dr. Kerr begins by stating that while vaccines have certainly sparked controversy in recent years, she strongly recommends that Ana become fully vaccinated. Dr. Kerr explains that vaccines have saved the lives of millions of children worldwide and have been largely responsible for decreases in child mortality over the past century. For example, the decreased incidence of infection with the potentially fatal Haemophilus influenzae type b, has resulted from routine immunization against that bacterium. Similarly, epidemics such as the recent outbreak of measles are usually associated with individuals who have not been vaccinated against that pathogen.

Dr. Kerr goes on to endorse the general safety of vaccines by informing Ana’s parents that safety profiles of vaccines are updated regularly through data sources such as the federal government’s Vaccine Adverse Event Reporting System (VAERS). The VAERS, a nationwide vaccine safety surveillance program sponsored by the Food and Drug Administration and the Centers for Disease Control and Prevention, is accessible to the public at https://vaers.hhs.gov/index. This system allows transparency for vaccine safety by encouraging the public and healthcare providers to report adverse reactions to vaccines and enables the federal government to monitor their safety. No vaccine has been proven casual for autism spectrum disorder (ASD), or any developmental disorder. On the contrary, many studies have shown that vaccines containing thimerasol, an ingredient once thought to cause autism, do not increase the risk of ASD.

Finally, Dr. Kerr reminds the Smiths that some children in the general population have weakened immune systems because of genetic diseases or cancer treatment, for example. It may not be medically feasible to vaccinate such children. Other children are too young to receive certain immunizations. Instead, these children are protected because almost all other children (and adults) have been vaccinated and this decreases their exposure to vaccine–preventable illnesses (VPIs). This epidemiological concept is known as “herd immunity.” As more parents refuse immunization for their healthy children, however, the rate of VPIs will increase. This puts vulnerable children at significant risk of morbidity and mortality. Routine childhood immunization contributes significantly to the health of the general public, both by providing a direct benefit to those who are vaccinated and by protecting others via herd immunity. Dr. Kerr concludes by stating that after considering the risks versus the benefits of immunization, most states require vaccinations before children can attend school. Parents may decide not to vaccinate under specific circumstances, however, which vary by state.

Jenna and Chris Smith confirm their understanding of what Dr. Kerr has explained, but restate that they do not want Ana vaccinated at this time. Dr. Kerr is perplexed as to what to do.