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Ethical Dilemma

Ethical Dilemma Discussion Board due 8/28/16

The following is a fictitious scenario:

Following an automobile accident, a 16-year-old boy who had recently escaped from a detention center was brought to the hospital emergency department by ambulance. The patient seemed to be alert and claimed to be suffering withdrawal symptoms from a drug habit. The patient claimed that he participated in a methadone treatment program. The physician administered 40 milligrams of methadone. The patient needed blood but refused it. After being observed in the emergency department for several hours, the patient was placed on a medical-surgical unit for observation. The following morning it was not possible to awaken him, and he was pronounced dead. It was discovered that he had never been an addict or in a methadone treatment program. Rather, the previous night he had been drinking beer and taking librium. He had not told this to hospital authorities. His estate sued the physician.

Consider the possible outcomes if death was the result of (1) overdose, (2) failure to administer blood, or (3) subdural hematoma. Consider the possible outcomes if the patient was not a minor.

  1. How would you argue for the plaintiff? And what evidence would you present?
  2. How would you defend the defendant? And what are your defense options?
  3. If you were on the jury, what would your finding be, based on only the facts as presented above?
  4. If you find the defendant responsible, what damages would you award, and for what reasons?

Without knowing many details of healthcare law and legal obligations (that’s why you are in this class), answer the above questions based on what you think is ethical. 
You are responsible for at least a 250 word post, plus an educated response, including thoughtful comments or questions, to two of your classmates. This discussion board response is worth 10 points of your grade.

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Radiology

Select at least three (3) of the following information systems:

  • Radiology
  • Emergency
  • Surgical
  • Dental
  • Pharmacy

Create a 10- to 15-slide Microsoft® PowerPoint® presentation in which you define and describe each information system, including a discussion of its purpose and use.

Write a 1-page handout to accompany your presentation, and include speaker notes within the presentation. This should be a high level overview of the presentation.

Cite at least two (2) outside sources according to APA guidelines. For additional information on how to properly cite your sources, access the Reference and Citation Generator in the Center for Writing Excellence.

Submit your assignment via a Microsoft Word document.

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Compilation

Compilation

Summarize, in 3-4 pages, this assignment that provides information from Weeks 1 to 4.

In addition to the work you completed in the last four weeks, your assignment should also:

  • Include an introduction and a conclusion.
  • Implement the recommendations from the instructor.
  • Describe the role of nursing informatics.
  • Explain how nursing informatics or technology in health care will help or hinder your leadership.

On a separate references page, cite all sources using APA format

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. Federal health policymaking

Shi, L. (2014). Overview of health policy. In Introduction to health policy (pp. 3-27). Chicago: Health Administration Press. Please See Attachment with Reading Reference

Shi, L. (2014). Federal health policymaking. In Introduction to health policy (pp. 31-52). Chicago: Health Administration Press.

Shi, L. (2014). Health policymaking at the state and local levels and in the private sector. In Introduction to health policy (pp. 53-73). Chicago:

POLICYMAKING IN THE GOVERNMENT AND THE PRIVATE SECTOR

Assignment Overview

Health policymaking happens at all levels of government and for a wide variety of topics. The private sector also plays a considerable role in the process. This assignment will give you the opportunity to demonstrate your knowledge of how policymaking happens in government and the roles of various entities as well as the numerous stakeholders.

Homework Case Assignment

After reading the background materials for Module 1, please address the following questions.

· Compare and contrast policymaking at the federal, state, and local levels. How are they similar? How are they different?

· What is the role of the private sector in policymaking?

· Identify the various stakeholders in health policymaking. Why is it important to seek input from all involved?

Assignment Expectations

1. Conduct additional research to gather sufficient information to justify/support your analysis.

2. Limit your response to a maximum of 3 pages.

3. Support your paper with a minimum of 3 reliable sources. The course textbook counts as one, and at least one of the others should be a peer-reviewed article. Use the following link for additional information on how to recognize peer-reviewed journals: http://www.angelo.edu/services/library/handouts/peerrev.php

4. Please use the following resource for evaluating information found on the internet to ensure that you are using reliable sources: https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content

5. You may use the following source to assist in your formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/.

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monitoring tools

· Your assignment is to write a 2 page section describing the monitoring tools for each compliance plan. (1.Clinical staff members are not washing their hands between patients. 2.Employee attacks patients while under the influences of narcotics.)  (That means a total of 4 pages for the two plans) Then, create a 1-page procedure based on one of your monitoring tools. Monitoring tools you should cover for each plan should relate to the policies and procedures you developed in previous modules.

· You chose policies/procedures under the key compliance areas of Compliance Standards, High-Level Responsibility, Education, Communication, Monitoring/Auditing (for Safety), Enforcement/Discipline, and Response/Prevention.

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Leadership Styles Questionnaire

Complete the assigned readings and the “Leadership Styles Questionnaire” (Northouse Chapter 4). See attached pictures.

In three well developed paragraphs (650–700 words total), address the following prompts:

1- What do your responses to the questionnaire reveal about your leadership style?

Note: My leadership style is the “Democratic”

2- How will this style influence your intended professional role (upon graduation from your program of study)?

Note: My program of study is Psychiatric Mental Health Nurse Practitioner.

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Articles of Confederation

  • Pick two (2) issues of the Articles of Confederation and describe the main problems that the United States was faced with under the Federation government.
  • Analyze two major debates (see textbook Section 7.4) by which the Constitution was created in the summer of 1787.

Then, address one (1) of the following to your initial post:

  • Discuss the ratification process of the Constitution of 1787.
  • How did ratification lead to the formation of America’s first two political parties, the Federalists and Anti-Federalist?
  • What were the major differences between the Federalist and Anti-Federalist, and who were the best-known members of each party?

APA format for in-text citations and list of at least **2 references*

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Statistical Technique in Review

Statistical Technique in Review

 

 

 

Most research reports describe the subjects or participants who comprise the study sample. This description of the sample is called the sample characteristics, which may be presented in a table and/or the narrative of the article. The sample characteristics are often presented for each of the groups in a study (i.e., intervention and control groups). Descriptive statistics are calculated to generate sample characteristics, and the type of statistic conducted depends on the level of measurement of the demographic variables included in a study (Grove, Burns, & Gray, 2013). For example, data collected on gender is nominal level and can be described using frequencies, percentages, and mode. Measuring educational level usually produces ordinal data that can be described using frequencies, percentages, mode, median, and range. Obtaining each subject’s specific age is an example of ratio data that can be described using mean, range, and standard deviation. Interval and ratio data are analyzed with the same statistical techniques and are sometimes referred to as interval/ratio-level data in this text.

 

 

 

 

 

 

 

Research Article

 

 

 

Source

 

 

 

Oh, E. G., Yoo, J. Y., Lee, J. E., Hyun, S. S., Ko, I. S., & Chu, S. H. (2014). Effects of a three-month therapeutic lifestyle modification program to improve bone health in postmenopausal Korean women in a rural community: A randomized controlled trial. Research in Nursing & Health, 37(4), 292–301.

 

 

 

 

 

Introduction

 

 

 

Oh and colleagues (2014) conducted a randomized controlled trial (RCT) to examine the effects of a therapeutic lifestyle modification (TLM) intervention on the knowledge, self-efficacy, and behaviors related to bone health in postmenopausal women in a rural community. The study was conducted using a pretest-posttest control group design with a sample of 41 women randomly assigned to either the intervention (n = 21) or control group (n = 20). “The intervention group completed a 12-week, 24-session TLM program of individualized health monitoring, group health education, exercise, and calcium–vitamin D supplementation. Compared with the control group, the intervention group showed significant increases in knowledge and self-efficacy and improvement in diet and exercise after 12 weeks, providing evidence that a comprehensive TLM program can be effective in improving health behaviors to maintain bone health in women at high risk of osteoporosis” (Oh et al., 2014, p. 292).

 

 

 

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Relevant Study Results

 

 

 

“Bone mineral density (BMD; g/cm2) was measured by dual energy x-ray absorptiometry (DXA) with the use of a DEXXUM T machine . . . . A daily calibration inspection was performed. The error rate for these scans is less than 1%. Based on the BMD data, the participants were classified into three groups: osteoporosis (a BMD T-score less than −2.5); osteopenia (a BMD T-score between −2.5 and −1.0); and normal bone density (a BMD T-score higher than −1.0)” (Oh et al. 2014, p. 295).

 

 

 

 

 

“Characteristics of Participants

 

 

 

The study participants were 51–83 years old, and the mean age was 66.2 years (SD = 8.2). The mean BMI was 23.8 kg/m2 (SD = 3.2). Most participants did not consume alcoholic drinks, and all were nonsmokers. Antihypertensives and analgesics such as aspirin and acetaminophen were the most common medications taken by the participants. Less than 20% of participants had a regular routine of exercise at least three times per week. Daily calcium- and vitamin D-rich food intake (e.g., dairy products, fish oil, meat, and eggs) was low. Seventy-five percent (n = 31) of the participants had osteoporosis or osteopenia. There were no differences in the baseline characteristics of the groups (Table 2). The adherence rate to the TLM program was 99.6%” (Oh et al., 2014, p. 296).

 

 

 

TABLE 2

 

BASELINE CHARACTERISTICS AND HOMOGENEITY OF THE TREATMENT AND CONTROL GROUPS

 

 

 

Intervention (n = 21)Control (n = 20)CharacteristicMean ± SD Mean ± SD t or χ2 a

 

Anthropometric Age (years)65.95 ± 8.5966.35 ± 7.940.154 Height (cm)152.33 ± 6.53150.57 ± 6.010.896 Weight (kg)57.90 ± 10.8554.66 ± 9.481.016 BMI (kg/m2)24.17 ± 3.1423.38 ± 3.320.782Lifestyle Years since menopause20.21 ± 10.4417.5 ± 11.050.767 Calcium-rich food intake (times/week)27.3 ± 11.423.8 ± 8.81.110 Vitamin D-rich food intake (times/week)2.4 ± 2.53.1 ± 3.10.705Intervention (n = 21) Control (n = 20) Characteristic n  %  n  % t or χ2  a    History of fracture8385251.026 Regular exercise (≥3 times/week)4194200.006 Non-drinker (alcohol)2095201000.024 Non-smoker21100201000.024Bone statusb   Normal (T ≥ −1.0)6294201.995 Osteopenia (−1.0 > T > −2.5)8381260 Osteoporosis (T ≤ −2.5)733420Intervention (n = 21) Control (n = 20) Characteristic Mean ± SD  Mean ± SD  t or χ2  a   BMD Lumbar 2–40.83 ± 0.120.85 ± 0.200.526 Femur neck0.67 ± 0.150.67 ± 0.130.055Bone biomarkers Serum osteocalcin (ng/ml)13.97 ± 4.9015.85 ± 5.641.135 Serum calcium (mg/dl)9.47 ± 0.409.54 ± 0.590.405 Serum phosphorus (mg/dl)3.68 ± 0.443.70 ± 0.500.165 Serum alkaline phosphatase (IU/L)68.43 ± 21.5266.70 ± 13.240.308 Serum 25-OH-Vitamin D (ng/ml)14.03 ± 4.3412.38 ± 4.651.177 Urine deoxypyridinoline (nM/mM creatinine)5.70 ± 1.705.95 ± 1.120.555

 

 

 

image

 

 

 

 

 

a All group differences p > 0.05.

 

 

 

b Defined from T-score of femur neck site based on World Health Organization criteria.

 

Note. SD, standard deviation; BMD, bone mineral density (g/cm2).

 

Oh, E. G., Yoo, J. Y., Lee, J. E., Hyun, S. S., Ko, I. S., & Chu, S. H. (2014). Effects of a three-month therapeutic lifestyle modification program to improve bone health in postmenopausal Korean women in a rural community: A randomized controlled trial. Research in Nursing & Health, 37(4), p. 297.

 

 

 

 

 

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Study Questions

 

 

 

 

 

1.  What demographic variables were described in this study?

 

2.  Which variable was measured at the ordinal level? Provide a rationale for your answer.

 

3.  What level of measurement is the data for history of fracture? Provide a rationale for your answer.

 

4.  What statistics were calculated to describe history of fracture? Were these appropriate? Provide a rationale for your answer.

 

5.  Could a mean be calculated on the history of fracture data? Provide a rationale for your answer.

 

6.  What statistics were calculated to describe the regular exercise (≥3 times per week) for the intervention and control groups? Calculate the frequency and percentage of the total sample who exercised regularly. Round your answer to the nearest tenth of a percent.

 

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7.  What statistics were calculated to describe age in this study? Were these appropriate? Provide a rationale for your answer.

 

8.  Were the intervention and control groups significantly different for age? Provide a rationale for your answer.

 

9.  What was the mode for bone status for the total sample (N = 41)? Determine the frequency and percentage for the bone status mode for the sample. Round your answer to the nearest whole percent. Why is this clinically important?

 

10.  Based on the bone status of the study participants, discuss the clinical importance of this study. Document your response.

 

 

 

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Answers to Study Questions

 

 

 

 

 

1.  Demographic variables described in the study were age, height, weight, body mass index (BMI), lifestyle (years since menopause, calcium-rich food intake, vitamin D-rich food intake), history of fracture, regular exercise, alcohol consumption, and smoking. You might have identified the bone status, bone mineral density (BMD), and bone biomarkers but these are dependent variables for this study (Grove et al., 2013).

 

2.  The variable bone status provided ordinal-level data. The researchers classified the participants into three groups, normal (T-score higher than −1.0), osteopenia (T-score between −1.0 and −2.5), and osteoporosis (T-score less than −2.5), based on their BMD scores. These categories are exhaustive, mutually exclusive, and can be ranked from greatest or normal BMD to osteoporosis or least BMD.

 

3.  The data collected for history of fracture are nominal level, including the two categories of no history of fracture and yes history of fracture. These categories are exhaustive and mutually exclusive, since all study participants will fit into only one category. These yes and no categories of history of fracture cannot be ranked so the data are nominal versus ordinal level (see Exercise 1).

 

4.  Frequencies and percentages were used to describe history of fracture for the intervention and control groups. Since the data are nominal, frequencies and percentages were appropriate. The researchers might have also identified the mode, which was no history of fracture since 13 participants had a history of fracture and 28 had no history of fracture.

 

5.  No, a mean cannot be calculated on the history of fracture data, which are nominal-level data that can only be organized into categories (see Exercise 1). A mean can only be calculated on interval- and ratio-level data that are continuous and have numerically equal distances between intervals.

 

6.  Regular exercise was described for both the intervention and control groups using frequencies and percentages. A total of 8 or 19.5% of the participants exercised regularly. Eight of the participants (4 in the intervention and 4 in the control groups) were involved in regular exercise of the sample (N = 41). Percentage = (8 ÷ 41) × 100% = 0.1951 × 100% = 19.51% = 19.5%. Researchers also indicated in the narrative that less than 20% of the participants were involved in regular exercise, supporting the importance of providing these individuals with an exercise program.

 

7.  Age was described with means and SDs for the intervention and control groups (see Table 2). In the narrative, the range of ages for the participants was identified as 51–83 years, and the mean age for the total sample was 66.2 years (SD = 8.2). The statistics were appropriate since age was measured in years, which are ratio-level data that are analyzed with mean, SD, and range (Grove et al., 2013).

 

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8.  No, the groups were not significantly different for age. The results from the t-test (t = 0.154) indicated that the groups were not significantly different for age. In addition, the bottom of Table 2 states that all group differences were p > 0.05. The level of significance (alpha) in nursing studies is usually set at α = 0.05, and since all differences were p > 0.05, then no significant differences were found for the baseline characteristics between the intervention and control groups.

 

9.  The mode was osteopenia for the intervention and the control groups. The number and percentage of participants with osteopenia for the sample was (8 + 12) ÷ 41 × 100% = (20 ÷ 41) × 100% = 0.488 × 100% = 48.8% = 49%. It is clinically important that 49% of the women in the study had osteopenia or thinning bones and needed assistance in managing their bone health problem. Also 11 participants had osteoporosis or holes in their bones, an even more serious condition, requiring immediate and aggressive management to prevent fractures.

 

10.  Oh et al. (2014) indicated that 75% (n = 31) of the study participants had osteopenia or osteoporosis. So it is important for these individuals to have their bone health problem diagnosed and managed. The TLM program is multifaceted and has the potential to reduce these women’s bone health problems (osteopenia and osteoporosis). Additional research is needed to determine the effect of this intervention with larger samples and over extended time periods. National guidelines and important information about the assessment, diagnosis, and management of osteoporosis and osteopenia might be found at the following website: http://www.guideline.gov/search/search.aspx?term=osteoporosis or the National Osteoporosis Foundation (NOF) website at http://www.nof.org. You might use a variety of resources for documentation including research articles, websites, and textbooks.

 

 

 

 

 

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EXERCISE 10 Questions to Be Graded          (NEED THESE QUESTIONS ANSWERED)

 

 

 

Follow your instructor’s directions to submit your answers to the following questions for grading. Your instructor may ask you to write your answers below and submit them as a hard copy for grading. Alternatively, your instructor may ask you to use the space below for notes and submit your answers online at http://evolve.elsevier.com/Grove/statistics/ under “Questions to Be Graded.”

 

 

 

Name: _______________________________________________________ Class: _____________________

 

Date: ___________________________________________________________________________________

 

 

 

1.  What demographic variables were measured at the nominal level of measurement in the Oh et al. (2014) study? Provide a rationale for your answer.

 

2.  What statistics were calculated to describe body mass index (BMI) in this study? Were these appropriate? Provide a rationale for your answer.

 

3.  Were the distributions of scores for BMI similar for the intervention and control groups? Provide a rationale for your answer.

 

4.  Was there a significant difference in BMI between the intervention and control groups? Provide a rationale for your answer.

 

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5.  Based on the sample size of N = 41, what frequency and percentage of the sample smoked? What frequency and percentage of the sample were non-drinkers (alcohol)? Show your calculations and round to the nearest whole percent.

 

6.  What measurement method was used to measure the bone mineral density (BMD) for the study participants? Discuss the quality of this measurement method and document your response.

 

7.  What statistic was calculated to determine differences between the intervention and control groups for the lumbar and femur neck BMDs? Were the groups significantly different for BMDs?

 

8.  The researchers stated that there were no significant differences in the baseline characteristics of the intervention and control groups (see Table 2). Are these groups heterogeneous or homogeneous at the beginning of the study? Why is this important in testing the effectiveness of the therapeutic lifestyle modification (TLM) program?

 

9.  Oh et al. (2014, p. 296) stated that “the adherence rate to the TLM program was 99.6%.” Discuss the importance of intervention adherence, and document your response.

 

10.  Was the sample for this study adequately described? Provide

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Hip replacement surgery

Hip replacement surgery is often recommended for patients who have continually painful and stiff hip/s caused by various medical conditions or injury. Hip replacement is a surgery in which the hip joint is replaced with a prosthetic implant. Hip prosthetics are designed to mimic the function of a functioning hip and provide normal to near-normal ranges of hip motion for a patient. However, prosthetic hips can have disadvantages including, dislocation which is a risk factor inherent to prosthetic hip replacements.

In your own words, describe the following, while citing the sources of any research that aided your answer:

Hip replacement surgery (describe the procedure)
Advantages and disadvantages
Recovery
Effectiveness
Complications
Prevention for dislocation
Why does a dislocated hip prosthesis cause pain to the patient, since the socket is not made of the patient’s bone?
Please make an initial post by midweek, and respond to at least two other student’s posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation.

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Culturally Diverse Patients

This written assignment will consist of two parts. The first part will include a discussion on the understanding and importance of cultural diversity in the medical field and how to overcome possible cultural barriers to improve patient care and outcomes. The second part of the written assignment will provide you further practice at creating and formatting a patient letter summarizing clinical results.

Part 01: Interacting with Culturally Diverse Patients

Mrs. Abdul, a devoted Muslim, has recently emigrated from the Middle East to live with her daughter and son-in-law. The Abdul family are patients at the clinic you work at as a Medical Administrative Assistant for about 4 months now. In that time, you have noticed that Mrs. Abdul has arrived late for all of her appointments to date. She has arrived late for her appointment today and seemed reluctant to answer many of the questions that are being asked to her. Also, it is observed that Mrs. Abdul allows her daughter to speak for her most of the time. Based on some preliminary testing that was conducted, Dr. Jones is concerned that Mrs. Abdul may have cancer, but must do some further diagnostic testing to be sure.

Requirements

In 1-2 pages with the use of a minimum of two credible resources, discuss the importance of understanding cultural differences in the medical environment and how they can improve patient care and outcomes. Then discuss methods how to resolve the communication barrier between the doctor and Mrs. Abdul to allow for further diagnostic testing, importance of arriving on time for appointments, and highlight possible complications to overcome to ultimately improve patient care and outcomes for Mrs. Abdul.

Part 02: Writing Professional Correspondence

You will practice writing a professional correspondence to a patient summarizing the results of their recent visit and the doctor’s recommendations. The requirements of your letter are:

  • Block or modified block format
  • Indented paragraphs
  • 1-2 paragraphs in length
  • Include current date
  • Letter addressed to patient: Monica Peters
  • Letter signed by doctor: Julia D. Mallard, MD

Take the following data/information and format it into complete sentences summarizing the results of Mrs. Peters’ recent visit and her doctor’s recommendations in 1-2 paragraphs within your letter.

Make sure you include of the following data/information in your letter:

  • Clinical Data to include
    • Hemoglobin A1C results were within normal limits from recent visit
    • Test results of Hemoglobin A1C were 6.8%
    • Desired results would be a value less than 7.0%
  • Type II diabetes is under control
  • Current dosage of Glucotrol XL of 5mg/day is appropriate and should be continued
  • Glucotrol XL prescription is enclosed for continued use
  • Repeat Hemoglobin A1C test in 6 months
  • If any questions or changes occur, contact office

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