The Tuskegee Syphilis Study is one of the most important landmark cases related to ethics in medical research. It offers chilling insight into why ethics is so critically important to the advancement of medical research and practice.

To prepare for this Application, review this week’s Learning Resources, paying close attention to those related to the four ethical principles and the Tuskegee Syphilis Study. Consider how the four ethical principles of autonomy, beneficence,non-maleficense, and justice can be applied to this historic case.

To complete this Application, write a 1- to 2-page paper that addresses the following:

• Summarize the Tuskegee Syphilis Study.
• Identify how each of the four ethical principles can be applied to the case.
• What are some of the legal and ethical lessons that can be learned from the Syphilis Tuskegee Study?

Your written assignments must follow APA guidelines. Be sure to support your work with specific citations

Resources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1733786/pdf/v029p00275.pdf

https://www.cdc.gov/tuskegee/timeline.htm

References to the added files below:

Gillon, R. (1994). Medical ethics: Four principles plus attention to scope. British Medical Journal, 309(6948), 184.

Gamble, V. (1997). Under the shadow of Tuskegee: African Americans and health care. American Journal of Public Health, 87(11), 1773-1778.

Walker, C. (2009). Lest we forget: The Tuskegee experiment. Journal of Theory Construction & Testing, 13(1), 5-6

Respond by offering additional thoughts regarding the examples shared, Systems Development Life Cycle SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.

Main Post

                         Systems Development Life Cycle

The systems development life cycle (SDLC) is a process whereby a company or entity determines the need for the implementation of new technology.  SDLC provides information systems that are effective at incorporating the company’s business plan (McGonigle & Garver Mastrian, 2018).  It is essential that a working knowledge of the problems or issues are understood.  In the case of healthcare organizations, this means establishing an assessment that discovers the needs of each department (McGonigle & Garver Mastrian, 2018).  Most of the time when analyzing these needs an outside company is brought in to assess, interview, and determine the type of system that would benefit the company.

Consequences of Lack of Inclusion of Nurses

In the application of any new technology or policy, it is essential to trial it with the individuals that will be using it.  When considering an update or new system in the healthcare setting, it is beneficial to involve nurses in the decision-making process.  The Agency for Healthcare and Research (n.d.a) report that it is important to consult with nurses in the preliminary period of development.  By incorporating nurses into the initial design, the researchers learn nursing processes, possible new tasks, effect the technology will have on patient care, staffing needs, and usability of the design.  This analysis of workflow is used to determine the best use of technology (McGonigle & Garver Mastrian, 2018).  Including nurses in this process opens routes for discussion and collaboration that will benefit the designers and users.

Failure to include nurses in the planning stages of technology design is detrimental to the intended use of the new system.  A researcher or computer designer could miss critical elements of the nursing process due to their lack of knowledge regarding nursing procedures.  McGonigle & Mastrian (2018) state, “nursing informatics professionals should always be included in these activities to represent the needs of clinicians and to serve as a liaison for technological solutions to process problems” (p. 250).  The role of the informatics nurse and a nurse, in general, can play in designing technology is critical.  Their contribution to the analysis of workflow and clinical implications is invaluable information needed for the formation of a system that will be used to its potential.

An Example of Collaboration

A study was done in Canada to determine the impact of the initiation of computerized order entries for medications on nursing workflow and reduction of medication errors.  Registered nurses participated in a study where interviews and observations were used to study the effects of digital technology on the nursing process (Vito, Borycki, Kushniruk, & Schneider, 2017).  The researchers spent considerable time observing and recording how the technology affected nurses and the influence it made on time spent with patients.  This study is one example of the impact that nurses can have on the design and implementation of technology in the healthcare setting.

Current Healthcare Facility

When our facility transitioned to electronic health records (EHR) as an ER nurse, I was not involved in the planning.  The nurse informaticist I assume worked with the company to create templates that are in use today.  Within the ER portion of the EHR, there have been changes made because of nursing input.  As a unit, we have asked for an ED narrator to be developed with our order sets, documentation narrators, and medication administration policies.  Recently we asked for changes to our trauma narrator to include additional documentation options for different trauma levels.  As a group we have also discussed missing pieces of data that is beneficial for everyday use and discussed this with our leaders.  The leaders take this information to the information technology (IT) individuals that work directly with the EHR company and changes are then made.  There are times when the nurse’s input is not embraced due to financial constraints or leadership ability to see the need.  The size of the healthcare organization plays a significant role in the inclusion of nurses in decision-making practices.  Many variables exist to modification of technology in healthcare.  In an ideal setting, it would be ideal to include nurses throughout the design process.

References

Agency for Healthcare Research and Quality (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide.  Retrieved April 17, 2019, from https://healthit.ahrq.gov/sites/default/files/docs/page/impact-of-hit-on-nurses-quick-reference-guide.pdf

McGonigle, D., & Garver Mastrian, K. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning, LLC.

Vito, R., Borycki, E., Kushniruk, A., & Schneider, T. (2017). The impact of computerized provider order entries on nursing practice. Studies in Health Technology and Informatics, 234, 364-369. doi:/10.3233/978-1-61499-742-9-364

Promoting Health Care Quality-  Quality Improvement Issue

To help you move forward with your Course Project, this week you identify a quality issue that you would like to address and submit a description of this issue for Instructor feedback.   Your proposed issue should reflect a genuine need for improvement within your selected health care organization. Through your Course Project, you will analyze this issue and propose strategies to improve outcome(s), including the redesign of a related process.

To prepare: •Review the six quality improvement aims from the Institute of Medicine (IOM) presented in Chapter 3 of the Sadeghi, Barzi, Mikhail, and Shabot text.

•Conduct a search of the literature to help you identify a specific issue that warrants attention and action to promote quality improvement.

•Consider what you have surmised thus far through your analysis of the organization that you selected. What have you noticed that could help you identify a quality-related need for improvement? For instance:

•What has captured your attention in meetings, reports, and/or daily activities?

•Have you noticed discrepancies between activities in the organization and recommendations in the research literature, quality standards, and/or the organization’s stated policies and procedures?

•If so, what do you think could be the reason(s) for variations or gaps between what you have observed and what is recommended?

•Identify a quality improvement issue that you would like to investigate for this project.

The instructions for this assignment asks for students to identify a quality improvement issue, and provide a description of the issue they wish to pursue. This can be accomplished in 2 paragraphs.

ReferencesHickey, J. V., & Brosnan, C. A. (2017). Evaluation  of health care quality in for DNPs (2nd  ed.). New York, NY: Springer Publishing Company.

•Chapter 10, “Evaluation of Patient Care Standards, Guidelines, and Protocols” (pp. 207-226)

•Chapter 12, “Evaluating Populations and Population Health” (pp. 265-280) Chapter 10 reviews methods for using national, local, and organizational standards to evaluate the quality of health care practices. Chapter 12 examines strategies for identifying quality issues through the evaluation of populations.   Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. M. (2013). Integrating quality and strategy in health care organizations, Burlington, MA: Jones & Bartlett Publishers.

•Chapter 3, “General Concepts in Quality” (pp. 45–82) See the six aims for quality proposed by the Institute of Medicine (IOM).   Bellot, J. (2011). Defining and assessing organizational culture. Nursing Forum, 46(1), 29–37.

https://class.waldenu.edu/bbcswebdav/institution/USW1/201870_27/MS_NURS/NURS_6231/artifacts/USW1_NURS_6231_Week04_Bellot_2011.pdf

Select a patient that you examined during the last three weeks. With this patient in mind, address the following in a SOAP Note:

• Subjective: What details did the patient provide regarding her personal and medical history?
• Objective: What observations did you make during the physical assessment?
• Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
• Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan.
• Reflection notes: What would you do differently in a similar patient evaluation?