Does the provider have an ethical obligation to intervene on behalf of the fetus as a patient? What are the best interests of the pregnant woman and how are they determined? What ethical considerations, other than best interests, can inform the decision-making process?

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Maternal-Fetal Conflict

Pregnancy is a unique circumstance in medical ethics because of the absolute requirement to access the fetus only through intervention on the pregnant woman. Increasingly, as medical advances have offered the promise of therapy to the fetus, fetal interests have been considered separately from maternal interests by clinicians, policy makers, and the bioethics community. This is a somewhat artificial distinction, as usually maternal and fetal interests are aligned, and care of the fetus is intertwined with and dependent on care of the pregnant woman.
When conflict arises between maternal and fetal interests (eg, treatment of cancer during pregnancy that may result in fetal demise), a variety of ethical frameworks may be useful to consider for conflict resolution and decision-making. Helpful theoretical approaches include case-based analysis, the ethics of care, feminist theory, and traditional ethical principlism that uses the framework of autonomy, beneficence and nonmaleficence, and justice. In addition, societal and practitioner values can elevate emotionally laden issues of obstetric conflict and benefit from a comprehensive, thoughtful analysis from a variety of perspectives.
Different theoretical approaches all agree with the importance of promoting the autonomy and bodily integrity of the pregnant woman, ensuring that she has the information to provide a fully informed consent that is consistent with her values regarding pregnancy outcome.

In cases in which her decision may harm her fetus, coercion to force treatment is never justified. In extraordinary cases, legal intervention has been attempted. Using the courts to enforce treatment compliance by pregnant women has frequently been unsuccessful or has activated processes that are hasty and incomplete, and such court rulings are frequently overturned on appeal. Evidence shows that continuing a trusting, compassionate, professional relationship with the pregnant woman generally results in greater success in improving maternal and child health. Feminist ethics perspectives can help detect subtle, gender-based biases in clinicians’ approaches to conflict resolution and support collaborative decision-making for the pregnant woman and her health care team.

Jesse is a 24-year-old who presents in active labor with no prenatal care. The fetus appears to be term, quite large, and at risk for dystocia. Jesse is told that a cesarean birth is the best route of delivery for the fetus’ well-being. She declines the operation and requests a natural childbirth. Although the fetus begins to have heart rate deceleration consistent with fetal distress, Jesse continues to decline the recommended cesarean delivery.
1. Does the provider have an ethical obligation to intervene on behalf of the fetus as a patient?

2. What are the best interests of the pregnant woman and how are they determined?

3. What are the best interests of the fetus and how are they determined?

4. What ethical considerations, other than best interests, can inform the decision-making process?

5. Can the pregnant woman refuse the recommended treatment, particularly if harm is expected to come to the fetus?

What options should be offered to the parents for resuscitation and treatment? If informed parents request resuscitation and intensive care but the clinical team feels they are inappropriate, is the team nevertheless obligated to provide it?

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Critically Ill Newborns

The newborn intensive care unit (NICU) is a common setting for difficult ethical challenges, often involving life-and-death decisions. These may include withholding treatment such as resuscitation, mechanical ventilation, or surgery, or withdrawing life-sustaining medical treatment such as mechanical ventilation and artificial nutrition and hydration. Such decisions are frequently faced because of the high morbidity and mortality of some conditions commonly encountered in this setting, such as extreme prematurity, perinatal asphyxia, and major congenital anomalies. Who should decide when a treatment should be withheld or withdrawn? Ideally, decisions are made by the parents, providers, and nurses working together, but what is to be done when they disagree? On what basis should decisions be made? Ideally, a careful ethical analysis is carried out, based on solid clinical and prognostic data and the values of those involved in making the decision. In reality, data are often very vague and values are often not shared in common, but a decision must nevertheless be reached.
Such critical ethical decisions may be more common in the NICU than in other pediatric settings, but they are certainly not unique to the NICU. Nonetheless, is there something unique about ethical problems encountered with this patient population? For example, is borderline viability based on extreme prematurity a unique situation in pediatrics, or is it analogous to other problems sometimes encountered in the care of older children? Are clinicians more willing to withdraw or withhold life-sustaining treatment for this patient population than for others in pediatrics or adult medicine? If so, is this justified?

A 36-year-old woman who has been pregnant 3 times but has no living children presents to the hospital in active labor and ruptured membranes at 22 weeks and 5 days’ gestation. The fetus is a female singleton, the product of in vitro fertilization. Pregnancy was otherwise unremarkable, including several normal ultrasounds. Estimated fetal weight is 530 grams. On physical examination the cervix is dilated and the obstetrician believes that delivery will occur within the next several hours. The pediatric team meets with the woman and her husband to share information, answer questions, and discuss the plan.

1. What options should be offered to the parents for resuscitation and treatment?

2. If informed parents request resuscitation and intensive care but the clinical team feels they are inappropriate, is the team nevertheless obligated to provide it?

3. If informed parents decline resuscitation and intensive care measures but the clinical team feels it is inappropriate to withhold those measures, is the team nevertheless obligated to withhold those treatments?

4. What ethical principles or approaches can be applied to guide clinicians and parents through the care provided to this child?

Research the various change models used by organizations today. Create a change model conducive to your field, and that will work within your organization’s culture. Create a visual representation of your model using a graphic organizer of your choice.

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Change Initiative: Develop a Change Model Benchmark

Research the various change models used by organizations today. After assessing these models, create a change model conducive to your field, and that will work within your organization’s culture. This model should serve to implement a strategic process that can help your organization integrate a change and respond to the internal or external driving forces that affect organizational success.

Create a visual representation of your model using a graphic organizer of your choice (flow chart, concept map, etc.). The design of your model will be unique and relevant to your organization, based on a critical analysis of its culture and behavior. However, your model must demonstrate the necessary steps for realistic implementation. Your model will be assessed on the quality of strategic implementation you design, the support you present for your model, and inclusion of the following concepts:

Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.

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Therapy for Clients With Personality Disorders

Review this week’s Learning Resources and reflect on the insights they provide about treating clients with personality disorders.

Select one of the personality disorders from the DSM-5 (e.g., paranoid, antisocial, narcissistic). Then, select a therapy modality (individual, family, or group) that you might use to treat a client with the disorder you selected.

The Assignment:

Succinctly, in 1–2 pages, address the following:

Briefly describe the personality disorder you selected, including the DSM-5 diagnostic criteria.

Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.

Next, briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client in order to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session.

Support your response with specific examples from this week’s Learning Resources and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Critically discuss and analyse lack of teamwork as a human factor known to impact on interprofessional collaboration and service user safety

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Interprofessional collaboration

Critically discuss and analyse lack of teamwork as a human factor known to impact on interprofessional collaboration and service user safety

What California State Bill did you find? What is your bill about? Do you oppose or support the bill? Why do you oppose or support the bill? What was the most interesting thing about the California Nurse Practice Act?

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Letter to respresentative

1. Watch the video I’M Just a Bill from SchoolHouse Rock
2. Find a California State Bill (Links to an external site.)
3. Interesting Web site (Links to an external site.)to see status of bill
4. Find your California State Representative (Links to an external site.)
California Nurse Practice Act

Before writing this letter please answer the following questions separately
1. What California State Bill did you find?
2. What is your bill about?
3. Do you oppose or support the bill?
4. Why do you oppose or support the bill?
5. What was the most interesting thing about the California Nurse Practice Act?

Explain the importance of performing a quality literature review in evidence-based practice Based on your previous PICOT question, preform a literature search identifying key terms,

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Discussion Question

Explain the importance of performing a quality literature review in evidence-based practice Based on your previous PICOT question, preform a literature search identifying key terms, Boolean operators, and search criteria i.e., full text gender, publication dates, etc. Choose 1 article from the CINAHL data base and 1 from either Google Scholar, PubMed, Ebsco, or Pro Quest. Discuss your rationale for choosing each article and its relevance to your PICOT question. Next, determined which level of evidence your articles are classified as based on the article by Ingham-Broomfield (2016). Evaluate 2 classmates’ search strategies and the quality of each article in relation to their PICOT questions and relevance to current nursing practices.

What is the clinical practice problem/issue selected? Why do you think there needed to be a change? Explain the general idea of your change proposal.

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Scholarly paper/How to Prevent Pressure Ulcers

Your paper should be five to six pages in length (not including the title page or references section) and have at least three quality references.

What is the clinical practice problem/issue selected?
Why do you think there needed to be a change?
Explain the general idea of your change proposal.

 

Critical Thinking—Support and Evidence
Identify the change you want to bring about.
What issues have you seen in practice or found in research that made you select this topic for a change proposal?
How will your leadership style and gifts be used to lead the change proposal?

Conduct a Literature review
Utilize the CCU library to assist in finding scholarly research articles.
Is your evidence valid to support the change you are proposing?

Leadership and Management—Development
Identification of change theory for project
State one specific long-term and short-term goal

Leadership and Management—Implementation
Develop a basic timeline for your project that shows the plan for implementation.
What is the role of the change agent/s?

Critical Thinking and Clinical Reasoning—Evaluation
Suggest specific evaluation points along the way based on your implementation timeline.

Critical Self-Reflection—Personal Impact of Change Proposal
Analyze your personal assumptions and perspectives regarding your proposed change.
How did your personal perspective impact your proposal?
How was the content from this course integrated into the paper or proposal?
What perspective did you gain from formulating this proposal and doing research on this topic?

What have you learned?
Integration of Biblical Worldview
Analyze change through a biblical worldview.
Integrate Scripture appropriately.

Conclusion
Summarize the change proposal.
Examine the implications of the Clinical Problem/Issue/Thesis Statement.
Bring closure to the paper.
Communication (refer to the rubric in Due Dates and Grades for grading criteria related to conventions and mechanics):
Use strong, effective academic words, variety in sentence structure, and active voice.
Your paper should be presented in APA format with appropriate grammar, spelling, and organization.

Defines the epidemiology of the condition in the United States via three epidemiology terms numerically. Defines by statistics per younger, middle, and older adults or by specific age ranges in adulthood.

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Diverse Populations, Age, and Interprofessional Health Promotion Resources

What interprofessional resources exist for the topic? Also, consider using terms such as multidisciplinary and team-based care in your search related to the topic.

The adult lifespan, young, middle, and older adult, by ages and ranges in adulthood, should be addressed clearly through the condition’s epidemiology. Are there interventions that benefit the outcome? Epidemiological support and evidence-based practice guidelines should be included in the paper.

 

Define the topic.

Definition includes content related to young, middle, and older adults. (Should not include teen or childhood content.)

Epidemiology

Defines the epidemiology of the condition in the United States via three epidemiology terms numerically.
Defines by statistics per younger, middle, and older adults or by specific age ranges in adulthood.

Interventions

One clinical management guideline is explained with 2–3 criteria considerations.

Interprofessional Collaboration

Provides 4–5 specific examples of interprofessional roles and functions for the collaborative management of the condition.
Two studies are included addressing interprofessional collaboration.

Summary

Provide a summary of the general interprofessional collaborative content related to the topic and the benefit to populations. Include why it is important.

Determine how the hospital could charge and be reimbursed using the two methods. In this case, which would be better for the hospital? How do each of these payment models contribute to or detract from the goal of the Triple Aim?

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Week 2 Hawes

Models of payment to healthcare organizations have begun to shift from paying for volume (fee for service) to paying for value (quality). Using a Venn Diagram, compare volume-based versus value-based reimbursement. Be sure the overlapping area contains the commonalities between the two systems.Use the editable template for the Venn Diagram, which is available for download above. This template (with your findings) will need to be posted as an attachment in your discussion post along with your written prompt.

Consider Jim, who is 69 years old and comes to your Emergency Department (ED) with severe abdominal pain. His evaluation, besides a physical exam, includes an abdominal ultrasound, a CT scan with and without contrast, multiple lab studies, all lead to his having an emergency appendectomy. Other than having Type II diabetes well controlled on diet and exercise, he is in otherwise good health. Jim is treated as an outpatient and is discharged home the next morning. Two weeks later he returns to the ED with fever, continued abdominal pain, and a surgical site infection. He is admitted and is treated for 5 days before being sent home.

Using your findings from your comparison of volume- versus value-based reimbursements, analyze the scenario. Determine how the hospital could charge and be reimbursed using the two methods. In this case, which would be better for the hospital? How do each of these payment models contribute to or detract from the goal of the Triple Aim? Considering payer mix, delivery systems, population demographic, and value-based purchasing of the institution. How do all of these elements influence the financing of the type and quality of care provided at your facility? What are the implications on access and availability of types of care provided by your institution?