Nursing

Ethical Framework Essay
Consider the “Four Topics Approach” (or Four Box method) to ethical decision making on Table 2.1 in Butts (below). Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.
In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way? Does this seem like a valid process for you to apply in your practice?
Your paper should be 1-2 pages. Adhere to APA formatting throughout, and cite any outside sources you may use.
Review the rubric for further information on how your assignment will be graded.
TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases
Medical Indications: The Principles of Beneficence and Nonmaleficence
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of various treatment options?
5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Patient Preferences: The Principle of Respect for Autonomy
1. Has the patient been informed of benefits and risks, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
6. What are plans and rationale to forgo life-sustaining treatment?
7. What is the legal and ethical status of suicide?
Contextual Features: The Principles of Justice and Fairness
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
6. Are there religious issues that might influence clinical decisions?
7. What are the legal issues that might affect clinical decisions?
8. Are there considerations of clinical research and education that might affect clinical decisions?
9. Are there issues of public health and safety that affect clinical decisions?
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?
Source: Jonsen et al., 2010
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Solution
Ethical Framework Essay
One of the most challenging situations in my nursing career that required me to consider ethical dimensions was when I attended to an 80-year-old woman suffering from stage IV cervical cancer. I needed to consider different ethical dimensions related to the patient’s care when attending to the patient.
Medical Indications: The Principles of Beneficence and Nonmaleficence
What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
The patient’s medical problem was stage IV cervical cancer which can be classified as a terminal disease. In stage IV, cancer means that cancer will have spread in an individual’s body to other parts of the body and organs of an individual, making it difficult to treat.
What are the goals of treatment?
The goals of treatment for stage IV cervical cancer include controlling symptoms and improving a patient’s quality of life, and stopping cancer growth in some instances.
In what circumstances are medical treatments not indicated?
For patients with stage IV cervical cancer, medical treatment is not indicated when cancer has spread extensively to major organs.
What are the probabilities of success of various treatment options?
For patients with stage IV cervical cancer, the probability of success of various treatment options such as chemotherapy are low because cancer has already metastasized to major organs.
In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Stage IV cancer patients can benefit significantly from medical and nursing care, especially through receiving counseling services to avoid trauma from the diagnosis and the various treatment procedures such as surgery that may be associated with the diagnosis. The provision of a non-judgmental environment for the patient and consistent therapeutic communication can also help significantly to improve the health outcomes of the patient. On the other hand, harm can be avoided on the eight-year-old stage IV cancer patients by avoidance of unnecessary treatments that can negatively affect the patient’s quality of life while not providing the patient any benefits as a result of the significant advancement of their cancer Guidolin et al., (2021). For instance, chemotherapy may not be preferred for the Stage IV cancer patient due to the significant harm it could cause on the patient while also having less impact on the improvement of symptoms related to the patient.
Patient Preferences: The Principle of Respect for Autonomy
Has the patient been informed of benefits and risks, understood this information, and given consent?
For the case study involving the 80-year-old female patient suffering from stage IV cancer, they were advised on the risks and benefits of any form of treatment such as chemotherapy. The patients were therefore educated on how chemotherapy would affect them and were given space to decide whether to begin chemotherapy treatment or to forgo treatment and receive less engaging treatments to improve their daily life.
Is the patient mentally capable and legally competent, and is there evidence of incapacity?
The 80-year-old female with stage IV cancer was legally competent and mentally capable of making informed decisions. This is because the patient did not show any form of mental incapacity or impairment of thoughts.
If mentally capable, what preferences about treatment is the patient stating?
In the case study, the eight-year-old patient highlighted that she did not want to go through chemotherapy as her cancer had already spread to different organs and that what she needed was a treatment that would improve her quality of life and extend her life. The patient stated that she did not want to go through chemotherapy as such treatment was risky, and she had no chances of controlling cancer which had advanced significantly.
If incapacitated, has the patient expressed prior preferences?
Because the eight-year-old patient with stage IV cancer was not incapacitated, she had not expressed any prior preferences.
Who is the appropriate surrogate to make decisions for the incapacitated patient?
Patient’s children
Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
The eight-year-old patient with stage IV cancer was, therefore, unwilling to cooperate with medical treatment because she did not believe it would make her better in any way but would only cause severe side effects on her.
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
Considering the condition of the eight-year-old patient with stage IV cancer, the prospects for a return to normal life with or without treatment were significantly low. It will therefore be difficult to try and cure stage IV cancer that had already spread to major organs using chemotherapy, with the management of symptoms being the major priority.
On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
A third party can judge that the quality of life is undesirable for a patient who cannot express such a judgment in cases of patients who have lost consciousness for a long time (Forte et al., 2018). Patients who have stayed on life support for long periods of time require Third parties such as close family members to assess their quality of life and determine whether it’s desirable.
Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
Different prejudices can affect providers’ evaluation of patients’ quality of life, such as considering a patient’s diagnosis.
What ethical issues arise concerning improving or enhancing a patient’s quality of life?
The ethical issues that arise in relation to improving and enhancing the patient’s quality of life are related to beneficence and nonmaleficence.
Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
Quality of life assessments determines different issues, such as assessing the treatment plan and administering life-changing treatment to patients.
What are plans and rationale to forgo life-sustaining treatment?
The rationale and plan to forgo life-sustaining treatment would involve instances where patients would have a poor quality of life and would not have any chance of recovery.
What is the legal and ethical status of suicide?
Physician-assisted suicide is illegal in some states, where it is still illegal in others. On the other hand, the practice is mainly viewed as unethical because the main role of healthcare providers is preserving life and not assisting patients in taking their own life (Gornick & Zikmund-Fisher, 2019).
Contextual Features: The Principles of Justice and Fairness
Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
There are different interprofessional professional and business interests that might create conflict in the clinical treatment of patients especially related to health insurance and reimbursement. In some instances, health insurance providers may fail to reimburse certain treatments for patients affecting the whole treatment process (van Bruchem-Visser et al., 2020).
Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
Family members and insurance providers might have an interest in clinical decisions due to various reasons.
What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
Generally, patient confidentiality is protected from any third parties; however, insurance providers may sometimes access patient information during reimbursement to assess the need for reimbursements of certain treatments.
Are there financial factors that create conflicts of interest in clinical decisions?
Financial factors can create a conflict of interest in clinical decisions, especially in instances where a patient cannot be able to afford certain recommended treatments.
Are there problems of allocation of scarce health resources that might affect clinical decisions?
On the other hand, instances of allocation of scarce resources can affect clinical decisions, especially in healthcare facilities that do not have adequate resources and a high number of patients (van Bruchem-Visser et al., 2020).
Are there religious issues that might influence clinical decisions?
Religious issues such as the prohibition of certain treatment approaches in a given religion can influence clinical decisions significantly.
What are the legal issues that might affect clinical decisions?
Malpractice laws can significantly affect clinical decisions
Are there considerations of clinical research and education that might affect clinical decisions?
Considerations of clinical education and research can affect clinical decisions because health care practitioners will favor evidence-based practices compared to those that are not supported by evidence.
Are there issues of public health and safety that affect clinical decisions?
Different issues of public safety and health care affect clinical decisions, especially in instances where a certain treatment is not approved for general public use and is only experimental.
Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?
Issues of conflict of interest between organizations can affect clinical decisions, especially in instances where institutions want to be more efficient and save on costs (Gornick & Zikmund-Fisher, 2019).
References
Forte, D. N., Kawai, F., & Cohen, C. (2018). A bioethical framework to guide the decision-
making process in the care of seriously ill patients. BMC medical ethics, 19(1), 78. https://doi.org/10.1186/s12910-018-0317-y.
Guidolin, K., Catton, J., Rubin, B., Bell, J., Marangos, J., Munro-Heesters, A., Stuart-McEwan,
T., & Quereshy, F. (2021). Ethical decision making during a healthcare crisis: a resource allocation framework and tool. Journal of medical ethics, metaethics-2021-107255. Advance online publication. https://doi.org/10.1136/medethics-2021-107255.
Gornick, M., & Zikmund-Fisher, B. (2019). What clinical ethics can learn from decision science. AMA Journal of Ethics, 21(10). https://doi.org/10.1001/amajethics.2019.906.
Van Bruchem-Visser, R. L., van Dijk, G., de Beaufort, I., & Mattace-Raso, F. (2020). Ethical frameworks for complex medical decision making in older patients: A narrative review. Archives of Gerontology and Geriatrics, 90, 104160. https://doi.org/10.1016/j.archger.2020.104160

PHN 652-Classmate Catherine-Response (3): Evidence-Based Practice In Public Health
QUESTION-TOPIC 1 DQ 2-How has evidence-based practice evolved? What are the advantages and disadvantages of this evolution for public health nurses as well as communities?
Classmate (Catherine’s) response to the above question-Please read and respond to her.
Societies have the potential to help achieve a significant reduction in the prevalence of the most common and costly behavioral and psychological problems that develop in childhood and adolescence—if they can implement evidence-based practices widely and effectively. Putting it more positively, we could assure that many more young people reach adulthood with the skills and interests needed to become productive and caring adults who contribute to the wellbeing of others (Biglan,2008).The impact of evidence-based practice (EBP) has echoed across nursing practice, education, and science. The call for evidence-based quality improvement and healthcare transformation underscores the need for redesigning care that is effective, safe, and efficient. In line with multiple direction-setting recommendations from national experts, nurses have responded to launch initiatives that maximize the valuable contributions that nurses have made, can make, and will make, to fully deliver on the promise of EBP. Such initiatives include practice adoption; education and curricular realignment; model and theory development; scientific engagement in the new fields of research; and development of a national research network to study improvement.
Public health nurses are part public health specialist and part healthcare provider. Their role is to improve the overall health of a larger population. To do this, they help develop, initiate, and manage public health programs, advocate for public health policies, educate the community on important health matters, and provide direct healthcare to individuals in need.
Advantage.
-When you’re trying to improve the health of a community, there’s a lot of room for new ideas and initiatives. Public health nurses often have the opportunity to come up with new methods of communication, new messages, and new programs designed to improve the community’s health. This makes community health nursing a great fit if you’re creative and enjoy developing new solutions.
Disadvantages
-The disadvantage to this type of practice is it takes an extended period of time to gather data before it can be applied. Overall EBP is the best type of research for healthcare professionals.
-The disadvantage of the evolution of evidence based practice are the effects that evidence based practice has on lower income communities that have traditionally suffered from fewer resources, poor community health, and increased workload.
-In both rural and impoverished urban communities, health resources are often scarce. The community itself may lack funds and nonprofits and public health departments do not typically have expansive budgets. This can leave you facing a number of challenges as a pubic health nurse.
Reference
Biglan, A., & Ogden, T. (2008). The Evolution of Evidence-based Practices. European journal of behavior analysis, 9(1), 81–95. https://doi.org/10.1080/15021149.2008.11434297.
What is evidence-based practice in nursing? University of Maine Fort Kent Online. (2020, September 2). Retrieved November 7, 2021, from https://online.umfk.edu/articles/rnbsn/evidence-based-practice-nursing.aspx.
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Solution
Response Catherine
Evidence-based practice in nursing plays a vital role in enhancing the quality of health and care for the general wellbeing of the people. Reliability on evidence in nursing reduces mistakes in decision making for safety and quality healthcare practices. The use and nature of evidence-based practice have evolved over the years, indicating a vast difference and improvement. In your response, you have described the importance of evidence-based practices in nursing and the initiatives that have led to the advancement of evidence-based practice, such as practice adoption, nursing education, curriculum realignment, and scientific engagement. You could also have indicated how the use of evidence-based practise has evolved from the conception of the nursing profession to the current nursing. McMenamin et al. (2019) trace the history of evidence-based practice to Florence Nightingale’s time, who documented the interventions against the mortality rates associated with the diseases or chronic conditions to determine the effectiveness of the interventions. Nightingale’s model used observation as the primary source of evidence and not scientific researches. You can also note that the EBP evolved on introduction and formalization of nursing education, with theorists defining nursing as a collaborative and interpersonal process.
EBP in nursing was later transformed to focus on patient outcomes, primarily safety, quality and effectiveness. The healthcare systems gained a significant influence to adopt the best practices and policies for a sustainable practice called institutionalization. The founding of Cochrane Collaboration considered randomized controlled trials as a gold-standard source of highly objective evidence with minimum bias (McMenamin et al., 2019). The advantage of the evolution is that it improved the level and quality of care to the communities. You can also add that the educational evolution on the use of EBP improved the nurses’ abilities to advance in their role as researchers in nursing instead of leaving the responsibility to nurses who specialized in research. Every nurse can translate the data around them for an effective response to health issues. According to Falkenberg-Olson (2019), current nurses can carry out nursing practice research to advance the quality of care compared to earlier when nurses relied on a few. Advanced nursing education provides a better opportunity to improve on the use of EBP in nursing.
References
Falkenberg-Olson, A. C. (2019). Research translation and the evolving PhD and DNP practice roles: A collaborative call for nurse practitioners. Journal of the American Association of Nurse Practitioners, 31(8), 447–453. https://doi.org/10.1097/jxx.0000000000000266
McMenamin, A., Sun, C., Prufeta, P., & Raso, R. (2019). The evolution of the evidence-based practice. Nursing Management, 50(9), 14–19. https://doi.org/10.1097/01.numa.0000579000.09987.b0

Jamie is a 3-month-old female who presents with her mother for evaluation of “throwing up.” Mom reports that Jamie has been throwing up pretty much all the time since she was born. Jamie does not seem to be sick. In fact, she drinks her formula vigorously and often acts hungry. Jamie has normal soft brown bowel movements every day and, overall, seems like a happy and contented baby. She smiles readily and does not cry often. Other than the fact that she often throws up after drinking a bottle, she seems to be a very healthy, happy infant. A more precise history suggests that Jamie does not exactly throw up—she does not heave or act unwell—but rather it just seems that almost every time she drinks a bottle she regurgitates a milky substance. Mom thought that she might be allergic to her formula and switched her to a hypoallergenic formula. It didn’t appear to help at all, and now Mom is very concerned.
Cases like these are not uncommon. The mother was concerned and thinking her daughter may have an allergy; she changed to a different formula. However, sometimes babies have immature GI tracts that can lead to physiology reflux as they adapt to normal life outside the uterus. Parents often do not consider this possibility, prompting them to change formulas rather than seeking medical care. As in the case study above, GI alterations can often be difficult to identify because many cause similar symptoms. This same issue also arises with adults—adults may present with symptoms that have various potential causes. When evaluating patients, it is important for the advanced practice nurse to know the types of questions he or she needs to ask to obtain the appropriate information for diagnosis. For this reason, you must have an understanding of common GI disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.
To Prepare
Review this week’s media presentation on the gastrointestinal system.
Review Chapter 35 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.
Review Chapter 37 in the Huether and McCance text. Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different.
Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor.
Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for gastritis. Consider the epidemiology and clinical presentation of gastritis.
To Complete
Write a 2- to 3-page paper that addresses the following:
Describe the normal pathophysiology of gastric acid stimulation and production. Explain the changes that occur to gastric acid stimulation and production with GERD, PUD, and gastritis disorders.
Explain how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
Construct a mind map for gastritis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.
References to use in the paper.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Hammer, G. G. , & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.
Chapter 13, “Gastrointestinal Disease”
de Bortoli, N., Martinucci, I., Bellini, M., Savarino, E., Savarino, V., Blandizzi, C., & Marchi, S. (2013). Overlap of functional heartburn and gastroesophageal reflux disease with irritable bowel syndrome. World Journal of Gastroenterology, 19(35), 5787-5797. doi:10.3748/wjg.v19.i35.5787

PHN 652-Topic 2 DQ 1: Classmate response (1)-Models And Tools Used In Public Health
QUESTION- TOPIC 2 DQ1-Why are public health models important in providing quality health care? Briefly describe two public health models and their impact on quality health care.
Classmate Chayah’s-Response
Public health models can be important in delivering quality care for many reasons. These models can enrich current public health programs and help with identifications of areas of need. Models can examine where interventions are needed and where collaborations are desired to improve outcomes. Programs can be specific at times and using models can broaden perspective for overall improvement (Friedman & Starfield, 2003). Models can also help in practice to focus programs to be integrated and multifactor. Many models show the need for intersectoral activities and bring attention to environmental and community influences. Evaluation frameworks suggested by models can help with evaluation frameworks as well (Friedman & Starfield, 2003). All of these important factors can improve quality health care.
While there are many traditional models there are also developing models for the modern time. One of interest was an article looking at the Laugh Model used in Utah. A low-cost social media platform was examined. The goal being communication with the public concerning public health hoping to get their message received and community engagement to occur (Lister et al., 2015). There was an online campaign concerning healthy family meals. Facebook ads, Twitter ads, and other social media engagement and results were measured looking at people visiting the intended nutrition site. The model they followed resulted in an indeed lower cost way to reach more people. When the population was engaged this way, it was found that it may be more effective, evidence of social media enhancing collaborations, effectiveness, and increased sustainability (Lister et al., 2015). When communication and access is improved it is one way to get people quality care.
Another, more widely used, public health model is the Health Belief Model. This model is theoretical in nature and used in guidance with health promotion and disease prevention programs. It is used to predict and comprehend individual health behaviors (Rural Health Information Hub, 2018). The model looks at key variables that influence behaviors such as personal belief of perceived threat, how severe one thinks the consequence will be, how beneficial they think a change may be, perceived barriers, and confidence of success of any changes undertaken. This model is useful for the creation of both short- and long-term interventions (Rural Health Information Hub, 2018). The implementation of this model can help quality care be delivered for many reasons. There is guidance for a needs assessment helping to determine populations that should be targeted for interventions, education of risk, communication to the public in appropriate ways, working to reduce barriers, and providing support that is likely to help individual behavior changes (Rural Health Information Hub, 2018).
References
Friedman, D. J. & Starfield, B. (2003). Models of Population Health: Their Value for US Public Health Practice, Policy, and Research. American Journal of Public Health, 93, 366-369. https://doi.org/10.2105/AJPH.93.3.366
Lister, C., Royne, M., Payne, H. E., Cannon, B., Hanson, C., & Barnes, M. (2015). The Laugh Model: Reframing and Rebranding Public Health Through Social Media. American journal of public health, 105(11), 2245–2251. https://doi.org/10.2105/AJPH.2015.302669
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Solution
Public Health Models
Hello, thank you for this opportunity to respond to your post. I want to thank you for taking the time to contribute to this post. I will only add a few points to your post since I fully agree with your discussion. The public health model is an epidemiological concept that uses other approaches to reduce illnesses in a particular region by identifying risk factors. Different public health models function uniquely in the essence of providing quality care services.
In summary of the importance of the public health model on quality healthcare, I would like to interpret the process and strategical ways. The models identify all the potential risks in the population, reducing its size, strengths in the population size, thus creating a differential pattern (Scott et al., 2016). Therefore, the population at risk can be studied and samples taken for further preventive interventions. These public health models are crucial for healthcare organizations working at community levels to provide quality care and manage the risk factors of diseases.
The health belief model can also predict physical activities or behavioral changes of patients, especially in the community (Wu et al., 2020). For instance, the model can be helpful in trying to find out the association between obesity and physical fitness among youths and adults aged between 25-45 years. The model will check on their behaviors towards diet and physical exercise routines every week. It becomes easier to analyze the population’s health based on the findings of their results. Public health models have proven to significantly contribute to managing potential risks of diseases and illnesses among people. The models use diverse approaches in giving evidence-based results that health organizations can use and improve quality healthcare.
References
Scott, D., Lonne, B., & Higgins, D. (2016). Public health models for preventing child maltreatment: Applications from the field of injury prevention. Trauma, Violence, & Abuse, 17(4), 408-419. https://journals.sagepub.com/doi/full/10.1177/1524838016658877?casa_token=czE-y1SOtboAAAAA%3ATuYPMshzG-qrSaOD9ZR8feUeYam3M-xjwZewiyhhhWuwBiVQq-_i9yIxqNkbujTgFEbvhkU-rQ
Wu, S., Feng, X., & Sun, X. (2020). Development and evaluation of the health belief model scale for exercise. International journal of nursing sciences, 7, S23-S30. https://www.sciencedirect.com/science/article/pii/S2352013220300983

Classmate Response (1): PHN 652-Topic 8 DQ 1 -Evaluating Population-Based Interventions
Please elaborate on one or two points from the classmate’s post.
-Also, provide feedback to the classmate’s post.
-And also add other points related to the topic.
-Please use your own words and do not copy what she wrote
– Sources must be published within the last 5 years. It must be from 2017 and after and appropriate for the paper criteria and public health content.
– Please do not use blogs as references
-References should be in APA 7th ed.
-Add references to reference page
-Add the hyperlink/DOI for each reference in APA 7th edition format.
Thank you.
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Solution
Response to Classmate (1)’s Post
Hello, thank you for giving me this opportunity to respond to your post. I want to thank you for taking the time to contribute to the discussion. I will add on few points in addition to your post. As a public health nurse, it is my responsibility to ensure that the implemented interventions are up to date to improve patients’ outcomes and quality health care (Eldh et al., 2017). Understanding the meaning of clinical interventions and implementing the same is crucial to facilitating quality outcomes during the evaluation process.
Evaluation is crucial as it provides the organization with the progress of the implemented strategies. The main goal is to provide the organization with the knowledge to understand the strong elements and ways to develop the weak elements to improve the organization’s stability (Rørtveit et al., 2020). Effective evaluation is mandatory to ensure that the implemented strategies are appropriate for the community and the healthcare organizations. Evaluating health trends and risk factors can also help reduce health disparities with higher-risk infections, especially among the population. This is because I will be able to study the risk factors and introduce strategies that can also be used for future reference, thus avoiding higher infections in the future.
Evaluation is a continuous process that begins right from the planning stage. If an error is made at the planning stage and not corrected, it can affect the outcome of the implementation and evaluation. Therefore, it is crucial to ensure that all the project elements are included. All those involved must be included in the planning, implementation and evaluation stages to enhance the quality outcome and effective strategies to solve the public health problem. If the evaluation is conducted appropriately, the implemented strategies will determine the organization’s performance.
References
Eldh, A. C., Almost, J., DeCorby-Watson, K., Gifford, W., Harvey, G., Hasson, H., … & Yost, J. (2017). Clinical interventions, implementation interventions, and the potential greyness in between-a discussion paper. BMC health services research, 17(1), 1-10. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1958-5
Rørtveit, K., Saetre Hansen, B., Joa, I., Lode, K., & Severinsson, E. (2020). Qualitative evaluation in nursing interventions—A review of the literature. Nursing open, 7(5), 1285-1298. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/nop2.519

Reflect/research the top organization (if you have a clear idea) or industry sector (if you are still undecided) you wish to work in/for. Identify the top three skills/traits that would allow you to excel in that position/sector and would make you a highly qualified candidate. How do you plan to acquire these skills
This are the questions I need to answer.
Reflect/research the top organization (if you have a clear idea) or industry sector (if you are still undecided) you wish to work in/for.
Identify the top three skills/traits that would allow you to excel in that position/sector and would make you a highly qualified candidate. How do you plan to acquire these skills?
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Solution
Hotel Industry
Hospitality management and hotels are a broad sector of entrepreneurship. In recent times, independent hotels have been on a rising level, especially in the United States (Nazarian et al.,2019). Hospitality management and the hotel industry are more likely the same with just a few differences. They both focus on travel and tourism though hospitality management is concerned in a broader way, such as events, beverages, and diverse foods. In contrast, hotels are concerned with housekeeping, cooking food, and allowing sitting-in clients to take meals as they leave afterward.
Top Skills
I specialize in hospitality management and hotels, but I would like to venture into the hotel industry and have my hotel. The reason is that I enjoy making delicious meals as cooking is my main hobby and organizing a room. I like when everything is in order and cleanliness describes me better. My other aspiration is on tourism. I find it easier to interact with people and make them smile and be happy.
Some of the skills that I would like to focus on are; flexibility, consistency, and attention to detail. The hotel industry is competitive, with many owners looking for improvement. As a small independent industry, I have a major task in ensuring that I meet the three skills to reach my target and successfully run the business.
Ways to Acquire the Skills
I decided to major in hospitality management and hotels to get the best knowledge and skills to start my own hotel. Therefore, I will have to ensure that the meals we prepare services we offer maintain a consistent flow as I work on ways to improve depending on the clients’ feedback. In the concept of flexibility, I will ensure that both the management team and I are well equipped with skills and knowledge. This will be done by hiring specific staff with required skills and attainment levels to quickly adapt to changes and maintain flexibility. Attention to detail is crucial as it can help maintain the flow of the business positively. For instance, any compliment made by a client or complains, I will note them down and engage my team on how to maintain the same or work on the weakness.
Reference
Nazarian, A., Atkinson, P., Foroudi, P., & Dennis, K. (2019). Finding the right management approach in independent hotels. International Journal of Contemporary Hospitality Management. https://westminsterresearch.westminster.ac.uk/download/a93d33fbf738990c51fa8d241f198801b7d54c9a35f61b912f585adfa1f78527/855058/Finding%20the%20Right%20Management%20Approach.pdf

POSTPARTUM TEACHING PLAN GUIDELINES-(Use either breastfeeding or postpartum hemorrhage as an educational topic to teach mother/family about)
PURPOSE:
To provide the student with the opportunity to provide postpartum education to a mother/family about safe care of herself and her newborn in preparation for discharge.
GUIDELINES:
1. Select a mother/baby couplet who will be discharged home within the next 24 hours. (10pts)-
2. Complete a brief nursing history to substantiate the client’s need for educative/supportive intervention. Identify the client’s strengths and limitations in meeting the therapeutic self-care demand and documenting the nursing diagnosis. ( 20pts)
3. Develop a teaching plan which includes: (40pts)
a. Specific client/focused learning objectives; at least 5.
b. Topical outline of content material;
c. Planned teaching strategies and learning activities
d. Evaluation criteria.
4. The teaching plan must include learning activities for at least one of the following learning domains.
a) Cognitive
b) Psychomotor
c) Affective)
4. Implement the teaching plan. (10pts)
5. Evaluate the effectiveness of the teaching plan in achieving learning objectives using established evaluation criteria using teach-back. Include any reinforcement or new approaches needed. (20pts)
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Solution
Postpartum Teaching Plan
Mother/Baby Couplet
The couplet comprises a 25-year-old African American woman and her newborn daughter. The birth was normal delivery with no complications.
Nursing History
The patient is a primipara, a 25-year-old African American woman. She came to the maternity clinic and delivered her newborn girl naturally, without an epidural injection administered. The baby is healthy and the mother has no after-birth complications, apart from the stitches in the perineum. The mother’s caregiver includes her older sister and brother. She is single and separated from her partner, who is the baby’s father. She will need more help with the baby upon discharge. The following is the teaching plan designed for her discharge to ensure continued wellness for her and the baby.
Learning Objectives
To help the mother learn how to observe proper nutrition
To help mother engage in proper bowel care
To teach mother how to perform perineal care
To teach mother how to perform breast care
To help the mother learn psychological adjustment after childbirth
Topical Outline
Observing proper nutrition
Avoid weight-reduction diets until after the postpartum checkup. Most mothers take up to one year to return to their pre-partum weight.
Observe a well-balanced diet that is high in protein, fiber, fluids, and calcium (Suplee & Janke, 2020).
Communicate any allergies with the clinician to avoid affecting the baby.
Bowel care
It is normal to have concerns about bowel movements after childbirth.
Bowel function should return to normal in about 4 days after delivery.
To avoid constipation that may lead to tearing the stitches, observe a diet high in fiber and fluids (McKinney et al., 2017).
Consider adding prunes to the diet to reduce the chances of constipation.
Consider walking to promote bowel movements and to increase circulation.
Perineal care
Patients should continue to use their peri-bottle to clean the perineum
Rinse the perineum front to back with warm water until the bleeding ceases.
Sitz-bath should be used as directed to dissolve the stitches (Suplee & Janke, 2020).
If bleeding increases and blood darkens, the patient should consider resting more.
If blood clots larger than the size of an egg appear, the patient should consult their healthcare provider for medical advice.
Breast care
The patient should ensure that the baby is properly latched on the nipples to avoid cracked or sore nipples.
Breasts may become engorged. To manage this, apply ice packs for 15 to 20 minutes while lying flat.
Engorgement may be painful. The mother should consider OTC analgesics. The engorgement should resolve in two to three days (Suplee & Janke, 2020).
The mother should check for lumps, sore or hot areas in the breast that do not go away after nursing. If this happens, the mother should consult their healthcare provider.
Psychological adjustment
‘Baby-blues’ are considered normal where the mother may experience feelings of sadness and anxiety. These feelings are temporary.
Persistent feelings of worthlessness, hopelessness, low self-esteem, anxiety and depression are serious and indicate post-partum depression (McKinney et al., 2017).
If the mother experiences PPD, she should consider consulting a therapist to explore the available psychotherapeutic interventions to help them manage their condition.
Planned Teaching Strategies and Evaluation Criteria
For this patient, one of the effective teaching strategies is patient teach-back. The clinician will explain to the patient the aforementioned concepts in detail. The clinician may also provide the patient with brochures containing the same information. Asking the patient to explain what they have learned would be an effective evaluation criterion to assess the effectiveness of the patient education efforts (Miller, 2021).
Implementing Teaching Plan
The session will include a discussion on what to do if any complications with perineal, bowel, breast, psychological care, and nutrition arise. The clinician will provide the patient with a brochure with the education required for new mothers. The clinician will also use the teach-back method to assess the effectiveness of the education before discharging the patient.
Effectiveness of Teaching Plan in Achieving Learning Objectives
Teach back is the most effective way to achieve learning outcomes. Additional approaches to reinforce the lessons include using posters, sending patients PowerPoint presentations, and introducing trained peer educators to the patient (Miller, 2021).
References
McKinney, E., James, S., & Murray, S. (2017). Maternal-Child Nursing. Elsevier Health Sciences.
Miller, W. (2021). Strategies for Clinical Teaching in the Health Professions. Taylor & Francis.
Suplee, P., & Janke, J. (2020). Association of Women’s Health, Obstetric & Neonatal Nurses. AWHONN, Association of Women’s Health, Obstetric and Neonatal N

Public health-655-Topic 2 DQ 1- The State Of Global Health-Please see upload for full question
-The question will be uploaded
– Please refer to the Link to the United Nations’ Sustainable Development Goals is also uploaded
– Sources must be published within the last 5 years. It must be from 2017 and after and appropriate for the paper criteria and public health content.
– Please do not use blogs as references
-References should be in APA 7th ed.
-Please make sure you add the in text citations
NO PLAGARISM
-Add references to reference page
-Add the hyperlink/DOI for each reference in APA 7th edition format.
Thank you
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Solution
Sustainable Development Goals
United Nations’ agenda of the seventeen sustainable development goals has been termed a special gift to the people worldwide (Colglazier, 2018). The sustainable development goals act as pillars to create change in the economic, social, and health sectors. The main aim is to achieve strategic development in all three sectors and mainly include all people across the globe. In commemoration of the sustainable development goals, the United Nations has managed to work on projects and programs focusing on humanity and health to achieve the goals and partner with stakeholders of private and public organizations.
Based on the statement, sustainable development goals are roadmaps and not a menu. I support the goals being roadmaps because they indicate strategic plans that describe goals on achieving the desired outcome. On the other hand, they cannot be referred to as menu because menu entails just a list of plans with no directives or plans on how to achieve the outcome.
Most of the sustainable goals are related to health in one way or another. In this case, I will refer to goals number five and six, respectively; Gender equality and clean water and sanitation. Gender equality has enhanced the achievement of equality in gender and empowerment of women and girls. The women and girls can access education and acquire jobs in society, thus being independent and caring for their families. Accessing safe, clean water and sanitation have reduced people’s chances of contracting infectious and waterborne diseases.
Sustainable development goals focus on protecting humanity, providing a safe environment, and promoting good health. Therefore, goal 3 is a core issue in achieving the three outcomes. Goal 3 entails two critical issues: health, that is, it is a universal right and essential in promoting safe, sustainable development settlements in other countries (Colglazier, 2018). On the other hand, welfare entails both physical and psychological factors that function interchangeably in achieving sustainable development goals.
In achieving sustainable development goals as a global society, I would encourage the United Nation’s team and stakeholders to ensure that worldwide monitoring and evaluation of sustainable goals is conducted consistently to show the progress of the goals (Bali Swain & Yang-Wallentin, 2020). Another action would be ensuring that the nation understands the objectives of the sustainable development goals through educative programs and global projects and programs.
References
Bali Swain, R., & Yang-Wallentin, F. (2020). Achieving sustainable development goals: predicaments and strategies. International Journal of Sustainable Development & World Ecology, 27(2), 96-106. https://www.tandfonline.com/doi/pdf/10.1080/13504509.2019.1692316
Colglazier, E. W. (2018). The sustainable development goals: Roadmaps to progress. Science & Diplomacy, 7(1). https://www.sciencediplomacy.org/editorial/2018/sdg-roadmaps
Guégana, J. F., Suzán, G., Kati-Coulibaly, S., Bonpamgue, D. N., & Moatti, J. P. (2018). Sustainable Development Goal# 3,“health and well-being”, and the need for more integrative thinking. Veterinaria México, 5(2), 1-18. https://www.medigraphic.com/pdfs/vetmex/vm-2018/vm182c.pdf

Health History Tina Jones Shadow health Transcript
Transcript
Started: May 24, 2020 | Total Time:350 min
Height: 170 cm
Exam Action
05/22/20 12:11 PM EDT
Weight: 90 kg
Exam Action
05/22/20 12:11 PM EDT
BMI: 31
Exam Action
05/22/20 12:11 PM EDT
Random blood glucose: 238
Exam Action
05/22/20 12:11 PM EDT
Temperature: 101.1 F
Exam Action
05/22/20 12:11 PM EDT
Blood pressure: 142/82
Exam Action
05/22/20 12:11 PM EDT
Respiratory rate: 19
Exam Action
05/22/20 12:11 PM EDT
O2 sat: 99%
Exam Action
05/22/20 12:11 PM EDT
Heart rate: 86
Exam Action
05/22/20 12:11 PM EDT
Hello. My name is Joan and I will be interviewing you today and later examine you.
Greet
05/22/20 12:12 PM EDT
Hey.
What is your name?
Question
05/22/20 12:12 PM EDT
Tina Jones.
Why are you here today?
Question
05/22/20 12:13 PM EDT
I got this scrape on my foot a while ago, and I thought it would heal up on its own, but now it’s looking pretty nasty. And the pain is killing me!
Am sorry to hear that?
Empathize
05/22/20 12:13 PM EDT
I appreciate you saying that.
When did you get the scrape?
Question
05/22/20 12:14 PM EDT
Well, I got the scrape a week ago, but the scrape and the pain got a lot worse in the last few days.
How severe is the pain?
Question
05/22/20 12:14 PM EDT
It’s really bad.
Can you describe the pain?
Question
05/22/20 12:15 PM EDT
It’s throbbing and like, sharp if I try to put weight on it.
Did you hurt any other part?
Question
05/22/20 12:15 PM EDT
No, I caught myself on the railing so I didn’t fall on the ground. Only my foot got hurt.
how has the pain changed over time?
Question
05/22/20 12:16 PM EDT
At first, it seemed like it was healing up fine and it didn’t give me a lot of pain. But the last two days, the pain got way worse.
Does the pain radiate anywhere else?
Question
05/22/20 12:17 PM EDT
The pain’s worse in my foot, but I feel it moving up into my ankle, too.
How painful is the ankle? (Clarified to How did you hurt your ankle?.)
Question
05/22/20 12:18 PM EDT
I was going down the back steps, and I tripped. . . I caught the railing, but I guess I kind of turned my ankle a little bit. And I scraped up my foot on the edge of the step. (Clarified to how I hurt my ankle.)
is it possible for you to stand on your foot?
Question
05/22/20 12:18 PM EDT
No, I can’t put weight on my foot without really sharp pain.
How do yo rate the pain on a scale of 0 o 10 (Clarified to Can you rate your current pain level on a scale of 0 to 10?.)
Question
05/22/20 12:19 PM EDT
I’d say a 7. It hurts a lot, and the pain pills haven’t kicked in yet. (Clarified to how I would rate my pain on a scale.)
can you tell me where the pain is located?
Question
05/22/20 12:19 PM EDT
It feels like the pain is just centered around the scrape, like around the ball of my foot. That’s where it hurts the most, but my whole foot feels some pain.
Which foot did you injure?
Question
05/22/20 12:20 PM EDT
My right foot.
Were you wearing shoes?
Question
05/22/20 12:20 PM EDT

Module 4: Endocrine Disorders
What’s Happening This Module?
Module 4: Endocrine Disorders is a 1-week module, Week 6 of the course. In this module you will examine fundamental concepts of diseases and disorders that impact endocrine systems. You will also evaluate the impact of patient characteristics, including racial and ethnic variables, on physiological functioning within these systems.
What do I have to do? When do I have to do it?
Review your Learning Resources Days 1–7 of Week 6
Knowledge Check: Endocrine Disorders Complete by Day 5 of Week 6
Midterm Exam Complete by Day 7 of Week 6
Go to the Week’s Content
Week 6
Week 6: Concepts of Endocrine Disorders
Endocrine disorders are complex matters, and there is not always a one-size-fits-all treatment. Particularly in matters requiring the adjustment of hormone levels, treatment may require a custom approach tailored to individual patients. An understanding of these complications is essential to supporting these individual treatment plans.
This week, you examine alterations in the endocrine system and the resultant disease processes. You also consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.
Learning Objectives
Students will:
Analyze concepts and principles of pathophysiology across the lifespan
Learning Resources
Required Readings
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Chapter 21: Mechanisms of Hormonal Regulation, including Summary Review
Chapter 22: Alterations of Hormonal Regulation, including Summary Review
Chapter 23: Obesity and Disorders of Nutrition, including Summary Review
American Diabetes Association (2020). Standards of medical care of patients with diabetes mellitus. Diabetes Care, 26(suppl 1), pp. s33-s50. https://care.diabetesjournals.org/content/26/suppl_1/s33
Orlander, P. R. (2018). Hypothyroidism. Retrieved from https://emedicine.medscape.com/article/122393-overview
Hoorn, E. J., & Zietse, R. (2017). Diagnosis and treatment of hyponatremia: Compilation of the guidelines. Journal of the American Society of Nephrology, 28(5), 1340–1349
Document: NURS 6501 Midterm Exam Review (PDF document)
Note: Use this document to help you as you review for your Midterm Exam in Week 6.
Required Media
Module 4 Overview with Dr. Tara Harris
Dr. Tara Harris reviews the structure of Module 4 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check and your Midterm. (3m)
Online Media from?Pathophysiology: The Biologic Basis for Disease in Adults and Children
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 21 through 23 related to the endocrine system and disorders. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/
Optional Resources
The following source provides various tutorials related to maximizing your time management and managing stress. Feel free to access this resource to support you as you move through this course.
Walden University. (2019). ASC success strategies interactive tutorials. Retrieved from https://academicguides.waldenu.edu/academic-skills-center/skills/tutorials/success-strategies
Knowledge Check: Endocrine Disorders
In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content.
Possible topics covered in this Knowledge Check include:
Diabetes
Hyper- and hypothyroidism
Adrenal disorders
Parathyroidism (hyper and hypo)
Checks & balances / negative feedback
Syndrome of Inappropriate Antidiuretic Hormone
Pheochromocytosis
Diabetes insipidus
Diabetic ketoacidosis
(Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Midterm Exam.)
Complete the Knowledge Check By Day 5 of Week 6
To complete this Knowledge Check:
Module 4 Knowledge Check
Midterm Exam
This 101-question exam is a test of your knowledge in preparation for your certification exam. No outside resources, including books, notes, websites, or any other type of resource, are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.
This exam will be on topics covered in Weeks 1, 2, 3, 4, 5, and 6. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of 2 hours for completion. When time is up, your exam will automatically submit.
(Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Midterm exam.)
To prepare:
To help you review for your midterm exam, access the Midterm Exam Review document found in this week’s Learning Resources as well as any Knowledge Check feedback you might have received. (Note: You will also need to review all of your materials from each of these weeks to also help you better prepare for your midterm.)
By Day 7 of Week 6
Submit your Midterm Exam.
To complete your exam:
Midterm Exam
What’s Coming Up in Module 5?
In Module 5, you will analyze processes related to neurological and musculoskeletal disorders through case study analysis. To do this, you will analyze alterations in the relevant systems and the resultant disease processes. You will also consider patient characteristics, including racial and ethnic variables, which may impact physiological functioning and altered physiology.
Week 7 Knowledge Check: Neurological and Musculoskeletal Disorders
In the Week 7 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 5. This Knowledge Check will be composed of a series of questions related to specific scenarios provided. It is highly recommended that you review the Learning Resources in their entirety prior to taking the Knowledge Check, since the resources cover the topics addressed. Plan your time accordingly.
Next Module
To go to the next Module:
Module 5