Nursing

Which data elements of the patient record are considered protected health information (PHI) and which record types across the EHR system are considered PHI? Provide reasoning and examples.
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Solution
Protected Health Information (PHI) and EHR
Protected Health Information (PHI) is also known as personal health information. Some of the data elements that are considered PHI include demographic information, mental health conditions, insurance information, lab results among data that is collected by healthcare professionals for identification of an individual and come up with the required care (Baumann, Baker, Elshaug, 2018). Health Insurance Portability and Accountability act of 1996 is the principal law that helps in overseeing the use, access to disclosure of PHI in the US. It defines data that relates to the past, present future health information of a patient. It also outlines the provision and payment of healthcare to a patient.
Healthcare entails dealing with some of the sensitive information about a patient such as the date of birth, medical conditions as well as insurance claims. Regardless of whether the information about a patient is stored on paper or in an electronic health record (EHR), PHI will always explain the medical history of a patient. This may include ailments, treatment methods, and the resultant outcome (Akhu-Zaheya, Al-Maaitah, Hani, 2018).
EHR consolidate patients’ medical chart into digital documents. They are updated and can be accessed in real-time by authorized users in a digital way. HER contains information about the medical history of patients, the type of medications patients have received, allergies, radiology images, and information about treatment plans required for patients (Snowden, Kolb, 2017). HER also provides physicians as well as care providers with tools necessary to help them in coming up with decisions about the care of patients. This, therefore, implies that the HER systems that are considered PHI are protected health information that is in digital form.
References
Baumann, L.A.; Baker, J.; Elshaug, A.G. (2018). The impact of electronic health record systems on clinical documentation times: A systematic review. Health Policy 2018, 122, 827–836
Akhu-Zaheya, L.; Al-Maaitah, R.; Hani, S.B. (2018). Quality of nursing documentation: Paper-based health records versus electronic-based health records. J. Clin. Nurs. 2018, 27, e578–e589
Snowden, A.; Kolb, H. (2017). Two years of unintended consequences: Introducing an electronic health record system in a hospice in Scotland. J. Clin. Nurs. 2017, 26, 1414–1427

Public health-655-Defining Poverty And Global Health -Topic 1 DQ 2-Please see upload for full question.
-The question will be uploaded
The Link to the video on “Defining Poverty” to help in responding to this discussion question 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
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-Add references to reference page
-Add the hyperlink/DOI for each reference in APA 7th edition format.
Thank you
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Solution
State Your Definition Of Poverty Prior To Studying Public Health. Based On This Definition, What Would Be The Focus Of Poverty Alleviation Solutions?
Before studying Public health, I defined poverty as a condition or state in which an individual or community lacks the financial essentials or resources that are necessary for a minimum standard of living (Gweshengwe & Hassan, 2020). I viewed poverty through income levels characterizing individuals who are poor as those people who make an income that cannot meet their needs. I defined poverty-stricken families as those without clean water, proper housing, medical attention, and healthy food. Based on my definition of poverty, the focus of poverty alleviation solutions would therefore focus on providing infrastructure to poor communities, including better housing, access to clean water, and access to healthcare through the building of more health care facilities (Gweshengwe & Hassan, 2020).
Based On The Relational And Spiritual Definition Of Poverty, Discuss How The Focus Of Solutions Would Change To Include A Holistic Approach.
The relational and spiritual definition of poverty attributes poverty to broken relationships, which creates a sense of helplessness and hopelessness among individuals and communities considered poor. Individuals struggling with poverty typically describe their conditions as a lack of hope and dignity as opposed to a lack of finances (Feldman, 2018). Considering the relational and spiritual definition of poverty, the focus of poverty alleviation efforts change to include solutions to repairing relationships and strengthening communities, such as through vibrant local churches. This holistic approach to poverty that includes repairing broken relationships in the community, which are the main causes of poverty, in combination with other physical poverty alleviation solutions such as improving infrastructure and access to healthcare, will therefore be effective in dealing with poverty (Aufseeser, 2020).
Identify An Example Of A Health Program Or Solution That Integrates A Relational Definition Of Poverty
A health program that integrates the relational definition of poverty is one that provides counseling services to individuals in poverty. Some NGOs provide counselling services as an intervention to poverty in marginalized communities. Such a health program considers the impact of relational issues in contributing to poverty (Aufseeser, 2020).
References
Aufseeser, D. (2020). Towards a relational understanding of child poverty: Care and adverse inclusion among street-affiliated children in Peru. Geoforum, 114, 10–18. https://doi.org/10.1016/j.geoforum.2020.05.016
Feldman, G. (2018). Towards a Relational Approach to Poverty in Social Work: Research and Practice Considerations. The British Journal of Social Work. https://doi.org/10.1093/bjsw/bcy111
Gweshengwe, B., & Hassan, N. H. (2020). Defining the characteristics of poverty and their implications for poverty analysis. Cogent Social Sciences, 6(1), 1768669. https://doi.org/10.1080/23311886.2020.1768669

I) Overview of the cardiovascular system
II) Discuss the physiology(structure and function) of the cardiovascular system including details about the major organ systems
III) Construct relevant health history questions(subjective data) pertaining to the body system(cardiovascular)
IV) Provide an overview of the objective data and expected normal physical examination findings for the cardiovascular system
V) Analyze and discuss how you might adapt your physical assessment skills or interviewing techniques to accommodate each of the following specific populations
A)Infant/pediatric
B)Pregnancy
C) Geriatric
VI) identify one major disease(Heart failure) or disease process that may significantly impact this body system
VII) Synthesis and discuss the expected abnormal physical examination findings that may be associated with this disease process
VIII) summarize the key points
Reference in correct APA form
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Solution
Week 4 Assignment: Cardiovascular
The Cardiovascular System Overview
The cardiovascular system is the body’s circulatory system, which transports blood throughout the body. This system consists of two major parts, including the heart and a closed system. The heart is a muscular organ that pumps blood to other body parts, organs, and tissues. On the other hand, the closed system consists of various blood vessels, including veins, arteries, and capillaries.
The Physiology of the Cardiovascular System
The cardiovascular system consists of various organ systems involved in transporting materials, such as oxygen and nutrients, to body cells (Wakim & Grewal, 2021). The system transports oxygenated blood from the lungs to the cells and deoxygenated blood from the cells to the lungs. Additionally, the cardiovascular system transports nutrients from the digestive system to body tissues. The transport is also involved in transporting hormones from the endocrine system glands. Finally, it transports waste materials from various body cells. Thus, the cardiovascular system maintains the body’s homeostasis by transporting various important materials. The circulatory system consists of three major components, including the heart, blood, and blood vessels.
The Heart
The cardiac muscle is located in the chest. It is composed of cardiac muscle tissue and blood vessels, including veins, arteries, and capillaries. The heart muscle pumps blood repeatedly to other body parts and tissues through major blood vessels in rhythmic contractions. It is subdivided into four chambers: right atrium, left atrium, right ventricle, and left ventricle (Wakim & Grewal, 2021). While pumping, the blood leaves the atrium to the ventricle located below it. Additionally, blood is pumped from the ventricle to other body parts. The heart muscle contracts routinely without the nervous system stimulation. The contractions are initiated by electrical impulses that are produced by special cells of the cardiac muscle. Hence, contractions in the ventricles and atria occur automatically with the right timing to enhance blood pumping through the cardiac muscle. The heart also consists of blood valves through which the blood flows throughout the body via the heart muscle.
Blood Vessels
The cardiovascular system consists of interconnected blood vessels, including veins, arteries, and capillaries. The vessels facilitate the transportation of materials from one body part to another. Arteries transport blood from the heart except those that supply the cardiac muscle with nutrients. Particularly, arteries transport oxygenated blood from the heart to other body organs and tissues. Arterioles are the tiniest arteries in the body. On the other hand, veins transport deoxygenated blood to the cardiac muscle (Wakim & Grewal, 2021). Venules form the smallest veins. The last category of the blood vessel is the capillaries, which are the smallest blood vessels, connecting venules and arterioles. Capillaries facilitate the exchange of materials, such as oxygen, nutrients, and waste, between the blood and body tissues. Two circulations facilitate the movement of materials in the body.
Two Circulations
Two interconnected circulation
systems facilitate the transportation of materials in the cardiovascular system: Systemic circulation and pulmonary circulation.
Pulmonary Circulation
The pulmonary circulation consists of three significant components, including the cardiac muscle, lungs, and major blood vessels connecting the heart and the lungs. The flow of blood from the heart to and from the lungs occurs through the pulmonary circulation. The deoxygenated blood becomes oxygenated once it gets to the lungs. The deoxygenated blood is pumped from the right ventricle of the heart via the left and right pulmonary arteries, which transport blood to the left and right lungs, respectively (Wakim & Grewal, 2021). Once the deoxygenated blood from the heart gets to the lungs, it passes through a network of smaller arteries and then over a network of blood capillaries surrounding the alveoli, thus facilitating the exchange of gases. Oxygen moves from the alveoli to the deoxygenated blood flowing in blood capillaries, while the alveoli take waste gases, such as carbon dioxide. Oxygenated blood then flows from the left and right lungs via the left and right pulmonary veins. The four pulmonary veins then enter the cardiac muscle’s left atrium.
Systemic Circulation
The blood saturated with oxygen that enters the heart’s left atrium in the pulmonary circulation later gets into the systemic circulation. This second part of the cardiovascular system is responsible for the transportation of blood to other body tissues. The blood supplies the body tissues with oxygen and nutrients as it flows through them and collects various wastes, such as carbon dioxide. The systemic circulation consists of the cardiac muscle and blood vessels. They work together to meet all the metabolic needs of all body cells, including the lungs and the cardiac muscle. The oxygenated blood from the left atrium is pumped to the left ventricle (Wakim & Grewal, 2021). The blood from the left ventricle is then pumped directly into the largest artery in the body, the aorta. The blood is then transported to the upper extremities, including the head, by major arteries, which branch from the aorta. Additionally, the aorta transports blood to the abdomen and lower body parts. A network of systemic circulation’s veins then returns blood to the cardiac muscle. The vena cava collects blood returning from the tissues to the heart. The superior vena cava collects blood from the upper body, while blood from the lower body flows to the inferior vena cava. Blood from the superior and inferior vena cava then flows into the right atrium.
Blood
Blood is a significant component of the circulation system. This fluid is facilitated by the pumping mechanism of the cardiac muscle to circulate through blood vessels to the entire body. Blood takes oxygen and nutrients to the cells and removes wastes and carbon dioxide from the cells for excretion. Additionally, the body transport other substances that facilitate various activities, including protecting the body against infection, regulating pH level, and repairing worn-out cells and tissues. Plasma, a yellowish liquid, forms the fluid part of the blood. It contains blood cells, dissolved substances, and blood cells (Wakim & Grewal, 2021). The blood cells contained in the plasma support different functions of the blood. Red blood cells (RBCs) are many in number transport oxygen from the lung and the cardiac muscle to body cells. Hemoglobin is the major component of red blood cells. It has iron, which binds with oxygen to facilitate its transportation. The second type of blood cell is the white blood cells, which are less than RBCs. The main function of these blood cells involves protecting the body against infections. The white blood cells utilize various defensive mechanisms such as phagocytes, in which the cells swallow and destroy disease-causing microorganisms. The last category of the blood cells is the platelets, which are cell fragments responsible for blood clotting. These cells stick together to form a plug at the injured body part. Additionally, platelets produce chemicals, which are perquisites for the clotting process (Wakim & Grewal, 2021).
Relevant Health History Questions
A healthcare provider asks a patient health history questions to gather relevant data during diagnosis and treatment processes. First, a clinician enquires about any experience of chest pain that might occur as pressure or a burning sensation. Additionally, the healthcare provider can enquire if any pain is experienced in the upper body, including the shoulders or neck. One can also be asked about the duration of the pain before disappearing and accelerating and reducing factors. Specifically, a patient is asked what happens to the pain while undertaking an activity and a rest or upon lying down. The second question is about the shortness of breath and what happens at an activity while lying down. The patient is also asked about any experience of lightheadedness or dizziness.
The Objective Data and Expected Normal Findings of the Cardiovascular System’s Physical Examination
In addition to subjective data, a healthcare provider collects objective data when dealing with a client presented with a cardiovascular system disorder system. Thus, a physical examination is conducted to assess the cardiovascular system. Some normal findings are expected following the cardiovascular system’s physical examination. First, expected normal findings on palpation include regular heart rate, regular respiratory rate (RR), and the feeling of an apical pulse, which occurs over the midclavicular fifth intercostal space (Suez & Oiseth, 2021). Other expected normal findings that occur on auscultation include a lack of murmurs and a regular rhythm. Lastly, no apical impulse was observed on inspection.
The Adaptation of Interviewing Techniques to Accommodate Special Populations
Interviewing techniques will differ depending on the patient population that I am interviewing. First, I refrain from asking complicated questions when dealing with pediatrics since they cannot respond to such questions. Secondly, I will be very patient when interviewing the pregnant mother, and I will give them adequate time to respond to interview questions since most of them experience mood swings. Finally, I will avoid asking fatigue and exercise intolerance-related questions to elderly patients. Decreased peak exercise ability and high skeletal muscle fatigability are associated with age (Wan et al., 2017). Hence, fatigue and exercise intolerability do not characterize heart failure in geriatrics.
A Major Circulatory System Disorder: Heart Failure
Heart failure occurs due to the inability of the heart muscle to pump enough blood to meet all body’s needs. The inability to pump enough blood to other body parts is associated with various factors, including lack of adequate blood in the heart; damage, stiffness, or weakness of the ventricles, preventing them from functioning properly; or weakness of heart muscle, compromising its ability to pump blood properly (National Heart, Lung, and Blood Institute, 2021). Consequently, the ventricles thicken and expand, and the heart muscle pumps blood faster to meet blood requirements in the body. Heart failure is one of the circulatory system disorders that adversely impacts the body system since it compromises other major organs, such as the lungs and kidneys. Fluids build up in the lungs since they do not supply adequate oxygenated blood to the heart muscle following the inability of the heart to pump blood to other body parts. Swelling is also experienced in the lower body due to the inability of the kidney to excrete wastes and excess water from the body.
Expected Abnormal Physical Examination Findings Attributed to Heart Failure
Various abnormal findings are expected in an individual diagnosed with heart failure, including high blood pressure (above 130/80 mm Hg), which builds up as the heart muscle strives to pump adequate blood to other body parts. An irregular heart rate is also anticipated in a heart failure patient (Suez & Oiseth, 2021). One can also hear a third heart sound, which portrays abnormal blood flow via the heart muscle. Another finding involves the presence of murmurs. Swollen neck veins are common, indicating backing up of blood in the right ventricle. Crackling or bubbling noises can also be heard, indicating the buildup of fluids in the lungs. Finally, swelling in the legs, feet, or ankles can be seen due to fluids building up in the body.
Summary
In conclusion, the cardiovascular system consists of various organ systems that transport materials, such as oxygen and nutrients, to body cells. The circulatory system consists of three major components, including the heart, blood, and blood vessels, which facilitate the transportation of materials throughout the body. Objective and subjective data are collected to guide healthcare providers during diagnosis and treatment processes. Expected normal findings on palpation include regular heart rate, regular respiratory rate (RR), and the feeling of an apical pulse. As a clinician, I should adjust my interview techniques to accommodate special populations, including pediatrics, expectant mothers, and geriatrics. Heart failure is one of the circulatory system’s disorders that affect other systems in the body. Abnormal findings in patients with this condition include high blood pressure (above 130/80 mm Hg), murmurs, irregular heartbeat, and swelling in the lower extremities.
References
National Heart, Lung, and Blood Institute. (2021). Heart Failure. NHI. https://www.nhlbi.nih.gov/health-topics/heart-failure
Suez, E & Oiseth, S. (2021). Lecturio Medical Knowledge Essentials – Physical Examination of the Cardiovascular System. https://www.lecturio.com/magazine/lecturio-medical-knowledge-essentials-physical-examination-of-the-cardiovascular-system/
Wakim, S & Grewal, M. (2021). Introduction to the Cardiovascular System. Biology Libre Texts. https://bio.libretexts.org/Bookshelves/Human_Biology/Book%3A_Human_Biology_(Wakim_and_Grewal)/17%3A_Cardiovascular_System/17.2%3A_Introduction_to_the_Cardiovascular_System
Wan, J. J., Qin, Z., Wang, P. Y., Sun, Y., & Liu, X. (2017). Muscle fatigue: general understanding and treatment. Experimental & molecular medicine, 49(10), e384-e384.

Assignment Description:
For this week assignment, write a 1500-word essay addressing each of the following points/questions.
Read the case study presented at the end of Chapter 10, which begins “The elderly patient resided at the nursing home for almost a year before she died at the hospital.”
• Did the lack of documentation in the admitting nurse’s assessment and notes affect the ultimate outcome of this case?
• Was there negligence on the part of the nursing staff in the care of this patient?
• What could the nurse have done differently to facilitate a different outcome in this case?
• How would you decide this case?
Using the sample professional liability insurance policy (Chapter 11 p. 191-192 Figure 11-1) locate the various provisions:
• Limits of liability
• Declarations
• Deductibles
• Exclusions
• Reservation of rights
• Covered injuries
• Defense costs
• Coverage conditions and supplementary payments
• Did you have difficulty finding some of the sections? Would this be a policy that you would consider purchasing for your own liability coverage? Why or why not?
Read the case study presented at the end of Chapter 11, You Be the Judge, which begins, “During an unexpected heat wave,…” (Guido, p. 195):
• What provisions of an insurance policy would you consult to determine if an insurance company should pay such a claim, and what would the limits of the liability be?
• Is the nursing home insurance company correct in saying that this is a professional judgment issue?
• Which insurance company (the nursing home’s or that of the administrator of the nursing home, assuming she has coverage) should pay the court-ordered judgment?
• How would you decide the case?
Please combine all of these responses into a single Microsoft Word document for submission. Submit only completed assignments (not partial or “draft” assignments). Be thorough in your responses to adequately address all aspects of each question.
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EXAMPLE 1
Introduction
Evidence-based, quality, and safe nursing practice is termed accurate, clear, and accessible discrimination of a patient’s diagnosis history, treatment, and progress. All phases of the nursing practice are responsible and accountable for documentation. Documenting the nurses’ tasks is crucial as it helps attain effective communication. Nursing documentation is also used in legal issues, payment practices, and insurance policies. Lastly, documenting shows the contribution of nurses to a patients’ care results and proves contribution to the viability and effectiveness of the healthcare organization that encourages the provision of quality care. The essay will look into two major case studies related to legal proceedings resulting from inadequate patient documentation and examination and poor healthcare professionals’ decisions.
Case Study, Chapter 10
Failure to document in admitting nurse’s assessment notes and effect on the outcome
My main concern is whether the nursing home laid out guidelines on managing bedridden patients and whether there are strategies to provide special mattresses for non-ambulatory clients to curb and care for pressure ulcers. I think that lack of documentation of the patient’s necrotic grade III pressure ulcer on the coccyx and particular care like the need for a special mattress could or could not have affected the patient outcome. Firstly, it can be termed a missed diagnosis that the nurse overlooked while attending to the patient. In this case, the unnoticed diagnosis could not have been documented. The professionalism of the nurses in the nursing home should also be questioned. There is a likelihood lack of experience results in the inability to detect the pressure ulcer during the examination and the importance of having a mattress. There was a need to detect the task for the pressure ulcers hence indicating the urgency of having a particular mattress to avoid worsening the condition. I would also highlight that if the diagnosis was developed but no documenting was done, this would affect the failed outcome of the patient. If a recording was done, then it could aid in ensuring positive patients outcomes.
Evidence of presence or absence of negligence
My opinion is that there was evident negligence among the nurses in the way they cared for the patient, which led to death. The nurses failed to adhere to the clinical nursing practice standards, which is evident by failing to examine and monitor the patient (Guido, 2001). A nurse should help the patients by examining them and frequently documenting the changes in their health condition. Nurses should also interact with patients in a friendly way to ensure that they grasp all-important details on how they are progressing. This would aid in detecting any signs of health deterioration, and once such is noted, close exanimation should be done, including a physical examination (Guido, 2001).
In this scenario, a thorough physical examination would have helped detect the ulcers in the patient, and negligence would not be associated with the nurse or the facility. In this case, the nursing staff did not thoroughly access hence failing to diagnose pressure ulcers, which impacted the patient outcome (Arganata, 2021). There is also evident negligence as the nursing staff did not copy to suitable standards of documentation and care. Bedridden patients need to be aided in ambulation and rippled mattresses to curb and manage the pressure ulcers, which was not documented in the patient records. In this case, I assume that if it was not documented, it was not done, and the staff looking after the patient failed to adhere to the requirements.
What could have been done differently by the nurses to change the outcome?
I believe that the patient’s outcome could have been changed if the nurses had shown more vigilance regarding the effects of pressure ulcers on the patient (Guido, 2001). Pressure ulcers are common among non-ambulatory and bedridden patients. In this case, the nursing staff could have detected the risk of pressure ulcers in the patient and suffered the use of rippled mattresses to curb the progression of the pressure ulcers. Also, the nurse could have done a thorough examination on the patient during admission and during the patient’s stay in the facility to detect the pressure ulcers early, which would have curbed progression. Doing this would have enabled the nurse to document and alert the management and physician to take action. This would have inhibited developing sepsis and gram negative septicemia in a patient with low immunity aggravated by acute myeloid leukemia.
How I would rule the case
I would rule in favor of the patient’s family and argue that the facility portrayed negligence in the type of acre they offered the patient. My verdict would be based on the fact that the nurse failed to examine the patient fully and notice the pressure ulcers. I would also favor the patient’s family because the facility did not establish guidelines for caring for bedridden elderly patients. There was no clear record that the patient had been provided with the unique mattress to cope with the condition (Arganata, 2021).
Various provisions (Chapter 11, pages 191-192)
The limit of liability in this particular context is the personal, professional liability of $3,000,000 comprehensive/ $1,000,000 in each claim.
Declarations: In the event of a lawsuit, the insured agreed to inform the insurer in writing, detailing the addresses of the injured party, as well as witnesses, as well as the time and location of the event. She also stated that she would explicitly reference the insurer’s claim delegate about the incident and would provide complete support.
Exclusions: The insurance policy does not cater for the liability of the insured party as a superintended proprietor, execute officer of a facility, clinic with boarding amenities, laboratory, or sanitarium except those outlined in the declarations.
Deductibles: There is no specific amount stated regarding what policyholders should compensate from their pockets in case of a claim.
Reservation of rights: The insurer will not cater for a person’s professional liability as a participant of a partnership engaged in the practitioner of the person insured’s a profession as defined in the declarations, which include service by the participant certified on a formal certification or similar career board, hospital review panel, or society of experts.
Covered injuries: The policy caters for all damages due to the provision of or lack of offering professional services during the coverage by the insured or by any person whose oversights and acts when the insured is lawfully responsible.
Coverage conditions and the additional expenses: The coverage terms indicate the compulsions of the insured when a suit or claim occurs, that the insured should do a written and formal notification. The insured should also ensure they quickly submit all demands summons to the company in the occurrence of a claim or suit. The additional expenses the company will incur entail all costs taxed against the person insured in the case defended, expenses incurred by the company, and practical costs incurred by the insured during a request by the company to aid in investigating or defending a legal suit or claim.
Defense costs: The insurance company will cater for costs incurred by the company and other expenses taxed by the insured party in any suit against the company and all the interest on the overall judgment.
Challenges in finding some sections
Some of the sections are not well-illustrated; hence I encountered vast challenges in finding them. I would not opt to use this policy for my professional policy as it has missing segments and is difficult to understand.
Case Study, Chapter 11, page 195
Provisions of the insurance to consult to analyze if the claim can also be covered the limits of liability
These provisions include the policy declarations, reservation of rights, liability limits, coverage conditions, defense costs, supplemental payments, exclusions, and deductibles (Hughes, 2021).
The exactness of the nursing home insurance in indicating the issue as a professional decision
In this case, the insurance company offers professional liability policy to the facility’s administrator who was sued rather than the nursing home’s insurance. My opinion is that the issue indicated in the case study is a clear professional judgment related to the administrator opting not to switch on the air conditioner. This is a professional judgment as the decision by the administrator was based on experience and understanding hence not turning on the air conditioner, which caused the death of four patients.
The insurance company is supposed to pay for the court-ordered judgment.
The administrator used her proficient comprehension to decide what led to deaths (Guido, 2001). The nursing homes insurance company has the right to claim that the decision made was professional. The nursing home’s insurance company should not pay. Rather, her insurance company should do so if she possesses a professional liability policy.
My decision
I was to decide on this case and review the situation leading to the deaths of the patients. My take would be that this is a professional judgment concern. I would argue that the administrator utilized experience and made a decision that unfortunately led to the death of the patients. In this case, I would order the court-ordered judgment to be agreed upon by her insurance company, offering her a professional liability insurance policy, which would help manage the issue at hand.
Conclusion
In a nutshell, it is evident that documenting/recording in nursing care is vital to help attain safe and quality care. All steps and communications with the patients and procedures/medications and interventions used should be recorded. This allows nurses to stay free from lawsuits caused by misconducts like patient negligence, as illustrated in the case study in chapter 10. It is also significant to have a professional liability policy to help health providers protect their careers and themselves if misfortune does not intend to occur.
References
Arganata, R. (2021). The Nurses’ Negligence on Patients. Journal of Computational and Theoretical Nanoscience, 18(1-2), 100-104.
Guido, G. W. (2001). Legal and ethical issues in nursing.
Hughes, T. (2021). Ethical Conflicts and Legal Liability in Professional Nursing. In The Medical-Legal Aspects of Acute Care Medicine (pp. 393-415). Springer, Cham.

Choose an older adult to interview. This cannot be a patient in your clinical setting. You can use a friend, family member, or co-worker. The older adult should be 65 years or older. Use the format provided to record the responses. A list of questions is available for you to start with. Include 2–3 questions of your own to get a complete picture of the older adult. Summarize your findings and also contrast the responses with findings in your readings and other current literature.
This form should be used as an example:
[Patient Questionnaire
INTERVIEW OF CHOSEN ELDER ADULT
Name:
Age:
Brief Introduction (Background information):
1. Philosophy on living a long life:
2. Thoughts about when a person is considered “too old”:
3. Opinion on the status and treatment of older adults:
4. Beliefs about health and illness:
5. Health promotion activities he or she participates in:
6. Something special that helped the person live so long:
7. Life span of other family members:
8. Special dietary traditions in patient’s culture attributed with aiding long life:
9. Any remedies/medications that have been handed down in family/group. If yes, describe.
10. Patient’s description of current and past health status
11. The values that guided life so far
Additional Questions
1.
2.
3.
Summary:
Contrast of client’s responses with findings in current literature:]
After gaining permission, conduct a physical and mental functional assessment of the older adult you have chosen. Review your readings for the process of functional assessment.
Make use of the tools discussed this week to complete a comprehensive assessment of your patient. Search the Internet for resources on these tools.
Tinetti Balance and Gait Evaluation
Katz Index of Activities of Daily Living
Assessment of Home Safety
The Barthel Index
Make sure the older adult is clearly identified on the tools. Do not include their name, but do include professional or other designation, and age. Your name should also be identified on the tool. (This should be a part of your Appendix.)
Compare and contrast the age-related changes of the older person you interviewed and assessed with those identified in this week’s reading assignment. During this data analysis process provide at least 4–6 preliminary issues that you have identified. Identify three alterations in health that you would propose and describe them. Identify a minimum of three comprehensive interventions for each problem.
Make sure that you integrate personal cultural awareness and cultural competency.
Paper should be 5–6 pages, not including the questionnaire or tools used. These should be attached as an Appendix. Remember to use headings to identify the different sections in your paper.
On a separate references page, cite all sources using APA format.

NRNP 6552: Advanced Nurse Practice in Reproductive Health Care. Discussion: Different Roles of the Nurse Practitioner
Post a brief explanation about the differences in roles related to a CRNP, a CNM, and a PA and how each of these roles might impact the how you practice as an FNP. Be specific and provide examples.
Discussion: Different Roles of the Nurse Practitioner
The term ‘history” is broad in meaning. Within that broad framework, archeologists tend to focus their careers on various specialties and areas of interest, such as specific historical eras or geographical areas.
NRNP 6552: Advanced Nurse Practice
So it is with nurses. Within the broad framework of healthcare, nurse practitioners focus their careers on various roles. These roles may, in part be based on narrower areas of interest such as women’s health. Careers also focus on selected technical nursing specialties.
For this Discussion, you will explore your professional interests and those interests are addressed in specific guidelines and competencies. You also examine the different nurse practitioner roles related to women’s health and how these roles might impact the way you work.
To prepare:
Review the modular structure of this course and reflect on how each module defines the specific skills needed as an advanced Nurse Practitioner (NP).
Review the ANA guidelines, NP competencies, and the Ethic resources found in this week’s Learning Resources and consider how they impact the work of the NP.
By Day 3
Post a brief explanation about the differences in roles related to a CRNP, a CNM, and a PA and how each of these roles might impact the how you practice as a FNP. Be specific and provide examples.
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NRS 437V All Weekly Assignments
NRS 437V Week 1 Assignment My Nursing Ethics
After reading the Topic 1 materials, complete the questionnaire titled, “My Nursing Ethic.”
Complete the questions below:
PASSION: Why am I here?
MOTIVATION: What moves me to act?
INSPIRATION: What keeps me in motion?
LOYALTY: Whom do I serve?
Using the reading and the questionnaire, write a paper of 750-1,000 words in which you describe your professional moral compass. As you write your paper, include the following:
What personal, cultural, and spiritual values contribute to your worldview and philosophy of nursing? How do these values shape or influence your nursing practice?
Define values, morals, and ethics in the context of your obligation to nursing practice. Explain how your personal values, philosophy, and worldview may conflict with your obligation to practice, creating an ethical dilemma.
Reflect and share your own personal thoughts regarding the morals and ethical dilemmas you may face in the health care field. How do your personal views affect your behavior and your decision making?
NRS 437V Weekly Assignments
Do not be concerned with the use of ethical terminology for this paper.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center
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NRS 437V Week 3 Assignment Applying Ethical Frameworks in Practice
Details:
Using the steps outlined in the decision-making models in your readings, select one ethical decision-making model and use the model to analyze the case provided.
Case Scenario:
A 6-year-old develops a high fever accompanied by violent vomiting and convulsions while at school. The child is rushed to a nearby hospital. The attending physician makes a diagnosis of meningitis and requests permission to initiate treatment from the parents. The child’s parents are divorced. The mother, who is not the biological parent of the child, has primary custody. She is a Christian Scientist who insists that no medical treatment be offered for religious reasons. The biological father, who resides in another state, is also contacted. He insists that treatment be given and seeks independent consultation from another physician.
Assignment:
In a formal, written paper of 800-1,200 words, answer the following questions:
What is the ethical dilemma here?
Describe the decision-making model you selected from your readings.
How would you resolve this dilemma using the model?
Include, at the end of your paper, a 200-word dialog in which you explain your decision to the family. (Remember to use language that the family would understand).
A minimum of three references must be used.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.
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NRS 437V Week 4 assingment Analysis of an Ethical Dilemma (Part One)
Details:
Refer to the “Collaborative Learning Community: Analysis of an Ethical Dilemma” resource for the dilemmas and resources that will be used for this multi-part Analysis of an Ethical Dilemma assignment. Part ONE is an individual assignment that will also be used in Part TWO, the culminating paper.
For this individual assignment, interview a hospital administrator, a spiritual leader, a health care colleague, or a neighbor/friend.
In your interview, ask about the individual’s philosophy and worldview in relation to the ethical dilemma of your choosing, which was:
[[ Dilemma 3: Voluntary/Assisted Euthanasia
Confronting Death: Who Chooses? Who Controls? A Dialogue between Dax Cowart and Robert Burt http://digitalcommons.law.yale.edu/fss_papers/706/
The Terry Schiavo Documentary http://www.youtube.com/watch?v=cki55BM42kw ]]
Individually, you will need to interview all 4 (four) different individuals and perspectives to complete Part Three of the Analysis of an Ethical Dilemma assignment.
Make sure all roles are covered.
Craft a 250-500-word summary of the individual’s response, including the individual’s identified philosophy and worldview.
APA format is not required, but solid academic writing is expected
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NRS 437V Week 5 Assignment Analysis of an Ethical Dilemma (Part Two)
Details:
This is a CLC assignment.
Refer to the “Collaborative Learning Community: Analysis of an Ethical Dilemma” resource for the dilemmas and resources that will be used for this multi-part assignment.
After completing the individual interviews (Part ONE), share your interview results. Consider the responses of the four types of individuals interviewed. Assess their similarities and differences.
Compose a written recommendation of 750-1,000 words. Incorporate the research YOU HAVE done as well as your interview results for the four types of individuals to come to a resolution to the ethical dilemma. Be sure to clearly articulate your position and the rationale for your position.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin.
Order a NRS 437V Weekly Assignments Today !
NRS 437V Week 5 Assignment Analysis of an Ethical Dilemma (Part Three)
This is a CLC assignment.
Refer to the “Collaborative Learning Community: Analysis of an Ethical Dilemma” resource for the dilemmas and resources that will be used for this multi-part assignment.
After completing the individual interviews (Part Two), share your interview results. As a group, consider the responses of the four types of individuals interviewed. Assess their similarities and differences.
Compose a written recommendation of 750-1,000 words. Incorporate the research your group has done as well as your interview results for the four types of individuals to come to a resolution to the ethical dilemma. Be sure to clearly articulate your group’s position and the rationale for your position.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Applied analysis-Public Health Nurse- Classmate Response (2): Topic 6 DQ 1
QUESTION- Given the limited amount of statistical calculations required by some public health positions, explain why it is important for you to know how to utilize appropriate software to analyze public health data. Support your ideas with reasons, facts, and examples.
Classmate (Chayah’s) Response-
Technology and ways to track data are becoming an increasingly important in public health. One reason is because it improves responses to urgent public health events including outbreaks of diseases. It can assist with epidemiological investigations including detecting an event, managing exposed persons, and to evaluate the public health response (Hamilton & Hopkins, 2018). During a field investigation decisions and recommendations are made. Which tools to use and how to use them can result in a better investigation with better outcomes for the population. An investigation attempts figure out if an event is local or will likely be bigger such as an epidemic. This can guide what technology may be better to use, this can also change as more information becomes available. In the past more field investigations were more hands on in the field where as now with technology advances there are plenty parts of the investigation that are completed through those means (Hamilton & Hopkins, 2018). Data collection and analysis may be done out of the field using technology. Through recent investment of improving technology in health care there are many things can be used to collect, sort, and analyze public health data. Technology can be software applications, apps, personal health monitoring devices, electronic health records, and computers. It can also be used in public health surveillance systems, databases, and programs to store and manage data (Hamilton & Hopkins, 2018). Technology for data specifically should help to support the workflow of researchers, it should help to create more time for researchers to do other takes to support an investigation (Hamilton & Hopkins, 2018). Given the numerous benefits that the knowledge of technology and specifically utilizing appropriate software to analyze public health data. Saving time and improved accuracy over human error with calculations are some quick benefits. Using SPSS or excel can give a researcher an easier way to complete a variety of statistical tests and easily share the outcomes.
There are so many examples that exist that show how technology and specifically software that assists with analyzing improve public health outcomes. There is currently a text program that one can sign up for to provide reminders in order to increase rates of persons getting their second Covid-19 vaccine. There was also study conducted by Kilimanjaro Christian Medical Center that found that while they were trying to help the local population by providing pediatric cataract surgery there were lower rates of those attending the follow up appointments, putting at risk to the initial surgery being successful. Being able to analyze their data alerted them that there was a problem with their current approach (Unite for Sight, n.d.). They developed a tracking system to store the data of those coming and missing their follow up appointment, had an intervention of phone calls to parents, and the results were that they drastically improved follow up numbers (Unite for Sight, n.d.).
References
Hamilton, J. J. & Hopkins, R. S. (2018). Using Technologies for Data Collection and Management. Epidemiology Training and Resources. https://www.cdc.gov/eis/field-epi-manual/chapters/data-collection-management.html
Unite for Sight. (n.d.). Using Data in Public Health Delivery. http://www.uniteforsight.org/public-health-management/public-health-data
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Solution
Chayah’s Response
I agree with you that the development of technology is playing a significant role in advancing public health. The use of personalized devices such as smartphones and phone applications makes it easy for public health practitioners to collect data related to the health of certain populations and better understand the health of such populations. Through technology such as smartphones, public health practitioners have access to data from diverse populations that can allow them to understand the public health needs of such populations better (Budd et al., 2020). For instance, public health practitioners can utilize phone applications to conduct interviews and studies related to the health of certain communities. This is because some phone applications allow users to provide feedback, with such feedback is vital data that public health practitioners can utilize to understand the public health needs of given communities and formulate much-needed interventions. On the other hand, technology such as smartphone applications can be used to implement public health interventions across communities. For example, during the Covid- 19 pandemic, different public health departments in various countries have relied on phone applications to perform important public health functions such as contact tracing, enhancing the distribution of vaccinations, and providing reminders to different members of the population to procure the Covid- 19 vaccine (Uohara et al., 2020). Therefore, the wide application of technology in public health has contributed to the advancement of the discipline and helped increase the chances of better health outcomes among populations. Through technology such as smartphone applications, public health practitioners can include underserved populations in their research and interventions. Therefore, the inclusion of the underserved population in public health initiatives can play a significant role in improving their health outcomes (Uohara et al., 2020).
References
Budd, J., Miller, B. S., Manning, E. M., Lampos, V., Zhuang, M., Edelstein, M., Rees, G., Emery, V. C., Stevens, M. M., Keegan, N., Short, M. J., Pillay, D., Manley, E., Cox, I. J., Heymann, D., Johnson, A. M., & McKendry, R. A. (2020). Digital technologies in the public-health response to COVID-19. Nature Medicine, 26(8), 1183–1192. https://doi.org/10.1038/s41591-020-1011-4
Uohara, M. Y., Weinstein, J. N., & Rhew, D. C. (2020). The Essential Role of Technology in the Public Health Battle Against COVID-19. Population Health Management, 23(5), 361–367. https://doi.org/10.1089/pop.2020.0187

NURS 6512: Advanced Health Assessment and Diagnostic Reasoning: Digital Clinical Experience (DCE): Health History using Shadow Health
Digital Clinical Experience (DCE): Health History -using shadow health
Prepare:
Review the DCE (Shadow Health) Documentation Template for Health History and use this template to complete your Documentation Notes for this DCE Assignment.
Access and login to Shadow Health.
Review the Shadow Health Student Orientation media program and the Useful Tips and Tricks document to guide you through Shadow Health.
Review the Week 4 DCE Health History Assessment Rubric, for details on completing the Assignment.
Note: There are 2 parts to this assignment – the lab pass and the documentation. You must achieve a total score of 80% in order to pass this assignment. Carefully review the rubric.
Assignment:
Complete your Health Assessment DCE assignments in Shadow Health via login credentials
Once you complete your assignment in Shadow Health, you will need to download your lab pass and upload in order to submit to instructor ( I will do this part)
From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database
Note: You must pass this assignment with a minimum score of 80% in order to pass the class. Once submitted, there are not any opportunities to revise or repeat this assignment.
DCE Health History Assessment:
Complete the following in Shadow Health:
Orientation
DCE Orientation
Conversation Concept Lab ( Required)
Health History
Health History of Tina Jones
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 4 Day 7 deadline.
Advanced Heath Assessment Documentation Tutorial
In each of the Shadow Health (SH) Assignments, you will be asked to complete a narrative note as part of the grading criteria. Narrative or progress notes are often a new skill. This document is provided to assist students in understanding how to write a narrative note. Shadow Health refers to these notes as Provider Notes.
Documentation of patient care is essential to quality and safety of care. Much of the clinical documentation is completed electronically using point and click tools to describe the patient condition (Lindo, et al., 2016). Often computer prompts fall short of fully describing the patient condition. Other situations such as lack of technology, electrical outages, system hacking, failure of equipment, and any number of situations which may interfere with normal electronic documentation may require a narrative nurses/progress note. Nurses must be able to clearly communicate patient information with everyone on the health care team to ensure quality and safety of care (Lindo, et al., 2016).
Documentation must be clear, paint a picture of the patient, and provide measurable concise information in a timely manner. The information communicated must be able to be understood by others and provide enough information to understand if a change has occurred in the patient condition and to clearly communicate all treatments, interventions, and therapies received by the patient and/or planned for the patient. Documentation also serves as a legal record of care (Lippincott Williams and Wilkins, 2007).
Documentation begins with subjective data/information. This is information the patient, family member, or caregiver may provide if the patient is unable to communicate which includes such data as the history of present illness (HPI), the past history- allergies, medications, medical surgical & social and the review of systems (ROS). Objective data/information includes the physical exam, observations and measurements obtained during the examination of the patient. Objective data also includes vital signs, laboratory and diagnostic results (Bates, 2017, pg.7)
Subjective vs. Objective Data-As you begin to acquire data from the patient interview and physical exam, it is important to remember the difference between subjective and objective information. Symptoms are the subjective concerns of what the patient tells you of their experience. Signs are the objective findings from your observations. (Bates, 2017, pg.6). Sequence of data is documented in the manner it is collected from the sequence of the examination. Physical examination follows a cephalocaudal sequence with the cardinal techniques of inspection, palpation percussion and auscultation (Bates, 2018)
Subjective information assists in understanding the patient condition and provides a basis upon which the nurse decides which body systems need to be assessed and which assessments need to be completed. Many of the assessments to be performed in the class are focused or problem based and focus on the assessment of a specific body system. The Comprehensive assessment is a complete health history and physical exam of most all body systems (Bates, 2017. Pg.5)
Once subjective and objective information are obtained and have been thoroughly considered an assessment/nursing diagnosis or medical diagnosis (physicians and advanced practice only) is identified. A plan of care will then be developed based on the nursing diagnoses. In the health assessment competencies, the primary focus is on gathering accurate subjective and objective data (Bates, 2017, pg.24)
Subjective data should be recorded using the patient’s own words and describing his/her feelings and experiences related to health. When interviewing the patient about a current issue or illness the seven attributes of a symptom need to be included in the documentation (Bates, 2017, pg.79)). The seven attributes of a symptom would be asked for any positive response during the health history (HH) and review of systems (ROS). Here is a list of the attirbutes and a few sample questions for a patient with complains of abdominal pain (Bates, 2017, pg.79)
Location: “Where does it hurt?” “Please point to the area of pain.”
Quality: “How would you describe the pain?” “Is it sharp pain?” “Dull pain?”
Quantity or Severity: “On a scale of 0-10, 0 being no pain and 10 being the worst pain ever, what is your level of pain?” “How has the pain impacted your daily routine?”
Timing: “When does the pain occur?” “How long does it last?” “Approximately how long after you have eaten does the pain begin?” ”Does the pain radiate?” “If yes, where does it radiate?”
Onset or Setting in which it occurs: “What were you doing when the pain began?”
Aggravating or Relieving Factors: “Is the pain worse after eating certain foods?” “What makes the pain better?”
Associated Factors: “Do you have any nausea or vomiting?” “Any diarrhea?” “Any constipation?”
Another way to remember what to ask the patient is to use the mnemonic OLDCARTS or OPQRST (Bates, 2017. p.79)
O: Onset
L: Location
D: Duration of symptoms
C: Character
A: Aggravating/Alleviating Factors
R: Radiation
T: Timing
S: Severity
OR
O: Onset
P: Provocative or Palliative
Q: Quality or Quantity
R: Region or Radiation
S: Site
T: Timing
When documenting the ROS it is necessary to document each condition or item asked about because others will be reading the notes and relying on the information provided. If information is incomplete or inaccurate patient safety and quality of care may be affected. Documentation of pertinent negatives should be specifically described. Do not overgeneralize by using terms such as “WNL”, or neurologic exam negative” as this does not convey what exactly was assessed subjectively and/or objectively (Bates, 2018, p. 38)
ROS (Subjective) Documentation Example:
Review the following ROS areas and the associated documentation and note the quality of the information provided for each system.
Skin: Denies any rashes or changes to skin
Head: No problems with head or headaches.
Ears: Positive for fullness feeling in bilateral ears for past 2 days, denies changes in hearing, pain in ears or any drainage.
Eyes: No problems, says they are normal.
Skin and ears are documented correctly. The skin description relays what items were subjectively asked of the patient. The ears ROS also includes pertinent positive with further information and pertinent negatives.
Head and eyes are not documented correctly. There is not a description of the items subjectively asked and is an incomplete picture.
(Bates, 2017, pg. 32)
Assessment (Objective) Documentation Example:
Skin: Uniform in color, tan, warm, dry, intact. Turgor good, skin returns immediately when released. Scattered flat small macules on face around nose. On back of left shoulder 4mm, symmetrical, smooth borders, dark brown, evenly colored, slightly raised nevus, without tenderness or discharge. Well healed pale scar 3 cm right forearm. Left wrist approximately 1 cm area around the circumference of the wrist pruritic papules and vesicles with an erythematous base. Silver colored striae around lower outer quadrants of abdomen and hips.
Head: Shape okay.
Eyes: Eye color brown. brows, lids, and lashes symmetric, right brow ridge piercing with intact silver hoop, no redness, tenderness, or discharge; lacrimal ducts pink and open without discharge. Conjunctiva clear, sclera white, moist, and clear, no lesions or redness, no ptosis, lid lag, discharge or crusting. Snellen vision assessment 20/20 in each eye with corrective lenses. EOMs intact, no nystagmus, PERRLA
Ears: TM with good cone of light, pearly gray appearance, canal clear of wax bilaterally, no edema or drainage present. Auditory acuity present bilaterally to whispered voice.
Skin is documented very complete and concise a picture of the patient is evolving and measurable assessment data is provided. Complete description of the rash on the left wrist provides a measurable concise picture. A mole was noted and documentation included the ABCDE of the mole. It is important to describe both normal and abnormal findings in a measurable manner. The text offers examples of how to provide measurable information for many assessment findings such as tonsils, pulses, reflexes, and strength (Bates, 2017, pg. 33)
The documentation for head is less measurable. How is one to know what “shape okay” is for this patient?
The documentation for the eyes is very thorough and concise. Measurable terms are used and a description of the patient’s eyes is provided.
The documentation for the ears is also very concise and thorough. Measurable terminology is used and a description is provided.
Some of the Shadow Health (SH) exams focus on one body system such as Cardiac. In this situation focus on pertinent questions related to the ROS and physical assessment for cardiac and any associated body systems. In the case of cardiac, peripheral vascular and respiratory would be additional systems to assess.
When completing the assessments in SH use the textbook as a guide. Open to the appropriate chapter and follow along to ensure all aspects of the assessment are covered for both subjective and objective assessment areas. Document carefully for each assessment area keeping in mind the differences between subjective and objective information and ensuring measurable concise information is recorded.
Subjective and objective information is separated and each body system is used as a heading for easier retrieval of information. When information is disorganized it is difficult to know which is the information provided by the patient and which is the objective clinical assessment data. In an emergency retrieval of information must be done quickly. Well organized and written notes allow for timely retrieval (Lindo et al., 2016).
References
Bickley, L. S. (2017). Bates Guide to Physical Examination and History Taking (12th ed.). Wolters Kluwer Health/Lippincott Williams & Wilkins: Philadelphia, PA.
Lindo, J., Stennett, R., Stephenson-Wilson, K., Barrett, K.A., Bunnaman, D., Anderson-Johnson, P., Waugh-Brown, V., and Wint, Y. (2016). An audit of nursing documentation at three public hospitals in Jamaica. Journal of Nursing Scholarship, 48(5), 508-516.
Lippincott Williams & Wilkins (2007). Charting: An incredibly easy pocket guide. Ambler, PA: Author.