Nursing

Discussion: Therapy for Pediatric Clients
Discussion: Therapy for Pediatric Clients
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Assignment: Therapy for Pediatric Clients With Mood Disorders
Mood disorders can impact every facet of a child’s life, making the most basic activities difficult for clients and their families. This was the case for 13-year-old Kara, who was struggling at home and at school. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. As a psychiatric mental health nurse practitioner working with pediatric clients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.
This week, as you examine antidepressant therapies, you explore the assessment and treatment of pediatric clients with mood disorders. You also consider ethical and legal implications of these therapies.
Photo Credit: GettyLicense_185239711.jpg
Assignment: Assessing and Treating Pediatric Clients With Mood Disorders
When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.
Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.
Learning Objectives
Students will:
Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy
Evaluate efficacy of treatment plans
Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 6, “Mood Disorders”
Chapter 7, “Antidepressants”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Review the following medications:
amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine
Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from
Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171
Note: Retrieved from Walden Library databases.
Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from
Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
Note: Retrieved from Walden Library databases.
Required Media
Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.
Note: This case study will serve as the foundation for this week’s Assignment.
Optional Resources
El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3
Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655
Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497
To prepare for this Assignment:
Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.
The Assignment
Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select? See below.
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
BACKGROUND INFORMATION
The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.
Client complained of feeling “sad”
Mother reports that teacher said child is withdrawn from peers in class
Mother notes decreased appetite and occasional periods of irritation
Client reached all developmental landmarks at appropriate ages
Physical exam unremarkable
Laboratory studies WNL
Child referred to psychiatry for evaluation
Client seen by Psychiatric Nurse Practitioner
MENTAL STATUS EXAM
Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.
The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)
RESOURCES
§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
Decision Point One
Select what the PMHNP should do:
Begin Zoloft 25 mg orally daily
Begin Paxil 10 mg orally daily
Begin Wellbutrin 75 mg orally BID
Case Study of the above client
Decision Point One
I selected Zoloft 25 mg orally daily
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
No change in depressive symptoms at all
Decision Point Two
Increase dose to 50 mg orally daily
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Depressive symptoms decrease by 50%. Cleint tolerating well
Decision Point Three
Maintain current dose
Guidance to Student
At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy

Discussion: Price discovery mechanisms
Discussion: Price discovery mechanisms
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The following video describes auctions as price discovery mechanisms
Use the video on auctions and at least 3 academic and/or high-quality business publications, see definitions below, to answer the following questions in 5-7 pages:
1. There are many types of auctions each with strengths and weakness at uncovering the real price/value of an item. Compare and contrast:
a) the English and Dutch auctions; and,
b) the sealed bid first price auction and the Vickery Auction.
2. Concierge Auctions Limited sells very high end and unique properties worldwide using an English style auction, selling to the highest bidder. They have been embroiled in multiple law suits, see the link to the Wall Street Journal. Advise Concierge as to the weakness that an English auction may have in uncovering a property’s value. Provide a recommendation for at least one other auction type which may better uncover the value of unique real estate properties.
3. Auctions are widely used in finance, e-commerce and in e-games. Identify 3 uses of auctions by firms in finance, e-commerce and/or e-games. Explain the:
a) need for an auction in the product/service; and
b) what type of auction is used and why that type of auction is appropriate for the product/service.
4. Auctions are also widely used to generate revenue for not-for-profit organizations. What are the advantages/disadvantages of auctions as revenue generators for not-for-profit organizations?
5. Suggest ways in which the company you work for, or the company which you aspire to work for, can use auctions to better uncover value and increase revenue.
Your assignment must follow these formatting requirements:
Be typed, double spaced, using Times New Roman font (size 12) with one-inch margins on all sides; citations and references must follow APA format. Check with your professor for any additional instructions.
Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title and the date. The cover page and the reference page are not included in the required assignment length.
Acceptable Types of Publications
The definition of a high-quality professional business publication is one which is primarily a publication directed to reporting and/or analysis of the workings of business. Examples are: Wall Street Journal, Bloomberg, Reuters…etc. Avoid general news publications such as USA Today, Washington Post, NY Times.
PLEASE DO NOT RELY ON WIKIPEDIA, INVESTOPEDIA OR ANY OTHER PEDIA AS A REFERENCE AT ANYTIME IN THIS COURSE.
Submission Rules
You may submit 1 attempt at the assignment to test your SafeAssign Score. The SafeAssign score should be 25% or less.
You may submit ONE AND ONLY ONE ADDITIONAL ATTEMPT.

ETHICAL DILEMMA ANALYSIS
ETHICAL DILEMMA ANALYSIS
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Collaborate with your team, using Cisco Spark, email, phone meetings, or any collaboration tool you find useful or prefer. In your collaboration, consider the ethical dilemmas below and select 1 in which to conduct a deep drill.
Ethical Dilemma 1: A newspaper columnist signs a contract with a newspaper chain. Several months later, she is offered a position with another newspaper chain, offering a higher salary. Because she would prefer making more money, she notifies the first chain that she is breaking her contract. The courts will decide the legality of her action, but what of the morality? Did the columnist behave ethically?
Ethical Dilemma 2: An airline pilot receives his regular medical checkup. The doctor discovers that he has developed a heart murmur. The pilot only has a month to go before he is eligible for retirement. The doctor knows this and wonders whether, under these unusual circumstances, she is justified in withholding information from the company regarding the pilot’s condition.
Ethical Dilemma 3: An office worker has had a record of frequent absence. He has used all his vacation and sick-leave days, and has frequently requested additional leave without pay. His supervisor and co-workers have expressed great frustration because his absenteeism has caused bottlenecks in paperwork, created low morale in the office, and required others to do his work in addition to their own. However, the individual believes he is entitled to take his earned time and additional time off without pay. Is he right?
Ethical Dilemma 4: Rhonda enjoys socializing with fellow employees at work, but their discussions usually consist of gossiping about other people, including several of her friends. At first, Rhonda feels uncomfortable talking in this way about people she is close to; but then she decides it does no real harm, and she feels no remorse for joining in.
In conjunction with the readings, and within your teams, decide which ethical dilemma you believe is most problematic and why. In your teams, discuss the ideas of “good vs. evil,” “wrong vs. right,” and “ought/should be vs. what is.” Form the readings, discuss the ways in which Augustine and Aquinas would have solved the problem based on lecture and course reading material. In what ways do Augustine and Aquinas differ and why?
You may wish to meet throughout the week to share ideas. Create a report of your findings as individuals and as a team. The report should be approximately 2 pages accompanied by a 2-minute oral presentation, using VoiceThread or a PowerPoint narrated slide show.
Rubric
Ethical Dilemma AnalysisEthical Dilemma AnalysisCriteriaRatingsPtsThis criterion is linked to a Learning OutcomePurposeFull Marks20.0 ptsNo Marks0.0 pts20.0 pts
This criterion is linked to a Learning OutcomeSupport/DevelopmentFull Marks30.0 ptsNo Marks0.0 pts30.0 pts
This criterion is linked to a Learning OutcomeGrammar, Mechanics, StyleFull Marks25.0 ptsNo Marks0.0 pts25.0 pts
This criterion is linked to a Learning OutcomeSlidesFull Marks15.0 ptsNo Marks0.0 pts15.0 pts
This criterion is linked to a Learning OutcomeOral NarrationFull Marks10.0 ptsNo Marks0.0 pts10.0 pts

Assignment: Diagnosis of Diabetes
Assignment: Diagnosis of Diabetes
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Question 1: How often should the clinician examine the feet of a person with diabetes?
a. Once a year
b. Every 6 months
c. Every 3 months
d. Every visit
Question 2: Which drug for Alzheimer’s disease should be administered beginning at the time of diagnosis?
a. Cholinesterase inhibitors
b. Anxiolytics
c. Antidepressants
d. Atypical antipsychotics
Question 3: Most adult poisonings are:
a. intentional and self-inflicted.
b. accidental.
c. caused by someone wishing to do harm to the person.
d. not attributed to any reason.
Question 4: A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?
a. “It is probably just a cyst, because that is the most common breast mass.”
b. “We will order a mammogram and ultrasound to help establish a diagnosis.”
c. “We will go ahead and schedule you for a biopsy because that is the only way to know for sure.”
d. “Because your lump is painful, it is most likely not cancer.”
Question 5: Which of the following is a specific test for multiple sclerosis (MS)?
a. Magnetic resonance imaging (MRI)
b. Computed tomography (CT) scan
c. A lumbar puncture
d. There is no specific test.
Question 6: After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient?
a. Suggest she use a heating pad to improve circulation
b. Refer to a podiatrist for a foot care treatment plan
c. Send her for acupuncture treatments
d. All of the above
Question 7: Which characteristic of delirium helps to distinguish delirium from dementia?
a. Abrupt onset
b. Impaired attention
c. Affective changes
d. Delusions
Question 8: Which clinical feature is the first to be affected in increased intracranial pressure (ICP)?
a. Decrease in level of consciousness (LOC)
b. Headache
c. Nausea
d. Widening pulse pressure
Question 9: Jennifer is an 18-year-old girl who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited range of motion in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?
a. Posterior dislocations are more common than anterior dislocations.
b. There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses.
c. Recurrent dislocations are uncommon and would require a greater force to result in injury.
d. Surgery is most commonly the treatment of choice.
Question 10: Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?
a. Decreased C-reactive protein
b. Hyperalbuminemia
c. Morning stiffness
d. Weight gain
Question 11: The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?
a. Overweight
b. Mild obesity
c. Moderate obesity
d. Morbid obesity
Question 12: The vegetarian patient with gout asks the clinician about food that he should avoid. The clinician should advise the patient to avoid which of the following foods?
a. Rice
b. Carrots
c. Spinach
d. Potatoes
Question 13: A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her exam?
a. Human papillomavirus (HPV)
b. Endometrial hyperplasia
c. Vagismus
d. Polycystic ovarian syndrome
Question 14: Which of the following classes of drugs should be used as first-line therapy for treatment of delirium?
a. Benzodiazepines
b. Antipsychotics
c. Anticonvulsants
d. Antidepressants
Question 15: What is the treatment of choice for a patient diagnosed with testicular cancer?
a. Radical orchidectomy
b. Lumpectomy
c. Radiation implants
d. All of the above
Question 16: A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease (STD) has she most probably been exposed to?
a. Gonorrhea
b. Human papillomavirus (HPV)
c. Chlamydia
d. Trichomonas
Question 17: A 58-year-old woman who had a total abdominal hysterectomy at the age of 45 is diagnosed with atrophic vaginitis. Which of the following is the most appropriate treatment?
a. Conjugated estrogen 0.625 mg/day oral
b. Estradiol 7.5 mcg/24 hr vaginal ring
c. Medroxyprogesterone 10 mg/day oral
d. Conjugated estrogen 0.3 mg + medroxyprogesterone 1.5 mg/day oral
Question 18: When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval to round shapes. What do you suspect they are?
a. Spores
b. Leukocytes
c. Pseudohyphae
d. Epithelial cells
Question 19: Patients with a spontaneous pneumothorax should be counseled that up to what percentage may experience a reoccurrence at some point?
a. 10%
b. 20%
c. 30%
d. 50%
Question 20: John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?
a. Valgus stress test
b. McMurray circumduction test
c. Lachman test
d. Varus stress test
Question 21: During a digital rectal exam (DRE) on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?
a. An enlarged rubbery gland
b. A hard irregular gland
c. A tender gland
d. A boggy gland
Question 22: Janet is a 30-year-old woman who has been recently diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?
a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks
Question 23: The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (text revision) (DSM-IV-TR) state that excessive worry or apprehension must be present more days than not for at least:
a. 1 month.
b. 3 months.
c. 6 months.
d. 12 months.
Question 24: A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram (ECG) changes should the clinician expect as a manifestation of the disease?
a. Sinus bradycardia
b. Atrial fibrillation
c. Supraventricular tachycardia
d. U waves
Question 25: Which type of burn injury results in destruction of epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?
a. Superficial burns
b. Superficial partial-thickness burns
c. Deep partial-thickness burns
d. Full-thickness burns
Question 26: Immunizations are an example of which type of prevention?
a. Primary
b. Secondary
c. Tertiary
Question 27: If a previously frostbitten area becomes frostbitten again after it has healed, what might occur?
a. Permanent tissue damage may occur, resulting in necrosis to that body part.
b. The area will be super sensitive.
c. The area is prone to a repeat frostbite.
d. The area is as susceptible as any other area.
Question 28: A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?
a. Pregnancy test
b. Pelvic ultrasound
c. Endometrial biopsy
d. Platelet count
Question 29: Julie, aged 50, has migraine headaches, frequent asthma attacks, coronary artery disease, and hypertension. Which of the following prophylactic medications would you order for her migraines?
a. Propranolol
c. Ergotamine
b. Timolol
d. Topiramate
Question 30: A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment?
a. Tricyclic antidepressants
b. Capsacin cream
c. Vitamin B12 injections
d. Insulin
Assignment: Diagnosis of Diabetes
Assignment: Diagnosis of Diabetes

Assignment: Bipolar Disorder Assessment
Assignment: Bipolar Disorder Assessment
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Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for clients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) clients often present as depressive or manic, but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with bipolar disorder.
Learning Objectives
Students will:
Assess client factors and history to develop personalized plans of bipolar therapy for clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring bipolar therapy
Evaluate efficacy of treatment plans
Analyze ethical and legal implications related to prescribing bipolar therapy to clients across the lifespan ..
The Assignment
Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
you can use my sample/ edit or do a new assignment.
you can edit or use my sample with same medication therapy.

Assignment: ethical constructs of ethics
Assignment: ethical constructs of ethics
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Introduce the conceptual frameworks of the ethical constructs of ethics, moral, or legal standards and the purpose of the paper.
Consider an ethical, moral, or legal dilemma that you have encountered in your work environment and describe it.
Analyze the moral, ethical, and legal implications utilized in this situation. Describe your role as a moral agent or advocate for this specific issue.
Consider your leadership styles identified by your self-assessment and determine if they act as a barrier or facilitation during this dilemma.
A Conceptual Framework for Ethics
What is ethics? What is bioethics? How do we solve bioethical dilemmas? These are the main topics that will be studied in this chapter. The thoughts presented in this section are drawn from the historical study of ethics and 15 years’ experience teaching and consulting in clinical medicine as an ethicist in a pluralistic medical community. Those familiar with the contemporary presentations of medical ethics may be concerned that this presentation says little about the three principles often presented as normative for medical ethics: that is, the principles of autonomy, beneficence, and justice. In our opinion, these principles have meaning only if based upon the following considerations.
Defining Good and Bad Actions
Ethics is an effort to determine which human actions are good and which human actions are bad. In order for an action to have ethical meaning, it must be a free action; that is, it must be subject to human control. Being subject to the laws of gravity is not a free action and therefore does not have ethical import. But whether or not you pay debts or fulfill your responsibilities toward parents, spouse, or children are actions that are subject to your free choice. Hence, these actions have ethical meaning.
In order to say that something is good for a person (beneficial) or bad for a person (harmful), there must be some agreement in regard to human fulfillment or well-being. In other words, one must have some notion of the purpose of life before one can say that actions are good or bad. If I believe that my well-being or my purpose of human life consists in amassing as much wealth as possible, any action that would help me amass wealth would be a good action. Hence, robbing banks and swindling widows and orphans would be good actions because they would help me achieve well being. But if I believe that amassing wealth is subservient to other goals, such as respecting the private property rights of other people, I have a different context for deciding which human actions are good and which are bad.
Clearly, determining the meaning of human fulfillment or the purpose of life will have a very important impact upon the determination of good and bad human actions. Striving for an accurate definition of this concept has occupied philosophers and theologians throughout the ages. At least subconsciously or implicitly, all of us have goals or purposes in life. When we ask ourselves: “What makes life worthwhile?” “What do I want to do in life?” “Do I went to spend money on a new car or invest the money to pay for my children’s education?” We are asking questions that are concerned with human fulfillment or the purpose of life?
The Basic Human Needs
People describe human fulfillment or the purpose of life in different ways. In the Judeo-Christian tradition, human fulfillment is usually described as loving God, loving oneself and loving one’s neighbor as oneself. The precise description of “loving actions” is the work of Jewish and Christian theology. A more pluralistic or philosophical way of describing human well-being is to say that it consists in fulfilling human needs in an integrated manner. Upon examination of the human person, we find there are physiological, psychological, social, and creative needs. — While the word spiritual is often used to describe this fourth set of needs, I prefer to use the word creative because the word spiritual is often confined to religious concerns. The creative needs are the need to know, to love, to plan for the future, to learn from the past, to relate to others, etc. — The functions of the human personality seek to fulfill these needs. Human needs and the functions that fulfill them are interrelated. For example, occasionally a young student will study so intently that his health suffers. The pursuit of creative needs hinders fulfillment of physiological needs; the creative function is not integrated with the physiological function.
Eating, drinking, enjoying friendships, studying, fulfill human needs and thus are good actions provided they are performed in a manner that is considerate of other needs. However, if a person does not fulfill a personal need in an integrated or balanced manner, for example, if one drinks so much that he is unable to work, then he performs a bad action. A rapist may fulfill a need for physical and psychological pleasure by obtaining pleasure through sexual activity, but he is abusing his social and creative needs. Sexual activity should he entered into freely and should be prompted by mutual love. By violently forcing someone else to perform a sexual action with him, the rapist violates the responsibility to integrate social and creative needs with pleasure needs. Thus rape is a bad action; harmful to the rapist as well as the victim.
Rights, Values, Laws
The word “right” is often used to indicate a person’s freedom to perform actions that fulfill human needs, and a correlative responsibility on the part of other persons not to hinder or prevent a person from performing the good action in question. Rights are called natural if they arise from nature and acquired if they arise from the development of human culture. Thus the right to food, friends, and knowledge are natural rights. The right to a job, education, or health care are acquired rights. Rights are called inalienable if they seem to he necessary for a person’s purpose in life. Rights are called equity rights if they contribute to achieving the purpose of life but are not absolutely necessary in order to achieve that purpose. Equity rights are often balanced against one another, while inalienable rights are preemptive of equity rights.
As culture progresses, some equity rights become inalienable rights. In the United States, seeking a basic education was considered an equity right 200 years ago. Today, we would consider education to be integrally connected with a fulfilled life and hence would describe it as an inalienable right. Today there is dispute in our country over whether the right to health care is a natural right or an equity right.
The founders of our country were enumerating human needs necessary for human fulfillment when they stated inalienable rights in the Constitution. When they spoke about “life, liberty, the pursuit of happiness, freedom of religion and speech” they sought to describe some of the fundamental needs to which people have inalienable rights. Most of the inalienable rights in the Constitution are acquired rights, the result of cultural development. More then 30 basic rights are listed in the Declaration of Human Rights issued by the United Nations.
If an act fulfills a human need in an integrated manner, it is called good; An act that does not fulfill human need in a balanced manner is celled bad. A good act is also called a value; an act that is bad is called a disvalue. Thus, a value is not some vague source of human behavior, as contemporary speakers often indicate, (e.g.,”We all have different values that have to be respected.”) Rather, a value is a definite pronouncement that some action fulfills integrated human needs.
When considering which actions are good and which actions are bad, we realize that many actions are good or bad for all people. In other words, people have needs in common. Fulfilling these common needs is intrinsically related to human well-being. If one does not realize that there are common needs, ethical reasoning results in moral relativism. That is, unless we acknowledge that certain actions help everyone achieve the purpose of life, and other actions make it difficult or impossible for everyone to achieve the purpose of life, the result of ethical reflection becomes totally subjective.
Our laws against violence and murder and our laws concerning taxes are based upon the concept of common needs. In general, needs that are common to everyone are such things as the need to prolong life, to pursue knowledge and health, to form communities of friendship and family, to respect the property rights of others, and to work together for the common good. If human beings do not have a common and shared notion of which actions are beneficial and which actions are harmful, they would never be able to fulfill their social needs or to form communities. Peaceful life in society is impossible without consensus in regard to good end bad actions and the rights associated with these actions.
In order to educate people concerning good and bad actions and coerce people to respect the rights of others, laws are promulgated and enforced. Laws cannot be formulated and enforced unless there is consensus in regard to basic human needs and the right to be free in pursuing these needs.
Of course, there will never be complete uniformity in regard to good and bad human actions, because we have individual needs as well as needs in common. Rules or laws will not be able to guide all ethical decisions, What may be a good act for you because of some particular need may not be a good act for me, because we do not have the same need. In sum, some needs and ethical determinations will be shared with others, and some needs and ethical determinations will be particular to individual people.
Valid Basis for Individual Ethical Desire
How do people make individual decisions about good and bad human actions? How do people decide that some action will or will not fulfill a basic or acquired need in an integrated manner? Some people depend on emotion — e.g., “I know rape is wrong because I feel strongly against it.” Some depend upon the law — e.g., “Rape must be wrong because there is a law against it.” Some look to the custom of society — e.g., “Rape is wrong because our society has always considered it a crime.” Some depend upon religious directions — e.g., “Rape is wrong because it is against God’s law.”

Professional Obligations Paper
Professional Obligations Paper
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Advanced registered nursing graduates are entering the profession at dynamic time when roles and scope of practice are shifting based on developments in legislation and policy in response to the evolving needs of the health care system. Professional nursing organizations play an important role in making sure the perspectives of advanced registered nurses are heard, and in supporting nurse specialties in their efforts to expand their scope of practice and their full participation throughout the health care system.
For this assignment, you will conduct research on the current scope of practice for your specialty and efforts that are being made to expand that scope and the role of the advanced nurse in positively influencing the health care system.(Emergency Room R.N.) Write a 1,250-1,500-word paper that includes the following:
A discussion of the scope of your future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope.
A discussion of three professional nursing organizations that you think are most influential in advancing the scope and influence of advanced nursing. Of these organizations, evaluate the one that you would most like to join. How do its goals and mission fit in with your worldview and philosophy of care? How might membership in this organization improve your practice?
A discussion of a controversial or evolving issue that is most likely to affect your scope of practice or role in the next few years. How do you think this issue could influence the profession and other stakeholders, and why does it matters to the advanced registered nurse?
You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Prepare this assignment according to the 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. (attached)

Assignment: EBP Identification of Clinical Question
Assignment: EBP Identification of Clinical Question
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The Collaborative Learning Community: EBP Identification of Clinical Question assignment is due.
Prepare for your upcoming Topic 5 assignment, Collaborative Learning Community: EBP Literature Search/Appraisal of Evidence. Remember to record all communication in the CLC Forum.
Use the evidence hierarchy pyramid provided in Figure 2.1 in the Nursing Research: Generating and Assessing Evidence for Nursing Practice textbook as a guide for the levels of evidence in your reference list.
Locate case studies, relevant clinical articles written by experts, research articles, evidence-based guidelines, protocols, and theories that may guide the identification of appropriate solutions. This can include the articles reviewed in Topic 3. Note: Not all theories will have research that allows them to have a level assigned to them. This does not mean they are not good theories. A true proposal would require a comprehensive review of the literature and inclusion of all relevant works.
Appraise the evidence using the guidelines provided in the Nursing Research: Generating and Assessing Evidence for Nursing Practice textbook. Use these guidelines to discard references that are untrustworthy or irrelevant. Box 2.2 can help with this decision-making process. Chapter 5 provides guidance on how to synthesize the article findings.
Use the assigned Topic Material, “CLC EBP Research Table,” to consolidate and present the findings. Limit the articles to no more than 10 (two per student in the CLC group would be reasonable). Choose one group member to submit the completed assignment by the end of Topic 5.
The Collaborative Learning Community: EBP Identification of Clinical Question assignment is due.
Prepare for your upcoming Topic 5 assignment, Collaborative Learning Community: EBP Literature Search/Appraisal of Evidence. Remember to record all communication in the CLC Forum.
Use the evidence hierarchy pyramid provided in Figure 2.1 in the Nursing Research: Generating and Assessing Evidence for Nursing Practice textbook as a guide for the levels of evidence in your reference list.
Locate case studies, relevant clinical articles written by experts, research articles, evidence-based guidelines, protocols, and theories that may guide the identification of appropriate solutions. This can include the articles reviewed in Topic 3. Note: Not all theories will have research that allows them to have a level assigned to them. This does not mean they are not good theories. A true proposal would require a comprehensive review of the literature and inclusion of all relevant works.
Appraise the evidence using the guidelines provided in the Nursing Research: Generating and Assessing Evidence for Nursing Practice textbook. Use these guidelines to discard references that are untrustworthy or irrelevant. Box 2.2 can help with this decision-making process. Chapter 5 provides guidance on how to synthesize the article findings.
Use the assigned Topic Material, “CLC EBP Research Table,” to consolidate and present the findings. Limit the articles to no more than 10 (two per student in the CLC group would be reasonable). Choose one group member to submit the completed assignment by the end of Topic 5.

Practicum Reflective Journal Assignment
Practicum Reflective Journal Assignment
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Assignment 1
Question: Throughout the course, students will engage in weekly reflection and scholarly activities. These assignments are presented in Topic 1 to allow students to plan ahead, and incorporate the deliverables into the Individual Success Plan if they so choose.
The weekly reflective journals and scholarly activities will not be submitted in LoudCloud each week; a final, culminating submission will be due in Topic 10. No submission is required until Topic 10.
Professional Capstone and Practicum Reflective Journal
Students are required to maintain weekly reflective narratives throughout the course to combine into a final, course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course. This course-long journal assignment will be due in Topic 10.
In each week’s entry, you should reflect on the personal knowledge and skills gained throughout the Professional Capstone and Practicum course. Your entry should address a variable combination of the following, dependent on the specific practice immersion clinical experiences you encountered that week:
1. New practice approaches
2. Intraprofessional collaboration
3. Health care delivery and clinical systems
4. Ethical considerations in health care
5. Population health concerns
6. The role of technology in improving health care outcomes
7. Health policy
8. Leadership and economic models
9. Health disparities
In the Topic 10 submission, each of the areas should be addressed in one or more of the weekly entries.
This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how they met competencies and course objectives.
Scholarly Activities
Throughout the RN-to-BSN program, students are required to participate in scholarly activities outside of clinical practice or professional practice. Examples of scholarly activities include attending conferences, seminars, journal club, grand rounds, morbidity and mortality meetings, interdisciplinary committees, quality improvement committees, and any other opportunities available at your site, within your community, or nationally.
You are required to post one scholarly activity while you are in the BSN program, which should be documented by the end of this course. In addition to this submission, you are required to be involved and contribute to interdisciplinary initiatives on a regular basis.
In Topic 10, you will submit a summary report of your scholarly activity. You may use the “Scholarly Activity Summary” resource to help guide this assignment.

Assignment: Ethics and EvidenceBased Research
Assignment: Ethics and EvidenceBased Research
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Write a 1250-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be three main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least two (2) sources using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.
Part 1: Describe why ethical safeguards designed for clinical research may not be feasible or appropriate for evidence-based practice or evidence-based practice implementation projects.
Part 2: Review the sectioned headed, Two Ethical Exemplars in Chapter 22 of the textbook (Melnyk and Fineout-Overholt, 2015, pages 518-519). Discuss three main ethical controversies related to implementing Evidence-Based Quality Improvement (EBQI) Initiatives. Describe how these controversies relate to the four core ethical principles.
Part 3: Identify which ethical principles may be in conflict with the concept of “patients having an ethical responsibility in improving healthcare.” Discuss how these conflicts may be resolved.
Assignment Expectations:
Length: 1250 – 1500 words
Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.
References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.