Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following:

• Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
• Any racial/ethnic variables that may impact physiological functioning.
• How these processes interact to affect the patient.

A 58-year-old obese white male presents to ED with chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl.

Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following:

• Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
• Any racial/ethnic variables that may impact physiological functioning.
• How these processes interact to affect the patient.

 
Reply 1

Provide two different examples of how research uses hypothesis testing, and describe the criteria for rejecting the null hypothesis. Discuss why this is important in your practice and with patient interactions.

In order to provide examples of uses for hypothesis testing it is important to understand what a hypothesis is. “The hypothesis statements are the blueprint for completing the statistical analysis of the gathered data.” (Ambrose, 2018) Testing a hypothesis evaluates if the prediction made on two variables is valid. Gathering data to show correlations is how you test a hypothesis.

The two examples that came to mind when thinking of a hypothesis in health care are the prediction that washing hands decreases infections and following a specific diet will lead to increased health. “The Null hypothesis indicates the lack of relationship between the variables or that there is no effect on the variables.” (Ambrose, 2018) The criteria to reject a null hypothesis is data proving that the hypothesis is false. When the research is reliable, patterns should occur. When there are patterns, this will permit the researcher to reject the null hypotheses. (Ambrose, 2018) Hypotheses are tested using a one or two tailed testing. (Ambrose, 2018) A one-tailed test is used when the researcher is sure that direction of data will go in a certain way. “A two-tailed test identifies both the positive and negative differences.” (Ambrose, 2018)

As health care professionals, it is important to be able to utilize hypotheses and being able to evaluate them. Nursing interventions and care for patients are products of evidence based practice guidelines, which can be every changing with new research and data. Being able to interpret and utilize these guidelines is important to positive patient care. Nursing improvements and positive patient outcomes can be determined by quality research.

References

Ambrose, J. (2018). Applied Statistics for Health Care. Retrieved from Grand Canyon University: https://lc.gcumedia.com/hlt362v/applied-statistics-for-health-care/v1.1/#/chapter/3

Reply 2

Predictions of what will happen in a study between two variables is a hypothesis. A hypothesis is needed prior to starting the research to guide the data that is needed to be gathered for the variable. With the data that is collected, research process validates a hypothesis by showing correlation or mutual relationship. Research is always a measure in in a study or understanding differences. “Hypothesis testing is used to establish whether a research hypothesis extends beyond those individuals examined in a single study.” (Laerd, 2018)

One example is two groups of students virtual and in person. The hypothesis could be that in person students did better than virtual students in test taking, showing in person learning is important for the education of school age students. Another example could be that daily zoom meetings or virtual class has a higher classroom average of the students compared to the students who attends zoom virtual classes biweekly. For both, examples the average of test in grades for the sample represents the population.

In health care it shows findings that can be empowered and shows alternative explanations that may or may not be significant without research and hypothesis testing advancements could be detrimental for care of those that need advanced medication or treatment. Sample of 100 breast cancer sufferers depend on research to have new chemotherapy treatment to eradicate cancer more effectively than current treatment type. Consider the process first involved in what your measuring then outlines your structure. This is important for the patients and given opportunity to have treatment that has evidence to work versus medication that has not worked and no evidence to work.

Criteria for rejecting the null hypothesis: “the null hypothesis indicates the lack of relationship between the variables or that there is no effect on the variables.”(Ambrose, 2018) “Data should show patterns, allowing the researcher to reject or fail to reject the null hypothesis.” (Ambrose, 2018) Keep in mind a rejection could be in error. The rejection based on probability results are accurate. If shown effect, null rejected. “A failure to reject the null hypothesis indicates no effect is shown by the evidence.” (Ambrose, 2018) For a null to be rejected, 95% of values need to set close to the mean.

Resources

Ambrose, J. (2018). Applied statistics for health care.Retrieved from https://lc.gcumedia.com/hlt362v/applied-statistics-for-health-care/v1.1

There are more than 1.4 million senior citizens living in nursing homes. Elderly residents are a particularly vulnerable population, with mental or physical incapacitation leaving them more susceptible to abuse and neglect. The National Center on Elder Abuse (NCEA) has classified seven different types of elder abuse, including physical abuse, sexual abuse, emotional or psychological abuse, financial or material exploitation, neglect, abandonment, and self-neglect.
Physical abuse is the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include but is not limited to such acts of violence as striking, hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning (NCEA, 2020).
Sexual abuse is defined as non-consensual sexual contact of any kind with an elderly person. Sexual contact with any person incapable of giving consent is also considered sexual abuse. It includes, but is not limited to, unwanted touching, all types of sexual assault, or battery, such as rape.
Emotional or psychological abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment.
Financial or material exploitation is defined as the illegal or improper use of an elder’s funds, property, or assets. Examples include, but are not limited to, cashing an elderly person’s checks without authorization or permission, forging an older person’s signature, misusing or stealing an older person’s money or possessions, and coercing or deceiving an older person into signing any document (NCEA, 2020).
Neglect is defined as the refusal or failure to fulfill any part of a person’s obligations or duties to an elder. Neglect may also include the failure of a person who has fiduciary responsibilities to provide care for an elder for example pay for necessary home care services or the failure on the part of an in-home service provider to provide the necessary care.
Abandonment is defined as the desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder.
Self-neglect is characterized as the behavior of an elderly person that threatens his/her health or safety. Self-neglect generally manifests itself in an older person as a refusal or failure to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medication when indicated, and safety precautions (NCEA, 2020).
Ethical Dilemmas and Considerations on Euthanasia, Suicide, and Assisted Suicide
Ethics in nursing do not appear sporadically when a decision regarding a law needs to be made, they are the ever-present guide to nursing practice. Every interaction with people, be they patients or colleagues is guided by ethics. Therefore, they have an important place in euthanasia, suicide, and assisted suicide (Wright, 2020).
The first step towards dealing with an ethical issue is identifying the moral or ethical conflict. In the case of euthanasia, suicide, and assisted suicide, one ethical conflict is that between the principles of autonomy, the right of the ill individual to practice self-determination and take action that he or she deems best for him or herself, and non-maleficence, the act of doing no harm.
An individual suffering from a terminal or incurable illness may wish to act autonomously and request euthanasia but, Wright (2020) proposes that the sacredness of our existence does not allow the act of euthanasia to be presented as ethical nursing practice. However, the answer is not so clear. They say that if the individual is deemed medically competent and is fully aware of the proposed consequences then their autonomy should be respected.
References
National Center on Elder Abuse (2020). Types of abuse. https://ncea.acl.gov/Suspect-Abuse/Abuse-Types.aspx (Links to an external site.)
Wright, A., (2020). Ethical considerations and implications for euthanasia and assisted suicide in New Zealand. https://www.nursingjournal.co.nz/volume-four-1-2017/ethical-considerations-and-implications-for-euthanasia-and-assisted-suicide-in-new-zealand/ (Links to an external site.) ReplyReply to Comment

REPLY 2

According to the National Center of Elder Abuse (NCEA), one in ten Americans aged sixty and above suffers from at least two forms of elder abuse. The different forms of elder abuse include physical abuse, which is an intentional use of force against an older person’s wishes. It is characterized by broken bones, bruises, burns, joint dislocation, sprains, and tooth loss. Sexual elder abuse is the second most common form of elder abuse. It is unwanted or forced sexual association with older adults. It is associated with genital or anus bleeding, bruised inner thighs or genitals, panic attacks, injuries in the pelvic region, and emotional and social withdrawal. The list also includes emotional and psychological elder abuse. It inflicts fear, mental agony, and distress to the respective adult. It takes several forms, including isolation, intimidation, terrorizing, insults, and threats. The most common signs of psychological abuse in adults include depression and withdrawal, isolation from family and friends, weakened self-esteem, and frequent attempts to hurt those around them.Stichler (2013) also argues that elder neglect is considered a form of abuse, according to NCEA. It occurs when the caregiver fails to prevent the elders from meeting their basic needs or preventing harm. Failure to provide the elders adequately with necessary daily activities, clothing, medical care, hydration, nutrition, and protection from damage are forms of elder neglect. The list also includes elder abandonment, which is often linked with neglect. When caretakers leave the elders in nursing homes, hospitals, or facility centers without an official arrangement on their care is a form of abandonment.In most cases, elders abandoned in healthcare centers might seem confused, scared, or lost. They may also appear depressed, lonely, dehydrated, and malnourished. The last two types of elder abuse, according to NCEA, include financial elder abuse and elder self-neglect. Financial elder abuse is linked to the improper, illegal, or unauthorized use of older people’s resources. Some of the warning signs of financial elder abuse include a pattern of missing property or belongings, elders facilitating discussions with mere documentation, and elders with no idea of their economic conditions. Elder self-neglect occurs when elders are weak enough to withdraw from meeting their daily needs.Practical Approaches for Ethical Dilemmas and Considerations in Healthcare Some of the ethical dilemmas and considerations in healthcare include cases linked to suicide, euthanasia, and assisted suicide. One of the primary approaches includes comparing the issue at hand to the specific rules in the Codes of Ethics (Stichler, 2013). In the long run, the health professionals would have analyzed the problem at hand with the Codes of Ethics and come up with a useful course of action relative to the issue presented with each patient. It is also vital to identify the party in power and control over the situation at hand. These steps are crucial as nurses will identify the resource relative to ideas, information, or clarification at hand.U.S. Department of Health & Human Services and Centers for Disease Control and Prevention (2014) states that addressing ethical dilemmas comes with breaking down the situation into competent parts. It provides room for identifying the issue at hand and generating the critical steps necessary to solve the issue. Healthcare professionals will identify and describe the possible question accurately and develop relevant ethical dilemmas and considerations. Ethical dilemmas and concerns in healthcare linked in activities above are easily found in the medical bodies’ legal sources such as legal codes and statues of practice.

ReferencesStichler, J. F. (2013). Healthy work environments for the ageing nursing workforce. Journal of Nursing Management, 21(7), 956–963. https://doi.org/10.1111/jonm.12174  (Links to an external site.)U.S. Department of Health & Human Services and Centers for Disease Control and Prevention. (2014). The State of Aging & Health in America 2013 [E-book]. CreateSpace Independent Publishing Platform. https://www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf (Links to an external site.)Elder Abuse, discussion board week 1.doc

For this week’s assignment, you are going to request funding for a new project from the executive level of your company. Feel free to be creative with this assignment, but remember your target audience and keep your presentation professional. I would like a PowerPoint presentation describing what you need money for and why (a new product line, upgraded computer system, new chairs for the office, etc.). Keep in mind that your executives are concerned with the financial future of the company, you will need to explain how this expenditure will benefit the company in the long run. Include a budget and a timeline. While the numbers are fictitious, you need to provide valid justifications for your requests, so provide research that supports the idea. The executives of every company have a duty to the stockholders/investors, so your justification will more than likely be passed along in some way to the annual report. Keep this in mind when creating your presentation.

There is no minimum required slide count, the content on the slides is more important than the number of slides. Include notes on each slide with a dialogue of what you would say if you were presenting. You could also choose to dictate each slide if you prefer. This is essential to a complete proposal.

Make sure to include a reference page using APA format!

Case Study, Learning Unit 4: Quality Improvement

The nursing director has asked you to form a team for quality control that addresses the issue of extended stay of patients who have been noncompliant with their diabetic protocol. These patients are staying an extra 72 hours in the acute care facility and usually have repeated admissions.

Related question #1

Based on what you know about the need for continuous quality control, who would you select to be part of this team?

Related question #2

What data should you ask your team to collect?

Related question #3

What could your team member produce that would assist in assessing the situation? 

Unfolding Case Study, Learning Unit 4: Quality Improvement

(Based on case in Module 4.1)

Part I

Sylvia has recently received complaints from her nursing staff that cancer patients are waiting up to 2 hours to begin their chemotherapy IV regime. Some of the oncologists often leave out important details when ordering the chemotherapy agents, and therefore, the pharmacy must contact the oncologists to get further instructions. If the order is incomplete, oftentimes it is not brought to the nurses’ attention until the patient has been waiting. At times, the oncologist cannot be contacted or located, which is adding to the frustration of the staff and patients.

Related question #1

What can Sylvia do to improve this process?

Part II

Sylvia asks the pharmacy and oncologist to appoint a team member that would serve on the task force to develop a process that would decrease the delay in chemotherapy treatments. The team meets and creates a sample checklist. The checklist is approved by all team members, and Sylvia decides it is time to incorporate the checklist in the process.

Related question #2

What steps should Sylvia take to assess the effectiveness of the new protocol?

Part III

Sylvia writes a report summarizing her findings of the audit she conducted on patient satisfaction, waiting time, and time of filling orders to time of administration of the chemotherapy.

Related question #3

According to quality improvement guidelines, what is the logical next step for Sylvia?