Generally speaking, bioethics helps determine what is responsible by considering four key principles: autonomy, beneficence, nonmaleficence, and justice. The principle of autonomy is about respecting people and their free will. Beneficence and nonmaleficence are two sides of the same coin: doing what is helpful, and not doing what is harmful. Justice, in this context, has to do with being fair in giving out both benefits and risks.

 Using your own words, answer the following questions:

 1. How these models relate to one another varies with each circumstance?

 2. In your personal opinion which model may be the most important?

 Models:

 1.  Ethics of Care Model

 2.  Narrative Ethics Model

 3. Complementary/Alternative Medicine (CAM)

 Requeriments:

 1. Use APA format.

 2. Utilize more than three references to answer the questions.

 3. Your answers must be at least 2 paragraphs to each question.

Remedios Hebert RE: Discussion – Week 3COLLAPSE

Main Post

            Nurse informaticists, nurse informatics specialists (NIS), and data specialists work with different departments across the continuum.  One of my experiences in working with a NIS occurred during my orientation as a new hire at a Magnet recognized hospital.  A NIS was the person in charge of ensuring that newly hired employees were trained to use their software system called Epic.  Some strategies that I recommend are providing new hires a break in between the lengthy modules and making the training interesting and fun, while assuring there are enough computer technicians to answer questions that newly hired employees may have.  The modules were easy to follow for some of the new hires, but others had difficulty.  The problem was that everyone was on a different level of learning.  Some of the new hires already had the experience of using Epic software, and some did not.  Creating employee training is difficult, especially if one is training a new hire without any experience in using a computer. 

            The following scenario was what I remembered:  Every new hire was provided with a thick binder that contained different scenarios in different nursing departments.  It felt almost like a race to complete through all the scenarios in the binder, leaving some of the people behind who were not tech-savvy, and were unfamiliar with the use of an EHR system.  One data specialist and a NIS were available throughout the orientation to answer questions; however, many of the new hires who lacked understanding from the modules waited a long time to raise their questions and to get help.  What was helpful for those who fell behind and needed continuing practice in Epic was going to the learning laboratory.  This notion was started on the self-regulated learning principle that effective learning can be achieved by encouraging learners to participate in their own learning process (Sandars, 2013).  Everyone was welcome and encouraged to use the computer learning library even after completing their orientation.  Sometimes, it just takes getting used to technology by practicing over and over before getting better at it.  Going to the computer library is an incentive that many organizations do not have and using it helps the employee to become more knowledgeable. 

            In 2017, Heidarizadeh et al. reported that many nurses identify some of their challenges are related to systems and technology.  This is especially true for me, and I am sure that many other nurses feel they spend a lot of time on documentation requirements, which takes us away from nursing care.  Interdisciplinary is a word that I often use when needing to count on other co-workers.  Nurses cannot do everything on their own; they must learn to rely on their teammates, other disciplines, and the support of technology.  McGonigle and Mastrian (2018) concluded that interprofessional collaboration is emerging as a key to better quality outcomes for patients.  This collaboration is supported by the EHR and other technologies that facilitate communication among health professionals. To summarize, I believe that informatics and the repeated upgrades in technology will only continue to help improve the quality and safety of care for our patients.  Informatics will always play an important role in our everyday lives. 

References

Heidarizadeh, K., Rassouli, M., Manoochehri, H., Zagheri, M. T., & Kashef, R. G. (2017).  Nurses’ perception of challenges in the use of an electronic nursing documentation system.  CIN:  Computers, Informatics, Nursing, (35)11, 599-605.  https://doi:10.1097/CIN.0000000000000358

McGonigle, D. & Mastrian, K. G.  (2018).  Nursing informatics and the foundation of knowledge (4th ed., pp. 537-552).  Jones & Bartlett Learning. 

Sandars, J. (2013).  When I say…self-regulated learning.  Medical Education, 47, 1162-1163.  https://doi.org/10.1111/medu.12244

Johnny Herrera RE: Discussion – Week 3COLLAPSE

Efficiency, accuracy, and communication are transformed daily to ensure that medical providers promote patient safety. Nurses play a role in this transition by providing their experience and aiding in developing precise and useful tools. The informatics competency helps nurses use information and technology to communicate, manage knowledge, mitigate error, and support decision-making at the point of care (Glassman, 2017). Technology, while taking leaps to improve performance, can also undermine nurse-patient relationships and responsibility.  

 Among the 2.8 million registered nurses currently working in the United States (U.S.), 61% work in hospitals (Macieira et al., 2018).  With hospitals engaging in the use of electronic health records, most graduate nurses have not had any experience with paper medical records. Going to a correctional facility and being introduced to paper medical records was a big shock for me. Immediately I could gage the differences between both systems and the loss of time, resources, and accuracy paper records contribute to. A few months into my experience at the facility, the conversion to electronic health records initiated, and I had the first opportunity to work with a nurse informatics specialist.

           As challenging as it is, working with an EHR system from day one has its benefits, as the medical team can make changes and create a well-balanced mold. The nurse informatics specialist was present at every staff training and at the physical site when the system launched. Using his nursing experience, the specialist made changes to the format that was beneficial to the entire team and worked one on one with staff members having difficulty. The most important suggestion I would support is the ability to make changes to systems in less time. Waiting months for changes to be implemented can be challenging and discouraging to staff.

 Care and promotion of health are at the core of the nursing profession. These principles are overlooked, and “the overwhelming presence of technology at the clinical bedside has the power to become the strongest reference point that nurses use to inform, direct, interpret, evaluate, and understand nursing care” (McGonilge as cite in O’Keefe-McCarthy, 2018, p.526). I have experienced this in the NICU when assessing a monitor that is reading 100% oxygen saturation, and looking closer only to find a disconnected probe. Nurses are cognizant that not one single reference point should determine the clinical state of the patient, and dependence should not be on technology.

           Technology and the nursing profession are married in an unbreakable relationship with a common goal. Promotion of health and care is delivered with precision and evidenced-based practice thanks to the work of professionals developing technological advances. Nurses are responsible for contributing to further advancements through their experience, research, and communication with the healthcare team.

References:

Glassman, K.S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45-47. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2017/11/and11-Data-1030.pdf

Macieira, T., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G. (2018). Evidence of Progress in Making Nursing Practice Visible Using Standardized Nursing Data: a Systematic Review. AMIA … Annual Symposium proceedings. AMIA Symposium, 2017, 1205–1214.

McGonigle, D. (2018). Nursing Informatics and the Foundation of Knowledge. [MBS Direct]. Retrieved from https://mbsdirect.vitalsource.com/#/books/9781284142990/

Assessment Tools and Diagnostic Tests

Student name

Instructor name

Institution affiliation

Course

Date

Assessment Tools and Diagnostic Tests

Mammogram

A mammogram can refer as an X-ray picture of the heart that is helpful in the detection of breast cancer early on, even before some symptoms present themselves. Screening mammography is essentially a mammogram that checks or observes individuals with no signs (Henderson, 2015). A mammogram refers to a breast image in the form of an X-ray used in breast cancer screening (Shih, Huang, & Chan, 2016). It is through the mammogram that breast cancer is detected and deaths related to the disease decreased significantly. The process involves compression of the breasts between two surfaces that are firm in a bid to ensure the breast tissues are spread. 

Validity and reliability

The black and white images captured by the X-ray are later displayed on the computer screen after which the doctor assessing the patient will look for cancer signs. The test mainly used in the detection of abnormalities in the breast and any tumours that could be present. The mammogram X-ray is either for diagnostic and screening purposes. Screening is done for patients that do not have any noticeable signs for breast cancer while diagnostic mammography is used in the investigation of changes noted in the breast including pain, nipple discharge or thickening and unusual breast skin (Shih, Huang, & Chan, 2016). The use of mammograms can help lower the number of women aged between 40 and 70 who die from breast cancer. According to Glover (2015), women, especially those 40 years old and above, should participate in annual screening mammography. It is, therefore, essential to observe the validity and reliability of mammograms.

Validity and Reliability

Women, 40 years and older for five years to study and record the validity and reliability of mammography. 87 % accuracy and sensitivity are revealed in mammography. This sensitivity testing is higher in women over 50 years of age and more senior in women with fatty breasts, then dense breasts (Breast Cancer Foundation, 2019). A susceptible test will pick up even the slightest abnormal finding. These means it will miss a few cases of the disease, but it will also mistake some people as having the disease when they don’t. It was found that the percentage is 7 to 12 per cent of having a false positive after one mammography.

However, younger women are more likely to have false positives. After ten years of mammograms, a false positive is about fifty per cent. Many women use menopausal hormonal therapy, and this can increase the risk of breast cancer; thus, a low dose is recommended (Breast Cancer Foundation, 2019).  Mammography misses thirteen per cent of breast cancers, and some are much harder to detect. Mammography finds cancers that begin in the milk ducts very accurately, than the ones that start in the lobules (Breast Cancer Foundation, 2019). The reason is lobules do not always appear as a distinct mass on a mammogram and are harder to find.

Health assessments

Mammography can be used as a diagnostic tool when a patient presents with a lump in their breast that is a palpable mass and has nipple discharge.  To identify that this lump is indeed abnormal or to rule out a benign fibrous growth, a diagnostic mammogram will provide different views to assess the features of the mass and to pinpoint its exact location in breast tissue. This could include a spot compression, magnification, exaggerated craniocaudal to the medial or lateral side, tangential, and a ninety-degree lateral view (Dains, Baumann & Scheibel, 2016). Because the density of the breast tissue matters for identification, mammography is of less value in women younger than age thirty years of age. 

When women who have breast complaints and women who do not have complaints an x-ray is done. It is highly efficient because the procedure allows for the detection of cancers before palpation becomes a possibility. After mammography shows a mass on the x-ray, a tissue sample can be removed for testing of cancer by a procedure called biopsy (Qin, White, Sabatino & Febo-Vazquez, 2018). Mammography usage began thirty years ago, and in the past decade, the technique has improved drastically (Qin et al., 2018). Today, high-quality results can be obtained with a low radiation dose.  

Concepts

Mammography is of crucial importance in the detection and diagnosis of breast cancer and other breast diseases (Sardanelliet al., 2016). It usually follows a manual breast examination. A mammogram provides several different views of breast tissue which can give the doctor a better look of breast tissue enabling them to pinpoint a  specific area of muscle and possibly discover tumours that are too small to feel as well as identify cancer cells of the lining of the ducts of the breast tissue (National Breast Cancer Foundation, 2016). While screening mammograms are routinely administered to detect breast cancer in women who have no apparent symptoms, diagnostic mammograms are used after suspicious results on a screening mammogram or after some signs of breast cancer alert the physician to check the tissue (National Breast Cancer Foundation, 2016).

The primary focus of performing a mammogram is early detection of breast cancer before symptoms (screening mammography) and secondly to make a diagnosis for patients with symptoms such as a palpable lump (diagnostic mammography) (Sardanelli et al., 2016). It is recommended that annual mammograms be performed for women after age 40 for routine screening or earlier if clinically indicated. One indication for earlier detection are women with a high frequency of breast cancer in their family should start even earlier with periodic imaging (Sardanelli et al., 2016). I have seen women in their twenties getting mammograms. But they don’t always go annually; some are examined every three years.

References

Shih, J., Huang, I., & Chan, S. (2016). Annotation System to Conducting a Mammography. 2016 International Conference on Educational Innovation through Technology (EITT). doi:10.1109/eitt.2016.50

Henderson, L. M., O’Meara, E. S., Braithwaite, D., & Onega, T. (2015). Performance of Digital Screening Mammography among Older Women in the United States. Cancer, 121(9), 1379-1386. Doi:10.1002/cncr.29214.

Glover, L. (2015). Access Denied. Retrieved from https://health.usnews.com/health-news/patient-advice/articles/2015/06/18/how-often-do-you-really-need-a-mammogram

National Breast Cancer Foundation. (2016). Mammogram. Retrieved from 

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis. Advanced health assessment and clinical diagnosis in primary care (5th Ed.). St. Louis, MO: Elsevier Mosby.

Qin, J., White, M. C., Sabatino, S. A., & Febo-Vázquez, I. (2018). Mammography use among women aged 18-39 years in the United States. Breast Cancer Research and Treatment, 168(3), 687–693. https://doi-org.ezp.waldenulibrary.org/10.1007/s10549-017-4625-6

Sardanelli, F., Fallenberg, E. M., Clauser, P., Trimboli, R. M., Camps-Herrero, J., Helbich, T. H., 

Forrai, G. (2016). Mammography: an update of the EUSOBI recommendations on 

Information for women. Insights into Imaging, 8(1), 11-18. Doi: 10.1007/s13244-0160531

Assessment Tools and Diagnostic Tests

Student name

Instructor name

Institution affiliation

Course

Date

Assessment Tools and Diagnostic Tests

Mammogram

A mammogram can refer as an X-ray picture of the heart that is helpful in the detection of breast cancer early on, even before some symptoms present themselves. Screening mammography is essentially a mammogram that checks or observes individuals with no signs (Henderson, 2015). A mammogram refers to a breast image in the form of an X-ray used in breast cancer screening (Shih, Huang, & Chan, 2016). It is through the mammogram that breast cancer is detected and deaths related to the disease decreased significantly. The process involves compression of the breasts between two surfaces that are firm in a bid to ensure the breast tissues are spread. 

Validity and reliability

The black and white images captured by the X-ray are later displayed on the computer screen after which the doctor assessing the patient will look for cancer signs. The test mainly used in the detection of abnormalities in the breast and any tumours that could be present. The mammogram X-ray is either for diagnostic and screening purposes. Screening is done for patients that do not have any noticeable signs for breast cancer while diagnostic mammography is used in the investigation of changes noted in the breast including pain, nipple discharge or thickening and unusual breast skin (Shih, Huang, & Chan, 2016). The use of mammograms can help lower the number of women aged between 40 and 70 who die from breast cancer. According to Glover (2015), women, especially those 40 years old and above, should participate in annual screening mammography. It is, therefore, essential to observe the validity and reliability of mammograms.

Validity and Reliability

Women, 40 years and older for five years to study and record the validity and reliability of mammography. 87 % accuracy and sensitivity are revealed in mammography. This sensitivity testing is higher in women over 50 years of age and more senior in women with fatty breasts, then dense breasts (Breast Cancer Foundation, 2019). A susceptible test will pick up even the slightest abnormal finding. These means it will miss a few cases of the disease, but it will also mistake some people as having the disease when they don’t. It was found that the percentage is 7 to 12 per cent of having a false positive after one mammography.

However, younger women are more likely to have false positives. After ten years of mammograms, a false positive is about fifty per cent. Many women use menopausal hormonal therapy, and this can increase the risk of breast cancer; thus, a low dose is recommended (Breast Cancer Foundation, 2019).  Mammography misses thirteen per cent of breast cancers, and some are much harder to detect. Mammography finds cancers that begin in the milk ducts very accurately, than the ones that start in the lobules (Breast Cancer Foundation, 2019). The reason is lobules do not always appear as a distinct mass on a mammogram and are harder to find.

Health assessments

Mammography can be used as a diagnostic tool when a patient presents with a lump in their breast that is a palpable mass and has nipple discharge.  To identify that this lump is indeed abnormal or to rule out a benign fibrous growth, a diagnostic mammogram will provide different views to assess the features of the mass and to pinpoint its exact location in breast tissue. This could include a spot compression, magnification, exaggerated craniocaudal to the medial or lateral side, tangential, and a ninety-degree lateral view (Dains, Baumann & Scheibel, 2016). Because the density of the breast tissue matters for identification, mammography is of less value in women younger than age thirty years of age. 

When women who have breast complaints and women who do not have complaints an x-ray is done. It is highly efficient because the procedure allows for the detection of cancers before palpation becomes a possibility. After mammography shows a mass on the x-ray, a tissue sample can be removed for testing of cancer by a procedure called biopsy (Qin, White, Sabatino & Febo-Vazquez, 2018). Mammography usage began thirty years ago, and in the past decade, the technique has improved drastically (Qin et al., 2018). Today, high-quality results can be obtained with a low radiation dose.  

Concepts

Mammography is of crucial importance in the detection and diagnosis of breast cancer and other breast diseases (Sardanelliet al., 2016). It usually follows a manual breast examination. A mammogram provides several different views of breast tissue which can give the doctor a better look of breast tissue enabling them to pinpoint a  specific area of muscle and possibly discover tumours that are too small to feel as well as identify cancer cells of the lining of the ducts of the breast tissue (National Breast Cancer Foundation, 2016). While screening mammograms are routinely administered to detect breast cancer in women who have no apparent symptoms, diagnostic mammograms are used after suspicious results on a screening mammogram or after some signs of breast cancer alert the physician to check the tissue (National Breast Cancer Foundation, 2016).

The primary focus of performing a mammogram is early detection of breast cancer before symptoms (screening mammography) and secondly to make a diagnosis for patients with symptoms such as a palpable lump (diagnostic mammography) (Sardanelli et al., 2016). It is recommended that annual mammograms be performed for women after age 40 for routine screening or earlier if clinically indicated. One indication for earlier detection are women with a high frequency of breast cancer in their family should start even earlier with periodic imaging (Sardanelli et al., 2016). I have seen women in their twenties getting mammograms. But they don’t always go annually; some are examined every three years.

References

Shih, J., Huang, I., & Chan, S. (2016). Annotation System to Conducting a Mammography. 2016 International Conference on Educational Innovation through Technology (EITT). doi:10.1109/eitt.2016.50

Henderson, L. M., O’Meara, E. S., Braithwaite, D., & Onega, T. (2015). Performance of Digital Screening Mammography among Older Women in the United States. Cancer, 121(9), 1379-1386. Doi:10.1002/cncr.29214.

Glover, L. (2015). Access Denied. Retrieved from https://health.usnews.com/health-news/patient-advice/articles/2015/06/18/how-often-do-you-really-need-a-mammogram

National Breast Cancer Foundation. (2016). Mammogram. Retrieved from 

https://www.nationalbreastcancer.org/diagnostic-mammogram

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis. Advanced health assessment and clinical diagnosis in primary care (5th Ed.). St. Louis, MO: Elsevier Mosby.

Qin, J., White, M. C., Sabatino, S. A., & Febo-Vázquez, I. (2018). Mammography use among women aged 18-39 years in the United States. Breast Cancer Research and Treatment, 168(3), 687–693. https://doi-org.ezp.waldenulibrary.org/10.1007/s10549-017-4625-6

Sardanelli, F., Fallenberg, E. M., Clauser, P., Trimboli, R. M., Camps-Herrero, J., Helbich, T. H., 

Forrai, G. (2016). Mammography: an update of the EUSOBI recommendations on 

Information for women. Insights into Imaging, 8(1), 11-18. Doi: 10.1007/s13244-0160531