• Review the DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
• Consider what history would be necessary to collect from the patient.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

Subjective Documentation in Provider Notes

Subjective narrative documentation in Provider Notes is detailed and organized and includes:

Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS)

ROS: covers all body systems that may help you formulate a list of differential diagnoses. You should list each system as follows: 
General: Head: EENT: etc.

Select one (1) peer-reviewed, original research article that discusses an outbreak investigation to share with the class. 

The article cannot be older than 3 years (2017-2020). Do not discuss a review article, case study, systematic review, meta analysis, or letter to editor.  Do not repeat an article that a classmate has already chosen.

After reading your selected article, post the following information: 

1. What step in Outbreak Investigation (see CDC resources) does the study address?   

2. What was the purpose of the study?  

3. What was the study design?  

4. Who was in the study population(s)/sample(s)? 

5. What was the outcome and was it consistent with the researcher(s)’ original research question?  

6. What recommendation(s) did the researcher offer for future studies?  

7. How do you know this article was peer-reviewed?

Must be at least 250 words

 Consider the “Four Topics Approach” (or Four Box method) to ethical decision making on page 61, Table 2.1 in Butts (below).  Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.

In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way?  Does this seem like a valid process for you to apply in your practice? 

Your paper should be 2 pages. Adhere to APA formatting throughout, and cite any outside sources you may use.

TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases

Medical Indications: The Principles of Beneficence and Nonmaleficence

1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?

2.  What are the goals of treatment?

3.  In what circumstances are medical treatments not indicated?

4.  What are the probabilities of success of various treatment options?

5.  In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?

Patient Preferences:  The Principle of Respect for Autonomy

1. Has the patient been informed of benefits and risks, understood this information, and given consent?

2.  Is the patient mentally capable and legally competent, and is there evidence of incapacity?

3.  If mentally capable, what preferences about treatment is the patient stating?

4.  If incapacitated, has the patient expressed prior preferences?

5.  Who is the appropriate surrogate to make decisions for the incapacitated patient?

6.  Is the patient unwilling or unable to cooperate with medical treatment? If so, why?

Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy

1.  What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?

2.  On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?

3.  Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?

4.  What ethical issues arise concerning improving or enhancing a patient’s quality of life?

5.  Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?

6.  What are plans and rationale to forgo life-sustaining treatment?

7.  What is the legal and ethical status of suicide?

Contextual Features: The Principles of Justice and Fairness

1.  Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?

2.  Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?

3.  What are the limits imposed on patient confidentiality by the legitimate interests of third parties?

4.  Are there financial factors that create conflicts of interest in clinical decisions?

5.  Are there problems of allocation of scarce health resources that might affect clinical decisions?

6.  Are there religious issues that might influence clinical decisions?

7.  What are the legal issues that might affect clinical decisions?

8.  Are there considerations of clinical research and education that might affect clinical decisions?

9.  Are there issues of public health and safety that affect clinical decisions?

10.  Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?

Conflict Handling Style

This assignment will help you understand conflict at the individual, team and organizational levels.

Using the South University Online Library or the Internet, research and identify additional information on handling conflict.

Based on your research and understanding, create a paper in a 3- to 4-page Microsoft Word document that:

Includes a description of change theories, conflict theories, and leader as a change agent.

Integrates how your ability to handle conflict can either enhance or hinder effective leadership in the health care environment.

Week 11: Question for Discussion

(Wk # 11: July 13 to July 19 – Main post under Assignment by Wed, July 15 at 11:59 PM EST).

Students are required to post a minimum of three times per week (1 main post answering the question 100% before Wednesday at 11:59 PM EST and 2 peer responses by Sunday at 11:59 PM EST).The three posts in each individual discussion must be on separate days (same day postings / replies will not be accepted).

Chapter 14 – Violent Behavior in Institutions

Question(s): Be prepared to discuss 2 questions

Statistics shows that 48% of no fatal injuries from occupational assaults in the United States occurred in health care and social services particularly mental health workers.

1. Mention at least 3 precipitating factors for violent behavior in institutions?

2. Discuss each of them (3 precipitating factors).

Grading Criteria:  The answer should be based on the knowledge obtained from reading the book, no just your opinion. If there are 2 questions in the discussion, you must answer both of them. Your grade will be an average of both questions. Student mentions 3 precipitating factors for violent behavior in institutions (45 points – 15 points each clue). Student discusses / explains each precipitating factor (55 points – 18.3 points each clue).