N522PE Life-Span Assessments, Ethics & Legal Issues Final Project

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Discussion 7

Caring for persons across the life span and from very diverse cultural backgrounds can present challenges in nursing practice. As you studied the ethical and legal issues related to advanced physical assessment what insights have you gained to advance your clinical reasoning? Describe knowledge gained or re-affirmed through a de-identified clinical story.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria. N522PE Life-Span Assessments, Ethics & Legal Issues Final Project

Sample Approach to Discussion 7

I feel this week’s discussion was challenging to understand. We live in a very diverse world, with challenges and changes occurring as we speak, with this in mind it is always advisable to keep ethical and legal information issues at the forefront while caring for patients. As a nation we lack tolerance and patience, so why should we think our patients will be any different? The patient’s privacy must be respected at all times as it is especially important when talking with staff members involved in the patient’s care, as well as with physicians, and referrals.

There were a couple of ethical situations I encountered the past couple of weeks with the most recent situation occurring this past weekend. My morning started busy with assessments, medications, and education, as I needed to discharge two of my three moms and babies by 1100. I received my fourth couplet, a cesarean section at 0800, which was manageable; however, this mom was unstable with blood pressure (BP) of 82/40’s with a pulse of 104. After using clinical reasoning, assessing the patient for postpartum hemorrhage (PPH), and amniotic fluid embolus or pulmonary embolism, I notified the obstetrical anesthesia resident to come over to evaluate the patient. The resident proceeded to give the patient medication to raise her BP stabilizing her for the next 45 minutes while I checked on my other patients briefly.

Upon entering the room, my patient’s husband started to list and communicate all of her blood work results that his wife had drawn before leaving the RR as he had access to her medical records via her “my chart” (2020). The fact that her husband, a physician at a competitive hospital, had gained access to her medical records before me gaining access or even knowing this information due to lack of report given to me during the transition made me very apprehensive and uncomfortable with the care we were providing. I was not very happy finding out the patient had issues with her BP in the recovery room (RR) with pressures ranging from mid 80’s / 50’s, having fluid boluses and epinephrine before leaving the RR as well as blood work drawn. The patient was taken back to the RR for closer one on one nursing care as she became symptomatic with BP dropping once again.

In respect to the transparency of information offered to the patient by the hospitals, it can create a situation where the nurse has not had time to review the patient’s status while caring for other patients finding themselves in a situation where they may have to answer questions from a patient or family member without knowledge that precedes them.

References

(2020). https://www.epic1.org/Portals/0/Articles/MyChart Questions and Answers for Providers and Staff.pdf?ver=2017-05-11-150338-967

Response

Diane, I agree that we as nurses and nurse practitioners must keep legal and ethical issues at the forefront while caring for patients. Supportive and educative resources for practitioners must be included in both the academia and occupational fields (Moody, et al., 2011). This idea, allows nurse practitioners to be amply prepared to function as a patient’s advocate, able to protect their rights and safety. N522PE Life-Span Assessments, Ethics & Legal Issues Final Project

One case, which occurred in my hospital, consisted of a patient who was an elderly patient who was in a quadriplegic state, intubated and in a vegetative state, the patient was no longer tolerating tube feeds, was losing his extremities from both diabetic and circulatory ischemia, had been in the hospital ICU for over three months, but continued to regain a heart rhythm after several cardiac arrests. The doctors on the case had recommended a do not resuscitate (DNR) status, the wife kept him as a full code status. The daughter agreed with the doctors and believed the mother only wanted the father kept alive to receive his benefits. The case was brought up to the ethics committee, but, before the ruling had been given, the patient went into cardiac arrest and there was an ethical issue between the doctor refusing to call a code blue on the patient and the nurses refusing not to perform CPR.

As a practitioner in this situation, the nurse may face many conflicts, on a daily basis with what is ethically correct and what they believe is correct and always remember that our primary goal is to function as a patient advocate.

References

Moody, K., Siegel, L., Scharbach, K., Cunningham, L., & Cantor, R. M. (2011). Pediatric palliative care. Primary care, 38(2), 327–ix. https://doi.org/10.1016/j.pop.2011.03.011

Final Project

Final Project

The Final Project (6-8 page paper) synthesizes the previous weeks’ study of advanced physical assessment by conducting a comprehensive assessment in ShadowHealth. The final project synthesis is focused upon designing evidence-based, culturally competent nursing interventions through the development of an individualized health plan. Assessment of competency is based on the Comprehensive Patient Interview, Physical Examination and Individualized Plan of Care incorporating Healthy People 2020 and evidence-based interventions and patient-centered goals.

You will use one comprehensive digital clinical experience health history and physical assessment for this assignment: Comprehensive Assessment. Please submit your summary documentation in MS Word. Use the submission parameters and rubric below to guide you in completion of this written assignment. The use of Headers in your paper is strongly encouraged.

Submission Parameters:

For this written assignment, please use the following guidelines and criteria. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the paper is approximately 6-8 pages, which does not include the cover page and reference page(s).

Introduction (including purpose statement)
Subjective Findings Synthesis
Objective Findings Synthesis
Plan of Care
1. Apply one nursing theory in planning care for this patient
2. Incorporate Healthy People 2020 Objectives into the plan of care prioritized to meet the health needs of the patient
3. Document evidence to support clinical reasoning for selected evidence-based plan of care
4. Plan of care is individualized to findings, life-span stage of development with culturally specific considerations, and patient-centered.
Conclusion
References (use primary and/or reliable electronic sources)

In regards to APA format, please use the following as a guide:

Include a cover page and running head (this is not part of the 6-8 pages limit)
Include transitions in your paper (i.e. headings or subheadings)
Use in-text references throughout the paper
Use double space, 12 point Times New Roman font
Apply appropriate spelling, grammar, and organization
Include a reference list (this is not part of the 6-8 pages limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. NCSBN, AANP)

The Final Project documentation is due in Week Seven. Please see the Final Project below to help you complete the assignment.

Final Project Rubric – N522PE Life-Span Assessments, Ethics & Legal Issues Final Project

Competency	20	18	16	0	Earned/ Possible Points
The history, assessment and key findings are synthesized	Documentation clearly shows student has completed a comprehensive assessment with a written synthesis of key findings.	Documentation supports the student has completed the comprehensive assessment with key findings. N522PE Life-Span Assessments, Ethics & Legal Issues Final Project	Documentation supports the student has completed the assessment without documentation of key findings.	Documentation supports the student attempted to complete the comprehensive assessment without identification of key findings. The comprehensive health history is briefly documented and lacks depth and specificity.	/20
	20	18	16	0
Documented Prioritized Physical Examination Findings	Documentation clearly shows student has completed the physical examination with findings prioritized.	Documentation supports the student has completed the physical examination with findings.	Documentation supports student completed some of the physical examination. Documentation is accurate but lacks depth.	No evidence that the student is applying read concepts of advanced focused physical assessment. Documentation lacks depth and may lack coherence for understandability.	/20
	20	18	16	0
Documented Evidence to Support Clinical Reasoning with External Course Resources	Discourse clearly shows the student has studied the topic and has given thought in developing the final plan of care with one nursing theory applied and integration of Healthy People 2020.	Discourse supports the student has studied the topic and has given thought in developing the final plan of care. Lacks integration of either one applied nursing theory or integration of Healthy People 2020.	Discourse supports student studied some of the topic, however, lacks detail and depth in developing the final plan of care. Lacks integration of either one applied nursing theory or integration of Healthy People 2020.	No evidence that that student has read or studied the topic. Discourse lacks depth. May be presented in a rambling manner. Content is inaccurate &/or is unclear. No use of one applied nursing theory or integration of Healthy People 2020.	/20
	20	18	16	0
Individualized and Prioritized Plan of Care is Based Upon Clinical Findings	Accurately presents an individualized plan of care based upon clinical findings.	Presents an individualized plan of care based upon clinical findings. Some minor omissions are noted.	Presents a plan of care that is not individualized based upon the clinical findings.	A plan of care is not presented or the plan of care presented lacks demonstration of competency or is irrelevant to the clinical findings.	/20
	5	4	3	0
Developmentally and Culturally Specific	Accurately documents a development-ally and culturally specific assessment and plan of care for the selected patient.	Documents a development-ally and culturally specific assessment and plan of care.	Presents a development-ally and culturally specific assessment or plan of care and one or both are not based upon the selected patient.	A development-ally and culturally specific assessment and plan of care are not presented or based upon the selected patient’s findings.	/5
	5	4	3	0
Demonstration of Compliance with Ethical and Legal Standards of Professional Nursing Practice	Compliance with the ethical and legal standards of professional nursing practice is explicitly stated in the documentation of the comprehensive physical assessment.	Compliance with the ethical and legal standards of professional nursing practice is stated in the documentation. N522PE Life-Span Assessments, Ethics & Legal Issues Final Project	Compliance with the ethical and legal standards of professional nursing practice is briefly implied in the documentation of the comprehensive physical assessment or inaccuracies are evidenced in the written assessment.	Compliance with the ethical and legal standards of professional nursing practice is not included in the documentation of the physical assessment.	/5
	10	9	8	0
Grammar, Spelling, and Punctuation APA Format	APA Format, grammar, punctuation and spelling is accurate with errors.	APA Format, grammar, punctuation and spelling is accurate with less than two types of errors.	APA Format, grammar, punctuation and spelling is accurate with five or fewer types of errors.	APA Format, grammar, punctuation and spelling is accurate with more than five types of errors.	/10
COMMENTS:				TOTAL:	/100

N522PE Life-Span Assessments, Ethics & Legal Issues Final Project