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Should the new staffing policy give the nurses authority to refuse to admit patients when the staff is not sufficient to handle them? (In some hospitals, nurses have this authority.) Can any policy take precedence over the professional judgment of trained ICU nurses?

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In each case, answer the questions at the end of the case and give researched references to support your assertions; also, explain what would be the ethical course of action and the legal requirements for action in the case.

Case One

Mrs. Lewis was head nurse on a medical surgical floor in a community hospital with 250 beds. Over the course of 6 months, she noticed that all patients admitted from the Shady Rest Nursing Home had signs of severe injuries other than those connected with the admitting diagnosis. There appeared to be patient abuse in the nursing home. Mrs. Lewis investigated discreetly and found no explanation possible except abuse. In accord with the obligations of the law in her state, she reported the matter to the Department of Welfare Bureau of Inspection.

The Welfare Department investigated immediately, found proof of abuse, and threatened to close down Shady Rest if there were any more recurrences. Mrs. Lewis was overjoyed until her hospital administrator, bypassing the director of nursing, called her in and warned her that she would be fired if she reported any other instances of abuse. Shady Rest sent the hospital a lot of business, and good relations had to be maintained.

Mrs. Lewis was even more shocked when she discovered that the administrator was a golf partner of the owner of Shady Rest and was doing an old buddy a favor. Despite fears of retaliation, Mrs. Lewis consulted a lawyer, who threatened the hospital with exposure and with penalties that would follow if one of its employees failed to follow the reporting provisions of the law on abuse in nursing homes.

Did Mrs. Lewis act correctly? What should she have done if she could not have afforded to consult with a lawyer? In what ways can whistle-blowers protect themselves? Must the art of intimidation be part of the toolbox of healthcare professionals in order to protect their patients? Is power an appropriate consideration in healthcare ethics?

Case Two

On a July weekend, Mrs. Allesfertig, nursing supervisor of the whole hospital, discovered that the intensive care unit was seriously understaffed. She pulled two nurses with previous ICU experience off other floors to bring the unit up to strength in view of the extreme level of acute care needed. On the following Monday, Dr. Bestknabe, who has overall responsibility for the ICU unit, closed the unit for further admissions until the staffing had been worked out on a permanent basis.

Should the new staffing policy give the nurses authority to refuse to admit patients when the staff is not sufficient to handle them? (In some hospitals, nurses have this authority.) Can any policy take precedence over the professional judgment of trained ICU nurses?

 

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Explain how your proposed resolution to the problem would uphold the organization’s mission and values and improve the culture and climate.

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For this Assignment, you apply systems theory to the examination of a problem in a department or a unit within a health care organization. (Note: You may use the same problem you identified for the Discussion as long as it meets the criteria for this assignment.)
To prepare:
Review the Meyer article, “Nursing Services Delivery Theory: An Open System Approach,” in this week’s Learning Resources. Focus especially on the information presented in Table 1 (p. 2831) and Figure 2 (p. 2833).
Reflect on your organization or one with which you are familiar. Within a particular department or unit in this organization, identify a problem the staff is encountering.
Using Table 1 in the Meyer article as a guide, analyze the department or unit, identifying inputs, throughput, output, cycles of events, and negative feedback. Consider whether the problem you have selected relates to input, throughput, output, cycles of events, and/or negative feedback.
Think about how you could address the problem: Consider what a desired outcome would be, then formulate related goals and objectives, and translate those goals into policies and procedures.
Research professional standards that are pertinent to your identified problem.
Reflect on the organization’s mission statement and values. In addition, consider how addressing this problem would uphold the mission and values, while improving the organizational culture and climate. (Depending on the organization you have selected, you may have explored these in the Week 1 Discussion.)
To complete:
By Day 7
Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:
Describe a department or unit within a health care organization using systems theory terminology. Include a description of inputs, throughput, output, cycles of events, and negative feedback.
Describe the problem you identified within the department or unit using an open- systems approach, and state where the problem exists using the systems theory model (input, throughput, output, cycles of events, or negative feedback).
Based on this information, explain how you would address the problem as follows:
Formulate a desired outcome.
Identify goals and objectives that would facilitate that outcome.
Translate those goals and objectives into policies and procedures for the department or unit.
Describe relevant professional standards.
Explain how your proposed resolution to the problem would uphold the organization’s mission and values and improve the culture and climate.

 

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• Explain the community-based response to the issue, including community-based planning, needs assessments, and selection of locally identified objectives.

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Develop Part II of a health campaign plan. Part II focuses on assessment and planning for a health campaign.
Write a 1,750- to 2,450-word analysis of the population and resources for your health campaign. Building on the Part I submission, provide the following:
• Summarize Part I in a single paragraph as part of your introduction to create the context for Part II.
• Describe how the target population is defined at the national level and compare how these data may differ in the defined community, relating to the nationally identified objective specific to the issue you identified in Part I.
• Describe the target population’s incidence, prevalence, and mortality differences between the national and state level.
• Explain the community-based response to the issue, including community-based planning, needs assessments, and selection of locally identified objectives.
• Compare institutional and community leadership roles in responding to these targeted health objectives.
• Describe any economic factors and funding intervention strategies that will address the issue.
• Describe the role of social marketing in promoting public health related to your chosen issue

 

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Write a 1,750- to 2,450-word analysis of the population and resources for your health campaign

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Develop Part II of a health campaign plan. Part II focuses on assessment and planning for a health campaign.
Write a 1,750- to 2,450-word analysis of the population and resources for your health campaign. Building on the Part I submission, provide the following:
• Summarize Part I in a single paragraph as part of your introduction to create the context for Part II.
• Describe how the target population is defined at the national level and compare how these data may differ in the defined community, relating to the nationally identified objective specific to the issue you identified in Part I.
• Describe the target population’s incidence, prevalence, and mortality differences between the national and state level.
• Explain the community-based response to the issue, including community-based planning, needs assessments, and selection of locally identified objectives.
• Compare institutional and community leadership roles in responding to these targeted health objectives.
• Describe any economic factors and funding intervention strategies that will address the issue.
• Describe the role of social marketing in promoting public health related to your chosen issue

 

 

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