1. This is a theoretical case taken from VHA Intensive Ethics Advisory Committee Training, 1998, as presented by Arthur R. Derse MD, JD. An 87-year-old woman widowed for six years, who is otherwise healthy, was visiting another city and abruptly became ill. She was seen in the emergency department of the local VA and admitted to the on-call physician. The on-call physician (who has not previously seen her) made the diagnosis of bowel obstruction arid made arrangements for a surgeon to evaluate her. The surgeon recommended surgery and obtained her consent for surgery. The surgeon expects an uneventful recovery. She is told that she will be on a ventilator for a short time after surgery. The patient tells the surgeon that is OK as long as it is for a short time. She tells the surgeon that she does not want to be dependent upon machines. She was asked upon admission whether she had an advance directive. She replied that she has a living will and a power of attorney for health care which names her daughter (who does not live in the area) as her health care agent. The patient undergoes surgery, which is successful in treating the underlying problem and does not show any malignant causes, but in the recovery room she has a cardiopulmonary arrest and is resuscitated. She is transferred to the ICU in the care of the on-call physician. The physician attempts to wean her gradually from the ventilator, but this is unsuccessful. Three days later, she has regained consciousness but is still intubated. Though she cannot speak because of the ventilator, she is able to write and asks that the tube be removed. The attending physician tells her that she is dependent upon the ventilator and the patient needs to remain on the ventilator until she can breathe on her own. She writes that she understands that she may die, but she does not want to be on machines. Her only children -- a daughter and son -- - have arrived. She repeats her wish to them that she wants the tube removed. She writes to her daughter that "I don't want to die, but we all have to die sometime, and I don't want to have to live on a machine. I know that whatever the outcome, God will take care of me." Her daughter tells the physician that her mother is adamant that she be off of machines and she respects her mother's wishes, even if she cannot breathe on her own. She says this is consistent with her previously expressed wishes and her religious beliefs. Her son tells the physician that he disagrees with his sister -- since his mother does not have a terminal condition, he can not see why she should not be forced to put up with the ventilator until she can be weaned from it. He feels that she is being shortsighted, and she will be thankful to have been kept on the ventilator when she is finally able to be weaned. Describe the criteria for giving "legal" consent. Were all elements met in this case? In other words, did the patient demonstrate decision-making capacity? Explain. (Minimum of 1 page including in-text citations and references in proper APA format)2. Based on case study above: Is this patient requesting to be euthanized or for her physician to assist in her suicide (PAS)? In your answer describe how the two terms differ. (Minimum of 2 paragraphs including in-text citations and references in proper APA format)3. A managed care group may want to market their organization as being "the best" or "a leader" in providing certain services/ treatment. How can this type or marketing effect quality of care and utilization of services, hence costs? (Minimum of 2 paragraphs including in-text citations and references in proper APA format)4. According to Darr, MCO enrollees can be described as either light/moderate users or heavy users. What are some of the strategies that management uses to turn "heavy" users into light/ moderate users? In your personal opinion, what positives or negatives may result? (Minimum of 2 paragraphs including in-text citations and references in proper APA format)5. Describe the constraints/challenges that physicians experience as being service providers affiliated with a Managed Care Organization. (Minimum 2 paragraphs including in-text citations and references in proper APA format)6. Give a very brief "real-life" example/instance where drugs/ medical treatment/services were microallocated. And give a "real-life" example of macroallocation. (Do not include the examples provided in the text.) (Minimum 1 paragraph including in-text citations and references in proper APA format)7. Read the case of Karen Ann Quinlan (p. 248-249). Explain why this is a case involving medical futility. (Include in your an answer the definition of medical futility). Darr(2011, p. 218) writes, "[the] futility theory has quantitative and qualitative aspects." What is meant by these terms? Present arguments for each as it relates to this case. (Minimum 2 paragraphs including in-text citations and references in proper APA format) Reference: Darr, K. (2011). Ethics in Health Services Management. (Fifth Edition). Baltimore, MD: Health Professions Press, Inc.

Download and use the required PPE Worksheet (Links to an external site.). Review the information provided in our library of how to search for journal articles here (Links to an external site.). Review the information provided in our library of how to locate and copy a journal permalink (Links to an external site.). You are required to complete the worksheet using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the ".docx" format. Do NOT save as Word Pad. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.edu (Links to an external site.). Click on the envelope at the top of the page. Complete each section of the Problem/PICOT/Evidence (PPE) Worksheet. For the Clinical PICOT Question,use the NR439 Guide for writing PICOT Questions and Examples (Links to an external site.). Use one of the templates/guides to write your Clinical PICOT Question using all of the PICOT elements. Be sure to include the PICOT letters in your question. Be sure to use the rubric to make certain you are meeting all grading criteria of the PPE Worksheet. Submit the completed PPE Worksheet on the Week 3 Assignment page. Students, A short tutorial with tips for completing the Week 3 Problem/PICOT/Evidence Search (PPE) worksheet assignment may be viewed here. https://cdnapisec.kaltura.com/index.php/extwidget/...

In a 5-7 page written assessment, determine how health care technology, coordination of care, and community resources can be applied to address the patient, family, or population problem you've defined. In addition, plan to spend approximately 2 direct practicum hours exploring these aspects of the problem with the patient, family, or group you've chosen to work with and, if desired, consulting with subject matter and industry experts. Report on your experiences during the second 2 hours of your practicum.As a baccalaureate-prepared nurse, you’ll be positioned to maximize the use of technology to achieve positive patient outcomes and improve organizational effectiveness. Providing holistic coordination of patient care across the entire health care continuum and leveraging community resource services can lead both to positive patient outcomes and to organizational improvements.Demonstration of ProficiencyBy successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:Competency 4: Apply health information and patient care technology to improve patient and systems outcomes.Analyze the impact of health care technology on a patient, family, or population problem.Competency 5: Analyze the impact of health policy on quality and cost of care.Analyze state board nursing practice standards and/or organizational or governmental policies associated with health technology, care coordination, and community resources.Competency 6: Collaborate interprofessionally to improve patient and population outcomes.Explain how care coordination and the utilization of community resources can be used to address a patient, family, or population problem.Competency 8: Integrate professional standards and values into practice.Support main points, assertions, arguments, conclusions, or recommendations with relevant and credible evidence.Apply APA style and formatting to scholarly writing.PreparationIn this assessment, you’ll determine how health care technology, coordination of care, and community resources can be applied to address the health problem you’ve defined. Plan to spend at least 2 direct practicum hours working with the same patient, family, or group. During this time, you may also choose to consult with subject matter and industry experts.To prepare for the assessment:Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete and how it will be assessed.Conduct sufficient research of the scholarly and professional literature to inform your assessment and meet scholarly expectations for supporting evidence.Review the Practicum Focus Sheet: Assessment 3 [PDF], which provides guidance for conducting this portion of your practicum.Note: Remember that you can submit all, or a portion of, your draft assessment to Smarthinking for feedback, before you submit the final version. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.InstructionsComplete this assessment in two parts.Part 1Determine how health care technology, the coordination of care, and the use of community resources can be applied to address the patient, family, or population problem you’ve defined. Plan to spend at least 2 practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice. Use the Practicum Focus Sheet: Assessment 3 [PDF] provided for this assessment to guide your work and interpersonal interactions.Part 2Report on your experiences during the second 2 hours of your practicum.Whom did you meet with?What did you learn from them?Comment on the evidence-based practice (EBP) documents or websites you reviewed.What did you learn from that review?Share the process and experience of exploring the effect of the problem on the quality of care, patient safety, and costs to the system and individual.Did your plan to address the problem change, based upon your experiences?What surprised you, or was of particular interest to you, and why?CORE ELMSUpdate the total number of hours on the NURS-FPX4900 Volunteer Experience Form in CORE ELMS.RequirementsThe assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.Analyze the impact of health care technology on the patient, family, or population problem.Cite evidence from the literature that addresses the advantages and disadvantages of specific technologies, including research studies that present opposing views.Determine whether the evidence is consistent with technology use you see in your nursing practice.Identify potential barriers and costs associated with the use of specific technologies and how those technologies are applied within the context of this problem.Explain how care coordination and the utilization of community resources can be used to address the patient, family, or population problem.Cite evidence from the literature that addresses the benefits of care coordination and the utilization of community resources, including research studies that present opposing views.Determine whether the evidence is consistent with how you see care coordination and community resources used in your nursing practice.Identify barriers to the use of care coordination and community resources in the context of this problem.Analyze state board nursing practice standards and/or organizational or governmental policies associated with health care technology, care coordination, and community resources.Explain how these standards or policies will guide your actions in applying technology, care coordination, and community resources to address care quality, patient safety, and costs to the system and individual.Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of technology, care coordination, and community resources.Explain how nursing ethics will inform your approach to addressing the problem through the use of applied technology, care coordination, and community resources.Support main points, assertions, arguments, conclusions, or recommendations with relevant and credible evidence.Apply APA style and formatting to scholarly writing.Additional RequirementsFormat: Format your paper using APA style. Use the APA Style Paper Template. An APA Style Paper Tutorial is also provided to help you in writing and formatting your paper. Be sure to include:A title page and reference page. An abstract is not required.A running head on all pages.Appropriate section headings.Length: Your paper should be approximately 5–7 pages in length, not including the reference page.Supporting evidence: Cite at least five sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.Proofreading: Proofread your paper, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on its substance.