the moral and ethical considerations

Write a 2-3 page paper that examines the moral and ethicalconsiderations of organ conscription policiesandtheories.Scarcity of Medical Resources
For this assessment, you will continue your survey of ethical principles in health care. Especially in our contemporary world, where needs for health care outstrip available resources, we regularly face decisions about who should get which resources.
There is a serious shortage of donor organs. Need vastly outstrips supply, due not only to medical advances related to organ transplantation, but also because not enough people consent to be cadaveric donors (an organ donor who has already died). Munson (2014) points out that in the United States, approximately 10,000 patients die each year because an organ donor was not available, which is three times the number of people killed in the terrorist attacks on 9/11.
But what is an efficient and morally sound solution to this problem? The policy of presumed consent, where enacted, has scarcely increased supply, and other alternatives, such as allowing donors to sell their organs, raise strong moral objections. In light of this, some have advocated for a policy of conscription of cadaveric organs (Spital & Erin, 2002). This involves removing organs from the recently deceased without first obtaining consent of the donor or his or her family. Proponents of this policy argue that conscription would not only vastly increase the number of available organs, and hence save many lives, but that it is also more efficient and less costly than policies requiring prior consent. Finally, because with a conscription policy all people would share the burden of providing organs after death and all would stand to benefit should the need arise, the policy is fair and just.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

  • Competency 1: Articulate ethical issues in health care.
    • Articulate the moral concerns surrounding a policy of organ conscription.
    • Articulate questions about the fairness and justness of organ conscription policy.
    • Explain the relevance and significance of the concept of consent as it pertains to organ donation.
    • Evaluate alternative policies for increasing available donor organs.
  • Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals.
    • Exhibit proficiency in clear and effective academic writing skills.
  • References
    Munson, R. (2014). Intervention and reflection: Basic issues in bioethics (concise ed.). Boston, MA: Wadsworth.
    Spital, A., & Erin, C. (2002). Conscription of cadaveric organs for transplantation: Let’s at least talk about it. American Journal of Kidney Disease, 39(3), 611–615.
    Do you consider the policy of organ conscription to be morally sound?
    Write a paper that answers this question, defending that answer with cogent moral reasoning and supporting your view with ethical theories or moral principles you take to be most relevant to the issue. In addition to reviewing the suggested resources, you are encouraged to locate additional resources in the school  library, your public library, or authoritative online sites to provide additional support for your viewpoint. Be sure to weave and cite the resources throughout your work.
    In your paper, address the following:
  • On what grounds could one argue that consent is not ethically required for conscription of cadaveric organs? And on what grounds could one argue that consent is required?
  • Is the policy truly just and fair, as supporters claim? Explain.
  • Do you consider one of the alternative policies for increasing available donor organs that Munson discusses to be preferable to conscription? Explain why or why not.
  • Submission Requirements
  • Written communication: Written communication is free of errors that detract from the overall message.
  • APA formatting: Resources and citations are formatted according to current APA style and formatting guidelines.
  • Length: 2–3 typed, double-spaced pages.
  • Font and font size: Times New Roman, 12 point.

first step towards adequate pain relief

first step towards adequate pain relief. It has two major problems: first, the subjective nature of the pain experience; and second, the lack of quantifiable measurements (McGuire 1992, Watt-Watson et al. 2000). Most prostatectomy patients are old, and as such may need more time to assess their pain (Simons & Malabar 1995, Melzack & Wall 1996). Older patients may receive more attention and pain interventions than younger patients, and evidence suggests that men might be given more medication than women (Simons & Malabar 1995, Yorke et al. 2004).

Information and other support may help patients evaluate their experiences of pain, but the main difficulty is that different people respond to pain in different ways. Hence, direct comparisons are therefore impossible, even where the underlying cause of pain is the same. Verbal assessments may also be misinterpreted (McGuire 1992, Ferguson et al. 1997).

Pain measurement tools

The use of a simple, valid and reliable pain assessment tool in the clinical practice would standardize assessment and contribute to more effective management and evaluation of pain (Taylor 1997). The most common tools are the visual analogue scale (VAS) and 0–10 numeric rating scale (NRS) (Jensen et al. 1986, Carpenter & Brockopp 1995, Coll et al. 2004b), as well as the verbal rating scale (VRS) or verbal descriptor scale (VDS) (Bondestam et al. 1987). The quantitative analysis of the results from these scales is problematic, because it yields a classification where pain is slotted into given categories that are defined in advance. However, the boundary lines between the different categories have not been verified, which complicates the task of interpreting the results (Chapman et al. 1985, Bondestam et al. 1987).

Although VAS provides only a unidimensional measure of pain, its construct validity is good and it can adequately distinguish between minimal, regular and maximal pain (Price et al. 1983). Carpenter and Brockopp (1995) concluded that patients have a tendency to use the middle parts or the ends of the scales. The VAS is easy to complete: it has limited use if the patient is too ill to point at the line, if he or she is unable to conceptualize pain in an abstract fashion along a line, or if the patient is visually, cognitively or physically impaired (Kremer et al. 1981, Chapman et al. 1985, Paice & Cohen 1997). The VAS may also be designed as a red wedge that increases in size towards the right. This has been found to simplify and clarify the use of the tool (Zalon 1993).

Problems have also been reported in the use of NRS, but it is still a useful tool for the purposes of assessing the intensity of acute pain (Bondestam et al. 1987, Scott 1994, Heid & Jage 2002). The NRS offers more alternatives than VDS, but less than VAS (Paice & Cohen 1997). The problem with NRS is that some people have difficulty describing the intensity of pain by reference to numbers (Scott 1994, Ferguson et al. 1997, De Rond et al. 1999).

Several studies on cancer patients have proven VAS, NRS and VRS as valid tools (De Conno et al. 1994, Paice & Cohen 1997), but it was also found that patients did not rate their pain in a mathematically equivalent way – VAS ratings were lower than NRS ratings. On the other hand, many studies in cancer patients have reported positive correlations between estimations based on VAS and NRS (Carpenter & Brockopp 1995, Paice & Cohen 1997).

The reliability of VAS and NRS has not been widely tested in surgical patients, and there are no earlier studies set in a recovery room context. The NRS has been used in an

Australian intensive care unit to measure pain intensity and pain distress (Ferguson et al. 1997), as well as in the clinical area of an emergency department (Puntillo et al. 1999). Sjo¨stro¨m et al. (2000) investigated the pain assessments of critical care nurses (n ¼ 30), physicians (n ¼ 30) and postsurgical patients (n ¼ 180) using VAS. Patients’ expressions seem to be associated with the fact that nurses have underestimated their pain.

In the recovery room, where patients are often tired and unwell, it is important that pain assessment is a quick and easy process with simple and sensitive measures (Jenkinson et al. 1995), especially with the elderly (Closs 1996). Analgesics and anaesthetics may influence patients’ awareness and their ability to assess pain after operation (Bowman 1994). With VAS and NRS pain assessment can easily be repeated, allowing for accurate estimates of the effectiveness of pain management (Scott 1994).

Nurses’ assessments

Nurses are especially inclined to underestimate severe pain (Ketovuori 1987, Zalon 1993, Dalpra & Zampieron 1998, Puntillo et al. 1999) or to overestimate mild pain (Zalon 1993). Nurses have difficulty estimating patients’ pain adequately; mistakes can also occur if patients are asleep (Schaufheuthle et al. 2001). Nurses draw their conclusions on the basis of observations and measurements of physiological features such as blood pressure or pulse (McGuire 1992, Salantera¨ et al. 1999), which, however, are unreliable indicators of pain because they are influenced by a large number of other factors (Closs 1996). Nurses’ overestimations tend to increase if a patient has a rising blood pressure and pulse (Teske et al. 1983, Bondestam et al. 1987).

The study


The aim of the study was to explore the congruency of patients’ and nurses’ pain assessments and the possibility of measuring pain using a pain tool in the recovery room.


A descriptive comparative cross-sectional study design was used. A convenience sample of 45 consecutive prostatectomy patients was chosen and then pain was evaluated six times consecutively.

Premedication and anaesthesia were standardized, and the surgical procedure was performed under general and epidural anaesthesia, which effectively reduce dynamic pain (Heid & Jage 2002). These were based on the following criteria:

• Intervertebral epidural anaesthesia Th 12 L1.

• Start dose was bupivacaine 12Æ5 mg epidurally.

• After 1 h from the start of the procedure epidural infusion was started: fentanyl 0Æ5 mg, bupivacaine 50 mg and physiological saline 20 mL.

• The same pain medication continuing at 3–5 mL/h during and after procedure.

• Combined anaesthesia was induced using: fentanyl 2 mg/ kg, propofol 2 mg/kg, rocuronium 1 mg/kg, nitrous oxide and desflurane.

• Minimum alveolar concentration (MAC) was kept over one and patients received no further relaxants (during the procedure). As the epidural analgesia was effective patients were given only 0Æ6 mg fentanyl, on average, during the operation.


A convenience sample of 45 consecutive prostatectomy patients during the year 2001 was enrolled. Power analysis was not carried out because there are no previous studies conducted in the recovery room. The mean age of patients was 62 years, range 47–73 years. The criteria of the American Society of Anaesthesiologists (ASA) were used in classifying patients into groups according to their physical condition. In this classification, a healthy patient is ASA I, one with mild systemic disease is ASA II and one with severe systemic disease is ASA III. ASA IV refers to a patient with life-threatening severe systemic disease and ASA V to a moribund patient. The majority of patients in this study were in ASA class 2 (f ¼ 40); a few were in class 3 (f ¼ 4) or 4 (f ¼ 1). The operation lasted from 2 to 4 h.

Data collection

Postoperative pain was studied with three pain intensity scales being used by patients: a red-wedge version of VAS; NRS scale (0–10); and the patients’ verbal expressions, VRS. On the VAS scale, the two anchor points represented ‘no pain’ and ‘worst imaginable pain’. Patients’ verbal descriptions were classified into four categories: no pain, moderate pain, intense pain and intolerable 

paediatric patient that was presented



Select a paediatric patient that  presented to the clinic, who you examined as a nurse practitioner/ providerduring the last 4 weeks. With this patient inmind,address the following in a SOAP Note:


•Subjective: What details did the patient or parent provide regarding the personal and medical history? Include any discrepancies between the details provided by the child and details provided by the parent, as well as possible reasons for these discrepancies.


•Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any growth and development or psychosocial issues.


•Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?


•Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters to the clinic , as well as a rationale for this treatment and management plan.


•Reflection notes: What was your “aha” moment? What would you do differently in a similar patient evaluation?




•Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier.


◦Chapter 34, “Genitourinary Disorders” (pp. 809–843)


◦Chapter 35, “Gynecologic Disorders” (pp. 844–876)




American Academy of Pediatrics, Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. (2011). Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics, 128(3), 595–610. Retrieved from


•Cox, A. M., Patel, H., & Gelister, J. (2012). Testicular torsion. British Journal of Hospital Medicine, 73(3), C34–C36. Retrieved from the Walden Library Databases.




19-year-old college student


Organization and Control of Neural Function

Riku is a 19-year-old college student. One morning, after a long night of studying, Riku woke up and made himself a hot cupofcoffee and toast.

Much to his surprise, when he brought the cup to his mouth to drink, the coffee spilt onto the table. Riku went to the bathroom mirror and noticed the left side of his face seemed to droop. He quickly got dressed and ran to the medical clinic on the college campus. As he ran, his left eye began to feel scratchy and dry, but he could not blink in response. The physician at the clinic listened to Riku’s story and then did a careful cranial nerve examination. She concluded that Riku had Bell palsy, an inflammatory condition of the facial nerve most likely caused by a virus.

  1. What are an afferent neuron and efferent neuron? What are efferent components of the facial nerve and their actions?
  2. Under certain circumstances, axons in the peripheral nervous system can regenerate after sustaining damage. Why is axonal regeneration in the central nervous system much less likely?
  3. At a healthy myoneural junction, acetylcholine is responsible for stimulating muscle activity. What mechanisms are in place to prevent the continuous stimulation of a muscle fiber after the neurotransmitter is released from the presynaptic membrane?

Case Study 2

Somatosensory Function, Pain, and Headache

Ramandeep is an active 23-year-old. She works as a part-time nurse during the day and is studying for a postgraduate certificate in the evening. Ramandeep started to wear a bite plate at night after she began to experience jaw pain and headaches. Sometimes the pain radiated to her ear, and she would apply a hot water bottle to it to ease the discomfort. Her husband mentioned to her that he heard her grinding her teeth at night while she was sleeping. She knew then that her headaches might be from temporomandibular joint syndrome, and she went to her dentist to confirm her thoughts. In addition to the bite plate, the dentist also recommended she should continue with the application of heat, use NSAIDs when needed, and incorporate regular relaxation exercises throughout her stressful days.

  1. What effect does heat have on nociceptors so that it makes a good nonpharmacologic treatment for pain?
  2. Heat and cold treatment are both hypothesized to have an effect on the release of endogenous opioids. What are these chemicals, and why are they hypothesized to be beneficial in the body?
  3. Using your knowledge of physiology, how do NSAID analgesics function in the management of pain?

Case Study 3

Disorders of Motor Function

John is 63 years old and receives home care by an occupational therapist twice a week. His therapist is currently working with John on maintaining joint flexibility and balance. John demonstrates resting tremor, so his therapist is also working on adaptive techniques, so John can continue to use his hands to write, use the computer, and cook simple meals. John’s wife assists with his mobility and walks slowly beside him, holding his arm. Sometimes she needs to help him open his prescription bottles, so he can take his medicine, a combination of levodopa and carbidopa.

  1. What motor disease does John demonstrate? One of his signs is resting tremor. What is the difference between a resting tremor and an intention tremor?
  2. What is the advantage of combining levodopa with carbidopa? What is the benefit of anticholinergic drugs in the management of Parkinson disease?
  3. Parkinson disease involves the destruction of the substantia nigra and the nigrostriatal pathway. Where are these structures anatomically?
  4. The patient with Parkinson disease typically presents with a masklike facial expression. Why does he or she have a masklike facial expression? How are the eyes, mouth, and laryngopharynx affected by this disease?

Case Study 4

Disorders of Brain Function

Bonnie is a 70-year-old woman who lives alone. One evening, she felt light-headed and dizzy. When her head began to ache, she decided to take an analgesic and go to bed early. The following morning, upon awakening, she was unable to move the bed sheets with her right arm. At this point she was experiencing tingling sensations in her limbs, and she had difficulty keeping her balance. She dialed 911 for help, and by the time the ambulance arrived, she was confused and unable to articulate her words although she knew what information he was asking of her. In the hospital, she was examined and treated for ischemic stroke.

  1. Stroke, or brain attack, involves brain tissue injury. Describe ischemic penumbra and what factors contribute to the survival of the neurons involved. What happens if the cells of the penumbra are unable to be preserved?
  2. Compare and contrast hypoxia and ischemia. What condition is more dangerous to the brain? Explain your answer.
  3. Knowing what you do about the effects of ischemia on the brain, why would someone with ischemic stroke develop cerebral edema?
  4. What type of aphasia was Bonnie exhibiting when talking to her caregivers? Explain your answer.

Case Study 5

Sleep and Sleep Disorders

Jessica is six years old. Her parents recently saw her pediatrician because they were concerned about the sleeping difficulties Jessica has been having. Often she would scream out loud in her sleep. Her parents would rush to her room and find her sitting upright in bed, panting heavily in a state of panic. Jessica would not respond to her parent’s words of consolation, and the next morning she would have no memory of the incident at all. Her parents were worried about the anxiety their daughter was experiencing and asked the pediatrician what they could do about her nightmares. The pediatrician explained Jessica was likely suffering from sleep terrors and carefully described what that meant.

  1. What are the similarities and differences between nightmares and sleep terrors?
  2. What are the characteristics of motor, sensory, and autonomic function during REM sleep? What is thought to be the importance of this stage of sleep?
  3. Jessica’s pediatrician said that the careful management of sleep hygiene may help to decrease the incidence of her sleep terrors. What is included in an overview of the general features that demonstrate good sleep hygiene?

Case Study 6

Disorders of Thought, Emotion, and Memory

Ella is 88 years old and was living at home until very recently. Her children, who visited her regularly, noticed she was becoming more forgetful. At first, she mislaid objects, and then she began to forget her doctor’s appointments. With time, her personality changed and she became withdrawn. At home she would forget to turn off the stove or leave the kettle on until it boiled dry. After seeking advice from a gerontologist and social worker, Ella’s children placed her in a nursing home with a unit equipped for patients with Alzheimer disease.

  1. What is dementia? Why is Alzheimer disease based on a “diagnosis of exclusion”?
  2. What are the macroscopic and microscopic features of the brain that are typical in Alzheimer disease?
  3. One of Ella’s children brought her a new pair of slippers to wear in the nursing home. A minute after she received them, Ella could not remember the exchange and asked what they were doing on her bed. What part of the brain has largely been affected to produce this behavior, and what is the pathophysiology involved?

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Home.


leadership by examining a policy

Policy Analysis Paper (30% of final grade)

Due, Sunday, 12/03/17

Policy Analysis Paper Guidelines

Purpose: To investigate & integrate knowledge of advanced nursing practice, scholarly inquiry, & leadership by examining a policy at the level of clinical practice, health care systems, or public/social health policy. Students are to submit a paperbetween 7-10 pages long excluding title page and referencepages. Paper must be organized according to the guidelinesbelow and should include all the identified sections as required. Paper must be completed in APA format and contain current scholarly sources dated from 2010 until current. The following may be selected as topics for this paper:

-Food and drug regulation

-Abortion clinic access

-Planned Parenthood funding

-Correctional health

-LGBTQ health

-Tobacco regulation

-Veterans health



-Prescription drugs

-Managed health care

-Clean Air act

-Clean Water act

-NIH reauthorization

-Head Start

-Healthcare reform

Has to have

introduccion 10 points

background 10 points

analysis 30 points

recomendations 20points

discussion 20 points

conclusion 5 points

referents 5 points


A Sample Paper has been attached above for students to view an example of how this written assignment should be completed and organized. 

the role of organisational development



Describe the role of organisational development in contemporary organisations. How doesorganisationaldevelopment help organisationspreparefororimplement change? Provide anexamplefromyourorganisation.


What environmental forces drive organization development in your field or industry? What are the steps successful organizations take when responding to change? Have you experienced forces of change in your work environment? How did the changes affect your organization?



1. The Heart of Change: Real-Life Stories of How People Change Their Organizations

Read the Introduction and Chapter/Step 1 in The Heart of Change: Real-Life Stories of How People Change Their Organizations.

e-Library Resource

1. Chapter 2: Successful Change and the Force That Drives It 

Read “Chapter 2: Successful Change and the Force That Drives It,” by Kotter, from the online eBook, Leading Change (1996).^B&bookid=3479&chunkid=338027656&rowid=17

2. Chapter Twenty Two: Managing Change

Read “Chapter Twenty Two: Managing Change,” by Lewthwaite, from the online eBook, Everything You Need for an NVQ in Management (2000). 

3. Empirical Development of a Model of Performance Drivers in Organizational Change Projects

Read, “Empirical Development of a Model of Performance Drivers in Organizational Change Projects,” by Parry et al., from Journal of Change Management (2014). 

week history of itchy eyes

Janet, a 20 year-old college student, is experiencing a five-week history of itchy eyes and nasal congestion She also complains with watery nasal discharge. She also complains of a“tickling” cough, especially at night, and shehashadepisodes of repetitive sneezing. Janetgetsfrequent“colds” every spring and fall.

Physical Examination

Vital Signs: Temp, 98.8; BP 110/68; Pulse 72; Respirations 18

Skin: Flaking erythematous rash on the flexor surfaces of both arms

Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red, irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous, with clear postnasal drainage

Lungs: Clear to auscultation and percussion

Discussion Questions:
1. Provide three differential diagnoses based on Janet’s subjective and objective data and discuss your reasoning for each.

2. What additional history questions would be useful in your evaluation of Janet?

3. Discuss the pathophysiological process of your primary diagnosis.

4. Differentiate the types of hypersensitivity mechanisms.

5. As per your analysis, what type of hypersensitivity reaction is Janet experiencing?

Two pages minimun.

Informatics in Systems and Implementation

Assignment: The Role of the Nurse Informatics in Systems Development and Implementation

Assume you are a nurse manager on a unit where a new nursing documentation system is to be implemented. You want to ensure that the system will be usable and acceptable for the nurses impacted. You realize a nurse leader must be on the implementation team.

To Prepare:

  • Review the steps of the Systems Development Life Cycle (SDLC) and reflect on the scenario presented.
  • Consider the benefits and challenges associated with involving a nurse leader on an implementation team for health information technology.

The Assignment: (2-3 pages)

In preparation of filling this role, develop a 2- to 3-page role description for a graduate-level nurse to guide his/her participation on the implementation team. The role description should be based on the SDLC stages and tasks and should clearly define how this individual will participate in and impact each of the following steps:

  • Planning and requirements definition
  • Analysis
  • Design of the new system
  • Implementation
  • Post-implementation support

Healthcare organisation seek to optimise

Healthcare organisation continually seek to optimise healthcare performance. For years, this approach was a three pronged one known as the Triple Aim, with effortsfocusedonimproved population health, enhancedpatienexperience,andlower healthcare costs.

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions.

To Prepare:

  • Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.
  • Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
  • Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.

To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

  • Patient experience
  • Population health
  • Costs
  • Work life of healthcare providers