Nursing/Health Care: Ethical Concern Narrative

Assignment: Ethical Concerns
As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?
In this Assignment, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.
Scenario 1:
The parents of a 5-year-old boy have accompanied their son for his required physical examination before starting kindergarten. His parents are opposed to him receiving any vaccines.
Scenario 2:
A 49-year-old woman with advanced stage cancer has been admitted to the emergency room with cardiac arrest. Her husband and one of her children accompanied the ambulance.
Scenario 3:
A 27-year-old man with Crohn’s disease has been admitted to the emergency room with an extreme flare-up of his condition. He explains that he has not been able to afford his medications for the last few months and is concerned about the costs he may incur for treatment.
Scenario 4:
A single mother has accompanied her two daughters, aged 15 and 13, to a women’s health clinic and has requested that the girls receive a pelvic examination and be put on birth control. The girls have consented to the exam but seem unsettled.
Scenario 5:
A 17-year-old boy has come in for a check-up after a head injury during a football game. He has indicated that he would like to be able to play in the next game, which is in 3 days.
Scenario 6:
A 12-year-old girl has come in for a routine check-up and has not yet received the HPV vaccine. Her family is very religious and believes that the vaccine would encourage premarital sexual activity.
Scenario 7:
A 57-year-old man who was diagnosed with motor neuron disease 2 years ago is experiencing a rapid decline in his condition. He prefers to be admitted to the in-patient unit at a hospice to receive end-of-life care, but his wife wants him to remain at home.
To prepare:
• Select one scenarios, and reflect on the material presented throughout this course.
• What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
• Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.
To complete:
Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least 3 different references from current evidence based literature.
Rubric Detail

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Name: NURS_6512_Week_11_Assignment_Rubric

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Excellent Good Fair Poor
Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking. 27 (27%) - 30 (30%)
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics. 24 (24%) - 26 (26%)
Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics. 21 (21%) - 23 (23%)
Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed. 0 (0%) - 20 (20%)
Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.
Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student's ability to:
Understand and interpret the assignment's key concepts. 27 (27%) - 30 (30%)
Demonstrates the ability to critically appraise and intellectually explore key concepts. 24 (24%) - 26 (26%)
Demonstrates a clear understanding of key concepts. 21 (21%) - 23 (23%)
Shows some degree of understanding of key concepts. 0 (0%) - 20 (20%)
Shows a lack of understanding of key concepts, deviates from topics.
Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student's ability to:
Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources. 18 (18%) - 20 (20%)
Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to support point of view. 16 (16%) - 17 (17%)
Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view. 14 (14%) - 15 (15%)
Minimally includes and integrates specific information from 2-3 resources to support major points and point of view. 0 (0%) - 13 (13%)
Includes and integrates specific information from 0 to 1 resource to support major points and point of view.
Written Expression and Formatting
Paragraph/Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused--neither long and rambling nor short and lacking substance. 9 (9%) - 10 (10%)
Paragraphs/Sentences follow writing standards for structure, flow, continuity and clarity 8 (8%) - 8 (8%)
Paragraphs/sentences follow writing standards for structure, flow, continuity and clarity 80% of the time. 7 (7%) - 7 (7%)
Paragraphs/sentences follow writing standards for structure, flow, continuity and clarity 60%- 79% of the time. 0 (0%) - 6 (6%)
Paragraphs/sentences follow writing standards for structure, flow, continuity and clarity < 60% of the time.
Written Expression and Formatting
English writing standards: Correct grammar, mechanics, and proper punctuation. 5 (5%) - 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors. 3 (3%) - 4 (4%)
Contains a few (1-2) grammar, spelling, and punctuation errors. 2 (2%) - 2 (2%)
Contains several (3-4) grammar, spelling, and punctuation errors. 0 (0%) - 1 (1%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting
The assignment follows parenthetical/in-text citations, and at least 3 evidenced based references are listed. 5 (5%) - 5 (5%)
Contains parenthetical/in-text citations and at least 3 evidenced based references are listed. 3 (3%) - 4 (4%)
Contains parenthetical/in-text citations and at least 2 evidenced based references are listed 2 (2%) - 2 (2%)
Contains parenthetical/in-text citations and at least 1 evidenced based reference is listed 0 (0%) - 1 (1%)
Contains no parenthetical/in-text citations and 0 evidenced based references listed.
Total Points: 100
Name: NURS_6512_Week_11_Assignment_Rubric
Learning Resources
Note: To access this week's required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel's guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
• Chapter 23, “Sports Participation Evaluation” (pp. 581-593)

In this chapter, the authors describe the process of a sports participation evaluation. The chapter also states the most common conditions encountered in a sports participation evaluation.

• Chapter 24, “Putting It All Together” (pp. 594-609)

In this chapter, the authors tie together the concepts introduced in previous chapters. In particular, the chapter has a strong emphasis on the patient-caregiver relationship.

• Review of Chapter 16, “Breasts and Axillae” (pp. 350-369)

• Review of Chapter 18, “Female Genitalia” (pp. 416-465)
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
• Chapter 12, "Discharging Patients from the Hospital" (pp. 285-293)
Tingle, J. & Cribb, A. (2014). Nursing law and ethics (4th ed.). Chichester, UK: Wiley Blackwell. Retrieved from http://site(dot)ebrary(dot)com/lib/waldenu/reader.action?docID=10774345
Furman, C. D., Earnshaw, L. A., Farrer, L. A. (2014). A case of inappropriate apolipoprotein E testing in Alzheimer’s disease due to lack of an informed consent discussion. American Journal of Alzheimer’s Disease & Other Dementias, 29(7), 590-595. doi:10.1177/1533317514525829.
Retrieved from the Walden Library Databases.
Navarro-Illana, P., Aznar, J., & Díez-Domingo, J. (2014). Ethical considerations of universal vaccination against human papilloma virus. BMC Medical Ethics, 15(29). doi:10.1186/1472-6939-15-29 Retrieved from http://www(dot)biomedcentral(dot)com/1472-6939/15/29
Maron, B. J., Friedman, R. A., & Caplan, A. (2015). Ethics of preparticipation cardiovascular screening for athletes. Nature Reviews Cardiology, 12(6), 375–378. doi:10.1038/nrcardio.2015.21 Retrieved from the Walden Library Databases.
May, K. H., Marshall, D. L., Burns, T. G., Popoli, D. M. & Polikandriotis, J. A. (2014). Pediatric sports specific return to play guidelines following concussion. The International Journal of Sports Physical Therapy, 9(2), 242–255. PMCID: PMC4004129. Retrieved from http://www(dot)ncbi(dot)nlm(dot)nih(dot)gov/pmc/articles/PMC4004129/
American Academy of Pediatrics. (2008). Recommendations for preventative pediatric health care (periodicity schedule).
Retrieved from https://www(dot)harmonyhpi(dot)com/WCAssets/illinois/assets/IL_MedicaidProviderManual_PEM_AdultPHGsForProviders.pdf

This resource provides recommendations for preventative pediatric health care from infancy through adolescence. The periodicity schedule covers a variety of areas from health history to measurements, developmental/behavioral screenings, physical exams, procedural screenings, and oral health.
Rourke, L., Leduc, D., & Rourke, J. (2011). Rourke Baby Record. Retrieved from http://rourkebabyrecord(dot)ca/

This website provides information on the Rourke Baby Record (RBR). The RBR supplies guidelines on growth and nutrition, developmental surveillance, physical exam parameters, and immunizations for well-baby and child care.