1.Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).

1.Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).

HPI:

Ms. Susan Johnston is a 60 year old female that presented to the clinic with complaints of intermittent chest pain that has been occurring for the last 3 months on exertion. She has a history of hyperlipidemia, hypertension and a family history of Diabetes and cardiac disease. At the present time she is non-compliant with her current medication regime of lisinopril 20mg, hydrochlorothiazide 25mg and occasional aspirin. 

Ms. Johnston states that her chest pain is in the “middle of her chest” and says her pain level can be 6/10 on the pain scale at its worst. She states that the discomfort occurs when she is “active” climbing stairs and is relieved by rest. Ms. Johnston describes her pain as “burning at times and sometimes tingling” but also stated “it always goes away”. She did state that she has some shortness of breath with the occurrence.

She denies any symptoms of dizziness or passing out. Also denies any radiation of pain to the neck, jaw or arm. She has not been woken by the pain and has no nausea or vomiting during or after pain onset.

Describe the physical exam and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not? 

 The physical exam to be used on Ms. Johnston includes a full head to toe assessment which showed no abnormalities besides obesity and hypertension.  An EKG was also completed which showed normal sinus rhythm. Labs were drawing including a CBC, TSH, basic metabolic panel, and a fasting lipid panel. CBC allows us to get a foundation of the hemodynamic of her system and check for signs ischemia. By drawing a TSH we can check for possible thyroid dysfunctions that may be contributing to her aliments such as her weight gain. With the lipid panel we can assess the risk to Ms. Johnston for coronary artery disease 

After receiving the Lab results back it was noted that her ASCVD score was at a 7.2% which increases her risk for a cardiac event. A chest xray was completed and Ms. Johnston was sent for stress test and a cardiac Cath procedure where a stent was placed. 

I feel that all the diagnostics and labs performed were appropriate. If we were do add anything possibly dopplers to make sure there are no other signs of lack of perfusion to the peripherals as well.  

What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?

During the follow up visit we would like to gauge Ms. Johnston’s compliance with her medications. Set up an appointment for 6-12 weeks to redraw the lipid panel to check for compliance (University of Michigan Medicine, 2014).We will discuss possible diet changes and safe physical activities for her to complete in order to better her health and weight.

Discussion #2

Ms. Johnston, a 60-year old patient presented with complaint of non-radiating midline chest pain, onset about 3 moths ago, intermittent in nature and lasting 2-3 minutes after the onset, described as burning with occasional tingling sensations. The patient is not endorsing any aggravating factors, associated with the complaint of this chest pain.The patient didn’t identify any specific relieving factors, stating that the chest pain is self-resolving with worst exacerbation’s pain score of 6/10.

The patient’s initial vital signs are within defined limits, with exception of blood pressure of 138/78, and 136/82 thereafter. Review of medications was performed in order to connect the findings from the physical exam to the medication efficacy. The patient endorses taking lisinopril and hydrochlorothiazide, although is still hypertensive. Family history was obtained, which helps identify the risk factors, as related to the genetic pre-disposition. Paternal family history of heart attack at age 57, which poses a risk factor when looking comprehensively at findings. Social history was obtained and the patient is a non-smoker, which decreases her associated cardiovascular risk. Also, the dietary habits were assessed with the patient shown to be obese with a BMI of 35.5 and denying following healthy diet habits. This finding created a need for associated education and dietary intervention plan. Overall, the physical assessment was within defined limits. I think that additionally, an EKG should be a standard tool of gathering data when related to any patients with complains of chest pain, arrhythmia and/or shortness of breath. In this particular case with Ms.Johnson, she also presents with multiple risk factors that just amplify the need for EKG testing.

This patient should be given a thorough education about the need for lifestyle modifications. The patient needs to follow a heart healthy diet that will help her heart function and also potentially reduce the excess weight. The patient also will need to be instructed that she may benefit from a individually tailored physical activity program and refer her to the resources available. The patient had been started on new medications, so a thorough teaching on medication regiment and medication side effects is warranted. Medication compatibility needs to be assured. The patient will benefit from a referral to cardiology for follow up, so a new evaluation later on can be conducted and see if further need for intervention is warranted. The patient needs to be given education on signs and symptoms of worsening condition, therefore prompting the patient to seek further medical care. It is important to understand that the patient will feel comfortable in received information and navigate it accordingly. Increasing healthcare literacy is paramount. Physicians must promote patient education and engagement through improvement in patients’ health literacy. Health literacy is defined as the capacity to seek, understand, and act on health information. The presumption has been that low health literacy means that physician communication is poorly understood, leading to incomplete self-health management and responsibility and incomplete health care utilization. It is the responsibility of physicians to proactively enable patients to have more accessible interactions and situations that promote health and well-being (Paterick, Patel, Tajik, & Chandrasekaran, 2017).

 
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Global Healthcare Comparison Matrix And Narrative Steatment

If you talk about a possible poor health outcome, do you believe that outcome will occur? Do you believe eye contact and personal contact should be avoided?

You would have a difficult time practicing as a nurse if you believed these to be true. But they are very real beliefs in some cultures.

Differences in cultural beliefs, subcultures, religion, ethnic customs, dietary customs, language, and a host of other factors contribute to the complex environment that surrounds global healthcare issues. Failure to understand and account for these differences can create a gulf between practitioners and the public they serve.

In this Assignment, you will examine a global health issue and consider the approach to this issue by the United States and by one other country.

To Prepare:

  • Review the World Health Organization’s (WHO) global health agenda and select one global health issue to focus on for this Assignment.
  • Select at least one additional country to compare to the U.S. for this Assignment.
  • Reflect on how the global health issue you selected is approached in the U.S. and in the additional country you selected.
  • Review and download the Global Health Comparison Matrix provided in the Resources.

The Assignment: (1- to 2-page Global Health Comparison Matrix; 1-page Plan for Social Change)

Part 1: Global Health Comparison Matrix

Focusing on the country you selected and the U.S., complete the Global Health Comparison Matrix. Be sure to address the following:

  • Consider the U.S. national/federal health policies that have been adapted for the global health issue you selected from the WHO global health agenda. Compare these policies to the additional country you selected for study.
  • Explain the strengths and weaknesses of each policy.
  • Explain how the social determinants of health may impact the global health issue you selected. Be specific and provide examples.
  • Using the WHO’s Organization’s global health agenda as well as the results of your own research, analyze how each country’s government addresses cost, quality, and access to the global health issue selected.
  • Explain how the health policy you selected might impact the health of the global population. Be specific and provide examples.
  • Explain how the health policy you selected might impact the role of the nurse in each country.
  • Explain how global health issues impact local healthcare organizations and policies in both countries. Be specific and provide examples.

Part 2: A Plan for Social Change

Reflect on the global health policy comparison and analysis you conducted in Part 1 of the Assignment and the impact that global health issues may have on the world, the U.S., your community, as well as your practice as a nurse leader.

In a 1-page response, create a plan for social change that incorporates a global perspective or lens into your local practice and role as a nurse leader.

  • Explain how you would advocate for the incorporation of a global perspective or lens into your local practice and role as a nurse leader.
  • Explain how the incorporation of a global perspective or lens might impact your local practice and role as a nurse leader.
  • Explain how the incorporation of a global perspective or lens into your local practice as a nurse leader represents and contributes to social change. Be specific and provide examples.
  • 3 to 4 References
 
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Explain the policy and how it is designed to improve cost-effectiveness and health care equity for the population. Is the policy financially sound? Why or why not? How does the policy account for any relevant ethical, legal, and political factors and the nursing perceptive one must consider when implementing it?

Select a current or proposed health care policy that is designed to improve a specific population’s access to quality, cost-effective health care. In a 4 page, include the following:

  1. Explain the policy and how it is designed to improve cost-effectiveness and health care equity for the population. Is the policy financially sound? Why or why not? How does the policy account for any relevant ethical, legal, and political factors and the nursing perceptive one must consider when implementing it?
  2. To what state, federal, global health policies or goals is this particular policy related? How well do you think the policy is designed to achieve those goals?
  3. Finally, discuss the advocacy strategies you would employ on behalf of your population to ensure they have access to the benefits of the policy. Explain, from a Christian perspective, the professional and moral obligation of advanced registered nurse to advocate for and promote health and prevent disease among diverse populations.

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

 
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Which of the following is an important reason to consume insoluble fiber?


1.  You have version A of the exam. Please mark A for question 1.

2.  Which of the following is an important reason to consume insoluble fiber?

a.    It provides digestible energy.

b.    It provides a source of energy for intestinal bacteria in humans.

c.    It facilitates the removal of solid waste by providing bulk.

d.    It inhibits the passage of stool.

e.    It supplies many water-soluble vitamins.

3.  If an individual receives federal nutrition assistance and nutrition education, and lives near a grocery store, why might he/she still suffer from food insecurity?

a.    Instability in economic or environmental climate

b.    Lack of food availability

c.    Lack of resource access

d.    Lack of utilization knowledge

e.    All of the above factors are resulting in food insecurity.

4.  Why do white breads contain minimal fiber?

a.    The process of refinement removes the bran, which contains most of a grain’s fiber.

b.    The process of refinement removes the endosperm, which contains most of a grain’s fiber.

c.    Gluten inhibits the bioavailability of fiber.

d.    Grains are poor sources of fiber.

e.    Wheat is a poor source of fiber.

5.  Which of the following is NOT a result of glucagon release?

a.    Increased blood glucose concentration

b.    Decreased blood glucose concentration

c.    Increased rate of glycogenolysis

d.    Increased rate of gluconeogenesis

e.    Increased release of glucose from liver

6.  Which of the following pieces of information MUST appear on labels of dietary supplements?

a.    Structure-function claims

b.    Nutrient content claims

c.    Disease prevention claims

d.    Disease treatment claims

e.    Suggested daily dose

7.  Why is it important to avoid consuming dietary supplements with mega-doses of micronutrients?

a.    They may exceed the Tolerable Upper Intake Level and pose risks of toxicity.

b.    They are more expensive than supplements with lower doses.

c.    They are less effective than supplements with lower doses.

d.    They are not absorbed as well as supplements with lower doses.

e.    They will be readily excreted if consumed in excess of the body’s need.

8.  Which of the following is a/are modifiable risk factor(s) for type 2 diabetes mellitus?

a.    Age greater than 45 years

b.    Family history

c.    Non-Caucasian ethnicity

d.    Low HDL

e.    All of the above are modifiable risk factors.

9.  Which of the following substances helps with digestion and absorption by emulsifying fats?

a.    Salivary amylase

b.    Hydrochloric acid

c.    Bile acids

d.    Pepsin

e.    Trypsin

10.  All of the following are functions of cholesterol EXCEPT:

a.    Precursor to bile salt

b.    Structure of cell membranes

c.    Precursor to hormones

d.    Precursor to vitamin D

e.    Energy source

11.  Heme iron is more ______ than nonheme iron. This means that a higher percentage of heme iron can be absorbed and used by the body.

a.    Competitive

b.    Bioavailable

c.    Essential

d.    Energy efficient

e.    None of the above

12.  All of the following are trace minerals EXCEPT:

a.    Iron

b.    Copper

c.    Calcium

d.    Selenium

e.    Zinc

13.  Which of the following is NOT a function of lipids in the body?

a.    Facilitate absorption of some vitamins

b.    Comprise cell membranes

c.    Store energy in adipose tissue

d.    Provide energy during fasting

e.    Provide energy during short, intense exercise

14.  Which of the following polysaccharides is not digestible?

a.    Glycogen

b.    Fiber

c.    Glucose

d.    Starch

e.    Amylase

15.  ______ blood levels of calcium cause the release of parathyroid hormone, which ______

intestinal absorption of calcium.

a.    High; stimulates

b.    Low; increases

c.    High; decreases

d.    Low; decreases

e.    Moderate; halts

16.  Which of the following is a critical function of water-soluble vitamins?

a.    Promote blood clotting

b.    Act as coenzymes to facilitate chemical reactions

c.    Act as hormones to promote bone formation

d.    Yield energy

e.    All of the above

17.  Which monosaccharides are released and absorbed after digesting milk?

a.    Sucrose, maltose, and lactose

b.    Glucose

c.    Glucose and fructose

d.    Glucose and galactose

e.    Lactose itself is a monosaccharide.

18.  Which of the following statements about triglycerides is true?

a.    They are the most abundant form of lipid in food and the body’s energy stores.

b.    They are components of cell membranes.

c.    They cannot be broken down to release free fatty acids.

d.    They always contain trans bonds.

e.    They always contain double bonds.

19.  Which of the following statements regarding niacin deficiency is true?

a.    It is associated with diets low in fruits and vegetables.

b.    It is associated with corn (maize)-based diets.

c.    It cannot be supplemented with fortified or enriched foods.

d.    It is never fatal.

e.    It may result in beri-beri.

20.  What is the relationship between vitamin B6 and amino acids?

a.    It can be produced from certain essential amino acids.

b.    It can be produced from certain non-essential amino acids.

c.    It facilitates transamination to produce non-essential amino acids.

d.    It prevents the production of neurotransmitters from amino acids.

e.    It is not involved in amino acid synthesis.

21.  Which of the following is/are (a) symptom(s) of toxicity from excessive intake of iron supplements?

a.    Constipation

b.    Nausea

c.    Anemia

d.    Both a and b

e.    All of the above

22.  Although necessary for survival, too many ______ in the diet can lead to high levels of inflammation and high blood pressure.

a.    Trans fatty acids

b.    Omega-6 fatty acids

c.    Omega-3 fatty acids

d.    Essential amino acids

e.    None of the above

23.  The function of ______ is to transport lipids and cholesterol in the blood.

a.    Hemoglobin

b.    Lipoproteins

c.    The liver

d.    Antibodies

e.    The pancreas

24.  Which of the following is NOT a key function of calcium?

a.    Regulate blood pressure

b.    Facilitate muscle contraction

c.    Regulate enzyme activity

d.    Promote blood clotting

e.    All of the above are true

25.  Which of the following statements regarding type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) is FALSE?

a.    T1DM accounts for most (about 95% of) cases in the U.S.

b.    T1DM results from impaired insulin production.

c.    T2DM can be controlled or reversed with diet and exercise.

d.    T2DM results from insulin resistance and an impaired ability of cells to remove glucose from the blood.

e.    T1DM was historically called “juvenile-onset diabetes,” while T2DM was historically called “adult-onset diabetes.”

26.  Secretion of parathyroid hormone may increase absorption, release, or synthesis of which of the following?

a.    Calcium

b.    Vitamin D

c.    Phosphorus

d.    Both a and c

e.    All of the above

27.  All of the following are functions of phosphorus EXCEPT:

a.    Component of phospholipids

b.    Bone mineralization

c.    Component of energy transfer molecule

d.    Protein modification

e.    Carrying oxygen in the blood

28.  Too much iron can lead to:

a.    Free radical-mediated damage

b.    Increased susceptibility to infection

c.    Increased risk of heart disease

d.    Both a and b

e.    All of the above

29.  Omega 3 fatty acids are beneficial because they raise ______ levels in the blood and decrease ______ levels.

a.    Triglyceride; HDL

b.    LDL; triglyceride

c.    HDL; LDL

d.    LDL; protein

e.    HDL; hemoglobin

30.  Which of the following is/are (a) function(s) of thiamin?

a.    Help metabolize carbohydrates

b.    Help metabolize some amino acids

c.    Help synthesize DNA and RNA

d.    Both b and c

e.    All of the above

31.  What is the role of vitamin C in iron absorption?

a.    It reduces non-heme iron to enhance its absorption.

b.    It oxidizes non-heme iron to enhance its absorption.

c.    It binds to iron to prevent absorption.

d.    It reduces heme iron to enhance absorption.

e.    It oxidizes heme iron to enhance its absorption.

32.  Which of the following is a reason why someone’s body might produce ketones?

a.    The diet lacks a source of carbohydrates to yield glucose.

b.    The diet lacks a source of fat to yield acetyl CoA.

c.    An obese person is not able to efficiently metabolize glucose, and instead relies on ketone bodies.

d.    Ketone bodies are necessary components of the citric acid cycle.

e.    Producing ketone bodies can spare fatty acids from being metabolized.

33.  Which of the following is NOT a dietary factor that increases risk of cardiovascular disease?

a.    Excess sugar

b.    Excess calories

c.    Trans fat

d.    Moderate alcohol

e.    Sodium

34.  Which of the following functions does NOT involve a prominent role for copper?

a.    Iron metabolism

b.    Connective tissue synthesis

c.    Immune system

d.    Maintenance of heart muscle

e.    Hemochromatosis

35.  Which of the following is a disaccharide?

a.    Starch

b.    Sucrose

c.    Fiber

d.    Glycogen

e.    Fructose

36.  In order to derive energy from glucose, what must happen after glycolysis yields pyruvate?

a.    It must be converted to acetyl CoA to enter the electron transport chain.

b.    It must be converted to acetyl CoA to enter the citric acid cycle.

c.    It must be stored as glycogen.

d.    It must be converted to a triglyceride.

e.    It must be used to break down triglycerides.

37.  Which of the following statements about water-soluble vitamins is FALSE?

a.    The excess amount will be excreted through the urine.

b.    High doses can potentially be toxic.

c.    The human body stores them in tissues such as adipose.

d.    The human body can’t store excess amounts.

e.    The human body can only use a certain amount of these vitamins at a time.

38.  If you have an essential fatty acid deficiency, which of the following might be compromised?

a.    Growth

b.    Skin integrity

c.    Fertility

d.    Structure and function of cell membranes

e.    All of the above

39.  Which of the following foods likely has the lowest glycemic index?

a.    Whole orange

b.    Orange juice

c.    Orange candy

d.    Orange soda

e.    All of the above items have the same glycemic indices.

40.  Which of the following characterizes vitamin C deficiency?

a.    Diarrhea, dermatitis, dementia, death

b.    Microcytic anemia, encephalopathy

c.    Bleeding gums, slow wound healing, poor appetite

d.    Numbness, fatigue

e.    None of the above

41.  Which micronutrient(s) is/are important for blood formation?

a.    Iron

b.    Vitamin B12

c.    Vitamin C

d.    Both a and b

e.    All of the above

42.  Which of the following characteristics of dietary supplements is/are regulated by the Food and Drug Administration (FDA) after they are on the market?

a.    Safety

b.    Advertising

c.    Ingredient accuracy

d.    Both a and c

e.    All of the above

43.  Hydrogenation is the addition of ______ atoms to ______ fats to make them more solid and shelf-stable at room temperature.

a.    Carbon; saturated

b.    Hydrogen; saturated

c.    Carbon; unsaturated

d.    Hydrogen; unsaturated

e.    Oxygen; saturated

44.  Research in the 1970s suggested that consuming saturated fat and cholesterol in the diet led to increased rates of cardiovascular disease. This led the food industry to replace saturated fat with ______.

a.    Trans fat

b.    Fiber

c.    Monounsaturated fat

d.    Essential amino acids

e.    Protein

45.  What is the storage form of fat found in adipose tissue?

a.    Chylomicrons

b.    Triglycerides

c.    Cholesterol

d.    VLDL

e.    Phospholipids

46.  Which statement accurately describes a characteristic of osteoporosis?

a.    Increased risk for active individuals

b.    Increased risk for males

c.    Increased bone density

d.    Increased calcification of bone

e.    Reduced calcium and bone matrix

47.  Folate or folic acid supplementation is especially important for women during pregnancy in order to prevent ______.

a.    Scurvy

b.    Rickets

c.    Pellagra

d.    Neural tube defects

e.    Pneumonia

48.  ______ is/are necessary to prevent megaloblastic (macrocytic) anemia.

a.    Folate

b.    Niacin

c.    Vitamin B12

d.    Vitamin C

e.    Both a and c

49.  Which of the following statements about trace minerals is FALSE?

a.    They are often cofactors to enzymes.

b.    They are important for DNA synthesis.

c.    They do not directly provide energy.

d.    They are not essential in the diet.

e.    They can compete with each other for absorption.

50.  Which of the following federal nutrition programs provides the greatest flexibility in what foods may be purchased and consumed by recipients?

a.    Supplemental Nutrition Assistance Program (SNAP)

b.    Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC)

c.    National School Lunch Program (NSLP)

d.    Both a and b allow equivalent purchases.

e.    All of the above allow equivalent foods.

 
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Benchmark – Human Experience Across The Health-Illness Continuum


The benchmark assesses the following competency:

Benchmark: 5.1. Understand the human experience across the health-illness continuum.

Research the health-illness continuum and its relevance to patient care. In a 750-1,000 word paper, discuss the relevance of the continuum to patient care and present a perspective of your current state of health in relation to the wellness spectrum. Include the following:

  1. Examine the health-illness continuum and discuss why this perspective is important to consider in relation to health and the human experience when caring for patients.
  2. Reflect on your overall state of health. Discuss what behaviors support or detract from your health and well-being. Explain where you currently fall on the health-illness continuum.
  3. Discuss the options and resources available to you to help you move toward wellness on the health-illness spectrum. Describe how these would assist in moving you toward wellness (managing a chronic disease, recovering from an illness, self-actualization, etc.).

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

 
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Nursing Informatics

Chamberlain College of Nursing NR361

Course Project Milestone 1 Template

Directions: Prior to completing this template, carefully review Course Project Milestone 1 Guidelines. After saving the document to your computer, type your answers directly on this template and save again. This assignment is due by Sunday end of Week 2 by 11:59 p.m. Mountain Time.

Name: __________________________

Assignment CriteriaNOTE: See Milestone 1 Rubric for details required in each area.
Scenario for Milestone Assignment:Scenario is clear and concise, including a disease process, diagnosis, OR identify a patient with a desire to maintain good health and prevent illness. Include the nurse’s assessment of learning needs and readiness to learn.50 points
Education:Describe in detail content planned for teaching this patient in the scenario.40 points
Identify the mHealth application:Identify a mHealth app that could benefit the patient. Describe the app including the mHealth app name, purpose, intended audience, mobile device(s) upon which it will operate, where to download or obtain it. Include a working link if it is to be downloaded from a website. Add any other information you believe would be pertinent to this situation. Make sure to add a citation for this mHealth app in APA format.45 points
NR361 Course Project Milestone 1 Template.docx 07/19 JMJ2
 
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Running head: CAPSTONE PROJECT EVIDENCE-BASED PRACTICE TOPIC PROPOSAL 1

Running head: CAPSTONE PROJECT EVIDENCE-BASED PRACTICE TOPIC PROPOSAL 1

CAPSTONE PROJECT EVIDENCE-BASED PRACTICE TOPIC PROPOSAL 2

Capstone Topic Selection and Approval

Anita, Oguh

Grand Canyon University, Phoenix, Arizona

Professional Capstone Project

NRS-490-O501

July 17, 2019

Capstone Project Evidence-Based Practice Topic Proposal

The problem

“The effect of inadequate nurse staffing on patient care” The writer was prompted to write on this topic because inadequate Nurse staffing is one of the main problems facing the nursing sector. most healthcare facilities have a limited number of nurses hence overwhelming the few nurses that are supposed to attend a relatively high number of patients. Inadequate nurse staffing is a major problem that needs to be addressed because overworking nurses has serious consequences for instance increased errors that affects patients negatively (Buerhaus, et al., 2007). The nurses are also negatively affected psychologically due to fatigue and stress, and other aspects of being which include emotional and physical. Nurses need a healthy working environment which includes being allocated adequate and sensible amount of task (Cox, Willis, & Coustasse, 2014). Such an environment makes them to handle patients with care and remain motivated all through the working shift.

The setting

To understand the impact of a healthcare facility where nurses are understaffed, examples of the healthcare facility can be a hospitals, nursing homes, mental health facilities, outpatient clinics, home health, correctional facilities etc. it is important to observe from how the nurses address patients and respond to issues brought to their attention (Lee, Blegen, & Harrington, 2014). Where nurses are limited and there is a lot of work to be done, limited or no attention is granted to some issues. The nurses also seem less motivated, stressed, and they feel that the patients are a bother to them instead of them being passionate and caring towards the patients (Aiken, et al., 2018). Overworked nurses also seem to be disorganized as it is hard to plan and prioritize activities in a working environment where there is excess work to be handled and more work keeps on being added in the course of working (Cox, Willis, & Coustasse, 2014). Moreover, by the end of working shift, there are a lot that is left unattended to hence making it hard for the incoming nurse to understand exactly where to pick from (Clarke, & Donaldson, 2008). This is not ignoring the fact that whenever there is nurse staffing issues, working shifts are prolonged.

Problem description

Nurse staffing is the act of having a limited or inadequate number of nurses within a healthcare facility. This is to mean that a single nurse is allocated much more duties that it is legally and professionally recommended (Cho, et al., 2015). Nurse staffing is a problem allowed by the healthcare organization to take place. the latter is in the sense that it is realized when the management recruits and hires a small number of nurses while as the facility receives and offers services a higher number of patients (Clarke, & Donaldson, 2008). This is a challenge because in an ordinary situation, it is the approximated number of patients that a facility receives that should be used to determine the number of nurses that should be hired.

Impact of the problem

Staffing problem in the nursing practice has serious negative impacts on the nurses and the entire facility. Overworked nurses gradually underperform as they are stressed and not in the right physical and mental ability. This is to mean that nurse staffing problem hinders nurses from realizing their real potentials and abilities (Cho, et al., 2015). Secondly, it affects overall performance of the facility which means that the facility does not become as productive as it should. Due to fatigue and the need to handle as much work as possible; errors are easily triggered that have far reaching consequences on the patients. This is to mean that the quality of care is highly compromised, and the nurses do not have the time to build rapport with patients which is vital in the recovery process (Bridges, et al., 2019). As a matter of reality, nursing errors have led to patient’s developing other complications that they did not have in the first place as well as reduced recovery pace (Martin, 2015).

Proposed solution

The nursing issue has no other shortcut to address the problem apart from hiring the right number of nurses (Lee, Blegen, & Harrington, 2014). The latter is in the sense that there is the recommended number of people that a nurse should at least serve. The facility should conduct a statistic research to determine the number of patients it serves and determine the number of nurses it should hire (Clarke, & Donaldson, 2008). Also, different measures should be put in place to make sure that nursing tasks are done in a much easier and effective way. For instance, advanced technology strategies can be used to reduce nursing errors and motivation strategies applied as well.

References

Aiken, L. H., Cerón, C., Simonetti, M., Lake, E. T., Galiano, A., Garbarini, A., … & Smith, H. L. (2018). Hospital nurse staffing and patient outcomes. Revista Médica Clínica Las Condes29(3), 322-327.

Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: an observational study. BMJ Qual Saf, bmjqs-2018.

Buerhaus, P. I., Donelan, K., Ulrich, B. T., Norman, L., DesRoches, C., & Dittus, R. (2007). Impact of the nurse shortage on hospital patient care: Comparative perspectives. Health affairs26(3), 853-862.

Cho, E., Sloane, D. M., Kim, E. Y., Kim, S., Choi, M., Yoo, I. Y., … & Aiken, L. H. (2015). Effects of nurse staffing, work environments, and education on patient mortality: an observational study. International journal of nursing studies52(2), 535-542.

Clarke, S. P., & Donaldson, N. E. (2008). Nurse staffing and patient care quality and safety. In Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality (US).

Cox, P., Willis, W. K., & Coustasse, A. (2014). The American epidemic: The US nursing shortage and turnover problem.

Lee, H. Y., Blegen, M. A., & Harrington, C. (2014). The effects of RN staffing hours on nursing home quality: a two-stage model. International journal of nursing studies51(3), 409-417.

Martin, C. J. (2015). The effects of nurse staffing on quality of care. MedSurg Nursing24(2), S4-S4.

 
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Altered Patterns Of Elimination

Discuss how functional patterns help a nurse understand the current and past state of health for a patient. Using a condition or disease associated with an elimination complexity, provide an example like kidney failure or voiding problem

 
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Pathology: Paraplegia

Pathology: Paraplegia

Transfer: Slide board transfer to wheel chair

· APA format

· At least three research articles

· 12 font times New Roman

· Double space

· Pages numbered

· 3-4 pages not including the references page

· Content free of plagiarism

· Brief description of the pathology

· Complete summary of topic including analysis of patient care activity

· Sources cited properly

· Implications for the diagnosis

· Preparatory components to patient care activity (equipment, set-up as applicable, preparation of area)

· Procedures to activity (be as concise as possible)

· Clinical implications per your chosen patient population

 
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Ethical Conduct Of Research; Infections Disease: A Global Perspective

Ethical Conduct of Research

power point from this document, 15 slides

Introduction

Depending on the context of the study, researchers often encounter ethical dilemmas that are associated with respect for privacy, establishment of honest and open interactions, and avoidance of misrepresentation. From an ethical standpoint, such challenging circumstances may surface if researchers are grappling with conflicting issues and have to choose between different methodological approaches in complex circumstances. In such circumstances, disagreements among different components including participants, researchers, researchers’ disciplines, the financing organization, and the society might be inevitable. Therefore, there are numerous ethical concerns that should be taken into account when undertaking studies that deal with human subjects. Understanding ethical principles can guide researchers to conduct studies that safeguard the wellbeing of human subjects.

Overview of the Research

In a research work titled Resilience of People Living with HIV/AIDS in Indonesia: a Phenomenological Study, Kumboyono et al. (2018) observe that HIV/ AIDS is among the most prevalent and expanding communicable diseases on the planet. The number of individuals who are diagnosed with HIV/AIDS continues to skyrocket every year in Indonesia and other parts of the world. According to Kumboyono et al. (2018), individuals who suffer from HIV/AIDS often plunge themselves into a series of crises, which indicate the challenges of living with the chronic pathological condition. As such, resilience is one distinct phenomenon that is common among persons living with the diseases Indonesia, a pattern that indicates the results of current health management and expectations of HIV/AIDS patients for better and improved health outcomes. In light of this concern, Kumboyono et al. (2018) undertook a study that sought to examine the mechanism of resilience in Indonesian people living with HIV/AIDS and the factors that influence their specific mechanisms. 

Using qualitative phenomenological design, the researchers sampled a total of 27 people living with HIV/AIDS from a primary health care institution in Malang City, East Java, Indonesia. The participants were selected from different socioeconomic, gender, and sexual orientations. The researchers informed participants about the conduct and processes involved in the study, resulting in their consent to participate in the interview process. The findings of the study indicated that the diagnosis of HIV/AIDS reflects the onset of psychological and social distress. Moreover, Kumbomoyo et al. (2018) found that the spiritual response that follows diagnosis is a state that is characterized by crises. As a consequence, the coping strategies and understanding of life by HIV patients is a definite sign on resilience. Based on these findings, Kumbomoyo et al. (2018) infer that HIV/AIDS is a chronic infection that has the potential to induce the unique mechanism of resilience within the Indonesian social system. Therefore, future health and management of persons living with HIV/ AIDS will be needed to enhance and encourage this strategy to guide persons living with HIV into a more comfortable and healthy way of life. 

Ethical Issues in Research

The relationships and interactions established between the researcher and participants in a study can potentially generate a wide range of varying ethical issues. While ethical codes, policies and principles are highly significant and beneficial, like any set of norms, they do not cater for all situations. Thus, they often have a high potentiality of conflicting. Nonetheless, the vast majority of decisions often entail the straightforward application of ethical codes and practices. Ethics is one of the most important issues that are commonly mentioned by educators in the scientific community. Ethical misconducts most commonly stem from environmental and individual causes. For instance, when people who are morally weak or unaware of the rules participate in research, ethical violations are bound to occur. Thus, many significant forms of the ethical deviations that are observed in many scientific studies are attributed to the fact that some researchers are oblivious of the ethical norms of scientific research. 

Protection of Human Rights

The most important ethical principles in research focus on protecting human rights when dealing with human subjects. Principles of protection of human rights during research emerged out of a dark history that was littered with accounts of abuses undertaken in the name of medical research.  One of the most dreadful of these atrocities were undertaken by the Nazi physicians who utilized convicts for human experimentation (Avasthi et al. 2013). The unearthing of these experiments sent ripples of shock across the world, a situation that resulted in the development of the Nuremberg Code to deter recurrence of similar episodes. The Nuremberg Code was the first international code of ethics in clinical research that laid down the guidelines for research dealing with human subjects. This policy made laid down principles, guidelines and standards to be followed by researchers and make voluntary consent essential, allowed subjects withdraw from the experimentation at any time, banned experiments that could lead to major injuries or fatalities of the subjects, and made it mandatory to have preclinical data prior to the experimentation of humans. However, the Nuremberg Code failed to end unethical practices conducted by certain researchers (Avasthi et al. 2013). As a consequence, a collection of guidelines was developed by the 18th World Medical Association General Assembly, also referred to as the Declaration of Helsinki. 

The Helsinki Declaration had a collection of principles, which emphasize on informed consent, confidentiality of data, vulnerable populations, and requirements of a protocol, including the scientific justifications for the study. All researches had to be reviewed based on these standards by the ethics committee for a research to be declared as ethically fit (Avasthi et al. 2013).  However, it is during the time of the Helsinki Declaration that other major scandals continued such as the Tuskegee Syphilis Experiment in the United States. This malpractice raised concerns in the ethics community, thereby resulting in the establishment of the Belmont Report in 1979. The Belmont Report established the modern regulations and human rights principles associated with research dealing with human subjects in the United States and other parts of the world (Avasthi et al. 2013). Nonetheless, with the growing interest in pharmaceutical, health, and psychological research in the developing and the underdeveloped nations, the Council for International Organization of Medical Sciences, in collaboration with the World Health Organization (WHO) and other health researchers designed the International Ethical Guidelines for Biomedical Research Involving Human Subjects in 1982 (Avasthi et al. 2013).  Thereafter, other professional research organizations such as the American Psychological Organization (APA), have designed similar standards that relate to protection of human rights in studies that deal with human subjects. 

The Five Human Rights that Must Be Protected

There are five cardinal ethical principles that reflect the five human rights that must be protected during research. These principles include: nonmaleficence, beneficence, respect for autonomy, justice, as well as right to self-determination. The principle of nonmaleficence states that the researcher has an obligation to avoid infliction of harm on human subjects in a study. This principle is closely interlinked with the maxim primum non nocere (‘first do no harm’). The principle of nonmaleficence prohibits killing, causing pain or suffering, incapacitating, and causing an offense on the human subject during research. Therefore, this principle encourages researchers to act in ways that do not cause physical or mental harm on the research participants. More precisely, the principle states that researchers should not cause avoidable or intentional harm. This should incorporate avoidance of any possible risks associated with harm (Jahn, 2013). Researchers should avoid intentional and unintentional violations of this ethical principle. For instance, a researcher does not necessarily intend to harm in order to violate this principle. As a matter of fact, knowingly or unknowingly subjecting a research participant to unnecessary risk amounts to violation of the principle of nonmaleficense. 

The principle of nonmaleficense has been applied to this study in many ways. One of the primary focuses of the study was to investigate the coping skills of people living with HIV/AIDS. Thus, when analyzing these coping skills and strategies, the researcher must engage in a one-on-one interview with the participants (Jahn, 2013). In the process, questions that trigger psychological and emotional pain might be asked unknowingly. Such situations are likely to occur in the study, especially when dealing with participants who suffer from HIV/AIDS. In almost all parts of the world, HIV/AIDS patients often witness numerous cases of social stigma. These negative experiences may interfere with the manner in which they respond to interview questions. Therefore, it is the task of the researcher to develop strategies that can help to minimize any possible mental and emotional paint that the persons living with HIV are likely o experience as a result of the data gathering and interview questions. Many studies on nonmaleficense often narrow down to physical harm (Chagani, 2014). However, the concept of harm is broad and dynamic, incorporating all dimensions of human life, including the mental and physical realms. In this particular study, there is no serious physical interaction with the participants that might cause physical pain, harm or death. 

The concept of harm is broad and takes many forms. They range from physical and emotional injuries to deprivation of property or violations of human rights. Within the research context, the primary emphasis of harm is often linked to a narrower definition, such as pain, disability, or death (Chagani, 2014). Within these standards, the research has observed avoidance of harm since all the participants who took part in the study did not die, sustain any physical injury or disability stemming from the research. However, harm can be strongly within the eye of the beholder, and a wider definition of harm is often required during ethical considerations. In light of the above, more than one level of harm may come into play in a situation. For instance, the researchers are more likely to inflict mental pain and suffering in the participants by asking questions related to the way in which they responded to the news that they had been diagnosed with HIV/AIDS. However, in such a situation, the researchers have imposed one harm in order to avoid a greater harm. Nonetheless, in all situations, researchers should be prohibited from acting in ways that are likely to generate undue risks or needless harm to participants. 

The principle of beneficence is a moral obligation to act for the benefit of others. In this respect, any research work that observes this principle should be designed in a way that is meant to promote societal good and wellbeing (Jahn, 2013). There are various ways in which this principle comes into play. For instance, the principle suggests that researchers should act in a manner that provides benefits to the society, and balances benefits with risks or harms. The principle of beneficence is broad and multifaceted. It includes protecting and defending the rights of others, preventing harm from occurring to others, removing conditions that will cause harm, and supporting persons with disabilities. Furthermore, this principle advocates for rescuing persons in danger during and after research. In furtherance of these ethical standards advocated by beneficence, there are various ways in which the study can be assessed. For instance, the outcomes of the study seeks to improve health professionals’ understanding of HIV/AIDS patients’ coping skills and strategies and the psychological pain that they undergo in the process of coping. As a result, it provides health professionals and psychological researchers with insights into ways of developing interventions that are meant to address mental health problems that affect HIV patients. 

The study encourages researchers to design interventions that are meant to enable HIV patients to bounce back to their normal psychological and social norms after receiving adversities as a consequence of HIV/AIDS diagnosis. Indeed, the nature of resilience among individuals who are diagnosed with chronic infections can be grouped into the crisis and survival stages. The former is characterized by the onset of a psychological and physical struggle that follows after diagnosis with several struggles. This study can inform future evidence-based practices that seek to design cognitive and counseling strategies for improving the quality of life of persons living with HIV/ AIDS. As such, the study fulfills the ethical principle of benefiting the participants and the society at large by promoting greater good and wellbeing for persons living with HIV/AIDS. 

The ethical principles of beneficence and nonmaleficense are multidimensional and intertwined. These dimensions include positivity and utility. Positivity can be described as the benefits that are gained after undertaking the research, which outweighs its costs. For instance, timely understanding of the mental and pain that HIV patients undergo after diagnosis can help to reduce major depression and help to cope will with the disease. On the other hand, utility refers to the benefits of undertaking an action that balances its costs. For instance, in a clinical research that explores psychological pain that patients undergo, the patient control group may only receive psychological treatment-as-usual instead of the experimental treatment that could generate extra gains. Beneficence and nonmaleficence are fundamental ethical principles that are essential in guiding the clinical practice and research in both psychology and healthcare. Beneficence encourages the researcher to exercise responsibility of promoting the wellbeing of the patients, especially participants in clinical trials, often by researching and administering therapeutic interventions with the highest possibility of positive patient responsivity. One of the biggest ethical dilemmas that psychologists confront is the need to strike a balance between beneficence and nonmaleficence. This balance may sometimes entail weighing the possible benefits and limitations or net risks associated with a specific research. In all jurisdictions, researchers are required by law to inform their participants or patients of the possible risks and gains of a research, procedure, or testy. This move allows the study participants to make an informed decision, with theirs being the burden to assess the potential costs and benefits of the available alternatives. 

Autonomy and self-determination are other fundamental human right that the participants should be granted during a research. Thus, respect for autonomy is a practice that obligates the researcher to respect the decisions of adults who have the capacity to make their own decisions. There are three conditions that must be existent for an action by the research subject to be regarded as autonomous. They include: intentionality, understanding, as well as complete absence of controlling influences that determine the subject’s decisions. In order to meet the ethical obligation of autonomy, there are several moral standards or guidelines that can be used. They include: telling the truth, respecting the privacy of others, protecting the confidentiality of information, as well s seeking consent from the participant before commencing the data gathering process. Respect for autonomy represents an obligation to the researcher to respect the decision making capabilities of the participants. It also denotes the provision of choices and alternatives to the subject so that they can practice self-determination. In this study, the participants’ rights to autonomy were observed by providing them with all the relevant information about the study and giving them the opportunity to decide whether or not to participate in the research. This process was primarily exercised through issuance of informed consent forms to the subjects. 

Within the context of this study, the subjects’ autonomy were respected by first giving them all sufficient information that are necessary for the research and then giving them the opportunity to consent or reject proposals to participate in it. Based on this practice, it is the responsibility of the researcher to ensure that the subject is sufficiently competent to practice autonomy. By competency, a research subject should be not only conscious, but also possess the sufficient knowledge and understanding to gain and maintain the information offered to take relevant decisions. Along with this view, the principle also requires the researcher to offer complete information to the participant and not hide anything so that the patient may seek to meet an obligation or can desire to spend some valuable time with family members and friends. The subject, after knowing the truth, may desire to do a hobby with which he or she desired to do. The participant may also seek to select other options of the research that may not be available or provided by the researchers. However, it is the right of human beings to be treated in a way that does not cause pain and anguish. Therefore, the researcher should go by the data gathering method in which the participants are comfortable with in order to avoid restraining the subject from exercising autonomy. In addition, in many jurisdictions, going ahead with a research against patients’ rights and decisions even if it is meant for their goodwill, is considered as an illegal decision. Therefore, a comprehensive justification on legal is often needed to undertake a research involving subjects who are patients against their knowledge and will. The principle of beneficence supports the autonomy of the patients as in the case of telling the truth to the research subject and respecting the subject’s autonomy can go a long way in generating the desired benefits to the participants, who will feel more confident in determining their course of life. 

Further, self-determination is a human right that is also relevant and interrelated to the right to autonomy. Self-determination is a right and principle that plays a critical role in the contemporary research ethics associated with human subject. Put simply, this principle suggests that ultimately, it is the participant who should make the final decision as to whether or not to accept a proposed research process (Lindberg, Johansson & Broström, 2019).  While this principle is widely discussed in many academic works, one of its most significant elements has often been overlooked- the fact that real-world decision making is temporarily extended. In this respect, decision-making is a process that broadly takes a significant period of time from the time at which the researcher determines that there is a need for the subject to participate in the clinical research and that there is a decision that should be made. Moreover, the participant should be able to make it to the point at which they are actually asked for their views. The principle of self-determination is broadly viewed as the center of research ethics and trials in the health sector (Lindberg, Johansson & Broström, 2019).   It is a principle that is commonly codified in legal frameworks and standards across different parts of the world, and has had a major effect on researchers’ understanding of ways of dealing with several legal and ethical issues associated with handling human subjects in research. 

There are several accounts of the content and implications of the principle that have been put into use within the context of this study.  For instance, in all stages of the study, the patients were given the liberty to opt out of the research. Through the issuance of informed consent documents and explaining to them the conduct and content of the study, they were sufficiently empowered to determine whether or not they would like to chat their own path by either remaining or opting out of the research. In view of this phenomenon, it would be deduced that it is the research subject who ultimately, following evaluation of all relevant information offered by the researchers, has the authority to decide whether or not to consent to the research. The principle of self-determination raises many fundamental questions. One such question revolves around who should self-determination be applicable to. In this study, the main subjects of self determination are the participants of the research. They are the HIV/AIDS patients who were interviewed on their psychological coping skills. Since a right to self-determination is often traditionally ascribed only to people with sufficient decision-making capabilities, one major issue that confronts many researchers is what it takes for a patient to be above the recommended threshold. Based on this standard, it is not clear in this study whether or not the HIV patient populations that were sampled were above the recommended normal mental threshold that is required of them to make informed decision on whether or not they should take part in the research. However, it can still be implied that they were mentally upright at the time of decision-making based on the nature of the data that have been gathered. 

When it comes to self-determination, real-world decision-making capabilities can be temporarily extended in that it broadly takes some significant period of time from the point at which the researcher determines that there is a consent decision that should be made, and that the patient is mentally fit or able to make it (Lindberg, Johansson & Broström, 2019).   Moreover, such a situation should extent to the point at which the subject is asked about their views. Such a temporal element of decision-making raises normative questions. For instance, it may not be clear under what situations and length of time the researcher should wait in order to get the feedback from the subject on the decisions that they have made regarding participation in the research. 

Finally, the principle of justice in research can also be used to analyze the ethical standards that were used in the study. The right to justice requires the researcher to exercise equity in the distribution of the benefits of the research. These include the benefits, costs, and resources. The key justice principles in a study include: promotion of equal share, giving each person in accordance with heir efforts, rewarding each individual according to their contributions, and issuing gains made out of the research according to merits (Silver, Ventura & Castro, 2016). In almost all forms, clinical trials require the active participation of human subjects and entail clinical interventions that are comprised of various procedures. However, this study only engaged human subjects in the interviewing process alone. Still, the performance of a study involving human subject can be beneficial to the economy and the whole society, especially the participating country, thereby generating employment opportunities and promoting local scientific and technological progress through the scientific data found and studied in collaboration with many research centers (Silver, Ventura & Castro, 2016). The financial and economic gains of this particular study have not yet been determined. However, its insights can be used to develop interventions that help to promote psychological wellbeing of persons living with HIV/AIDS. In so doing, the study can immensely improve their quality of life. 

Ethical Scientific Integrity

The credibility of a researcher or author is very critical in assessing the authenticity and quality of a specific research work. The personal details of the authors who developed this research work have not been provided in the journal article. However, there are other standards that can still be used to determine the credibility and level of suitability of the researchers to undertake the above study. For instance, the authors have revealed at the end of the article that their study was funded by the Directorate General of Higher Education, Ministry of Culture and Education in the Republic of Indonesia. Based on this standard alone, it can be deduced that the authors have the necessary academic credentials and intellectual acumen or capacity to undertake such a study. In addition, the mere fact that the study was approved by these higher educational bodies raises the credibility of the authors. Another factor that raises the credibility of this particular study is that its findings were assessed and later published by the Research HIV Nursing, which is a widely known reputable international journal that publishes studies on HIV research. 

Plagiarism is one of the ethical issues in research that are hardly ever mentioned. However, its violations can have far-reaching consequences on the credibility and authenticity of a specific body of knowledge. Plagiarism can be defined as the unethical practice of stealing and passing off ideas or group of words as one’s own (Ben-Yehuda & Oliver-Lumerman, 2017). Plagiarism is also the act of utilizing someone’s ideas and works and pretending to be one’s own. In light of the above, there are various ways in which plagiarism manifests itself in research. For instance, many researchers often fail to recognize the originators of their collection of words. However, this specific study can be said to have passed plagiarism test. First, the body section of the study has various in-text citations, indicating that the authors acknowledged the sources or originators of the ideas that were sued in the study (Ben-Yehuda & Oliver-Lumerman, 2017).  In addition, all the in-text citations have their corresponding bibliographic citations. As such, the authors do not have a case of plagiarism or copyright violation. 

Fabrication and falsification are some of the cardinal malpractices ion research conduct. They are commonly regarded as the key concerns in averting research misconduct. Any deviation or departure from such standards often undermines the integrity of a specific body of research for an individual or organization as a whole (Ben-Yehuda & Oliver-Lumerman, 2017).  Falsification can be described as the practice of altering or omitting research findings to support certain claims, hypotheses, as well as other data. This can include the act of manipulating study instrumentation, materials, or procedures. Usually, manipulations of images or representations in a way that distorts the figures or data or reads too much between the lines can also be regarded as an act of falsification (Ben-Yehuda & Oliver-Lumerman, 2017). The process of identifying a case of falsification or fabrication is often a complex one. As such, it was not possible for this specific study to detect any case of falsification. This is because the main data that were being explored were primarily qualitative and they were derived from the interview responses. In the same way, it was not easy to detect any case of outright fabrication. Fabrication is the development of or inclusion of data, observations, or characterizations that never took place during the collection of data. Fabrications are likely to take place during the process of filling out the entire of an experiment runs (Ben-Yehuda & Oliver-Lumerman, 2017).  Moreover, the researchers might come up with claims on the basis of incomplete or presumed findings, which are regarded as outright forms of fabrication. 

Institutional Review Board

Details on the Institutional Review Board (IRB) pertaining to this study have not been written in the article. However, the researchers indicate that they passed through the due process of informed consent and other ethical standards before they were approved to participate in the study. In addition, the study was approved by the Ministry of Higher Education, although such a ministry may or may not develop an IRB to assess the ethical suitability of the researchers. Therefore, it is not easy to determine whether or not the above study was approved by IRB. However, the researchers’ use of human subjects was not experimental in nature. Rather, use of human subjects in this study was minimized to data collection process through interviews. 

The absence of details regarding the IRB in this study calls for the need for future researchers to report as to whether or not their studies were approved by an ethics body. All individual organizations or sponsors may demand that all studies, irrespective of their sources of funding, be assessed and approved by an IRB (Whitney, 2015). An IRB has the specific power and authority over the nature of the research within its jurisdiction. For instance, no clinical research may be approved to stat enrolling participants until it has been given the green light by the IRB. The IRB primarily has the authority to approve, dismiss, or halt all research activities that fall within its jurisdictions in accordance with the relevant government regulations and institutional standards and procedures. The IRB also ensures that a given research meets the needed ethical standards by demanding for modifications in processes, protocols as well as previously approved studies (Whitney, 2015). Furthermore, the IRB has the power and authority to demand that participants in a specific research be granted any extra information that will enable them to make informed decisions to participate in the study. 

One of the most important documentations that the IRB may require is the informed consent form. While researchers who indicate that they provided participants with informed consent might have gone through the IRB, it might not be the case in all situations. All institutions that take part in the research process that engage human subjects are often tasked with the responsibility of identifying an IRB to assess and approve such studies (Whitney, 2015). The IRB is charged with the responsibility of adhering to the requirements and standards recommended by the Office for Human Research Protections. Many study sites may be under the jurisdiction of more than one IRB. Then IRB plays a significant role in safeguarding the rights, safety, and wellbeing of all human study participants. The IRB meets this responsibility by assessing the full research plan for a specific research study in order to ensure that it meets the standards that have been recommended by local and international codes of research ethics (Whitney, 2015). Moreover, the IRB undertakes a confirmation and approval that the study plan does not expose human subjects to unreasonable risks. In this particular study, human subjects are not exposed to unreasonable risks because their role in the research is to simply explain how they psychologically cope with the news of their diagnosis with HIV/ AIDS. 

Informed Consent

Informed consent is the main ethical practice that has been extensively observed by the researchers in this study. For instance, after selecting the populations to participate in the study, the participants were informed regarding the conduct of the research. Thereafter, the researchers report that the participants consented to the proposals to participate in the interview. The researchers also indicate that the study participants were given the opportunity to opt out of the research at any stage if they so wished. Therefore, it can be deduced that the study adhered to the recommended informed consent procedures and standards. 

Informed consent can be described as the voluntary acceptance by a study subject to participate in a research (Minor, 2015). Thus, informed consent should not be treated simplistically as a form that is signed but a process. As a process, informed consent is regarded as an essentiality before registering a participant for study. As such, informed consent should be sought in all forms of human subjects studies, ranging from diagnostics and therapeutic investigations, to intervention and behavioral assessments. 

The process of seeking informed consent entails informing the participants on their rights, objective and role in the study. The processes should of informing the participant should also entail enlightening the human subject about all the possible risks and the advantages involved in participating in the study (Minor, 2015). Usually, the target participants of the research should take part willingly and not through compulsion. Therefore, vulnerable and disadvantaged groups of participants such as prisoners, expectant women, and children should be accorded extra protections in order for them to make more informed decisions during the research process. 

HIPAA

The study was conducted outside the jurisdictions of the United States. As such, it is not bound by the standards, laws and regulations of the Health Insurance Portability and Accountability Act (HIPAA). However, if the study and its findings were to be used to inform evidence-based practices in the United States, it would be bound by HIPAA laws. One of the most sensitive and important area of research is dealing with the privacy of HIV/AIDS patients during research. Indeed, the privacy of patients is safeguarded by the US Department of Health and Human Services in line with HIPAA regulations. 

The Authority of HIPAA goes beyond protection of patient privacy and confidentiality within the health setting to incorporate protection of welfare of human study subjects. While this does not indicate that the privacy and confidentiality of participants’ data were protected, HIPAA calls for the safeguarding of the human rights of research subjects under the Basic HHS Policy for Protection of Human Research Subjects, also widely referred to as Common Rule (Majumder & Guerrini, 2016). While the word ‘privacy does not feature in HIPAA’s title, almost all sections of this law calls to attention the need for researchers to safeguard the privacy and confidentiality of participants (Majumder & Guerrini, 2016).  As such, privacy is critical to the realization of HIPAA’s goals. 

Risk to Benefit Ratio

In this article, the researchers do not show if they calculated a risk to benefits ratio. However, the research can comfortably be categorized as a minimal risk study. A minimal risk is a situation in which the likelihood and degree of harm or discomfort expected in a proposed study are not higher or greater in them than those that are commonly encountered in daily situations during the furtherance of normal physical or psychological assessments or tests (Melnyk & Morrison-Beedy, 2012).  The potential risks posed by this study are low because there is no physical engagement of the bodies of human subjects in the study. Instead, the human subjects were only required to answer interview questions regarding their HIV psychological coping skills. 

Benefits are associated with the potentiality of the research treatment to eliminate a condition or address certain problems. These problems can especially relate to an individual or population that is being surveyed (Melnyk & Morrison-Beedy, 2012).   For instance, some of the problems that the research focused on are the psychological and emotional pain that HIV patients undergo. The potential benefits that can be gained from the study include providing insights into the development of interventions to improve HIV/AIDS patients’ resilience after facing adversities due to HIV diagnosis. In addition, the study provides benefits to the study population by providing strategies of fighting stigma. 

Conclusion

Ethical problems are bound to occur in all studies. However, researchers who deal with human subjects must take extra caution not to affect the participants. Study participants might be exposed to various malpractices that can adversely affect their wellbeing. For instance, researchers may fail to protect them from physical and mental harm. Moreover, their privacy and confidentiality rights might be at risk during the study process. However, understanding ethical practices that guide dealing with human subjects can ensure that the study passes the tests recommended by the IRB.

References

Avasthi, A., Ghosh, A., Sarkar, S., & Grover, S. (2013). Ethics in medical research: General 

principles with special reference to psychiatry research. Indian journal of 

psychiatry, 55(1), 86.

Ben-Yehuda, N., & Oliver-Lumerman, A. (2017). Fraud and Misconduct in Research: 

Detection, Investigation, and Organizational Response. Michigan: University of 

Michigan Press.

Chagani, S. M. I. (2014). Telling the truth-A tussle between four principles of ethics. Journal of 

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Infections disease: a global perspective

Recent Health Care Legislature (within 3 years)

· Literature review regarding issue (4 peer reviewed articles) 

· Statistical data related to issue, population impacted, and health outcome of issue and legislature. 

· Nursing role in passing the legislature

·  References within 5 years

· 10 Pages including Title page and Reference page

· APA Format

 
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