Week 2 Ethical Frameworks Essay

Consider the “Four Topics Approach” (or Four Box method) to ethical decision making on page 61, Table 2.1 in Butts (below).  Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.

In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way?  Does this seem like a valid process for you to apply in your practice? 

Your paper should be 1-2 pages. Adhere to APA formatting throughout, and cite any outside sources you may use.

Review the rubric for further information on how your assignment will be graded.

TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases

Medical Indications: The Principles of Beneficence and Nonmaleficence

· What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?

· What are the goals of treatment?

· In what circumstances are medical treatments not indicated?

· What are the probabilities of success of various treatment options?

· In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?

Patient Preferences: The Principle of Respect for Autonomy

· Has the patient been informed of benefits and risks, understood this information, and given consent?

· Is the patient mentally capable and legally competent, and is there evidence of incapacity?

· If mentally capable, what preferences about treatment is the patient stating?

· If incapacitated, has the patient expressed prior preferences?

· Who is the appropriate surrogate to make decisions for the incapacitated patient?

· Is the patient unwilling or unable to cooperate with medical treatment? If so, why?

Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy

· What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?

· On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?

· Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?

· What ethical issues arise concerning improving or enhancing a patient’s quality of life?

· Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?

· What are plans and rationale to forgo life-sustaining treatment?

· What is the legal and ethical status of suicide?

Contextual Features: The Principles of Justice and Fairness

· Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?

· Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?

· What are the limits imposed on patient confidentiality by the legitimate interests of third parties?

· Are there financial factors that create conflicts of interest in clinical decisions?

· Are there problems of allocation of scarce health resources that might affect clinical decisions?

· Are there religious issues that might influence clinical decisions?

· What are the legal issues that might affect clinical decisions?

· Are there considerations of clinical research and education that might affect clinical decisions?

· Are there issues of public health and safety that affect clinical decisions?

· Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?

Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeContent	20 to >17.2 pts Proficient The writer clearly and effectively responds to the assignment. 17.2 to >15.0 pts Approaches Proficiency The response to the assignment is generally adequate, but may not be thorough. 15 to >0 pts Does Not Meet Expectations The writer does not respond to the assignment.	20 pts
This criterion is linked to a Learning OutcomeFocus and Detail	18 to >15.48 pts Proficient There is one clear, well-focused topic. Main ideas are clear and are well supported by detailed and accurate information. 15.48 to >13.5 pts Approaches Proficiency There is one clear, well-focused topic. Main ideas are clear but are not well supported by detailed information. 13.5 to >0 pts Does Not Meet Expectations The topic and main ideas are not clear.	18 pts
This criterion is linked to a Learning OutcomeOrganization	14 to >12.04 pts Proficient The introduction is inviting, states the main topic, and provides an overview of the paper. Information is relevant and presented in a logical order. The conclusion is strong. 12.04 to >10.5 pts Approaches Proficiency The introduction states the main topic and provides an overview of the paper. A conclusion is included. 10.5 to >0 pts Does Not Meet Expectations There is no clear introduction, structure, or conclusion.	14 pts
This criterion is linked to a Learning OutcomeMechanics and APA	8 to >6.88 pts Proficient The assignment consistently follows current APA format and is free from errors in formatting, citation, and references. No grammatical, spelling, or punctuation errors. All sources are cited and referenced correctly. 6.88 to >6.0 pts Approaches Proficiency The assignment consistently follows current APA format with only isolated and inconsistent mistakes and/or has a few grammatical, spelling, or punctuation errors. Most sources are cited and referenced correctly. 6 to >0 pts Does Not Meet Expectations The assignment does not follow current APA format and/or has many grammatical, spelling, or punctuation errors. Many sources are cited and referenced incorrectly, or citations and references are missing.	8 pts
Total Points: 60

Assignment: Articulate the Development of Quality Models and Associated Theoretical Frameworks

Using your reading assignments in your textbook as a starting point, you will conduct additional research on the early aspects of quality assessment, improvement, and management. Your Research Report must include an
introduction, body of discussion, and a summary. You will discuss the following quality models in-depth and the experts responsible for developing the models and frameworks for quality improvement and management. 

1. PDSA Cycle

2. Total Quality Management model

3. Lean Six Sigma model

4. Toyota Production System Lean Manufacturing

5. Donabedian Quality Framework 

In your summary paragraph, you will discuss the connection between the development of the Donabedian Quality Framework and its application in healthcare quality measurement.

In addition to your narrative, you will create a table that contains a timeline in chronological order for the introduction of the quality models you discussed in your research paper. Your table will be an
appendix to your research report and the entries will include the name of the quality model, the year it was introduced, and its purpose. The purpose will be a synopsis from your findings and may be presented using bullet points. Be sure to follow APA standards for the use of appendices.

Here is an example of the table. Add rows to complete your timeline. Download the table from your Weekly Resources.   

Year	Quality Model Name	Quality Model Purpose

Length: A minimum of 3 pages, not including the title page, reference page, and Appendix page.

Discussion

Purpose

Discuss barriers to practice as an APN in one’s state from both a state and national perspective.  Research methods to influence policy change from various forms of competition, state legislative and executive branches of government and interest groups. 

Preparing the Discussion

Using the readings from this week as well as reliable outside resources to: 

1. Identify and describe practice barriers for all four APNs' roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist.

2. Identify forms of competition on the state and national level that interfere with APNs' ability to practice independently.

3. Identify the specific lawmakers by name at the state level (i.e., key members of the state's legislative branch and executive branch of government)

4. Discuss interest groups that exist at the state and national levels that influence APN policy.

5. Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups.

6. A scholarly resource must be used for EACH discussion question each week.

Write a one-page abstract on chapter from McEwen and Wills, Chapter 3. The abstract shall highlight the salient points in the chapter, not to exceed one page double-spaced, including a brief critique, and comply with APA format and style.

APA Reference format: [Author, A. A. (Year). Title of chapter. In B. B. Editor (Ed.), Title of book (pp. xxx–xxx). Publishers].

APA 7th Edition

Theoretical Basis for Nursing 6th edition Chapter 3

Topic: Atherosclerosis

-etiology, clinical manifestations, evaluation, and treatment.

-potential for heart disease and stroke.

at least two sources and masters level terminology

two pages.