Carefully review this Milestone 2 Guidelines document rubric and the Milestone 2 Template.

Review the Differences Between Closed and Open-Ended Questions document.

Use the suggestions to formulate your initial and follow-up questions.

Download the required Milestone 2 Template

. Save it to your computer with the file name as Your Last Name NR393 Milestone 2.docx.

Carefully review the rubric criteria for Milestone 2 and type directly on your saved Milestone 2 Template. Note that some of the questions have been provided for you on the template.

 

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Important nurses of the 19th century are often overshadowed by Nightingale’s prominence. Select one 19th century nurse other than Nightingale, and describe this person’s contributions to the profession. Although some duplication is expected, please try to select a nurse who has not already been presented by a classmate.

 

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Identify a potential individual who has been living in a culture other than the one of origin for at least 2 years. This individual must be born outside the United States. The individual can be a patient, friend, or colleague, such as a physician, or acquaintance, but cannot be a relative. The individual must be living in your community and must be currently receiving or have previously received healthcare services in your community. The individual’s race, ethnicity, language, religion, and culturally based beliefs about healthcare and illness should be quite different from yours. The individual must speak your language. An interpreter is not permitted for the actual assessment, which occurs in Milestone 3 (Week 6). 

Note: This is the same individual for whom you will develop verbal assessment questions in Milestone 2 and whom you will ask those questions in Milestone 3 and then reflect on your learning about the Course Project and the assessment.

Individuals can come from a variety of settings. Recent immigrants, migrant workers, exchange students, international students, long-term care residents, refugees, coworkers, physicians, patients, employees at local ethnic businesses, religious venues, community centers, and individuals who have recently moved to your community are some suggestions. The individual does not need to be a healthcare worker but must have received healthcare services in the country of origin as well as since arriving in the United States. Speak with the individual, and obtain permission to conduct an assessment later in the course. 

. Although you are not performing the official assessment until Milestone 3, it will be necessary to obtain some general information about your individual to complete Milestone 1. This information may come from the individual or Internet sources.

Fill in information about the potential individual using the template. You are expected to write clearly and use proper grammar and spelling and eliminate typos.

Example: KC was born in Hwidiem, Ghana, a small village in Africa, where he did not graduate from high school. He is 72 years old. He immigrated to the United States at age 28 and has lived in Grove City near Columbus, Ohio since then. Hwidiem is considered the provincial capital (fill in information about the community or city as you can find). He was married but divorced after a traumatic brain injury. Since then, he has had many part-time jobs and studies his Bible faithfully. Grove City is a town in Ohio (fill in information about the city or community). Currently, he receives healthcare for his hypertension control. I met him 3 years ago at a senior citizens’ center where I volunteer.

 

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his week students will complete an APA paper to address the following case study.

Mr. Corley Case Study:

Walter and Sheila Corley were married on January 20, 1984.   At the time, they lived in Texarkana, Arkansas.   Their son Jerry was born in July 1985.   Later that year, the Corleys separated and were divorced.   Sometime thereafter, the Corleys reconciled and resumed living together, holding themselves out to others as a married couple.   In February 1988, the Corleys moved to Mr. Corley’s hometown of Ferriday, Louisiana.   The Corleys were remarried in December 1988.

Neurofibromatosis, a disease of the peripheral nerves of the body, is a condition marked by the presence of numerous neurofibromas, which are tumors or growths arising from the Schwann cells which form the covering membrane or sheath of a nerve fiber.   Persons with neurofibromatosis frequently have café au lait spots of varying sizes on their bodies as well.   In addition, people afflicted with neurofibromatosis experience a significantly increased risk of developing cancer.

In 1978, Mr. Corley was diagnosed with neurofibromatosis and had four neurofibromas removed from his head, arm, hip and leg by a physician in Texarkana.   Thereafter, a few months prior to his return to Louisiana in 1988, Mr.  Corley, who had no other known health problems, began experiencing low back pain.

On February 11, 1988, Mr. Corley sought medical treatment from Dr. Maurice Gremillion, a family practitioner in Ferriday.   On that date, Mr. Corley complained that he had been experiencing low back pain and abdominal discomfort for approximately four months.   He also noted that he had intermittent right shoulder pain and trouble sleeping.   At Mr. Corley’s request, Dr. Gremillion ordered a total work-up which included x-rays of the lower spine, chest, kidneys and gall bladder, as well as an upper GI series.   Dr. Gremillion also prescribed Flexeril, a muscle relaxer, and Anaprox, an anti-inflammatory pain medication.   Dr. Gremillion, feeling that Mr. Corley should be seen by a specialist, then gave him a written referral to E.A. Conway Medical Center in Monroe for an orthopedic evaluation.

E.A. Conway, which is part of the L.S.U. system, is a teaching facility staffed by permanent, full-time physicians as well as by doctors who are employed on a temporary, rotating basis as interns and residents following their graduation from medical school.   The general operating procedure of E.A. Conway at the time of Mr. Corley’s presentment was that all new patients, even those who have referrals to a specific service or department, first go through the emergency room.   At that time, a patient is charted and evaluated by an emergency room physician.   From there, the patient is either treated or referred to a specific clinic for further follow-up.   In most cases, patients see different doctors each time they report to the hospital or one of its clinics.

On March 2, 1988, Mr. Corley, accompanied by Sheila Corley, reported to the E.A. Conway Emergency Room. The Corleys presented admitting personnel with all of Mr. Corley’s records from Dr. Gremillion, including the x-rays and other test reports.   Dr. Bruce Fuller, an emergency room physician, took a history from Mr. Corley and reviewed Dr. Gremillion’s notes and the x-ray reports.   He also conducted a routine physical examination and had x-rays made of Mr. Corley’s low back.   Notwithstanding the presence of several growths and café au lait spots on Mr. Corley’s back and torso, Dr. Fuller was unaware that his patient had neurofibromatosis.

Dr. Fuller found everything to be within normal limits and it was his impression that Mr. Corley was suffering from low back pain based on minimal subjective complaints of pain.   Dr. Fuller continued Mr. Corley on the medication prescribed by Dr. Gremillion and made an appointment for him with the Orthopedic Clinic on March 16, 1988.

On that date, Mr. Corley was seen in the Orthopedic Clinic by fourth year resident McIntyre Bridges.   Dr. Bridges does not recall looking at or reading the x-rays or reports from Mr. Corley’s previous examinations.   Dr. Bridges conducted a physical exam, which was normal, and started Mr. Corley on a conservative course of treatment for low back pain.   Dr. Bridges’ notes from this date indicate his awareness of Mr. Corley’s neurofibromatosis.

Mr. Corley was next seen on April 20, 1988 by Dr. David Mehta.   At the time, Dr. Mehta was doing a surgical internship and was rotating through the Orthopedic Department.   Dr. Mehta’s notes reflect that his physical exam of Mr. Corley was normal, but that he felt that Mr. Corley had a posture problem and referred him to physical therapy for correction of his posture.   Again, the notes do not reflect whether Dr. Mehta reviewed any of Mr. Corley’s previous medical records, x-rays or reports.

On September 14, 1988, Mr. Corley was seen by fourth year surgical resident Keith White.   On that date, Mr. Corley noted that his pain had worsened and was occasionally affecting his walking.   Dr. White’s examination yielded no objective findings of low back pain, but he did notice several café au lait spots indicative of neurofibromatosis so he ordered a CT scan of Mr. Corley’s low back to rule out any neurofibroma changes in the nerve roots.   Dr. Ellis, a radiologist at E.A. Conway, interpreted the CT scan as showing arthritis consistent with fibrosis or spinal stenosis and possible edema of the right L-5 nerve root, which, according to Dr. White, may or may not have been the cause of Mr. Corley’s back pain.   As with Drs. Bridges and Mehta, Dr. White did not review any of the previous medical records, x-rays or reports.   Mr. Corley’s last visit to E.A. Conway was September 21, 1988.   On that date, Dr. White reviewed the results of the CT scan with Mr. Corley, continued him on an anti-inflammatory drug and encouraged him to continue his back exercises.   Dr. White instructed Mr. Corley to return to the clinic in three months.

Thereafter, on October 26, 1988, Mr. Corley, plagued by constant back pain and beginning to experience difficulty breathing, consulted Dr. Rick Maxwell, a chiropractor, who did a full spinal x-ray which revealed a markedly diminished right lung area.   Dr. Maxwell sent Mr. Corley to his father, also a chiropractor, who confirmed that there was a potential problem with Mr. Corley’s right lung and recommended that he see a pulmonary specialist.

On October 31, 1988, Mr. Corley presented to Dr. Gremillion complaining of chest congestion and shortness of breath.   Dr. Gremillion diagnosed him with bronchitis and implemented treatment accordingly.   Mr. Corley returned to Dr. Gremillion on November 14, 1988 with complaints of shortness of breath and marked weight loss.   Subsequent diagnostic testing confirmed the presence of a very large mass in Mr. Corley’s right chest.

Prior to his death on January 23, 1990, Mr. Corley received radiation and chemotherapy treatment at LSU Medical Center in Shreveport.

Corley v. State Department of Health Hospitals. http://caselaw.findlaw.com/la-court-of-appeal/1071352.html

Student should address the following questions regarding this case in an APA paper

1. What are the facts of the case? This should include: what do we need to know, who is involved in the situation, where does the ethical situation take place, and when does it occur?
2. What is the precise ethical issue in regards to autonomy, nonmaleficence, beneficence, fidelity, and justice?
3. Identify the major principles, rules, and values of the case.  Values are sets of beliefs about good and bad, right and wrong, and about many other aspects of living and interacting in the society with others. A principle is a personal rule that governs personal behavior. A rule is generally imposed by a figure of authority, and used to guide and govern people.
4. Is there legal ground for this case, if so what? Who is at fault? What legal action should be taken?
5. Are there alternative to the actions completed in this case by both the patient and healthcare facility? Do you feel the physician were following hospital protocol?
6. If you were a member of the ethics committee at this facility, what actions or changes would you recommend changing? Why?

For the case study, an APA formatted paper should be used, and needs to include a title page, level headings, references and citations. This assignment should include at least 2 references and should be at least five pages in length. Students should address the proposed questions providing ample detail, examples, and additional support.

Assignment Expectations:  

• Length:
  • answers must thoroughly address each question in a clear, concise manner; complete answers will likely take 5-6 pages
• Structure:
  • reference page required
  • address each question in a numbered list
• References:
  • Two references required
• Format:
  • save your assignment as a Microsoft Word (.doc or .docx), Open Office (.odt) or rich text format (.rtf) file type
• File name:

 

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As you learn more about the research that documents the effects of ACEs (adverse childhood experiences) on long-term health, what are your initial thoughts? What are some ideas you have for your community? Do you have an example from practice where having an ACEs lens would have been beneficial? What are the most compelling learnings for you?

The SDOH (social determinants of health) are clearly connected to “root causes” and the readings and Unnatural Causes videos have provided data, narratives, and interventions for local action. World Health Organization (WHO) has also focused on SDOH globally.

Questions

· Cultural competence, cultural safety, cultural humility all provides models for health care practice. From your readings and your experience, how does culture inform and affect health? Please give an example

· How do social determinants of health affect your practices/institutions?

· Please reflect with your definitions and descriptions on how these would be more applicable to yourself.  

800-1000 words 

 

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