A two page Letter to the Editor in response to concerns/reservations regarding nurse practitioner practice and participation in Patient Centered-Medical Home (PCMH) Programs expressed in a White Paper by the American Academy of Family Physicians (AAFP).

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A two page Letter to the Editor in response to concerns/reservations regarding nurse practitioner practice and participation in Patient Centered-Medical Home (PCMH) Programs expressed in a White Paper by the American Academy of Family Physicians (AAFP). The White Paper is entitled, “Ensuring a Quality, Physician-Led Team for Every Patient,” published in 2012 and is posted in Canvas under Content. This new approach to primary care is likely to be a major way that primary care is provided in the future; thus it is important that nurse practitioners be seen as major players in the PCMH movement.

The format for a Business Letter should be followed such as one might use when writing a letter applying for a nurse practitioner job or for entry into graduate school. Grammar/syntax must be appropriate (Merriam Webster online dictionary defines syntax as “the way in which words are put together to form phrases or sentences.” This must be no more than two pages, and single spaced as appropriate for a business letter.

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

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Let’s have a debate!!! Is nursing theory important to the nursing profession? If you believe that it is important, explain why it is useful. If you do not believe that it is useful, explain why nursing theory is not necessary to the profession? Be sure to provide an example that demonstrates your opinion and a scholarly reference (not using the required textbook or lesson) which supports your opinion.

The diversity movement suggests that there is strength in our differences and that our differences enhance each other. At the same time, the movement insists that our differences should not have economic, social, or political consequences. We are entitled to the same access to resources and opportunities regardless of our differences. The human suffering from Hurricane Katrina and the images of victims has stimulated the debate about differential access to resources.
Read the report Women in the Wake of the Storm: Examining the Post-Katrina Realities of the Women of New Orleans and the Gulf Coast. On the basis of your reading, create a report, answering the following:
• Discuss the prominent dimensions of diversity revealed as a result of the Hurricane Katrina disaster.
• Discuss factors that specifically influenced women’s vulnerability to Hurricane Katrina. While answering, consider the primary dimensions mentioned in the lectures as well as the secondary dimensions such as parental and marital status, income, educational level, military experience, geographic location, work background, and religious beliefs.
• Describe the implications for healthcare organizations as a result of the disaster.
• Discuss at least of two of the policy implications that are outlined in the report. If you were given the task to add another policy recommendation what would it be and why?

Medical Indications: The Principles of Beneficence and Nonmaleficence
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of various treatment options?
5. 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
1. Has the patient been informed of benefits and risks, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
6. 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
1. 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?
2. 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?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
6. What are plans and rationale to forgo life-sustaining treatment?
7. What is the legal and ethical status of suicide?
Contextual Features: The Principles of Justice and Fairness
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
6. Are there religious issues that might influence clinical decisions?
7. What are the legal issues that might affect clinical decisions?
8. Are there considerations of clinical research and education that might affect clinical decisions?
9. Are there issues of public health and safety that affect clinical decisions?
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?

What is constitutional law and was constitutional law broken in this scenario?

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Legal Issues Actions for Legal Issues

A student is doing a clinical rotation on a medical-surgical unit. In the hallway outside a patient’s room, a staff nurse explains the patient’s diagnosis to the student, mentioning that the medical condition typically is seen in patients with long-term cocaine use. When providing care for the patient, the student asks about any illegal drug use. The patient becomes upset and says that he has never used illegal drugs in his life. The student tells the patient that his condition is usually seen with long-term cocaine use. The patient orders the student out of his room, yelling that she has violated his constitutional rights and he is going to sue her for not providing a reasonable standard of care.

1.Did a breach of confidentiality occur between the student and the patient or between the student and the nurse? Explain.

2.What is constitutional law and was constitutional law broken in this scenario?

Two months after the patient in the scenario is discharged, his wife leaves him and he loses his job. The patient files an intentional tort action against both the student and the nurse.

3.Is this an appropriate legal action? ?
4.Would the patient in this scenario have grounds for malpractice?

Discuss how the Arizona Supreme Court distinguished between on-duty and off duty. Do you agree with this distinction?

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Review Case Study 18-1: EMT Injured by Toxic Fumes – Files Suit Against Chemical Company, found on page 231 in the textbook. Kapherr v. MFG Chemical, Inc., No. A06A0184, December 28, 2005.

The full decision is available at

http://caselaw.findlaw.com/ga-court-of-appeals/1005355.html

In Kapherr, the Georgia Court of Appeals found that the fireman’s rule does apply to emergency medical technicians. Address the argument that Kapherr maintained regarding treating the injured only if the scene had been secured. Do you agree with the court’s reasoning in responding to this defense? Explain why, or why not.

Describe a set of circumstances under which it would not be reasonable to consider that the emergency responder has assumed the risk of the hazardous circumstances at the scene.

Research and determine the status of the fireman’s rule in Georgia. Identify whether there has been any change to the law since Kapherr. Research and determine the status of the Fireman’s rule in your state. If your state is Georgia or Florida, please select a neighboring state. Has the rule been adopted and enacted into law? Have there been any exceptions enacted into law?

Your response should be at least 300 words in length. You are required to use at least your textbook as source material for your response. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations.

FIR 4301, Political and Legal Foundations of Fire Protection 8

Case Study 2: 50 points

Read Espinoza v. Schulenburg, CV-05-0158-PR, Arizona Supreme Court, 2006.

To view the full decision copy and paste the following web address into a web browser:

http://www.myazbar.org/AZAttorney/PDF_Articles/0706appellate.pdf

Espinoza was an off duty firefighter and emergency medical technician who was injured while providing roadside assistance to the Schulenburgs. The trial court granted summary judgment to the Schulenburgs, holding that the firefighter’s rule bars Espinoza’s claim. The court of appeals reversed that decision, holding that the firefighter’s rule should be narrowly construed so as not to bar the claims of off duty firefighters.

To see the full Court of Appeals decision, copy and paste the following web address into a web browser: http://statecasefiles.justia.com/documents/arizona/court-of-appeals-division-one-published/CV040438.pdf

However, the appeals court remanded for determination of whether Espinoza had a duty as part of her job as a firefighter to render assistance, in which case the court would apparently conclude that the rule should apply to bar her suit. On appeal to the Arizona Supreme Court, a more conclusive decision was handed down. That Court made the clear distinction between on-duty and off duty, finding that Espinoza volunteered to render aid and, therefore, the fireman’s rule did not apply.

Discuss how the Arizona Supreme Court distinguished between on-duty and off duty. Do you agree with this distinction? Can you suggest other distinguishing factors that should have been considered? Should the fact that one receives workers’ compensation for the injury enter into the distinction? Describe how your department addresses rendering aid off duty. Is it part of your “duty” as a firefighter, or is it more so an ethical duty? Also, describe how your department addresses off duty injuries incurred as a result of rendering aid.